Developing and testing the EPICC Spiritual Care Competency Self-Assessment Tool for student nurses and midwives.

AIMS AND OBJECTIVES: To develop and psychometrically test a self-assessment tool that measures undergraduate nursing and midwifery students' perceptions of spiritual care competence in health care practice. BACKGROUND: Spiritual care is part of nurses/midwives' responsibility. There is a need to better benchmark students' competency development in spiritual care through their education. The EPICC Spiritual Care Education Standard served as groundwork for the development of the EPICC Spiritual Care Competency Self-Assessment Tool. DESIGN: Cross sectional, mixed methods design. A STROBE checklist was used. METHODS: The Tool (available in English, Dutch and Norwegian) was developed by an international group. It was tested between July-October 2020 with a convenience sample of 323 nursing/midwifery students at eight universities in five countries. The Tool was tested for validity using Kaiser-Meyer-Olkin (KMO) test, exploratory and confirmatory factor analysis, one-way ANOVA and independent samples t test. The reliability was tested by Cronbach's alpha coefficient. Qualitative data were analysed using thematic analysis. RESULTS: The KMO test for sampling adequacy was 0.90. All, but two, items were related to the same factor. Cronbach's alpha coefficient for the Tool was 0.91. Students found the Tool easy to use, and they gained new insights by completing it. However, students felt that some questions were repetitive and took time to complete. CONCLUSIONS: The Tool has construct and discriminant validity, and high internal consistency (is reliable). In addition, students found the Tool useful, especially in early stages of education. RELEVANCE TO CLINICAL PRACTICE: The Tool affords student nurses and midwives the opportunity to self-evaluate their knowledge, skills and attitudes about spirituality and spiritual care. The Tool offers students, educators and preceptors in clinical practice a tangible way of discussing and evaluating spiritual care competency.

Norway's Kirkens Bymisjon Leads the Way in Care of the Vulnerable.

Caring for vulnerable persons is a global humanitarian and nursing concern. The Norwegian Kirkens Bymisjon system cares for vulnerable people groups in 40 cities, serving as a model for other countries. In 2009, church-city-mission collaborations in Bergen, Trondheim, and Tromsø were visited; follow-up data were collected in 2014. At each site, a combination of the diaconal organization, the city or municipality, and donors from the private sector identify and establish a governing board, analyze vulnerable groups most in need of service, and build programs to meet needs.

Nurses' comfort level with spiritual assessment: a study among nurses working in diverse healthcare settings.

AIMS AND OBJECTIVES: To gain knowledge about nurses' comfort level in assessing spiritual matters and to learn what questions nurses use in practice related to spiritual assessment. BACKGROUND: Spirituality is important in holistic nursing care; however, nurses report feeling uncomfortable and ill-prepared to address this domain with patients. Education is reported to impact nurses' ability to engage in spiritual care. DESIGN: This cross-sectional exploratory survey reports on a mixed-method study examining how comfortable nurses are with spiritual assessment. METHOD: In 2014, a 21-item survey with 10 demographic variables and three open-ended questions were distributed to Norwegian nurses working in diverse care settings with 172 nurse responses (72 % response rate). SPSS was used to analyse quantitative data; thematic analysis examined the open-ended questions. RESULTS/FINDINGS: Norwegian nurses reported a high level of comfort with most questions even though spirituality is seen as private. Nurses with some preparation or experience in spiritual care were most comfortable assessing spirituality. Statistically significant correlations were found between the nurses' comfort level with spiritual assessment and their preparedness and sense of the importance of spiritual assessment. How well-prepared nurses felt was related to years of experience, degree of spirituality and religiosity, and importance of spiritual assessment. CONCLUSION: Many nurses are poorly prepared for spiritual assessment and care among patients in diverse care settings; educational preparation increases their comfort level with facilitating such care. Nurses who feel well prepared with spirituality feel more comfortable with the spiritual domain. RELEVANCE TO CLINICAL PRACTICE: By fostering a culture where patients' spirituality is discussed and reflected upon in everyday practice and in continued education, nurses' sense of preparedness, and thus their level of comfort, can increase. Clinical supervision and interprofessional collaboration with hospital chaplains and/or other spiritual leaders can facilitate tailor spiritual assessment of patients based on patient concerns and view of life.

Discerning the healing path--how nurses assist patient spirituality in diverse health care settings.

