Spiritual Development of Nursing Students: Developing Competence to Provide Spiritual Care to Patients at the End of Life

Professional quality of life and perceptions of spirituality and spiritual care among nurses: Relationship and affecting factors

PURPOSE

This study aims to determine the relationship of nurses' perception of spirituality and spiritual care to the dimensions of professional quality of life, namely, nurses' compassion fatigue, burnout and compassion satisfaction, and identify the influencing factors, respectively.

DESIGN AND METHODS

The population consisted of 316 nurses (response rate: 91.32%) working in various clinics of a Training and Research Hospital (gynecology, pediatrics, surgery, internal medicine and emergency service) between December 2018 and May 2019. Data was collected through the Socio-Demographic Form, The Professional Quality of Life Scale (ProQOL), and Spirituality and Spiritual Care Rating Scale (SSCRS).

FINDINGS

A meaningful relationship between SSCRS and ProQOL's "burnout" and "compassion fatigue" subscales was granted (p < 0.001). In particular, the comparison of ProQOL subscales to SSCRS's "spirituality/spiritual care" and "religiosity" subscales revealed a negative and strong relationship (p < 0.01) while SSCRS's "personalized care" subscale yielded a very strong positive relationship (p < 0.001). The nurses' professional quality of life was affected by variables such as "monthly number of shifts," "manner of work," and "average weekly working hours." It was determined that burnout was experienced at a higher level, whereas compassion fatigue at a moderate level. In terms of spirituality and spiritual care, the subscale mean scores for "spirituality/spiritual care," "personalized care," and "religiosity" were low.

PRACTICE IMPLICATIONS

In light of the research findings, the charge nurses and nursing managers should oversee variables such as monthly income, monthly number of shifts, average weekly working hours at all times in the context of spiritual care and professional quality of life. Institution managers need to be competent in the prioritization of employee requests, planning the number of employees taking into account the ratio of nurse/patient/clinic capacity. Institution managers should familiarize themselves with notions such as compassion fatigue, burnout, and compassion satisfaction and spiritual care to plan and sustain the activities of the institution while overwatching the needs of her/his employees along the way. Nurses could also benefit from counseling services and in-service training programs contemplating sociodemographic and profession related variables that affect spiritual care and professional quality of life.

The Relationship Between Turkish Nursing Students' Perceptions of Spiritual Care and their Attitudes Towards Death

This study aimed to examine the relationship between nursing students' perception of spiritual care and their attitudes towards death. This cross-sectional study was conducted in Turkey between March and April 2021 with 601 nursing students using the Google Forms questionnaire. The "Spirituality and Spiritual Care Rating Scale (SSCRS)" and "Attitude towards Death Scale (ATDS)" were utilised to assist with data collection and analysis. While there was no relationship between the students' total SSCRS and total ATDS scores, there was a positive relationship between the total SSCRS and the Neutral Acceptance-Approach Acceptance Subscale (r = 0.129, p = 0.002), and a negative relationship between SSCRS and the Fear of Death and Avoidance of Death Subscale (r =  - 0.097, p = 0.017). Providing support in terms of spiritual care and viewing spiritual care as related to nursing were related to the total SSCRS score. Alcohol use, viewing spiritual care as related to nursing, self-perceptions of spirituality, and fear of death were associated with the total ATDS score (p < 0.05). It is recommended that spiritual care and death perceptions be addressed more comprehensively in the educational curriculum of nursing students.

The Role of Spiritual Care with the Introduction of an End of Life Order Set

Delivering comprehensive end-of-life care to dying patients must involve addressing physical symptoms and psychosocial concerns. Care pathways have been introduced to support health care teams in delivering this care. This retrospective chart review explores the contributions of the Spiritual Care Team in the care of dying patients. They offer a range of interventions which include supportive care, religious and spiritual support. This study was one step towards appreciating the contributions of the Spiritual Care Team.

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.

Student Perceptions of Spirituality and Spiritual Care

Nurse educators must equip students with beginning skills of assessment, communication, and awareness of spiritual care. Barriers to spiritual care-lack of time or of space, inadequate training-reduce nurses' provision of spiritual care. Nursing students observe patient needs for spiritual care, but often are not skilled or comfortable offering spiritual care. This article relays observations of 28 senior nursing students about spirituality and spiritual care with implications for teaching.

