Does Prayer Make a Difference for Patients - Research Paper Example

Evidence Based Paper: Does prayer make a difference for patients? From times immemorial, prayer has been considered to be one of the strategies to cure illness and promote good health. Certain religious groups believe that prayer is the most important therapy for any sick person, placing it above medical therapy. Several research-based studies have evaluated the effects on prayer on the health of patients. However, the results have been contradictory and non-conclusive. In some cultures, like the African-Americans, who lack proper health care, individuals with poor health resort to faith in prayers. Despite the fact that intercessory praying, which means praying for others, is a "common response to sickness for millennia" (Harris et al, 1999), little scientific attention has been paid to it. According to Allison Abner, a famous socialist and writer, “because of limited access to quality health care and our distrust of the medical establishment we have occasionally relied on spiritual healing through such practices as prayer and the laying on of hands; most of us, at some time have used prayer chanting or proverbs as ways to guide, direct, and heal ourselves, and now, our beliefs are being backed by medical research" (cited in Williams, 1999). Believers of prayer therapy claim that prayer does not only have therapeutic effects on those who pray, but also on those who are prayed by other people who do not actually know them. However to implement prayer therapy as an adjunct to medical therapy in hospitals, evidence based practice is essential. Several research-based studies have evaluated the effects on prayer on the health of patients. In this article, literature review is done to search, ascertain and evaluate the benefits of prayers on patients. Nursing Intervention 55 year old Susan was admitted in the ICU with ARDS. She was critically ill. The nurse taking care of her casually informed that supervisor if some intercessory prayers could be offered to her because she believed in prayer therapy as she heard about it elsewhere. The supervisor asked her if there was any evidence to ascertain benefits of prayer therapy on the health of patients. This incident triggered the search for evidence based practice for prayer therapy and the results of the literature review and implications for practice are described below. Literature review, critical analysis and implications for practice Several research studies have been conducted to ascertain the benefits of prayer therapy with reference to patients. However, for evidence-based practice, only some studies can be taken into account. The gold standard for any evidence based practice are randomized controlled trials which when performed with optimized research designs that can answer pertinent questions. However, meta-analysis and systematic review have topped the hierarchy list and when present, they are preferred to randomized controlled trials (Evans, 2003). It is interesting to note that prayer does not only have therapeutics effects on those who pray, but also on those who are prayed by other people who do not actually know them. According to Hefti and Koenig (2007), "active prayer within the framework of a doctor-patient relationship can strengthen the patients optimism and activate the bodys healing resources." The first randomized controlled study evaluating the benefits of prayer therapy was studied in 1988 by Byrd. The study was conducted on 393 patients admitted to coronary care unit of San Francisco General Hospital at San Francisco. In this study, the intervention group received structured intercessory prayers by persons unaware to them. Results of this study pointed to the benefits of intercessory praying in decreasing hospital course scores. Those who were prayed for had lesser need for cardio-pulmonary resuscitation, lesser use of mechanical ventilators, decreased need for diuretics and antibiotics, decreased incidence of pulmonary edema and decreased deaths. However, this study had several limitations, the most important of which was prayers in control group. Though no structured intercessory prayers were offered for patients in the control group, it could have happened that some friend or relative of the patient would have offered prayers and this is beyond the control of the investigators. Though this study proved the benefits of prayers on cardiac patients, several other studies which were conducted after this study disputed such a therapeutic benefit and some others opined inconclusively. Harris et al (1999) conducted a randomized, double-blind, controlled, parallel group and prospective trial to ascertain the effects of remote intercessory prayer in reducing the length of stay and adverse effects on cardiac patients who are hospitalised. In this study, the intervention group received remote intercessory prayers by intercessors who did