Empirical validation of a teaching course on spiritual care in Taiwan

Spirituality and Spiritual Care in Nursing: Validity of the Spirituality and Spiritual Care Rating Scale in an Indian Context

This study was undertaken to test the validity of the Spirituality and Spiritual Care Rating Scale (SSCRS) by McSherry et al. (IJNS 39:723-734, 2002) in an Indian context. The study was conducted in a tertiary care teaching hospital with a convenience sample of 200 nurses. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were completed to assess the reliability and validity of the tool. The results of the present study were similar to but differed from the McSherry et al's (IJNS 39:723-734, 2002) study which identified 17 items on the scale. Only 15 items loaded on three factors.

Perceptions and practices of spiritual care among hospice physicians and nurses in a Taiwanese tertiary hospital: a qualitative study

Background

Spiritual care is frequently cited as a key component of hospice care in Taiwanese healthcare and beyond. The aim of this research is to gauge physicians and nurses’ self-reported perspectives and clinical practices on the roles of their professions in addressing spiritual care in an inpatient palliative care unit in a tertiary hospital with Buddhist origins.

Methods

We performed semi-structured interviews with physicians and nurses working in hospice care over a year on their self-reported experiences in inpatient spiritual care. We utilized a directed approach to qualitative content analysis to identify themes emerging from interviews.

Results

Most participants identified as neither spiritual nor religious. Themes in defining spiritual care, spiritual distress, and spiritual care challenges included understanding patient values and beliefs, fear of the afterlife and repercussions of poor family relationships, difficulties in communication, the patient’s medical state, and a perceived lack of preparedness and time to deliver spiritual care.

Conclusions

Our study suggests that Taiwanese physicians and nurses overall find spiritual care difficult to define in practice and base perceptions and practices of spiritual care largely on patient’s emotional and physical needs. Spiritual care is also burdened logistically by difficulties in navigating family and cultural dynamics, such as speaking openly about death. More research on spiritual care in Taiwan is needed to define the appropriate training, practice, and associated challenges in provision of spiritual care.

Effect of an Educational Intervention Delivered to Senior Nursing Students to Strengthen Spiritual Care for People with Chronic Illness

This is an experimental, quantitative, parallel design study (control and experimental groups) with pre- and post-intervention assessment without blinding, which aimed to determine the effect of an educational intervention delivered to ninety Colombian senior nursing students to strengthen perceptions of spirituality and spiritual care for people with chronic illness. The Spirituality and Spiritual Care Rating Scale (SSCRS) was used as the instrument of measurement. The Wilcoxon test was used for comparisons between two groups, and the Kruskal-Wallis test for the comparison of global scale scores between the intervention group and the control group. To determine the effect of the intervention, Cohen's d statistic was used. The intervention modified the perceptions of spirituality and spiritual care in the experimental group (median = 80.2, SD = 10.2) compared with their initial perceptions (median = 70, SD = 11.2), p ≤ 0.001. The effect size (ES) of the intervention was 0.63, with a power of 0.80, indicating a moderate and acceptable effect size.

Intervención educativa para enfermería: cuidado espiritual durante la enfermedad crónica

Objetivos: evaluar la efectividad de la intervención educativa Cuidado espiritual de enfermería: integralidad del ser humano en el cuidado en personal de enfermería que trabaja con personas con enfermedad crónica. Materiales y método: se diseñó una intervención educativa para fortalecer la percepción de la espiritualidad y el cuidado espiritual del personal de enfermería. Se planteó un diseño cuasi experimental, con grupo control y experimental y evaluación pre y posprueba. Participaron enfermeras y auxiliares de enfermería de tres instituciones clínicas, seleccionadas en un muestreo no probabilístico, por conveniencia y asignación 1:1 para el grupo experimental (n = 112) y el control (n = 110). Resultados: la intervención modificó significativamente la percepción final total de la espiritualidad y el cuidado espiritual (p ≤ 0,016), con un tamaño del efecto d = 0,4 y una p = 0,84. Fue efectiva en modificar significativamente la percepción de la espiritualidad y el cuidado espiritual total (p ≤ 0,001), así como las subescalas de percepción de la espiritualidad, cuidado espiritual y cuidado personalizado (p ≤ 0,001); sin embargo, la subescala percepción del cuidado espiritual final no presentó diferencias significativas al comparar los grupos (p ≤ 0,024). grupos (p ≤ 0,024). Conclusiones: la intervención fue efectiva en modificar la percepción de la espiritualidad y el cuidado espiritual. Debe comprobarse su efectividad en entornos diferentes al de este estudio y se evidencia la necesidad de capacitar al personal de enfermería en esta temática a fin de que este cuidado se implemente en la práctica en el cuidado de personas en situaciones de enfermedad crónica.

Death and Help Expected from Nurses when Dying

This project was undertaken to ascertain the perceptions of a group of Taiwan’s fourth-year bachelor of science in nursing (BSN) students regarding death and help expected from nurses during the dying process. Within the Chinese culture, death is one of the most important life issues. However, in many Chinese societies it is difficult for people to reveal their deepest feelings to their significant others or loved ones. It was in this context that this project was developed because little is known about how Taiwan’s nursing students perceive death and the dying process. Using an open-ended, self-report questionnaire, 110 senior BSN students recorded their thoughts on: (1) their fears before physical death; (2) afterlife destinations; and (3) the help they would expect from nurses when dying. The data were analyzed using a three-layer qualitative thematic analysis. The students’ reported needs during the dying process were directed towards three main goals: (1) help in reaching the ‘triple targets of individual life’; (2) help in facilitating in-depth support so that both the dying person and significant others can experience a blessed farewell; and (3) help in reaching a destination in the afterlife. The results support the belief of dying as a transition occurring when life weans itself from the mortal world and prepares for an afterlife.

