NURS 750 Week 2 Caring Ministry Exemplar Paper Example

Twenty-Six Days to the First Hold: A Caring Ministry Exemplar on Spiritual Well-Being, Presence, Touch and Prayer for the Parents of an Extremely Preterm Infant

Introduction

At four in the afternoon on his sixth day of life, a boy born at twenty-five weeks returned from the operating room with a stoma and a third of his small bowel removed for necrotizing enterocolitis. When I came to the bedside to review his ventilator settings, his mother was sitting with her hands in her lap, not touching the incubator. "I have prayed every day since he was born," she said, "and this is what happened. I can't pray anymore." Her husband stood behind her with his hand on her shoulder and said nothing.

I work as a neonatal nurse practitioner in a regional level IV NICU. This exemplar describes the twenty-six days between that afternoon and the first time she held her son, and the caring ministry that the nurses, the chaplain and I tried to offer the family. It uses the theory of spiritual well-being in illness (O'Brien, 2018) to explain what happened to the family's spirit and how the elements of caring, presence, listening, touch, prayer and blessing, supported them. The family is a composite drawn from several I have cared for, with details changed.

The Theory of Spiritual Well-Being in Illness

O'Brien (2018) developed a middle-range theory to describe how spiritual well-being shapes a person's response to serious illness. In the theory, illness is a stressor whose effect depends on its severity and on the resources the person has, including social support. Spiritual well-being is the central concept, and O'Brien describes it through three components. Personal faith is the person's belief in and relationship with God or a transcendent power. Religious practice is the way that faith is expressed, through prayer, worship, Scripture, sacraments and community. Spiritual contentment is the peace that comes when faith and practice are intact; its opposite is spiritual distress, which may show itself as anger at God, guilt, fear or a sense of abandonment. The theory proposes that spiritual well-being helps a person cope with illness and find meaning in it, and that nurses can support it through spiritual care.

Two features of the theory matter for the neonatal unit. First, the patient cannot speak for himself, so the family's spiritual well-being becomes the focus of care, both for their own sake and because it shapes their capacity to parent a fragile infant. Second, the components can move separately. A parent may keep personal faith while losing religious practice, as this mother did, and may need help with one before the other recovers.

The Exemplar

Presence

On that first afternoon I did not answer her. I pulled a chair beside her, sat down and stayed for twenty minutes while the bedside nurse finished her assessment. O'Brien (2018) describes presence as being with a patient or family fully, not only physically, and as one of the most important gifts a nurse can offer. Presence in an intensive care unit is difficult because so much competes for attention. I silenced my phone and let the next consult wait, and I told the bedside nurse I would stay. Before I left, I said that I would come back in the morning and that she did not have to pray for my sake or anyone else's.

Listening

The next morning she talked. She described a miscarriage two years earlier, a pregnancy she had prayed through every night, and her fear that God was teaching her something she could not learn. She asked whether the bowel surgery meant her son would die. I answered the medical question honestly: the next few days would tell us a great deal, and many infants recover from this surgery. I did not try to answer the spiritual question. Instead, I asked what her faith had meant to her before the pregnancy, and she described a church that had carried her through her mother's death. That question was the beginning of a spiritual assessment, and it showed me that her personal faith was wounded but present.

Touch

For eighteen days after surgery, her son was too unstable to hold. Touch, though, did not have to wait. The bedside nurses taught both parents to give hand containment, resting a still, warm hand on his head and another around his feet, during cares and painful procedures. The mother began to come at every care time. On day twenty-six, with the surgeon's approval, she held him against her chest for the first time, an hour and ten minutes with a nurse adjusting the lines and tubes. Evidence supports the value of this closeness for parents. In a randomized trial of very preterm infants born at 28 to 33 weeks, skin-to-skin contact begun at birth and continued for the first six hours significantly reduced mothers' depression symptoms one week later and lowered fathers' anxiety, with effects on fathers still visible at term-equivalent age (Lilliesköld et al., 2025). Her son was more fragile than the infants in that trial, but the principle held: the first hold gave her a way to be his mother before it gave her an answer about his future.

Prayer

On the fourth day after surgery, she asked if I prayed. I said that I did, and asked whether she would like me to pray with her or for her, or neither. She asked me to pray because she could not. I asked what she wanted said. She wanted her son to be comfortable, and she wanted to stop being angry. I prayed briefly for both, with her husband's hand on hers, and then returned to the plan for his feeds. O'Brien (2018) cautions that prayer with patients should be offered, never imposed, and should follow the patient's own words and tradition. Asking first and praying in the mother's words kept the prayer hers, not mine.

