Spiritual Care Education of Health Care Professionals

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.

A survey regarding the role of UK dietitians in spiritual care

BACKGROUND

Users of dietetic services have unmet spiritual needs, although no study has yet explored dietitians' opinion, perceptions or experience of assessing spiritual needs and delivering spiritual care in clinical practice.

METHODS

A cross-sectional survey assessed the role of UK dietitians in spiritual care.

RESULTS

Thirty-seven practicing dietitians, with experience ranging from newly qualified to over 21 years of practice, took part in the survey containing open and closed questions. Almost half (49%) of dietitians said they always conducted spiritual assessments and most (57%) said they sometimes made a referral for spiritual concerns. When spiritual issues arose, dietitians were highly likely to listen well (score 4.6 out of 5) and encourage service users in their own (the service user) spiritual or religious practices (score 4 out of 5). However, the likelihood of taking the initiative and enquiring about religious and spiritual issues was lower (score <3 out of 5) in all areas of practice including end of life care. This may have been because confidence around spiritual care was also low (score 4.7 out of 10), uncertainty was high (score >3.5 out of 5) and there was a strong desire to receive training (>4 out of 5). Qualitative responses expanded further on these results suggesting that there was positive "intention" to provide spiritual care, but lack of training was a significant barrier (qualitative theme: "inadequacies"). The recognition of necessity but uncertainty of how to meet spiritual needs was also shown through qualitative findings to be a source of "emotional labour", particularly where there were conflicting beliefs between a dietitian and service user.

CONCLUSIONS

Although limited by a small sample size, these results provide new knowledge that spiritual care is considered an important part of the dietitians' role and that this is the case regardless of the dietitians own spiritual identity or religion. Dietitians would value training in spiritual care so that they can support service user needs more readily and confidently.

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Palliative care and spiritual care competency measurement among Turkish Nurses: A scale adaptation study

OBJECTIVES

This study aimed to conduct a Turkish validity and reliability study of the Palliative Care Spiritual Care Competency Scale.

METHODS

The sample of the study consisted of 354 nurses. In the first stage, the forward-backward translation method was used to develop the Turkish version of the Palliative Care Spiritual Care Competency Scale. The comprehensibility, purposefulness, cultural appropriateness, and discrimination of the scale items were evaluated with content validity. Confirmatory factor analysis (CFA) was applied to examine the construct validity of the scale. To evaluate the ability of the scale to give consistent results at different time intervals, the relationship between the scores obtained from the first and second applications was examined with the intraclass correlation coefficient (ICC). The reliability of the scale was evaluated with the Cronbach's alpha reliability coefficient and item-total score correlation coefficients.

RESULTS

The content validity index of the Palliative Care Spiritual Care Competency Scale was found to be 0.98 after expert opinion was obtained. The goodness-of-fit values of the scale were χ2/sd: 3.125; GFI: 0.915; AGFI: 0.875; IFI: 0.926; TLI: 0.905; CFI: 0.925; RMSEA: 0.078; SRMR: 0.054. As a result of CFA, some items were removed from the scale, and a Turkish version of the scale consisting of 14 items and three sub-dimensions was developed. The reliability of the scale over time was evaluated with the test-retest method, and it was found that the inter-response agreement was very good (ICC: 0.981; p < 0.001). The Cronbach's alpha reliability coefficient of the scale was 0.89 and the Cronbach's alpha reliability coefficient of the subscales ranged between 0.78 and 0.85.

SIGNIFICANCE OF RESULTS

It was determined that the Turkish version of the Palliative Care Spiritual Care Competency Scale is a short, easy-to-understand, and psychometrically sound measurement tool that can be safely applied to Turkish nurses.

Evaluation of Midwives' Perceptions of Spirituality and Spiritual Care in Aydın, Turkey

Spirituality is an integral part of holistic care, but studies have revealed that the spiritual dimension of care is largely neglected in healthcare settings. This study evaluated midwives' perceptions of spirituality and spiritual care. The study is a cross-sectional design and was conducted from April 1 to June 30, 2018 in Aydın, Turkey. The research sample of the study contacted 101 midwives. The Spirituality and Spiritual Care Rating Scale were used to collect data. It was found that the midwives' perceptions of spirituality and spiritual care were affected by age, having children, family type, and working unit (p < 0.05).

