Tragedy or transformation? Online survey of nurse spirituality during the COVID pandemic.

AIM: To describe positive and negative spiritual responses to providing COVID-related nursing care among nurses working in hospitals. BACKGROUND: The COVID pandemic has intensified and publicised the threats to nurse well-being. Absent from the recommendations for promoting nurse well-being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well-being. DESIGN: Cross-sectional, descriptive observational, mixed methods study. METHODS: Data were collected from 523 registered nurses employed in three Southern California hospitals during March-May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic and work-related items. STROBE guidelines for cross-sectional observational studies were observed. RESULTS: The mean for religious/spiritual struggles was 1.98 (range of 1-5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%-36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); applying established criteria indicated it was troubling for at least 50%. The mean for post-traumatic growth was 4 (on a scale of 0-6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently. CONCLUSION: The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative. RELEVANCE TO CLINICAL PRACTICE: Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy-and allow spiritual transformation.

How Christian Nurses Respond to Patient Requests for Prayer: An Observational Study.

ABSTRACT: Nurse-provided spiritual care includes support of patient spiritual practices such as prayer. However, limited evidence exists about how nurses respond when a patient requests prayer. A subsample of nurses (n = 381) from a larger study responded to two open-ended questions in an online survey in response to a prayer scenario. Among these mostly Christian nurses, 97% indicated willingness to pray. Content analysis revealed a five-component structure for praying: Open, Set the Stage, Request, Wrap-up, Close. The structure provides a template for future research and nurse prayer in clinical contexts.

Social Empathy and Associated Factors Among Nurses: An Observational Study.

Integral to holistic "big picture" nursing care is an empathy that strives for social justice. Social empathy requires more than technical skills or even interpersonal empathy or other-focus; it also requires a perspective that appreciates the impact of social determinants and seeks action to address them. This study sought to measure social empathy and potentially associated demographic, personal, and work-related factors among nurses. This cross-sectional, observational study used online survey methods to collect data from 614 registered nurses employed in a faith-based health care system in the northwestern United States. Constructs measured included social empathy, social advocacy, self-compassion, emotional exhaustion, and trust/mistrust in God. Parametric statistical tests, including multiple logistic regression, allowed analyses. Findings indicated that social empathy was high in this sample. Younger nurses, those more inclined to advocate, those more self-compassionate, those less burned out, those working part-time (in contrast only with those working overtime), and those with at least a baccalaureate degree in nursing were more socially empathic. Findings highlight further rationale for creating healthy work environments that foster self-compassion and minimize burnout.

Frequency of nurse-provided spiritual care: An international comparison.

AIMS AND OBJECTIVES: To compare the frequency of nurse-provided spiritual care across diverse cultures. BACKGROUND: Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. DESIGN: This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. METHODS: Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed. RESULTS: Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. CONCLUSIONS: In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. RELEVANCE TO CLINICAL PRACTICE: Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Validation of the Nurse Spiritual Care Therapeutics Scale in Portuguese palliative care settings: a methodological study.

BACKGROUND: Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care. AIM: To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings. METHODS: A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings. FINDINGS: A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23-60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution. CONCLUSION: The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

An online survey to describe pharmacy student spirituality and spiritual care perspectives.

INTRODUCTION: Little is known about student pharmacists' perspectives of spirituality and spiritual care (SC) in pharmacy education and practice. The purpose of this study was to examine student pharmacists' perspectives about spirituality and incorporating SC in pharmacy education and practice. METHODS: Student pharmacists were recruited from two private pharmacy schools in California, one religiously-affiliated and one non-religiously affiliated. A faculty member at each school invited student pharmacists via email or through Zoom (Zoom Video Communications) chat to complete the 37-item online survey through an embedded link. The investigator-designed survey was comprised of 22 items inquiring about spirituality and SC as well as several items assessing demographic and religious characteristics. RESULTS: Participants included 470 student pharmacists (87.2% response rate) who were 28.9 ± 5.7 years old on average. Half of the respondents (50.5%) attended the non-religiously affiliated university. Most of the respondents were female (67%), Christian (67.8%), spiritual (79.2%), and religious (75.2%). They "agreed" or "strongly agreed" that: "understanding patients' spiritual beliefs is an important part of pharmacy practice" (83%), "I would pray with my patients as a pharmacist" (54.8%), "it is appropriate for a pharmacist to have spiritual or religious conversations with patients" (52.9%), and "it is appropriate for a pharmacist to pray with and for patients who request it" (66.9%). These beliefs were positively correlated with self-reported religiosity and spirituality. CONCLUSIONS: Most students considered themselves spiritual and religious and felt that spirituality and learning about SC were important. The respondents' SC perspectives were associated with their religiosity and spirituality.

