The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic Review

A survey regarding the role of UK dietitians in spiritual care

BACKGROUND

Users of dietetic services have unmet spiritual needs, although no study has yet explored dietitians' opinion, perceptions or experience of assessing spiritual needs and delivering spiritual care in clinical practice.

METHODS

A cross-sectional survey assessed the role of UK dietitians in spiritual care.

RESULTS

Thirty-seven practicing dietitians, with experience ranging from newly qualified to over 21 years of practice, took part in the survey containing open and closed questions. Almost half (49%) of dietitians said they always conducted spiritual assessments and most (57%) said they sometimes made a referral for spiritual concerns. When spiritual issues arose, dietitians were highly likely to listen well (score 4.6 out of 5) and encourage service users in their own (the service user) spiritual or religious practices (score 4 out of 5). However, the likelihood of taking the initiative and enquiring about religious and spiritual issues was lower (score <3 out of 5) in all areas of practice including end of life care. This may have been because confidence around spiritual care was also low (score 4.7 out of 10), uncertainty was high (score >3.5 out of 5) and there was a strong desire to receive training (>4 out of 5). Qualitative responses expanded further on these results suggesting that there was positive "intention" to provide spiritual care, but lack of training was a significant barrier (qualitative theme: "inadequacies"). The recognition of necessity but uncertainty of how to meet spiritual needs was also shown through qualitative findings to be a source of "emotional labour", particularly where there were conflicting beliefs between a dietitian and service user.

CONCLUSIONS

Although limited by a small sample size, these results provide new knowledge that spiritual care is considered an important part of the dietitians' role and that this is the case regardless of the dietitians own spiritual identity or religion. Dietitians would value training in spiritual care so that they can support service user needs more readily and confidently.

Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems

Reimagining public health's future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities. Spirituality includes a sense of ultimate meaning, purpose, transcendence, and connectedness. With that end in mind, we assessed how recommendations recently issued by an expert panel for integrating spiritual factors into public health and medicine are being adopted in current practice in the United States. These recommendations emerged from a systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022. For each recommendation, we reviewed current federal, state, and local policies and practices recognizing spiritual factors, and we considered the ways in which they reflected the panel's recommendations. In this article, we highlight opportunities for broader application and scale while also noting the potential harms and benefits associated with incorporating these recommendations in various contexts. This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey

BACKGROUND

Spiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education.

OBJECTIVE

This study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries.

DESIGN

A cross-sectional survey was used.

PARTICIPANT/SETTING

Nursing students (n = 785) from five universities in Middle Eastern countries were included.

METHODS

Participants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care.

RESULTS

Nursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores.

CONCLUSION

Nursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Spiritual nursing education programme for nursing students in Korea: a systematic review and meta-analysis

PURPOSE

This study conducts a systematic review and meta-analysis to understand the characteristics and contents of studies on spiritual nursing education programmes and their effects.

METHODS

The literature search included five databases (RISS, KISS, DBpia, Science ON, and KmBase) published in South Korea until September 30, 2021. Nine studies were included in the final review, with six for the meta-analysis using the RevMan 5.4. 1 programme. The programmes targeted nursing students and nurses in the RN-BSN course and employed methods such as lecturing, discussions, and case presentations. The contents focused on self-spirituality awareness, spirituality-related concepts, understanding others' spirituality, and the process and application of spiritual nursing.

RESULTS

The meta-analysis revealed statistically significant effects on spiritual nursing competencies, spirituality, spiritual well-being, existential well-being, and spiritual needs, except self-esteem. Spiritual nursing education was effective in enhancing spiritual nursing competencies.

CONCLUSION

The study confirmed that spiritual nursing education effectively improves spiritual nursing competency, indicating a need for increased focus and administrative and financial support for such education in schools and hospitals. Furthermore, future studies should employ randomised experimental designs to examine the effects of online education programmes with short training time on clinical nurses in hospitals.

Spiritual care experiences of nurses working in intensive care units: A qualitative study

BACKGROUND

Most nurses working in intensive care units are unprepared to provide spiritual care to patients and they lack the competence and skills to provide spiritual care. Lack of moral evaluation of patients has negative effects on the patient. Spiritual care given to patients has effects on patient-nurse communication, general condition of the patient, and the quality of care.

AIM

This study was conducted to find out the spiritual care experiences of nurses working in intensive care units.

STUDY DESIGN

A qualitative descriptive design was used. The study was carried out with 14 nurses who were working in the intensive care units of a university hospital in eastern Turkey between May and July 2022. Two forms were created by the researcher according to the purpose of the study and the population. Inductive thematic analysis was used to evaluate the data. Ethics committee approval was obtained.

RESULTS

Ten of the nurses were women. Their ages were between 25 and 47 years, their working years ranged between 2 and 28 years, and their weekly working hours ranged between 40 to 56 hours. As a result of the thematic analysis, six themes and 18 sub-themes were determined: The themes determined are (1) Definition of spiritual care (2) Time of spiritual care, (3) Benefits of spiritual care, (4) Spiritual care practices, (5) Obstacles in providing spiritual care.