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

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

Perceived Barriers to Providing Spiritual Care in Palliative Care among Professionals: A Portuguese Cross-Sectional Study

Spiritual care is an important dimension of palliative care (PC) and a facet of holistic care that helps ill people find meaning in their suffering and lives. This study aims to: (a) develop and test the psychometric properties of a new instrument, Perceived Barriers to Spiritual Care (PBSC); (b) explore participants' perceptions of how prevalent those (pre-identified) barriers are; and (c) examine the association of their personal and professional characteristics with those perceptions. A descriptive cross-sectional study was carried out using a self-reporting online survey. In total, 251 professionals registered with the Portuguese Association of Palliative Care (APCP) completed the study. The majority of respondents were female (83.3%), nurses (45.4%), had more than 11 years of professional experience (66.1%), did not work in PC (61.8%), and had a religious affiliation (81.7%). The psychometric assessment using PBSC provided sound evidence for its validity and reliability. The three most common perceived barriers were late referral for palliative care (78.1%), work overload (75.3%), and uncontrolled physical symptoms (72.5%). The least commonly perceived barriers were different spiritual beliefs among professionals (10.8%), differences between the beliefs of professionals and patients (14.4%), and the shame of approaching spirituality in a professional context (26.7%). The findings show there is some relationship between sex, age, years of professional experience, working in PC, having a religious affiliation, the importance of spiritual/religious beliefs, and responses to the PBSC tool. The results highlight the importance of advanced training in spirituality and intervention strategies. Further research is needed to properly study the impacts of spiritual care and establish outcome assessments that accurately reflect the effects of the various spiritual care activities.

SPACEE Protocol: "Spiritual Care Competence" in PAlliative Care Education and PracticE: Mixed-Methods Research in the Development of Iberian Guidelines

Spiritual care requires understanding the spiritual experiences of patients and recognizing their resources and needs. Therefore, educators and practitioners should develop their knowledge and understanding in this regard. Spiritual care helps people overcome their anxieties, worries, and suffering; reduces stress; promotes healing; and encourages patients to find inner peace. To provide comprehensive and appropriate care while upholding human/ethical virtues, the spiritual dimension must be a priority. We aim to develop spiritual care competence guidelines for Palliative Care (PC) education and practice in Portugal and Spain. The study detailed in this protocol paper will include three phases. In phase I, the phenomenon will be characterized and divided into two tasks: (1) a concept analysis of "spiritual care competence"; and (2) a systematic review of interventions or strategies used to integrate spiritual care in PC education and practice. Phase II will entail a sequential explanatory approach (online survey and qualitative interviews) to deepen understanding of the perceptions and experiences of educators, practitioners, and patients/family carers regarding spiritual care in PC education and practice and generate ideas for the next steps. Phase III will comprise a multi-phased, consensus-based approach to identify priority areas of need as decided by a group of experts. Results will be used to produce guidelines for integrating spirituality and spiritual care competence within PC education and practice and synthesized in a white book for PC professionals. The value of this improved examination of spiritual care competence will ultimately depend on whether it can inform the development and implementation of tailored educational and PC services. The project will promote the 'spiritual care' imperative, helping practitioners and patients/family carers in their preparedness for End-of-Life care, as well as improving curricular practices in this domain.

The Polish Catholic Church in Martin Coronado, Buenos Aires, and its Role in the Life of the Argentinian Polish Community during the COVID-19 Pandemic

The objective of the article is to determine the role of the Catholic Church in the life of the Polish community in Argentina as exemplified by the Polish Catholic Centre in Martin Coronado during the pandemic caused by the SARS-Cov-2 coronavirus. The article presents opinions of the Polish community in Buenos Aires concerning the priestly service of the Bernardine friars during the pandemic. The research confirms that the Argentinian Polish community evaluates the work of the clergymen very highly and emphasises that thanks to their support, peace and constant contact through, inter alia, introduction of the broadcast of the masses in the Polish language, they felt the care and support of the priests, which was necessary during social isolation. The article will also present a proposal of the model of activities that Polish priests from Martin Coronado can implement during the COVID-19 pandemic so that the faithful feel even greater support and closeness to the Polish missionary centre in Argentina.

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

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

Have we been able to improve the conscientious intelligence levels of nursing students sufficiently?

PURPOSE

This study was aimed at comparing the conscientious intelligence levels of nursing students and determining the factors affecting their conscientious intelligence.

DESIGN AND METHODS

Two hundred and forty nursing students were involved in the study.

FINDINGS

There were no statistically significant differences between the first and fourth-year students in terms of the mean scores they obtained from the compassion, responsibility toward the creator, conscious awareness, and social sensitivity sub-dimensions. Of the students, those who chose the profession willingly, those who were women and those who did not perceive nursing as a profession just to earn money obtained higher mean scores in the Conscientious Intelligence Scale.

PRACTICE IMPLICATIONS

The results of the study revealed that Nurse Academics should make more attempts to improve students' conscientious intelligence.

A training programme for medical students in providing spiritual care to people with advanced diseases and their loved ones: A case study from the Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland

Purpose

This article presents the first programme on spiritual care particularly for people with advanced life-limiting illness including heart failure, lung disease or cancer for medical students in Poland implemented at the Collegium Medicum in Bydgoszcz of the Nicolaus Copernicus University in Toruń.

Methods and materials

Several steps were identified for the development of the first programme on spirituality for medical students at the Collegium Medicum in Bydgoszcz including preliminary work on the content of the programme, agreement on key concepts, terms, and definitions; consultations with teachers and review of the literature.

