Spirituality in nursing: A concept analysis

Spirituality, Religiosity, Caring Behavior, Spiritual Care, and Personalized Care Among Student Nurses: A Descriptive Correlational Study in the Philippines

This study sought to determine the student nurses' spirituality, religiosity, caring behavior, spiritual care, and personalized care. Further, it sought to determine the relationship between spirituality, religiosity, and caring behavior in student nurses' spiritual care and personalized care. The study used a descriptive correlational design using convenience sampling to collect data from 1248 student nurses in the Philippines from December 2023 to February 2024. We collected data using the Spirituality and Spiritual Care Scale rating scale and the Caring Behaviors Inventory. The study revealed that the mean scores of the students in their "spirituality" and "religiosity" were 4.08 (SD = 0.98) and 2.99 (SD = 1.26), respectively. Student nurses had sufficient confidence and skills in spiritual care, caring behavior, and personalized care. The students' age had a weak and negative association with the students' spirituality and religiosity. Students from University A had higher levels of spirituality and religiosity than students from University B, University C, and University D. Students in the 4th year level were more religious than 3rd year students. Students who had their last clinical exposure in the Admission and emergency room reported poorer caring behaviors than those who had previous clinical exposure in the Medical-surgical ward, Obstetrics and gynecology, Intensive Care Units, and Community. There is no significant relationship between a student nurse's spiritual care and caring behavior. This trend is similar to caring behavior and personalized care. The students' age predicts their personalized care.

Nurses' Perceptions of Spirituality and Spiritual Care and Influencing Factors in Türkiye, Italy, and Albania: A Multicultural Study

The present study aimed to explore the perceptions of spirituality and spiritual care among nurses who work in three different countries with different cultures as well as the factors influencing their perception. This is a cross-sectional multicultural study conducted with a total of 1090 nurses from Türkiye, Albania, and Italy. Data were collected through the "Individual Information Form" and the "Spirituality and Spiritual Care Rating Scale". Nurses' mean score on the Spirituality and Spiritual Care Rating Scale was above average. It was also found that country, marital status, religious belief, Islamic religion, training for spiritual care, and using spiritual practices to cope with difficulties or illnesses influenced nurses' perception of spirituality and spiritual care. It was concluded that nurses from the three countries associated spirituality and spiritual care with religion and that some personal characteristics influenced their perceptions of spiritual care. The results highlight the need for training in spiritual care to improve nurses' perceptions and practices of spiritual care.

Insights on spirituality and bereavement: A systematic review of qualitative studies

AIM

To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies.

DESIGN

A systematic review of qualitative studies.

DATA SOURCE

A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review.

METHODS

A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology.

REPORTING METHOD

PRISMA checklist.

RESULTS

The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome.

CONCLUSION

In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement.

IMPLICATIONS

The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a systematic review.

Spiritual care for clients with mental illness from an Islamic background: Nursing students' perspectives

WHAT IS KNOWN ON THE SUBJECT?: Spirituality is an important aspect for clients with mental illness. Spirituality is essential to holistic care in mental health nursing. Nurses found an apparent disconnection between the theory and practice of spiritual care.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Nurses acknowledged that attitudes that allocate blame towards clients with mental illness have the most negative impact on clients' spiritual wellbeing. The conflicting worldviews between spiritual healing and a biomedical approach impact the provision of care as relationships among the mental health team are disrupted. The non-assessment of the client's spirituality hindered nurses from providing spiritual care. Language differences between nurses and clients impede nurses from providing spiritual care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of spiritual therapy as an element of nursing care works if clients and nurses are both aware of the importance of spirituality. Nursing staff must also be aware of several issues that may make it difficult for nurses to provide such therapy, including specific symptoms of mental illness. Nurses can apply spiritual care effectively when they have significant spirituality. Nurses with good competency in mental health nursing skills are more likely to provide efficient spiritual care as part of holistic care.

ABSTRACT

INTRODUCTION: Spiritual care is essential to clients with mental illness.

AIM

To explore mental health nursing students' perspectives on spirituality and spiritual care and how this impacts clients with mental illness in an Islamic context (Saudi Arabia).

METHOD

Thematic analysis is used to analyse data from two focus groups of mental health nursing students (one comprising eight, the other six).

RESULTS

Six themes emerged: factors affecting spirituality in mental illness, the impact of mental illness on spirituality, the use of spiritual healing in mental illness, nurses' use of spiritual healing; challenges in providing spiritual care and recommendations for improving spiritual care.

DISCUSSION

Clients being blamed for having mental illness by health professionals and the community harmed their spirituality. The religious support of peers was a practical approach to spiritual therapy, asserted as a beneficial element of nursing care. However, nurses found providing such therapy challenging because of the language barrier and the lack of any assessment of clients' spirituality. It was also challenging when dealing with specific symptoms of mental illness.

IMPLICATIONS FOR PRACTICE

The study asserts that spiritual therapy in nursing care will work if the client knows its importance. Nurses who have significant spirituality can apply it effectively.

Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis

BACKGROUND

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear.

AIM

To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science.

METHOD

Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria.

RESULTS

Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented.

