Integrating spiritual care into nursing education and practice: Strategies utilizing Open Journey Theory

Hope that provides strength in illness-patients' perspectives: Nursing students' narratives after conversation with patients

BACKGROUND

The aim of this article is to explore sources of hope for patients by using patients' narratives and perspectives on how they find hope when facing illness. Hope enables people to endure suffering and can be critical to how people cope with illness. Hope is not a singular phenomenon, so nurses need to understand how to support the patients' sources of hope.

METHODS

We used a qualitatively descriptive design with qualitative content analysis. We examined reflective notes from 385 first-year nursing students after they had had a conversation with patients with disease experiences following Graneheim and Lundman's description of analysis. The conversation with the patients/persons was related to sources of hope and strength, who they turned to when they needed help, and if they were available. After the conversation, the students had to write a reflective log with a summary of the conversation.

RESULTS

We found four categories that explained how patients found hope: (1) relational hope, (2) spiritual hope, (3) hope in nature and (4) hope in oneself. Most of the patients found hope in more than one of these categories.

CONCLUSION

It is important for nursing to have knowledge about patients' narratives about how they build and sustain hope during times of illness. Nursing can contribute to promoting hope and thus alleviating patients' suffering. The four categories in this study can serve as a guide for nurses to assess and support patients' hope and encourage them to find their strength through different sources.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

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.

Building Spiritual Care Competency in Undergraduate Psychiatric Mental Health Nursing Students: A Quality Improvement Project

Purpose: The spiritual care of patients is often overlooked in health care as many nurses are unprepared to provide competent, holistic care that addresses patients' spiritual needs. Since undergraduate academic instruction prepares nurses for practice, innovative strategies that train pre-licensure nurses to care for the spiritual needs of patients are essential. Design: A course needs assessment identified spiritual care as the most deficient competency for undergraduate psychiatric students. A three-phase quality improvement project designed to increase student awareness and practice of spiritual care included (a) development of a quality improvement plan, (b) implementation, and (c) outcome evaluation. Methods: Spiritual care was introduced into the Spring 2020 semester through didactic content and experiential practice. Additionally, an evidence-based spiritual assessment tool (i.e., HOPE questions) was integrated into the course to train students for use in clinical and simulation. Surveys were used to compare the 2019 and 2020 cohorts. Findings: Results showed a statistically significant increase in students' perception of spiritual care competency after project completion. Conclusions: Future implications include the use of similar methods to improve spiritual care competency for pre-licensure nursing students. Keywords: Spiritual care, undergraduate nurse, spiritual assessment.

Development and Validation of the Nursing Care and Religious Diversity Scale (NCRDS)

(1) Background: In response to the impact of religious intervention on health outcomes and the importance of documenting how nurses experience the spiritual need of 392 hospitalized patients, it is vital to provide the nursing profession with instruments to evaluate these spiritual aspects. This study describes the development and validation of the Nursing Care and Religious Diversity Scale (NCRDS); (2) Methods: A two-step design was used for NCRDS translation and psychometric validation. The tool design was developed in the first step, while the psychometric characteristics were tested in the second step. An inductive study was conducted to test the validity and reliability of the NCRDS tool. The overall sample consisted of 317 nurses; (3) Results: The final instrument comprised 25 items in five dimensions. The construct validity indicated five dimensions. The face and content validity were adequate. Test-retest reliability displayed good stability, and internal consistency (Cronbach's α) was acceptable (0.83); (4) Conclusions: Initial testing of the NCRDS suggested that it is a valid and reliable instrument to evaluate individuals in religious diversity, with five dimensions for evaluating the meaning of spirituality and individual belief, the religious healthcare environment, educational adequacy, spiritual and religious needs, and religious plurality.

Developing and testing the EPICC Spiritual Care Competency Self-Assessment Tool for student nurses and midwives

AIMS AND OBJECTIVES

To develop and psychometrically test a self-assessment tool that measures undergraduate nursing and midwifery students' perceptions of spiritual care competence in health care practice.

BACKGROUND

Spiritual care is part of nurses/midwives' responsibility. There is a need to better benchmark students' competency development in spiritual care through their education. The EPICC Spiritual Care Education Standard served as groundwork for the development of the EPICC Spiritual Care Competency Self-Assessment Tool.

DESIGN

Cross sectional, mixed methods design. A STROBE checklist was used.

METHODS

The Tool (available in English, Dutch and Norwegian) was developed by an international group. It was tested between July-October 2020 with a convenience sample of 323 nursing/midwifery students at eight universities in five countries. The Tool was tested for validity using Kaiser-Meyer-Olkin (KMO) test, exploratory and confirmatory factor analysis, one-way ANOVA and independent samples t test. The reliability was tested by Cronbach's alpha coefficient. Qualitative data were analysed using thematic analysis.

