Nurses’ comfort level with spiritual assessment: a study among nurses working in diverse healthcare settings

Spiritual Care in Undergraduate Nursing Education: An Integrative Review

BACKGROUND

The growth of international migration and globalization has increasingly diversified patient populations, emphasizing the need for nursing students to provide competent spiritual care.

PURPOSE

To understand the teaching and learning strategies used to prepare undergraduate nursing students for spiritual care.

METHODS

An integrative review with deductive data analysis was used to evaluate, analyze, and synthesize diverse research methodologies.

RESULTS

Three educational approaches were identified, including passive, reflective, and combinatory approaches. The combinatory approach appears most appropriate for diverse learning styles within a student group.

CONCLUSIONS

No one strategy is best, but any combination of educational strategies can positively impact spiritual care competency within clinical practice.

Strengths and challenges with spiritual care: Student feedback from the EPICC Spiritual Care Self-Assessment Tool

AIM

To explore qualitative data from students' self-reported competencies in spiritual care gathered during testing of a student self-assessment tool based on the EPICC Spiritual Care Education Standard.

DESIGN

Reflexive thematic analysis of qualitative data from a multinational study on validating a new self-assessment tool.

METHODS

The EPICC Spiritual Care Education Standard for competency in spiritual care was developed to enhance nurses' and midwives' ability to provide spiritual care by creating a baccalaureate education standard for spiritual care competencies. Spiritual care researchers then developed a self-assessment tool to raise student awareness of spirituality and track personal and professional growth in spiritual care competency. The EPICC Spiritual Care Competency Self-Assessment Tool, tested at eight universities in five countries, provided many opportunities for student comments, resulting in rich qualitative data presented here.

RESULTS

Themes related to strengths, weaknesses and areas for improvement. Identified strengths were similar across countries: caring attitudes, general knowledge of caring and compassion and good communication skills. Weaknesses/challenges touched on spirituality as overlooked in some cultures but part of life for others, complex questions were hard to understand, and self-assessment tools are common for some and rare for others. Areas for improvement included need for knowledge of religious and other deeply held beliefs and for greater spiritual assessment skills. Similarities across countries related to basic training in communication and compassionate care for nurses globally. Differences lay in the challenges and/or barriers for spiritual care and may relate to cultures within countries and/or university test sites.

RELEVANCE TO CLINICAL PRACTICE

The Tool raises awareness of spirituality among students and working nurses, providing an accessible way to self-check personal and professional growth in spiritual care competencies, which increases student and nurse capacity to become more knowledgeable and skilled in facilitating spiritual care, thus be role models for students at the intersection of spirituality and health.

Faith Community Nurses Key to Promoting Health in At-Risk Communities: An Integrative Review

ABSTRACT

An integrative literature review was conducted to identify recommendations to implement culturally congruent and spiritually connected approaches to health promotion in at-risk faith communities. Five themes emerged from an analysis of 48 articles meeting criteria for the review. Review results repeatedly highlighted the impact nurses-more specifically faith community nurses (FCNs)-can have on at-risk population outcomes and bridging the gap between minority communities and the healthcare establishment. Five recommended action steps provide program guidance to FCNs for promoting faith-based health in at-risk minority communities.

Spiritual care in Australian general practice nursing: An interpretive descriptive study

Spiritual care as an aspect of holistic or person-centered care has been well documented. Studies on spirituality and spiritual care in nursing have taken place in various countries and contexts. Studies about spiritual care from the nurse perspective in the primary healthcare setting of Australian General Practice are not evident. Using an interpretive description study design, data about views on spirituality, spiritual care experiences, and descriptions about any spiritual care provided were collected from eight practice nurses. Four themes were drawn from the findings: the personal importance of spirituality and spiritual care to nurses and patients, spiritual care as an aspect of person-centered care, spiritual care practices, and barriers and enablers to addressing spiritual needs. Participants identified that practice nurses require improved education about spirituality to adequately address spiritual needs as expressed by patients, as well as the tools to be able to provide spiritual care. They also identified that documentation templates used in general practice should include prompts to address spiritual and/or religious needs.