Results

The first Polish spiritual curriculum for medical students was implemented. The spirituality curriculum will potentially contribute to better care for the people with advanced illnesses such as heart failure, chronic lung disease or cancer and improve the quality of relationships between professionals and patients.

Conclusion

The article presents the content of the program, the expected learning objectives and ascribed teaching methods, along with the preliminary evaluation made by students.

A Call for Faith Integration Among Graduate Nursing Students

ABSTRACT

Spiritual assessment and faith integration are essential components of faith-based graduate nursing education. However, there are limited resources on faith integration in the graduate nursing curriculum. The author provides a framework and examples of application of four major concepts that can assist Christian nurse educators to engage students in transformational integration of faith and learning.

Spiritual Care Professionals as Unit-Based Interdisciplinary Team Members? Considering Patient and Staff Perceptions in a Forensic Mental Health Care Setting

This project considers two co-occurring studies accounting perceptions of patients (n=8) and staff (n=8) related to assignment of Spiritual Care students as full-time interdisciplinary team members at a Forensic mental health facility. Students on 12-week placements were individually assigned to care units. Qualitative method consistent with Interpretative Phenomenological Analysis was employed. The co-occurring studies identified that enhanced access to Spiritual Care was valued. Staff and patients indicated a desire for more spirituality focused participation.

GPs´ Personal Spirituality, Their Attitude and Spiritual Competence: A Cross-Sectional Study in German General Practices

To understand if GPs' spiritual competence, their personal spirituality and attitude towards enquiring about spirituality in practice interrelate, we conducted a cross-sectional survey of 30 German GPs regarding issues of SC. We found correlations between GPs' personal spirituality, their spiritual competence and their attitudes towards SC. The ability to perceive spiritual needs of patients was the competence most strongly related to GPs' attitude towards SC. The competence with the strongest correlation to personal spirituality was Self-awareness and Proactive opening. No correlation was found between affiliation to a spiritual community and GPs' attitude towards SC. The results show that GPs' personal spirituality and spiritual competence are indeed related to addressing spirituality with their patients. To foster SC, training programmes should raise awareness for one's personal spirituality and encourage one to reflect on spiritual competence.

Spiritual Care Competences among Health Care Professionals in Pakistan: Findings from a Cross-Sectional Survey

Introduction: There is a gap in healthcare literature related to the spiritual competence of physicians and nurses practicing in South Asian Muslim communities. To fill that gap, the Spiritual Care Competence Questionnaire (SCCQ) was applied which was developed to address multi-professional spiritual care competences. Materials and Methods: A cross-sectional study among 294 health professionals (61% physicians, 17% nurses, and 22% other professions) in 10 hospitals in Punjab, Pakistan. Results: The highest scoring competences were “Dealing with patients/Communication competences”, while “Team Spirit” scored lowest. There were no gender related differences, but there were effects related to professions. “Team Spirit”, “Dealing with patients/Communication competences”, and “Empowerment competences” scored significantly higher in nurses as compared to physicians and other health care professionals, while there were no significant differences for their “Perception/Documentation competences”. These competences were not relevantly related to the intensity of their prayer/meditation activity. Conclusions: Health care professional from Punjab were preferred to tolerate the pain and the suffering of patients and their relatives rather than to talk about spiritual care issues. Their spiritual care competences were less developed. Thus, there is a clear need for further specific education and training of health professionals.

"We are also here"-Spiritual Care Practitioners' Experiences of the COVID-19 Pandemic: A Qualitative Study from Poland

Although healthcare professionals have become the symbol of risk and sacrifice during the COVID-19 pandemic, spiritual care practitioners (SCP) have also put themselves at great risk while offering their service in hospitals, hospices and other healthcare facilities. This study was designed to explore the lived experiences of SCP during the current health crisis in Poland. Semi-structured interviews were conducted with twenty-four SCP. Nine major themes emerged from the interviews: personal reactions to the pandemic, SCP's perception of the pandemic, the impact of COVID-19 on the provision of spiritual care, spiritual needs during the pandemic, work-related emotions, the impact of the COVID-19 on religion, the role of spiritual care during the outbreak, the healthcare professionals' perceptions of SCP and barriers to the provision of spiritual care during the pandemic. The SCP indicated that although the COVID-19 crisis has affected the availability of pastoral, religious and spiritual care, it has amplified the importance of such care and has positively influenced the visibility of SCP in modern healthcare practice. Nonetheless, in such desperate times, SCP are still neglected and should be further recognised and integrated into the healthcare system.