RESULTS

The KMO test for sampling adequacy was 0.90. All, but two, items were related to the same factor. Cronbach's alpha coefficient for the Tool was 0.91. Students found the Tool easy to use, and they gained new insights by completing it. However, students felt that some questions were repetitive and took time to complete.

CONCLUSIONS

The Tool has construct and discriminant validity, and high internal consistency (is reliable). In addition, students found the Tool useful, especially in early stages of education.

RELEVANCE TO CLINICAL PRACTICE

The Tool affords student nurses and midwives the opportunity to self-evaluate their knowledge, skills and attitudes about spirituality and spiritual care. The Tool offers students, educators and preceptors in clinical practice a tangible way of discussing and evaluating spiritual care competency.

Theories informing technology enhanced learning in nursing and midwifery education: A systematic review and typological classification

BACKGROUND

Learning is a complex process involving internal cognitive processes and external stimuli from curricula, pedagogical strategies, and the learning environment. Theories are used extensively in higher education to understand the intricacies of adult learning and improve student outcomes. Nursing and midwifery education uses a range of technology enhanced learning (e-learning) approaches, some of which are underpinned by theoretical frameworks.

OBJECTIVE

Synthesise literature on theories that inform technology enhanced learning in nursing and midwifery education.

DESIGN

A systematic review.

DATA SOURCE

CINAHL, ERIC, MEDLINE and PubMed were searched for relevant studies (2000-2021). Reference lists of related literature reviews were hand searched.

REVIEW METHODS

Title and abstract, followed by full texts were screened by two reviewers independently using predefined eligibility criteria. Quality appraisal was not undertaken. Data were extracted and Merriam and Bierema's typology of adult learning theories used to categorise theories in each study.

RESULTS

Thirty-three studies were included, incorporating twenty-nine distinct learning theories from the behaviourist, cognitivist, constructivist, and social cognitivist domains, with constructivist being the most widely used. Kolb's Experiential Learning Theory and Driscoll's Constructivist Learning Theory were the most commonly reported theories. The population of learners were mainly undergraduate nursing students who used a range of online, mobile, blended or computerised learning, virtual reality, or digital forms of simulation, primarily in university settings. Theories were employed to inform the technology enhanced learning intervention or to help explain how these could improve student learning.

CONCLUSION

This review highlighted a range of theories, particularly constructivist approaches, that underpin research on technology enhanced learning in nursing education, by informing or explaining how these digital interventions support learning. More rigorous research that examines the myriad of theoretical frameworks and their effectiveness in informing and explaining technology enhanced learning is needed to justify this approach to pedagogical nursing research and practice.

Improving psychiatric nurses' competencies in spiritual care and integration of clients' religion/spirituality into mental healthcare: outcomes of an online spiritual care training program

BACKGROUND

Religion/spirituality (R/S), which is associated with individuals' well-being and psychological health, plays a significant role in most clients' lives in healthcare systems. Although clients in mental healthcare settings prefer their R/S to be employed in nursing care, R/S has neither been adequately integrated into mental healthcare nor discussed in the assessment and nursing interventions of mental healthcare. Evidence shows that most psychiatric nurses receive little or no training in spiritual care (SC) and are unable to integrate clients' R/S into mental healthcare. To address this gap, the present study aimed to investigate the effects of an online SC training program on psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare.

METHODS

This experimental study was conducted with nurses working in a psychiatric hospital affiliated with a large University of Medical Sciences in southeast Iran. Random sampling was performed and 95 nurses were assigned to the intervention (n = 50) and control (n = 45) groups. Online SC training was conducted for the intervention group in four sessions over four weeks. Data were collected using the Self-Assessment of Spiritual Care Competency and R/S Integrated Practice Assessment Scale before and one month after the training program.

RESULTS

There were no significant differences between the two groups before training (p > 0.05). After the training, nurses in the intervention group obtained significantly higher scores in competencies in SC and integration of clients' R/S into mental healthcare compared to the control group, with a considerable effect size (P < 0.05).

CONCLUSION

The online training program positively affected psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare. Since SC is a critical need for clients, specifically in mental healthcare settings, nurses must receive continuous education to provide SC to various clients.

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

AIMS AND OBJECTIVES

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

BACKGROUND

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

DESIGN

A scoping review using the PRISMA-ScR checklist.

METHOD

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

RESULTS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

Mental Health Staff Perspectives on Spiritual Care Competencies in Norway: A Pilot Study

Spirituality and spiritual care have long been kept separate from patient care in mental health, primarily because it has been associated with psycho-pathology. Nursing has provided limited spiritual care competency training for staff in mental health due to fears that psychoses may be activated or exacerbated if religion and spirituality are addressed. However, spirituality is broader than simply religion, including more existential issues such as providing non-judgmental presence, attentive listening, respect, and kindness (International Council of Nursing [ICN], 2012). Unfortunately, healthcare personnel working in mental health institutions are not well prepared to address spiritual concerns or resources of their patients (Cone and Giske, 2018). Therefore, a mixed-method pilot study was conducted using a self-assessment survey tool to examine spiritual care competencies of mental health staff in Norway and to understand the perspectives of mental health staff in the Scandinavian context (Stockman, 2018). Five questions and comments related to survey items provided rich qualitative data. While only a small pilot with 24 participants, this study revealed a need for spiritual care educational materials targeted specifically for those who work in mental health, materials that address the approach of improving attitudes, enhancing skills, and increasing knowledge related to spirituality and spiritual care of patients.