CONCLUSION

Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Spirituality in Adolescents and Young Adults With Cancer: An Evolutionary Concept Analysis

Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality.

Jordanian Nurses' Perspectives of Spirituality and Spiritual Care: A Qualitative Study

BACKGROUND

Spirituality is considered one of the main aspects of wholesome care for human beings. Spirituality is a multidimensional concept and has several definitions in the literature. Most of the studies concerning spirituality were conducted in Western cultures and the Middle East; however, there are a limited number of studies regarding spirituality in Jordan.

OBJECTIVE

The aim of this study was to explore Jordanian nurses' perspectives on spirituality and spiritual care in a palliative care unit in 1 cancer center in Jordan.

METHODS

A descriptive qualitative design with 20 semistructured interviews was used to access Jordanian nurses' perspectives on spirituality. This study was conducted in the major specialist center for the treatment of cancer in Jordan. A purposive sample of 20 registered nurses who had worked at least 6 months in the palliative care unit was recruited.

RESULTS

Nurses' perceptions of spirituality were represented by 2 themes: spirituality means connectedness to "Allah," and spirituality evokes enjoyment in life. Two themes emerged in terms of nurses' perceptions of spiritual care: ensuring patients' comfort and relaxation, and sharing patients' religious rituals.

CONCLUSION

These findings underscore the importance of the nurses' perspectives on spirituality in the context of Islamic and Arabic culture, and the need for training in spirituality.

IMPLICATIONS FOR PRACTICE

The concept of spirituality is recognized as a fundamental aspect of the nurse's role, making it essential to improve nurses' capabilities to integrate spirituality courses into the nursing curriculum.

Nurses' perceptions and competencies about spirituality and spiritual care: A systematic review and meta-analysis

OBJECTIVE

To identify and synthesize nurses' perceptions of spirituality and spiritual care and their spiritual care competencies.

DESIGN

A systematic review and meta-analysis of observational studies.

DATA SOURCES

The electronic databases PubMed, EMBASE, Web of Science, CINAHL, ProQuest, Scopus, CNKI, and WANFANG were systematically searched from the inception of each database to April 19, 2023.

REVIEW METHODS

Two reviewers independently completed the selection of included studies and data extraction. The Agency for Healthcare Research and Quality (AHRQ) checklist was used to assess the methodological quality of the included studies. The study outcomes were meta-analyzed using STATA 15 software. Predefined subgroup analyses were conducted to explore differences in spiritual care competencies among nurses across religious affiliation and education levels.

RESULTS

Thirty-five cross-sectional studies conducted in 11 countries and territories met the inclusion criteria, with 17,786 participants. The meta-analysis revealed that the pooled mean scores for spirituality and spiritual care perceptions and spiritual care competencies were 3.62 (95 % CI: 3.41-3.83) and 3.46 (95 % CI: 3.28-3.63), respectively. Nurses with no religious affiliation had inferior spiritual care competencies (3.24) than nurses with religious affiliation (3.31); nurses with a master's degree or above had the greatest spiritual care competencies (3.59), while nurses with an associate's degree had the least (3.31).

CONCLUSION

Nurses' perceptions and competencies about spirituality and spiritual care were moderate, and both needed to be improved, especially among nurses with no religious affiliation and low education levels. Nursing educators and leaders need to emphasize both theory education in the spiritual dimension and dedication to training in spiritual care practice, as well as provide nurses with targeted teaching and training to improve their competency in addressing the spiritual needs of their patients.

A structural equation modeling analysis of the effects of nurses' spirituality and spiritual care on professional quality of life

Spiritual care helps nurses establish a deeper connection with patients and meet their spiritual needs. Spiritual belief is thought to enable nurses to be more effective in their profession and positively affect their quality of life. This study aimed to investigate the effects of nurses' spirituality and spiritual care on quality of life. This study was designed as a descriptive cross-sectional study using structural equation modeling. A total of 221 nurses were included. Data were collected using the Professional Quality of Life Scale, and Spirituality and Spiritual Care Scale. The data were analyzed using descriptive statistics, correlational statistics, and structural equation modeling. Spirituality and spiritual care were negative predictors of burnout and positive predictors of compassion satisfaction. Spirituality and spiritual care decreased the level of burnout in nurses and significantly increased the level of compassion satisfaction. This study suggests raising nurse awareness of spirituality and spiritual care. Supporting nurses with professional training programs, including spiritual care, may benefit their quality of life.

The Role of Spirituality in Anxiety and Psychological Resilience of Hemodialysis Patients in Turkey

Chronic kidney disease (CKD) is a significant health problem that affects millions of people worldwide and its end-stage manifestation requires hemodialysis treatment, which can have a considerable impact on patients' mental health and quality of life. This study aims to examine the relationship between spirituality and anxiety, as well as spirituality and psychological resilience among hemodialysis patients using the iterative weighted least squares method. Participants included 91 hemodialysis patients, consisting of 49 females and 42 males, whose ages ranged from 20 to 82 years, with a mean age of 48 (SD = 14). The data were collected using the Beck Anxiety Inventory, Spirituality Scale, and Brief Psychological Resilience Scale. Results indicated a weak positive relationship between spirituality and psychological resilience (t = 1.35, P = .183) and a moderate negative relationship between spirituality and anxiety (t = -2.84, P = .006). Furthermore, spirituality accounted for a 1% variance in psychological resilience and a 5% of the variance in anxiety. Additionally, patients' education level, gender, and whom they live with were relatively stronger correlates of psychological resilience, while the patient's education level, gender, marital status, whom they live with, presence of another patient at home receiving hemodialysis treatment were strong correlates of anxiety. This study emphasizes the need for comprehensive care that addresses both physical and psychological aspects of CKD management to improve patient outcomes and quality of life.

