Objectives: The purpose of the original mixed-method, two-phased project among nurses and patients was to explore and understand their perspectives on spiritual care in diverse in-patient with the goal of influencing nursing education.
Methodology: This study involved secondary analysis of data collected as part of a sequential, transformative (Creswell, 2013) mixed-method study conducted in Norway utilizing qualitative focus groups of nurses (n=22) in 2014 (Giske & Cone, 2015) and individual interviews of patients (n=6) conducted in 2016 (Cone & Giske, in submission) and quantitative surveys (n=167) in 2015 Cone & Giske, 2017). The Nurse/Patient Spiritual Assessment Questionnaire, developed and validated by Taylor (2013) in New Zealand, was translated into Norwegian and tested in this project. Upon approval of the Norwegian ethics board, nurses and patients were recruited at a hospital in Bergen. Nurses responded to a survey packet containing the study purpose, demographic sheet, survey, and return envelope provided through the hospital mail system, thus ensuring anonymous participation (77% response rate). Later, nurses offered the survey packet with a brief explanation of the study to patients, choosing those whom they determined could participate without burden, so a response rate could not be calculated. Respondents left their packets in the hospital mail upon discharge, which also kept them anonymous. The Co-PI did data collection and sorting, while the PI did data entry and analysis using SPSS-19 for chi square, t-tests, ANOVA, and correlations. For the qualitative phase, nurses were invited to participate anonymously in focus groups where a semi-structured interview guide was used by the PI and Co-PI to understand the nurse view of spirituality and spiritual care with hospitalized patients. The co-PI led one-on-one interviews of patients who were willing to participate, also anonymously. All the interviews were audio-taped and transcribed, and those in Norwegian were translated before data analysis was doing using the constant comparative approach of classical grounded theory.
Findings: Interestingly, nurses and patients both expressed a positive comfort level with most questions about spiritual or deeply important personal concerns even though religion is considered taboo to discuss. There was consensus about the need to address spirituality in hospital. While nurses found ways to assess spiritual needs and tried to facilitate spiritual care in a variety of ways, patients often questioned whether or not spiritual assessment was in the nurse’s domain. Patients preferred that chaplains/priests ask about their spiritual needs, though nurses were second on their list of who could ask about the spiritual and patients identified four approaches for nurses relating to spiritual concerns, with views ranging from “Don’t ask” to “Ask anything.” Four of the questions with reported high comfort level were the same for both patients and nurses, while one question had completely different views by nurses and patients as to whether or not nurses should ask such questions of hospitalized patients.
Implications for Nursing: Because of the private nature of deeply held beliefs, nurses must proceed with caution as they work to discern what will facilitate spiritual care for their patients. With a deeper understanding of patient perspectives, nurses can be better prepared for spiritual care through appropriate readings, spiritual scenarios, and brief training sessions to help recognize patient cues and to identify best approaches to care that will promote healing at all levels, including the spiritual. Interdisciplinary collaboration between nurses and chaplains as they cooperate to facilitate spiritual care is an approach that both patients and nurses may value.
Conclusion: Understanding both the nurse and the patient perspective care in this deeply personal domain will allow nurse educators to prepare resources and develop teaching strategies for teaching and preparing nurses across the curriculum in nursing education around the world.