Taiwanese Undergraduate Nursing Students' Personal Priorities before Death

Death is a taboo subject to the Chinese. People rarely discuss this subject in public. However, it is inevitable that a nursing student will encounter a patient with a fatal disease or an end-of-life situation. Though death is a personal issue for each nurse, their unique perspective can affect the patient under their care. This article explores nursing students' personal priorities if told they had six months to live. The 167 participants were asked one question, “List five things you plan to do six months before your death.” The results yielded 815 responses categorized into five dimensions as follows: connecting or reconnecting with family and close friends, specific goals, spiritual awareness, self-determination, and altruism. The results of this study can facilitate the teaching of death education and spiritual nursing courses.

The relationship between spiritual well-being and quality of life among elderly people

This study aims to identify the relationship between spiritual well-being and quality of life among elderly people residing in Kahrizak Senior House, Tehran, Iran. It was an analytical study. After obtaining approval from the ethics committee of the Iran University of Medical Sciences Research Deputy; the 141 elderly people residing in Kahrizak Senior House who signed the inform consent were recruited by census. Data were collected by Ellison & Palutzian Spiritual Well-Being Index and Short Form Quality of Life (SF-36). The mean score of quality of life was (50.36 ± 11.3). The mean score of spiritual well-being was (96.26 ± 17.93). There was a positive correlation between spiritual well-being and quality of life (P = .008). According to positive correlation between spiritual well-being and quality-of-life scores, awareness of the importance of spiritual well-being in caring of these people is recommended.

Spiritual Care Training Provided to Healthcare Professionals: A Systematic Review

This systematic review was conducted to assess the outcomes of spiritual care training. It outlines the training outcomes based on participants' oral/written feedback, course evaluation and performance assessment. Intervention was defined as any form of spiritual care training provided to healthcare professionals studying/working in an academic and/or clinical setting. An online search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, ERIC, PsycINFO, ASSIA, CSA, ATLA and CENTRAL up to Week 27 of 2013 by two independent investigators to reduce errors in inclusion. Only peer-reviewed journal articles reporting on training outcomes were included. A primary keyword-driven search found 4912 articles; 46 articles were identified as relevant for final analysis. The narrative synthesis of findings outlines the following outcomes: (1) acknowledging spirituality on an individual level, (2) success in integrating spirituality in clinical practice, (3) positive changes in communication with patients. This study examines primarily pre/post-effects within a single cohort. Due to an average study quality, the reported findings in this review are to be seen as indicators at most. Nevertheless, this review makes evident that without attending to one'the repeliefs and needs, addressing spirituality in patients will not be forthcoming. It also demonstrates that spiritual care training may help to challenge the spiritual vacuum in healthcare institutions.

Factors contributing to poor sleep quality as perceived by heart transplant recipients in Taiwan

BACKGROUND

The aims of this project were to explore the factors contributing to poor sleep quality at 1 to 3 years after heart transplantation (post-HT), and to explore economic problems and social support for HT recipients (HTRs).

METHODS

This study used a cross-sectional retrospective triangulation approach combining qualitative and quantitative research method designs. Quantitative data included data from the visual analog scale and the Taiwanese version of the World Health Organization Quality of Life questionnaire. Qualitative data were derived from questions that explored physiological, psychological, and economic factors contributing to poor sleep quality postprocedure for HTRs.

RESULTS

Sixty-four subjects (81% male, 19% female) participated in this research. Their ages ranged from 20 to 70 (M = 46.88 ± 12.12) years old. Their post-HT timeframe ranged from 1 to 4.10 years; 33% received preoperative extracorporeal membrane oxygenation support. Sleeping disturbances were reported by 72.7% of subjects after HT. Poor sleeping quality at 2 to 3 years post-HT (P = .028) was a complaint, and was worse than at 1 to 2 years post-HT (P = .008). Six physiological (62.5%) and 3 psychological (37.5%) contributing factors were further identified in qualitative interviews. Physiological factors were the major causes affecting their sleep quality 2 to 3 years after HT, whereas psychological factors arose from various family roles, responsibilities, and economic-related pressures.

CONCLUSIONS

Medical teams should find the causes that lead to sleep disturbances and use the findings to improve HTR sleep quality. When the family financial status is affected, these teams should offer assistance and suggestions for patients who are unable to work due to post-HT physical decline. Establishing and providing good family support systems or patient support groups may allow patients to obtain physical, psychological, and spiritual comfort.

The relationship of spiritual well-being and involvement with depression and perceived stress in Korean nursing students

This study was conducted to identify the relationship among spiritual well-being, depression and perceived stress. Participants were 518 nursing students located in K province, Korea.

DESIGN

Exploratory design was used for this study. Data were collected and analyzed by t-test, ANOVA, Pearson correlation coefficients. The results were as follows; 1) Participants' mean scores were Spiritual Well-Being 76.03 (15.74), Religious Well-Being 32.8 (15.74), Existential Well-Being 43.23 (8.12), depression 9.10 (7.06), and level of stress 15.47 (5.49). 2) Spiritual Well-Being, Existential Well-Being, and Religious Well-Being were significantly different with the number of attendance to religious ceremony, the degree of subjective satisfaction regard to major and idea for future employment. 3) Negative correlations existed between Spiritual Well-Being and participants' perceived stress, and depression. 4) Particularly, Existential Well-Being has more inverse correlation with depression and stress than Religious Well-Being. This investigation highlighted Existential Well-Being as an important factor with lower levels of depression and perceived stress. According to these result, Spiritual Well-Being promotion program is needed to develop as a positive concept to adjust college life and spiritual well-being is required to take care of patients as potential power for nursing students in their future.