Experiences and requirements in nutritional management of patients with esophageal cancer: a systematic review and qualitative meta-synthesis

PURPOSE

Nutritional management of patients with esophageal cancer is a significant issue. This systematic review aimed to comprehensively synthesize qualitative research evidence on the experiences and requirements in nutritional management from the perspective of patients with esophageal cancer.

METHODS

A systematic review and meta-synthesis of qualitative studies were conducted. Studies written in Chinese or English were retrieved from nine databases, namely, PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, WanFang, VIP, and SinoMed, from inception to December 23, 2022. After screening the titles, abstracts, and full texts, 19 articles were finally included for quality assessment and meta-synthesis.

RESULTS

Three comprehensive themes were derived. These were dietary experiences (perception of symptoms and dietary behaviors), emotional experiences (negative and positive emotions), and social support (inappropriate social support and inadequate nutritional management).

CONCLUSIONS

The experiences and requirements of esophageal cancer patients in terms of nutritional management during treatment and rehabilitation were reviewed and factors influencing nutritional management were discussed. The findings suggested that medical institutions should expedite the development of comprehensive nutritional management systems, create conducive nutritional environmental facilities, and establish interdisciplinary teams to implement personalized comprehensive interventional models for the management of patient nutrition. These steps would maximize the effectiveness of nutritional therapy, promote early patient recovery, and bridge the gap between healthcare professionals and patients in the understanding of nutritional management.

Spiritual care competence, moral distress and job satisfaction among Iranian oncology nurses

BACKGROUND

Nurses have a crucial role in identifying spiritual needs and providing spiritual care to patients living with cancer.

AIM

This study evaluated Iranian oncology nurses' spiritual care competence and its relationship with job satisfaction and moral distress.

METHOD

This cross-sectional study was conducted on 280 Iranian oncology nurses in 2020 using four questionnaires: demographic questionnaires, the Spiritual Care Competence Questionnaire (SCCQ), the Minnesota Job Satisfaction Questionnaire (MSQ) and the nurses' Moral Distress Questionnaire (MDS-R).

FINDINGS

The mean scores indicated a medium to high Spiritual Care Competence (SCC), mild to moderate moral distress and high job satisfaction. There was a positive correlation between SCC and external job satisfaction (r=184, p<0.05) and a negative correlation between SCC and moral distress (r=-0.356, p<0.05).

CONCLUSIONS

SCC diminishes with decreasing external job satisfaction and increasing moral distress. To improve the SCC of nurses working with patients living with cancer, it is recommended that nursing managers and policymakers revise the organisational policies to tackle the obstacles and consider the related factors to provide an ethical climate, implement quality spiritual care and increase job satisfaction.

The Knowledge, Practices, and Perceptions of Surgical Nurses Concerning Spirituality and Spiritual Care

PURPOSE

The purpose of this descriptive study was to describe the knowledge, practices and perceptions of nurses concerning spirituality and spiritual care.

DESIGN

A descriptive study.

METHODS

The study was performed with 142 surgical nurses working in three public hospitals in a city in Turkey. A "Personal Information Form" and the "Spirituality and Spiritual Care Grading Scale" were used for data collection. The data were analysed on SPSS 25.0 software.

FINDINGS

While 77.5% of the nurses reported having heard about the concepts of spirituality and spiritual care, 17.6% reported having received instruction concerning spirituality and spiritual care during their initial nursing education and 19.0% after graduation. In addition, 78.2% provided spiritual care in the clinics where they worked, 40.5% reported that patients were given religious support and 37.8% stated that patients were given the opportunity to be involved in their own care. The nurses' total mean spirituality and spiritual care grading scale score was 57.6±5.6. A statistically significant difference was determined in mean scale scores between nurses who had and had not heard about the concepts of spirituality and spiritual care (P=0.049) and between those who practiced and did not practice spiritual care in the clinics where they worked (P=0.018).

CONCLUSIONS

The majority of surgical nurses had heard about the concepts of spirituality and spiritual care but had not been exposed to them during their initial nursing education. However, the majority practiced spiritual care in their clinics, and their perception levels were above average.

Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting

BACKGROUND

The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings.

METHODS

This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1.

RESULTS

The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96.

CONCLUSIONS

The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

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.

