Spiritual coping strategies: a review of the nursing research literature

AIMS OF THE PAPER: This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care. LITERATURE SEARCH: The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used. THEORETICAL BACKGROUND: Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers. IMPLICATIONS: This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.     

Inadequate care in Norwegian nursing homes – as reported by nursing staff

Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.     

A reassessment of nurses'' attitudes towards stroke patients in general medical wards

This paper summarizes a research study inquiring into the attitudes of qualified nursing staff and nursing auxiliaries towards stroke patients in general medical wards. The survey was undertaken on eight mixed-sex general medical wards in a large general hospital. All wards are used for clinical nursing experience for nurses in training. Each of the wards, despite having a particular interest in one or more medical specialities, regularly admit patients following stroke. All nurses were therefore familiar and in regular contact with this particular client group. A Likert scale with demonstrated reliability and validity was employed as the data collection instrument. Results indicated that nurses were largely ambivalent in their attitudes towards stroke rehabilitation. The patterns of responses indicate that the nurses who have the more positive attitudes about stroke patients consider that they have a role in stroke rehabilitation and that they value the nursing contribution. The nurses with less positive attitudes towards stroke patients see stroke patients as unco-operative and demanding. The findings suggest the need for specific education for the role of the nurse as a rehabilitator.     

Nurses'' opinions of the introduction of computer-assisted learning for use in patient education

Computers have only recently begun to find a place in the everyday work of health care staff. The use of computer-assisted learning (CAL) in patient education is in its infancy. However, the medium appears to offer several advantages to patients. The successful integration of the medium into clinical practice requires the acceptance and support of staff members. Little research exists to date which examines staff responses to the introduction of CAL into their workplace. This small study (n = 14) aims to explore the reactions of staff to the introduction of an experimental CAL package for use in the education of renal patients on continuous ambulatory peritoneal dialysis (CAPD). The opinions of staff members to CAL are probed and their views ascertained regarding the usefulness of CAL to both staff and patients. Results suggest that, despite their initial reservations about CAL, staff were generally positive about the medium.     

Cost-effectiveness of nursing interventions in a post-stroke eating training programmea pilot study

Background Despite the fact that nursing staff make up the single largest cost item of the health care, calculations are lacking regarding the utility and costs of nursing care.
Aim The aim of the present pilot study is to test the usefulness of the cost-utility analysis with regard to nursing interventions by applying it to a post-stroke eating programme.
Method Health-related quality-of-life improvements, costs and savings as results of eating training were calculated in 11 patient cases.
Results The analysis shows that eating training following stroke is an extremely cost effective intervention. Health-related quality of life was improved in nine patients and the costs involved were comparatively low. When the savings that result from the removal of gastric tubes were also taken into account, the training programme saved more than it cost. The example shows that it is poosible to apply health-economic methods to analyse nursing interventions.
Conclusions The pilot study pointed to the need of further research in the following areas: the efficacy in the eating training programme must be verified in a controlled trial; the methods for calculating QALY-scores must be better adapted to the goals of nursing care, and; the ethical foundation for priority setting in health economics as well as in nursing care is an important issue to address.     

Quality assurance: is it professional insurance?

Quality assurance (QA) is being hailed as a 'new frontier' of nursing. Its diffusion into nursing theory and practice in the United Kingdom is outlined. QA is not an alien import; favourable preconditions already existed. The systems-reasoning of the nursing process, which sprawned a plethora of models, each geared to the 'orderly' progression of stages, objectives and process, is resonant with the values and measurement techniques of QA. A major limitation of QA is that it downplays the organizational complexity of hospitals. Although QA is projected as being in the service of clients, its major impetus is concerned with professional self-defence, as regards other professions, the state and litigious clients. Further, QA enlisted by nursing strongly reproduces the ethos and logic of the dominant medical model; patients are 'objectified' as the technical products of production. The 'medical gaze' is now being joined with the 'nursing gaze'.     

Ageist attitudes among young adults: implications for a caring profession

It is frequently suggested that younger adults are negative in their attitudes toward elderly people. There are also claims that such attitudes develop as a result of the socially constructed phenomenon of ageism. This paper briefly addresses the concept as it is presented in the literature and goes on to describe an attitudinal study which supports the existence of ageism. An Attitudes Toward the Elderly inventory was administered to secondary school pupils during their final 2 years of schooling, to student nurses at the very beginning of their training and to qualified nurses. It was found that the subjects did demonstrate negative attitudes and that there appeared to be a definite gender socialization influence, with females demonstrating less negative attitudes than males. Contrary to expectations, entry into nursing did not lead to more positive attitudes but had the converse effect. The influence of ageism and more specific professional socialization processes are suggested as explanations for these patterns. Implications for nursing and other occupational groups involved in caring for the elderly are discussed.     

Nurses' creativity, tedium and burnout during 1 year of clinical supervision and implementation of individually planned nursing care: comparisons between a ward for severely demented patients and a similar control ward

The aim of this study was to study creativity and innovative climate, tedium and burnout among the nurses on two wards during 1 year of systematic clinic supervision combined with the implementation of individualized care on an experimental ward (EW) for severely demented patients, as compared with a similar control ward (CW) EW nurses had systematic clinic supervision and each patient had his/her nursing care carefully planned, documented and evaluated The intervention was evaluated by means of the Creative Climate Questionnaire, Burnout Measure and the Maslach Burnout Inventory Creativity and innovative climate improved significantly among the EW nurses ( n = 19) in eight out of 10 factors during the year of intervention while there was no change on the control ward ( n = 20) Tedium and burnout decreased significantly among the EW nurses while no change was seen in this respect among the CW nurses It seems reasonable to assume that systematic clinical supervision and individualized planned care decreases the negative outcome of stress caused by the psychological burden imposed by nursing care It also increases nurses' creativity, which, in turn, may benefit patient care The findings of this study point to the necessity for a support system that focuses on the work itself, i e the nursing care Individualized planned care and systematic clinical supervision may offer this kind of support     

Nurses' attitudes towards aggressive behaviour, following attendance at 'The Prevention and Management of Aggressive Behaviour Programme'

The issue of aggression and violence is current in society Recent reports indicate that this is not just an issue for society at large, but also for its organizations and institutions The health care industry is no exception in this regard Nursing, among other disciplines, has focused an increasing amount of attention on this problem for its members This is evidenced by the increasing amount of literature on the topic One feature of this writing is the study of programmes designed to train professionals in techniques to prevent and manage aggression and violence To date, little attention has been paid to the evaluation of such programmes In these times of economic difficulty, this position cannot be supported This paper describes the study of one such educational programme In this case the evaluation focused on the study of attitude change in participants following attendance at'The Prevention and Management of Aggressive Behaviour Programme'Although the indications are that the programme had a positive effect on attitudes, the author concludes that further study is required to illuminate the statistical significance of this positivity     

An evaluation of a workshop for teachers of nursing by comparing the members' expectations with their opinions of the outcome

Fifty-seven teachers of nursing, who comprised 42 women and 15 men and who also comprised 12 senior tutors, 16 nurse tutors and 29 clinical teachers, participated in a study to evaluate a workshop which they attended.
The method of inquiry used was that of a survey by questionnaire. Two questionnaires were used, one being set at the beginning of the workshop and the other at the end of the proceedings. The learning objectives for the workshop were used as the questionnaire items and comprised 20 in all. When the before and after scores relating to the questionnaire items were compared through the use of t tests significant differences were found on 12 out of the 20 objectives. In the course of the paper the differences found are identified and discussed. Some of the limitations of the method of inquiry used are discussed and finally some conclusions are reached.