A lack of standardisation in the conceptualisation and assessment of spiritual care causes challenges in reviewing, however several themes do emerge. In general student and qualified nurses are aware of the importance of providing spiritual care and are hindered by a lack of education about how best to implement such care. The religiosity of individual nurses or their training institutions seems to be of less importance than training in spiritual care interventions.
There exists a lack of agreement around the definition of spirituality, indeed debate continues within the academic literature around the conceptualisation and definition of both spirituality and religiosity 1. Spirituality has been described as an umbrella term to denote the various meanings and interpretations of the term 2. Within nursing definitions of spirituality have been seen to include elements such as a higher power, feelings of connectedness, purpose and meaning in life, relationships and transcendence 3 - 5.
Regardless of the way it is defined or conceptualised spirituality is reported to contribute to the health and wellbeing of individuals 6. Spiritual wellbeing is associated with a number of positive outcomes including a greater tolerance of the emotional and physical demands of illness amongst patients 7 decreases in pain, stress and negative emotions 8 , and lower risk of both depression and suicide 7. Patients who receive adequate spiritual care are also reportedly more satisfied with their hospital care and treatment 9.
Unmet spiritual needs appear to have a profound impact upon patient wellbeing These adverse outcomes include reduced levels of quality of life, increased risk of depression and reduction in perceptions of spiritual peace Subsequently spiritual needs are acknowledged as being an important part of nursing care and assessment, and as such it can be regarded as a patient outcome.
Indeed internationally there is growing emphasis on the importance of the spiritual needs of patients It has also been found 17 that nurses were both more likely to provide spiritual care and to contact specialist spiritual carers than physicians.
Despite this, there is evidence that spiritual needs and assessment are not always well engaged with by nursing staff, with suggestion in the literature that engagement with the spiritual needs of patients does not consistently occur A variety of reasons may contribute to this, with the literature proposing various contributors including time pressures 19 and fear around the reaction of the patient to their attempts to aid with spiritual care Cultural and religious differences may also affect ability to provide spiritual care, research 21 has found differences in knowledge of and training in spiritual care between Taiwanese and Mainland Chinese nurses.
There is also said to be confusion amongst nurses about their role in spiritual care and assessment 22 a lack of clear definition over spiritual care as well as confusion over spiritual distress can act to make nurses less likely to deliver spiritual care to their patients A perceived lack of skill in the area of spiritual care and of under preparation 23 and lack of confidence may also contribute 1.
Indeed nurses often report the need for additional training provision in this area e. This review intends to outline what measures have been used to examine spiritual care and assessment by nurse health professionals and explore what the literature using these methods tells us about how to increase the quality and quantity of spiritual care delivery.
Limiters were placed by age such that only results involving adults were returned. It was specified that scholarly journal articles should be returned, written in English. This resulted in 15 hits. Content was again limited to academic journals. This resulted in results. Duplicates were removed and then titles and abstracts of articles were viewed and inappropriate articles discarded.
The remaining articles were then viewed in full. The search identified 14 measures related to spiritual care and assessment and upon examination it appeared they could be largely categorised into the following five domains as detailed below.
Further details of the specific scales can be found in Table 1. The original scale was of 23 items. After a pilot testing on seventy nurses working in surgical wards, the structure was changed to a final of 17 items with answers on a five-point Likert scale. The validation was conducted on a sample of ward-based nurses and the factor analysis identified four subscales: Spirituality, Spiritual Care, Religiosity and Personalised Care.
The Spiritual Care in Practice SCIP 25 , is an instrument used to measure the frequency of use of different methods to recognize a patient cue and providing spiritual interventions. It is a survey made of 12 items with answers on a five-point Likert scale. Its psychometric properties were tested on a sample of 78 nurses. The first version was designed with 48 items with answers on a five-point Likert scale, tested on adults patients, nurses, general population.
After an exploratory factor analysis, a final version of the scale with 17 items was released and tested on 78 adults nurses and nursing students.
It includes three subscales. Spiritual nursing intervention, meaning making, and faith rituals. Communicating for Spiritual Care Test CSCT 29 , is an instrument developed to evaluate the knowledge about how to communicate to provide spiritual care. Modification of the Response Empathy Scale RES; 30 , is an instrument assessing the ability to respond empathically to patient spiritual pain.
It is made of three vignettes illustrating different patient expressions of spiritual pain. Scores range from 12 low — 60 high empathy. Spiritual Care Perspectives Scale SCPS 31 , is an instrument assessing nurse attitudes, beliefs, practices, perspectives, and preparation regarding spiritual care. It is made of six items, three of them with a five points Likert scale answer, one with a check list and two with a four points Likert scale answer.
It was used to assess spiritual care education in oncology and hospice nurses. It is made of 9 items with a six-point Likert scale answer. It is made of 15 short-answer and multiple-choice questions about demographics and perceived barriers to spiritual care and 26 questions about spiritual care practices on a 4-point Likert scale answer. It is made of 10 items with answers on a Likert scale.
It was validated on a sample of thirty-nine students and assesses three domains: level of comfort related to performing spiritual care, ability to differentiate between religion and spirituality, and the role of nurses in providing spiritual care. It is made of 8 items. It includes 21 items reproduced from North American and British health-care literature advocating spiritual assessment. It consists of three sections. The first section contains 10 questions on demographic variables.
One open-ended question in the second part eliciting self-exploration about personal spirituality and life satisfaction. The responses to this question are intended to be analysed using qualitative methods.