CONCLUSIONS

Providing spiritual care to patients in intensive care is a very important experience for nurses. Understanding spiritual care, recognizing its importance, and including it in nursing practice have a central significance.

RELEVANCE TO CLINICAL PRACTICE

Spiritual care provided in nursing profession is as important as physical care, and supporting patients in intensive care is at the heart of providing the best holistic care.

Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation

BACKGROUND

The concept of "total pain" plays an important role in palliative care; it means that pain is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension. Understanding what spirituality entails, however, is a challenge for health care professionals, as is screening for the spiritual needs of patients.

OBJECTIVE

This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format.

METHODS

In a mandatory seminar within the palliative care curriculum at our university, both a physician and a hospital chaplain teach strategies in symptom control from different perspectives (somatic domain - spiritual domain). For evaluation purposes of the content taught on the spiritual domain, we conducted a questionnaire consisting of two parts: specific outcome evaluation making use of the comparative self-assessment (CSA) gain and overall perception of the seminar using Likert scale.

RESULTS

In total, 52 students participated. Regarding specific outcome evaluation, the greatest gain was achieved in the ability to define total pain (84.8%) and in realizing its relevance in clinical settings (77.4%). The lowest, but still fairly high improvement was achieved in the ability to identify patients who might benefit from spiritual counselling (60.9%). The learning benefits were all significant as confirmed by confidence intervals. Overall, students were satisfied with the structure of the seminar. The content was delivered clearly and comprehensibly reaching a mean score of 4.3 on Likert scale (4 = agree). The content was perceived as overall relevant to the later work in medicine (mean 4.3). Most students do not opt for a seminar solely revolving around spiritual care (mean 2.6).

CONCLUSIONS

We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. Students do not wish for a seminar which solely revolves around spiritual care but prefer a close link to clinical practice and strategies.

Experiential training course on spirituality for multidisciplinary palliative care teams in a hospital setting: a feasibility study

BACKGROUND

There is widespread agreement about the importance of spiritual training programs (STPs) for healthcare professionals caring for cancer patients, and that reflecting on one's spirituality is the first step. Health professionals (HPs) working in hospitals must develop this dimension to guarantee the quality of life as well as spiritual and emotional support. In this paper, we propose a possible training format for hospital professionals and assess its implementation.

METHODS

This is a phase 0-I study that follows the Medical Research Council (MRC) framework. The program was implemented for hospital palliative care specialists. The program included one theory lesson, three spiritual interactions, four pieces of reflective writing, and two individual follow-up sessions for each participant. The evaluation was performed quantitatively according to the MRC framework and qualitatively according to Moore's framework with data triangulation from interviews, reflective writings, and indicators.

RESULTS

The program was implemented for palliative care physicians, nurses, psychologists, and bioethicists according to the plan, and the program components were highly appreciated by the participants. The results suggest the feasibility of a training course with some corrections, regarding both the components of the training and organizational issues. The qualitative analysis confirmed a shift in the meaning of the themes we identified. The trainees went from intrapersonal spirituality to interpersonal spirituality (engagement with the other person's spirituality, acknowledging their unique spiritual and cultural worldviews, beliefs, and practices), with colleagues, patients, and people close to them. The training had an impact on Moore's Level 3b.

CONCLUSIONS

Spiritual training for hospital professionals working in palliative care is feasible. Having time dedicated to spirituality and the ongoing mentorship of spiritual care professionals were suggested as key elements. The next step is increasing awareness of spirituality from our hospital reality and creating a stable competent group (with nurses, chaplains, nuns, counselors, etc.) with the support of the management.

Effect of a Spiritual Care Training Program to Build Knowledge, Competence, Confidence and Self-awareness Among Australian Health and Aged Care Staff: An Exploratory Study

The aim of this study was to evaluate a new spiritual care training program with health and aged care staff. A four-module program was delivered to 44 participants at a large Catholic health and aged care provider in Australia. Pre, post and 6 week follow-up surveys were administered and included measures of spiritual care competency, confidence, perspectives of spirituality and spiritual care, spiritual well-being, and satisfaction. Paired sample t-tests showed total scores of participants' spiritual well-being, spiritual care competency and confidence significantly improved following the training and were largely maintained at follow-up. Perspectives on spirituality and spiritual care did not significantly change over time.

Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.

[Spiritual interventions in multimodal pain management]

If we understand chronic pain not only as a disease but also as an existential crisis, it seems logical and reasonable to consider spiritual aspects in the treatment process. Spirituality is understood as an umbrella term for all activities and experiences that give meaning and significance to people's lives-irrespective of their religious affiliation. So far, spiritual aspects have been considered therapeutically mainly in the palliative context. According to current survey-based studies of pain patients, the inclusion of spiritual themes in therapy leads to an improvement in quality of life and pain tolerance and is moreover explicitly desired by those patients. A consistent expansion of multimodal treatment approaches in the sense of a biopsychosocial-spiritual concept has not yet been implemented. The following basic attitudes and behaviors are relevant for practical implementation: openness to spiritual themes and authenticity, taking a spiritual history, listening, standing firm, activation of values, use of motives from religion, mythology, and art. Professional competence generally involves all practitioners, but may also require qualified professionals for specialized assistance. The integration of authentic spiritual assistance into multimodal pain management should help to stabilize self-esteem and the experience of identity of the patients through resource activation and identification of burdensome spiritual beliefs. The detailed integration and investigation of the efficiency of spiritual interventions in multimodal pain therapy require further research.

