NURS 750 Week 4 Spiritual Care Workshop Part 2 Learning Activity Example

From Candle Lighting to Saturday Night: An Unfolding Case Learning Activity on Spiritual Care for an Orthodox Jewish Family in the Neonatal Intensive Care Unit

Introduction

In Part 1 we prepared a ninety-minute workshop for nurses at our regional medical center on how to meet the spiritual needs of observant Orthodox Jews and their relatives when illness is grave, and stated five learning outcomes: describe the principles of Jewish law that shape decisions, identify accommodations for Sabbath, diet, modesty and prayer, demonstrate a spiritual assessment that asks about rabbinic guidance, explain and communicate the difference between withholding and withdrawing treatment, and plan care at and after death. This paper presents the learning activity at the center of the workshop. It is a 75-minute unfolding case set in our neonatal intensive care unit, in which nurses follow a premature infant and his parents from Friday afternoon, through the Sabbath, into Saturday night.

Why an Unfolding Case With Role-Play

Spiritual care is a skill that nurses rarely get to practice before they need it. O'Brien (2018) describes spiritual care as something offered through the nurse's presence and conversation, which a lecture can describe but not build. The evidence favors active, reflective methods. In a randomized controlled trial with 120 nurses, a four-session program that combined interactive lectures, scenario-based learning and reflective discussion structured by the Gibbs reflective cycle improved nurses' spiritual well-being and their clinical competence across domains including interpersonal relationships and legal and ethical practice, with gains sustained at two months (Hemati et al., 2026). Role-play matters for confidence. In a pilot of an online program that included a simulated spiritual history and a debrief, oncology nurses described fear, vulnerability and cultural difference as barriers, and said that the role-play and the structure of the FICA tool left them feeling equipped to begin spiritual conversations (Beck et al., 2026). An unfolding case adds a third advantage: because one family's story moves through several days, nurses see how early assessment shapes later decisions.

Overview of the Activity

Participants and Setting

The activity is designed for twelve to sixteen registered nurses and advanced practice nurses from the neonatal, pediatric and adult intensive care units. It runs in the simulation center in a room set up as a neonatal bedside with an incubator, a manikin, a call light, an electric bed for the parent and a telephone.

Roles and Materials

Two trained volunteers from the hospital's standardized patient program play the parents, Rivka and Yosef, an Orthodox Jewish couple whose first son was born at 27 weeks. A member of the chaplaincy staff plays the family's rabbi by telephone. Each actor receives a role card describing the character's beliefs, worries and the information to give only if asked. Participants rotate through the nurse role in pairs while the rest observe with a scoring checklist. Materials include the case script, role cards, the checklist, a pre- and post-workshop quiz and a one-page reference sheet on Sabbath, dietary, modesty and end-of-life practices drawn from Part 1.

Prebriefing (10 minutes)

The facilitator explains the outcomes, the format and the ground rules: mistakes are expected, the actors will respond realistically, and the goal is practice, not performance. The facilitator reminds participants that Orthodox Jewish families vary and that the purpose of every scene is to ask, not assume.

The Unfolding Case

Scene 1: Friday, 2:30 p.m., Admission Spiritual Assessment (12 minutes, Outcome 3)

The infant has been transferred from a community hospital. The nurse pair meets the parents at the bedside for the first time. The facilitator's prompt: complete the admission assessment and learn what the family needs before the Sabbath begins in four hours. Observers score whether the nurses introduce themselves without offering a handshake to the parent of the opposite sex unless one is offered, ask an open question about what helps the family in hard times, ask whether faith is important to them and whether a rabbi guides their medical decisions, ask how to reach the rabbi, and ask what the family will need over the Sabbath. If the nurses ask well, Yosef explains that their rabbi must be consulted on any major decision and gives his number. If they do not ask, the information emerges only in Scene 4, which the debrief will use to show why early assessment matters.

