A critical incident study of nurses' responses to the spiritual needs of their patients

AIMS OF STUDY: The aims of the study were to carry out a critical incident study to: (1) Describe what nurses consider to be spiritual needs; (2) Explore how nurses respond to the spiritual needs of their patients; (3) Typify nurses' involvement in spiritual dimensions of care; (4) Describe the effect of nurses' intervention related to spiritual care. BACKGROUND: In the caring professions a focus on individuals as bio-psychological-spiritual beings is gaining recognition and this notion is based on the premise that there should be a balance of mind, body and spirit for the maintenance of health in a person (Stoll 1979). Emerging research highlights the importance of spiritual care in nursing and suggests that there is scope for improving this dimension of care in order to improve the quality of life for many patients. However, there is very little evidence about how nurses respond to the spiritual needs of their patients. Therefore the purpose of this study was to map by critical incident techniques how nurses construct and respond to patients' spiritual needs in a variety of clinical settings. METHODS: Critical incidents were obtained from 115 nurses. The data from these incidents were subjected to content analysis and categories were developed and described. The emerging categories were subjected to peer reviews to ensure reliability and validity of findings. FINDINGS: The findings suggest that there is confusion over the notion of spirituality and the nurse's role related to spiritual care. A variety of approaches to spiritual care emerged in this study from the critical incidents derived from nurse respondents. These were categorized as 'personal', 'procedural', 'culturalisit' or 'evangelical'. There was an overwhelming consensus that patients' faith and trust in nurses produces a positive effect on patients and families, and nurses themselves derived satisfaction from the experience of giving spiritual care. In this respect, spiritual care interventions promote a sense of well-being in nurses as well as being a valuable part of total patient care. CONCLUSION: The study concluded that there is scope for developing an ideal model of spiritual care using the critical incident data from this study.     

Ethnicity and patient satisfaction with tuberculosis care: A cross‐sectional study

Patients presenting in major tuberculosis (TB) centres in two Australian metropolitan hospitals and three central hospitals in Malawi were interviewed for health and other information, including their satisfaction with nursing care. The main objective of the study was to investigate differences in satisfaction rates among ethnically similar and different patients coming from two dissimilar health systems. A multivariable Generalized Estimating Equations model was constructed to identify sociodemographic and health‐related factors associated with dissatisfaction, while focusing on ethnic differences between and within each country. The Australian and Malawian patients were similar in age, gender, marital status, and employment. However, the Malawians were mostly inpatients, with recurrent TB episodes, and were more seriously ill with impaired physical and mental wellbeing. Nonetheless, being Australian was more associated with dissatisfaction observed in all components of care. However, Australian ethnic minorities were less dissatisfied than their Anglo‐Saxon or European counterparts, being more similar to Malawian patients irrespective of the health care provided. Our study suggests that patients coming from similar ethnic backgrounds may express similar satisfaction irrespective of the health system they belong to.     

Elderly patients' perceptions of their spiritual needs and care: a pilot study

This paper describes a pilot study, in a small sample of elderly patients, designed to ascertain their perceptions of their spiritual needs and care. According to the nursing literature, spiritual care is part of the nurse's role. But it is not clear what spiritual needs are or how nurses are expected to give spiritual care. Ten patients from a care of the elderly assessment unit located in a hospital in Edinburgh, Scotland were interviewed about their spiritual needs in the summer of 1995. Eight patients admitted to having experienced spiritual needs at some time in their lives, six while in hospital. The types of needs experienced related to religion, meaning, love and belonging, morality, and death and dying. Their spiritual needs could have been better met if, for example, a quiet room for reflection/prayer had been available and if they had been told about hospital church services and provided with transport to attend. Although limited, the findings contribute to our understanding of spiritual need and spiritual care from the elderly in-patients' view point. Further research, however, is needed to explore the type of spiritual help other elderly patients and other patient groups in different geographical locations feel they would like.     

Factors predicting clinical nurses' willingness to care for Ebola virus disease‐infected patients: A cross‐sectional,descriptive survey

The purpose of this study was to identify factors predicting clinical nurses' willingness to care for Ebola virus disease (EVD)‐infected patients. Data were collected from 179 nurses employed at 10 hospitals in Korea using self‐reporting questionnaires. Only 26.8% of the participants were willing to care for EVD‐infected patients. Factors predicting their willingness to provide care were their belief in public service, risk perception, and age. Nurses' willingness to provide care was high when their belief in public service was high, low when their risk perception was high, and low as their age increased. In order to strengthen nurses' willingness to care for EVD‐infected patients, education that targets the enhancement of belief in public service should be included in nurse training. Efforts should be directed toward lowering EVD risk perception and developing systematic responses through government‐led organized support.     

