Should Healthcare Organizations Promote a Spiritually Healthy Work Environment?

Both personal spirituality/religiosity and perception of a spiritually respectful work climate are inversely related to burnout among nurses. In addition to briefly reviewing the empirical evidence that consistently supports these assertions, this essay offers some practical suggestions for how nurses can promote a spiritually healthy work environment.

Praying Online: Reflections and Suggestions for Nurse Educators

ABSTRACT

This article presents reflections and suggestions for nurse educators in a Christian institution who want to pray with students while teaching online. Suggestions primarily relate to recording prayers for class, including avoiding the appearance of coercion; being clear that students' participation in the recorded prayer will have no effect on grades; placing prayer in recorded material at a consistent location (such as the beginning or the end) so students know when it is coming; being creative in offering varying ways to pray; being authentic; and inviting student participation.

How Christian Nurses Respond to Patient Requests for Prayer: An Observational Study

ABSTRACT

Nurse-provided spiritual care includes support of patient spiritual practices such as prayer. However, limited evidence exists about how nurses respond when a patient requests prayer. A subsample of nurses (n = 381) from a larger study responded to two open-ended questions in an online survey in response to a prayer scenario. Among these mostly Christian nurses, 97% indicated willingness to pray. Content analysis revealed a five-component structure for praying: Open, Set the Stage, Request, Wrap-up, Close. The structure provides a template for future research and nurse prayer in clinical contexts.

Tragedy or transformation? Online survey of nurse spirituality during the COVID pandemic

AIM

To describe positive and negative spiritual responses to providing COVID-related nursing care among nurses working in hospitals.

BACKGROUND

The COVID pandemic has intensified and publicised the threats to nurse well-being. Absent from the recommendations for promoting nurse well-being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well-being.

DESIGN

Cross-sectional, descriptive observational, mixed methods study.

METHODS

Data were collected from 523 registered nurses employed in three Southern California hospitals during March-May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic and work-related items. STROBE guidelines for cross-sectional observational studies were observed.

RESULTS

The mean for religious/spiritual struggles was 1.98 (range of 1-5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%-36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); applying established criteria indicated it was troubling for at least 50%. The mean for post-traumatic growth was 4 (on a scale of 0-6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently.

CONCLUSION

The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative.

RELEVANCE TO CLINICAL PRACTICE

Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy-and allow spiritual transformation.

Pharmacy students' perceived barriers to spiritual care: A qualitative study

Background

Spiritual care (SC) is an important component of whole person care, a goal that many pharmacists embrace. Knowledge about barriers to incorporating SC in pharmacy practice may allow understanding of how to increase its provision.

Objectives

The objective of the study was to investigate pharmacy students' perceived personal and professional barriers to incorporating SC in pharmacy practice.

Methods

Second-year pharmacy students (n = 62) who attended a required class lecture on SC in healthcare responded to three open-ended questions that explored beliefs about SC in pharmacy practice. Students' responses were thematically analyzed using NVivo.

Results

Most (68%) of the students were female; 34% were Asian American. Students identified the following barriers to incorporating SC: limited or lack of time for SC, lack of supervisor and company support for SC, discordant pharmacist-patient spiritual beliefs, discomfort with talking about spirituality, lack of knowledge about spirituality and SC, personal factors, patient refusal of SC, fear of offending patients by discussing spirituality, and pharmacy environment.

Conclusion

Major barriers to SC include lack of time for SC, lack of supervisor and company support for SC, and discordant pharmacist-patient spiritual beliefs. Future studies should be conducted to investigate these and other barriers to SC in pharmacy practice.

Frequency of nurse-provided spiritual care: An international comparison

AIMS AND OBJECTIVES

To compare the frequency of nurse-provided spiritual care across diverse cultures.

BACKGROUND

Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement.

DESIGN

This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument.

METHODS

Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed.

RESULTS

Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics.

CONCLUSIONS

In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care.