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.

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

Soul care in the hospital nursing context: an analysis based on Transpersonal Caring

Abstract Objective: To unveil spirituality in the care process of nursing professionals in the hospital context under the lens of Transpersonal Caring. Method: A descriptive-exploratory study implementing a qualitative approach conducted with professionals from the nursing team in a general hospital in Bahia, using a semi-structured interview submitted to the content analysis technique and analyzed from the perspective of the Theory of Transpersonal Caring theoretical framework. Results: There were 16 professionals who participated. It was found that the nursing team perceives the patient and family’s demand for spiritual care, and sometimes even has experiences and suggestions for interventions, especially those which cultivate faith and spirituality, but this does not happen with most of these professionals who demonstrate difficulties, unpreparedness and fear of taking on such care responsibility. Conclusion: There is a need to develop better interaction/spiritual care skills by nursing professionals in the challenging context of the search for meaning, faith and hope mobilized by the disease experience. The Systematization of Spiritual Nursing Care and Transpersonal Caring stand out as appropriate devices, which provide consistent subsidies for undertaking spiritual care.

Embedding spiritual care into everyday nursing practice

This article explains how patients' spiritual needs can be embedded into everyday nursing practice, rather than being seen as an additional task for nurses to undertake. It outlines an integrated person model of care, which involves the nurse using the unique contact involved in providing physical care to meet the patient's spiritual needs. In addition, nurses can use the principles of therapeutic relationships such as empathy and providing a non-judgemental presence to support spiritual care, as well as respecting patients' dignity and individuality. This article also describes techniques for discussing spirituality with patients, and explains how touch can be a useful therapeutic intervention that can enhance patients' spiritual well-being.

Interprofessional collaboration between health sciences librarians and health professions faculty to implement a book club discussion for incoming students

Background

The following case example provides an overview of one innovative way to engage health professions faculty with health sciences librarians in the development of an interprofessional book discussion and identifies strategies to address implementation challenges. Academic health sciences librarians worked with the Interprofessional Education (IPE) Steering Committee to organize interprofessional book discussion groups for incoming health professions students. This inaugural book discussion brought together students and faculty of different disciplines to engage students in “learning from, with, and about” other professions.

Case Presentation

When Breath Becomes Air, by Paul Kalanithi, allowed involved discussions on important health sciences issues. The project included outreach, designing pre- and post-surveys, scheduling participants, and communicating with all participants before, during, and after the event. A total of seventy-nine students and thirty-six faculty, representing all health professions schools, participated in the small group IPE book discussions over two weeks.

Conclusions

Small group book discussions have been shown to be an effective tool to engage students and faculty in IPE. The results of the participant surveys were positive, and the IPE Steering Committee found value in including health sciences librarians throughout the process. Lessons learned from the pilot project include needing an efficient scheduling system, strongly communicating at all stages of the project, and starting the planning process months ahead of time. The IPE Steering Committee plans to conduct similar book discussions every fall semester moving forward and explore options for other IPE events.

Psychosocial Effects of a Holistic Ayurvedic Approach to Well-being in Health and Wellness Courses

Background

As individuals are increasingly attending health and wellness courses outside of the conventional medical system, there is a need to obtain objective data on the effects of those programs on well-being.

Methods

In total, 154 men and women (mean age 54.7 years; range 25–83) participated in 3 different holistic wellness programs based on Ayurvedic Medicine principles (Seduction of Spirit, Journey into Healing, and Perfect Health) or a vacation control group. Psychosocial outcomes included spirituality (Delaney Spirituality Scale), mindful awareness (Mindful Attention Awareness Scale), psychological flexibility (Acceptance and Action Questionnaire), mood (Center for Epidemiology Studies-Depression), and anxiety (Patient-Reported Outcomes Measurement System Anxiety Scale).

Results

Participants in the Seduction of Spirit (P < .004), Journey into Healing (P < .05), and Perfect Health (P < .004) courses showed significant increases in spirituality as compared to vacation controls. Participants in Seduction of Spirit (P < .007) also showed significant increases in mindfulness as compared to vacation controls. Participants in the Seduction of Spirit (P < .001) and Journey into Healing (P < .05) courses showed significant decreases in depressed mood as compared to those in the Perfect Health and vacation control groups. All study participants showed similar increases in psychological flexibility (P < .01) and decreases in anxiety (P < .01).

Conclusion

Participation in wellness courses that incorporate a mind–body–spirit approach to health improves multiple domains of psychosocial well-being, which persists even after course participation.