AIMS AND OBJECTIVES: To examine nurses' experiences in spiritual care in diverse clinical settings, preferably not palliative care. BACKGROUND: Spirituality is part of holistic nursing care. The concept of spiritual literacy is introduced as the nurse's ability to read the spiritual signs of the human experience. DESIGN: Classical grounded theory methodology with open and selective coding was used to identify the participants' main concern and the strategies they used to resolve it, and to develop a substantive grounded theory. METHOD: Data were collected in 2008 and 2014 during eight focus group interviews with a total of 22 nurses recruited from a master's programme, postgraduate programmes and a local hospital. Data were analysed through constant comparison until the grounded theory emerged. RESULTS: The participants' main concern was how to assist the patient to alleviation. The participants resolved this by Discerning the healing path, which comprises three stages: Tuning in on spirituality, Uncovering deep concerns and Facilitating the healing process. These three stages are accompanied all the way by the participants' Willingness to overcome own comfort zone and Building a trusting relationship. CONCLUSION: Spirituality is of relevance for all areas of nursing care, not just dying patients or those in palliative care. Spirituality relates to the deep and important things in life and affects how patients face health issues. Nurses attend to spirituality in patients because the pain of the soul touches them and the calmness of spiritual peace amazes them. RELEVANCE TO CLINICAL PRACTICE: The professional culture in the health care team socialises nurses into the workplace, and leaders need to pay close attention to how they can foster openness to spiritual matters. The personal and professional maturity of the nurse is fundamental to his or her willingness and ability to overcome own comfort zone.

Teaching spiritual care--a grounded theory study among undergraduate nursing educators.

AIMS AND OBJECTIVES: To explore teachers' understanding of spirituality and how they prepare undergraduate nursing students to recognise spiritual cues and learn to assess and provide spiritual care. BACKGROUND: Nursing education addresses patient care in all domains of the person. Systematic teaching and supervision of students to prepare them to assist patients spiritually is an important part of holistic care. However, few role models for spiritual care are seen in clinical practice, and limited research addresses necessary student competencies or how teachers can best facilitate this process. DESIGN: Grounded theory was used to identify teachers' main concern and develop a substantive grounded theory. METHODS: Data collected during semi-structured interviews at three Norwegian University Colleges in five focus groups with 19 undergraduate nursing teachers were conducted from 2008 to 2009. Data were analysed through constant comparison of transcribed interviews until categories emerged and were saturated. RESULTS: The participants' main concern was 'How to help students recognize cues and ways of providing spiritual care'. Participants resolved this by 'Journeying with Students through their Maturation'. This basic social process has three iterative phases that develop throughout the nursing programme: 'Raising Student awareness to Recognize the Essence of Spirituality', 'Assisting Students to Overcome Personal Barriers', and 'Mentoring Students' Competency in Spiritual Care'. CONCLUSION: Nursing education should prepare students to recognise and act on spiritual cues. Making spiritual assessment and interventions more visible and explicit throughout nursing programmes, in both classroom and clinical settings, will facilitate student maturation as they learn to integrate theoretical thinking into clinical practice. RELEVANCE TO CLINICAL PRACTICE: Nursing students need role models who demonstrate spiritual care in the fast-paced hospital environment as well as in other clinical practice settings. To model spirituality as part of nursing care can assist students to overcome their vulnerability and to safeguard ethical issues and promote patient integrity.

Strengths and challenges with spiritual care: Student feedback from the EPICC Spiritual Care Self-Assessment Tool.

AIM: To explore qualitative data from students' self-reported competencies in spiritual care gathered during testing of a student self-assessment tool based on the EPICC Spiritual Care Education Standard. DESIGN: Reflexive thematic analysis of qualitative data from a multinational study on validating a new self-assessment tool. METHODS: The EPICC Spiritual Care Education Standard for competency in spiritual care was developed to enhance nurses' and midwives' ability to provide spiritual care by creating a baccalaureate education standard for spiritual care competencies. Spiritual care researchers then developed a self-assessment tool to raise student awareness of spirituality and track personal and professional growth in spiritual care competency. The EPICC Spiritual Care Competency Self-Assessment Tool, tested at eight universities in five countries, provided many opportunities for student comments, resulting in rich qualitative data presented here. RESULTS: Themes related to strengths, weaknesses and areas for improvement. Identified strengths were similar across countries: caring attitudes, general knowledge of caring and compassion and good communication skills. Weaknesses/challenges touched on spirituality as overlooked in some cultures but part of life for others, complex questions were hard to understand, and self-assessment tools are common for some and rare for others. Areas for improvement included need for knowledge of religious and other deeply held beliefs and for greater spiritual assessment skills. Similarities across countries related to basic training in communication and compassionate care for nurses globally. Differences lay in the challenges and/or barriers for spiritual care and may relate to cultures within countries and/or university test sites. RELEVANCE TO CLINICAL PRACTICE: The Tool raises awareness of spirituality among students and working nurses, providing an accessible way to self-check personal and professional growth in spiritual care competencies, which increases student and nurse capacity to become more knowledgeable and skilled in facilitating spiritual care, thus be role models for students at the intersection of spirituality and health.