RELEVANCE TO CLINICAL PRACTICE

Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Perspectives about Spiritual Care in Pharmacy Practice: A Community-based Survey

Background: Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public’s perspectives about pharmacists providing spiritual care (SC). Objectives: To explore how community members perceive, experience, and desire pharmacist-provided SC. Method: IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents’ perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics. Results: Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients’ religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist. Conclusion: Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.

Nurse Spiritual Care Therapeutics Scale: Validation Among Nurses Who Care for Patients With Life-Threatening Illnesses in South Korea

Although clinical and empirical literature documents the variety of spiritual care interventions available to palliative care clinicians, the frequency with which they are provided is rarely and inadequately measured. Given the growing interest in implementing spiritual care across Asia, including South Korea, this study sought to cross-culturally validate the Korean version of the Nurse Spiritual Care Therapeutics Scale (NSCTS-K), a scale initially developed in the United States. The World Health Organization process for cross-cultural adaptation of scales and Polit and Yang's process for evaluating validation were implemented. With data from a sample of 252 Korean nurses providing care to patients with life-threatening illnesses, various statistical procedures for evaluating validity and reliability were applied during this cross-sectional, observational study. Exploratory factor analysis for the structural validity of the Korean scale generated 3 factors that accounted for 69.40% of the variance. The Cronbach α was 0.95. The NSCTS-K is one of the few scales available to determine the impact of nurse-provided spiritual care frequency on patient outcomes. Thus, this tool can quantify the frequency of spiritual care better and be used in quality improvement initiatives or palliative care research.

Validation of the Nurse Spiritual Care Therapeutics Scale in Portuguese palliative care settings: a methodological study

BACKGROUND

Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care.

AIM

To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings.

METHODS

A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings.

FINDINGS

A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23-60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution.

CONCLUSION

The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

An online survey to describe pharmacy student spirituality and spiritual care perspectives

INTRODUCTION

Little is known about student pharmacists' perspectives of spirituality and spiritual care (SC) in pharmacy education and practice. The purpose of this study was to examine student pharmacists' perspectives about spirituality and incorporating SC in pharmacy education and practice.

METHODS

Student pharmacists were recruited from two private pharmacy schools in California, one religiously-affiliated and one non-religiously affiliated. A faculty member at each school invited student pharmacists via email or through Zoom (Zoom Video Communications) chat to complete the 37-item online survey through an embedded link. The investigator-designed survey was comprised of 22 items inquiring about spirituality and SC as well as several items assessing demographic and religious characteristics.

RESULTS

Participants included 470 student pharmacists (87.2% response rate) who were 28.9 ± 5.7 years old on average. Half of the respondents (50.5%) attended the non-religiously affiliated university. Most of the respondents were female (67%), Christian (67.8%), spiritual (79.2%), and religious (75.2%). They "agreed" or "strongly agreed" that: "understanding patients' spiritual beliefs is an important part of pharmacy practice" (83%), "I would pray with my patients as a pharmacist" (54.8%), "it is appropriate for a pharmacist to have spiritual or religious conversations with patients" (52.9%), and "it is appropriate for a pharmacist to pray with and for patients who request it" (66.9%). These beliefs were positively correlated with self-reported religiosity and spirituality.

CONCLUSIONS

Most students considered themselves spiritual and religious and felt that spirituality and learning about SC were important. The respondents' SC perspectives were associated with their religiosity and spirituality.

Burnout, Self-Efficacy, and Resilience in Haitian Nurses: A Cross-Sectional Study

Purpose of Study: Though nursing burnout is a global problem, research on nurse burnout in Haiti is scarce. In a context of multiple personal, social, and environmental challenges, this study assessed burnout and associated factors among Haitian nurses. Design of Study: A multi-site cross-sectional study. Methods: A survey in French and Haitian Creole was conducted in five Haitian hospitals using forward and back translated scales measuring burnout (emotional exhaustion [EE], depersonalization [DP], personal accomplishment [PA]), self-efficacy, nursing work environment, resilience, and demographics. Findings: Haitian nurses (N = 179) self-reported moderate EE (M = 21, SD = 11.18), low DP (Mdn = 2.0, range = 29), and high personal accomplishment (Mdn = 41.0, range = 33). General self-efficacy (M = 32.31, SD = 4.27) and resilience (M = 26.68, SD = 5.86) were high. Dissatisfaction with salary, autonomy, and staffing were evident. Conclusions: It is noteworthy that burnout was lower than expected given the scarce resource, difficult socio-politico-economic environment. High levels of self-efficacy and resilience likely mitigated a higher level of burnout. Adaptation enables these nurses to manage their critical conditions and practice holistic nursing, which may inspire hope among nurses in similar contexts.