“We are also here”—Spiritual Care Practitioners’ Experiences of the COVID-19 Pandemic: A Qualitative Study from Poland

Although healthcare professionals have become the symbol of risk and sacrifice during the COVID-19 pandemic, spiritual care practitioners (SCP) have also put themselves at great risk while offering their service in hospitals, hospices and other healthcare facilities. This study was designed to explore the lived experiences of SCP during the current health crisis in Poland. Semi-structured interviews were conducted with twenty-four SCP. Nine major themes emerged from the interviews: personal reactions to the pandemic, SCP’s perception of the pandemic, the impact of COVID-19 on the provision of spiritual care, spiritual needs during the pandemic, work-related emotions, the impact of the COVID-19 on religion, the role of spiritual care during the outbreak, the healthcare professionals’ perceptions of SCP and barriers to the provision of spiritual care during the pandemic. The SCP indicated that although the COVID-19 crisis has affected the availability of pastoral, religious and spiritual care, it has amplified the importance of such care and has positively influenced the visibility of SCP in modern healthcare practice. Nonetheless, in such desperate times, SCP are still neglected and should be further recognised and integrated into the healthcare system.

Natality and Relational Transcendence in Humanist Chaplaincy

Every life has a beginning and an end. Natality and mortality are both profound existential fundaments of life that may lead us to question meaning in life as well as to find meaning. In spiritual care, the focus is often on mortality as a source of existential suffering, and on ways to deal with such suffering according to worldview traditions. In humanist traditions, mortality is not only seen as an existential threat but also as an existential given that people need to embrace to find meaning in life. Natality has received much less attention, both in spiritual care and in humanist thought. In this article, we build on philosophical ideas of Arendt and Butler to explore the significance of natality for a humanist perspective on meaning in life and spiritual care. We argue that taking natality into account results in a relational understanding of humanist spiritual care in which the notion of “relational transcendence” is a central element. Natality also means that we can initiate, create, and act in the world, which highlights the political dimension of humanist spiritual care. We reflect on the implications of natality and relational transcendence for humanist spirituality and chaplaincy and formulate some concrete building blocks for working from this perspective.

Empowerment of nurses for integrating clients' religion/spirituality into clinical practice: outcomes of an online training program

Background

Integration of clients’ religion/spirituality (R/S) into nursing practice can have effective outcomes in clients’ health. In this regard, nurses’ lack of competency can disrupt this process and interfere with the treatment process. Limited studies examined the impact of training programs on nurses’ competency in spiritual care and integration of clients’ R/S into clinical practice. This study aimed to investigate the impact of an online training program on nurses’ empowerment for integrating clients’ R/S into clinical practice.

Methods

In the present interventional study, 80 nurses were selected by stratified sampling from two hospitals in the southeastern Iran. Nurses were randomly divided into the intervention (n = 40) and control (n = 40) groups. An online training program was performed for the intervention group in four 2-hour sessions during three weeks. Data were collected from all participants using the R/S Integrated Practice Assessment Scale (RSIPAS) before and one month after the intervention.

Results

Prior to the intervention, scores of integrating clients’ R/S into clinical practice were not significantly different between the intervention and control groups (t = 0.23, p = 0.81). However, after the training program, these scores increased significantly with a very large effect size compared to the control group (t = 4.31, p = 0.001). Although the control group scores improved significantly after the intervention compared to the pre-intervention stage, the effect size was very small (t = -2.55, p = 0.01).

Conclusions

The online training program had a positive effect on nurses’ competency for integrating clients’ R/S into clinical practice in the intervention group. Due to the importance of integrating clients’ R/S into clinical practice, nurses’ competency should be strengthened in this area. Managers are suggested to consider appropriate strategies in order to empower nurses in integrating clients’ R/S into clinical practice. Nurse educators can benefit from our experiences in application of online training programs in nursing schools.

Perceived professional competence in spiritual care and predictive role of spiritual intelligence in Iranian nursing students

AIM/OBJECTIVE

The aim of this study was to identify the relationship between perceived competence in spiritual care and spiritual intelligence among nursing students.

BACKGROUND

One of the most important duties of nurses is to pay attention to the spiritual needs of patients and provide them with proper spiritual care. Therefore, professional competence in this area is essential for nurses and nursing students. Also, spiritual intelligence is a factor influencing the caring behaviors of nurses.

DESIGN

A cross-sectional and correlational study SETTINGS/PARTICIPANTS: This study was included 510 undergraduate nursing students in two public faculties of nursing in Iran in the 2018-2019 academic year.

METHODS

The samples were selected using a census method. A demographic information questionnaire, the valid and reliable Iranian questionnaire of nurses' competencies in spiritual care and the spiritual intelligence self-report inventory (SISRI) were used to collect data.

RESULTS

A significant positive correlation was found between nursing students' competence in spiritual care and spiritual intelligence (p < 0.001, r = 0.26). No significant differences were found between the mean competence scores of spiritual care in terms of demographic characteristics. There were significant differences between the mean spiritual intelligence score in terms of age, marital status, history of clinical practice and academic year. The regression model indicated that for increased rates of spiritual intelligence, professional competence in spiritual care would rise as much as 0.39.

CONCLUSION

Spiritual intelligence can affect the competence of nursing students in providing spiritual care to patients. Therefore, to promote students' spiritual intelligence, appropriate plans with the aim of promoting the level of critical thinking and spiritual self-awareness are recommended.

