Prayer in Healthcare:

1. A Conceptual Model of Praying with Patients Prayer in Healthcare: Iris Mamier, PhD, RN Carla Gober-Park, PhD, MPH, RN

2. Objectives • To identify elements of prayer in the context of healthcare. • To describe teaching methods that are useful to prepare healthcare providers to respond to patient request for prayer • To identify pitfalls for praying with patients in a professional context

3. Background • According to Barna Research Group (2017) prayer is: • the most common faith practice among American Adults • 79% say that they prayed at least once in the last three month • 98% of residents of Augusta-Aiken, GA and 53% of Springfield/Holyoke, MA had prayed to God in the last 7 days • Prayer is the most complex and multifaceted faith practice  ”Perhaps the only consistent thing about people’s prayers is that they are different” David Kinnaman & Roxy Lee Stone, Barna Research Group

4. Fast facts on Prayer in American Adults – true or false? • The majority of American Adults pray to God. • Prayer is typically practiced in a communal way • Of those who pray (at least 1 time in past 3 months) most prayed aloud with others. • Of those who engaged in communal prayer only 2% prayed audibly with another person.

5. Barna study (2017) Silent & Solo: How Americans Pray

6. Barna study (2017) Silent & Solo: How Americans Pray

7. Barna study (2017) Silent & Solo: How Americans Pray

8. Background • Grant (2004) asked N = 299 RNs if they had ever offered/ provided prayer to a patient; 71% responded they had. • Mamier (2009) studying 4 LLUH hospitals found that out of 554 RNs 326 indicated they had offered to pray with a patient/ family in the past 72-80 hours at work • Taylor, Gober, Schoonover-Shoffner, Mamier, Somaiya, Bahjri, (2017) surveyed N = 423 RNs and found that those scoring higher in personal prayer were 9% more likely to offer prayer, and that those working in religious settings were 2.5 times more likely to offer prayer to patients. • In the same study, of the 12 participants who responded to a prayer vignette that they would not pray with a patient who asked them to pray with them, 10 never prayed privately.

9. Religion at the Bedside Study • Cross sectional, descriptive online survey study: QUANT/qual total study • Purpose of the qualitative part: • To explore how nurses respond to patient’s overt request for prayer • To describe how practicing nurses pray with patients. • Recruitment through ad in the Journal of Christian Nursing (JCN), as well as on the website of JCN, Home Health Now, & the American Journal of Nursing • A sample of n = 381 nurses responded to a case vignette followed by two open-ended questions at the end of the survey • “P. J., age 72, is getting prepared for surgery that will take place soon. You sense she is apprehensive and nervous. She asks, ‘Nurse, will you pray for me?’” • Open ended questions: • What would you likely say or do? • If you agree to pray, how would you likely pray? • Descriptive content analysis was used to identify emerging categories from nurses’ prayer descriptions

10. Emerging Conceptual Model for Praying with Patients/Families 1) Open(identify divine listener) 2) Set the stage(connect with the here and now) 3) Request(link perceived needs with how God can help) 4) Wrap-up(prepare for closing) 5) Close(signal the end of prayer)

11. Open (identify the divine listener by name) • Nurses opened prayers in one of three ways • “Dear …”. • Directly addressing the Divine (e.g., Father, God, Jesus, Lord) • Using descriptive adjectives such as “gracious …”; “heavenly …”, “Our Creator”, etc. • All prayers open in one of these three ways. • One of the first decisions that a praying healthcare provider makes is how to refer to the Divine. • Unless the healthcare provider asks, they don’t know if the patient addresses God in the same way.

12. Set the stage (connect with here & now) • Does not occur in every prayer. • Signals arrival to God’s presence: “We are here now!” • focus on God’s attributes & actions, • thankfulness/praise • Patient, or activity of praying • Builds a sense of connection and intimacy • Connects with the patient and his/her situation: • Identifies the patient by name • how the patient feels and/or • the immediate experience • where the patient is in relation to God • or the activity of praying together • Focus direction on God’s attributes, express thanks & praise

13. Request(link perceived needs with how God can help) • Request lay at the core of every prayer • maybe because of the pre-surgery scenario? • All requests link perceived needs with how God can be involved through: • Requests for God’s qualities (peace, love, presence, strength, calmness, faith, knowledge, comfort) • Requests for God’s action (through the healthcare professional, divine action, preparing the patient, safe procedure, or providing good outcome/recovery)

14. Wrap-up (prepare for closing) • There is either a wrap-up phase or nurses move directly to the Close phase. • Wrap-up phase signals the leaving of requests and prepares for closing the prayer. It may include: • Thanking/praising (e.g., “thank you for hearing our prayer”) and/or by • Making faith statements (“We trust in You!” or “You always hear our prayers!”)