Communicating with Persons Who Express Spiritual Struggle at the End of Life

This paper provides practical suggestions for how palliative care clinicians can address the expressions of spiritual struggle voiced by patients and their loved ones. In addition to practical tips for listening and responding, ethical guidance and opportunities for self-reflection related to spiritual care are briefly discussed. Principles to guide practice when the clinician is listening and responding to a patient expressing spiritual struggle include being non-directive, honoring (vs. judging) the patient's spiritual or religious experience, keeping the conversation patient-centered, focusing on the core theme of what the patient is expressing presently, using the patient's terminology and framing, and responding "heart to heart" or "head to head" to align with the patient. Ultimately, the goal of a healing response from a spiritual care generalist is to allow the patient to "hear" or "see" themselves, to gain self-awareness. To converse with patients about spirituality in an ethical manner, the clinician must first assess the patient's spiritual needs and preferences and then honor these.

Healing Communication: A Precision Instrument for Spiritual Care

OBJECTIVE

To describe holistic, empathic, and person-centered approaches to communication and apply these to the context of oncology nurse-provided responses to patients' expressions of spiritual concern.

DATA SOURCES

Conceptual, empirical, and practice literature about communication, primarily from the disciplines of psychology and communication sciences, is resourced to inform this practice-oriented discussion.

CONCLUSION

Holistic, empathetic, and person-centered models for communication are complementary, and although there is overlap, there is also distinct value added from each.

IMPLICATIONS FOR NURSING PRACTICE

Each model offers excellent guidance for nurses seeking to provide a therapeutic verbal response during spiritual care for people affected by cancer.

Spiritual needs among Koreans and Americans with advanced chronic illnesses: A cultural comparison

AIMS AND OBJECTIVES

This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross-cultural perspective.

BACKGROUND

Persons with serious or life-limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well-being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures.

DESIGN

A quantitative, cross-sectional, observational cross-cultural comparison was undertaken.

METHODS

The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness-related variables were also assessed using paper-and-pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis.

RESULTS

The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self-reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs.

CONCLUSIONS

In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently.

RELEVANCE TO CLINICAL PRACTICE

Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in-depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs.

Pharmacists' perspectives about spiritual care: A state-wide survey

BACKGROUND

Patients' religious and spiritual beliefs affect their health behaviors, health outcomes, and interactions with health care providers. Incorporating spiritual support in clinical care contributes positively to patient health outcomes. No known studies have explored spiritual care (SC) within the context of pharmacy practice.

OBJECTIVE

To examine pharmacist perspectives about SC, the frequency with which SC is incorporated in pharmacy practice, and the ways that pharmacists provide SC.

METHODS

Data were collected using a cross-sectional statewide survey. The 57-item questionnaire was mailed to 1000 randomly selected registered pharmacists in California in 2019. Descriptive statistics, Pearson correlation, independent samples t test, and chi-square tests were used to analyze the data.

RESULTS

Most of the 215 respondents were female (57.5%); the average length of work experience was 23.3 years (SD = 14.4). Just over half practiced in an urban setting (51.1%); similarly, half worked with terminally ill patients (50.2%). Most of the respondents were "somewhat" to "very spiritual" (77.8%) and "somewhat" to "very religious" (64.3%). Most pharmacists agreed that pharmacists should know about patients' spiritual concerns that may relate to their health (60.5%), that they should practice in a spiritually sensitive manner (73.4%), and that addressing patients' spiritual concerns improved their mental and physical health (76.7%). Respondents "rarely" to "very often or always" prayed privately for a patient (63.8%) and talked to patients about a spiritual and/or religious topic (51.2%), encouraged a patient to pray (49.3%), referred patients to their clergy or religious leader (39.5%), and prayed with a patient (33.5%). The frequency of spiritual services provided by pharmacists differed by their own spirituality, religiosity, and perception of institutional support (P < 0.05).

