Efficacy of a self-study programme to teach spiritual care

Implementing a Spiritual Care Subject for Holistic Nursing Practice: A Mixed Method Study

Aim: The aims of this sequential explanatory mixed method study were twofold 1. Firstly, to evaluate the implementation of a spiritual care subject in a nursing program. 2. Secondly, to examine undergraduate nursing students' perceptions of providing spiritual care within their holistic care practice. Background: Studies conducted internationally indicate many nurses feel inadequately prepared to provide holistic care inclusive of spiritual care due to insufficient spiritual care education. Design: Two phase, sequential explanatory mixed method design which comprised of a quantitative study followed by a qualitative study. Methods: The setting was an Australian faith-based university. Participants comprised of undergraduate nursing students who were enrolled in a spiritual care subject. Findings: Two study findings emerged: 1. Participants' knowledge and practice of spiritual care were transformed by the spiritual care subject, and 2. The spiritual care subject broadened perceptions of spiritual care so participants viewed themselves more equipped to provide spiritual care in their holistic care provision. Conclusion: The spiritual care subject had an affirmative influence on participants' perceptions of providing spiritual care within holistic care practice. The findings have implications for nurse educators to consider how spiritual care content can be included within undergraduate nursing curricula.

Spiritual needs in Denmark: a population-based cross-sectional survey linked to Danish national registers

Background

Spiritual aspects of the human condition may give rise to spiritual pain and suffering, especially in the face of illness or difficult life situations. A growing volume of research documents the effects of religiosity, spirituality, meaning, and purpose on health. In supposedly secular societies, however, spiritual matters are rarely addressed in healthcare. This is the first large scale study to examine spiritual needs in Danish culture, and the largest study on spiritual needs to date.

Methods

A population-based sample of 104,137 adult (≥18 yrs) Danes were surveyed cross-sectionally (the EXICODE study) and responses were linked to data from Danish national registers. The primary outcome was spiritual needs in four dimensions: religious, existential, generativity, and inner peace. Logistic regression models were fitted to examine the relationship between participant characteristics and spiritual needs.

Findings

A total of 26,678 participants responded to the survey (25.6%). Of included participants 19,507 (81.9%) reported at least one strong or very strong spiritual need in the past month. The Danes scored highest on inner peace needs, followed by generativity, then existential, and lastly, religious needs. Affiliating as religious or spiritual, regularly meditating or praying, or reporting low health, low life satisfaction, or low well-being increased the odds of having spiritual needs.

Interpretation

This study demonstrated that spiritual needs are common among Danes. These findings have important implications for public health policies and clinical care. Care for the spiritual dimension of health is warranted as part of holistic, person-centered care in what we term 'post-secular' societies. Future research should inform how spiritual needs might be addressed in healthy and diseased populations in Denmark and other European countries and the clinical effectiveness of such interventions.

Funding

The paper was supported by the Danish Cancer Society (R247-A14755), The Jascha Foundation (ID 3610), The Danish Lung Foundation, AgeCare, and the University of Southern Denmark.

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

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

Factors influencing nurse spiritual care practices at the end of life: A systematic review

OBJECTIVES

The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients.

METHODS

A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses' spiritual/existential care practices toward adult end-of-life patients.

RESULTS

The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources.

SIGNIFICANCE OF RESULTS

A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

The Relationship Between Nursing Students' Perceptions of Spirituality and Spiritual Care and their Personal Values

This study involved a descriptive and correlational study to determine how nursing students at one university in Turkey perceive spiritual care. The data were collected through a personal information form, the Spiritual Care-Giving Scale and the Portrait Values Questionnaire. The data were analyzed using Pearson's Correlation Analysis and hierarchical regression analysis. There was a correlation between perceptions of personal values and spiritual care. It was observed that the values that predicted perception of spiritual care were the values of hedonism and tradition. Therefore, it is recommended to plan value-based training, especially on subjective concepts such as spiritual care and plan simulation-based training where students can measure the results of their behaviors and reactions in given scenarios.

