Controversies in Holistic Nursing

By Karilee Halo Shames, PhD, RN, HNC

Should Religious Expression Be a Part of Holistic Nursing?

Nursing has a tradition richly intertwined with religious thought and expression. From the earliest recorded reflections of the art of nursing, there has been a necessary connection with religion. Nurses care for the sick and dying, people in dire conditions who seek support from their religion and spiritual understanding. How could we not address the religious/spiritual nature of life, and still claim to provide whole person health care?

The question of whether religion should be included in the domain of nursing lingers. The clergy are responsible for caring for the religious aspects of the person in need, while nurses care for the body. More and more, however, nurses are considering their work to encompass caring for both body and soul. Most nurses will agree that caring for the person’s spirit is part of nursing, but many will not agree that nurses should be involved in the religious aspects.

Some nurses feel strongly that religious expression must be a part of nursing care, handled carefully; others believe that religious expression is acceptable for nurses in their private lives, but should never be discussed with patients unless specifically asked.

"Nurses need to be knowledgeable about religions and other practices that impact decision-making," advises Susan Dyess, RN, MSN, Coordinator, Parish Nurse Program, Intracoastal Health Systems, Inc., West Palm Beach, FL, and Adjunct Faculty, Florida Atlantic University College of Nursing.

Practicing as a parish nurse, Dyess feels strongly that an important part of the service she provides is related to the practice of religion. She also believes that nurses in other settings may be called upon to help a patient clarify beliefs and find strength through religious ritual and prayer.

Ann Solari-Twadell, RN, MSN, MPA, Director, International Parish Nurse Resource Center, Park Ridge, IL, understands the challenges nurses face with regard to religion. "Nurses need to have knowledge of different religious beliefs, so they can relate to the patients they serve," she explains. "Evangelizing, however, is another matter, and is a difficult issue to discuss."

When considering whether nurses should pray over a dying patient, Solari-Twadell says there is no one clear answer; it depends on the circumstances. She believes it is best to ask the family what they feel is most appropriate. In those instances where a nurse is alone with a patient, and not knowing, a nurse must operate from her own centered state. If the patient is non-responsive, Solari-Twadell believes the nurse should explore what is most meaningful to herself, in being present with this patient.

However, Eleanor Schuster, RN, DNSc, Professor, Florida Atlantic University College of Nursing, believes nurses in many settings should not incorporate religious expression into their practice. Schuster understands that practitioners may use their religious grounding for their own strength, but they should never offer this to patients unless it is specifically requested from the patient.

Schuster refers to Holistic Nursing: A Handbook for Practice,1 in which contributing authors Burkhardt and Nagai-Jacobson discuss the relationship between spirituality and religion. They suggest that spirituality is a manifestation of each person’s wholeness, whereas religion, the organized system of beliefs shared by a group of people, is chosen. These authors suggest that religion reflects a particular understanding of spirituality, but is only one of many ways to access spirituality. Burkhardt and Jacobson suggest that "although some people may not be religious, everyone is spiritual."1


I believe nurses should always relate to patients’ spiritual aspects, but must exercise extreme caution and care when integrating religious principles in the health care setting. Nurses should do whatever helps them maintain a centered state, and strive to know their patients well enough to know their desires during times of extreme stress, illness, or death.

We must come to know the patient as a caring, whole person, which is our sacred trust as nurses. Only when we know ourselves fully and honor these aspects deeply within ourselves, will we have developed the sensitivity and knowledge base to be able to know what is the most meaningful action to take on behalf of our patients.

Perhaps for this reason, nurses may need to refrain from treading on controversial topics with patients, lest we provoke and distress the patient. Florence Nightingale, who deeply believed in God, was secular in her approach to work. She allowed her close connection to God to empower her work, but was extremely cautious not to stimulate patients who needed rest and quietude. Nurses in most settings might consider strengthening their connection with the patient, and with their own higher power, and leave the rest to clergy.


1. Dossey BM, et al. Holistic Nursing: A Handbook for Practice. 3rd ed. Gaithersberg, MD: Aspen Publishers; 2000.