Implementing a Spiritual Care Subject for Holistic Nursing Practice: A Mixed Method Study.

Aim: The aims of this sequential explanatory mixed method study were twofold 1. Firstly, to evaluate the implementation of a spiritual care subject in a nursing program. 2. Secondly, to examine undergraduate nursing students' perceptions of providing spiritual care within their holistic care practice. Background: Studies conducted internationally indicate many nurses feel inadequately prepared to provide holistic care inclusive of spiritual care due to insufficient spiritual care education. Design: Two phase, sequential explanatory mixed method design which comprised of a quantitative study followed by a qualitative study. Methods: The setting was an Australian faith-based university. Participants comprised of undergraduate nursing students who were enrolled in a spiritual care subject. Findings: Two study findings emerged: 1. Participants' knowledge and practice of spiritual care were transformed by the spiritual care subject, and 2. The spiritual care subject broadened perceptions of spiritual care so participants viewed themselves more equipped to provide spiritual care in their holistic care provision. Conclusion: The spiritual care subject had an affirmative influence on participants' perceptions of providing spiritual care within holistic care practice. The findings have implications for nurse educators to consider how spiritual care content can be included within undergraduate nursing curricula.

Developing an Elective on Spirituality for the BSN Curriculum.

When a curriculum evaluation of a BSN program at a public university revealed a content gap on spirituality and spiritual assessment, faculty developed an elective covering a nurse's role in spiritual care and assessment of patients. The resulting 300-level course was of hybrid design and received positive evaluation from students after implementation.

Effect of an Educational Intervention Delivered to Senior Nursing Students to Strengthen Spiritual Care for People with Chronic Illness.

This is an experimental, quantitative, parallel design study (control and experimental groups) with pre- and post-intervention assessment without blinding, which aimed to determine the effect of an educational intervention delivered to ninety Colombian senior nursing students to strengthen perceptions of spirituality and spiritual care for people with chronic illness. The Spirituality and Spiritual Care Rating Scale (SSCRS) was used as the instrument of measurement. The Wilcoxon test was used for comparisons between two groups, and the Kruskal-Wallis test for the comparison of global scale scores between the intervention group and the control group. To determine the effect of the intervention, Cohen's d statistic was used. The intervention modified the perceptions of spirituality and spiritual care in the experimental group (median = 80.2, SD = 10.2) compared with their initial perceptions (median = 70, SD = 11.2), p ≤ 0.001. The effect size (ES) of the intervention was 0.63, with a power of 0.80, indicating a moderate and acceptable effect size.

Spiritual Care in Holistic Nursing Education: A Spirituality and Health Elective Rooted in T.R.U.S.T. and Contemplative Education.

Research to date demonstrates that spiritual care as an integral part of holistic nursing can be hampered if nurses experience insufficient preparation or organizational cultures that fail to prioritize spiritual well-being. In response, the author has developed a three-credit spirituality and health elective in an undergraduate nursing program to help participants address spiritual needs and mobilize spiritual strengths within themselves, patients, and workplaces. Using the T.R.U.S.T. Model for Inclusive Spiritual Care as its framework, the six-unit course draws on contemplative education practices in hopes of preparing a critical mass of nurses with the ability and confidence to foster safe, relevant spiritual care and promote a holistic, patient-centered health care culture. Course participants regularly demonstrate and report deeper self-awareness, skills development, and confidence in relation to spiritual care; the course also has been positively evaluated and fully subscribed over its seven offerings to date, validating its effectiveness in relation to short-term outcomes. Research is needed to evaluate its long-term effectiveness in helping alumni integrate spiritual care into their holistic practice and workplace culture.

Interprofessional Spiritual Care Training for Geriatric Care Providers.

Background: Despite the importance patients place on religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many nonchaplain clinicians feel unprepared to address religious and spiritual issues in their practice. Objectives: The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for nonchaplain clinicians who provide care to elderly long-term care patients. Methods: Clinician participants (N = 68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three-month follow-up survey to evaluate their comfort in engaging in spiritual issues before and after the workshop. An average ability score of 13 items in the survey was calculated as well as an average comfort score, which was an average of three items in the survey. Ability scores and comfort scores were analyzed using a pairwise t-test, comparing pre- versus post-workshop and post- versus three-month scores. Results: Overall average scores for clinicians' self-reported perceived ability in engaging in issues around spirituality with patients and their families increased from before the workshop to the post-workshop and three months later. Participants' self-perceived comfort increased from before the workshop to immediately following the workshop. Discussion: This study suggests that a spiritual care training program targeted toward geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.