CONCLUSION

Most of the respondents were spiritual and religious and believed that spirituality is important for their patients. Thus, some provided SC to their patients. Future research is warranted to examine ethically appropriate strategies for pharmacists to provide SC.

What Chaplains Wish Nurses Knew: Findings From an Online Survey

This report presents qualitative data from a larger study that sought to examine chaplain perspectives on collaboration and nurse-provided spiritual care. This cross-sectional, descriptive study used online survey methods to distribute an investigator-designed questionnaire to a convenience sample of members of the Association of Professional Chaplains (N = 298). Findings were generated by written responses to 3 open questions that were thematically analyzed, as well as 1 quantitative item. Over half of these chaplains reported they did experience nurse "gatekeeping" at least occasionally. Themes from qualitative data revealed chaplains perceive nurses: lack understanding about the role and abilities of chaplains, sometimes overstep their role or impede the work of chaplains, and allow personal "baggage" to influence their collaboration with chaplains. Likewise, however, respondents respected nurses and were eager to collaborate. Naming these challenges to nurse-chaplain collaboration allows nurses and chaplains to begin to address them.

Dedication in a Difficult Context: Faith-Based Nursing in Haiti

ABSTRACT

Haitian nurses live in a precarious environment, with healthcare disparity and low wages. In the presence of significant politico-social-economic disparities, adverse effects of natural disasters, deleterious infrastructure, challenged self-boundaries, and the burden of caring for high-need patients, the authors sought a better understanding of nurses' perspective of the situation. During qualitative interviews, Haitian nurses in two faith-based hospitals (N = 17) reported feeling powerless yet exhibited resilience and dedication to nursing as a calling. These conditions cry out for support of nurses' self-care needs. Future interventions may help nurses identify better resources to care for themselves and guide their practice.

Cross-cultural Validation of the Spiritual Interests Related to Illness Tool-Korean Version

Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation-back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BACKGROUND

Although nurses typically view spiritual care as important, it is provided infrequently.

OBJECTIVES

This research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.

METHODS

This cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.

RESULTS

The most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.

CONCLUSIONS

Nurses need education about providing spiritual care to those with psychiatric mental health needs.

Sanctification of work and hospital nurse employment outcomes: An observational study

Aim

To explore nurse ascriptions of sacredness to work and measure its association with the employment outcomes of job satisfaction, burnout, organisational commitment, employee engagement and turnover intention.

Background

High portions of hospital nurses experience burnout. Many factors contributing to burnout also contribute to job dissatisfaction and other negative employment outcomes. Personal factors, such as religiosity, help nurses to cope with work.

Methods

Questionnaires measuring study variables were distributed to all nursing personnel at a faith‐based hospital in Los Angeles; 463 responded. Regression analyses allowed measurement of how sacredness ascribed to work (measured by Sanctification of Work Scale) and religiosity (measured by Duke Religiosity Index) were associated with the various employment outcomes.

Results

Sanctification of work consistently was found to be associated with less burnout and intention to leave, and more job satisfaction, employee engagement and organisational commitment.

Conclusion

The sacredness with which a nurse views work explains, in part, positive employment outcomes.

Implications for Nursing Management

Nurturing a sense of sacredness for work in nurses may provide them with an internal buffer against negative employment outcomes. Suggestions for creating rituals and educating nurses are offered.

Healthcare Chaplains' Perspectives on Nurse-Chaplain Collaboration: An Online Survey

The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain-nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.