Perspectives about Spiritual Care in Pharmacy Practice: A Community-based Survey.

Background: Addressing religious and spiritual needs are important components of holistic healthcare. Little is known about the general public's perspectives about pharmacists providing spiritual care (SC). Objectives: To explore how community members perceive, experience, and desire pharmacist-provided SC. Method: IRB approval was obtained for this observational, cross-sectional study. Adults receiving COVID-19 vaccinations at an immunization clinic completed an investigator-designed 33-item online survey. The survey measured respondents' perspectives about and experiences with pharmacist-provided SC, as well as demographic characteristics. Results: Of the respondents (n = 261), 57% were female and 46% were Hispanic/Latino. Most (59%) agreed that their religion/spirituality would be important to them if they were ill; 64% also agreed that it would be helpful for a pharmacist to know about patients' religious/spiritual beliefs pertaining to their healthcare, and 60% agreed that pharmacists should provide SC to patients who request it. While 96% indicated that they had never talked to a pharmacist about a spiritual or religious matter related to their health or medication, 96% also indicated that no pharmacist had asked to pray with them. These results are contextualized perhaps by the finding that 76% reported having no professional relationship with a pharmacist. Conclusion: Respondents often reported an openness to receiving SC from pharmacists. Most respondents, however, had not received SC from a pharmacist. Future studies should be conducted to better understand patient preferences for pharmacist-provided SC.

Healing Communication: A Precision Instrument for Spiritual Care.

OBJECTIVE: To describe holistic, empathic, and person-centered approaches to communication and apply these to the context of oncology nurse-provided responses to patients' expressions of spiritual concern. DATA SOURCES: Conceptual, empirical, and practice literature about communication, primarily from the disciplines of psychology and communication sciences, is resourced to inform this practice-oriented discussion. CONCLUSION: Holistic, empathetic, and person-centered models for communication are complementary, and although there is overlap, there is also distinct value added from each. IMPLICATIONS FOR NURSING PRACTICE: Each model offers excellent guidance for nurses seeking to provide a therapeutic verbal response during spiritual care for people affected by cancer.

Spiritual needs among Koreans and Americans with advanced chronic illnesses: A cultural comparison.

AIMS AND OBJECTIVES: This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross-cultural perspective. BACKGROUND: Persons with serious or life-limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well-being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. DESIGN: A quantitative, cross-sectional, observational cross-cultural comparison was undertaken. METHODS: The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness-related variables were also assessed using paper-and-pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. RESULTS: The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self-reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. CONCLUSIONS: In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. RELEVANCE TO CLINICAL PRACTICE: Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in-depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs.

Pharmacists' perspectives about spiritual care: A state-wide survey.

BACKGROUND: Patients' religious and spiritual beliefs affect their health behaviors, health outcomes, and interactions with health care providers. Incorporating spiritual support in clinical care contributes positively to patient health outcomes. No known studies have explored spiritual care (SC) within the context of pharmacy practice. OBJECTIVE: To examine pharmacist perspectives about SC, the frequency with which SC is incorporated in pharmacy practice, and the ways that pharmacists provide SC. METHODS: Data were collected using a cross-sectional statewide survey. The 57-item questionnaire was mailed to 1000 randomly selected registered pharmacists in California in 2019. Descriptive statistics, Pearson correlation, independent samples t test, and chi-square tests were used to analyze the data. RESULTS: Most of the 215 respondents were female (57.5%); the average length of work experience was 23.3 years (SD = 14.4). Just over half practiced in an urban setting (51.1%); similarly, half worked with terminally ill patients (50.2%). Most of the respondents were "somewhat" to "very spiritual" (77.8%) and "somewhat" to "very religious" (64.3%). Most pharmacists agreed that pharmacists should know about patients' spiritual concerns that may relate to their health (60.5%), that they should practice in a spiritually sensitive manner (73.4%), and that addressing patients' spiritual concerns improved their mental and physical health (76.7%). Respondents "rarely" to "very often or always" prayed privately for a patient (63.8%) and talked to patients about a spiritual and/or religious topic (51.2%), encouraged a patient to pray (49.3%), referred patients to their clergy or religious leader (39.5%), and prayed with a patient (33.5%). The frequency of spiritual services provided by pharmacists differed by their own spirituality, religiosity, and perception of institutional support (P < 0.05). CONCLUSION: Most of the respondents were spiritual and religious and believed that spirituality is important for their patients. Thus, some provided SC to their patients. Future research is warranted to examine ethically appropriate strategies for pharmacists to provide SC.