Deconstructing spiritual care: Discursive underpinnings within palliative care research

Religion and spirituality are integral to the philosophy of palliative care, shaping its approach to spiritual care. This article aims to examine the discourses within palliative care research to illuminate prevailing assumptions regarding spiritual care. Eighteen original articles were analyzed to examine how spiritual care is understood within palliative care. The analysis, informed by Foucault, aimed to identify recurring discourses. The finding reveals that, in palliative care research, spirituality is viewed as enigmatic yet inherently human and natural, assuming that every individual has a spiritual dimension. The analysis points to healthcare professionals being expected to hold certain qualities to put spiritual care into practice. The analysis also reveals that in the analyzed articles, the concept of spiritual care is rooted in a Christian context, with the belief that all individuals possess inherent spirituality or religiosity, a concept often associated with Christian theology. The included articles often utilize theological terms and emphasize a monotheistic viewpoint. Spirituality is articulated as a complex, distinct concept, challenging clear definitions and professional responsibilities. Further, a moral formation of healthcare professionals is described, interpelling and ascribing qualities that healthcare professionals need to provide spiritual care.

A structural equation modeling analysis of the effects of nurses' spirituality and spiritual care on professional quality of life

Spiritual care helps nurses establish a deeper connection with patients and meet their spiritual needs. Spiritual belief is thought to enable nurses to be more effective in their profession and positively affect their quality of life. This study aimed to investigate the effects of nurses' spirituality and spiritual care on quality of life. This study was designed as a descriptive cross-sectional study using structural equation modeling. A total of 221 nurses were included. Data were collected using the Professional Quality of Life Scale, and Spirituality and Spiritual Care Scale. The data were analyzed using descriptive statistics, correlational statistics, and structural equation modeling. Spirituality and spiritual care were negative predictors of burnout and positive predictors of compassion satisfaction. Spirituality and spiritual care decreased the level of burnout in nurses and significantly increased the level of compassion satisfaction. This study suggests raising nurse awareness of spirituality and spiritual care. Supporting nurses with professional training programs, including spiritual care, may benefit their quality of life.

Nursing and Medical Students' Responses About End-of-Life Communication Reveal Educational Opportunities for Spiritual Care

BACKGROUND

The need for improved spiritual care education is a national directive, prompting many nursing and medical education programs to respond with spiritual curriculum. This article reports on research that tested an educational intervention to enhance nursing and medical students' understanding of end-of-life communication with families.

METHOD

This mixed-methods study included three reflection questions to ascertain students' attitudes about their own death and dying.

RESULTS

Many of the students' responses were spiritual in nature. Findings revealed two important misconceptions about death and one educational strategy that can be used to help students identify potential sources of spiritual discomfort in clinical situations.

CONCLUSION

The findings offer a glimpse into the attitudes and beliefs of nursing and medical students that could influence how they view and deliver spiritual care, contributing to the evidence base for spiritual care education and curriculum. [J Nurs Educ. 2023;62(11):601-605.].

What is the role of spiritual care specialists in teaching generalist spiritual care? The perspectives of pastoral care staff in a large Catholic health and aged care organisation

The value of spiritual care training for all staff working in health and aged care has been demonstrated. This study investigated how spiritual care specialists (SCSs) perceive their role in delivering spiritual care education to other staff. Fourteen SCSs participated in three online focus groups. Two key themes were identified: First, SCSs build upon existing capacity of staff by: (i) recognising existing strengths and capabilities; (ii) using relevant stories; (iii) using language which makes spiritual care accessible; (iv) making training relevant and practical; (v) tapping into staff vocation or calling; and (vi) building awareness of one's own spirituality. Second, SCSs assist staff to draw upon SCS expertise by establishing a trusting relationship and developing staff awareness of the SCS role. The SCS's role in delivering spiritual care education is an important one, and further consideration regarding how to support them in this role is warranted.

"Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults

In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.

Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study

Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.