Spirituality in Australian Health Professional Practice: A Scoping Review and Qualitative Synthesis of Findings

This study explores how spirituality is integrated into practice across the different Australian health professions. Utilising the Joanna Briggs Institute's (JBI) protocol, six databases were searched, and sixty-seven articles were finally included. To present the findings, a qualitative synthesis was used. 'Meaning' and 'purpose in life' were found to be key to many spirituality definitions. The most frequently reported approach for Australian health professionals (HPs) in asking about client spirituality was using one or two questions within a comprehensive assessment. Major facilitators included a holistic care approach and prior training, whereas a key barrier was a lack of time.

A caring and living environment that supports the spirituality of older people with dementia: A hermeneutic phenomenological study

INTRODUCTION

Meeting spiritual needs is an important part of the quality of nursing for older people living with dementia. The spirituality-supportive caring and living environment has rarely been studied, even though the environment plays an important role in supporting the well-being of older people with dementia.

AIM

To further understanding about the spirituality-supportive elements of a caring and living environment from the perspective of older people with dementia and their family members.

DESIGN, SETTING AND PARTICIPANTS

We adapted hermeneutic phenomenology as a philosophical background and methodological approach in this study. After receiving the approval of the researcher's University Ethics Committee, a purposive sample of ten older people with dementia and their nine family members, in home care and long-term care settings in Southern Finland were recruited for interviews.

METHODS

An interview-based study was conducted using photography to collect the data. The in-depth interviews were conducted in dyads between September 2017 and March 2020 and transcribed verbatim. Thematic analysis was used to interpret the data.

RESULTS

Spirituality was seen as a continuum within human life, manifested through the environment even if older people with dementia were unable to express themselves. The spirituality experiences of the participants within the caring and living environment were summarized into three themes: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" The older people, their family members and other people involved in their care provided a caring and living environment that supported spirituality with opportunities to seek answers to these questions through to the meaning of their life.

DISCUSSION AND CONCLUSIONS

This hermeneutic phenomenological study provides a new insight into the environment that supports the spirituality of older people with dementia. The elements of caring and living environment can remind older people with dementia of what supports their own way of thinking about spirituality and brings meaning to their life. Therefore, spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia.

TWEETABLE ABSTRACT

Spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia.

Exploring cultural determinants to be integrated into preterm infant care in the neonatal intensive care unit: an integrative literature review

BACKGROUND

Cultural practices are an integral part of childrearing and remain a significant aspect for healthcare professionals to ensure culturally sensitive care, particularly in the neonatal intensive care unit.

OBJECTIVE

To synthesise literature on the cultural determinants that can be integrated into care of preterm infants admitted into the neonatal intensive care unit.

METHODS

The current review followed the integrative literature review steps proposed by Lubbe and colleagues. The registration of the review protocol was in PROSPERO. There was a literature search conducted in the EBSCOhost, PubMed, ScienceDirect and Scopus databases using the search string developed in collaboration with the librarian. Three reviewers employed a three-step screening strategy to screen the articles published in English between 2011 and 2021 that focused on culturally sensitive care. The Johns Hopkins Nursing Evidence-Based Practice Evidence critical appraisal toolkit assessed the methodological quality of the articles included at the full-text screening level.

RESULTS

There were 141 articles retrieved, and 20 included on the full-text screening level; the exclusion of one article was due to a low critical appraisal grade. Four topical themes emerged from 19 articles: spiritual care practices, intragenerational infant-rearing practices, infant physical care practices, and combining treatment practices.

CONCLUSION

Overall, the findings indicated that parental cultural beliefs and practices mostly influenced infant-rearing practices, emphasising the significance of integrating cultural practices when rendering healthcare services. The recommendation is that healthcare professionals understand various cultural determinants, mainly those specific to the community they serve, to provide culturally sensitive care.

Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care

INTRODUCTION

With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals.

METHODS

Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews.

RESULTS

Three themes emerged from the four focus groups (N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices.

DISCUSSION

Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.

Supporting the spirituality of older people living with dementia in nursing care: A hermeneutic phenomenological inquiry into older people's and their family members' experiences

BACKGROUND

Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion.

OBJECTIVE

To understand how older people living with dementia and their family members experience spirituality and its support in nursing care.

DESIGN

A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology.

SETTINGS

We conducted the study in home care and long-term care settings in Southern Finland.

PARTICIPANTS

We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19).

METHODS

We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis.

RESULTS

The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience.

CONCLUSIONS

Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals.

Spiritual comfort, spiritual support, and spiritual care: A simultaneous concept analysis

BACKGROUND

Spirituality is a dimension of life and the human being that should be included in holistic healthcare. One major barrier often described by nurses on implementing spirituality in practice relates to perceiving the concept of spirituality as subjective and sharing confounding similarities with other concepts. In this sense, the concepts of spiritual comfort, spiritual care, and spiritual support may require more distinct theoretical definitions aimed at clear and effective nursing interventions within spiritual care.

AIM

To provide a definition of spiritual comfort, spiritual support, and spiritual care.

METHODS

Simultaneous concept analysis (SCA) of three concepts according to Haase et al., which is grounded on Rodgers' evolutionary view. The method was based on a literature review with the search of electronic databases on May 2020. Search and analysis have been blinded conducted by two reviewers.