The Daily Spiritual Experience Scale: Empirical Relationships to Resiliency-Related Outcomes, Addictions, and Interventions

The Daily Spiritual Experience Scale (DSES) is a 16-item self-report measure designed to assess a set of experiences that may occur in the context of daily life for many different kinds of people. These include awe, a merciful attitude, giving other-centered love, deep inner peace, finding strength, guidance, or consolation from a transcendent source, among others. The DSES includes theistic and non-theistic language and alternatives, and has proven useful for those from many religions and for the unaffiliated. Since its original publication, it has been translated into over 40 languages, used in hundreds of published studies, and adopted for use in many practical settings. Empirically, the DSES predicts greater resilience, stress buffering, post-traumatic growth, and a sense of meaning in the face of illness, trauma, and daily stressors, as well as less substance abuse and burnout. Intervention studies using the DSES show that a variety of interventions can increase the frequency of these experiences. In this article, we will provide a brief overview of the scale and review its use in the empirical literature with respect to resilience and related outcomes. Findings suggest that the experiences measured by the DSES may serve as a resource for those experiencing distress of various kinds.

Nursing Students' Perception Levels of Spirituality and Spiritual Care in Turkey

The present study was conducted to determine nursing students' perception levels of spirituality and spiritual care and the factors affecting these levels. The study was carried out in the nursing faculty of a university located in eastern Turkey between April and June 2019. The study population was made up of students studying within a department of nursing (n = 1250), and involved a sample size of 420 students, determined by power analysis. Data were obtained from an 'Introductory Information Form' that included students' sociodemographic characteristics and questions related to spiritual care and the Spirituality and Spiritual Care Rating Scale (SSCRS). Students scored, on average, 59.8 ± 9.7 on the SSCRS. Gender, year of undergraduate education, father's education level, knowledge of spiritual care, beliefs on the relationship between spiritual care and nursing care, and the ability to meet patients' spiritual needs were variables with an impact on the total SSCRS scores (p < 0.05). The findings show that spiritual care perception levels of nursing students were high.

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.

A spiritual education course to enhance nursing students' spiritual competencies

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students' spiritual competencies, individual spiritual growth, and the ability to care for patients.

Pharmacy and Nursing Students' Perceptions Regarding the Role of Spirituality in Professional Education and Practice

Objective. To compare first-year student pharmacists and nursing students with respect to their spirituality and perceptions of the role of spirituality in professional education and practice. Methods. This was a five-year, cross-sectional study. All first-year student pharmacists and nursing students were invited to participate in the survey during the first week of the fall semester in 2012 through 2016. Descriptive and inferential statistics were used to analyze the data. Results. A total of 1,084 students participated, including 735 student pharmacists and 349 nursing students. Significant differences in baseline demographics were noted between the groups. Students in both groups reported having frequent spiritual experiences. A significantly larger percentage of nursing students reported these experiences compared to student pharmacists. Furthermore, compared with student pharmacists, nursing students were more likely to anticipate that spirituality would play a role in their academic course work (76% vs 58%) and professional practice (90% vs 74%). Conclusion. Student pharmacists and nursing students reported having frequent spiritual experiences, and both groups anticipated that spirituality would be incorporated into their education and professional practice.

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 care in nursing: an overview of the measures used to assess spiritual care provision and related factors amongst nurses

Background and aim of the work:

Spiritual wellbeing has important implications for an individual’s health and wellbeing. Whilst the provision of spiritual care and assessment of spiritual needs is a vital part of the nurse’s role, literature suggests that nurses do not always engage in spiritual care with their patients or assess their spiritual needs. This review aims to ascertain wider reasons for this inconsistent spiritual care delivery by nurses to their patients.

Methods:

A review of the literature was conducted to identify instruments available relating to nursing professionals spiritual care and assessment.

Results:

14 measures relating to spiritual care and assessment were identified covering the key domains of: ‘Beliefs and values and attitudes around spiritual care,’ ‘Frequency of provision or extent to which they provide spiritual care or willingness,’ ‘Respondents’ level of knowledge around spirituality and spiritual care,’ ‘Ability to respond to spiritual pain,’ and ‘Multiple Domains: beliefs and attitudes around spirituality and spiritual care, amount of preparation, training and knowledge, spiritual care practices, perceived ability and comfort with provision and perceived barriers to provision.’

Conclusions:

A lack of standardisation in the conceptualisation and assessment of spiritual care causes challenges in reviewing, however several themes do emerge. In general student and qualified nurses are aware of the importance of providing spiritual care and are hindered by a lack of education about how best to implement such care. The religiosity of individual nurses or their training institutions seems to be of less importance than training in spiritual care interventions. (www.actabiomedica.it)

The Impact of Patient and Family Advisors on Critical Care Nurses' Empathy

OBJECTIVE

The objective of this study was to determine if patient and family advisors' (PFAs) collaboration in an educational program could increase the empathy levels of intensive care unit (ICU) nurses.

