Guest Post – Hospitality and Nursing

In broad terms, hospitality can be defined as “the friendly reception and treatment of guests or strangers” or “the quality or disposition of receiving and treating guests and strangers in a warm, friendly, generous way.”¹ The words hospitality and hospital are both derived from the Latin hospes, signifying a guest, stranger, or foreigner—describing the connection between the two words. Through a Christian lens, hospitality begins in our relationship with and identity in God and represents the practice of receiving and interacting with people in a generous way.² Hospitality should be a part of the Christian life, as we are called to be witnesses of Christ’s kingdom to the world. I appreciate that hospitality can demonstrate the truth about who God is without speaking a word of scripture to those we are being hospitable to.³ As such hospitality can: play a large role in teaching the profession of nursing, influence scholarship on pain and pain management, and create space for the use of arts and humanities in nursing education.

Hospitality can shape teaching and scholarly work through the Christian theological concept of a transformationalist emphasis. Transformational emphasis is associated with the relationship of Christianity to culture, to a world-and-life view and to Christ as a transforming culture.⁴ Due to the fall, we do not relate to each other as we ought to, though we were created to be in relationships with others. We have, as an example, the persons of God communing with each other, showing each other “divine hospitality.”⁵ In our longings for what was meant to be regarding our relationships with others, hospitality brings us closer to God’s original intent for relationships and thus functions as a redemptive action for transforming relationships.

Hospitality can contribute to a supportive learning environment. Mary Rose O’Reilley writes “Hospitality defines a space for a visitor—the student—to be herself, because she is received graciously . . . Hospitality calls me to consider the singularity of each person . . . to try [to receive each student] with unconditional presence.”⁶  When a student feels valued, accepted, and is received graciously, they will feel supported, safe, and learning will be enhanced.

In my role as an assistant professor of nursing at a small liberal arts university, I teach such hospitality using healthcare simulation. Healthcare simulation is “ . . . a technique that uses a situation or environment created to allow persons to experience a representation of a real healthcare event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions . . . .”⁷ In my healthcare simulation courses, I try to create a welcoming learning space, where students can make mistakes on computerized mannequins and not harm an actual patient. Students take simulation very seriously. Many times, I see hands shaking as they carry out their patient care assignment. During the debriefing time after the simulated patient care scenario, I am present and open to hear students’ explanations about why they chose a certain action, instead of one I would have anticipated. Debriefing also allows a time to contribute to students’ learning needs by providing rationales for correct ways of performing nursing interventions.

The effects of hospitality are not limited to the student-professor relationship. Henri Nouwen notes that if we can practice hospitality with those with whom we are close, we will be able to extend this practice to others outside of our close relationships.⁸ It is important for nursing professors to model hospitality to their students so that students, in turn, will be hospitable to others. Nursing students must learn to be hospitable to other employees and during patient encounters. Nurses work in a team environment and hospitality should be shown to fellow team members. While all team members are important, new nurses are especially vulnerable to inhospitable treatment from other more experienced nurses. A significant percentage of new nurses leave their first job due to bullying.⁹ To push back against this toxic, yet pervasive problem, faculty must model hospitable behaviors in clinical settings to allow students to see and eventually model those same behaviors.

As nurses, it is also important to be hospitable towards our patients. This is emphasized in simulation. Healthcare settings can often be inhospitable places. Patients are in an unfamiliar environment, but nurses are very familiar with their work environment. Patients undergo uncomfortable procedures; nurses are often the ones carrying them out. Nurses must remember their roles in welcoming the stranger into their healthcare environment, doing everything in their power to make it as hospitable as possible. Specifically, this means keeping patients informed about and included in their care, making sure family members are involved in the patient’s plan of care, and ensuring the patient is as physically comfortable as possible.

Interestingly, when hospitality is extended in healthcare settings, it is not always clear who is filling the role of the stranger/guest and who is functioning as the host. I have seen it in my own nursing practice when the patient is the one being hospitable by inviting or welcoming healthcare team members to be part of their illness experience. This occurs when the patient shares the story of their illness trajectory or the meaning of the illness to him or her. The Symptom Management Model reveals how a patient symptom – like pain, for example – is a matter of perception, evaluation, and response to pain.¹⁰ As such, understanding a symptom requires a patient is willing to share their experience and a nurse who is willing to receive it in care.