Spirituality in Nursing and Health: A Historical Context, Challenges, and Way Forward

This article aims to share the historical context of spirituality in nursing, meanings and expressions of spirituality, and different models of spirituality along with its significance in nursing education and practice. Several challenges and tools for the successful integration of spirituality in education and practice are also discussed.

Nurses and Patients' Perspectives on Spiritual Health Assessment

Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.

Comparing Nurses’ and Patients’ Comfort Level with Spiritual Assessment

This paper presents and compares similarities and differences between nurses’ and patients’ reports on comfort levels with spiritual assessment. Spiritual care is a part of nurses’ professional responsibilities; however, nurses continue to report that they are poorly prepared for this. There is limited research on patients’ expectations or perspectives on spiritual care. For the original mixed-method, two-phased study, a 21-item survey with 10 demographic variables, and some open-ended questions related to the comfort level of assessing/being assessed in the spiritual domain were distributed to 172 nurses and 157 hospitalised patients. SPSS was used to analyse and compare the results from nurses and patients; thematic analysis was used to examine the open-ended questions. Nurses reported a higher high degree of comfort with spiritual assessment than patients reported towards being assessed spiritually. Both nurses and patients saw respect and trust as key to building a relationship where open questions related to spirituality can be used as a helpful way to assess patients spiritually. Increased understanding of the best approach toward a patient must be based on the beliefs, values, and practices of that patient so that spiritual care can be individually tailored, and nurses can help patients move along the path to healing.

Effectiveness of an Educational Intervention to Teach Spiritual Care to Spanish Nursing Students

Spirituality and spiritual care in professional nursing are conceptualised and recognised as fundamental components of holistic healthcare. Despite the acceptance of and interest in spiritual care, a lack of education and clinical training on the subject limits nurses’ ability to meet patients’ spiritual needs. Consequently, the aim of this study was to analyse the effectiveness of a training programme designed to teach the specific knowledge, attitudes and competencies necessary to provide spiritual care in nursing practice. This study consisted of a one-group pre-post intervention design with two measurement times (baseline/pre-intervention and post-intervention). A teaching activity about spiritual care in nursing practice was designed and implemented (focal groups, open discussion, discussion groups and clinical case studies). The educational intervention was developed by the authors based on a literature review, research and feedback from the undergraduate students. A convenience sample of 369 nursing students at the University of Alicante (Spain) who were enrolled in the teaching subject of Psychology participated in this study. The effectiveness of the teaching activity was assessed through a self-administered 15-item questionnaire. The post-intervention results indicated that the programme was effective in improving knowledge, competencies and attitudes related to spiritual care. The implications of this study for teaching practice and future research are discussed

The development of a consensus-based spiritual care education standard for undergraduate nursing and midwifery students: An educational mixed methods study

AIMS

The aim of this study was to develop a consensus-based Spiritual Care Education Standard for undergraduate N/M students to use in undergraduate programmes.

DESIGN

Mixed methods were used consisting of qualitative and quantitative methods based on the principles of Delphi research.

METHODS

The sample consisted of a total of 58 (N = 58) participants from 21 European countries. Data collection was conducted from June 2017 - February 2019 and took place in facilitated iterative action learning cycles and online surveys. Data were analysed by descriptive statistics and qualitative analysis. Consensus was stated by >90% agreement.

RESULTS

The process resulted in an EPICC Spiritual Care Education Standard consisting of the following four spiritual care competences: Intrapersonal spirituality, Interpersonal spirituality, Spiritual care: assessment and planning, Spiritual care: intervention and evaluation. For every competence, learning outcomes were described in knowledge, skills and attitudes.

