Nursing interventions for spiritual care: preferences of the community-based elderly

The role of spirituality in coping with the demands of the hospital culture amongst fourth-year nursing students

The aim of this research was to describe the role of spirituality in coping with the demands of the hospital culture amongst fourth-year nursing students. Qualitative, descriptive, hermeneutic interpretive research was done. A case study of 14 female Canadian nursing students was asked to write an essay on their experiences of the demands of the hospital culture. Content analysis was used and positive psychology served as the interpretive lens. Trustworthiness and ethicality were ensured. The findings indicated that although the nursing students expressed themselves in religious and spiritual words, they did not significantly illustrate the theoretically associated intra-, interpersonal and sacred behaviours to be referred to as being spiritual in their experience as a care giver in the hospital culture. They also did not illustrate behaviours linked to other positive psychology constructs such as sense of coherence, resilience, engagement or emotional intelligence. Rather, the nursing students experienced identity crises. Recommendations for the inclusion of mentoring in the curriculum of nursing students were formulated.

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.

A survey of emotional difficulties of nurses who care for oncology patients

Nurses who care for dying patients are under pressure emotionally because of their beliefs and values about death as well as the emotions and reactions of the patients and their families. This study examines the emotional difficulties of nurses caring for oncology patients in Turkey. The study used a descriptive survey design. The participants were 157 nurses from three medical oncology units in Ankara. Results showed that nurses had difficulty in talking to oncology patients about end-of-life issues and found that caring for dying patients affected their personal lives. This study also showed that the length of nurses' work experience had no effect on their feelings and perceptions toward terminally ill patients. However, the nurses who had more work experience were more likely to report difficulty in talking to patients. Most of the nurses expressed feelings of inadequacy and hopelessness about pain management and treatments.

Efficacy of a self-study programme to teach spiritual care

AIM AND OBJECTIVES

This study investigated the efficacy of a self study programme designed to teach nurses about how to talk with patients about spirituality, and to identify factors predicting this learning. Furthermore, the study investigated whether there were differences in learning between students and practicing clinicians, and between those in a religious or non-religious institution.

BACKGROUND

Although USA and UK accrediting bodies mandate nurses learn how to assess and support patient spiritual health, there is a paucity of evidence to guide educators regarding how to teach spiritual care to nurses. Indeed, it is unknown if aspects of spiritual care can be taught using formal approaches.

DESIGN

A pretest-posttest pre-experimental design was used to study how attitude toward spiritual care, ability to create empathic verbal responses to expressed spiritual pain, personal spiritual experience, and knowledge about communication for spiritual caregiving changed from before to after programme completion.

METHODS

Study participants, 201 nursing students and RNs, independently completed the mailed self-study programme (i.e. workbook with supplemental DVD) and self-report study instruments (i.e. Daily Spiritual Experience Scale, Spiritual Care Perspective Scale-Revised, Response Empathy Scale, Communicating for Spiritual Care Test, and Information about You form).

RESULTS

Significant differences were seen between the before and after scores measuring attitude, ability, spiritual experience, and knowledge. An interaction effect of time between students and registered nurses for both spiritual care attitude and personal spiritual experience was observed.

CONCLUSIONS

Findings suggest learning occurred for both students and RNs, regardless of whether they were at a religious institution or not. Relevance to clinical practice. These data indicate that this self-study programme was an effective approach to teach nurses about how to converse with patients about spirituality.

Spiritual assessment in African-Americans: a review of measures of spirituality used in health research

BACKGROUND

A number of instruments have been developed for investigating relationships between spirituality and health, and have been used to assess spirituality in African-Americans. Yet, the cultural appropriateness for African-Americans of these instruments has not been investigated to date.

OBJECTIVES

To evaluate the construct validity and reliability of spirituality measures used in health research from 1982 to 2005.

METHOD

Systematic review of the literature.

RESULTS

Thirty five studies and five measures of spirituality met the inclusion criteria. Most of the spirituality measures were developed in primarily Caucasian-American samples. African-Americans were represented in 71% of the studies (n = 25) using spirituality measures in health research. Distinct cultural attributes of African-American spirituality were omitted in most of the spirituality measures. Two studies were retrieved in which psychometric evaluation was conducted in entirely African-American samples.