RESULTS

One hundred thirty-six studies were included in the SCA. Findings suggest that spiritual comfort is an immediate state and an outcome. Spiritual support is related with an intimate and positive relationship with God. Spiritual care is defined as a complex and interactive process. Both spiritual support and spiritual care are grounded in a therapeutic context.

CONCLUSION

This SCA allowed the attributes of each concept to be identified and provides definitions that may facilitate the understanding of these concepts and promote the implementation of spirituality in nursing practice, but which has also led to future research on this topic.

Polish Adaptation and Psychometric Properties of the Long- and Short-Form Interfaith Spirituality Scale

Spirituality is widely believed to play an important role in securing health, and modern health care is increasingly being combined with spiritual care. This state of affairs is generating widespread interest in the construct from practitioners and researchers, resulting in the need to develop accurate and comprehensive measures of spirituality. The purpose of this study was to adapt the Polish version of the Interfaith Spirituality Scale (IFS), which consists of twenty-two statements, as well as its short version, including four statements. The IFS is not limited to any one religious denomination, making it possible to conduct research across diverse communities. The analyses were conducted on a sample of 642 Poles aged 18-68, 48% of whom were women. The Polish version of the scale showed high internal consistency (α = 0.96 for the IFS and α = 0.81 for the short version). Confirmatory factor analysis showed that the structure of the IFS consists of a unitary second-order factor with four first-order factors (direct connection with the creator, asceticism, meditation, and divine love). On the other hand, the structure of the short version is unifactorial. There were positive correlations of the IFS with another measure of spirituality, post-traumatic growth severity, mental well-being, and ecological behaviour, as well as negative correlations with post-traumatic stress disorder symptom severity and depressiveness; these confirmed the high validity of the tool. The results suggest that the IFS may be useful in the study of spirituality on Polish soil.

Muslim nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care: a qualitative study in southeast Iran

BACKGROUND

Spiritually sensitive nurses perceive the spiritual attitudes and feelings of others. They play a positive role in providing spiritual care to patients. Spiritually sensitive nurses deal appropriately with suffering, frustration, and spiritual dysfunction. Therefore, the present study aimed to explain Iranian nurses' experiences of spiritual sensitivity.

METHODS

This qualitative descriptive explorative study used conventional content analysis and purposeful sampling to explain the experiences of Iranian nurses (n = 19). This study used in-depth semi-structured interviews with 19 nurses, as well as maximum variation sampling to gather rich information (age, sex, religion, work experience, level of education, marital status, type of hospital and ward) from March 2021 to January 2022. The current study also employed Guba & Lincoln criteria to increase data trustworthiness and Graneheim and Lundman approach to analyze the content.

RESULTS

The research data showed 497 codes, 1 theme, 3 categories, and 6 subcategories. The theme of "Nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care" included three categories of the spiritual and professional character of the nurse, perception of the spiritual needs of patients and their families, and the nurse's reflection on the religious beliefs of patients and their families.

CONCLUSION

Spiritual sensitivity helps a nurse to provide holistic care for patients and their families. Therefore, managers and policymakers should create guidelines to help nurses become more spiritually sensitive as well as to meet spiritual needs of patients. Further quantitative and qualitative research should confirm these results in other social and cultural contexts.

Spirituality and Religious Diversity in Nursing: A Scoping Review

Spirituality is a common theme in the field of healthcare research. This study aimed to examine nurses’ perceptions of spirituality in the context of the religious diversity of patients in pluri-religious settings. We performed a scoping review following the methodology on studies conducted between 2010 and 2020. We searched the following databases: CINAHL Plus, PubMed, and PsycINFO. For the identification of grey literature, the OpenGrey database was used. In total, 789 articles were reviewed. Of these, 16 met predetermined inclusion criteria. Two main overarching themes emerged from our inductive analysis: (a) the intertwining of spirituality and spiritual care in diverse religious landscapes and (b) obstacles impeding the inclusion of spiritual care in pluri-religious settings. According to our results, nurses consider that spirituality is interconnected with spiritual care for individuals from different religious backgrounds. Interpretations of spirituality in nursing practice vary widely, with spirituality and religiosity often shaped and influenced by culture and the experience of the professionals. Nurses attribute various meanings to spiritual care, most of which center on respecting personal, interpersonal, and relational aspects of religious and cultural beliefs and practices. Lack of education and specific skills, insufficient time, role ambiguity, and different religious beliefs were identified as hurdles to spiritual care. A poor work environment, a lack of patient privacy, including personal space, and a lack of compassion were also reported as deterrents to spiritual healing. More knowledge and training on different religions and spirituality are required to meet patients’ spiritual needs to better overcome these hurdles.