Influence of Palliative Care Training on Last-Year Nursing Department Students' Perception on Regarding Spirituality and Spiritual Care: A Single-Group Pretest-Posttest Intervention Study.

Spiritual care is a part of integrated care and should not be considered as a separate aspect of palliative care. Spirituality is seen as a requirement that must be met for all patients. The aim of this study is to determine the influence of palliative care on the perception levels of student nurses regarding spirituality and spiritual care. The research was carried out as a single-group pretest-posttest intervention study. The study was conducted with 70 student nurses. Data were collected via personal information form and spirituality and spiritual care grading scale (SSCGS). Frequency, percentage, average, standard deviation, paired sample t-test and Wilcoxon test were used to analyze the data. 55.7% of the students who participated in research stated that they had never heard of spiritual care, and 81.4% of the students stated that they had not obtained any information regarding spiritual care. The point average of the student nurses related to SSCGS was found to be 3.27 ± 0.21 before training and 3.35 ± 0.22 after training. The difference between the total point averages of the student nurses pre- and posttraining was found to be statistically significant (p < 0.05).As a result of the research, the perception of the student nurses regarding spirituality and spiritual support was found to be above the middle and increased significantly after the training. In accordance with these results, it is suggested that spiritual care training should be included more into nursing education.

Training Physicians as Healers.

Spirituality is increasingly recognized as an essential element of patient care and health. It is often during illness that patients experience deep spiritual and existential suffering. With clinicians' care and compassion, patients are able to find solace and healing through their spiritual beliefs and values. This article chronicles a history of spirituality and health education, including the development of consensus-based clinical guidelines and competencies in health professions education that have influenced the curricular development.

Enhancing Spiritually Based Care Through Gratitude Practices: A Health-Care Improvement Project.

BACKGROUND: Addressing spirituality in health care is important as it improves health outcomes; however, several provider barriers exist to providing spiritually based care. Local problem: A chart audit at a multidisciplinary wellness center serving a population with chronic mental health problems identified a need to improve the number of spiritually based interventions provided to clients by the nurse practitioner. DESIGN: A quasi-experimental design and pre- and post-test questionnaire were used to measure outcomes including the number of spiritually based interventions and provider attitudes. INTERVENTION: Providers, including a nutritionist, exercise physiologist, pharmacist, acupuncturist, and nurse practitioner, participated in two, 1-hour interactive educational sessions on providing spiritually based care, emphasizing the use of gratitude practices. RESULTS: The mean number of spiritually based interventions charted per visit by the nurse practitioner increased from 0.4 pre-implementation to 1.1 post-implementation (rate ratio = 2.57, with 95% CI [1.75, 3.87]; p < .001). Descriptive statistics from all providers show improvements in attitudes and comfort level in addressing spiritually based care. Several intervention areas documented by the nurse practitioner decreased significantly, including mind/body, which may be related to the study, as many spiritually based interventions are also mind/body interventions. CONCLUSION: Interactive educational sessions on spirituality can improve a health-care team's attitudes, comfort level, and practice of providing spiritually based care. Generalizability is limited to the project site, but the process could be implemented in other facilities to determine if similar results can be achieved.

Student Perspective Improves Spiritual Care Curriculum.

Spiritual nursing care is a fundamental aspect of care often unobserved during students' clinical experiences. A nursing student shares her disillusionment about the lack of spiritual care she observed during a clinical rotation. Her instructor used the negative experience to identify areas for curriculum improvement to develop and address the lack of spiritual nursing care education.

Building Spiritual Care in Nursing: An Overview of Ku's Spiritual Studies in Taiwan.

This paper describes the overview of Ku's spiritual literature on nursing through five stages in Taiwan: the development of a spiritual framework, a scale of spiritual distress, a spiritual care model, a spiritual nursing course, and a spiritual care book in nursing. The article demonstrates the process of building spiritual care in nursing from constructing theoretical frameworks, measurements, and applying to education. The integrative overview of Ku's spiritual studies developed in this article could be an example in clinical and education fields for nurse administrators to develop spiritual capabilities.

A mobile hospice nurse teaching team's experience: training care workers in spiritual and existential care for the dying - a qualitative study.