The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic Review

CONTEXT

Spirituality has been demonstrated to play an important role in healthcare, yet many staff feel ill-equipped to deliver spiritual care. Spiritual care training programs have been developed to address this need.

OBJECTIVE

The aim of this mixed-methods systematic review was to identify spiritual care training programs for healthcare professionals or students, and to investigate program content, teaching methods, key outcomes, and identified challenges and facilitators.

METHODS

A mixed-methods systematic review was conducted. The search terms ('religio*' OR 'spiritual*' OR 'existenti*') were combined with ('educat*' OR 'train*' OR 'curricul*' OR 'program*'), AND ('care' OR 'therap*' OR 'treatment' OR 'competenc*'). Search terms were entered into the following data bases: PsycINFO, Medline, Cinahl and Web of Science. Findings were restricted to peer-reviewed studies published in English between January 2010 and February 2020.

RESULTS

Fifty-five studies were identified. The quality of studies was mixed. Programs encompassed a range of content and teaching methods. Reported outcomes included increased levels of competency across intrapersonal spirituality, interpersonal spirituality, and spiritual assessment and interventions. Identified barriers included competing healthcare priorities, negative perceptions of spirituality and spiritual care, resistance towards focusing on one's own spirituality, staff feeling inadequate, and the need for ongoing training. Facilitators included opportunities for reflection, involvement of chaplains, application of practical tools, opportunities for practice, online training, and managerial support.

CONCLUSIONS

Positive outcomes following spiritual care training were identified. Further research is needed to identify patient-related outcomes of staff training, and to examine how the benefits of such training can be maintained over time.

Statistical fit is like beauty: A rasch and factor analysis of the Scottish PROM

Chaplains help people face some of the most complex, intractable and traumatic issues in their lives. Spiritual care works. Unfortunately, spiritual needs are rarely met in health and social care because a) spiritual distress is not recognised as such, and b) chaplain interventions are undervalued and misunderstood. The Scottish Patient Reported Outcome Measure (PROM) © was created to help provide evidence for the impact of chaplain interventions. The aim of this study was to establish whether the PROM could also be used to identify patients in need of chaplain interventions. To test this psychometrically, Rasch and Confirmatory Factor Analysis was conducted on an international dataset of post intervention PROMS from UK, Europe and Australia completed between 2018-2020 (n = 1117). The data fit the Rasch model, and the PROM demonstrated uni-dimensionality, construct validity and reliability, meaning PROM scores represent a coherent concept. Higher scores represented lower levels of spiritual distress, and the mean score was 12 out of 20. PROM score of 9 was one standard deviation below the norm, a metric routinely used to identify 'clinically important difference' in psychometric scales. A Scottish PROM^© score of 9 and under could therefore identify people for whom chaplaincy may be beneficial. The clinical implications of this are considerable.

A Survey of Hospice and Palliative Care Nurses' and Holistic Nurses' Perceptions of Spirituality and Spiritual Care

The provision of spiritual care is referred to in professional practice guidelines and mandated in nurses' ethical codes. Still, a gap exists regarding essential training in spiritual conversation and assessment, leaving some health care providers feeling uncomfortable when assessing spiritual support needs. The purpose of this study was to assess hospice and palliative nurses' and holistic nurses' perceptions of spirituality and spiritual care. It was assumed that the standards of care for hospice and palliative nurses and holistic nurses stipulate that spiritualty is addressed within the framework of their specialties and provide education for spiritual care, thus making these nurses proficient in providing spiritual care. This exploratory, descriptive study utilized a web-based survey to measure perception of spirituality and spiritual care giving using a modified Spirituality and Spiritual Care Rating Scale. A convenience sample was recruited from members of the Hospice and Palliative Nurses Association and the American Holistic Nurses Association (n = 250). Descriptive statistics summarized data as well as qualitative analysis of written narratives. Content analysis of open-ended survey questions was used to identify themes until saturation. This study found that given adequate resources and education, nurses can be positioned to address the spiritual needs of patients and provide appropriate care. This study adds to an emerging body of evidence suggesting that training in spiritual care should be an important component of the foundational nursing curriculum.

Effectiveness of an Educational Intervention to Teach Spiritual Care to Spanish Nursing Students

Spirituality and spiritual care in professional nursing are conceptualised and recognised as fundamental components of holistic healthcare. Despite the acceptance of and interest in spiritual care, a lack of education and clinical training on the subject limits nurses’ ability to meet patients’ spiritual needs. Consequently, the aim of this study was to analyse the effectiveness of a training programme designed to teach the specific knowledge, attitudes and competencies necessary to provide spiritual care in nursing practice. This study consisted of a one-group pre-post intervention design with two measurement times (baseline/pre-intervention and post-intervention). A teaching activity about spiritual care in nursing practice was designed and implemented (focal groups, open discussion, discussion groups and clinical case studies). The educational intervention was developed by the authors based on a literature review, research and feedback from the undergraduate students. A convenience sample of 369 nursing students at the University of Alicante (Spain) who were enrolled in the teaching subject of Psychology participated in this study. The effectiveness of the teaching activity was assessed through a self-administered 15-item questionnaire. The post-intervention results indicated that the programme was effective in improving knowledge, competencies and attitudes related to spiritual care. The implications of this study for teaching practice and future research are discussed