BACKGROUND

Data suggest that nurse empathy is on the decline. Ensuring that nurses consistently empathize with patients and families helps create positive patient experiences.

METHODS

Thirty nurses participated in a PFA-designed educational intervention using simulation-based role playing. The Toronto Empathy Questionnaire (TEQ) was used to measure empathy before and after the intervention.

RESULTS

The TEQ empathy scores increased significantly after nurses completed the PFA-designed educational program. Younger nurses (<30 years) improved on average 3.03 ± 3.6 points compared with older nurses (>30 years), who improved, on average, only 0.43 ± 2.06 points (t24.4 = 2.46, P = .021). For the changes in TEQ scores from preintervention to postintervention, age was significantly associated with improvements in TEQ scores.

CONCLUSIONS

Patient and family advisors can positively impact empathy among ICU nurses.

Implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings: a pilot RCT and feasibility study

Background

Concerns about the degree of compassion in health care have become a focus for national and international attention. However, existing research on compassionate care interventions provides scant evidence of effectiveness or the contexts in which effectiveness is achievable.

Objectives

To assess the feasibility of implementing the Creating Learning Environments for Compassionate Care (CLECC) programme in acute hospital settings and to evaluate its impact on patient care.

Design

Pilot cluster randomised trial (CRT) and associated process and economic evaluations.

Setting

Six inpatient ward nursing teams (clusters) in two English NHS hospitals randomised to intervention (n = 4) or control (n = 2).

Participants

Patients (n = 639), staff (n = 211) and visitors (n = 188).

Intervention

CLECC is a workplace educational intervention focused on developing sustainable leadership and work team practices (dialogue, reflective learning, mutual support) theorised to support the delivery of compassionate care. The control setting involved no planned staff team-based educational activity.

Main outcome measures

Quality of Interaction Schedule (QuIS) for staff–patient interactions, patient-reported evaluations of emotional care in hospital (PEECH) and nurse-reported empathy (as assessed via the Jefferson Scale of Empathy).

Data sources

Structured observations of staff–patient interactions; patient, visitor and staff questionnaires and qualitative interviews; and qualitative observations of CLECC activities.

Results

The pilot CRT proceeded as planned and randomisation was acceptable to teams. There was evidence of potential contamination between wards in the same hospital. QuIS performed well, achieving a 93% recruitment rate, with 25% of the patient sample cognitively impaired. At follow-up there were more positive (78% vs. 74%) and fewer negative (8% vs. 11%) QuIS ratings for intervention wards than for control wards. In total, 63% of intervention ward patients achieved the lowest possible (i.e. more negative) scores on the PEECH connection subscale, compared with 79% of control group patients. These differences, although supported by the qualitative findings, are not statistically significant. No statistically significant differences in nursing empathy were observed, although response rates to staff questionnaire were low (36%). Process evaluation: the CLECC intervention is feasible to implement in practice with medical and surgical nursing teams in acute care hospitals. Strong evidence of good staff participation was found in some CLECC activities and staff reported benefits throughout its introductory period and beyond. Further impact and sustainability were limited by the focus on changing ward team behaviours rather than wider system restructuring. Economic evaluation: the costs associated with using CLECC were identified and it is recommend that an impact inventory be used in any future study.

Limitations

Findings are not generalisable outside hospital nursing teams, and this feasibility work is not powered to detect differences attributable to the CLECC intervention.

Conclusions

Use of the experimental methods is feasible. The use of structured observation of staff–patient interaction quality is a promising primary outcome that is inclusive of patient groups often excluded from research, but further validation is required. Further development of the CLECC intervention should focus on ensuring that it is adequately supported by resources, norms and relationships in the wider system by, for instance, improving the cognitive participation of senior nurse managers. Funding is being sought for a more definitive evaluation.

Trial registration

Current Controlled Trials ISRCTN16789770.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 33. See the NIHR Journals Library website for further project information. The systematic review reported inChapter 2was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, the University of Örebro and the Karolinska Institutet.

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.

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.