Blessing

The parents had not had their son baptized because their church practiced believer's baptism, but they wanted some sign that he belonged to God. With their permission, I asked our chaplain to meet them, and the chaplain arranged for their pastor to visit and offer a prayer of blessing at the bedside on day eleven. Partnership with chaplains extends what nurses can offer. In a qualitative study of compassion rounds, spiritual care rounds in a NICU that focused on emotional and spiritual well-being rather than diagnoses, parents and clinicians described positive effects on spiritual wellness, and physicians learned from chaplains how to offer spiritual support in the time they had (McManus & Robinson, 2022). Chaplains also matter at the end of life: in a review of 208 infant deaths in a level IV unit, parental holding at death was associated with chaplain visits and memory-making (Groden et al., 2024). The blessing did not change the infant's course, but it restored a religious practice to the family at the moment the mother could not restore it herself.

Analysis Through the Theory

Read through the lens O'Brien (2018) provides, the family's story is one of spiritual well-being disrupted and slowly restored. The illness experience was severe: an extremely preterm birth followed by emergency surgery and a real threat of death. The mother's personal faith was wounded but intact, as her account of her church showed. Her religious practice collapsed, since she could not pray, and her spiritual contentment gave way to distress expressed as anger at God. The father's spiritual well-being appeared steadier, and his presence was one of the family's resources.

The elements of caring addressed different components. Presence and listening gave the mother space to voice distress without being corrected. Prayer offered on her terms and the pastor's blessing restored religious practice by lending it to her when she could not practice alone. Touch, in hand containment and the first hold, restored her role as a mother and gave her something to do with her love besides fear. By the end of the twenty-six days she was praying again, briefly and on her own, and she described feeling "less alone with God." That is the movement from distress toward contentment that the theory predicts when spiritual well-being is supported.

Evidence suggests that strengthening spiritual well-being can also lower parental stress. In a quasi-experimental study of 95 mothers of preterm infants in Iran, a six-session spiritual self-care program rooted in the mothers' Islamic faith produced post-test spiritual well-being scores of 108.0 compared with 74.2 in the control group and markedly lower maternal stress, although the authors note the limits of a nonrandomized design (Khezri et al., 2026). The faith tradition differs from this family's, but the finding supports the theory's claim that spiritual well-being is a resource for coping that care can strengthen.

Christian Worldview

Jesus did not heal from a distance when He could have. He touched a man with leprosy whom no one else would touch (English Standard Version Bible, 2001/2016, Mark 1:41), and at the tomb of Lazarus He wept with the grieving before He acted (English Standard Version Bible, 2001/2016, John 11:35). His ministry joined presence, touch and prayer. Nurses cannot heal as He did, but we can follow His pattern of drawing near. The mother's anger at God did not need to be corrected; the psalmists brought their own anger and questions to God in prayer, and Scripture holds those prayers as faithful ones. Caring ministry in that light is not getting a family to feel better about God. It is staying close while they find their way back to Him.

Implications for Advanced Practice

This exemplar changed my practice in three ways. I now ask one spiritual question in my first conversation with every family facing surgery or a life-threatening diagnosis, usually what has helped them get through hard times before. I advocate for hand containment and early holding as care for parents, not only for infants, and I raise the first hold on rounds as a goal with a date. And I call the chaplain early, as a partner, rather than at the point of death. As a DNP-prepared nurse practitioner, I can build these habits into unit guidelines so that caring ministry does not depend on whether a particular clinician happens to be on duty.

Conclusion

The theory of spiritual well-being in illness (O'Brien, 2018) explains why a mother who could not pray after her son's surgery needed more than medical answers. Her faith was intact but her practice and peace were broken, and presence, listening, touch, prayer and blessing each helped repair a different part. The evidence on skin-to-skin contact, compassion rounds and spiritual self-care supports what the family experienced. Twenty-six days after the surgery, she held her son, and that evening she prayed again on her own.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Groden, C. M., Raed, M., Helft, P., & Allen, J. D. (2024). End of life care in a level IV outborn neonatal intensive care unit. Journal of Perinatology, 44(7), 1022-1028. https://doi.org/10.1038/s41372-024-01930-6

Khezri, M., Pouladi, S., Bagherzadeh, R., Shekariyan, M., & Gashmard, R. (2026). The impact of Islamic-based spiritual self-care training on stress reduction and improved spiritual well-being in mothers of preterm newborns: A quasi-experimental study. BMC Psychology, 14(1), Article 998. https://doi.org/10.1186/s40359-026-04742-9

Lilliesköld, S., Lode-Kolz, K., Westrup, B., Bergman, N., Sorjonen, K., Ådén, U., Mörelius, E., Rettedal, S., & Jonas, W. (2025). Skin-to-skin contact at birth for very preterm infants and symptoms of depression and anxiety in parents during the first year: A secondary outcome of a randomized clinical trial. Journal of Affective Disorders, 383, 323-332. https://doi.org/10.1016/j.jad.2025.04.160

McManus, K., & Robinson, P. S. (2022). A thematic analysis of the effects of compassion rounds on clinicians and the families of NICU patients. Journal of Health Care Chaplaincy, 28(1), 69-80. https://doi.org/10.1080/08854726.2020.1745489

O'Brien, M. E. (2018). Spirituality in nursing: Standing on holy ground (6th ed.). Jones & Bartlett Learning.