The Effect of Spiritual Care Based on the Sound Heart Model on the Spiritual Health of Patients with Acute Myocardial Infarction

Meeting the spiritual needs of patients with cardiovascular diseases has a significant effect on their speed of recovery and spiritual health, especially in coronary care units (CCUs). The present study was conducted to investigate the effect of spiritual care based on the sound heart model on the spiritual health of patients with acute myocardial infarction (AMI) admitted to the CCU of Chamran Hospital in Isfahan, Iran, in 2016. This clinical trial was conducted on 92 patients with AMI selected by convenience sampling and randomly assigned to the intervention (n = 46) and control (n = 46) groups. The spiritual care program based on the sound heart model was regularly carried out for the intervention group over 3 days at 5-8 PM during their hospital stay, and continued for 1 month at home after discharge from the hospital, and the control group only received routine nursing interventions. The patients completed Paloutzian and Ellison's Spiritual Well-Being Scale at baseline and a month after the intervention. Data were ultimately analyzed using Fisher's exact test, Mann-Whitney's test, the Chi-square test, and the t test. The spiritual care program was able to improve the mean scores of religious health (7.8), existential health (9.3) and the total score of spiritual health (17.1) in the intervention group, while these scores reduced to 0.9, 3.4 and 4.2 in the control group. A significant difference was found between the intervention and control groups in terms of the spiritual health score (P < 0.001). The present findings confirmed the effect of spiritual care based on the sound heart model on promoting spiritual health in patients with AMI. Its application as a holistic care approach is therefore recommended for improving the signs and dimensions of spiritual health in patients with coronary artery disease, especially MI.

Care of the Spirit: Effects of an Interdisciplinary Undergraduate End-of-Life Course on Knowledge, Competence, and Response Empathy

The purpose of this pilot was to identify the effects of a 4-credit interdisciplinary undergraduate course focused on communication strategies to enhance spiritual care at the end of life. The course provided students with opportunities to enhance their ability to communicate empathically with individuals facing the end of life. Evidence-based content focused on ways to live each day with hope and gratitude, strengthen relationships, create a legacy, and find meaning and purpose in life and death. Narayanasamy's (1999) Actioning Spirituality and Spiritual Care Education and Training in Nursing model guided project development. The study used a prospective, pretest/posttest design. Participants included undergraduate students (n = 34) from nursing, premedicine, athletic training, business, economics, and religious studies at a Midwest liberal arts college. Statistically significant differences were found in students' attitudes toward and knowledge of spirituality/spiritual care (P < .0001, Cohen's d = 0.59), spiritual care competence (P < .0001, Cohen's d = 0.79), and level of response empathy through role play (P < .0001, Cohen's d = 0.92). Many students referred to this course as "life changing" and "healing." As our students go out into the community, they may intimately touch the lives and hearts of future patients, family, and friends who face the end of life with their compassionate words.

Spiritual Care in Holistic Nursing Education: A Spirituality and Health Elective Rooted in T.R.U.S.T. and Contemplative Education

Research to date demonstrates that spiritual care as an integral part of holistic nursing can be hampered if nurses experience insufficient preparation or organizational cultures that fail to prioritize spiritual well-being. In response, the author has developed a three-credit spirituality and health elective in an undergraduate nursing program to help participants address spiritual needs and mobilize spiritual strengths within themselves, patients, and workplaces. Using the T.R.U.S.T. Model for Inclusive Spiritual Care as its framework, the six-unit course draws on contemplative education practices in hopes of preparing a critical mass of nurses with the ability and confidence to foster safe, relevant spiritual care and promote a holistic, patient-centered health care culture. Course participants regularly demonstrate and report deeper self-awareness, skills development, and confidence in relation to spiritual care; the course also has been positively evaluated and fully subscribed over its seven offerings to date, validating its effectiveness in relation to short-term outcomes. Research is needed to evaluate its long-term effectiveness in helping alumni integrate spiritual care into their holistic practice and workplace culture.

The Invisibility of Spiritual Nursing Care in Clinical Practice

Background and Purpose: Spirituality has been identified as the essence of being human and is recognized, by many health care professionals, as a central component in health and healing. Scholars have identified spiritual nursing care as essential to nursing practice and include caring for the human spirit through the development of relationships and interconnectedness between the nurse and the patient. However, despite the recognition of spiritual practices as important to health, little attention has been given to spirituality in nursing practice and education in the literature. The purpose of this article is to explore factors contributing to the invisibility of spiritual nursing care practices (SNCP), recognition and offer strategies to enhance the visibility of SNCP. Two major factors that reduce visibility of SNCP are conceptual confusion differentiating between spirituality and religion and limited education in the area of spirituality including nursing curricula and organizations. Strategies to enhance visibility of SNCP include educational approaches in nursing curricula and health care organizations. to influence nurses’ perceptions about spirituality and creation of a culture of spiritual care. Conclusion: Holistic nursing includes assessing and responding to the spiritual needs of patients. Changes in nursing education and health care systems are needed to increase the visibility of SNCP.