A critical analysis of scales to measure the attitude of nurses toward spiritual care and the frequency of spiritual nursing care activities

Quantitative studies have assessed nurses' attitudes toward and frequency of spiritual care [SC] and which factors are of influence on this attitude and frequency. However, we had doubts about the construct validity of the scales used in these studies. Our objective was to evaluate scales measuring nursing SC. Articles about the development and psychometric evaluation of SC scales have been identified, using, Web of Science, and CINAHL, and evaluated with respect to the psychometric properties and item content of the scales. Item content was evaluated by each of the five authors with respect to the following questions: Does the item (1) reflect a general opinion about SC instead of a personal willingness to offer SC; (2) reflect general psychosocial care instead of specific SC; (3) focus solely on religious care; (4) contain the words 'spiritual' (care/needs/health/strengths, etc.); and (5) contain multiple propositions, or have an unclear meaning? We found eight scales. Psychometric analysis of these scales was often meager and the items of all but one scale suffered from two or more of the five problems described above. This leads us to conclude that many quantitative results in this area are based on findings with questionable scales. Suggestions for improvements are provided.

Undergraduate nurse students' perspectives of spiritual care education in an Australian context

BACKGROUND

The Australian Nursing and Midwifery Accreditation Council competency standards highlight the need to provide holistic care that is inclusive of spiritual care. Literature shows that internationally many nurses feel unsure of how to provide spiritual care which has been attributed to a lack of spiritual care education during undergraduate nursing programs.

AIM

This study explores the impact of a spiritual care subject in an undergraduate nursing program in an Australian tertiary institution.

METHOD

Qualitative research design using in-depth semi-structured interviews.

SETTING

A tertiary institution with a Christian orientation in Sydney, Australia.

PARTICIPANTS

Six undergraduate nursing students who had completed the spiritual care subject.

DATA RESULTS

Two themes emerged from the data: Seeing the person as a whole and Being with the person.

CONCLUSIONS

The spiritual care subject had a positive impact on the perceptions of undergraduate nursing students. In particular students perceived themselves more prepared to provide holistic care that was inclusive of spiritual care.

Interventions for compassionate nursing care: A systematic review

BACKGROUND

Compassion has been identified as an essential element of nursing and is increasingly under public scrutiny in the context of demands for high quality health care. While primary research on effectiveness of interventions to support compassionate nursing care has been reported, no rigorous critical overview exists.

OBJECTIVES

To systematically identify, describe and analyse research studies that evaluate interventions for compassionate nursing care; assess the descriptions of the interventions for compassionate care, including design and delivery of the intervention and theoretical framework; and to evaluate evidence for the effectiveness of interventions.

REVIEW METHODS

Published international literature written in English up to June 2015 was identified from CINAHL, Medline and Cochrane Library databases. Primary research studies comparing outcomes of interventions to promote compassionate nursing care with a control condition were included. Studies were graded according to relative strength of methods and quality of description of intervention. Narrative description and analysis was undertaken supported by tabulation of key study data including study design, outcomes, intervention type and results.

RESULTS

25 interventions reported in 24 studies were included in the review. Intervention types included staff training (n=10), care model (n=9) and staff support (n=6). Intervention description was generally weak, especially in relation to describing participants and facilitators, and the proposed mechanisms for change were often unclear. Most interventions were associated with improvements in patient-based, nurse-based and/or quality of care outcomes. However, overall methodological quality was low with most studies (n=16) conducted as uncontrolled before and after studies. The few higher quality studies were less likely to report positive results. No interventions were tested more than once.

CONCLUSIONS

None of the studies reviewed reported intervention description in sufficient detail or presented sufficiently strong evidence of effectiveness to merit routine implementation of any of these interventions into practice. The positive outcomes reported suggest that further investigation of some interventions may be merited, but high caution must be exercised. Preference should be shown for further investigating interventions reported as effective in studies with a stronger design such as randomised controlled trials.

An Online Educational Program Improves Pediatric Oncology Nurses’ Knowledge, Attitudes, and Spiritual Care Competence

This study evaluated the potential impact of an online spiritual care educational program on pediatric nurses’ attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. It was hypothesized that the intervention would increase nurses’ positive attitudes toward and knowledge of spiritual care and increase nurses’ level of perceived spiritual care competence. A positive correlation was expected between change in nurses’ perceived attitudes toward and knowledge of spiritual care and change in nurses’ perceived spiritual care competence. A prospective, longitudinal design was employed, and analyses included one-way repeated-measures analysis of variance, linear regression, and partial correlation. Statistically significant differences were found in nurses’ attitudes toward and knowledge of spiritual care and nurses’ perceived spiritual care competence. There was a positive relationship between change scores in nurses’ attitudes toward and knowledge of spiritual care and nurses’ spiritual care competence. Online spiritual care educational programs may exert a lasting impact on nurses’ attitudes toward and knowledge of spiritual care and their competence to provide spiritual care to children with cancer at the end of life. Additional studies are required to evaluate the direct effects of educational interventions patient outcomes.