One of my research interests is pain and pain management. I am especially interested in how pain is a bio-psycho-social phenomenon and how we can teach nurses to be better managers of pain. Every patient has the right to access effective pain management. Pain can elicit a sympathetic nervous system response—the flight or fight phenomenon. This response and not having pain treated adequately can contribute to the patient feeling they are in a threatening, non-hospitable environment. Pain management has been prioritized in healthcare settings because of the negative effect of poor pain management on patient satisfaction surveys. A second issue regarding pain management is when nurses withhold necessary pain medications because they are afraid of addiction or that the patient is “drug seeking.” In a qualitative research study I recently published, new nurses found their relationships with patients altered due to their own suspicions regarding the motives of patients asking for pain medications.¹¹ Viewing patients as pain “problems,” drug seekers, or addicts is not hospitable. Viewing them as fellow image-bearers of God by meeting their physical, emotional, and spiritual needs is hospitable.

Another area of research I am working in is the use of arts and humanities in nursing education. Arts and humanities can tell the stories of illness experiences. By viewing and reading these experiences, nurses can become familiar with how people go through an illness and will know better how to care for them. By seeking out descriptions of illness experiences, we are showing hospitality toward others by valuing and honoring their illness experiences. Oden writes that “hospitality is not so much a singular act of welcome as it is a way, an orientation that attends to otherness, listening and learning, valuing and honoring.”¹² Exposure to the arts and humanities increases aesthetic knowledge in nursing, which is expressed through “…actions, bearings, conduct, attitudes, narratives, and interactions of the nurse in relation to others.”¹³ As such, the actions of aesthetic knowledge can be closely connected to arts and humanities and the actions of hospitality.

The use of arts and humanities in nursing education also encourages interdepartmental hospitality within university settings. With arts and humanities programs being frequently cut from university curricula, they need welcoming support from other departments. By including them in interdisciplinary research, we are showing that we value the contributions the arts and humanities make to all types of education.

In summary, hospitality is a concept that is connected to the Christian theological idea of transformationalism which can shape teaching and scholarship as a way of deeply connecting to the gospel. Hospitality is being welcoming and generous to those we encounter—connected to teaching through creating spaces to practice nursing care via simulation. It also entails offering others respect and recognition in both clinical and academic settings, and is related to pain and pain management because it helps patients feel that their needs are being met in healthcare settings. Finally, new opportunities for hospitality involve utilizing arts and humanities in nursing education; by maximizing the power of patient stories and personal experiences of the patients’ nurses can provide even more hospitable care.

1. Dictionary.com, “hospitality,” 2021, https://www.dictionary.com/browse/hospitality
2. Ruth Ann Buntin-Majawa, “The Basis for Christian Hospitality,” Church Renewal  (blog).  Christian Reformed Church of North America. October 23, 2017, https://network.crcna.org/church-renewal/basis-christian-hospitality
3. Ruth Ann Buntin-Majawa, “The Basis for Christian Hospitality.”
4. Christian Reformed Church, An Identity Statement: What It Means To Be Reformed, (Grand Rapids: Christian Reformed Church in North America, 2016).
5. Cornelius Plantinga, Engaging God’s World: A Christian Vision of Faith, Learning, and Living. (Grand Rapids: Wm. B. Eerdmans Publishing, 2002).
6. Mary Rose O’reilley, Radical Presence: Teaching as Contemplative Practice, (Boynton-Cook Publishers, 1998), 8.
7. Janice C. Palaganas, Juli C. Maxworthy, Chad A. Epps, and Mary E. Mancini, Defining Excellence in Simulation Programs, (Philadelphia: Lippincott Williams & Wilkins, 2014), xxxi.
8. Henry Nouwen, Reaching Out: Three Movements of the Spiritual Life, (New York: Doubleday, 1975).
9. Cole Edmonson and Caroline Zelonka, “Our Own Worst Enemies: The Nurse Bullying Epidemic,” Nursing Administration Quarterly, 43, no. 3 (2019): 274.
10. Marylin Dodd, Susan Janson, Noreen Facione, Julia Faucett, Erika S. Froelicher, Janice Humphreys, Kathryn Lee et al. “Advancing the science of symptom management,” Journal of Advanced Nursing, 33, no. 5 (2001): 668-676, http://doi.org/10.1046/j.1365 2648.2001.01697
11. Elizabeth A. Byma and Heidi Wheeler, “The Experience of New Graduate Registered Nurses as Managers of Pain,” Pain Management Nursing, 22, no. 3 (2021), 429-435, http://doi.org/10.1016/j.pmn.2020.12.001
12. Amy Oden (Ed.), And You Welcomed Me: A Sourcebook on Hospitality in Early Christianity. (Nashville: Abingdon Press, 2010), 14.
13. Peggy L. Chinn and Maeona K. Kramer, (2018). Knowledge Development in Nursing: Theory and Practice, (Amsterdam: Elsevier, 2018), 10.