Perceived Barriers to Providing Spiritual Care in Palliative Care among Professionals: A Portuguese Cross-Sectional Study

Spiritual care is an important dimension of palliative care (PC) and a facet of holistic care that helps ill people find meaning in their suffering and lives. This study aims to: (a) develop and test the psychometric properties of a new instrument, Perceived Barriers to Spiritual Care (PBSC); (b) explore participants' perceptions of how prevalent those (pre-identified) barriers are; and (c) examine the association of their personal and professional characteristics with those perceptions. A descriptive cross-sectional study was carried out using a self-reporting online survey. In total, 251 professionals registered with the Portuguese Association of Palliative Care (APCP) completed the study. The majority of respondents were female (83.3%), nurses (45.4%), had more than 11 years of professional experience (66.1%), did not work in PC (61.8%), and had a religious affiliation (81.7%). The psychometric assessment using PBSC provided sound evidence for its validity and reliability. The three most common perceived barriers were late referral for palliative care (78.1%), work overload (75.3%), and uncontrolled physical symptoms (72.5%). The least commonly perceived barriers were different spiritual beliefs among professionals (10.8%), differences between the beliefs of professionals and patients (14.4%), and the shame of approaching spirituality in a professional context (26.7%). The findings show there is some relationship between sex, age, years of professional experience, working in PC, having a religious affiliation, the importance of spiritual/religious beliefs, and responses to the PBSC tool. The results highlight the importance of advanced training in spirituality and intervention strategies. Further research is needed to properly study the impacts of spiritual care and establish outcome assessments that accurately reflect the effects of the various spiritual care activities.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

Evaluation of the Interprofessional Spiritual Care Education Curriculum in Australia: Online

OBJECTIVE

Spiritual care is a component of quality palliative care, but healthcare providers have reported lack of training as a barrier to its provision. This paper describes the evaluation of the Interprofessional Spiritual Care Educational Curriculum (ISPEC)© which is a six-module evidence-based curriculum developed for teaching interprofessional spiritual care based on a generalist-specialist model of spiritual care.

METHOD

The course was run online in 2020 and attended by 20 healthcare workers who were invited to join the evaluation. Questionnaires were completed by participants before the training program (baseline), immediately after the training (post), and 3 months following the end of the program (follow-up). After the follow-up questionnaires, participants were invited to join a Focus Group to expand on their responses. Descriptive and exploratory statistical analysis was performed on quantitative data, and qualitative data was subjected to Thematic Analysis.

RESULTS

Exploratory data analysis showed that self-reported competence, confidence, and comfort in providing spiritual care significantly improved following training (p = 0.002) and were maintained over time (p = 0.034). In qualitative analysis, the main themes were: (1) overwhelmed by content; (2) the importance of practical training; (3) spiritual care is for everyone; (4) spiritual care should come from the heart; (5) training needs to be inclusive; and (6) spirituality is culturally specific.

SIGNIFICANCE OF RESULTS

This article describes an evaluation of the ISPEC© spiritual care training course administered to an Australian healthcare cohort using an online format. These preliminary findings suggest that the ISPEC© program is effective in improving the ability of healthcare professionals to provide spiritual care. More work is needed to improve the cultural relevance of the program in Australia.

The Effects of a Scenario-Based Spiritual Care Course on Spiritual Care Competence among Clinical Nurses: A Quasi-Experimental Study

Across their lifespans, and in many clinical settings, patients have spiritual care needs. Many nurses lack competence related to providing spiritual care. Popular educational strategies, such as simulated educational programs and objective structured clinical examinations (OSCE), have not been widely adopted in nursing spiritual care education. The purpose of this study was to explore the effects of a scenario-based spiritual care course on spiritual care competence in nurses. This quasi-experimental study employed a repeated-measures pre-test/post-test design with assessments immediately before, immediately after, and 3 months post-intervention. Nurses providing direct patient care in diverse clinical settings were recruited from a large medical foundation in northern Taiwan. The intervention was a one day scenario-based spiritual care course and OSCE. The experimental group (n = 53) and controls (n = 85) were matched for their similar units, ages, working experience, and clinical ladder status. The Spiritual Care Competence Scale (SCCS), Spiritual Perspective Scale (SPS), Spiritual Care Perspective Scale-Revised (SCPS-R), and reflection logs were completed by both experimental and control groups. The Course Satisfaction Scale, OSCE Checklist, and Standardized Patient Feedback Scale (SPFS) were completed by the experimental group only. The experimental group had significantly higher SPS scores and self-evaluated SCCS scores, and lower SCPS-R scores (more positive spiritual perspectives), than controls at 3 months post-intervention. The experimental group showed significant within-subject effects at three time points on SPS scores, SCPS-R scores, and self-evaluated SCCS scores. Mean global performance of OSCE was 3.40 ± 0.91, and SP feedback indicated strengths and areas for improvement. In conclusion, the scenario-based spiritual care course effectively enhanced nurses' spiritual care competence, competence, and skills. Blended education techniques can therefore enhance nurses' ability to support patients with spiritual care needs.

Identifying, exploring and integrating the spiritual dimension in proactive care planning: A mixed methods evaluation of a communication training intervention for multidisciplinary palliative care teams

BACKGROUND

Patients receiving palliative care value attention given to their spiritual needs. However, these needs often remain unexplored as healthcare professionals lack the skills to identify and explore them and to integrate this information into care plans.

AIM

To evaluate the effects of an interactive communication training intervention for palliative care teams in order to identify and explore the spiritual dimension and integrate it in patients' care plans.