Factors contributing to student nurses'/midwives' perceived competency in spiritual care

BACKGROUND

The spiritual part of life is important to health, well-being and quality of life. Spiritual care is expected of nurses/midwives, but it is not clear how students can achieve competency in spiritual care at point of registration as required by regulatory bodies.

AIM

To explore factors contributing to undergraduate nurses'/midwives' perceived competency in giving spiritual care.

DESIGN

A pilot cross-sectional, multinational, correlational survey design.

METHOD

Questionnaires were completed by 86% (n=531) of a convenience sample of 618 undergraduate nurses/midwives from six universities in four countries in 2010. Bivariate and multivariate analyses were performed.

RESULTS

Differences between groups were small. Two factors were significantly related to perceived spiritual care competency: perception of spirituality/spiritual care and student's personal spirituality. Students reporting higher perceived competency viewed spirituality/spiritual care broadly, not just in religious terms. This association between perceived competency and perception of spirituality is a new finding not previously reported. Further results reinforce findings in the literature that own spirituality was a strong predictor of perceived ability to provide spiritual care, as students reporting higher perceived competency engaged in spiritual activities, were from secular universities and had previous healthcare experience. They were also religious, practised their faith/belief and scored highly on spiritual well-being and spiritual attitude/involvement.

CONCLUSIONS

The challenge for nurse/midwifery educators is how they might enhance spiritual care competency in students who are not religious and how they might encourage students who hold a narrow view of spirituality/spiritual care to broaden their perspective to include the full range of spiritual concerns that patients/clients may encounter. Statistical models created predicted factors contributing to spiritual care competency to some extent but the picture is complex requiring further investigation involving a bigger and more diverse longitudinal sample.

Spirituality in pre-registration nurse education and practice: A review of the literature

Spirituality is known to be an integral part of holistic care, yet research shows that it is not well valued or represented in nurse education and practice. However, the nursing profession continues to make efforts to redress the balance by issuing statements and guidance for the inclusion of spirituality by nurses in their practice. A systematic literature review was undertaken and confirms that nurses are aware of their lack of knowledge, understanding and skills in the area of spirituality and spiritual care, and desire to be better informed and skilled in this area. Consequently, in order for nurses to support the spiritual dimension of their role, nurse education has a vital part to play in raising spiritual awareness and facilitating competence and confidence in this domain. The literature review also reveals that studies involving pre-registration are few, but those available do provide examples of innovation and various teaching methods to deliver this topic in nursing curricular.

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.

Predictors of stress and coping strategies of US accelerated vs. generic Baccalaureate Nursing students: an embedded mixed methods study

BACKGROUND

Stress is an inevitable part of life and is especially pervasive in the lives of nursing students. Identifying the predictors of stress as well as coping strategies used can allow for the implementation of appropriate coping interventions to assist in the management of stress in nursing students. Mixed methods research that has been undertaken to gain an understanding about student stress, especially juxtaposing generic versus accelerated nursing students could not be identified.

OBJECTIVES

(1) Identify predictors of stress between accelerated and generic Baccalaureate Nursing (BSN) students; and (2) Describe stressors and coping strategies used by accelerated students in comparison with generic students.

DESIGN

Embedded mixed methods study.

SETTING

Accelerated and generic BSN third- and fourth-year nursing students at two Midwestern universities.

PARTICIPANTS

210 participants: accelerated (n=75) and generic (n=135).

METHODS

A questionnaire packet, including demographics, history of depression, the Perceived Stress Questionnaire, Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, and open-ended questions were administered to students at the end of a class. Simultaneous multiple regression was used to examine predictors of stress. Content analysis was used to analyze qualitative data.

RESULTS

Predictors of stress for both the accelerated and generic groups included history of depression, year in the program, emotional support, and self-esteem. Fear of failure and clinical incompetence, problematic relationships, and time management issues were identified as major stressors. Coping strategies used by both groups included positive thinking and social support.

CONCLUSIONS

Senior students with a history of depression, low self-esteem, and little social support were more likely to experience high levels of stress. This gives educators the potential to identify at risk students and establish stress reduction programs. Encouraging students to use individualized coping strategies will be beneficial.