Perspectives on a Couples-Based, e-Health HIV Prevention Toolkit Intervention: A Qualitative Dyadic Study with Black, Heterosexual Couples in New York State

Web-based technology provides an unparalleled opportunity to increase access and uptake of couples-based HIV prevention interventions. e-Health HIV prevention interventions for US Black heterosexual couples have largely been understudied. To address this gap, we applied the Assessment Phase of the ADAPT-ITT Framework to investigate Black heterosexual couples' perspectives on an existing e-Health, couples-based HIV prevention intervention. Applying a qualitative descriptive approach, joint dyadic interviews were conducted with 28 Black heterosexual couples from three jurisdictions in New York State. Content dyadic analysis revealed three descriptive categories: perspectives of the toolkit intervention (sub-codes: perceived relevance, reactions to core components), recommendations to enhance intervention relevancy (sub-codes: tailoring to relationship type, adding new content), and lasting intervention considerations (sub-codes: toolkit usability and language use). Overall, couples found the toolkit intervention content and usability acceptable and reflected on its potential to build sexual and relationship health. Couples recommended to enhance toolkit adaptability for varied couple's motivation and types re-consider terms like sexual agreements, and include content to facilitate communication regarding sensitive topics (e.g., childhood sexual trauma, co-parenting, family planning) and other issues that may have more relevance to the experience of US Black persons (i.e., wealth building).

A scoping review of spirituality and religiosity in people who have had a kidney transplant

Aim

To conduct a scoping review to discover what is known about the presence of spirituality and religiosity in people who have received a kidney transplant.

Design

Using Arksey and O'Malley's five‐stage framework, a scoping review of seven key databases was performed in June 2020. The scoping review follows the PRISMA extension for scoping review process.

Methods

CINAHL, MEDLINE, Embase, OvidPsychINFO, JBI, Scopus and Cochrane databases were searched to identify original research, from which seven studies were identified with only four meeting the criteria. The search strategy focused on studies that were published between January 2000‐May 2020.

Results

In synthesizing the available research, two key areas of interest were identified within the included studies, (1) clinical outcomes (medical adherence, renal function and transplant‐related outcomes) and (2) well‐being outcomes (locus of control and coping).

The Effect of Spiritual Care on Anxiety and Depression Level in Patients Receiving Hemodialysis Treatment: a Randomized Controlled Trial

The present study was conducted to determine the effect of spiritual care on the anxiety and depression levels of patients receiving hemodialysis treatment. The research was carried out between January and May 2019 in a training and research hospital hemodialysis unit in the Eastern Anatolian Region of Turkey. The research was completed with a total of 71 patients (33 experiments, 38 controls) who received hemodialysis treatment. Regarding in-group comparison, the difference between the mean scores of pre-test and post-test of the patients concerning the anxiety and depression in the experimental group was found to be statistically significant (p ˂ 0.05). It was determined that training for strengthening spirituality was effective in reducing the anxiety and depression levels of patients receiving hemodialysis treatment. It can be suggested that spiritual care should be used as a complementary method in health care practices to increase the effectiveness of the treatment.

Experiences Related to Patients and Families' Expression of Spiritual Needs or Spiritual Support Within Healthcare Settings During the COVID-19 Pandemic: A Scoping Review

The aim of this review was to explore the evidence surrounding patients and families' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic from the perspective of nursing practice. While there is a plethora of research and publications related to COVID-19 and there are reports of increasing attention to nurses' psychological distress, there is little understanding of experiences related to patients' expression of spirituality, spiritual needs or spiritual support within healthcare settings during the COVID-19 pandemic. A scoping review was conducted to search and select potential studies and undertake data extraction and synthesis. Twenty-one studies published between March 2020 and August 2021 were identified. Themes and subthemes that emerged from analysis of the studies included spiritual needs, new awareness of spiritual needs and spiritual interventions, chaplaincy referrals, and improved well-being. The potential requirement for spiritual care during these times has anecdotally never been greater. At the same time the existent ethical challenges persist, and nurses remain reticent about the topic of spirituality. This is evident from the clear lack of attention to this domain within the published nursing literature and a limited focus on spiritual care interventions or the experiences and spiritual needs of patients and their families. Greater attention is needed internationally to improve nurses' competence to provide spiritual care and to develop and advance nursing and research practice in the field of spiritual care.

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.

Exploring the Meaning in Life and the Influencing Factors among Patients Undergoing Hemodialysis in Macau

Introduction

The meaning in life (ML) is a significant predictor of the physical and mental health of patients with chronic diseases, and its construct is culturally specific.As a group between normal people and the patients with advanced cancer, patients with End-Stage Kidney Disease (ESKD) who are undergoing hemodialysis (HD) are often outside of research focus on ML.

Objectives

This study was to investigate the status of ML of patients on HD in Macau of China and to analyze the influence of social-demographic characteristics and disease-related factors on their ML. The study findings would inform the development of evidence-based interventions in nursing care for this patient population.

Methods

This study employed a cross-sectional survey design. Eligible participants were recruited by convenient sampling from the largest HD center in Macau in January 2020. The participants’ social-demographic and disease-related characteristics were collected, and their ML status was assessed by the Meaning in Life Scale for Hemodialysis Patients (MLSHP). SPSS 22.0 software was used to analyze the data.

Results

Questionnaires were distributed to 249 potential participants who were patients on HD, and 238 patients replied to the questionnaires effectively. The effective response rate was 95.58% (238/249). The average score of ML for the patients was 93.75 ± 10.00, which was 72% of the total score of 130 on the ML scale. Gender, religious belief, duration of dialysis treatment, and symptom-related distress had impacts on ML levels (p < .05), with religious belief being a particularly strong predictor (p < .001).