Spiritual Perspectives, Spiritual Care, and Knowledge of Recovery Among Psychiatric Mental Health Nurses

BACKGROUND: Promoting spiritual well-being aids the mental health recovery process. Furthermore, nursing governance bodies and national mental health care regulators support spiritual care as a mental health-promoting approach. Although spiritual well-being is integral to quality of life in people with mental illness, little is known about the psychiatric mental health (PMH) nurses' provision of spiritual care. AIMS: Spiritual perspectives, frequency of spiritual care, and knowledge of recovery-oriented practice were measured. Variables were explored to identify a model of spiritual care. METHOD: A descriptive correlational cross-sectional design was employed. Analyses of data using descriptive statistics, correlations, and hierarchical multiple regression were conducted with a convenience sample of 171 PMH nurses. RESULTS: Participants scored high on measurement of spiritual perspectives, moderate on measurement of knowledge about recovery-oriented practice, and indicated a moderate degree of frequency of provision of spiritual care. Nurses who viewed themselves as "spiritual and religious" provided more frequent spiritual care and had higher levels of spiritual perspectives than those who viewed themselves as "spiritual but not religious." Significant contributors to spiritual care were spiritual perspectives and years of experience as a PMH nurse. Knowledge of recovery-oriented practice, however, did not contribute to a model of spiritual care. CONCLUSIONS: Nurses' spiritual perspectives, religiosity, and years of experience are factors that may explain nurse-provided spiritual care. Findings imply that spiritual and/or religious development may support PMH nurses to provide spiritual care.

Nurse Spiritual Therapeutics Scale: Psychometric evaluation among cancer patients

AIMS AND OBJECTIVES

To translate and validate the Nurse Spiritual Therapeutics Scale (NSTS) among cancer patients in Beijing, China.

BACKGROUND

Spirituality is an essential and integrating facet of persons. However, spirituality is a new concept for most people in mainland China.

METHODS

The NSTS was translated, adapted and content-validated. The psychometric evaluation was performed with data collected from cancer patients hospitalised in one of the two academic medical centres. After computing the scale content validity index (S-CVI), exploratory factor analysis was conducted to understand the content validity of the scale. Internal consistency was evaluated using Cronbach's alpha. GRRAS checklist was used to enhance the quality and transparency of this research.

RESULTS

Participants (N = 153) completed the 18-item C-NSTS. The S-CVI of the C-NSTS was 0.92. Cronbach's alpha of C-NSTS was 0.88. The C-NSTS was observed to include three factors (providing of religious support, listening to one's life perception and finding of one's value) and three additional items that did not adequately load onto a factor, yet were retained given their face value. Together, these factors explained 65.2% of the variance.

CONCLUSION

This initial psychometric evaluation of the 18-item C-NSTS demonstrated it to be a valid and reliable instrument to assess cancer patients' wishes regarding nurse-provided spiritual care in the Chinese culture.

RELEVANCE TO CLINICAL PRACTICE

These findings could be used for spiritual care, hospice and palliative care, undergraduate or graduate studies.

Nurse Spiritual Care: Prevalence and Correlates

Many nurses embrace spiritual care as integral to holistic care. Evidence documenting the frequency of spiritual care provided in acute care settings, however, is sparse and weak. For this cross-sectional, correlational study, data were collected from N = 554 tertiary care nurses using the Nurse Spiritual Care Therapeutics Scale (NSCTS) measuring their self-reported spiritual care with patients/family members over the last 72 to 80 hours at work. While the most frequently endorsed practices centered on presence, listening, and spiritual assessment, the overall NSCTS score remained modest ( M = 37; SD = 12; possible range = 17-85). Several associations were found; 32.4% of the variance in frequency of spiritual care provision was explained by nurse perception that spiritual issues come up often in the work setting, high nurse spirituality score, not working in pediatrics, and having received education about spiritual care. Findings allow for benchmarking of nursing practices that have often been invisible.