Nurses' and midwives' acquisition of competency in spiritual care: a focus on education

BACKGROUND

The debate that spirituality is 'caught' in practice rather than 'taught' implies that spiritual awareness comes about through clinical experience and exposure, requiring no formal education and integration within the curricula. This is challenged as it seems that providing students with a 'taught' component equips students with tools to identify and strengthen resources in 'catching' the concept.

AIM

This study forms part of a modified Delphi study, which aims to identify the predictive effect of pre- and post-registration 'taught' study units in spiritual care competency of qualified nurses/midwives.

METHODS

A purposive sample of 111 nurses and 101 midwives were eligible to participate in the study. Quantitative data were collected by the Spiritual Care Competency Scale (SCCS) (Van Leeuwen et al., 2008) [response rate: nurses (89%; n=99) and midwives (74%; n=75)].

RESULTS

Overall nurses/midwives who had undertaken the study units on spiritual care scored higher in the competency of spiritual care. Although insignificant, nurses scored higher in the overall competency in spiritual care than the midwives.

CONCLUSION

'Taught' study units on spiritual care at pre- or post-registration nursing/midwifery education may contribute towards the acquisition of competency in spiritual care.

The effectiveness of self-directed learning (SDL) for teaching physiology to first-year medical students

BACKGROUND

Self-directed learning (SDL) has become popular in medical curricula and has been advocated as an effective learning strategy for medical students to develop competence in knowledge acquisition.

AIMS

The primary aim was to find out if there was any benefit of supplementing self-directed learning activity with a traditional lecture on two different topics in physiology for first-year medical students.

METHOD

Two batches of first-year Bachelor of Medicine and Bachelor of Surgery (MBBS) (Batch A and Batch B) comprising 125 students each, received an SDL session on Morphological classification of anaemia. The students belonging to Batch A received a one-hour lecture on the same topic three days prior to the SDL session. The students were given a 10 multiple choice questions (MCQ) test for a maximum of 10 marks immediately following the SDL session. The next topic, Conducting system of the heart, disorders and conduction blocks was taught to both batches in traditional lecture format. This was followed by an SDL session on the same topic for Batch A only. The students were evaluated with a MCQ test for a maximum of 10 marks.

RESULTS

The mean test scores on the first topic were 4.38±2.06 (n=119) and 4.17±1.71 (n=118) for Batch A and Batch B, respectively. The mean test scores on the second topic were 5.4± 1.54 (n=112) and 5.15±1.37 (n=107) for Batch A and Batch B, respectively. There was no significant difference between the groups.

CONCLUSION

For first-year medical students, SDL is an effective teaching strategy for learning physiology. However, no additional benefit is gained by supplementing SDL with a lecture to facilitate learning physiology.

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.

Nurse responses to patient expressions of spiritual distress

This secondary analysis of data from 200 practicing registered nurses' and student nurses' responses to 3 vignettes depicting patient spiritual distress were evaluated qualitatively and quantitatively (using the Empathic Response Scale). Findings showed wide variation in these nurses' ability to respond empathically; while some responses would be healing, others were potentially hurtful.

The impact of spiritual care education upon preparing undergraduate nursing students to provide spiritual care

Spiritual care is an important component of holistic care. In Australia competency statements relating to nursing practice emphasise the need to provide care that addresses the spiritual as well as other aspects of being. However, many nurses feel they are poorly prepared to provide spiritual care. This is attributed largely to lack a of spiritual care education provided in undergraduate nursing programmes. A few higher education providers have responded to this lack of spiritual care education by incorporating specific content related to this area into their undergraduate nursing programme. Minimal international studies have investigated the impact of spiritual care education on undergraduate nursing students and no Australian studies were identified. This review explores spiritual care education in undergraduate nursing programmes and identifies the need for an Australian study.

Systematic review of effectiveness of situated e-learning on medical and nursing education

OBJECTIVES

Because of the complexity of clinical situations, traditional didactic education is limited in providing opportunity for student-patient interaction. Situated e-learning can enhance learners' knowledge and associated abilities through a variety of activities. Healthcare providers who interact with virtual patients in designed situations may avoid unnecessary risks and encounters with real patients. However, the effectiveness of situated e-learning is inconsistent. The purpose of this study is to determine the effectiveness of situated e-learning in prelicensure and postlicensure medical and nursing education.