Perceptions of Spiritual Care Education, Competence, and Barriers in Providing Spiritual Care Among Registered Nurses

Purpose: The purpose of the study was to explore registered nurses’ (RNs) perceptions of their spiritual care competence (SCC), preparedness, and barriers to providing spiritual care and frequency of provision of spiritual care. Additionally, the study aimed to examine associations between spiritual care education, preparedness, competence, and frequency. Method: A descriptive, cross-sectional study included demographic questions, the Spiritual Care Competency scale, the Nurses’ Spiritual Care Therapeutics scale, the Spiritual Care Practice questionnaire subscale II, and three open-ended questions. Findings: This online survey was completed by 391 RNs enrolled in postlicensure programs at a public state university in southeastern United States. A majority of participants reported not feeling prepared to provide spiritual care. There were strong associations between receiving spiritual care education in prelicensure programs or at work, and self-reported feelings of preparedness, as well as overall SCC. The level of SCC was positively correlated with spiritual care frequency and number of years working as an RN. Conclusions: The results of this study highlight the need for spiritual care education in prelicensure programs as well as on the job training for RNs.

Team approaches in palliative care: a review of the literature

Background:

Interdisciplinary team involvement is commonplace in many palliative care settings across the world. Teamwork is perceived by many experts as an indispensable functionality of palliative care teams. Significantly different structural and functional attributes of these teams between regional and organisational contexts could potentially act both as strengths and weaknesses towards their overall productivity. The sustainability and resilience of the team also has an indirect bearing on the team functioning.

Aim:

This article describes international evidence on dynamic palliative care teams with a view of how and when they function efficiently or adversely. Emphasis is also placed on studies that suggest means to mitigate the conflicts and limitations of teamwork in palliative care and related healthcare settings.

Findings:

Evidence strongly suggests that palliative care is best delivered through a multidisciplinary team approach.

Conclusion:

The overall performance of a healthcare team is largely determined by the supportive work environment built through effective communication, leadership skills and mutual respect.

The implicit soul: Factors between the representation of death and dehumanization of patients

Spiritual approaches in healthcare settings proved effective in reducing the negative outcomes of dehumanization processes impacting health professionals and patients. Although previous literature focused on explicit measures of spirituality, the present research explored the role of implicit components of spirituality and their effects on the humanization of patients in two healthcare contexts. Professionals from hospices and nursing homes completed an implicit task to assess whether the diverse representation of death as physical or spiritual led to perceive patients with more uniquely human traits. Results showed that only for hospice participants, implicit and explicit spirituality predicts more humanness attribution to patients. This article discusses palliative care models and death education as a resource for reducing dehumanization.

Midwifery Students' Perceptions of Spirituality and Spiritual Care: An Example from Western Turkey

This cross-sectional study aimed to explore Turkish midwifery students' perceptions of spirituality and spiritual care and to investigate the factors affecting them. Data were collected from 271 students of the Midwifery Department of the High School of Health of a state university in the west of Turkey using the Spirituality and Spiritual Care Rating Scale. A significant difference was found between belief in the need for spiritual care and the practice of spiritual care during midwifery training and the total score on the Spirituality and Spiritual Care Rating Scale, but no significant difference was found between the students' year of class, whether they had heard about spiritual care, and their state of knowledge concerning spiritual care. An increase in awareness, knowledge and skills relating to spirituality and spiritual care on the part of midwifery students, who are the midwives of the future, will allow students to provide spiritual care to their patients after they qualify. For this reason, the education program of midwifery students should be seen from a holistic standpoint in order to develop spiritual care.

Spirituality in the continuing education of healthcare professionals: An approach to palliative care

Objective

A major barrier to the adoption of an approach that integrates spirituality into palliative care is the lack of preparation/education of healthcare professionals on the topic. This study aimed to evaluate the effectiveness of a continuing education activity for healthcare professionals addressing spirituality and spiritual care provision to patients and families within palliative care.

Method

We conducted an intervention study using a quantitative pre- and posttest design in a convenience sample of 52 healthcare professionals. Participants completed the Brazilian version of the Spiritual Care Competence Scale before and after attending a four-hour continuing education activity.

Result

Significant differences were observed between pre- and postintervention scores in the following dimensions: assessment and implementation of spiritual care, professionalization and improving the quality of spiritual care, personal support, and patient counseling (p < 0.001), and referral (p = 0.003).

Significance of results

The results of this study provide preliminary evidence of a positive effect of this educational intervention on the development of the competences needed by healthcare professionals to deliver a comprehensive approach centered on the patient/family, which includes attention to spirituality and spiritual care in the decision-making process.