The efficacy of integrating spirituality into undergraduate nursing curricula

Background:

Attention to patients’ spirituality, as a moral obligation of care, is now widely accepted in nursing practice. However, until recently, many nursing programs have paid little attention to spirituality.

Objective:

The objective of this study was to identify the impact of two different curricula, used to teach undergraduate nursing students, on increasing nursing student awareness of spirituality in the care of patients.

Research design:

A quasi-experimental post-intervention two-group design was conducted in 2009–2010 and 2010–2011 academic years.

Participants and research context:

The study included a total of 130 volunteer senior-year students. The students were assigned as “the intervention group/integrated system” that were informed about spirituality or as “the control group/traditional system” that received no information on spirituality. Data were collected via a personal information form and the Spirituality and Spiritual Care Rating Scale was used to assess responses. The study was conducted at the Department of Nursing of the Faculty of Health Sciences, Cumhuriyet University, in Central Anatolia/Turkey.

Ethical considerations:

Permission to conduct the study at the nursing school was obtained from the schools’ management teams. The rights of the participants were protected in this study by obtaining informed consent.

Findings:

The results revealed that the intervention group had a higher mean score on the Spirituality and Spiritual Care Rating Scale than did the control group. The students in the intervention group defined the terms of spirituality and spiritual care more accurately than did the control group students.

Discussion:

Nurses are professionally and ethically responsible for providing spiritual care. Nurses’ competence in meeting the spiritual needs of their patients should be improved by undergraduate education on spiritual care. Nursing scholars reported a significant difference in the knowledge and attitudes toward spirituality of nursing students as a result of the integration of spirituality into the undergraduate nursing curriculum.

Conclusion:

Spirituality should be more widely included in nursing education.

Spirituality and disability: an analysis of select themes

This paper is a thematic analysis of the literature regarding spirituality, which is applied to the understanding of spirituality and disability. Implications for occupational therapy practice are suggested. The themes of "connectedness" and "expressiveness" as aspects of spirituality were generated from both the occupational therapy literature and literature from other health professions. A definition of spirituality is proposed by the author for use by the profession of occupational therapy, as follows: experiencing a meaningful connection to our core selves, other humans, the world, and/or a greater power as expressed through our reflections, narratives, and actions. Persons with disabilities described a sense of disconnectedness to others, to the world, and to a greater power. They expressed their spirituality through actions to rectify that sense of disconnection. This study suggests that further research is warranted that explores the scope of spirituality in the lives of individuals with disabilities and how spirituality relates to the theoretical and philosophical realm of occupational therapy.

Student nurses' perspectives of spirituality and spiritual care

AIM

To investigate nursing students' perceptions of spirituality and spiritual care.

BACKGROUND

Spirituality is an essential part of holistic care but often neglected in practice. Barriers to spiritual care include limited educational preparation, negative attitudes towards spirituality, confusion about nurses' role, perceptions of incompetence and avoidance of spiritual matters. There is limited knowledge about students' perspectives of spirituality and spiritual care. Previous studies have predominantly focused on educational approaches to enhance spirituality. The next generation of clinicians may have different worldviews, cultural beliefs and values about spirituality and spiritual care from current nurses. There is a need to understand students' views and how their spiritual development is shaped in order to inform pre-registration education.

METHOD

A cross-sectional survey of final-year students from three educational institutions in Singapore was conducted from April to August 2010. Data included demographic details and responses on a new composite tool, the Spiritual Care Giving Scale (SCGS).

RESULTS

A response rate of 61.9% (n=745 out of 1204) was achieved. The lowest mean score was item 9, "Without spirituality, a person is not considered whole". Highest mean was item 2, "Spirituality is an important aspect of human being". Factor 5 (Spiritual Care Values) had the lowest mean with Factor 2 (Spirituality Perspectives) the highest. Participants considered spirituality as essential to being human; developmental in nature; and vital for individuals' state of well-being. Attributes important for spiritual care were identified. Multivariate analyses showed positive association between participants' scores and institution but not with other variables.

CONCLUSION

Participating student nurses reported a high level of spiritual awareness that was not constrained by age. Students affirmed the importance of spiritual awareness in order to address the spiritual needs of patients. There was some congruence between the perceptions of students in this ethno-culturally diverse Asian sample and responses by students in the UK and North America on the personal attributes needed to provide spiritual care. Comparative studies using the SCGS could inform our understanding of spirituality and best pedagogical approaches to develop spiritual awareness across the curricula and in clinical practice.

Determining intensive care unit nurses' perceptions and practice levels of spiritual care in Turkey

PURPOSE

The purpose of this study is to determine the validity and reliability of the Turkish version of the Spiritual Care Perceptions and Practices Scale and to evaluate factors that may be effective in providing spiritual care by general intensive care unit (ICU) nurses.

BACKGROUND

Spiritual needs are necessary to offset spiritual deficiencies or support moral strength. During hospitalization, patients with critical conditions and their families tend to become anxious because of fear of the unknown and an uncertain future. Spiritual issues become prominent concerns for these patients and their families.

