The omnipotent yet invisible coronavirus causing COVID-19 is bringing the world to its knees (to use an interesting metaphor). It is forcing many to face fears, frailty, disconnection, and possible death. When humans face their mortality, they often resort to religious practices—especially prayer.
The 2018 General Social Survey reported that 85% of Americans prayed; 59% of them did so at least daily. Another survey of Americans found that nearly half (47%) of those who did pray prayed about their health and illness; 49% prayed for personal guidance during crises. Considerable evidence documents that patients with illness benefit psychologically or spiritually from personal prayer.
Given that hospitalized patients with COVID-19 are at high risk for psychological and spiritual distress, and are likely to be praying during this crisis, should nurses initiate an offer to pray with a patient? Because chaplains are now unable to directly minister to these patients, should nurses try to fill the chaplain’s role by at least speaking a short prayer while at the bedside? Given that sharing such a brief, sacred moment could be deeply comforting to many patients, might it not also be comforting to nurses who feel they can do little to heal? Although many nurses will answer with a resounding yes, nurses need to pause to consider whether initiating an offer of prayer is appropriate and ethical.
I know that praying with patients can be comforting for patients and nurses. To be truly comforting, however, prayer ought to only be offered in a noncoercive and ethical manner. Here are some guidelines and tips that I have learned from chaplains, theologians, and ethicists.
- A self-check is imperative. Before offering to pray, ask: Am I wanting to pray with the patient because this is a way to comfort myself, a way to meet my needs? Do I want to convert the patient to my beliefs (e.g., to encourage a foxhole conversion)? Do I have deep respect and openness for the spiritual uniqueness of the patient and humility about my own beliefs? If any motivation to offer a prayer is clouded by a need be a savior, to comfort or glorify oneself, or to control or convert the patient, it then becomes unethical and even harmful to the nurse-patient relationship.
- Assess whether prayer would be welcome. Given the extreme vulnerability of the patient and the power differential within the nurse-patient relationship, this must be done in a way that avoids any hint of coercion. A helpful question I’ve learned from chaplains is: “Would a prayer be helpful?”
- If the patient says no, respect the answer. A gentle follow-up might be: “Is there another way I could support you to find spiritual comfort?” Never press the issue; always respect a patient’s autonomy.
- If the patient responds with yes, assessing for what they would like to pray about and how they like to pray will provide rich information about the patient’s needs and guide the nurse’s prayer. (For example, “Is there anything in particular you’d like me to pray about?” Or, “Is there a way you prefer that I pray?”)
- When a prayer is desired, follow the patient’s cues if any were obtained. It may be, however, that the nurse has little patient information upon which to construct a prayer. The nurse can only do his or her best, and this best will inherently reflect the nurse’s worldview. The patient in extremis who genuinely desires a nurse’s prayer will likely appreciate whatever form that prayer comes in. However, a colloquial prayer with least likelihood for offense might:
- Address the divine generically as “God” (in which 89% of Americans have some type of belief, according to Pew Research Forum).
- Name the suffering. Ulanov and Ulanov, a psychoanalyst and a theologian, described prayer as “primary speech,” something both religious and nonreligious people express. This primary speech allows us to listen to our innermost experiences, distresses, and yearnings. By naming our suffering, its grip gets loosened a little. An example of how a nurse might pray in such a primal way is: “God, this is such a scary [or uncertain, or painful, or lonely, or difficult, or . . . ] time. So many things are challenging, such as [identify the patient’s concerns]. . .”
- Submit the suffering to the divine for healing, taking care to avoid invoking magic. That is, express an attitude of “God’s will be done” (or “Let our hearts be aligned with what is ultimately good/loving/best”), rather than an ego-driven statement of what is humanly thought to be best. By naming our suffering in the presence of an ultimate other, we remember that we are not alone. By submitting it to the divine, we accept (or show a desire to perceive) that a greater good is at work.
- End the prayer with a knowing look, a squeeze of the hand, or statement that recognizes the closeness that prayer inherently creates (e.g., “Thanks for this sacred moment together.”)
Although this colloquial approach to prayer is common among Americans, there are also many other ways to pray. For example, a nurse (especially if uncertain about how to pray with a patient) can pray by remaining present, praying silently. For some patients, playing a recorded or musically expressed prayer (e.g., on YouTube) will be preferred. Indeed, most faith traditions have websites that include prayers or inspirational readings for their adherents. A nurse also may recite a written or memorized prayer. A “cheat sheet” of prayers appropriate for diverse faiths can be obtained from the hospital chaplain or constructed from various websites. Because more time in a patient room means more exposure to COVID-19, it may be necessary to ask the patient for what they would like and then promise them that prayer for them will be privately offered outside the room (e.g., “I’ll be praying for you”).
Nurses in the COVID-19 crisis areas will likely have little time at any patient’s bedside. The potential for comfort that prayer can bring to both the patient and nurse in discomfort, however, makes it worthy of serious consideration. If sensitively offered without the hint of coercion, patients will likely be appreciative. They will not care how much the nurse stutters through a spoken prayer. For the patient, learning that the nurse cares in this deep, vulnerable, soul-to-soul way will be comforting. For the believing nurse, prayer may decrease the sense of ineffectiveness, meaninglessness, and exhaustion.
Elizabeth Johnston Taylor is a professor in the Loma Linda University School of Nursing in Loma Linda California.
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