Scene 2: Friday, 6:15 p.m., Sundown (10 minutes, Outcome 2)

Rivka asks whether she may light Sabbath candles at the bedside. Yosef says he will be staying in the hospital because he will not drive until Saturday night, and that they brought their own food. The prompt: plan the family's Sabbath. Observers score whether the nurses offer battery-operated candles, since open flame is not allowed, explain the unit's Sabbath accommodations, such as a room light left on, a nearby sleep room and the Sabbath elevator, offer to check on the parents at set times so they need not use the call light, ask before opening or reheating sealed kosher food, and protect time for prayer. Participants must identify at least four accommodations to meet the outcome.

Scene 3: Saturday, 10:00 a.m., Consent (10 minutes, Outcomes 1 and 2)

The infant's hemoglobin has fallen and the team recommends a blood transfusion. Yosef hesitates to sign the consent form. The prompt: obtain consent in a way that respects the family's practice. Observers score whether the nurses recognize that the hesitation concerns writing on the Sabbath rather than the treatment, explain that the team considers the transfusion important to the infant's health, offer witnessed verbal consent under hospital policy, and offer to call the rabbi if the family wishes. The facilitator then asks the group to name the principle at work: the preservation of life overrides the Sabbath, so a family may accept urgent treatment without hesitation once its importance is clear (Tatz, 2023). Yosef also asks whether the brit milah, the circumcision on the eighth day, can take place on schedule; the nurses should know that Jewish law postpones it while an infant is unwell and that the family will plan it with their rabbi.

Scene 4: Saturday, 9:00 p.m., A Decision About the Ventilator (15 minutes, Outcomes 1, 4 and 5)

A head ultrasound shows a severe bleed in both sides of the brain. The neonatologist has told the parents the prognosis is poor and raised redirecting care toward comfort. The parents tell the nurses they cannot "take him off the machine" but do not want him to suffer. The prompt: support the family and help the team understand their position. Observers score whether the nurses stay present and listen before explaining, acknowledge the parents' faith without arguing with it, distinguish withdrawing the ventilator from declining new escalations such as resuscitation or additional drugs, ask whether the family would like the rabbi involved now and help arrange the call, and describe what comfort care can include without removing the ventilator. Theocentric ethics, in which life is a gift held in trust from God, explains why the parents and many observant families see withdrawal differently from withholding (Hossain et al., 2025). In a survey of clinicians who care for terminally ill Orthodox patients, respondents recommended early, direct communication with rabbinic authorities when families want it (Ornstein & Harris, 2026). The scene closes with the rabbi on the phone advising the family that they may decline escalation while continuing the ventilator. The skill being tested is not knowing the ruling but making room for the family to receive it.

Debrief (18 minutes, all outcomes)

The facilitator leads the debrief through the six stages of the Gibbs reflective cycle used in the Hemati et al. (2026) trial: description of what happened, feelings, evaluation of what went well and poorly, analysis using the Part 1 content, conclusion and an action plan. Questions include: When did you first learn that a rabbi guided this family, and how did the timing affect Scene 4? What did you feel when the parents refused withdrawal? Which accommodation would be hardest to provide on your own unit, and who could help? The facilitator closes by asking each participant to name one practice they will change on their next shift. The case also prepares nurses for what comes after. Bereavement support is one of the recommendations in the 2026 critical care society guideline for dying children and infants (Derrington et al., 2026), and the facilitator reviews how the unit would honor the family's practices at death: staying with the body, minimal handling before the burial society arrives, prompt release and no autopsy unless required.

Assessment of Learning

Each outcome is measured. The observers' checklist scores Outcomes 2, 3 and 4 during the scenes; a participant meets an outcome by performing at least four of the five listed behaviors for that scene. Outcomes 1, 4 and 5 are also measured with a ten-item quiz given before and after the workshop. Sample items include:

• 1. A family will not sign a consent form on Saturday. What is the most likely reason? Answer: writing is avoided on the Sabbath; offer witnessed verbal consent.
• 2. Which principle allows an observant patient to accept urgent treatment on the Sabbath? Answer: the duty to preserve life overrides Sabbath restrictions.
• 3. A family accepts a do-not-resuscitate order but refuses extubation. Is this consistent? Answer: yes; many authorities permit withholding new measures while forbidding withdrawal of continuous ones.
• 4. After death, what should the nurse ask before washing the body or removing lines? Answer: whether the family wishes the community burial society to prepare the body.