METHOD

The data of the study were collected from a university hospital, two public hospitals and two private hospitals. A total of 170 nurses were in the ICU of these hospitals, and 123 nurses (79·4%), agreed to participate and, were included in this study. Prior to the study, an information sheet was provided to all nurses to explain the purpose and procedures of the survey. The demographic data form of ICU nurses and the Nurses' Spiritual Care Perceptions and Practices Scale were used for data collection.

RESULTS

A statistically significant difference was found between the marital status of the nurses and the total scale mean score. It was also determined that ICU nurses are in a better position regarding their perception levels of spiritual care compared to their practice levels of spiritual care, and nurses with a higher perception of spiritual care also have higher scores in the practice of spiritual care.

CONCLUSIONS

ICU nurses were found to be inadequate in spiritual care practices. Study findings may be used to improve the support of nurses, to ensure sensitive spiritual care in their daily practices.

RELEVANCE TO CLINICAL PRACTICE

ICU nurses should be aware of the importance of spiritual care and develop tools for assessing the spiritual needs of patients.

[Development and effectiveness of a spiritual care education program for nursing students--based on the ASSET model]

PURPOSE

This study was done to develop a spiritual care education program (SCEP) for nursing students to help increase their awareness of the essence of spirituality in care so as to enable them to promote spiritual well-being and spiritual care competence.

METHODS

The participants were assigned to an experimental group (n=42) or a control group (n=39). From August to October 2009, the experimental group participated in the SCEP, which were held 2 hours a week for 6 weeks. The data were analyzed using χ²-test, Fisher's exact probability test, paired t-test, t-test with the SPSS WIN 17.0 statistics program.

RESULTS

The experimental group had a higher mean score for spirituality, spiritual well-being and spiritual care competence than the control group. Significant differences were found between the experimental group and the control group.

CONCLUSION

The results of this study indicate that the SCEP was effective in improving spirituality, spiritual well-being and spiritual care competence for nursing students.

Effects of a spiritual care training for nurses

Despite the fact that spiritual care is an essential part of nursing care according to many nursing definitions, it appears to be quite different in practice. A spirituality training for nurses may be necessary to give spiritual care the attention it deserves. In a trial a pre-tested "spirituality and nursing care" training was provided to nurses from four different nursing wards in a non-academic, urban hospital. Prior to the training and six weeks after the training, nurses and all patients were asked to fill up a questionnaire. In addition, the number of referrals from nurses to the chaplaincy was examined. Compared to before (n=44 patients), after the training (n=31), the patients from the intervention wards experienced more receptiveness and support when asking questions about illness and meaning. There were also specific changes in nurses' attitudes and knowledge, changes in clinical practice such as documenting spiritual needs and the number of referrals to the chaplains was higher. The results indicate that a training in spiritual care for nurses may have positive effects on health care that patients can experience.

An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes

AIMS AND OBJECTIVES

This study explores the spiritual needs of patients with advanced cancer during their therapeutic process in Taiwan and analyses the influence of Chinese culture in addressing their spiritual needs.

BACKGROUND

Many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer clients within their cultural context, possibly as a result of lack of knowledge and training. There has been little research exploring the potential impact of Chinese cultural values on the spiritual needs of patients with advanced cancer.

DESIGN

Explorative qualitative enquiry was used.

METHODS

Data were collected through participant observation and in-depth face-to-face interviews. Transcribed interview data were analysed by using qualitative content analysis. The purposive sample (n = 33) was drawn from a leading medical center (n = 19) with 3000 beds in the capital and a community-based rural teaching hospital (n = 14) with 581 beds in Taiwan.

RESULTS

Four spiritual needs emerged from the analysis: the need to foster hope for survival and obtain a peaceful mindset, to fulfil the meanings of life and preserve one's dignity, to experience more reciprocal human love and finally, to receive assistance in facing death peacefully.

CONCLUSION

This research has shown that patients with advanced cancer need caregivers, friends and the help of their religion to meet their spiritual needs during the therapeutic processes.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study could assist health professionals to detect the unmet spiritual needs of ethnic-Chinese patients with cancer in the context of their cultural or religious background as early as possible.

Factors affecting nursing staff in practising spiritual care

Aim. To examine nurses' attitudes to practising spiritual care and determine factors associated with nurses' attitudes to practising spiritual care. Background. Today, health is no longer viewed as a passive state of being, but as a dynamic process of achieving higher levels of wellness. In practices, nurse has increasingly focused on treating the whole person, including the four domains: physical, mental, social and spiritual. Of these four domains, the spiritual domain is the most neglected in daily nursing practice. Design. This is retrospective study. Methods. A convenience sampling was used and 110 nurses completed a structured questionnaire at a public hospital in September 2006. Outcome measures. Nurses' demographic data and perceptions and practices scores on spiritual care. Results. The results showed that nurses who more likely had religious beliefs (p = 0.028), were more likely to be married (p = 0.01), had past hospitalisation experiences (p = 0.009), worked in the obstetrics and gynaecology department (p < 0.001) and had higher perception levels towards spiritual care (p < 0.001) were significantly more likely to be practising spiritual care. Conclusion. As nurses are with patients all day, they are in a position to safeguard the wholeness and integrity of the patient. As mentioned in the results, there is a positive correlation between spiritual care perceptions and spiritual care practice among nurses, which means that the greater the nurse's spiritual care perceptions, the more frequently spiritual care is included in that nurse's practice. This correlation is vital and meaningful; it can drive hospitals to promote nurses' awareness of spiritual care to improve the quality of their spiritual care practice. Relevant to clinical practices. To facilitate collaboration between nurses and clergy, it might be beneficial for nurses to communicate more with the clergy, include clergy in patient profile discussions and treat clergy as members of the health care team. Given the influence of the spiritual dimension on the physical realm, it would be more economically viable in the long term to ensure that adequate staffing levels are maintained so that staff has enough time to spend with patients to attend to their spiritual needs.