METHODS

Literature databases of PubMed, Medline, CINAHL, ERIC, and Cochrane Library were searched. The study eligibility criteria included articles published in English, which examined the effectiveness of situated e-learning on the outcomes of knowledge and performance for clinicians or students in medicine and nursing. Effect sizes were calculated with 95% confidence intervals.

RESULTS

Fourteen articles were included for meta-analysis. Situated e-learning could effectively enhance learners' knowledge and performance when the control group received no training. Compared to traditional learning, the effectiveness of situated e-learning on performance diminished but still remained significant whereas the effect become insignificant on knowledge. The subgroup analyses indicate the situated e-learning program significantly improved students' clinical performance but not for clinicians.

CONCLUSIONS

Situated e-learning is an effective method to improve novice learners' performance. The effect of situated e-learning on the improvement of cognitive ability is limited when compared to traditional learning. Situated e-learning is a useful adjunct to traditional learning for medical and nursing students.

Measuring effectiveness of a spiritual care pedagogy in nursing education

Nurses have long recognized the importance of spiritual care in nursing practice as promoting the integration of meaning and purpose in life. More recently, both the American Nurses Association incorporates spiritual care in the Scope and Standards of Nursing Practice and the American Association of Colleges of Nursing has integrated spiritual care in the Essentials of Baccalaureate Education. However, research suggests that nurses do not know how to provide spiritual care. This study developed and tested a spiritual care pedagogy. In phase I, researchers designed a spiritual care educational and reflective program based on the Burkhart/Hogan theory of spiritual care in nursing practice, incorporating face-to-face and on-line components. In phase 2, the effectiveness of this program was measured in a pre-post test, randomized controlled trial with senior nursing students during their capstone clinical immersion course (n=59). Findings revealed a statistically significant increase in students' perceived ability in providing spiritual care, particularly in complex family clinical situations. Findings also indicated a significant increase in the student's use of reflective practices, which students found to help support them during stressful times. This study translates nursing theory and research into a successful pedagogy.

An integrative review of spiritual assessment: implications for nursing management

AIMS

To describe the current 'state of the art' in relation to spiritual assessment, focusing on quantitative, qualitative and generic approaches; to explore the professional implications of spiritual assessment; and to make practical recommendations to managers seeking to promote spiritual assessment in their places of work.

METHOD

The paper integrates aspects of a recent systematic review of quantitative approaches to measuring spirituality and a recent meta-synthesis of qualitative research into client perspectives of spiritual needs in health and the principles of generic assessment, before drawing on the wider literature to discuss a number of professional implications and making recommendations to nurse managers.

IMPLICATIONS FOR NURSING MANAGEMENT

The issues to emerge from this paper are (1) that spiritual assessment is an increasingly important issue for nursing practice, (2) that the range of reliable and valid quantitative instruments for use in clinical practice is limited, (3) that there is overlap in the domains and categories of spirituality identified by quantitative and qualitative researchers, and (4) that nurse managers seeking to introduce spiritual assessment will do so in the context of a professional debate about the relevance of spirituality to contemporary practice.

How undergraduate nursing students learn to care for patients spiritually in clinical studies--a review of literature

AIM

To gain knowledge about what is known about how undergraduate nursing students learn to care for patients spiritually in their clinical studies.

BACKGROUND

Spirituality is related to meaning, hope and comfort and spiritual care is part of nurses' responsibility. Clinical studies are vital for students to integrate knowledge, clinical reasoning and formation. However, nurses are important in role modelling.

METHOD

A literature search was undertaken using international databases from 1980 to 2012. Articles were thoroughly evaluated and 10 papers reviewed for this article.

RESULTS

Four main areas emerged as essential for learning spiritual care in clinical studies: (1) the importance of learning in real-life situations with repeated exposure to patients in diverse placements; (2) use of pedagogical methods that assist students to understand, work with and reflect on patients' spirituality; (3) to be aware of and overcome conditions prohibiting spiritual care learning; and (4) to see spiritual care learning in connection with how students are prepared and how they are followed up after clinical studies.

CONCLUSION

Clinical studies are fundamental to students' learning of spiritual care in nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders play a key role in keeping holistic care a nursing focus and creating a good learning environment.

Opening up to learning spiritual care of patients: a grounded theory study of nursing students

AIM

To determine undergraduate nursing students' perspectives on spiritual care and how they learn to assess and provide spiritual care to patients.

BACKGROUND

Nursing is concerned with holistic care. Systematic teaching and supervision of students to prepare them to assist patients spiritually is a growing focus. However, there is limited consensus about the competences students need to develop and little is written related to students learning processes.

