Spiritual care requires spiritual care support: The link nurse


To mark this world first, the European Association for Palliative Care (EAPC) is publishing a special series of 12 monthly posts to honour the work of nurses who work in palliative care and draw attention to several issues that are linked to this crucial workforce. Today, we are delighted to welcome as our guest writer, Dr Bart Cusveller PhDAssociate Professor of Ethics and Spiritual Care in Nursing, Spiritual Care Research Institute, Academy of Health Care, Viaa Christian University of Applied Sciences Zwolle, The Netherlands.

Dr Bart Cusveller, PhD.

In our part of the world, we have a saying that goes something like this: ‘When everyone is responsible, no one is responsible’. It finds its application to social issues, like the protection of the environment and sheltering refugees. It can also be applied to corporate and professional issues, such as respect for minorities and prudence on social media. The idea behind this saying is, of course, that all too general statements of expected behaviour may quite naturally lead some to think, ‘Sure it’s important, but someone else will do it.’ Another way of putting it, then, is: ‘If you make everyone responsible, no one will feel responsible.’

Now, both in palliative care as well as in nursing and health care more generally, most conceptual frameworks and theories of good care agree on the importance of holistic care. Not just in oncology or terminal care but across the entire spectrum of caring practice, healthcare professionals are prompted to see the patient and their needs through multidimensional, perhaps even multidisciplinary, lenses. One of the dimensions such holistic perspectives emphasise typically is the patient’s spirituality. Thus, providing spiritual care is recognised widely as part of every nurse’s professional responsibility.

Yet, often, in countries like mine, there still seems to exist substantial indecision, or even difficulty, among nurses to address profound issues a patient might have concerning life, suffering and death. Can this have anything to do with circumstances in which some do not always seem to take on their responsibility to address the patient’s spiritual needs, perhaps in favour of the necessity for other aspects of care in the daily realities of clinical care? Would it support the practice of spiritual care, then, when the imperative that all team members are responsible is not so much emphasised as the alternative that some are? Perhaps it would it help to appoint one or two nurses as a ‘team champion’, or ‘link nurse’ for spiritual care.

On the assumption that this is indeed plausible, an interesting project started in 2018 to implement and monitor the role of ‘Link Nurse Spiritual Care’ on all units of a general hospital, including its hospice. Using an extended version of a spiritual care competency profile from the literature (Van Leeuwen & Cusveller, 2004), nurses were appointed and prepared to take the lead among their colleagues in fostering spiritual care. After completing seminars and an e-learning course they acted as a resource person and coach for colleagues and patients, as well as liaisons for chaplaincy service, medical staff and hospital leadership. As such, they were equipped and encouraged to stimulate their teams to integrate spiritual care in use of self, use of nursing process, and use of institutional policy.

The results were monitored with surveys on competency scores, interviews with nurses and ‘link nurses’, and frequency of referral to chaplaincy in the patient files. The measurements before and after show an increased awareness of the need for spiritual care, and increased confidence to address spiritual issues with patients and colleagues, and a much-improved collaboration of care teams with the hospital’s chaplaincy, even though the nurses expressed the wish that medical staff would also be included in this project in the future. As we speak, publications are being prepared on the results of this exciting project (Cusveller et al. 2020). Studies are under way to look into the results and the requirements in the longer term.

In conclusion, we who promote holistic care in palliative care and professional care more generally need to avoid that this call for spiritual care creates a peculiar challenge. When we hope to make everyone responsible for spiritual care we potentially make no one responsible. At least, as long as this professional responsibility is not embedded in an organisational structure.

In other words, spiritual care requires institutional spiritual care support. Implementation in the team of the role of a link nurse for spiritual care may be a helpful strategy to help healthcare professionals assume their responsibility for holistic patient care.


Van Leeuwen RR & Cusveller BS. Nursing competencies for spiritual care. Journal of Advanced Nursing 48 (2004) 3, 234-246.

Cusveller B, Damsma-Bakker A, Streefkerk T, Van Leeuwen R. Implementing ‘link nurses’ as spiritual care support in a general hospital. Report of quantitative and qualitative results. Religions 2020, 11(6), 308; https://doi.org/10.3390/rel11060308 (Open access).

Celebrate the International Year of the Nurse and Midwife 2020 on the EAPC blog #nurses2020 #midwives2020. View the series here and join us again in July when Professor Phil Larkin, Professor of Palliative Care Nursing at University of Lausanne, Switzerland, will be our guest writer.  

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