Learning effects of thematic peer-review: a qualitative analysis of reflective journals on spiritual care

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students' competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are 'inclusion of actual experience' and 'reflecting on this experience'. The phases of 'abstraction of experience' and 'experimenting with new behaviour' are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research.

Meaninglessness in terminally ill cancer patients: a randomized controlled study

Although recent empirical studies reveal that fostering patients' perception of meaning in their lives is an essential task for palliative care clinicians, few studies have reported the effects of training programs for nurses specifically aimed at improving these skills. The primary aim of this randomized controlled trial was to determine the effects of an educational workshop focusing on patients' feelings of meaninglessness on nurses' confidence, self-reported practice, and attitudes toward caring for such patients, in addition to burnout and meaning of life. The study was designed as a single-institution, randomized controlled trial using a waiting list control. The intervention consisted of eight 180-minute training sessions over four months, including lectures and exercises using structured assessment. A total of 41 nurses were randomly allocated to three groups, which were separately trained, and all were evaluated four times at three-month intervals (before intervention, between each intervention, and after the last intervention). Assessments included validated Confidence and Self-Reported Practice scales, the Attitudes Toward Caring for Patients Feeling Meaningless Scale (including willingness to help, positive appraisal, and helplessness items), the Maslach Burnout Scale, job satisfaction, and the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp). One participant withdrew from the study before the baseline evaluation, and the remaining 40 nurses completed the study. The nurses were all female and had a mean age of 31+/-6.4, and mean clinical experience of 8.9+/-5.5 years. There were no significant differences in background among the groups. The intervention effects were statistically significant on the Confidence Scale, the Self-Reported Practice Scale, and the willingness to help, positive appraisal, and helplessness subscales, in addition to the overall levels of burnout, emotional exhaustion, personal accomplishment, job satisfaction, and the FACIT-Sp. The change ratio of each parameter ranged from 5.6% (willingness to help) to 37% for the helplessness score and 51% on the Confidence Scale. The percentages of nurses who evaluated this program as "useful" or "very useful" were 85% (to understand the conceptual framework in caring for terminally ill patients with meaninglessness), 80% (to foster nurses' personal values), and 88% (to know how to provide care for patients with meaninglessness). This educational intervention had a significant beneficial effect on nurse-perceived confidence, practice, and attitudes in providing care for patients feeling meaninglessness, in addition to the levels of burnout and spiritual well-being of nurses.

Efficacy of a self-study programme to teach spiritual care

AIM AND OBJECTIVES

This study investigated the efficacy of a self study programme designed to teach nurses about how to talk with patients about spirituality, and to identify factors predicting this learning. Furthermore, the study investigated whether there were differences in learning between students and practicing clinicians, and between those in a religious or non-religious institution.

BACKGROUND

Although USA and UK accrediting bodies mandate nurses learn how to assess and support patient spiritual health, there is a paucity of evidence to guide educators regarding how to teach spiritual care to nurses. Indeed, it is unknown if aspects of spiritual care can be taught using formal approaches.

DESIGN

A pretest-posttest pre-experimental design was used to study how attitude toward spiritual care, ability to create empathic verbal responses to expressed spiritual pain, personal spiritual experience, and knowledge about communication for spiritual caregiving changed from before to after programme completion.

METHODS

Study participants, 201 nursing students and RNs, independently completed the mailed self-study programme (i.e. workbook with supplemental DVD) and self-report study instruments (i.e. Daily Spiritual Experience Scale, Spiritual Care Perspective Scale-Revised, Response Empathy Scale, Communicating for Spiritual Care Test, and Information about You form).

RESULTS

Significant differences were seen between the before and after scores measuring attitude, ability, spiritual experience, and knowledge. An interaction effect of time between students and registered nurses for both spiritual care attitude and personal spiritual experience was observed.

CONCLUSIONS

Findings suggest learning occurred for both students and RNs, regardless of whether they were at a religious institution or not. Relevance to clinical practice. These data indicate that this self-study programme was an effective approach to teach nurses about how to converse with patients about spirituality.

Comparison of the psychospiritual needs of Chinese heart transplant recipients at pre- and postoperative stages

PURPOSE

This project sought to compare Chinese heart transplant (HT) recipients' psychospiritual needs during the preoperative (PS) and the postoperative predischarge stage (PDS).

METHODS

Thirty HT recipients from two leading medical centers in Taiwan were recruited for this research. Data collected by face-to-face interview were analyzed by content analysis.