DESIGN

A mixed methods pre-post study, including self-assessment questionnaires, evaluation of videos with simulated consultations (applied competence) and medical record review (implementation).

SETTING/PARTICIPANTS

Three palliative care teams including nurses (N = 21), physicians (N = 14) and spiritual caregivers (N = 3).

RESULTS

The questionnaires showed an improvement on 'Patient and family-centred communication' of the End-of-life professional caregiver survey (+0.37, p < 0.01; the 8-item S-EOLC (+0.54, p < 0.01) and regarding the Spiritual Care Competence Scale, on the three subscales used (+0.27, p < 0.01, +0.29, p < 0.01 and +0.32, p < 0.01). Video evaluations showed increased attention being paid to patient's aims and needs. The medical record review showed an increase in anticipation on the non-somatic dimension (OR: 2.2, 95% CI: 1.2-4.3, p < 0.05) and, using the Mount Vernon Cancer Network assessment tool, addressing spiritual issues (OR: 10.9, 95% CI: 3.7-39.5, p < 0.001).

CONCLUSIONS

Our training intervention resulted in increased palliative care professionals' competence in identifying and exploring patients' spiritual issues, and their integration in multidimensional proactive palliative care plans. The intervention directly addresses patients' spiritual concerns and adds value to their palliative care plans.

The correlation between spiritual care competence and spiritual health among Iranian nurses

Background

Considering the importance of spiritual aspects of human beings, spiritual care provision is increasingly recognized as a major duty of healthcare providers, particularly nursing staff. Spiritual care competence is necessary for the nurses to be able to provide spiritual care, but the competence itself is associated with other variables. This study aimed to investigate if the spiritual care competence of nurses is related to their spiritual health.

Methods

A cross-sectional study was conducted with the participation of 172 practicing nurses in hospitals affiliated with Qom University of Medical Sciences, selected through stratified random sampling. Participants completed the Persian versions of the Spiritual Health Questionnaire (Amiri) and the Spiritual Care Competence Scale (Van Leeuwen). To examine the correlation between nurses’ spiritual health and spiritual care competence, a Spearman coefficient was used and a linear regression analysis was done to determine the predictability of the spiritual care competence of the nurses. The data were analyzed using SPSS v.23 and the significance level was set at 0.05.

Results

The participants showed a mean (SD) score of 108.93 (19.04) on spiritual care competence and 213.38 (16.49) on spiritual health. Spiritual care competence of nurses showed no significant relationship with demographic characteristics and their spiritual health had a significant relationship with gender only. Correlation analysis revealed a significant relationship between spiritual health and spiritual care competence and their subscales. Moreover, the linear regression analysis indicated that the nurses’ performance regarding spiritual health can predict their spiritual care competence.

Conclusion

The study revealed that the spiritual care competence of nurses is correlated with their spiritual health and performance as a subscale of spiritual health can predict their spiritual care competence. Thus, it can be concluded that the spiritual health of nurses is an important factor in providing spiritual care for patients and meeting their spiritual needs.

Effectiveness of International Hospice and Palliative Care Training for Health Care Professionals in Countries of the Western Pacific Region

As hospice and palliative care is a holistic service grounded in spirituality, training in spiritual care is essential. This study aimed to describe an international workforce training program for hospice and palliative care that emphasized spiritual care and evaluate the effectiveness of the training implementation. A quasi-experimental study was conducted with 28 health care professionals from 4 countries in the Western Pacific Region, who attended the international workforce trainings on hospice and palliative care. Data were collected before and after the trainings using a self-reported survey questionnaire. The participants' palliative care knowledge, spiritual well-being, perceived stress, and compassion competency were analyzed to evaluate the training program. Whereas the participants' knowledge of hospice and palliative care ( P < .001) and compassion competency increased ( P = .004), their perceived stress decreased post training ( P = .002). This study provided an extensive description of an international workforce training program of hospice and palliative care for potential replication of the training in other regions of the world. Because training in hospice and palliative care positively influenced health care professionals' spiritual care competency, future training and studies should consider spiritual care factors, along with intellectual aspects.

Association between spiritual care competency and perceived professional benefit among nurses: A cross-sectional study

AIMS

This study aimed to investigate the status quo of nurses' spiritual care competency and their relationship with perceived professional benefit.

BACKGROUND

Spiritual care has always been considered a vitally important part of holistic nursing. Understanding the spiritual care competency of nurses during the COVID-19 pandemic can help nursing managers understand the weak links in spiritual care practice and improve the quality of nursing service. As a positive emotional experience and cognitive evaluation of the profession, perceived professional benefit can serve to adjust work pressure, relieve job burnout, and promote an individual's overall growth. However, the relationship between perceived professional benefit among nurses and spiritual care competency remains unclear.

METHODS

A total of 372 nurses were recruited from 15 separate Chinese hospitals. An online questionnaire was used to assess nurses' sociodemographic, spiritual care competency, and perceived professional benefit. Statistical analyses were performed using Pearson's correlation analysis, t-test, analysis of variance (ANOVA), and multiple stepwise linear regression analysis.

