by Carla Cheatham

Every time I train healthcare professionals about ethical and respectful spiritual care for persons of all faiths, backgrounds, or even no faith, I’m ALWAYS asked this question:

“What do I do if they ask me to pray?”

Nurses, aids, physicians, and volunteers most frequently ask this, and I greatly respect them for doing so!  We want to neither neglect persons’ R/S/E (Religious/Spiritual/Existential) needs nor abuse our position of “power” in the caregiving relationship by overstepping boundaries. I train professionals to, among other things, find the “Sweet Spot” in spiritual care.

The “Sweet Spot” is that space in the middle from which we learn what patients and families believe, then help them access their beliefs to find meaning, peace, and comfort. 

The fact that they want to handle such moments thoughtfully indicates a humility and compassion in care-giving that bodes well for their professionalism and their ability to avoid either extreme of what I call “spiritual malpractice”.

Even professional, clinically trained spiritual care counselors (chaplains) are taught to tread carefully when offering prayer.  We do not want persons to feel obligated to accept because they don’t feel comfortable telling us “No”.  So what DO we do in those moments?

1.)  Start with a patient-centered view–I believe that merely wanting to prevent harm by respecting a patient or family member’s boundaries and honoring their views is well over half the battle.  So we’re already off to a good start!

2.)  Let them initiate–Many fear that NOT offering to pray may offend or abandon a person who is in distress, but there is another way.

Even as a hospice chaplain, the member of the team MOST expected to offer prayer, I’ll simply state at the first visit, “Some persons want to talk, others want me to sing or read meaningful texts with them, some just want to sit quietly, some want me to pray, and others just want to play checkers.  Whatever it is you would like, I’m happy to do.”

Before I leave, I’ll ask if there’s anything else I can do for them.  At that point, some ask me to pray while others do not.  I indicate my willingness, and they can choose whether or when to ask.  What I am willing to give freely, I must be willing to never have requested.

Since this is their journey, their illness, their process, their life and it IS all about them, I get to have no ego invested here.  I trust them to take the lead by asking for what they need.  If I offer directly to pray, it can be very hard for them to refuse, even if they absolutely do not want me to do so.

That is why I recommend non-spiritual care professionals allow the request to come from the patient or family.  They may have never felt comfortable setting boundaries.

Now, at perhaps the most emotionally and physically vulnerable time of their lives, they may be even more wary of telling the persons bringing the good drugs, help with bathing and Medicare forms, supplies, support for their families, etc. “No” and risk offending us. 

There are creative ways to be available without putting them in that awkward position.

3.)  Determine your own comfort zone–Some professionals ask me the “do I pray” question with a deer in the headlights look!  Praying aloud is not their thing, yet they don’t want to feel like a clod and abandon someone in pain if they ask for prayer.

If you do NOT feel comfortable praying aloud, here is a sample response that can be said apologetically and gently:

“Praying out loud isn’t something I’m (comfortable with / good at / experienced with, etc.)  But I’d be happy to sit with you and hold your hand while we both pray in silence or you while pray aloud.  And I’ll definitely be holding you in my heart.”

If it feels appropriate, you can also offer to call for one of us!  “You know, this is what our spiritual care counselor (chaplain) is trained to do. May I call on him/her?”

4.)  Find their words–If you DO feel comfortable praying aloud, make sure you know how to pray in a way that honors the patient / family member’s beliefs.  The quickest and simplest way to do that is to ask,

“How do you typically begin and end your prayers?”      

Using the language that is comfortable for them honors their right to choose or refuse medical interventions and, since we’re talking about healthcare settings and professional relationships here, that’s what this is!  This prayer is for them, not for us, and they deserve to lead the way.

It is also important to ask them what they would like you to pray for.  If they ask you to pray for healing, ask them what healing looks like to them.  Then, equipped with words from their own heart, you can offer those words back, out loud, as a prayer that respects their needs.

Even if you fumble, most people can tell when we are honestly trying to be respectful, and they so appreciate the heck out of that they can typically overlook imperfect attempts to meet them where they are.

It’s important to note that I’m not asking you to deny your own faith or views.  For some, the two are not mutually exclusive.  But for others, it is simply too big of a leap from what feels do-able for them.  That’s ok!  That’s why you have someone on the team who IS trained to be able to care for the needs of persons of all views.

Part of our professional responsibility is knowing when to “refer out”.  There is no shame in doing so.  The only shame would be to, even if well-intentioned, cause harm to those for whom we are committed to honor and care.

If you do not feel you can comfortably be with them using their words, it is completely acceptable to refer back to #3 above and then call for the spiritual care counselor (chaplain)!  There is no reason for anyone, patient or professional, to suffer offense here.

5.)  Follow up–It is good practice to touch base with the spiritual care counselor (chaplain) with whom you work.  If a patient tells me they’re having a physical symptom, I call the nurse and let him or her know.  If they’re struggling with family dynamics, I contact the social worker.

It’s no different if someone expresses spiritual symptoms.  Coordinating care with the professional responsible for overseeing that aspect of a patient’s treatment plan is important and respects interprofessional boundaries.

I’ll write more about honoring and finding the “Sweet Spot” in spiritual care another day.  For now, I hope something of this is helpful to you as we all seek to care well for that sacred trust placed in us by persons walking a tremendous journey who deserve nothing less than our very best skills.

Peace…

About Rev. Dr. Carla Cheatham:   After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice. She now trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback, e-book through Amazon, and audiobook.  Being with suffering, others’ and our own, is the basis for her next book. Follow Carla’s writings through her website blog and also on facebook at https://www.facebook.com/HospiceWhispers?ref=hl or on Twitter @CarlaCheatham.