Pharmacists' spiritual care perspectives and experiences: Qualitative findings from a statewide survey.

OBJECTIVE: Pharmacists are encouraged to provide whole-person care. Because holistic care is conceptualized as including spiritual care (SC), this study investigated the experiences and perspectives of pharmacists regarding SC in pharmacy practice. METHODS: Data for this cross-sectional, qualitative study were collected from a survey mailed to 1000 randomly selected registered pharmacists in California in 2019. The data reported here are the responses to open-ended questions eliciting information about the last time the pharmacists provided SC to a patient, indicators that a patient needs spiritual assistance, and religious beliefs thought to be harmful. The data were content-analyzed by 2 investigators. RESULTS: Although 215 pharmacists responded to the survey, only 141 responded to the open-ended questions. Most of the respondents were women (58%), Christian (70%), religious (73%), attended religious services (78%), and practiced in an urban setting (56%). The themes observed indicated that these pharmacists prayed with, and for, patients; talked to patients about God and religion; referred patients to spiritual services; were sensitive to patients' spiritual or religious beliefs; and listened to patients' expressions of spirituality. Some respondents, however, avoided religious conversations and requests; some also reported unwillingness to provide SC to patients. The pharmacists had limited education, knowledge, and awareness about SC. CONCLUSIONS: The pharmacists in this sample reported diverse perspectives about SC that ranged from acceptance to rejection of SC in patient care. Pharmacists are not fully engaged in providing SC because of several challenges, including limited education and training on SC. Scholarly inquiry is needed to examine how pharmacists can best provide SC in pharmacy practice.

Perceived barriers to providing spiritual care among psychiatric mental health nurses.

BACKGROUND: Although nurses typically view spiritual care as important, it is provided infrequently. OBJECTIVES: This 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. METHODS: This cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care. RESULTS: The 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. CONCLUSIONS: Nurses need education about providing spiritual care to those with psychiatric mental health needs.

Insights on Spiritual Care for the Deaf Community.

Communicating effectively with persons who have a hearing disability can be challenging; assessing and providing spiritual care for these individuals is a more formidable expectation. Understanding the culture includes knowing available communication strategies and how best to use sign language interpreters. Building trust, demonstrating respect, and honoring privacy are essential components for nurses who wish to offer spiritual care. Utilizing spiritual caring moments as well as Helen Keller's example of successful communication across the hearing-nonhearing divide gives nurses valuable insights.

Healthcare Chaplains' Perspectives on Nurse-Chaplain Collaboration: An Online Survey.

The collaboration between nurses and chaplains is essential to provide spiritual support in healthcare institutions. Given challenges in collaboration exist between these disciplines, this study sought to further understand the nature of the chaplain-nurse relationship. Data obtained from an online survey of members of the Association of Professional Chaplains (N = 266) provide a quantified and nuanced picture of how chaplains perceive nurse collaboration and provision of spiritual care. This study not only provides evidence that can inform chaplain and nurse practice, but also an instrument for measuring perceptions about collaboration to provide spiritual care.

What Chaplains Wish Nurses Knew: Findings From an Online Survey.

This report presents qualitative data from a larger study that sought to examine chaplain perspectives on collaboration and nurse-provided spiritual care. This cross-sectional, descriptive study used online survey methods to distribute an investigator-designed questionnaire to a convenience sample of members of the Association of Professional Chaplains (N = 298). Findings were generated by written responses to 3 open questions that were thematically analyzed, as well as 1 quantitative item. Over half of these chaplains reported they did experience nurse "gatekeeping" at least occasionally. Themes from qualitative data revealed chaplains perceive nurses: lack understanding about the role and abilities of chaplains, sometimes overstep their role or impede the work of chaplains, and allow personal "baggage" to influence their collaboration with chaplains. Likewise, however, respondents respected nurses and were eager to collaborate. Naming these challenges to nurse-chaplain collaboration allows nurses and chaplains to begin to address them.