not know them, but prayed for them using their first names. The control group received only medical care. The main outcome measure in this study was coronary care unit score which was derived from blinded, retrospective chart review. The results of the study revealed that intercessory prayer was definitely associated with low coronary care unit scores, but it had no impact on the length of stay in the hospital and coronary care unit. The researchers opined that intercessory prayers are effective adjuncts to medical care. Since there is no evidence pointing to the benefits of prayer on health of patients, prayer cannot be recommended as an adjunct to medical therapy. According to a systematic review conducted by Roberts et al (1998), remote intercessory prayers do not have any impact on the clinical condition, duration of stay in hospital, complication rate or mortality of the patients, irrespective of the clinical condition for which they are prayed for. The researchers pointed that there were very few completed trials to ascertain the impact of intercessory prayers and that further research was necessary in this regard. They opined that "If prayer is seen as a human endeavor it may or may not be beneficial, and further trials could uncover this. It could be the case that any effects are due to elements beyond present scientific understanding that will, in time, be understood. If any benefit derives from Gods response to prayer it may be beyond any such trials to prove or disprove." According to cochrane review (Roberts, 2000), there is not much current data "to guide those wishing to uphold or refute the effect of intercessory prayer on health care outcomes" and that "there are no grounds to change current practices." The review concluded that "if any benefit derives from Gods response to prayer it may be beyond any such trials to prove or disprove." In yet another cochrane review (Roberts et a., 2007), it was found that there is some evidence of benefits of prayer on the outcomes of in vitro fertility. The review also opined that patients undergoing surgery my not wish to know that prayers are being offered on their behalf. The review however justified the need for further studies on the effects of prayer. In a study by Benson et al (2006), popularly known as the STEP or Study of the Therapeutic Effects of Intercessory Prayer, the researchers evaluated the effects of either "receiving intercessory prayer" or "being certain of receiving intercessory prayer" had implications for "uncomplicated recovery after coronary artery bypass graft (CABG) surgery." The study was a randomized controlled study conducted in 6 US hospitals and patients were assigned randomly to 3 groups: those who did not receive any prayers, those who received prayer but did not know about it and those who received prayer and were informed about it. The primary outcome measure in the study was any complication within 30 days of the surgery. Secondary outcomes that were measured were mortality and major life event. Though major life events and mortality were similar in all the 3 groups, rate of complications was much higher in the group who were aware of intercessory prayer (59 percent) as against those who did not know know about it or did not receive it (51 percent). The study concluded that intercessory prayer had no implications for complications following CABG and certainity of receiving the prayers was associated with increased incidence of complications. Believers of prayer claim that prayer lowers blood pressure. According to s study funded by the National Institutes of Health, regular attendance to religious services, atleast once a week decreases the risk of high blood pressure atleast by 40 percent in people between 65-74 years of age (Williams, 1999). The study was conducted on 4000 participants over 65 years of age. According to Larson, one of the "the at-risk population of people with illnesses, such as the elderly seem to be helped if they have faith and religious commitment." and that "faith brings a calming state which helps decrease nervousness and anxiety with coping with day to day stress." (cited in Williams, 1999). However, a recent study by Fitchett and Powell (2009) proved that spirituality had nothing to do with blood pressure, especially in middle aged women. Some research has shown that religious women with hip fracture recovered faster and were able to walk greater distances than non-religious women after discharge from hospital. Some researchers argue that prayer decreases suicidal and depression rates and can also decrease high blood pressure (Williams, 1999). However, since no concrete research evidence is available to ascertain the role of prayers in the health of the patient, prayer therapy cannot be recommended. Barriers for evidence based practice and recommendations to overcome them The first step in addressing various issues that surround implementation of