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.

Nursing perspective on the Genesis account of creation.

Biblical accounts of creation tell the origin of the world and the beginning of God's relationship with humankind. Azusa Pacific University assigns graduate nursing students a faith integration project analyzing Creation accounts through the eyes of a nurse researcher. This report integrates eight students' investigations of Genesis 1 and 2, offering deep, rich insight into nursing practice.

Hospitalized Patients' Perspectives on Spiritual Assessment: A Mixed Methods Study.

BACKGROUND: Research shows that spirituality is important, but patients report that nurses rarely address spiritual issues, and research from the patient viewpoint is limited. AIM: The research objective was to gain knowledge about hospitalized patients' perspectives on spiritual assessment by nurses. METHOD: This is a mixed methods exploratory study reporting on quantitative/qualitative aspects of the patient perspective. Norwegian nurses in an acute care hospital distributed a 21-item spiritual assessment survey to patients they felt would not be burdened by completing it. Patients' demographic data were not identifiable, survey packets were returned anonymously via hospital mail by 157 hospitalized patients. Each survey item and several variables on the demographic sheet had space for comments. Quantitative analysis used SPSS 21, qualitative data were thematically analyzed. FINDINGS: Statistically significant correlations were found with all survey items. Hospitalized people reported high comfort with spiritual assessment by nurses. Qualitative findings revealed that patients had differing views on if, when, and how nurses should ask spiritual questions of them. CONCLUSIONS: It is important to identify patients' perspectives in order to provide patient-centered holistic care. Understanding patient views will enlighten nurses and may promote spiritual care and improve patient health outcomes.

Integrating spiritual care into nursing education and practice: Strategies utilizing Open Journey Theory.

Throughout nursing, spirituality is a recognized domain of patient care, but nurses feel ill prepared by their nursing education to provide care that is spiritual in nature to patients and their families. Incorporating spiritual care into nursing curricula is challenging in light of the amount of topics for healthcare learning. Open Journey Theory is based on the merging of two grounded theories, one teaching and one learning theory, and is the suggested framework for integrating spirituality and spiritual care across all levels of nursing education. Specially chosen readings (books, articles), activities (role-plays, discussion groups), and assignments (journaling, writing papers, giving reports) can be integrated into already existing courses. By utilizing the three stages of preparing, connecting, and reflecting to frame student learning, nurse educators can introduce and build on spiritual concepts from the simple to the complex over the course of the entire nursing program.

Mobile clinics in Haiti, part 2: Lessons learned through service.

Learning from experience is a positive approach when preparing for mobile clinic service in a developing country. Mobile clinics provide healthcare services to people in hard to reach areas around the world, but preparation for their use needs to be done in collaboration with local leaders and healthcare providers. For over 16 years, Azusa Pacific University School of Nursing has sponsored mobile clinics to rural northern Haiti with the aim to provide culturally sensitive healthcare in collaboration with Haitian leaders. Past Haiti mobile clinic experiences have informed the APU-SON approach on best practices in study abroad, service-learning, and mission trips providing healthcare services. Hopefully, lessons learned from these experiences with mobile clinic service-learning opportunities in Haiti will benefit others who seek to plan study abroad service-learning trips for students in healthcare majors who desire to serve the underserved around the world.

Mobile clinics in Haiti, part 1: Preparing for service-learning.

Mobile clinics have been used successfully to provide healthcare services to people in hard to reach areas around the world, but their use is sometimes controversial. There are advantages to using mobile clinics among rural underserved populations, and providing access to those who are vulnerable will improve health and decrease morbidity and mortality. However, some teams use inappropriate approaches to international service. For over 15 years, Azusa Pacific University School of Nursing has sponsored mobile clinics to rural northern Haiti with the aim to provide culturally sensitive healthcare in collaboration with Haitian leaders. Experience and exploring the literature have informed the APU-SoN approach on best practices for planning and preparing study abroad, service-learning trips that provide healthcare services. The authors hope that this description of the preparation and planning needed for appropriate and culturally sensitive service-learning experiences abroad will benefit others who seek to provide healthcare study abroad opportunities around the world.