Health Care Providers' Perception of Their Competence in Providing Spiritual Care for Patients

Background:

Spiritual care is an important part of health-care provision. Spiritual care can improve patients' health. One of the requirements for providing appropriate spiritual care for patients is having the required competence.

Aim:

This study was conducted to investigate the perception of health-care providers of their own competence in providing spiritual cares for patients hospitalized in medical-educational centers of Iran.

Subjects and Methods:

This study is a cross-sectional, analytical research conducted on 555 nurses of medical-educational centers in Tabriz, Iran, in 2014. Data were collected using a two-part questionnaire including demographic information and the spiritual care competence scale. Data analysis was performed using descriptive (frequency, percentage, mean, and standard deviation) and inferential (independent t-test, Pearson, Spearman, ANOVA with Tukey test) statistics in SPSS software version 13.

Results:

Results showed that the mean score for nurses' perception of their competence in providing spiritual care for patients was average, that is, 95.2 ± 14.4. Mean score of nurses' perception of their competence in providing spiritual care in each aspect was significantly higher than average (P < 0.05). The highest score was related to individual support and consulting with patients, that is, 21.1 (4.0), and the lowest score was related to reference to experts, that is, 9.5 (2.3). The type of employment and participation in workshops had significant relationships with nurses' perception of their competence for providing spiritual care (P < 0.05).

Conclusion:

The findings indicate that authorities and policymakers should take steps in planning for nurses' training for promoting their competence in providing spiritual care for patients; therefore, holding workshops is necessary.

An Investigation of the Relationship Between Nurses’ Views on Spirituality and Spiritual Care and Their Level of Burnout

Purpose: This study aims to evaluate the relationship between nurses’ views on spirituality and spiritual care and their level of burnout. Method: This cross-sectional study used a convenience sample that comprised 118 nurses from one state hospital in eastern Turkey. The data were collected through questionnaires that were filled by the nurses individually, using a sociodemographic characteristics form, the Spirituality and Spiritual Care Rating Scale, and the Maslach Burnout Inventory. Results: A statistically significant relationship was found between subscale scores of Maslach Burnout Inventory and total score of Spirituality and Spiritual Care Rating Scale. With the increase in nurses’ spiritual care mean scores, there was an increase in the mean scores of the Emotional Exhaustion, Depersonalization, and Personal Accomplishment subscales. Conclusions: Nurses’ burnout levels increased with the increase in their spirituality and spiritual care mean scores. This situation can be associated with the fact that providing spiritual care increases nurses’ workload. Therefore, similar studies are recommended to be conducted with wider groups of participants.

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

BACKGROUND

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

AIM

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

DESIGN

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Spiritual intelligence, resiliency, and withdrawal time in clients of methadone maintenance treatment

BACKGROUND

Reports show an increasing interest in spirituality. It has been revealed that people with spiritual tendencies, can better deal with a trauma, manage the stressful situations, and have greater improvement in their health condition.

OBJECTIVES

Our aim was to examine the relationship between spiritual intelligence and resiliency, and the relation of these two variables with the withdrawal time of individuals treated with methadone.

MATERIALS AND METHODS

This research was conducted on patients referred to the addiction center of Baharan Psychiatric Hospital in Zahedan, Iran. Our sample included 100 referrals; they were provided with questionnaires and asked to answer them honestly. King's spiritual intelligence questionnaire and resilience questionnaires were used.

RESULTS

There were significant positive correlations between resiliency and scores of spiritual intelligence as well as with subscales of spiritual intelligence. In addition, there were significant positive correlations between withdrawal time and scores of spiritual intelligence as well as with subscales of spiritual intelligence as well as with resiliency.

CONCLUSIONS

Relationships between the spiritual intelligence and resiliency parameters with withdrawal time show that these parameters can have a role in relapse protection among addicted people.