Patient safety on psychiatric wards: A cross‐sectional,multilevel study of factors influencing nurses' willingness to share power and responsibility with patients

The World Health Organization highlights the need for more patient participation in patient safety. In mental health care, psychiatric nurses are in a frontline position to support this evolution. The aim of the present study was to investigate the demographic and contextual factors that influence the willingness of psychiatric nurses to share power and responsibility with patients concerning patient safety. The patient participation culture tool for inpatient psychiatric wards was completed by 705 nurses employed in 173 psychiatric wards within 37 hospitals. Multilevel modelling was used to analyse the self‐reported data. The acceptance of a role wherein nurses share power and responsibility with patients concerning patient safety is influenced by the nurses' sex, age, perceived competence, perceived support, and type of ward. To support nurses in fulfilling their role in patient participation, patient participation‐specific basic and continuing education should be provided. Managers and supervisors should recognize and fulfil their facilitating role in patient participation by offering support to nurses. Special attention is needed for young nurses and nurses on closed psychiatric wards, because these particular groups report being less willing to accept a new role. Ward characteristics that restrict patient participation should be challenged so that these become more patient participation stimulating. More research is needed to explore the willingness and ability of psychiatric nurses to engage in collaborative safety management with patients who have specific conditions, such as suicidal ideation and emotional harm.     

Care related pain in hospitalized patients: A cross‐sectional study

Context: Care‐related pain includes pain occurring during transportation, movement, diagnostic imaging, physical examination, or treatment. Its prevalence has never been assessed in a large adult inpatient population. Objective: To identify the procedures likely to induce or increase pain in hospital patients, attempting to separate the most painful from those reported as most frequently inducing pain. Design: A single‐day cross‐sectional survey conducted in two large French teaching hospitals, including all hospitalized patients, free of communication problems. One third was randomly selected and interviewed about the painful episodes that had occurred or were associated with the procedures performed during the previous two weeks. Patients were interviewed using a structured questionnaire. Results: Six‐hundred‐eighty‐four patients were randomly selected. Six‐hundred‐seventy‐one painful events were reported in 55% of the patients, with an average of 1.8events/patient. Fifty‐two percent of the painful events were associated with procedures performed by non‐medical staff; 38% of the painful episodes occurred during procedures involving vascular puncture and 24% during patients’ mobilization. In 57% of painful procedures, pain was rated as severe or extremely severe. The most painful procedures were invasive procedures, other than vascular and non vascular punctures (74% of severe and extremely severe painful episodes). Maximum pain intensity was rated higher for procedures that were repeated than for those experienced only once (62% versus 53%, p=0.02). Conclusion: This survey gives new insight into our daily practice. Proper management of care‐related pain should be a major concern of all hospital staff to improve the quality of our health care.     

Emotional communication with older people: A cross‐sectional study of home care

The aim of this study was to explore the influence of characteristics of nurses and older people on emotional communication in home care settings. A generalized, linear, mixed model was used to analyze 188 audio‐recorded home care visits coded with Verona Coding Definitions of Emotional Sequences. The results showed that most emotional distress was expressed by older females or with female nurses. The elicitation of an expression of emotional distress was influenced by the nurses' native language and profession. Older women aged 65–84 years were given the most space for emotional expression. We found that emotional communication was primarily influenced by sex for nurses and older people, with an impact on the frequency of expressions of and responses to emotional distress. Expressions of emotional distress by older males were less common and could risk being missed in communication. The results have implications for students' and health professionals' education in increasing their knowledge of and attentiveness to the impacts of their and others' characteristics and stereotypes on emotional communication with older people.     

Measuring perceptions of safety climate in primary care: a cross‐sectional study

Rationale, aims and objectives Building a strong and positive safety culture in health care teams and organizations is essential for patient safety. Measuring individual perceptions of safety climate is an integral part of this process. Evidence of the successful application and potential usefulness of this approach is increasingly available for secondary care settings but little is known about the safety climate in UK primary care. We therefore aimed to measure perceptions of safety climate in primary care. Further aims were to determine whether perceptions varied significantly between practice teams and according to specific participant and practice characteristics. Method We undertook a cross‐sectional, anonymous postal questionnaire survey of randomly selected west of Scotland primary care teams. Safety climate mean scores with standard deviations were calculated for respondents, practice teams and the region. Results A total of 563 (84%) team members from 49 practices (24.5%) returned questionnaires. The overall safety climate mean score was 5.48 (0.78). Significant differences in safety climate perceptions were found at the practice team level (P < 0.001) and for specific characteristics: respondents' years of experience, whether they were community or practice based, their professional roles and practices' training status. Practice managers and general practitioners perceived the safety climate more positive than other respondents (P < 0.001). Conclusion This was the first known attempt to measure perceptions of safety climate in UK primary care with a validated instrument specifically developed for that purpose. Reported perceptions of the prevailing safety climate were generally positive. This may reflect ongoing efforts to build a strong safety culture in primary care or alternatively point to an overestimation of the effectiveness of local safety systems. The significant variation in perception between certain staff groups has potential safety implications and may have to be aligned for a positive and strong safety culture to be built. While safety climate measurement has various benefits at the individual, practice team and regional level, further research of its association with specific safety outcomes is required.