Empirical validation of a teaching course on spiritual care in Taiwan

AIM(S) OF STUDY: The aims of this study were threefold: (a) to develop the first spiritual care program for master of science in nursing degree students (MSNDS) in Taiwan, since most of these students are or will be nursing leaders in clinical practice, education, administration, or research; (b) to facilitate the MSNDS in applying the contents of this program to care of their clients; and (c) to understand the MSNDS' appraisals of the usefulness of the program in helping them provide spiritual care in clinical settings. BACKGROUND: The World Health Organization (WHO) (1998) proclaimed that health needs should include spiritual well-being in addition to physical, mental, and social domains. Nevertheless, many dominant medical educational systems have not yet encompassed spiritual care as part of their comprehensive or core curricula. DESIGN/METHODS: The methodological triangulation research design used in this project included various strategies of developing a novice course entitled 'Spirituality in Nursing Practice' which was given to the subjects over 18 weeks from September 1998 to February 1999. The course included classroom lectures, field trips, clinical implications, and presentation-appraisal. A convenience sample of 22 female MSNDS who were or had the potential to be nursing leaders from two schools of nursing in northern Taiwan was obtained. RESULTS: Four types of help were identified: (a) help in clarifying the theoretical concepts of spiritual care (100%); (b) help in providing a culturally bonded spiritual care plan (100%); (c) help in self-disclosure of the nurse's personal value systems and spiritual needs (91%); and (d) help in clarifying the symbolic meaning and the impact of religious rituals (86%). The explicit spiritual care plans and an empirical example of spiritual care were provided. CONCLUSIONS: This study presented the first spiritual care program for MSNDS in Taiwan. All subjects considered the course helpful in providing spiritual care for their clients in various clinical settings. The concept of spirituality is arousing great interest in the world, and this is evident in the spiritual care courses appearing in nursing curricula for nursing leaders in Taiwan.     

Analysis of spirituality content in nursing textbooks

Although most nurses believe spiritual care is an integral component of quality, holistic nursing care, they rarely address spiritual issues and typically feel unprepared to do so. One reason for nurses' lack of preparedness to provide spiritual interventions is that their basic education only minimally discusses spirituality and related issues. This is compounded by the problem that only sporadic reference to spiritual care is found in most nursing textbooks. This study was conducted to analyze the content related to spirituality in nursing textbooks in order to determine where spiritual care is addressed and evaluate its adequacy. A total of 50 textbooks from a wide variety of nursing specialty areas were selected from the most recent Brandon Hill list. These books were examined to assess the percentage of pages discussing spiritual issues and analyze inclusion of core content essential for nursing practice. Although there was considerable variation among the books from all specialty areas, overall, hospice/terminal care, fundamentals of nursing, health assessment/health promotion, and transcultural nursing textbooks provided the most information about spirituality and spiritual care. Textbooks focusing on professional issues, medical-surgical nursing, maternal-child health nursing, critical care nursing, and community health nursing contained the least spiritual content. Suggestions are made regarding how to integrate spiritual issues and spiritual care in all nursing textbooks that pertain directly to patient care.     

The concept of spiritual care in mental health nursing

AIM: In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. BACKGROUND: The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. METHODS: A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. RESULTS: According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person's sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the 'mechanics of nursing'. CONCLUSIONS: The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.     

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BackgroundAlthough nurses typically view spiritual care as important, it is provided infrequently.ObjectivesThis research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.MethodsThis cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.ResultsThe most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.ConclusionsNurses need education about providing spiritual care to those with psychiatric mental health needs.     

The development of nursing students' spirituality and spiritual care-giving

Nursing education programs are being increasingly challenged to incorporate spirituality and spiritual care-giving into the curriculum. The purposes of this study were to explore how students in a baccalaureate curriculum perceived their spirituality and spiritual health, and their perceptions of spiritual nursing care. Students in the first and fourth years of the program filled out a survey that included a spiritual well-being scale and several open-ended questions. Overall, students had a strong awareness of personal spirituality and a high level of spiritual health. They identified a number of behaviours and characteristics of the nurse that facilitated spiritual nursing care. Fourth year students demonstrated a more patient-centered approach to spiritual care. They placed less emphasis on the nurse's agenda and qualities and more on supporting the patient's beliefs.     

