Nursing and spirituality: A discussion paper on intertwining metaparadigms

Finnish Palliative Care Nurses' and Physicians' Perceptions of Spirituality and Spiritual Care Related to Their Attitudes toward End-of-Life Care

Background

Spiritual care constitutes an indispensable aspect of palliative care (PC). Health care professionals encounter challenges when addressing spiritual care at the end of life. Developing appropriate attitudes toward end-of-life care can facilitate the acquisition of competencies needed for effective delivery of spiritual care.

Aim

To explore the perceptions of spiritual care and attitudes toward end-of-life care among PC professionals.

Design

The Finnish version of the "Spirituality and Spiritual Care Rating Scale" (SSCRS-FIN) and a newly developed "Attitudes toward End-of-Life Issues" (AEOLI) questionnaire were validated and utilized.

Setting/Participants

Both questionnaires were distributed to PC professionals involved in PC through an online survey. Exploratory and confirmatory factor analyses were conducted. The newly derived factors were subsequently examined for their associations with age, gender, profession, affiliation with a religious community, personal interpretation of spirituality, and years of professional experience.

Results

A total of 204 participants took part in the study (163 nurses, 19 nursing students, and 22 physicians). Exploratory factor analysis demonstrated satisfactory internal consistency, as indicated by Cronbach's alpha coefficients, for the five factors of SSCRS-FIN: "Spirituality" (0.733), "Existential" (0.614), "Spiritual Needs" (0.599), "Passive Spiritual Care" (0.750), and "Active Spiritual Care" (0.665); and for the seven factors of AEOLI: "Anxiety" (0.823), "Discussion" (0.924), "End-of-Life" (0.573), "Education" (0.692), "Medically Induced Death" (0.859), "Suffering" (0.671), and "Knowledge" (0.444). Confirmatory factor analysis demonstrated satisfactory fit values for both questionnaires. Significant positive correlations were observed between end-of-life care and the factors "Existential," "Spiritual Needs," and spiritual care factors, whereas an inverse correlation was found among "Anxiety," "Medically Induced Death," and all factors of SSCRS-FIN.

Conclusions

Valid and reliable questionnaires for assessing spiritual care (SSCRS-FIN) and attitudes toward end-of-life care (AEOLI) were developed. Attitudes toward end-of-life care were positively correlated with perceptions of spiritual care.

Validation of the Italian version of the spirituality and spiritual care rating scale (SSCRS‐ita)

PURPOSE

To translate and validate the Italian version of the Spirituality and Spiritual Care Rating Scale (SSCRS-ita).

METHODS

A single-center cross-sectional study was performed from October 15 to November 15, 2019 in a public hospital in Milan, Italy. The scale was drafted using the back-translation method. Prior to administration, the Italian version of the scale was assessed for content validity and retest stability by calculating the content validity index. Internal consistency was investigated by calculating Cronbach's alpha coefficient, test-retest stability by Spearman's rho coefficient.

FINDINGS

A total n = 337 nurses participated in the survey by correctly completing the scale. The Kaiser-Meyer-Olkin test (0.81) and Bartlett's test of sphericity (p < 0.001) confirmed the adequacy of the sample to conduct exploratory factor analysis (EFA). The factorial model of EFA without rotation and then with nonorthogonal Promax rotation confirmed the presence of the four constructs identified by the original author.

CONCLUSIONS

SSCRS-ita showed promising psychometric properties in terms of validity and reliability. The results of this study, together with the lack of in-depth studies in the Italian health and educational panorama, suggest the need to develop an educational pathway which, starting from the curricula of basic training and continuing with the updating of nursing staff, is dedicated to the detection of the spiritual needs of the patient.

IMPLICATIONS FOR NURSING PRACTICE

The SSCRS-ita is the first validated Italian tool concerning the consideration of the needs of spirituality and spiritual care in healthcare contexts; the possibility to use this tool is the first step towards a better integration of the mentioned dimensions of care in a nursing care qualitative perspective in Italy.

Spiritual aspects of the family caregivers' experiences when caring for a community-dwelling adult with severe mental illness: A systematic review of qualitative evidence

WHAT IS KNOWN ON THE SUBJECT?: Being a caregiver of a relative with severe mental illness often impacts the quality of life, physical and mental health. The use of coping strategies related to spirituality can enhance physical and mental well-being. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found 26 primary studies that refer to spiritual aspects of the experience of caring for a relative with mental health problems. Caregivers express spiritual needs, such as hope and finding meaning in life, and spiritual or religious practices that help to cope with stressful situations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Spiritual needs and spiritual coping strategies of family caregivers of a relative with severe mental illness should be included in mental health nursing care. A spiritually sensitive approach should be used when promoting coping strategies of the family caregivers of a relative with severe mental illness. ABSTRACT: Introduction Deinstitutionalization of individuals with severe mental illness transferred the responsibility of care to the relatives who need to adapt their personal life. Caregivers often develop coping strategies which involve the relationship with oneself, others, or the transcendent/God or nature and may include religious/spiritual practices. Question/Aim This review aims to identify the spiritual aspects of the family caregivers' experiences when caring for a community-dwelling adult with severe mental illness. Method The review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Search was conducted in March 2019, updated in August 2020, limited to English, Spanish and Portuguese. Results A total of 26 studies were included. Two synthesized findings emerged: spiritual coping strategies are used by family caregivers; spiritual needs are expressed by family caregivers. The findings are based on the experiences of 467 caregivers, from 14 countries. Discussion In stressful times, family caregivers question the meaning in life and acknowledge hopelessness. To cope, caregivers mention a turn to the sacred and the use of spiritual/religious practices. Implications for practice Spirituality should be considered according to caregivers' individual beliefs and needs, as may represent important resources for the sense of meaning and overall well-being.