CONCLUSION

This Standard guides N/M spiritual care education, student assessment and research. It can be the starting point for discussing spiritual care competences in other healthcare professions. Follow-up research should focus on implementation of the standard and on assessment of students' spiritual competence.

IMPACT

The Standard guides curriculum and programme development. The Standard guides students in performing their learning process. The Standard provides a frame of reference for policy making and follow-up research.

Brazilian nurses' concept of religion, religiosity, and spirituality: A qualitative descriptive study

Evidence points toward the impact of nurses' personal views and knowledge about religion, religiosity, and spirituality on health care. This qualitative research investigates nurses' concepts of religion, religiosity, and spirituality and how they use these concepts in practice. Thirty-four nurses were interviewed at a hospital in the state of São Paulo, Brazil. Content analysis was used to organize and code the results. Three main themes generated from the interviews were (i) religiosity/spirituality as an important dimension in life; (ii) notions of religiosity and spirituality; (iii) formal knowledge of the concept of religion, religiosity, and spirituality. The results indicate that religion, religiosity and spirituality should be incorporated into nurse training to improve the comprehension and competence of nurses in these areas of practice. It is recommended that to ensure holistic and person-centered care, there must be constant reflection on these concepts.

Spiritual Needs of Older Adults during Hospitalization: An Integrative Review

A hospital admission presents various challenges for a patient which often result in high or intense spiritual needs. To provide the best possible care for older adults during hospitalization, it is essential to assess patients’ spiritual needs. However, little research has been done into the spiritual needs of geriatric patients. This article seeks insight into what is known in the literature on the spiritual needs of geriatric patients. This integrative review presents a summary of the articles on this topic. To select eligible studies, the PRISMA Flow Diagram was used. This resulted in ten articles that have been reviewed. Results show (1) a wide interest in researching spiritual needs, using different research designs. In addition, (2) four subcategories of spiritual needs can be distinguished: (a) the need to be connected with others or with God/the transcendent/the divine, (b) religious needs, (c) the need to find meaning in life, and (d) the need to maintain one’s identity. Moreover, results show that (3) assessing spiritual needs is required to provide the best possible spiritual care, and that (4) there are four reasons for unmet spiritual needs. Further research is needed on the definition of spiritual needs and to investigate older patients’ spiritual needs and the relation with their well-being, mental health and religious coping mechanisms, in order to provide the best spiritual care.

Telling their story: A qualitative descriptive study of the lived experience of expatriate palliative care nurses in the United Arab Emirates

PURPOSE

To explore the experiences of expatriate nurses caring for Muslim patients near end-of-life in a palliative care unit in the United Arab Emirates.

METHODS

A qualitative descriptive study, with data collected through semi structured individual interviews with nine expatriate nurses working in a palliative care unit in one hospital in the United Arab Emirates. Thematic analysis of the data transcripts used a structured inductive approach.

RESULTS

Analysis of the interview transcripts yielded three themes. First, language was a significant barrier in end-of-life care but was transcended when nurses practiced authentically, using presence, empathetic touch and spiritual care. Secondly, relationships between nurses, patients and families were strengthened over time, which was not always possible due to late presentation in the palliative care unit. Finally, nurses were continually in discussions with physicians, families and other nurses, co-creating the meaning of new information and experiences within the hospital policy context.

CONCLUSION

For expatriate nurses, palliative nursing in a Muslim middle eastern country is complex, requiring nurses to be creative in their communication to co-create meaning in an emotionally intensive environment. Like other palliative care settings, time can strengthen relationships with patients and their families, but local cultural norms often meant that patients came to palliative care late in their disease trajectory. Preparing expatriate nurses for work in specialist palliative care settings requires skill development in advanced communication and spiritual practices, as well as principles of palliative care and tenets of Muslim culture.

Patient Perspectives about Spirituality and Spiritual Care

Objective:

This study was undertaken to explore the perspectives regarding spirituality and spiritual care held by individuals with advanced disease. The aim was to gain a deeper understanding about their viewpoints surrounding spiritual care and the role of health-care professionals in providing such care.