BACKGROUND: Nursing home and home care nursing staff must increasingly deal with palliative care challenges, due to cost cutting in specialized health care. Research indicates that a significant number of dying patients long for adequate spiritual and existential care. Several studies show that this is often a source of anxiety for care workers. Teaching care workers to alleviate dying patients' spiritual and existential suffering is therefore important. The aim of this study is to illuminate a pioneering Norwegian mobile hospice nurse teaching team's experience with teaching and training care workers in spiritual and existential care for the dying in nursing homes and home care settings. METHODS: The team of expert hospice nurses participated in a focus group interview. Data were analyzed using a phenomenological hermeneutical method. RESULTS: The mobile teaching team taught care workers to identify spiritual and existential suffering, initiate existential and spiritual conversations and convey consolation through active presencing and silence. The team members transferred their personal spiritual and existential care knowledge through situated "bedside teaching" and reflective dialogues. "The mobile teaching team perceived that the care workers benefitted from the situated teaching because they observed that care workers became more courageous in addressing dying patients' spiritual and existential suffering. DISCUSSION: Educational research supports these results. Studies show that efficient workplace teaching schemes allowexpert practitioners to teach staff to integrate several different knowledge forms and skills, applying a holisticknowledge approach. One of the features of workplace learning is that expert nurses are able to guide novices through the complexities of practice. Situated learning is therefore central for becoming proficient. CONCLUSIONS: Situated bedside teaching provided by expert mobile hospice nurses may be an efficient way to develop care workers' courage and competency to provide spiritual and existential end-of-life-care. Further research is recommended on the use of mobile expert nurse teaching teams to improve nursing competency in the primary health care sector.

Biographical similarities between spiritual healers and their clients in Germany - a qualitative study.

Spiritual healers in contemporary Germany comprise a heterogeneous and growing group, yet little data exists about them. Therefore, one aim of this study was to learn about which biographical aspects and events were important to the process of becoming a healer and which biographical aspects drove clients to consult a healer. The study was based on semi-structured interviews combined with participant observations. All data were recorded digitally, transcribed, entered into the software program MAXQDA and analysed subjected to Content Analysis. In total, 15 healers (nine male, six female) and 16 clients (13 female, three male) were included. According to the healers, a talent for healing can be inborn, inherited or developed through life experiences. Most of the healers experienced a crisis, which prompted their transformation to healers (the wounded healer type). A smaller group became healers mainly out of interest without going through crisis and by focusing on the spiritual attitude itself (the healer by interest type). The basis of healing is seen as a connection to a transcendent reality, which enables an open, loving and empathetic attitude. The experience of crises and illnesses and the importance of spirituality are major biographical similarities between healers and clients. Near-death experiences as an extreme form of crisis were reported from a few healers and clients. The connections between healing talents and crises, including a deepened exploration of near-death experiences and questions regarding inclining towards spirituality could be of interest in further studies.

Students' voices on spiritual care at a Higher Education Institution in the Western Cape.

BACKGROUND: Nurses have a moral obligation to ensure holistic care of patients, inclusive of the spiritual dimension. However, there seems to be a void in the teaching and learning of spiritual care in nursing curricula. Despite the South African Nursing Council being in favour of holistic nursing, there are no measures in place to ensure implementation of spiritual care, hence its practice is not standardised in nursing education in South Africa. Currently, the undergraduate nursing curriculum does not provide clear direction on how spiritual care in nursing should be integrated and the reason for this is not clear. It appears that the lack of professional regulation, difficulties in definition and the personalised nature of spiritual practice are partly responsible for the practice being barely enforced and scarcely practised by students in clinical placements. The aim of the study was to develop a practice theory for teaching-learning of spiritual care in the undergraduate nursing programme. OBJECTIVES: The study objective was to describe and explore the students' experiencs of teaching-learning of spiritual care in the undergraduate nursing programme. METHODS: A qualitative, explorative, descriptive and contextual design with purposive sampling was used. The sample consisted of undergraduate nursing students at a University in the Western Cape Province. Measures for trustworthiness were applied. RESULTS: The findings indicated a need to provide support, a conducive learning environment and structure for teaching, learning and practice of spiritual care. CONCLUSION: There is a need for formal education regarding spiritual care in nursing.

Integrating Spiritual Care into a Baccalaureate Nursing Program in Mainland China.

Holistic nursing care takes into account individual, family, community and population well-being. At the level of individual well-being, the nurse considers biological, psychological, social, and spiritual factors. However, in Mainland China spiritual factors are not well understood by nursing students. And accordingly, nursing faculty and students are reluctant to broach the topic of spirituality because it is either unknown to students or students believe that the provision of spiritual care is beyond their capabilities. We wonder then, what can we do as nurse educators to integrate spiritual care into a baccalaureate nursing program in Mainland China? The purpose of this article is to propose the integration of Chinese sociocultural traditions (namely religious/spiritual practices) into undergraduate nursing curricula as a means to enter into dialogue about spiritual well-being, to promote spiritual care; and to fulfill the requirements of holistic nursing care. However, prior to discussing recommendations, an overview of the cultural context is in order. Thus, this article is constructed as follows: first, the complexity of Chinese society is briefly described; second, the historical evolution of nursing education in Mainland China is presented; and, third, strategies to integrate Chinese religious/spiritual practices into curricula are proposed.