DISCUSSION

Spirituality is a significant cultural experience and belief that influences the health behaviors of African-Americans. The lack of a culturally appropriate measure of African-American spirituality is a major limitation of studies investigating spirituality and health in this population. Development of a culturally appropriate and sensitive measure of spirituality in African-Americans is suggested to strengthen the quality of research in this area.

Promoting spiritual health in home healthcare

This article explores how clinicians can promote patient and family caregiver spiritual health. After a review of pertinent theory and research, clinical implications are identified, including appropriate goals for clinicians with regard to spiritual health promotion.

Factors That Contribute to Levels of Independent Activity Functioning Among a Group of Navajo Elders

The purpose of this study was to examine factors that contribute to levels of independent activity functioning among a group of elder Navajos. Data were collected from a sample of Navajo elders from Tuba City, Arizona, and a health assessment survey was administered. Multiple regression analysis was used to examine the effects of social support and demographic factors on levels of independent activity functioning, such as bathing, toileting, dressing, eating, walking, and getting in and out of bed. The results indicated that assistive devices, marital status, the frequency of visits to Tuba City, and visits to the elders significantly affected independent activity functioning. Although other factors of social support were not significant, it appeared that visiting Tuba City and visits to the elders in their homes were important factors in maintaining higher levels of independent activity functioning among elder Navajos. Implications for practice, policy, and future research are discussed.

Meeting Clients' Spiritual Needs

True holistic care requires attention to spiritual as well as physical needs, but many health care providers do not feel comfortable discussing spiritual matters with clients. Although recognized by national nursing groups as a standard of care, nurses are not well prepared or rewarded for spiritual care efforts. There are several spiritual assessment tools available and many suggestions for interventions, but little research-based evidence on the effectiveness of spiritual care assessments or interventions. Nurses are well positioned by their continued intimate contact with clients and the importance of caring to nursing to lead the health care profession in developing spiritual care theory and practices.

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

Different concepts have been presented which denote driving forces and strengths that contribute to a person's ability to meet and handle adversities, and keep or regain health. The aim of this study, which is a part of The Umeå 85+ study, was to describe resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health in a sample of the oldest old. The study sample consisted of 125 participants 85 years of age or older, who ranked themselves on the Resilience Scale, Sense of Coherence Scale, Purpose in Life Scale and Self-Transcendence Scale and answered the SF-36 Health Survey questionnaire. The findings showed significant correlations between scores on the Resilience Scale, the Sense of Coherence Scale, the Purpose in Life Test, and the Self-Transcendence Scale. Significant correlations were also found between these scales and the SF-36 Mental Health Summary among women but not among men. There was no significant correlation between perceived physical and mental health. The mean values of the different scales showed that the oldest old have the same or higher scores than younger age groups. Regression analyses also revealed sex differences regarding mental health. The conclusions are that, the correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults. Another conclusion is that the dimensions that constitute mental health differ between women and men.

Spiritual care nursing: what cancer patients and family caregivers want

AIM

This paper presents findings from a study that was designed to understand, from the perspective of cancer patients and their family caregivers, what spiritual care is wanted from nurses.

BACKGROUND

Distressing and transformative spiritual responses to living with cancer have been documented. Although there is momentum for providing spiritual care, previous research provides scanty and conflicting evidence about what are the clients' wishes or preferences with regard to receiving spiritual care from nurses.

METHODS

A convenience sample of 156 adult cancer patients and 68 primary family caregivers, most of whom were Christians, independently completed the Spiritual Interests Related to Illness Scale and a demographic form, both of which were self-completed questionnaires.

RESULTS

A variation in responses to items about nurses providing spiritual care therapeutics was observed; means and medians for these items mostly fell between 2 (disagree) and 3 (agree) on a scale of 1-4. Generally, therapeutics that were less intimate, commonly used, and not overtly religious were most welcomed. No significant differences were found between patient and caregiver preferences. A modest, direct correlation was observed between frequency of attendance at religious services and increased preference for nurse spiritual care.