Conclusion

The level of ML for patients on HD in Macau is relatively high. Different demographic or disease-related factors impact participants’ ML, supporting or contradicting previous studies. While the study findings are meaningful under the local cultural contexts, they have implications for nurses in other places to develop evidence-based interventions for patients on HD.

Correlations among spiritual care competence, spiritual care perceptions and spiritual health of Chinese nurses: A cross-sectional correlational study

BACKGROUND

The significance of spiritual care competence among nurses has been emphasized across countries and cultures in many studies. However, there were few studies on correlations among spiritual care competence, spiritual care perceptions, and spiritual health of nurses in China.

OBJECTIVE

To investigate spiritual care competence, spiritual care perceptions, and spiritual health, and examine the correlations among spiritual care competence, spiritual care perceptions and spiritual health, and the mediating role of spiritual health between other two variables of Chinese nurses.

METHODS

A cross-sectional and correlational design was implemented, and the STROBE Checklist was used to report the study. A convenience sample of 2,181 nurses were selected from 17 hospitals in 3 provinces, China. Participants provided data on sociodemographic by completing the Chinese Version of the Spiritual Care Competence Scale, the Chinese Version of the Spiritual Care-Giving Scale, and the Spiritual Health Scale Short Form. Descriptive statistics, univariate, multiple linear regression, and Pearson correlation analysis were used to analyze data.

RESULTS

The total scores of spiritual care competence, spiritual care perceptions, and spiritual health were 58.25 ± 16.21, 144.49 ± 16.87, and 84.88 ± 10.57, respectively, which both were moderate. Spiritual care competence was positively correlated with spiritual care perceptions (r = 0.653, p < 0.01) and spiritual health (r = 0.587, p < 0.01). And spiritual health played a mediating role between the other two variables (accounting for 35.6%).

SIGNIFICANCE OF RESULTS

The spiritual care competence, spiritual care perceptions, and spiritual health of Chinese nurses need to be improved. It is recommended that nursing managers should pay attention to spiritual care education of nurses, and improve spiritual care perceptions and spiritual health in multiple ways, so as to improve their spiritual care competence and to maximize the satisfy spiritual care needs of patients in China.

Spirituality as a core concept in the theoretical literature of nursing: A comparative overview between Watson & Lovering's perspectives

Nurse theorists have addressed the primacy of the phenomenon of caring, aiming at providing a framework that captures the complex nature of caring. Several theorists emphasized the mechanical facet of care while others emphasized the holistic aspect of care. Spirituality as a central concept in caring theories was targeted in this manuscript; as it a fundamental aspect of holistic care. Watson's Human Caring Science Theory and Lovering's Crescent of Care Nursing Model represent two distinctive approaches to caring in the dimension of spirituality. A compare/contrast approach is used to depict the similarities and differences between both works, focusing on spirituality as a common concept. The outcome of the comparison showed that spirituality is a multidimensional metaphysical concept that both theorists had identified as an indispensable core aspect of holistic nursing and is context-bound in terms of its dimensions, applications, and meaningfulness.

Spiritual care needs and their associated influencing factors among elderly patients with moderate-to-severe chronic heart failure in China: A cross-sectional study

Background

The significance of spiritual care needs among chronic diseases patients has been emphasized across countries and cultures in many studies. However, there were few studies on spiritual care needs among elderly patients with moderate-to-severe chronic heart failure (CHF) in China.

Objective

To investigate spiritual care needs and associated influencing factors among elderly patients with moderate-to-severe CHF, and to examine the relationships among spiritual care needs, self-perceived burden, symptom management self-efficacy, and perceived social support.

Methods

A cross-sectional design was implemented, and the STROBE Checklist was used to report the study. A convenience sample of 474 elderly patients with moderate-to-severe CHF were selected from seven hospitals in Tianjin, China. The sociodemographic characteristics questionnaire, the Spiritual Needs Questionnaire Scale, the Self-Perceived Burden Scale, the Self-efficacy for Symptom Management Scale, and the Perceived Social Support Scale were used. Descriptive statistics, univariate, multiple linear regression, and Pearson's correlation analysis were used to analyze data.

Results

The total score of spiritual care needs among 474 elderly patients with moderate-to-severe CHF was 37.95 ± 14.71, which was moderate. Religious belief, educational background, self-perceived burden, symptom management self-efficacy, and perceived social support were the main factors affecting spiritual care needs, and spiritual care needs were negatively correlated with self-perceived burden (r = −0.637, p < 0.01) and positively correlated with symptom management self-efficacy (r = 0.802, p < 0.01) and social support (r = 0.717, p < 0.01).

Significance of results

The spiritual care needs of elderly patients with moderate-to-severe CHF were moderate, which were influenced by five factors. It is suggested that clinical nurses, families, and society should take targeted spiritual care measures to improve patients’ symptom management self-efficacy and perceived social support from many aspects, and reduce self-perceived burden to meet their spiritual care needs and improve the quality and satisfaction of spiritual care in nursing practice.

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.

The construction of contemporary nursing identity from narrative accounts of practice and professional life

OBJECTIVE

To explore the contemporary narrative of nursing identity in Spain.