Methods:

Sixteen individuals with advanced disease and a prognosis of <12 months underwent an in-depth interview. Transcripts were subjected to a qualitative descriptive analysis to identify salient content and themes.

Results:

Four overall themes were identified: Spirituality is personal, spiritual distress is about separation, spiritual care is about connecting, and conversations about spirituality must align with the patient's beliefs. Subthemes emphasized the individuality of spiritual expression, the potential for illness impacting spiritual beliefs, and the value of connections to one's spiritual community. Participants thought healthcare providers needed to be able to identify individuals who were experiencing a spiritual struggle, acknowledge the reality of that struggle, and connect the individual with the appropriate resource or person.

Conclusions:

Patients with advanced disease are likely to express their spirituality in unique ways. Being able to talk about their spiritual beliefs and doubts during illness without judgment was seen as a benefit to them. Healthcare providers ought to be able to identify those patients who require assistance in connecting to appropriate spiritual care resources.

Views on Spirituality in Old Age: What Does Love Have to Do with It?

This paper addresses the importance of providing spiritual care for older people within the context of nursing. Based on the author’s doctoral thesis, the importance of love in relation to spirituality and spiritual care will be discussed herein. The methodology is based upon Gadamer’s hermeneutical philosophy, and the included material is one qualitative metasynthesis, interviews of 17 older people, a research synthesis of articles concerning connectedness and love, and a book by Paul Tillich. Love in connectedness was found as a universal force in spirituality, and different forms of love emerged in relation to spiritual needs in older people care. Furthermore, love as a re-unifying and connecting force may foster confirmation of human worth and dignity, enable serving others in reciprocate love, longing towards being part of something larger than oneself, and holiness in the sense of pursuing existential meaning or religiousness.

Nursing and midwifery students' perceptions of spirituality, spiritual care, and spiritual care competency: A prospective, longitudinal, correlational European study

BACKGROUND

Nurses and midwives care for people at some of the most vulnerable moments of their lives, so it is essential that they have the skills to give care which is compassionate, dignified, holistic and person-centred. Holistic care includes spiritual care which is concerned with helping people whose beliefs, values and sense of meaning, purpose and connection is challenged by birth, illness or death. Spiritual care is expected of nurses/midwives but they feel least prepared for this part of their role. How nursing and midwifery students can be prepared for spiritual care is the focus of this study.

OBJECTIVES

1. To describe undergraduate nursing and midwifery student's perceptions of spirituality/spiritual care, their perceived competence in giving spiritual care and how these perceptions change over time. 2. To explore factors contributing to development of spiritual care competency.

METHODS

Prospective, longitudinal, multinational, correlational survey design. A convenience sample of 2193 undergraduate nursing and midwifery students (69% response rate, dropping to 33%) enrolled at 21 universities in eight countries completed questionnaires capturing demographic data (purpose designed questionnaire) and measuring perception of spirituality/spiritual care (SSCRS), spiritual care competency (SCCS), spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) on 4 occasions (start of course n = 2193, year 2 n = 1182, year 3 n = 736, end of course n = 595) between 2011 and 2015. Data were analysed using descriptive, bivariate and multivariate analyses as appropriate.

RESULTS

Perceived competency increased significantly over the course of students' study which they attributed to caring for patients, events in their own lives and teaching/discussion in university. Two factors were significantly correlated with perceived spiritual care competency: perception of spirituality/spiritual care, where a broad view was preferable, and personal spirituality, where high spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) scores were preferable.

CONCLUSIONS

We have provided the first international evidence that perceived spiritual care competence is developed in undergraduate nursing and midwifery students and that students' perceptions of spirituality and personal spirituality contribute to that development. Implications for teaching and learning and student selection are discussed. The study is limited by attrition which is common in longitudinal research.