CONCLUSION

For both patients and caregivers, nurses must be sensitive to providing spiritual nurture in ways that are welcomed.

Responses to the spiritual needs of older people

BACKGROUND

The literature suggests that the notion of holistic health has gained popularity in the nursing of older persons. Holistic care, based on the premises that there is a balance between body, mind and spirit, is important for well-being, that each of these is interconnected, and that each affects the others. Human spirit is considered to be the essence of being and is what motivates and guides us to live a meaningful existence. However, there is little evidence in the nursing literature about how nurses caring for older people respond to their spiritual needs.

AIM

The aim of this paper is to report a critical incident study to: (1) explore nurses' perceptions of their role in addressing the spiritual needs of older people; (2) describe what constitutes spiritual care of old people in the light of the findings.

METHODS

Descriptions of critical incidents were obtained from a convenience sample of 52 nurses working in the East Midlands Region of the United Kingdom (UK) and subjected to content analysis and construction of a data classification system.

FINDINGS

Respondents were prompted to identify patients' spiritual needs by factors such as religious beliefs and practice (prayer); absolution; seeking connectedness, comfort and reassurance, healing or searching for meaning and purpose. The interventions initiated to meet patients' spiritual needs included respect for privacy; helping patients to connect; helping patients to complete unfinished business; listening to patients' concerns; comforting and reassuring; using personal religious beliefs to assist patients and observation of religious beliefs and practices.

CONCLUSION

The findings provide empirical evidence of some practices related to spiritual care of older people. Further empirical research is needed to guide practice and education with regard to conceptual clarity and the delivery of spiritual care of older people.

Nurses caring for the spirit: patients with cancer and family caregiver expectations

PURPOSE/OBJECTIVES

To determine what patients with cancer and primary family caregivers expect from nurses with regard to having their spiritual needs addressed.

RESEARCH APPROACH

Descriptive, cross-sectional, qualitative study using Miles and Huberman s approach to data reduction.

SETTING

Outpatient and inpatient settings in a county hospital and a comprehensive cancer center, both located in a large, southwestern, metropolitan area.

PARTICIPANTS

28 African American and Euro-American adult patients with cancer and primary family caregivers were purposively selected to provide variation of experiences (e.g., religious backgrounds).

METHODOLOGIC APPROACH

In-depth, semistructured, tape-recorded interviews conducted by the investigator. Analysis of transcribed interviews concurrently with data collection followed a process of data concentration, data display, and conclusion drawing.

MAIN RESEARCH VARIABLES

Spiritual needs, spiritual care.

FINDINGS

Informants identified nursing approaches for spiritual needs, including kindness and respect; talking and listening; prayer; connecting with symmetry, authenticity, and physical presence; quality temporal nursing care; and mobilizing religious or spiritual resources. To provide spiritual care, nurses must possess requisites of a personal, relational, or professional nature.

CONCLUSIONS

Although some patients or caregivers do not want overt forms of spiritual care, others are eager for them. Many recognize nonreligious actions or attitudes that nurses can practice to care for spiritual needs.

INTERPRETATION

Nurses must consider how they can address patient preconceptions and requisites for spiritual caregiving. Nurses may need to educate the public regarding their role as holistic and spiritual healthcare providers.

The spiritual care meanings of adults residing in the midwest

Only limited nursing knowledge exists as theoretical guidance for nurses in providing spiritual care. Using Leininger's theory of culture care diversity and universality, the purpose of this ethnonursing research study was to discover the embedded spiritual care meanings, expressions, lived experiences, and practices of adults residing in the Midwest and their perceptions of spiritual nursing care. Data were collected through interviews of 6 key and 12 general informants. Five universal spiritual themes were supported by the findings. Culture care modes were used to explicate spiritual knowledge that can be integrated into nursing practice.

Prayer and health outcomes in church lay leaders

This study examined the relationship of frequency of prayer on health outcomes in a national sample of 1,014 church lay leaders. The survey included questions on the frequency of prayer and the Medical Outcomes Study, Short Form 36 Health Survey, measuring eight categories of functional health. The results indicated a high level of functioning overall. Age was strongly related to most aspects of health in this sample. Frequent prayer was associated with poor physical functioning and poor ability to carry out role activities, but these relationships were not significant when the effect of age and gender was controlled. Frequent prayer was also significantly associated with high mental health scores, regardless of age or gender. This study supports the growing body of data suggesting a positive relationship between frequency of spiritual practices and mental health, even in a homogeneous sample of active church members.