Spiritual dimensions of care: developing an educational package for hospital nurses in the Republic of Ireland.

The nurses' role in providing spiritual care to in-hospital patients is not clearly outlined in the Republic of Ireland (ROI). This and other deficits reveal that there are current gaps in nurses' knowledge and confidence in this area. In response, an educational innovation has been developed and this article reports on its development.

"I will never let that be ok again": student reflections on competent spiritual care for dying patients.

PURPOSE: To examine medical students' reflections on the spiritual care of a patient who has died so as to understand how students experienced this significant event and how they or their teams addressed patients' spiritual needs. METHOD: In 2010-2011, the authors gave third-year students at Loyola University Chicago Stritch School of Medicine an essay assignment, prompting them to reflect on the experience of the death of one of their patients. The authors analyzed the content of the essays using an iterative, multistep process. Three authors independently coded the essays for themes based on the competencies (developed by Puchalski and colleagues and reflected in the essay prompt) of communication, compassionate presence, patient care, and personal and professional development. The authors reached consensus through discussion. RESULTS: A salient theme in the students' writings was awareness of their personal and professional development. Students reported being aware that they were becoming desensitized to the human dimension of care, and particularly to dying patients and their families. Students wished to learn to contain their emotions to better serve their patients, and they articulated a commitment to addressing patient and family needs. Students identified systemic fragmentation of patient care as a barrier to meeting patient needs and as a facilitator of provider desensitization. CONCLUSIONS: Written student reflections are a rich source of data regarding the spiritual care of dying patients and their families. They provide insight into the personal and professional development of medical students and suggest that medical schools should support students' formation.

Assessing third-year medical students' ability to address a patient's spiritual distress using an OSCE case.

PURPOSE: To inform curricular development by assessing the ability of third-year medical students to address a patient's spiritual distress during an acute medical crisis in the context of an objective structured clinical examination (OSCE) case. METHOD: During March and April 2010, 170 third-year medical students completed an eight-station videotaped OSCE at Albert Einstein College of Medicine of Yeshiva University. One of the standardized patients (SPs) was a 65-year-old man with acute chest pain who mentioned his religious affiliation and fear of dying. If prompted, he revealed his desire to speak with a chaplain. The SP assessed students' history taking, physical examination, and communication skills. In a postencounter written exercise, students reported their responses to the patient's distress via four open-ended questions. Analysis of the postencounter notes was conducted by three coders for emergent themes. Clinical skills performance was compared between students who reported making chaplain referral and those who did not. RESULTS: A total of 108 students (64%) reported making a chaplain referral; 4 (2%) directly addressed the patient's religious/spiritual beliefs. Students' clinical performance scores showed no significant association with whether they made a chaplain referral. CONCLUSIONS: Findings suggest that the majority of medical students without robust training in addressing patients' spiritual needs can make a chaplain referral when faced with a patient in spiritual crisis. Yet, few students explicitly engaged the patient in a discussion of his beliefs. Thus, future studies are needed to develop more precise assessment measures that can inform development in spirituality and medicine curricula.

Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality.

PURPOSE: The objective structured clinical examination (OSCE) has only occasionally been used as a teaching tool. The authors describe the initial use of an educational innovation consisting of a teaching OSCE used as "sensitizing practice," followed by personal, guided, and group reflection. METHOD: Staff and resident physicians and one medical student (N = 28) at a community hospital's family medicine residency participated in the innovation during August 2012. The initial use of the educational innovation allowed learners to engage in a potentially challenging conversation with a standardized patient about religion and/or spirituality (R/S). The aim of the innovation was not to equip learners with a particular tactic to introduce or discuss R/S but, rather, to prompt learners to engage in mindful practice with patients who identify R/S as part of their biopsychosocial contexts. Written, dyadic, and group reflection added value to the OSCE by allowing participants to reflect on a difficult learning objective over time. RESULTS: Participants moved along the stages-of-change continuum when engaging in guided reflection compared with personal reflection. Additionally, all participants provided evidence of at least the preparation stage at the time of guided reflection. By following the OSCE's sensitizing practice with three periods of reflection, learners were enabled first, to recognize the need for readiness to address challenging communication topics (in this case, R/S) and, second, to reflect on practiced strategies for those conversations. CONCLUSIONS: The educational innovation can help learners become more aware of and skillful in dealing with difficult physician-patient communication topics.