RESULTS

The patients' ages ranged from 23 to 45 years (mean [M] +/- standard deviation [SD] = 28.5 +/- 4.1); 90% were married. The subjects' cardiac disease history ranged from 4.2 to 12.3 years (M +/- SD = 8.2 +/- 2.3). The waiting time list for HT ranged from 1.2 to 6.4 years (M +/- SD = 3.1 +/- 2.6). The subjects had the following six psychospiritual concerns: death (PS), unfulfilled family responsibilities (PS and PDS), unaccomplished personal life goals (PS and PDS), poor body image (PDS), loss of significant others' support and love (PDS), and discrimination by others (PDS). The following seven needs of help were reported: comforting the fear of failure in heart transplantation (PS and PDS), meeting unfulfilled family responsibilities (PS and PDS), accomplishing personal life goal (PS and PDS), religious support (PS and PDS), establishing confidence in body image (PDS), establishing positive relationship with significant others (PS and PDS), and preparation for dying with dignity when necessary (PS and PDS).

CONCLUSION

The in-depth investigation on Chinese HT recipients' psychospiritual needs was first compared in PDS and PS. More distress and needs were found in PDS than PS. These findings were attributed by the dilemma of pursuing prospective future versus taking the risk of loss of life, valuing families' and health professionals' support system, and expecting grief and dying with dignity. Health professionals are encouraged to understand and provide stage-specific support to help them meet psycho-spiritual needs.

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care

AIM

To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects.

BACKGROUND

Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used.

DESIGN

Quasi-experimental crossover design (pre-post-test).

METHOD

The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students' own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool.

RESULTS

Ninety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content.

CONCLUSIONS

The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development.

RELEVANCE TO CLINICAL PRACTICE

The results provide nurse educators with insight into the effects of education in spiritual care on students' competencies and help them consider a systematic place for spiritual care within the nursing curriculum.

Teaching on the spiritual dimension in care to undergraduate nursing students: the content and teaching methods

The study unit on 'The spiritual dimension in care'had a Judeo-Christian orientation. It was introduced to the Diploma nursing curriculum at the University of Malta in the academic year 2002-2003. The aim was to increase students' awareness about the essence of spirituality in care so as to enable them to implement holistic care. Spirituality may or may not incorporate religiosity. Thus, believers may have spiritual needs which may include religious needs whilst the atheists and agnostics may still have spiritual needs. While considering secularisation, the Christian culture of Malta was addressed in this study unit. This article describes the content structure of the study unit based on the ASSET model (Narayanasamy, A., 1999. ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285) and outlines the various teaching methods used. Following feedback from the first and second cohort groups in 2003 and 2004, respectively, the reviewed study unit was delivered to the third cohort group of students (n=65) in Semester 2 in the academic year 2004-2005. Apart from the use of traditional teaching methods, such as lessons and a seminar, other methods were used constantly throughout the study unit, for example, self-reflection exercises, case-studies and small group discussions to enhance learning. Recommendations are proposed to review the content of this study unit and to introduce other teaching methods for effective learning.

Teaching on the spiritual dimension in care: the perceived impact on undergraduate nursing students

The aim of the study unit, delivered in 2004-2005, to a cohort group of nursing students (n=65), who undertook the Diploma in Health Science, was to increase students' awareness about the spiritual dimension in nursing care so as to enable them to implement holistic care. The aim of this paper is to reveal the perceived impact of the study unit on students' life. This was derived from a written self-reflection account, which was submitted on voluntary basis, additional to the written assignment. The majority of students (97%, n=63) performed this written exercise which seems to demonstrate the students' interest in this study unit. Excerpts from students' written personal reflection indicate the personal, academic and professional impact of the study unit on nursing students. The positive feedback from students sheds light on the importance of teaching undergraduate students on the spiritual dimension in care. This implies that such a study unit is to be integrated within the curriculum of nursing education for the benefit of the nurses themselves and to enable delivery of holistic care.

Spiritual practice: a literature review related to spiritual health and health outcomes

Spirituality and the expression of spirituality have received renewed interest in both nursing and nonnursing literature over the last 20 years. Scholars in spirituality studies have contributed to the wealth of both qualitative and quantitative data that exist. Spiritual practices that facilitate spiritual health are embedded within many nursing interventions. The purpose of this review is to provide an overview of empirical and associated nursing literature on spiritual practices. Definitions of spirituality and spiritual health are included, and theoretical underpinnings of the empirical literature are discussed. Relation of spiritual practice as a health behavior is presented with implications for future research identified.

Meaninglessness in terminally ill cancer patients: a validation study and nurse education intervention trial