Meeting clients' spiritual needs

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

Creating conditions for good nursing by attending to the spiritual

biro a.l. (2012) Journal of Nursing Management  20, 1002–1011
Creating conditions for good nursing by attending to the spiritual Aim To note similarities, differences, and gaps in the literature on good nursing and spiritual care. Background Good nursing care is essential for meeting patient health needs. With growing recognition of the role of spirituality in health, understanding spiritual care as it relates to good nursing is important, especially as spiritual care has been recognized as the most neglected area of nursing care. Methods Nursing research, reports and discussion articles from a variety of countries were reviewed on the topics of good nursing, spiritual care and spirituality. Key issues A nurse’s spirituality and the nurse–patient relationship are integral to spiritual care and good nursing. Conclusions There are many commonalities between good nursing and spiritual care. Personal attributes of the nurse are described in similar terms in research on spiritual care and good nursing. Professional attributes common to good nursing and spiritual care are the nurse–patient relationship, assessment skills and communication skills. Implications for nursing management Good nursing through spiritual care is facilitated by personal spirituality, training in spiritual care and a culture that implements changes supportive of spiritual care. Further research is needed to address limitations in the scope of literature.     

Spiritual needs during COVID 19 pandemic in the perceptions of Spanish emergency critical care health professionals

ObjectivesTo investigate the perceptions and attitudes of health professionals working in emergency services and critical care units in Spain about spiritual care provided during the COVID-19 pandemic.MethodsA qualitative investigation was carried out using in-depth interviews.SettingEmergency and emergency and ICU health professionals from different regions of Spain.FindingsThe sample consisted of 47 nursing and one nursing assistant. The qualitative analysis yielded four main themes that reflect the following categories: “the experience with spirituality in clinical practice”; “resources and barriers to provide spiritual care”; “the COVID pandemic and spiritual care” and “training in spiritual care”. In addition, two subdeliveries were also obtained: “ethical dilemma” and “rituals of death”.ConclusionsThe majority of emergency and critical care nurses believe spiritual care is important to their clinical practice, but there are still several barriers to address patients’ spiritual needs. During the COVID-19 pandemic in Spain, professionals felt that spiritual beliefs have emerged as important needs of patients and the restrictions imposed by the pandemic made health professionals more exposed to ethical dilemmas and end-of-life religious issues. The general impression of health professionals is that more training and resources are needed on this topic.Implications for clinical practiceHealth professionals in emergency intensive care must provide nursing care that meets the spiritual needs of their patients to improve care in crisis situations such as the one suffered by the COVID-19 pandemic. For this, emergency services professionals must work and participate in the development of measures to overcome certain barriers present in emergency services, such as lack of time, lack of training and misconceptions that make it difficult to approach emergency services these needs.     

Themes of rural health and aging from a program of research

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.     

Towards a rhetoric of spirituality in mental health care

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.     

From private to public: negotiating professional and personal identities in spiritual care

AIM: This paper is an exploration of the challenge of negotiating the highly personalized concept of spirituality within the public sphere of professional-patient interactions. BACKGROUND: Spirituality has become increasingly prominent within the nursing discourse, and providing spiritual care is often positioned as an ethical obligation of care. However, bringing such a personal concept into the public domain of care creates some unique tensions and ethical risks. DISCUSSION: Nurses bring three potentially competing identities to spiritual care encounters with patients. Firstly, they are professionals with a public trust in health promotion and restoration, including those areas that intersect with spiritual health. Secondly, they are citizens of a liberal society where non-judgmental pluralism as it relates to spirituality is enshrined. Thirdly, they are individuals who hold particular beliefs and values about spirituality. Each of these identities may result in particular, and potentially conflicting, approaches to spiritual care. Ultimately, the identity which nurses choose to adopt is often determined by how they view themselves in the spiritual care encounter, either as experts with legitimate authority to intervene in the spiritual lives of patients or as people in a shared relational encounter. Each of these approaches carries ethical risks, although the nature of these risks is different. CONCLUSION: The identities which nurses bring to spiritual care encounters have far-reaching implications for patient experiences in those encounters. Nurses who position themselves as experts run the risk of objectifying the spiritual, being experienced as coercive and transcending nursings' competence. The work of Martin Buber is presented as a model that, while acknowledging competing identities, sets forth a vision of spirituality and spiritual care based upon relational reciprocity.     

