Many years ago, I read about an intriguing randomized controlled trial out of Harvard Medical School, looking into the therapeutic effects of intercessory prayer in cardiac bypass patients. The researchers wanted to find out if praying for someone benefited the person being prayed for. The study was multi-center, and included 1,802 patients. Don’t ask me why, but this past week, I decided to check what the results were of this 2006 study. The researchers concluded that intercessory prayer had no positive effect on complication-free recovery from coronary artery bypass surgery. Rather, those patients who knew they were being prayed for experienced a higher incidence of complications (e.g., new onset of atrial fibrillation). It appears that for patients going for heart surgery, knowing they are being prayed for can be bad for them. Can you imagine?
Contemplating the results and the limitations of the study, I share the observation that the effects of prayer on patients cannot be meaningfully studied through an experimental design, and prayers cannot be outsourced. Perhaps, when we bow our heads or fall to our knees in supplication to pray for someone, we are transformed in the way we respond to our circumstances based on our faith. The benefits we ourselves receive when praying for others may be easier to understand and measure than the benefits in those we pray for. Historically, almost all prayer intercessory prayer studies showed no difference in patient outcomes. Does this mean that people should stop praying for someone else? Could it be that the end-goal of praying is not the prevention of complications, but the communion with the existential and self-transformation?
Poultices, pills, and prayers
Prayers, medicine, and nursing have a rich and intertwined relationship. Throughout history, art and artifacts associated with praying and their talismanic power to heal the sick and ward off disease abound. The forerunners of organized modern healthcare were the faith-based hospitals operated by religious institutions where praying was prescribed. Once upon a time, nurses played the dual role of being a nun or a monk and a bedside caregiver. Of the 38 nurses who went with Florence Nightingale to the Crimea, fourteen were Anglican sisters and ten were Roman Catholic nuns. An early nursing program of the St. Thomas Hospital in London listed “prayer” and “chapel” as part of the training schedule. Before the advent of effective medicine and surgery, prayers and poultices were the first and last line of defense of the sick.
Pledge and Pray
As an undergrad in nursing, I recall having professors who started the class with a scriptural reading. One of my former classmates, who was working in one of the leading hospitals in Manila in the 1980s, told me that the incoming and the outgoing shifts recited the Lord’s Prayer together before the hand-off report. I wonder what might be the impact of nurses praying together on their work ethic, resiliency, and patient safety indicators. At every nursing pinning ceremony, graduates along with every nurse in the house collectively recite the professional nursing pledge (the Nightingale Pledge). For all intents and purposes, the pledge resembles a prayer; our collective promise to do good work. Imagine what patient care would be like if physicians read aloud together the Hippocratic Oath before work, or if nurses recited in unison before each shift:
“In the full knowledge of responsibilities I am undertaking, I promise to care for my patients with all the knowledge, skills and understanding I possess, without regard to race, color, creed, politics or social status, sparing no effort to conserve meaningful life, to alleviate suffering, and the promote health…”
There is a similarity between a care team huddle and a prayer circle – people gathered together hoping (and praying) for the same things – the best for the patient. It is an unquiet meditation on possibilities; a way of talking with God (if one is a believer) our modest attempt to consecrate the care we are about to give.
In my first RN job in 1990, I was a float nurse. The nurse-patient ratio was 1:16 in the night shift. Not knowing which unit I would be assigned each time I reported for work was terrifying. I could feel my own heartbeat on my way to the staffing office. Silently, I prayed to be spared from a certain unit, or hoped that a particular nurse-bully was off that night. In retrospect, I realized I may have been praying for the wrong things. I should have invoked what the Austrian psychiatrist Viktor Frankl advised: when we are no longer able to change a situation, we are challenged to change ourselves. In short, I should have prayed to find the serenity to accept the things I could not change.
The nurse Jonathan Bartels advocates observing the medical pause, a 45-second moment of silence after the death of a patient (https://thepause.me/2015/10/01/about-the-medical-pause/). The aim is to offer closure to both the medical team and the patient. I think this moment of silence is a form of prayer too. Bartels says it is a means of transitioning and acknowledging the brevity and sanctity of life, and honoring the work of the care team.
I would like to think that modern healthcare has not abandoned or devalued prayer as an adjunct to all our efforts to preserve, protect, and promote quality of life. By itself prayers are powerless against a cytokine storm or a cancer mutation, but they remain one of the most enduring non IRB-approved interventions to heal the sick and those they leave behind. I think praying is not connected with a particular religion or belief. Anyone who has ever hoped or wished has prayed. Praying is not surrender; it is an attempt at self-efficacy.
Benson H, Dusek JA, Sherwood JB, et al. Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. Am Heart J. 2006;151(4):934-942. doi:10.1016/j.ahj.2005.05.028.
Lilly SM. A “STEP” in the right direction. Am Heart J. 2006;152(4):e31. doi:10.1016/j.ahj.2006.06.031
Fidelindo Lim is a clinical associate professor at New York University – Rory Meyers College of Nursing.