Recent empirical studies revealed that fostering patients' perception of meaning in their life is an essential task for palliative care clinicians. However, few studies have reported the effects of training programs for nurses specifically aimed at improving skills to relieve the meaninglessness of terminally ill cancer patients, and we have had no specific measurement instruments. The primary aims of this study were 1) to validate measurement tools to quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness and 2) to explore the effects of the five-hour educational workshop focusing on meaninglessness on nurses' self-reported practice, attitudes toward caring for such patients, confidence, burnout, death anxiety, and meaning of life. A quasi-experimental pre-post questionnaire survey was performed on 147 nurses. The questionnaire was distributed before the intervention workshop and one and six months after. The workshop consisted of lecture, role-play, and the exercise of assessment and care planning based on two vignette verbatim records. First, using the first questionnaire sample and an additional sample of 20 nurses for the test-retest examination, we validated a six-item Self-Reported Practice scale, and an eight-item Attitudes Toward Caring for Patients Feeling Meaninglessness scale with three subscales (Willingness to Help, Positive Appraisal, and Helplessness). The nurses also completed a scale to assess confidence in caring for terminally ill patients with meaninglessness, the Maslach Burnout Inventory, the Death Attitude Inventory, the Frommelt Attitudes Toward Care of the Dying scale, the Self-Reported Practice Score in General Communication, and the three pain-related items from the Palliative Care Quiz for Nursing. For the Self-Reported Practice scale and the subscales of the Attitudes Toward Caring for Patients Feeling Meaninglessness scale, the Cronbach's alpha coefficients were 0.63-0.91, and the intra-class correlations were 0.89-0.94. The Self-Reported Practice scale significantly, but moderately, correlated with the Self-Reported Practice Score in General Communication (P=0.41). The Willingness to Help and Helplessness subscales significantly but weakly correlated with the Frommelt scale (P=-0.27, 0.21). Both scales did not correlate or minimally correlated with the Palliative Care Quiz for Nursing (P<0.20). The construct validity was confirmed using factor analysis. At the follow-up, of 147 nurses who participated in this workshop, 91 (62%) and 80 (54%) nurses responded. Self-reported practice and confidence significantly improved, whereas helplessness, emotional exhaustion, and death anxiety significantly decreased. The percentages of nurses who evaluated this program as "useful" or "very useful" were 79% (to understand the conceptual framework in caring for terminally ill patients with meaninglessness), 73% (to help in self-disclosing nurses' personal beliefs, values, and life goals), and 80% (to help in learning how to provide care for patients with meaninglessness). The Self-Reported Practice scale and the Attitudes Toward Caring for Patients Feeling Meaninglessness scale are reliable and valid tools to specifically quantify nurses' self-reported practice and attitudes toward caring for terminally ill cancer patients feeling meaninglessness of life. The five-hour workshop appeared to have a modest but significant beneficial effect on nurse-reported practice, attitudes, and confidence in providing care for terminally ill cancer patients feeling meaninglessness. Further educational intervention trials with control groups are promising.

Relationship of nurses? spirituality to their understanding and practice of spiritual care

AIM

This paper reports a study to examine the relationship of nurses' spirituality to their understanding and practice of spiritual care.

BACKGROUND

Continued debate surrounds the concept, practice and teaching of spirituality, highlighting the complexity and importance of understanding spirituality and the delivery of spiritual care. Spirituality is defined in this study as the relationship with the self and a dimension beyond the self.

METHOD

A convenience sample of 61 nurses from a part-time Bachelor of Science degree programme in nursing in Hong Kong, more than half of whom reported their religious affiliations, completed a newly developed, 27-item five-point Likert scale questionnaire. The data were collected in 2002. Descriptive statistics were calculated. Correlations were used to determine relationships among self, understanding and practices of spiritual care. The Mann-Whitney U and Kruskal-Wallis tests were used to examine differences between demographic variables and spirituality, understanding and practices of spiritual care. Multiple linear regression was used to determine factors contributing to understanding and practices of spiritual care.

FINDINGS

A positive statistically significant correlation was found between self and the following three variables: dimension beyond self (r=0.35, P<0.001), understanding of spiritual care (r=0 x 57, P<0 x 001), and practice of spiritual care (r=0 x 26, P<0 x 05). The relative contributions of self to understanding (beta=1 x 06, |t|=10 x 74, P<0.001) and practice of spiritual care (beta=0 x 68, |t| = 3 x 62, P=0 x 001) were statistically significant. There was no statistically significance difference between any of the demographic variables and understanding and practice of spiritual care, except for a negative relationship between religious affiliations and the dimension beyond self (P<0 x 001).

CONCLUSION

Through continuously seeking self-awareness and connecting to a dimension beyond the self for inner resource, the contented whole self will be able to provide spiritual care.

The impact of empirical studies of spirituality and culture on nurse education

AIMS AND OBJECTIVES

The aim of this paper is to share reflectively how my empirical studies on spirituality and culture have had an impact upon nurse education.

BACKGROUND

Spirituality and cultural dimensions of care are considered to be integral to holistic care. The healing potentials of spiritual and cultural care are well documented. The commitment to the research programme came due to the concern within early literature on nursing that the provision of spiritual care for patients is inadequate.

METHODS

The research programme used action research comprising largely qualitative approaches. As the holistic and multiperspective nature of spirituality and culture requires a multidisciplinary approach and flexibility of methodology, various research techniques were used.

RESULTS

The findings from the research programme led to the development of theories, models and conceptual literature on spiritual and cultural care. In particular, two models evolved from the studies: the ASSET for spiritual cares education and training and the ACCESS for transcultural care practice. The critical incident studies provide insights into nurses' roles in spiritual care interventions. The phenomenological study highlights that chronically ill patients use spiritual strategies in coping with their illness.

CONCLUSION

Overall, the paper offers a body of evidence that has an impact upon curriculum development in nurse education and nursing practice.

RELEVANCE TO CLINICAL PRACTICE

The ASSET model offers a framework for spiritual care education. The ACCESS model offers a framework for transcultural care practice. The critical incident studies map out nurses' roles in spiritual and cultural care with scope for development of care intervention models for the future. The coping mechanisms study highlights how patients use spiritual coping strategies such as prayer and other resources to cope with their chronic illnesses.

Spiritual care: implications for nurses' professional responsibility

AIM

This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses.

BACKGROUND

International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands.

METHOD

Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan.

RESULTS

Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment.

CONCLUSIONS

The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended.

RELEVANCE TO CLINICAL PRACTICE

Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision-making discussions of spiritual care in clinical nursing practice.

Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: results of a cluster analysis

AIM

Nurses' spiritual care perceptions and practices are explored by identifying profiles of nurses studying in a part-time baccalaureate course in a local Hong Kong university. Relationships between nurses' spiritual care perceptions and their practices are explored.

