Hospitalized patients frequently have unmet spiritual needs linked with poorer patient outcomes including depression (Pearce, Coan, Herndon, Koenig, & Abernethy, 2012), increased medical costs (Balboni et al., 2011), worse quality of life (Kang et al., 2012), and diminished quality (Astrow, Wexler, Texeira, He, & Sulmasy, 2007) and satisfaction with care (Johnson, Engelberg, & Curtis, 2014; Kang et al., 2012). These spiritual-care needs can be addressed by nurses, but the main barriers to spiritual-care provision include nurses’ attitudes about spiritual-care (Vance, 2001) and their perception they are inadequately prepared to discuss spiritual concerns with patients (McSherry & Jamieson, 2013) preventing them from competently addressing spiritual needs and care.
The Actioning Spirituality and Spiritual-Care Education and Training model that suggests self-awareness and spirituality can be integrated in educational programs to assist in values clarification and changed spiritual-care attitudes to augment nurses’ spiritual-care provision (Narayanasamy, 1999). Tested interventional formats have included 60 minutes to two-week face-to-face classes (O-Shea, Wallace, Griffin, & Fitzpatrick, 2011), a four-hour study unit on spiritual coping (Sandor, Sierpina, Vanderpool, & Owen, 2006), and 10-hours of self-study using a work-book and digital video disk (Taylor, Mamier, Bahjri, Anton, & Petersen, 2009). However, none have tested a collaborative, brief, two-hour class using values clarification and spiritual timeline exercises, and content regarding spirituality, spiritual needs, and spiritual-care interventions with case study application.
Purpose/Aims
The purpose of this study was to determine the effect of a collaborative (between a university nursing faculty member and the hospital’s nurse researcher) spiritual-care educational intervention on nurses’ spiritual-care attitudes and the relationships between demographics (age, gender, ethnic background, nursing education and experience, spiritual-care education in nursing school and through conferences, reading and continuing education, religious education in high school, and religious service attendance frequency) and nurses’ spiritual-care attitudes.
Methods
Following institutional review board approvals, a quasi-experimental, pre-post-intervention design was used to address the aims. Demographics were assessed with the Information about You and spiritual care attitudes with the Spiritual Care Perspectives Scale (Taylor, Highfield, & Amenta, 1999). Descriptive analysis, paired t-test, and univariate and multivariate correlational statistics were used.The majority of subjects [n=183 pre- and 103 post-intervention] were 46.2 (±1.31 years through conferences and continuing education. Subjects reported religious service attendance weekly (n=50, 27.5%). Nurses participated in an intervention that required reading an article about spiritual care in advance of attending a two-hour class about spirituality and spiritual care described above. With a sample size of 103, nine predictors and an observed R2 of 0.25, observed statistical power was 0.99 for a multiple regression.
Results
Spiritual care attitudes were statistically significantly improved by the intervention [pre: low (39.7±6.9), post: moderate (51.4±11.55, t test=-8.788, p<.001). Spiritual care attitudes pre-intervention were associated with older age (r=.24, p=.001), more nursing experience (r=.26, p<.001), less frequent religious services attendance (r=-.29, p<.001), more spiritual care education through conferences and continuing education (r =.19, p=.009) and explained 12.7% of the variability in spiritual care attitudes (4, 170, f=6.19, p<.001). Spiritual care attitudes post-intervention were associated with less religious education in high school (r=-.25, p=.03).
Conclusions
A collaborative two-hour class using values clarification and spiritual timeline exercises, and content regarding spirituality, spiritual needs, and spiritual-care interventions with case study application can change nurses’ spiritual-care attitudes and may change nurses spiritual-care provision and important patient outcomes.