DESIGN

Grounded theory was used to identify students' main concern and develop a substantive grounded theory.

METHOD

Data collected during semi-structured interviews at three Norwegian University Colleges in eight focus groups with 42 undergraduate nursing students were analysed through constant comparison of transcribed interviews until categories were saturated.

RESULTS

The participants' main concern was 'How to create a professional relationship with patients and maintain rapport when spiritual concerns were recognised'. Participants resolved this by 'Opening up to learning spiritual care'. This basic social process has three iterative phases that develop as a spiral throughout the nursing programme: 'Preparing for connection', 'Connecting with and supporting patients' and 'Reflecting on experiences'.

CONCLUSION

Nurses need a wide range of competences to fulfil the nursing focus on holistic patient care. Nursing education should prepare students to recognise and act on spiritual cues. A trusting relationship and respectful and sensitive communication assist students to discover what is important to patients. An educational focus on spiritual and existential themes throughout the nursing programme will assist students to integrate theoretical learning into clinical practice.

RELEVANCE TO CLINICAL PRACTICE

Study participants reported seeing few role models in clinical settings. Making spiritual assessment and interventions more visible and explicit would facilitate student learning in clinical practice. Evaluative discussions in clinical settings that include spiritual concerns will enhance holistic care.

Disease-specific training in Parkinson’s disease for care assistants: a comparison of interactive and self-study methods

Objective: To compare two approaches to providing training to care assistants in Parkinson’s disease.

Design: Pragmatic parallel arm controlled trial.

Setting: Training either by an interactive training day at a local medical education establishment or self study.

Subjects: Care assistants recruited from local health and social care providers.

Interventions: The content of both interventions was similar, covering causes, symptoms, diagnosis of Parkinson’s disease, multidisciplinary management, mobility, communication, swallowing, and involving 5 hours of study time.

Main measures: Knowledge about Parkinson’s (assessed by true/false quizzes and identifying ‘four facts’ about Parkinson’s) immediately post training and six weeks later; views on training methods of care assistants and employers/managers.

Results: Thirty-seven employers nominated 100 care staff who were allocated to interactive training (49) and self study (51). Training completion rates (retained to six-week follow-up) were lower for self study (42.1% vs. 83.7% training day). There were no significant differences between groups on quiz or ‘four facts’ scores at baseline or six-week follow-up. Immediately post training, the self-study group (with access to written materials) had significantly higher quiz scores than the training day group (no access to materials at test). Within-group comparisons showed improvements post training. Although interactive training may be preferred, obtaining release from duties can be problematic.

Conclusions: Both approaches have similar effects on knowledge of care assistants without prior specific training. Providing a variety of approaches will cater for all preferences. The findings may be generalizable to training the care workforce for other specific roles.

The effectiveness of self-directed learning in health professions education: a systematic review

OBJECTIVES

Given the continuous advances in the biomedical sciences, health care professionals need to develop the skills necessary for life-long learning. Self-directed learning (SDL) is suggested as the methodology of choice in this context. The purpose of this systematic review is to determine the effectiveness of SDL in improving learning outcomes in health professionals.

METHODS

We searched MEDLINE, EMBASE, ERIC and PsycINFO through to August 2009. Eligible studies were comparative and evaluated the effect of SDL interventions on learning outcomes in the domains of knowledge, skills and attitudes. Two reviewers working independently selected studies and extracted data. Standardised mean difference (SMD) and 95% confidence intervals (95% CIs) were estimated from each study and pooled using random-effects meta-analysis.

RESULTS

The final analysis included 59 studies that enrolled 8011 learners. Twenty-five studies (42%) were randomised. The overall methodological quality of the studies was moderate. Compared with traditional teaching methods, SDL was associated with a moderate increase in the knowledge domain (SMD 0.45, 95% CI 0.23-0.67), a trivial and non-statistically significant increase in the skills domain (SMD 0.05, 95% CI-0.05 to 0.22), and a non-significant increase in the attitudes domain (SMD 0.39, 95% CI-0.03 to 0.81). Heterogeneity was significant in all analyses. When learners were involved in choosing learning resources, SDL was more effective. Advanced learners seemed to benefit more from SDL.

CONCLUSIONS

Moderate quality evidence suggests that SDL in health professions education is associated with moderate improvement in the knowledge domain compared with traditional teaching methods and may be as effective in the skills and attitudes domains.