Perceptions and Practice of Spiritual Care in Student Nurses Courtesy of Dr. Cindy McCoy, RN, PhD and Deborah Rushing, RN, MSN Recognizing and supporting the spirituality of the patient population is an important component in the delivery of nursing care. Nurses must be prepared to address this aspect of patient care. To adequately care for a patient’s spiritual needs, nurses must first understand what is meant by spirituality, and be able to identify methods to support the spiritual needs of their patients. There are several terms associated with spirituality that should be clarified prior to attempting to describe spiritual care. In the nursing literature, religion is described as having an organized entity with definable boundaries, which may provide guidelines to which individuals adhere (Tanyi, 2002). Spirituality involves the individual’s search for meaningfulness and purpose in life. According to Martslof and Mickley, (1998) spirituality includes the concepts of meaning, value, transcendence, connecting, and becoming. The difference between religion and spirituality lies in the idea that a person can have a religious belief, or subscribe to the beliefs of an organization, but may not possess the key aspects of spirituality. However, a person may be very spiritual but not subscribe to an organization’s guidelines. In the framework of Watson’s model of caring, spirituality is a key concept. Nurses using this theory of caring promote the holistic harmony of the mind, body, and spirit. In nursing practice, there are specific interventions that have been identified to promote the spiritual health of the patient. For nurses to effectively meet the spiritual needs of their patients they will have to be educated about nursing interventions. This education begins at the student nurse level. To provide insight into students’ perceptions and practice of spiritual care, educators need to clearly comprehend the student’s perceptions regarding spirituality. This pilot study was implemented to determine the perception and current practice of nursing students regarding spirituality in an attempt to identify areas of improvement within the framework of a caring nursing curriculum. Purpose The specific goals of this study were to identify 1) the BSN students’ perceptions of spiritual care, 2) nursing interventions utilized to promote spirituality in the delivery of care, and 3) preparation of nursing students for the delivery of spiritual care. Research Questions 1. How do nursing students define spiritual needs? 2. How do nursing students describe spiritual care? 3. Do nursing students feel comfortable identifying spiritual needs? 4. Do nursing students deliver spiritual care? Methods This was a descriptive pilot study. Appropriate approval from the university Research Review Board was obtained. The population for this pilot study was all students enrolled in the second, third, and fourth semester of the Troy University School of Nursing Baccalaureate Program nursing sequence. Students enrolled in the first semester were not

invited due to their lack of clinical experience. Students were sent an e-mail invitation to participate, which included an information statement and informed consent statement. If the student chose to participate, they followed a hyperlink to the online survey. Twentyfour students (response rate of 48.9%) completed the Spiritual Care Inventory (SCI) developed by Garner, Gray, Snow, and Wright (1994). This tool asked participants to identify perceived definitions of spiritual needs and spiritual care, and value placed on spiritual care. This tool uses qualitative and quantitative methods to assess the student’s perceptions of spiritual care, and current practice of supporting spiritual care in nursing. Reliability in this study was measured by Cronbach’s alpha (r=.8351). Findings Demographic data The majority of students (91.7%) reported affiliation with a religion, with the highest percentage as Baptist (54.2%). Other religious affiliations reported were Catholic (4.2%), Chrisitan (12.5%), Pentocostal (8.3%), Latter Day Saints (4.2%), Non-denominational (4.2%), and Methodist (4.2%).

RELIGION Methodist no response Non-denominational Latter Day Saints

Pentocostal Baptist

Christian Catholic

The students were asked to categorize the frequency of participation in a religious activity prior to entering nursing school. prior_activity once a week twice a week three times a week 1-2 times a month

Frequency 11 1 5 4

Percent 45.8 4.2 20.8 16.7

1-2 times a year no participation Total

2 1 24

8.3 4.2 100.0

The students were also asked to categorize the frequency of current participation in a religious activity. current_activity once a week twice a week three times a week 1-2 times a month 1-2 times a year no participation Total

Frequency 5 3 3 6 3 4 24

Percent 20.8 12.5 12.5 25.0 12.5 16.7 100.0

Research question 1: How do nursing students define spiritual needs? All students agreed that patients have spiritual needs. When asked if spiritual care is part of the role of the nurse, 95.8% said that it was. The students defined spiritual needs as: Need Relationship with God Meaning in life Purpose in life Hope Forgiveness Trust Love Self-esteem Relationship with higher power Emotional stability Connectedness Belonging Will-power Self-determination Relationship with universe Physical health Creativity Relatedness Information Independence Health knowledge Financial stability

Percent 91.7 87.5 79.2 79.2 79.2 75.0 66.7 62.5 58.3 58.3 58.3 45.8 41.7 37.5 33.3 25 16.7 12.5 8.3 8.3 8.3 4.2

Research Question 2: How do nursing students describe spiritual care? Students described spiritual care as the following interventions: Spiritual Care Praying with a person Assessing the person’s source of hope and strength Assessing how the person’s spiritual beliefs affect spiritual , psychosocial, or physical needs Praying for a person Assessing the significance of the person’s religious practices for him or her Assisting a person with religious practices Reading devotional/inspirational material Calling pastor, chaplain, or other spiritual advisor Assessing the person’s concept of God or deity Helping a person relate to a higher power Assessing the person’s perceived relationship between his spiritual beliefs and his state of health Assisting a person to establish or maintain a relationship with God Sitting with a person and listening to him/her Assisting a person to find forgiveness from self, others or higher power Offering hope Assisting a person to clarify his/her values Assisting a person to determine meaning in life Use of touch Helping a person relate to himself/herself and his/her environment Assisting a person to relax Use of humor Investigating a person’s history of psychosocial health Investigating a person’s history of physical health

Percent 91.7 87.5 83.3 79.2 75 75 75 75 70.8 66.7 66.7 66.7 66.7 62.5 62.5 54.2 54.2 41.7 37.5 33.3 25 16.7 12.5

Do nursing students feel comfortable identifying spiritual needs? Do nursing students deliver spiritual patient care? Comfort level in identifying and delivering 75% identifying 75% delivering Do you feel the needs are met by you? o Poorly – 16.7% o Well – 8.3% o Adequately – 75% Last identified o never – 16.7% o in the last 6 months-83.3% Last delivered o Never – 12.5% o In the last six months – 87.5%

Discussion Discuss nursing student’s perceptions of spirituality in the delivery of care. Student nurses in this survey were able to identify that patients had spiritual needs, and they also identified what they thought those needs were. They identified barriers to the delivery of spiritual care including Question 27 comments. Identify preparation of nursing students for delivery of spiritual care. Overall, students indicated that they did not feel adequately prepared to deliver spiritual care, and the majority had not educational preparation to assist them in the delivery of spiritual care. Discuss the implications for nursing education. Implications for education Educators need to work with the students to • Increase knowledge of how to identify needs • Increase knowledge of different religions • Time management to allow for more time spent with the patient to identify and meet needs • Multidisciplinary resource identification • Identify resources available from clinical facility • Values clarification Conclusions This descriptive study demonstrates that nursing students believe that patients have spiritual needs, and that they are aware that nurses may not always meet those needs. References Tanyi, R. A. (2002). Towards classification of the meaning of spirituality. Journal of Advanced Nursing, 39 (5), 500-509. Martslof, D.S. & Mickley, J.R. (1998). The concept of spirituality in nursing theories: Differeng world views and extent of focus. Journal of Advanced Nursing, 27, 294-303.