Spirituality and Interprofessional Healthcare Education: An Exploratory Study

Undergraduate and graduate programs for healthcare professions are inconsistent in curricular offerings and incorporation of spiritual training. This study reviewed perceptions and opinions about spiritual care held by students at an American university. Data were collected using the Spirituality and Spiritual Care Rating Scale and one open-ended question. Findings indicated that many students were comfortable incorporating spirituality into practice, and they desired additional training. As to how students would apply spirituality to their practice, themes of facilitating connection, holistic care, spiritual interventions, and benefits of spirituality were identified.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses

OBJECTIVE

When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.

METHOD

We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p &lt; 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p &lt; 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Cross-cultural validation of the Brazilian version of the spiritual care competence scale

OBJECTIVE

This study describes the cross-cultural validation and psychometric evaluation of the Spiritual Care Competence Scale - Brazilian Portuguese version. This reliable and valid instrument is recommended in the literature to measure the outcomes of the education process in the development of spiritual care competences.

METHOD

This is a cross-sectional validation study following the stages proposed by Beaton et al.: translation into Portuguese, back translation into English, expert committee review for semantic equivalence, assessment of the clarity of the pre-final version, and evaluation of the psychometric properties of the final version in Portuguese. Health professionals working at a public hospital in South Brazil participated in the different stages of this study.ResultRegarding internal consistency, total Cronbach's alpha was 0.92 and the mean inter-item correlation was 0.29. The test-retest procedure showed no statistically significant differences in the six subscales. The intraclass correlation coefficient ranged from 0.67 to 0.84, demonstrating the stability of the scale.Significance of resultsThe results support the psychometric quality of the scale and indicate that the adapted instrument is a valid and reliable scale with good internal consistency for measuring spiritual care competencies of health professionals in Brazilian healthcare settings.

The role of palliative care in addressing the health needs of Syrian refugees in Jordan

Refugees are often afflicted with health conditions that require long-term, specialized and continuous care services that are costly and difficult to secure in host countries and camp settings. This study interviewed 21 Syrian refugees in Jordan with life-limiting conditions such as cancer, diabetes, chronic disability and renal failure, and 4 caregivers caring for refugee children with similar conditions. This study found that patients in refugee camps and communities would benefit from receiving palliative care services that are often either unavailable or inaccessible. Training humanitarian teams and primary care providers to implement pain management, offer psychosocial support services and address emotional, spiritual, and psychological conditions could ameliorate many of the problems faced by this vulnerable group.

Spiritual care training in healthcare: Does it really have an impact?

Objective

Spiritual care has formed an integral part of palliative care since its inception. People with advanced illnesses, however, frequently report that their spiritual needs are not attended to by their medical care team. The present study examines and describes the impact of a spiritual care training program on practice and cultural change in our Canadian hospice.

Method

A qualitative case study approach was adopted to gather feedback from hospice staff and volunteers using purposive sampling. In-depth interviews were conducted, transcribed, and analyzed using thematic (semantic and latent) analysis.

Result

Our data suggest that the program had a profound personal impact on attendees and contributed to a slight shift in practice patterns in our organization. Using a program not specifically tailored to our local and organizational cultural contexts resulted in some unanticipated challenges such as the range of tensions between personal and cultural boundaries. Although some people criticized parts of the program or questioned the program's value, a general agreement suggests that the program had a positive impact and meaningfully benefited our hospice. “What will happen next?” was the question most frequently voiced by interviewees.

Significance of results

Although the program may not have been a perfect fit for our organization, its use instigated a process of cultural change that unfolds today. The present study suggests that a systematic approach to spiritual care training that includes the concepts of workplace spirituality and sensitive practice offer useful frameworks for the development and implementation of spiritual care training in other institutions.

The Essence of Spiritual Care

Spiritual care is an important component of holistic nursing care. To implement spiritual care, the nurse must assess, diagnose, and respond to the needs of each patient and her or his significant others. Meeting the spiritual care needs of the patient can lead to physical healing, reduction of pain, and personal growth. Nurses providing spiritual care experience lower stress and less burnout.

The Effect of Spiritual Care on Stress Levels of Mothers in NICU

Hospitalization of an infant is a difficult situation for the family, and parents require support from the health care team during this difficult time. The aim of this study was to investigate the effect of spiritual care on levels of stress in mothers with infants in a neonatal intensive care unit. This spiritual care study was performed by comparing control and spiritual care pre- and posttest groups. The study population included 62 mothers. The Mother–Baby Introductory Information Form and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) were used for data collection. Prior to spiritual care, no significant difference was found between the mothers’ PSS:NICU scores, whereas following spiritual care, there was a significant difference between PSS:NICU scores of the mothers, in favor of the spiritual care group ( p < .05). Findings indicate that nurses should be aware and consider the spiritual needs of mothers and must identify and meet these needs.