15. Close (signal end of prayer) • The lastphase signals that the prayer has ended. • This is accomplished through wording such as: • “in the name of Jesus” or “in your name we pray!” • This wording is sometimes accompanied by a statement about the will of God • Almost all prayers end with “AMEN” • Opportunity for the healthcare provider to become aware of their own habits in closing prayer and to consider contextualizing prayer ending in a way that is consistent with patient’s spiritual orientation.

16. Guidelines derived from the data • Ask permission/obtain consent to pray with patient/family • Explore if they want to be prayed for or take the lead in prayer themselves • Ask permission if holding patients’ hands or touch patient’s shoulder. • Ask patients how they typically pray (consider religious traditions, name of the Divine, possibility of quiet prayer). • Ask what exactly they want the healthcare provider to address in prayer (requests). • Provide privacy (e.g., draw a curtain, shut door, etc.) • If possible, be on eye-level or below during prayer • Pray sincerely, confidently, in a soft voice, with reverence for the patient, with authenticity, short and to the point

17. Model Prayer • Model prayers go beyond the bare minimum of “open”, “request”, and “close”. • Model prayers create intimacy and connection with the Divine particularly in the way they “set the stage” and “wrap up”. Anyone wants to share?

18. Your thoughts on these prayers…? Five prayers fell outside the general feel of the rest… Any thoughts? “I always say the same prayer and people love it. ‘Angels guide this day. Angels guide the doctors and nurses. Angels guide P.J. today as she goes through this procedure. Thank you Angels for your protection and guidance. Amen.’ I do this up beat and happy.” “Pray specifically for surgical area, patency of vessels and speedy healing” “Jesus, we know you came and defeated death. You came to free us from our fear of death. We once had reason to fear it, but no longer. Jesus, I know that P.J. will awaken from this surgery - either in her bed here surrounded by her friends, or in your arms, gazing up into your face. I ask you to comfort and calm P.J. now. In your name, we pray.” “send forth the covering of the blood of the lamb, ministering angels, and angels with their swords drawn to defend and protect.” “In obedience to what Jesus has commanded me to do and in the authority of His name, I command this body to be whole and well. I command you to recover, Sickness, disease, weakness, malfunction, abnormality- I command you to go. Be well and be whole In Jesus name.”

19. Conclusions • People continue to have active prayer lives even if many do not attend church (Barna Group, 2017). • Given prayer is so common in adult Americans, health-care providers should be prepared to know how they will handle a request for prayer in an patient-honoring way. • If not comfortable praying, be prepared to know how you will respond (e.g., refer, let patient lead prayer) • If you do pray, be aware of cultural diversity, assess and consider need to contextualize to individual patients. • The model describes five elements of prayer in a professional context which healthcare providers contextualize to the individual patient/situation.

20. Conclusions • More developed prayers include the following: “Set the stage” and “wrap-up” – elements which create intimacy and connection with the divine in prayer. • Educators who want to promote whole person care should prepare students for this situation. • Writing out one’s own prayer may increase awareness for one’s own preferences. • Being aware of diverse ways in which people pray guards against assuming that everyone means the same thing by praying. • Peer feedback may allow for helpful reflections on how one’s prayer comes across with an imaginary patient and may increase the healthcare provider’s confidence in praying with patients.

21. Thank you! Any questions?

22. Acknowledgements • This work was supported through funding by Loma Linda University School of Religion and the LLU Center for Spiritual Life & Wholeness. • The authors also gratefully acknowledge The Journal of Christian Nursing, theAmerican Journal of Nursing, andHome Healthcare Nowfor placing recruitment information on their websites.

23. References • Barna Group (2017, August 15). Silent and solo: How Americans pray. Retrieved from URL https://www.barna.com/research/silent-solo-americans-pray/ • Grant, D. (2004). Spiritual interventions: How, when, and why nurses use them. Holistic Nurse Practitioner, 18(1), 36-41. • Mamier, I. (2009). Nurses’ spiritual care practices: Assessment, type, frequency, and correlates. (Dissertation). Loma Linda University. • Mamier, I., Ramal, E., Petersen, A.B. & Elder, H. (2017). Inviting spiritual dialogue: A Loma Linda Perspective. Journal of Adventist Education 79(5). • Taylor, E. J., Gober, C., Schoonover-Shoffner, K., Mamier, I.,Somaiya, C., Bahjri, K. (2017).Nurse religiosity and spiritual care: An online survey. Clinical Nursing Research.  DOI: 10.1177/1054773817725869 epublished ahead of print • Taylor, E. J., Gober-Park, C., Mamier, I.,&Schoonover-Shoffner, K., (in press). Religion at the Bedside: Reporting Results from an Online Survey. Journal of Christian Nursing. • Taylor, E. J., Mamier, I., Ricci-Allegra, P., & Foith, J. (2017). Self-reported frequency of nurse provided spiritual care. Applied Nursing Research, 35(17), 30-35.doi:10.1016/j.apnr.2017.02.019