RESEARCH METHOD

Hundred and ninety three nurses completed a structured questionnaire.

OUTCOME MEASURES

Spiritual care perceptions and practices.

RESULTS

Two-step cluster analysis yielded three clusters. Clusters A, B, and C consisted of 15.0% (n = 29), 44.6% (n = 86), and 40.4% (n = 78), respectively. Cluster A nurses were characterized by relatively negative spiritual care perceptions and practices. Cluster C nurses reported positive perceptions, but negative practices; they mainly chose 'uncertain' for most items on both scales. Cluster B was a large group of nurses holding both positive spiritual care perceptions and practices. Significant differences towards spiritual care were found among clusters. Nurses' perceptions were significant positively correlated with practices (r = 0.62). High positive correlations were found between the two scales (r = 0.83) for nurses in Cluster A, for nurses in Clusters B and C, low positive correlations (r = 0.37) were found.

CONCLUSION

Three clusters of Hong Kong nurses were differentiated. They showed differences in the level of their spiritual care perceptions and practices. Despite their level of spiritual care perceptions, nurses seldom incorporated spiritual care practices into their daily nursing care, and the level of spiritual care awareness of some nurses was low. Findings may be used to improve support of nurses, to ensure sensitive spiritual care in their daily practices, and to enhance nursing curricula.

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design

AIM

The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs.

DESIGN

Three phases were involved in this between-method triangulation design.

METHODS

The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs.

RESULTS

The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013).

CONCLUSION

Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

Perceptions of nurses with regard to doctor-patient communication

The objective of this study was to evaluate nurses' perceptions of communication between doctors and patients with cancer, AIDS and rheumatoid arthritis. A cross-sectional study was conducted with 741 nurses in 12 hospitals. Nurses received a self-questionnaire that included questions on personal value and attitudes. The answers were used in constructing affective variables (religious beliefs, attitude towards death, paternalism). The prevalence of explicit communication in 'nurse perception of doctor-patient communication' in the case of cancer was 4.5%, with AIDS 30%, and with rheumatoid arthritis 41.8%. When the value of communication was evaluated, it became evident that the likelihood of a nurse perceiving explicit communication in reference to a diagnosis of cancer was 6.5 time greater when communication was considered to be of greater value (CI 95% 2.6-6.6). For nurses who accept the possibility of death, the likelihood of perceiving explicit communication in the case of AIDs was 7.4 times greater than for nurses who deny this possibility (CI 95% 3.7-14.7), and when nurses displayed a deeply religious attitude, the likelihood of perceiving explicit communication was 80% greater than for nurses without this attitude (CI 95% 1.1-2.9). Nurses participate actively in the process of attending to patients with cancer and other disabling illnesses. Thus, there is a need for health professionals who provide compassionate attention, which will improve the various interrelationships between nurses and patients.

Spirituality in children confronting death

This article uses a developmental framework to consider common spiritual issues raised by children and adolescents who are confronting death. The literature exploring the role of children's spirituality in addressing death is used to illustrate specific areas of concern and topics deserving further research. Clinical examples are offered to illustrate the types of situations encountered by mental health professionals dealing with seriously ill children and their families. Recommendations are offered for concrete approaches for mental health professionals dealing with families confronting the death of a child.

Beyond the metaphysical: health-promoting existential mechanisms and their impact on the health status of clients

This paper aims to conceptualize the issues that surround the notion of existential health. It also seeks to establish the impact that existential issues have upon the health of the individual client and how these might explicitly be applied in clinical practice settings. The ability of clients to draw upon their own existential resources as a fundamental part of their health care experience often goes unrecognized in nursing. Whilst existential mechanisms may be theoretically recognized, as a valid aspect of an individual's unique and personal identity, they are not an established part of the health care activity of nurses. Entrenched biomedical frameworks of care delivery and the interchangeable use of metaphysical health states with existential health states in the established literature present particular dilemmas for the acknowledgement of existential health in clients. A review of the literature has been conducted. This account argues that the failure to recognize and assess a client's existential health status represents a major omission on the part of the clinical nurse. These nurses are, in effect, denying their clients the right to exercise and mobilize an important and valuable health resource.

Dilemmas of spiritual assessment: considerations for nursing practice

BACKGROUND

Interest in the spiritual dimension of nursing has resulted in a proliferation of published research internationally that is very prescriptive, suggesting that nurses should be providing spiritual care. However, little research has been published that provides nurses with a potential framework for the assessment and subsequent delivery of spiritual care. It would appear that there is a consensus of opinion that nurses can and should be able to undertake an assessment of their patients' spiritual needs. However, such assumptions may be unfounded, inaccurate, misguided and potentially detrimental to patient care.

AIM

This article explores the area of spiritual assessment, drawing on the international literature, highlighting potential dilemmas in conducting a spiritual assessment. A review of some of the currently available spiritual assessment tools is also undertaken.

DESIGN

A debate is presented based on the authors' experiences and opinions with regard to this aspect of care. The debate is informed by a review of the literature specifically addressing spiritual assessment. The authors use United Kingdom policy to illustrate drivers and provide a context for the debate. However the dilemmas presented and issues raised are of significance to a wider international audience.

CONCLUSION

It is argued that the area of spiritual assessment needs careful consideration, both nationally and internationally, by those professionals involved in the provision of spiritual care so that potential dilemmas can be identified and reviewed. Such consideration may prevent the construction and subsequent use of inappropriate assessment tools within practice. The article incorporates some considerations for practice.