The workshop meets its goal if at least 80% of participants meet every outcome on the checklist and post-test scores rise by at least 30 percentage points. Participants also complete a three-question evaluation of the activity's realism and usefulness.

Christian Worldview

The Samaritan in Jesus's parable crossed a line of religion and ethnicity to care for a wounded stranger, binding his wounds and paying for his lodging (English Standard Version Bible, 2001/2016, Luke 10:33-35). Caring for a family of another faith is that kind of neighbor love. Christian nurses can honor an Orthodox Jewish family's practice without sharing it, and doing so reflects respect for the Scriptures Christians and Jews hold in common. Peter's instruction to give an account of one's hope with gentleness and respect (English Standard Version Bible, 2001/2016, 1 Peter 3:15) describes the posture the activity teaches: confident in one's own faith, humble before another's.

Conclusion

This learning activity turns the content of Part 1 into practice. Over 75 minutes, nurses assess an Orthodox Jewish family's spiritual needs, plan for a Sabbath, obtain consent in a way that respects the family's law and support parents through a decision about their son's ventilator, then reflect on what they did. Evidence from trials of scenario-based spiritual care education and role-played spiritual histories supports the design, and each scene is tied to an outcome and scored. Our hope is that the next father in our unit who will not sign a form on a Saturday meets a nurse who knows why, and knows what to do.

References

Beck, M. L., Supiano, K. P., Clayton, M. F., Shannon Dorcy, K., & Cloyes, K. G. (2026). Oncology nurses' perceptions of barriers and facilitators to conducting spiritual histories. Journal of Hospice & Palliative Nursing, 28(3), e130-e138. https://doi.org/10.1097/NJH.0000000000001194

Derrington, S., Broden Arciprete, E. G., Lin, M. C., Oczkowski, S. J. W., Alladin, A., Anani, U. E., Borchik, A. K., Collins, C. A., Delgado-Corcoran, C., Dickerman, M. J., Harrod, C. G., Henner, N., Kon, A. A., Lewis-Newby, M., Lord, B. T., Masters, A. A., McCarthy, S., Moynihan, K. M., Munoz-Blanco, S. M., . . . DeCourcey, D. D. (2026). Society of Critical Care Medicine 2026 guidelines on the care and management of pediatric and neonatal intensive care patients at the end of life. Pediatric Critical Care Medicine, 27(4), 518-536. https://doi.org/10.1097/PCC.0000000000003914

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

Hemati, M., Jaberi, A., Heydari, N., & Momennasab, M. (2026). Efficacy of structured spiritual care education program on nurses' spiritual well-being and clinical competence: A randomized controlled trial. BMC Nursing, 25(1), Article 888. https://doi.org/10.1186/s12912-026-04987-0

Hossain, F., Gabbay, E., & Fins, J. J. (2025). Clinical ethics and the observant Jewish and Muslim patient: Shared theocentric perspectives in practice. Cambridge Quarterly of Healthcare Ethics, 34(2), 247-263. https://doi.org/10.1017/S0963180124000379

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

Ornstein, M. C., & Harris, D. (2026). Medical professionals' perceptions of and experiences with terminally ill Orthodox Jewish patients. American Journal of Hospice and Palliative Medicine, 43(2), 133-138. https://doi.org/10.1177/10499091241312395

Tatz, A. (2023). Life-threatening and terminal illness: Considerations for hospitalised Orthodox Jewish patients. British Journal of Hospital Medicine, 84(6), 1-5. https://doi.org/10.12968/hmed.2022.0118