The Religion of “I Don’t Know”

Abstract

The goal of this pilot study was to identify naturally occurring, spiritually relevant conversations and elucidate challenges for nurses in home hospice. We examined naturalistic communication data collected during nurse hospice visits with cancer patients and their family caregivers. Using deductive content analysis, guided by Consensus Conference spiritual categories and definition, categorical themes were identified. Thirty-three visits to seven families were recorded by five nurses. Although most spiritual dialogue was brief, analysis revealed five themes: Spiritual Beliefs and Rituals, Connection, Spiritual Comfort, Closure and Acceptance, and Spiritual Distress. Findings demonstrate the range of spiritual issues raised in hospice and challenges nurses face in maintaining boundaries while remaining genuine and family-centered in providing care. This work serves as a foundation for future research and education to help clinicians to engage in more intentional spiritual conversations in the support of families at end of life.

Spiritual care provision to end‐of‐life patients: A systematic literature review

“…than patients yet were more likely to change the subject (Ellington et al, 2015). Conversely, Wittenberg et al (2017) found that patients or families were most likely to initiate spiritual discussions.…”

“…Carroll (2001) differentiated between nurses who have a belief in God/universe and those who are agnostic/atheists. Ellington et al (2015) provided the religious/ spiritual identity of the patient families as Christian or Mormon. One study (Minton, Isaacson, Varilek, Stadick, & O-Connell-Persaud, S., 2018) identified the researchers' religious heritage as Christian and one study (Pittroff, 2013) identified the researcher as a lay minister in a Christian denomination.…”

“…Second, this spiritually integrated ethos was shaped by personal life experiences of loss and illness (Belcher & Griffiths, 2005;Carroll, 2001;Ellington et al, 2015;Keall et al, 2014). Cindy (nurse): 'Well, I've had surgery, chemotherapy, radiation.…”

“…were considered necessary to initiate and/or facilitate spiritual discussions, enabling needs to surface and be discovered; these discussions were considered essential to quality EoL care (Wittenberg et al, 2017) and required revisiting (Minton et al, 2018). Nurses in the studies by Ellington et al (2015) and Walker and Waterworth (2017) also considered it their duty to prepare patients for death and initiated sensitive conversations accordingly; this enabled practical decisions and uncovering hidden spiritual needs. Simple questions, such as "Is there anything bothering you, anything that you're fearful of?"…”

“…Verbal therapeutic communication skills were identified in all studies. These included asking questions (Belcher & Griffiths, 2005;Carroll, 2001;Harrington, 2006;Keall et al, 2014;Minton et al, 2018;Walker & Waterworth, 2017), clarifying responses (Bailey et al, 2009;Ellington et al, 2015;Harrington, 2006;Keall et al, 2014;Walker & Waterworth, 2017;Wittenberg et al, 2017), affirming and acknowledging fears, emotions, concerns and beliefs (Ellington et al, 2015;Keall et al, 2014;Minton et al, 2018;Walker & Waterworth, 2017), responding to patient-initiated questions (Ellington et al, 2015;Walker & Waterworth, 2017), and providing suggestions (Ellington et al, 2015).…”