evidence based practice is identification of barriers. This is essential to narrow the research-practice gap that exists in all health care systems. According to a study by McKenna et al (2004), barriers to evidence based practice as implied by general practitioners include "the limited relevance of research to practice, keeping up with all the current changes in primary care, and the ability to search for evidence -based information." In the same study, community nurses reported that "poor computer facilities, poor patient compliance and difficulties in influencing changes within primary care." According to a cross-sectional survey by Lai et al (2010), time constraints, poor facilities to access information and poor awareness of evidence were important barriers for evidence based practice. In yet another study by Agarwal et al (2008), several limitations and misperctions of evidence-based medicine were barriers to practice in South Asia. The most powerful tool to overcome barriers to evidence based practice is effective education (Agarwal, 2008). The clinical teacher must impart to the learners about the basis of decision making in research and evidence based practice. Principles of evidence based practice must be introduced even in preclinical education and students must be allowed to perform exercises regarding literature review and critical appraisal. Internet and electronic libraries are the best sources of information and students and clinicians must be provided training in operating computers and retrieving information. Computers and internet must be available round the clock and must become indispensable. Students and clinicians must be provided access to electronic databases for free. Seminars, conferences and presentations must be encouraged for updated information. Since for may clinicians time is a major constraint, critically appraised topics must be made available in a "ready-to-read" format. In order to protect the rights of the consumers and prevent malpractice, legislations must be introduced to punish those who do not practice medicine through updated information. Telemedicine is another important technology that can enhance evidence-based practice (Agarwal et al, 2008). Conclusion From the literature review it is evident that the therapeutic powers of praying is only a belief and not a scientific evidence, or rather, there is not enough evidence to ascertain the therapeutic benefits of praying on patients. Thus, it can be said that as of now, there is no clear cut evidence to implement prayer as adjunct to medical therapy and that further research is warranted to ascertain the benefits of prayer. However, since there is no harm in praying, those who believe in prayer therapy must be continued to do so for whatever little benefit and hope it offers. Because, it is beyond the human race to prove whether there is Some One above all of us and whether He is hearing to us!! References Agarwal, R., Kalita, J., and Misra, U.K. (2008). Barriers to evidence based medicine practice in South Asia and possible solutions. Neurology Asia, 13, 87 – 94. Benson, H., Dusek, J.A., Sherwood, J.B., et al. (2006). 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.,151, (4), 934-42. Byrd, R.C. (1988). Positive therapeutic effects of intercessory prayer in a coronary care unit population. South Med J., 81, 826-829. Evans, D. (2003). Hierarchy of evidence: a framework for ranking evidence evaluating healthcare interventions. Journal of Clinical Nursing, 12(1), p. 77 – 84. Fitchett, G., and Powell, L.H. (2010). Daily Spiritual Experiences, Systolic Blood Pressure, and Hypertension among Midlife Women in SWAN. Ann Behav Med., 37(3), 257–267. Harris, W.S., Gowda, M., Kolb, J.W., et al. (1999). A Randomized, Controlled Trial of the Effects of Remote, Intercessory Prayer on Outcomes in Patients Admitted to the Coronary Care Unit. Arch Intern Med., 159, 2273-2278. Hefti, R., and Koenig, H.G. (2007). [Prayers for patients with internal and cardiological diseases--an applicable therapeutic method?] MMW Fortschr Med., 13, 149(51-52), 31-2, 34. Lai, N.M., Teng, C.L., and Lee, M.L. (2010). The place and barriers of evidence based practice: knowledge and perceptions of medical, nursing and allied health practitioners in Malaysia. BMC Research Notes, 3, 279. McKenna, H.P., Ashton, S., and Keeney, S. (2004). Barriers to evidence-based practice in primary care. J Adv Nurs., 45(2), 178-89. Roberts, L., Ahmed, I. I., Hall, S., Sargent, C., Adams, C. (1998). Intercessory Prayer for ill Health: A Systematic Review. Forsch Komplementarmed., 5, Suppl S1, 82-86. Roberts, L., Ahmed, I., Hall, S. (2000). Intercessory prayer for the alleviation of ill health. Cochrane Database Syst Rev., (2), CD000368. Williams, D. D. (1999). Scientific Research of Prayer: Can the Power of Prayer Be Proven? 1999 PLIM REPORT, 8 (4), Retrieved on 9th November, 2010 from http://www.plim.org/PrayerDeb.htm Read More