RESULTS

The total mean score of spiritual care competency (99.43 ± 21.10) among nurses was found to be moderate. Nurses' spiritual care competency was positively correlated with perceived professional benefit (P < .01). The multiple stepwise linear regression model (n = 372) had an explained variance (R² = 0.218) and showed that perceived professional benefit and the manner of receiving spiritual training were the main influencing factors of nurses' spiritual care competency (P < .001).

CONCLUSION

The study findings indicated that nurses need to improve their spiritual care competency by improving their perceived professional benefit.

IMPLICATION FOR NURSING MANAGERS

Our study evaluated the spiritual care competency of nurses and explored the correlation between perceived professional benefit and spiritual care competency among nurses. The results of this study can help nursing managers to carry out relevant interventions, thus improving nurses' spiritual care competency and optimizing the quality of nursing.

Development of a spiritual care education matrix: Factors facilitating/hindering improvement of spiritual care competency in student nurses and midwives

Spiritual care is a fundamental aspect of caring and compassionate nursing/midwifery practice. However, nurses/midwives consistently report feeling unprepared to provide spiritual care for various reasons. A key reason appears to be the lack of structured spiritual care education in undergraduate nursing/midwifery curricula. Between 2016 and 2019, the three-year, European EPICC project ('Enhancing nurses' and midwives' competence in Providing spiritual care through Innovative education and 'Compassionate Care') sought to address gaps in nursing/midwifery competence in spiritual care. A key project output, and the focus of this paper, is the EPICC Gold Standard Matrix for Spiritual Care Education ('EPICC Matrix'), which depicts the complex array of factors hindering/facilitating the development of nursing/midwifery spiritual care competency. The EPICC project followed two major studies that identified factors contributing to nursing/midwifery spiritual care competency development. This evidence, along with the mixed methods focus of the EPICC project to enable co-projection of its outputs informed the development of the EPICC Matrix. The EPICC Matrix was considered to represent 'the cultural, social and political environment in which spiritual care competency develops' in student nurses/midwives. The EPICC Matrix illustrates spiritual care educational considerations during the process of selecting suitable nursing/midwifery students; through the specific aspects of the teaching and learning environment, the student as a person, and the clinical environment in which spiritual care competency develops; and finally, how the student is assessed as competent in providing spiritual care. Recent research supports the use of the EPICC Matrix in undergraduate nursing/midwifery curricula and strengthens the case for support of the other EPICC project outputs, including: the EPICC Spiritual Care Education Standard, EPICC Adoption Toolkit, and the continuation of the EPICC Network. Further testing of the EPICC Matrix to determine its relevance in different cultural/professional contexts within and outside of Europe would be welcomed.

The Application of Rehabilitation Therapy Occupational Competency Evaluation Model in the Improvement of College Students’ Innovation and Entrepreneurship

This paper constructs an evaluation model of occupational competency in rehabilitation therapy and applies it to the improvement of college students’ innovative and entrepreneurial competencies. Based on clarifying the connotation of college students’ entrepreneurial competency, this study carries out research on the evaluation system of college students’ entrepreneurial competency. First, the method of qualitative research is used to conduct in-depth interviews with college students and entrepreneurial mentors to understand the views of these groups on college students’ entrepreneurial competency, and the coding of the interview contents is carried out by applying the rooting theory, and finally, a theoretical model of the composition of college students’ entrepreneurial competency is derived. The front-line position of talent cultivation is the construction of faculty, because the faculty with high-quality vocational ability is an indispensable prerequisite for the development of universities, and the teaching level of the faculty is the key factor for the effectiveness of teaching to appear. Based on the perspective of role theory, we analyze the problems and reasons for the lack of competency in the role-playing process; integrate the three stages of understanding the role, playing the role, and adjusting the role with the competency model; and propose strategies to improve the competency of youth social workers in the process of playing the role, to help workers accurately understand the role, correctly play the role, and reasonably adjust the role. The curriculum is designed to cultivate the competency of college student nursing positions, which is conducive to improving the professional quality of college student nursing service providers and regulating college student nursing practice so that they can actively respond to problems. This will strengthen the entire teaching faculty and enhance the professional competence of full-time teachers.

Educational interventions and strategies for spiritual care in nursing and healthcare students and staff: A scoping review

AIMS AND OBJECTIVES

To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students' and staffs' spiritual care provision.

BACKGROUND

Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care.

DESIGN

A scoping review using the PRISMA-ScR checklist.

METHOD

Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009-May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used.

RESULTS

From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health-related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies.

CONCLUSIONS

Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings.

RELEVANCE TO CLINICAL PRACTICE

Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended.