Hospitalized Patients' Responses to Offers of Prayer

Most Americans pray; many pray about their health. When they are hospitalized, however, do patients want an offer of prayer from a healthcare provider? This project allowed for the measurement of hospitalized patient's responses to massage therapists' offers of a colloquial prayer after a massage. After the intervention, 78 patients completed questionnaires that elicited quantitative data that were analyzed using uni- and bivariate statistical analyses. In this sample, 88% accepted the offer of prayer, 85% found it helpful, and 51% wanted prayer daily. Patients may welcome prayer, as long as the clinician shows "genuine kindness and respect."

Nurse Religiosity and Spiritual Care: An Online Survey

This study measured the frequency of nurse-provided spiritual care and how it is associated with various facets of nurse religiosity. Data were collected using an online survey accessed from the home page of the Journal of Christian Nursing. The survey included the Nurse Spiritual Care Therapeutics Scale, six scales quantifying facets of religiosity, and demographic and work-related items. Respondents ( N = 358) indicated high religiosity yet reported neutral responses to items about sharing personal beliefs and tentativeness of belief. Findings suggested spiritual care was infrequent. Multivariate analysis showed prayer frequency, employer support of spiritual care, and non-White ethnicity were significantly associated with spiritual care frequency (adjusted R² = .10). Results not only provide an indication of spiritual care frequency but empirical encouragement for nurse managers to provide a supportive environment for spiritual care. Findings expose the reality that nurse religiosity is directly related, albeit weakly, to spiritual care frequency.

Researching in Collectivist Cultures

Commonalities are presented from the experiences of U.S. nurse researchers who conducted studies in India, Jordan, Aotearoa/New Zealand, and Trinidad and Tobago. While planning research, it is important to engage collaborators who are members of the culture to be studied to understand what are culturally appropriate aims and methods. It is also vital to observe cultural etiquette, especially while gaining entrée and collecting data. Issues related to data collection include timing it around local holidays and events, and adapting individualist methods for obtaining consent and data to be more respectful for those in a collectivist culture. Care must be taken to give back, to sharing findings, and insure sustainability for future research in the host culture. Based on these and other reflections, recommendations are offered to support investigators planning research in a culture that is not their own.

Modesty Among Muslim Women: Implications for Nursing Care

Modesty is central to Islamic life. Modesty is exemplified in dress and behavior with persons of the opposite sex. Because ethical nursing care requires respecting patient culture and religiosity, nurses should be able to provide care that respects Muslim interpretations of modesty.

Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer

OBJECTIVES

To review research on spiritual perspectives and spiritual care of adolescents and young adults (AYA) living with cancer.

DATA SOURCES

Peer-reviewed publications, book chapters, and websites of professional organizations.

CONCLUSION

There is a paucity of research specifically investigating AYA spirituality and lack of AYA-sensitive instruments to measure spirituality. Research that applies robust scientific methods to the study of AYA spirituality is needed. Research that provides evidence on which to base best practices for spiritual care that supports AYA spiritual well-being is likewise necessary.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can influence AYA health-related outcomes and experiences by providing ethical and evidence-based spiritual nurture.

Psychometric evaluation of the Nurse Spiritual Care Therapeutics Scale

To measure nurse-provided spiritual care, robust instrumentation is needed. This study psychometrically evaluated an instrument that operationalizes frequency of nurse-provided spiritual care, the Nurse Spiritual Care Therapeutics Scale (NSCTS). The 17-item NSCTS, with an established content validity index of 0.88, was administered online to registered nurses (RNs) in four hospitals. Responses from 554 RNs (24% response rate), most who identified as Christian, provided evidence for the NSCTS' reliability and validity. Internal reliability was supported by an alpha coefficient of .93. Validity was evidenced by item-total correlations ranging from .40 to .80, low to modest direct correlations between the NSCTS and Daily Spiritual Experience Scale and Duke University Religiosity Index, and strong loadings between 0.41 and 0.84 on one factor (explaining 49.5% of the variance) during exploratory factor analysis.

Does the DVR(®) plate restore bony anatomy following distal radius fractures?

INTRODUCTION

Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR^® plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted ‘normal’ values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction.

METHODS

A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR^® plate was undertaken.

RESULTS

Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon.

CONCLUSIONS

The DVR^® plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.