Faith, prayer, and health outcomes in elderly Native Americans

This survey questioned 71 Native Americans over age 65 living in the general community on their frequency of prayer, importance of faith, and their health status. The researchers hypothesized that people with higher scores in faith and prayer would experience a more positive health status. Self-reports of health indicated a high level of functioning overall. Older people and those living alone had poorer physical and emotional health outcomes than younger elders and those living with one or more persons, although neither age nor living situation was related to mental health. People who prayed more often and those who indicated a high importance of their faith scored higher in the mental health subscale, confirming the hypothesis for this dimension of health.

Alcoholics Anonymous and nursing. Lessons in holism and spiritual care

Alcoholic Anonymous (AA) is a worldwide, million-member organization that has assisted countless alcoholics to achieve sobriety through a spiritual program of recovery from alcoholism. Based on spiritual principles known as the "Twelve Steps" and "Twelve Traditions," AA has provided a model for other recovery programs such as Narcotics Anonymous (NA), Gamblers Anonymous (GA), and Sex and Love Addicts Anonymous (SLAA). Recovery in AA appears to involve a process of self-transcendence. In recent years, nursing scholars have increasingly explored the concepts of self-transcendence and spirituality as they apply to nursing theory and practice. This article explores the roots and spiritual dimensions of 12-step recovery programs. It further explores the ways in which theoretical and clinical knowledge about the delivery of spiritual care interventions may be gained from an understanding of AA's spiritual approach to recovery.

Spiritual nursing interventions

Oncology, parish, and hospice nurses in the Midwest were surveyed to explore what nursing interventions they implement to enhance the spirituality of clients and how they learned about these interventions. Some 95 spiritual nursing interventions were identified and ranked according to frequency of implementation. The most frequently identified nursing interventions were referral, prayer, active listening, facilitation and validation of clients' feelings and thoughts, conveying acceptance, and instilling hope. The most frequently ranked implemented interventions were communication and religious nursing interventions. Only 15% of the participants indicated that they learned the most about spirituality and spiritual nursing interventions from basic and advanced nursing education combined. Findings support the need for increased emphasis of theoretical and clinical spiritual knowledge in nursing education and the development of a typology of spiritual nursing interventions to direct nurses in enhancing the spirituality of clients and implementing holistic nursing care.

Spiritual interventions provided by mental health nurses

This descriptive qualitative study explored the spiritual nursing interventions provided by mental health nurses. Fifty mental health nurses responded to open-ended interrogative statements to report on nursing interventions in three situations that supported the spiritual needs of patients and families. Their responses were grouped into four categories, nurses being with the client, doing for the client, encouraging the client to look inward, and encouraging the client to look outward. Being with was demonstrated through the presence of the nurse. Doing for included interventions performed on the client's behalf and included the nurses using time, people, and space to provide care. Clients were encouraged to look inward for strength and look outward for people and objects that could be resources for them. A serendipitous findings was that mental health nurses were able to describe the ideal spiritual interventions but reported fewer instances of actually having intervened.

Integrating chronic illness into one's life: a phenomenological inquiry

Chronic illness is currently the number one health problem facing the United States. Little is known about the experience of making chronic illness a part of one's life, particularly from the perspective of the chronically ill person. The purpose of this phenomenological inquiry was to explore how chronically ill adults integrate chronic illness into their lives. Seventeen chronically ill adults were interviewed by the researcher. Using a modification of Colaizzi's (1978) method of data analysis, 4 major themes emerged. These themes were: confronting loss, fluctuating emotions, making changes, and gaining control of an altered life direction. Some of the major recommendations and implications for nursing practice centered around perceiving the entire experience of chronic illness with an emphasis on the need to recognize and assess loss as an ongoing and unending experience, and how this loss influences a participant's willingness and ability to implement changes required by the medical treatment plan.