Interprofessional spiritual care education in pediatric hematology-oncology: A pilot study

BACKGROUND

Evidence and clinical guidelines call care team members to address the spiritual well-being of pediatric patients, especially adolescents and young adults (AYA), with cancer and blood disorders. However, the lack of relevant training in generalist spiritual care has been a key barrier. Therefore, we aimed to improve clinicians' capabilities by utilizing the Interprofessional Spiritual Care Education Curriculum (ISPEC) to close this gap in pediatric hematology-oncology. A model of interprofessional spiritual care entails that all team members attend to patients' spirituality by employing generalist spiritual care skills and collaborating with spiritual care specialists such as chaplains.

METHODS

Interdisciplinary team members providing care for AYA with cancer and blood disorders were recruited to participate in interprofessional spiritual care education. Our intervention combined an evidence-based online curriculum and in-person discussion groups. Pretest-posttest study examined changes in participants' skills and practices to identify, address, and discuss spiritual concerns. Surveys were conducted at baseline and at 1, 3, and 6 months after the intervention.

RESULTS

Participants (n = 21) included physicians, advanced practice providers, nurse coordinators, and psychosocial team members. We observed positive changes in participants' ability (36%, P < 0.01), frequency (56%, P = 0.01), confidence (32%, P < 0.01), and comfort (31%, P = 0.02) providing generalist spiritual care baseline versus one month, with significant gains maintained through six months (Omnibus P < 0.05).

CONCLUSIONS

Utilizing ISPEC, interprofessional spiritual care education has a strong potential to develop pediatric hematology-oncology team members' capabilities to attend to the spiritual aspect of whole-person care and thus contribute to the well-being of AYA with cancer and blood disorders.

Impact of an online spiritual care course on perceived competency in spiritual care of students in social and health care professions / Wirksamkeit eines Online-Spiritual Care-Seminars auf die wahrgenommene Spiritual Care-Kompetenz bei Studierenden in Sozial- und Gesundheitsberufen

This study examines the impact of an online spiritual care course on perceived spiritual care competency of students in social and health care professions. A quasi-experimental, pre-post-test study using questionnaires was conducted in Bavaria, Southern Germany, with a sample of 78 participants and 67 respondents in a comparison group. A repeated measures ANOVA was performed, with time and group as factors. Statistically significant increases were found in participants' perceived knowledge, skills, and attitudes concerning spiritual care, in different facets of spiritual care competency, in spiritual awareness, and in general self-efficacy (p < .05). Results suggest the effectiveness of online spiritual care training, which can help prepare future caregivers in providing holistic care.

Spiritual Needs Assessment in Post-Secular Contexts: An Integrative Review of Questionnaires

Research across healthcare contexts has shown that, if provided appropriately, spiritual care can be of significant benefit to patients. It can be challenging, however, to incorporate spiritual care in daily practice, not least in post-secular, culturally entwined, and pluralist contexts. The aim of this integrative review was to locate, evaluate and discuss spiritual-needs questionnaires from the post-secular perspective in relation to their applicability in secular healthcare. Eleven questionnaires were evaluated and discussed with a focus on religious/spiritual (RS) wording, local culturally entwined and pluralist contexts, and on whether a consensual understanding between patient and healthcare professional could be expected through RS wording. By highlighting some factors involved in implementing a spiritual-needs questionnaire in diverse cultural and vernacular contexts, this article can assist by providing a general guideline. This article offers an approach to the international exchange and implementation of knowledge, experiences, and best practice in relation to the use of spiritual needs-assessment questionnaires in post-secular contexts.

Developing an Educational Course in Spiritual Care: An Action Research Study at Two Danish Hospices

Further improvement of spiritual care in palliative care is warranted. Particularly reducing barriers and enhancing spiritual care competencies among the healthcare professionals is needed. The aim was to develop a training course in spiritual care in close collaboration with patients and staff from two Danish hospices. We applied an action research design to ensure that the training course was rooted in everyday practice of patients and staff. The methodology applied was based on philosophical hermeneutics and existential phenomenology. The action research process enabled the division into three topics on how a training course can reduce barriers towards spiritual care among the healthcare professionals. These three topics functioned as a theoretical framework for educating staff at a hospice in spiritual care. The three topics were: (1) the vulnerable encounter; (2) self-reflection concerning spiritual needs, thoughts, beliefs, and values; and (3) shared professional language for spiritual care. We operationalized the three topics into a flexible course design that could be adaptable to the practical possibilities and limitations of the individual hospice. The curriculum includes theoretical teaching, reflection exercises, and an improvisation theater workshop with professional actors. Educating staff led to the improvement of spiritual care at the hospices involved in the study.

Translation and Validation of the Spanish Version of the Spiritual Care Competence Questionnaire (SCCQ)

We aimed to validate the Spanish version of the Spiritual Care Competence Questionnaire (SCCQ) in a sample of 791 health care professionals from Spanish speaking countries coming principally from Argentina, Colombia, Mexico and Spain. Exploratory factor analysis pointed to six factors with good internal consistency (Cronbach's alpha ranging from 0.71 to 0.90), which are in line with the factors of the primary version of the SCCQ. Conversation competences and Perception of spiritual needs competences scored highest, and Documentation competences and Team spirit the lowest, Empowerment competences and Spiritual self-awareness competences in-between. The Spanish Version of the SCCQ can be used for assessment of spiritual care competencies, planning of educational activities and for comparisons as well as monitoring/follow-up after implementation of improvement strategies.