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

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

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

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

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

AIM

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

The Use of Simulation to Instruct Students on the Provision of Spiritual Care

Providing spiritual care is recognized as a significant aspect of nursing practice. This pilot study was designed to determine if simulation is an effective method for instructing nursing students in the provision of spiritual care. Fifty-two students participated in a simulation exercise that introduced concepts of spiritual care. Simulation was successful in improving students’ attitudes toward patient spirituality, assessment of spiritual needs, ability to refer patients to the appropriate spiritual caregivers, and communication skills. Incorporating spiritual care instruction into curricula may prove to be valuable in increasing students’ awareness of spiritual care for patients and incorporation of such care into their practice.

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

AIM

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

BACKGROUND

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

DESIGN

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

METHOD

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

RESULTS

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

CONCLUSION

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

RELEVANCE TO CLINICAL PRACTICE

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

Spirituality-based nursing practice by nursing students: an exploratory study

This exploratory mixed-method study examines the nature of awareness and application of spirituality in senior nursing students in two separate nursing baccalaureate degree nursing programs. A comprehensive study of the literature yielded 45 statements on personal spirituality and its use in patient care, which were converted to a Likert-type scale questionnaire used as the instrument for this study. A purposive sample consisted of 86 senior-level nursing students in their final semester of study in both schools. Independent t tests, stepwise regression analysis, and factor analysis were used to determine the nature of spiritual-based nursing practice by these students in terms of their awareness, use, and understanding of this metaphysical dimension of health care. Combined mean spirituality score was 128.76; spirituality scores from the two groups were not significantly different, t(64)= 0.668, P = .507. Factor analysis extracted five dimensions of spirituality-based nursing. Results were used to support the development of a practice theory of spirituality-based nursing practice. Findings can be used to advance nursing theory, provide direction for curricular development, and strengthen nursing practice.

Spirituality in childbearing women

Childbearing is the ideal context within which to enrich spirituality. The purpose of this study was to generate themes regarding spirituality and religiosity among culturally diverse childbearing women. A secondary analysis was performed, using existing narrative data from cross-cultural studies of childbearing women. The following themes emerged from the data: childbirth as a time to grow closer to God, the use of religious beliefs and rituals as powerful coping mechanisms, childbirth as a time to make religiosity more meaningful, the significance of a Higher Power in influencing birth outcomes, and childbirth as a spiritually transforming experience. In clinical settings, understanding the spiritual dimensions of childbirth is essential. Assessments of childbearing women may include the question, "Do you have any spiritual beliefs that will help us better care for you?"

Learning effects of thematic peer-review: a qualitative analysis of reflective journals on spiritual care

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students' competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are 'inclusion of actual experience' and 'reflecting on this experience'. The phases of 'abstraction of experience' and 'experimenting with new behaviour' are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research.

The Provision of Spiritual Care by Registered Nurses on a Maternal—Infant Unit

Purpose: This study explores the spirituality, spiritual well-being (SWB), and spiritual care provision of registered nurses on a maternal—infant unit. Methods: Data collection instruments included a demographic and spiritual care form, Spiritual Perspective Scale (SPS), and Spiritual Well-Being Scale (SWBS) to address the study's research questions. Findings: Significant positive correlations were found between SPS and SWBS as well as religious well-being (RWB) and existential well-being (EWB; subscales of SWBS). Religious attendance was significantly correlated with SPS, SWBS, and RWB but not EWB. Frequency of spiritual assessment themes was first encounter and when needed, whereas reaching up and reaching out described their provision of spiritual care. Conclusion: The sample was highly spiritual, spiritually well, and provided varied spiritual care. Implications: More spiritual care research is needed. Content on providing spiritual care must be enhanced within nursing curriculums as well as with nurses in practice.

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care

AIM

To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects.

BACKGROUND

Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used.

DESIGN

Quasi-experimental crossover design (pre-post-test).

METHOD

The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students' own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool.

RESULTS

Ninety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content.

CONCLUSIONS

The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development.

RELEVANCE TO CLINICAL PRACTICE

The results provide nurse educators with insight into the effects of education in spiritual care on students' competencies and help them consider a systematic place for spiritual care within the nursing curriculum.