METHOD

This qualitative study was conducted between 2018 and 2020. Eleven registered nurses were interviewed. The conversations were recorded in audio, were semistructured, and held in a mental health clinic affiliated with a Catholic institution. Narrative analysis of the data was carried out.

FINDINGS

Two themes were identified: How do I construct my professional life?, with the subthemes 'Training and initiation in care practice', 'Ways of living the professional care experience', 'The sculpting of care' and 'Self-image and future projection'; and What do I know about my practice?, with the subthemes 'Nursing experience: shift, days, years', 'Strategy in the field of nursing care', 'Some foundations of caregiving practice', 'The specificity of the gesture of care' and 'Voice and recognition of nursing within the institution'.

CONCLUSION

Contemporary nursing identity is built in reflections on the epistemology of care, confronting the weight of tradition and breaking into new modes of self-image where the profession is legitimized and projected from historical consciousness. This claim can be used to support reflective practice in academic and healthcare settings as well as to promote a paradigm shift.

Spirituality and Standards for Practice: A Critical Discourse Analysis

Research Objective: The aim of this article is to report a study that explores how spirituality is understood to be represented in the current Australian Nursing and Midwifery Board of Australia (NMBA) Registered Nurse (RN) standards for practice. Research Design: Fairclough's approach to critical discourse analysis was applied in the examination of participant interview texts for the language used in relation to spirituality as well as power mechanisms which influenced the way the participants viewed spirituality's representation in the RN Standards for Practice. Participants: Three members of the RN Standards for Practice research and development team. Results: Findings indicate three discourses shaped the way participants viewed how spirituality is presently represented in the RN Standards for Practice. Discourses are (1) spirituality as part of holistic care, (2) spirituality as part of person-centered care, and (3) the professionalization of nursing. Conclusions: Participant interviews revealed these discourses exerted power over how spirituality was represented within the RN Standards for Practice. This has implications for the inclusion of spirituality in the practice standards and the practice of spiritual care.

Supporting diversity in person-centred care: The role of healthcare chaplains

AIM

To explore healthcare chaplains' experience of providing spiritual support to individuals and families from minority religious and non-religious faiths and to identify key elements of the role.

BACKGROUND

Currently, there is limited research uncovering the essential elements of healthcare chaplaincy, specifically with reference to religious and/or spiritual diversity, and as interprofessional collaborators with nurses and midwives in healthcare.

RESEARCH DESIGN AND PARTICIPANTS

Using phenomenology, we interviewed eight healthcare chaplains from a variety of healthcare settings in the Republic of Ireland. Data were analysed using a seven-step framework comprising Moustakas' (1994) modification of the Van Kaam method of data analysis.

ETHICAL CONSIDERATIONS

Ethical approval was granted by the university and the principles of informed consent applied.

FINDINGS

Three main themes emerged: what the chaplain brings; components of ritual, minority faith or no faith; and practising chaplaincy. Subthemes included 'offering', 'awareness and insight', 'acceptance and empathy', 'skilled companionship', 'presence', 'a confidant and holder of hope' and 'a vital resource'.

DISCUSSION AND CONCLUSIONS

The healthcare chaplain is a key collaborator in facilitating holistic person-centred care and in supporting healthcare professionals. Chaplaincy services are an essential but largely unrecognised and potentially cost-effective component of interprofessional team working.

RELEVANCE TO CLINICAL PRACTICE

This study has illuminated key aspects of the healthcare chaplain's role as interprofessional collaborator in person-centred care, in navigating diversity and ensuring respect and dignity for the person irrespective of religious or spiritual care needs.

What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping

OBJECTIVES

The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic.

DESIGN

Group concept mapping (GCM).

SETTING

The study was conducted within a university setting in Denmark.

PARTICIPANTS

Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13).

RESULTS

Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster.

CONCLUSION

Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni)

The process of removal of a chest tube can cause pain and anxiety. Spiritual care can be considered as a component of nursing care, especially in the pain and anxiety relating to such procedures. This study was a randomized clinical trial. Eighty patients completed the study. The findings showed significant differences in anxiety and pain between groups (p = 0.001). Spiritual care reduced anxiety and pain caused by chest tube removal in patients (Shia and Sunni Islam) undergoing heart surgery.

What is the practice of spiritual care? A critical discourse analysis of registered nurses' understanding of spirituality

Spirituality has been a part of nursing for many centuries and represents an essential value for people, including nurses and patients. Cumulative evidence points to the positive contribution of spiritually on health and wellbeing. However, there is little clarity about what spirituality means. The literature reveals that nurses have ascribed a diversity of interpretations to spirituality. However, no studies have investigated how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Therefore, the aim of this study was to uncover how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Twenty registered nurses from a non-denominational public hospital and a faith-based private hospital were interviewed about their understanding of spirituality and practice of spiritual care. A critical discourse analysis approach was used in the examination of the interview texts to uncover underlying social and power features. Links were made between the linguistic features the registered nurses used in their interviews and the broader social context of the study. Three discourses emerged from the interview texts. These include constructing spirituality through personal religious beliefs discourse, holistic discourse and empathetic care discourse. The findings of this study have implications for nurse education and policy makers.