The spiritual and pastoral dimensions of care in interprofessional contexts

Spiritual issues encompass what is most meaningful and central in human existence. During times of illness, crisis or transition spiritual issues are likely to come to the fore of human awareness for both patients and professionals. All health care professionals need to include the spiritual dimension in assessment and treatment of patients. Professionals in different disciplines have distinct contributions to make in the way they use the lens and language of their training to assess religious and spiritual issues of patients. Therefore, interprofessional dialogue and collaboration is important in understanding each other's perspective on the spiritual dimensions of care. In this article the spiritual dimensions of care are explored. The differences between pastoral, medical and nursing approaches to spiritual care are demonstrated through case examples. Guidelines for assessment of religion and spiritual information useful to health care professionals across interprofessional boundaries are presented.     

Living the as-yet unanswered: spiritual care practices in family systems nursing

A serious illness often creates suffering and precipitates a search for spiritual meaning. The purpose of this hermeneutic inquiry was to explore the meaning of spirituality and spiritual care practices in family systems nursing. The videotapes of 12 therapeutic conversations with three families living with serious illness were the primary data for the inquiry. Findings suggest that suffering embodies an invitation to respond to the spiritual. Identified spiritual care practices included gathering stories of illness and faith, opening space to reinterpret experiences from a spiritual perspective, drawing on imagination and metaphor, and listening with an opening silence. The therapeutic work with one family is highlighted. This inquiry revealed that spiritual care requires literacy in reading the spiritual, a willingness to respond to the particular and the unpredictable, and a belief that good care demands a wise and thoughtful response to the suffering other.     

Spiritual development of nursing students: developing competence to provide spiritual care to patients at the end of life

Nurses spend more time with their patients than do other health care workers. Therefore, the spiritual needs of patients must be recognized as a domain of nursing care. Holism cannot exist without consideration of the spiritual aspects that create individuality and give meaning to people's lives. The purpose of this article is to provide nursing faculty with tools that may be used to develop spiritually knowledgeable nursing students who can overcome barriers to providing spiritual care to end-of-life patients. Our students were required to complete care maps to ensure they are prepared for patient care at the end of life. In this article, we present tools that faculty and students may use to complete the spiritual concept in care mapping. The literature on spirituality is reviewed, use of care mapping in nursing curricula is described, and our teaching approach to develop nursing students who are skilled at providing spiritual care is explained. Three case studies and care maps created by former students are also presented to demonstrate examples of spiritual competence.     

The importance of spiritual assessment: one clinician's journey

Assessing spiritual values of a patient causes the nurse to assess and or re-examine his or her own beliefs. Self- reflection makes one aware of how spirituality affects the individual's life and nursing practice. Those who find themselves uncomfortable with spiritual issues may have difficulty in delivering spiritual care to others. Nonetheless, the ability to seek appropriate assistance should be possible, but in-depth conversation regarding spirituality may need delivery by another caregiver.[8]Before assessing spirituality, examine your own beliefs to provide compassionate care related to meeting the patient's spiritual needs. Today, I regularly ask if the elder has a religious or faith-based belief he or she follows. If so, I probe further to determine how this belief system helps them with their health care concerns. I watch for symbols such as a Bible, inspirational readings, or religious items in the home or health care setting. A practice choice I have made is to offer prayers together with my patients and families. This is an individualized involvement that some believe crosses the boundaries of professionalism and political correctness. However, this level of involvement provides a positive opportunity to provide fulfillment in my nursing practice for my patient and myself. I will continue this added dimension of care.Spiritual assessment involves the evaluation of spiritual needs and the relationship to health care issues, whereas spiritual care involves compassion, presence, listening, and the encouragement of hope. It may or may not involve God or religion. To best serve the elderly patient, nurses should examine their own spirituality and how this may affect their own unique ability to assess or deliver spiritual care.