The third section consists of 45 items on a Likert scale relating to the dimensions of spirituality: beliefs, values, therapeutic strategies, and behaviours. The first part of this section contains 30 questions on beliefs and values, the second part contains 15 questions on therapeutic strategies and behaviours. It includes ten items with five-point Likert response options. It was validated on nurses and factor analysis suggested a uni-dimensional scale. A high score indicates positive attitude toward spiritual care.
Reviewing the studies employing the measures outlined above, evidence around willingness to provide spiritual care initially appears to suggest that nurses are generally willing to provide spiritual care.
However, 37 observed that whilst students had a good knowledge of the importance of spiritual beliefs and values in nursing care, a smaller number of students regularly provided spiritual based care.
It would appear then that whilst nurses and nursing students acknowledge and have an awareness of the spiritual needs of patients and the importance of spiritual care as part of their nursing role, they do not always provide this care to their patients.
Studies examining the willingness to provide spiritual care found that there exist some differences in willingness to provide spiritual care, however the findings appear variable. Whilst 33 found some suggestion that younger nurses were more willing to perform spiritual assessment, others, such as 27 found that age and other nurse characteristics including clinical experience, gender level of education, and personal religiosity did not influence willingness to deliver spiritual care.
It was however noted that those who perceived that they had received sufficient training in the delivery of spiritual care felt more willing to provide such care to their patients When considering specific aspects of spiritual care provision, the source of the education appeared important.
However interestingly it was also reported that students who perceived spirituality as important were also more likely to be comfortable delivering spiritual care to patients, a finding echoed by Level of comfort with delivering spiritual assessment has also been considered. A study of hospice nurses 36 investigated factors associated with the level of comfort hospice nurses have in conducting spiritual assessment. Findings suggested that the nurses were generally comfortable with the types of questions involved in spiritual assessment and they also perceived spiritual assessment to be important.
What does seem apparent is that a number of factors are relevant to spiritual care delivery by nurses. Research has identified several barriers to the provision of spiritual care including time constraints, concern about spiritual care being inappropriate within their practice setting as well as a lack of knowledge This is consistent with the literature which suggest many nurses report feeling inadequately prepared to deliver spiritual care to patients.
Staff commonly report that they feel they receive inadequate preparation for this aspect of their role 27 and often report a lack of spiritual care training in nursing school Training therefore is an important consideration, with numerous studies considering the influence that this holds.
Outcomes from factor analysis and the themes from qualitative analysis were said to suggest that student nurses are aware of the importance of spiritual health and of incorporating it into their nursing practice. Demographics including age, years working in healthcare, highest level of education, religion, ethnicity, participation in a healing group, life satisfaction or degree of emphasis on spirituality in the nursing curriculum did not correlate with spirituality scale score.
Spiritual connectedness defined as a strong faith in a higher being or power and strong connection with the spiritual side of the self did however correlate positively with spirituality scale score. It appears that spiritual connectedness may be a construct which is distinct from religiosity. This serves to emphasise the importance in terminology and the importance of clearly distinguishing religiosity and aspects of spirituality. The literature has also considered students perceived level of spiritual care ability.
For example, 32 used the Student Survey of Spiritual Care SSSC 32 as part of an examination of spiritual care attitudes and spiritual care practices in students with findings around student characteristics and environmental factors. The HOPE questions cover the basic areas of inquiry for chaplains to use in formal spiritual assessments. This approach allows for meaningful conversation with a variety of patients, including those whose spirituality lies outside the boundaries of traditional religion or those who have been alienated in some way from their religion.
It also allows those for whom religion, God or prayer is important to volunteer this information. There are many ways of asking these questions. You can donate to support the work of Hospice Chaplaincy here! Thank you in advance for supporting our work to ensure that hospice chaplains have free quality resources to do the job well.
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Notify me of new comments via email. Notify me of new posts via email. I was wondering, what is there in your life that gives you internal support? What are your sources of hope, strength, comfort and peace? What do you hold on to during difficult times?
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Altern Ther Health Med. Spirituality, religion, and pediatrics: intersecting worlds of healing. O'Hara DP. Is there a role for prayer and spirituality in health care? Med Clin North Am. Int J Epidemiol. Association between attendance at religious services and self-reported health in 22 European countries. Soc Sci Med. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? The George Washington.
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Get Permissions. Read the Issue. Sign Up Now. Sep 15, Issue. The Spiritual Assessment. C 9 Addressing spirituality may help when forming a comprehensive treatment program for patients with chronic pain. C 10 Spirituality should be addressed as one of the core components of quality palliative care. Enlarge Print Table 1. Importance Have your beliefs influenced how you take care of yourself in this illness?
Community Are you part of a spiritual or religious community? Is this of support to you, and how? Address in care How would you like me to address these issues in your health care? Table 1. Enlarge Print Table 2. What do you hold on to during difficult times? O: organized religion Are you part of a religious or spiritual community? Does it help you? P: personal spirituality and practices Do you have personal spiritual beliefs?
E: effects on medical care and end-of-life issues Does your current situation affect your ability to do the things that usually help you spiritually? Table 2. Enlarge Print Table 3. Do you have a spiritual or faith preference? What helps you through hard times? Invite i. Does your spirituality impact the health decisions you make?
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Navigate this Article. Patients should have a spiritual assessment upon admission to the hospital. Have your beliefs influenced how you take care of yourself in this illness? Are you part of a spiritual or religious community?
How would you like me to address these issues in your health care? H: sources of hope. What are your sources of hope, strength, comfort, and peace? O: organized religion. Are you part of a religious or spiritual community? P: personal spirituality and practices. Do you have personal spiritual beliefs?
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