"The education is a mirror of where palliative care stands in Israel today": An exploration of palliative care undergraduate education at medical schools in Israel

OBJECTIVE

Israel serves as a case study for understanding the importance of undergraduate palliative care (PC) education in implementing, developing, and enabling access to palliative care services. This article presents the findings collected from the five medical schools.

METHOD

This qualitative study supported by a survey explores and describes the state of undergraduate PC education at medical schools in Israel. The survey included questions on voluntary and mandatory courses, allocation of different course models, teaching methods, time frame, content, institutions involved, and examinations. Semi-structured interviews with teaching faculty were conducted at the same locations.

RESULTS

Eleven expert interviews and five surveys demonstrate that PC is taught as a mandatory subject at only two out of the five Israeli universities. To enhance PC in Israel, it needs to become a mandatory subject for all undergraduate medical students. To teach communication, cultural safety, and other basic competencies, new interactive teaching forms need to be developed and adapted. In this regard, nationwide cooperation is proposed. An exchange between medical schools and university clinics is seen as beneficial. The new generation of students is open to PC philosophy and multidimensional care provision but resources to support their growth as professionals and people remain limited.

SIGNIFICANCE OF RESULTS

This study underlines the importance of teaching in PC at medical schools. Undergraduate education is a central measure of PC status and should be used as such worldwide. The improvement of the teaching situation would automatically lead to a better practical implementation for the benefit of people. Medical schools should cooperate, as the formation of expertise exchange across medical schools would automatically lead to better PC education.

Training General Practitioners and Medical Assistants Within the Framework of HoPES3, a Holistic Care Program for Elderly Patients to Integrate Spiritual Needs, Social Activity, and Self-Care into Disease Management in Primary Care

Background

This study presents a concept for training general practitioners (GPs) in taking a spiritual history. In the same workshop, medical assistants (MAs) were trained in counselling elderly, chronically ill patients on social activities and home remedies. After the training, GPs and MAs will apply the acquired skills in their practices within the scope of the HoPES3 intervention study, which aims at raising patients’ self-efficacy.

Methods

Sixteen GPs and 18 MAs were trained in a 5-hour workshop and completed an evaluation questionnaire.

Results

All participants reported great satisfaction. In particular, 85% of GPs (n=11) affirmed increased capacity to address patients’ spiritual needs. About 88% (n=15) of MAs were satisfied with the training, yet expressed difficulties in integrating theoretical knowledge into daily professional routine.

Discussion

While the evaluation of the workshop is promising, the results of the randomized-controlled trial evaluating the effectiveness of the complete HoPES3 intervention have to be awaited.

Conclusion

To our knowledge, this is the first interdisciplinary, holistic care training in primary care in Germany. It fosters GPs’ and MAs’ competency in providing a proactive support in spirituality, social activities, and home remedies to their patients. If the concept proves to be effective, it could be integrated into existing care models and curriculums and provide clear guidance on how to consider elderly patients’ spiritual needs and strengthen their self-efficacy in primary care settings.

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/hcz-CKYOk8s

Comparing perspectives: patients' and health care professionals' views on spiritual concerns and needs in chronic pain care - a qualitative study

BACKGROUND

The spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients' (CPP) and health care professionals' (HCP) perceptions on the integration of spiritual care into multimodal pain therapy.

METHODS

We conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP.

RESULTS

Views on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed.

CONCLUSIONS

Although there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain.

TRIAL REGISTRATION

This study was part of a larger research project, registered in a primary (clinicaltrial.gov: NCT03679871 ) and local (kofam.ch: SNCTP000003086 ) clinical trial registry.

Do Chronic Pain Patients Wish Spiritual Aspects to Be Integrated in Their Medical Treatment? A Cross-Sectional Study of Multiple Facilities

Background: Chronic pain is a complex, multidimensional experience. Spirituality is hypothesized to impact pain experience in various ways. Nevertheless, the role that spirituality plays in multimodal pain therapy remains controversial and, to date, quantitative data on whether and for which patients spiritual aspects should be considered in the treatment of chronic pain is lacking. The aim of this study was thus to investigate the proportion and characteristics of patients with chronic pain who wish spiritual aspects to be integrated in their treatment. Methods: Two hundred nine patients with chronic pain were recruited from five inpatient departments and outpatient clinics in the German-speaking part of Switzerland. Patients filled out validated questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Resilience Scale (RS-11), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), and the 12-item Spiritual Well-Being Scale (FACIT-Sp-12). Results: More than 60% (CI_95%: 55.5-67.9%) of the patients wanted to address spiritual aspects in their treatment. These patients were significantly younger, had higher levels of education, and suffered from more frequent and more severe pain than patients who did not wish to address spiritual aspects. Furthermore, there were high correlations with existing spiritual resources and higher scores of spirituality. Conclusions: These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.