A European, Collaborative Standard for Spiritual Care Competences for Undergraduate Nursing/Midwifery Education

Background: Many nursing and midwifery regulatory and educational bodies require nurses/midwives, at point of registration, to be able to address the personal, religious and spiritual beliefs of their clients as part of holistic care. Nurses continue to report that they are poorly prepared through their nursing education to assess and address spiritual concerns of patients (Giske & Cone, 2015; McSherry & Jamison, 2013). How learners acquire these skills, is not clear. Research to date highlights that the teaching students receive is important in their learning about spiritual/person centered care; however, there is a great deal of inconsistency in how this topic is addressed in nursing education throughout Europe (Cone & Giske, 2017; Ross et al., 2014).

Purpose: The purpose of the study was to develop an innovative, flexible, and dynamic matrix for pre-registration nursing and midwifery education as well as to identify resources and develop strategies to inform professional regulatory bodies and key stakeholders using the EPICC survey results.

Methods: A core group of 30 European nurse researchers from 19 countries across Europe collaborated to study how undergraduate nursing and midwifery students understand spirituality and develop spiritual care competences throughout their bachelor studies (Ross et al., 2016; Ross et al., 2018). On this evidence, nurse educators from this group were awarded a European grant to develop a collaborative European standard for spiritual care competence and a matrix explaining the context in which spiritual care competencies develop and can be implemented, Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care through Innovative Education and Compassionate Care (EPICC).

The survey results of 3,175 undergraduate nursing and midwifery students enrolled at 21 universities in 8 countries in September 2011 who were recruited via convenience sampling were examined thematically. Students completed the surveys across four occasions: start of course (n=2193), year two (n=1182), year three (n=736), and end of course (n = 595) between 2011 and 2015. Survey results were content analyzed and thematically coded from November 2017 – July 2018 by a collaborative subgroup of nurse educators from six universities (located in Malta, the Netherlands, Norway, and the United Kingdom). Through a consensus method, the subgroup collaborated to co-produce, test, refine, and agree a set of spiritual care competencies, a spiritual care matrix, and a toolkit providing educational resources and strategies for different educational and practice settings.

Results: At study completion, subjects (n=595) were female (89%) older than 21 years of age (89%), religious (27%) of which the majority (62%) were Christian, and had less than one year of health care experience.The four spiritual care competences with the knowledge, skills and attitudes were:

1. Intrapersonal spirituality,

2. Interpersonal spirituality,

3. Assessment and planning in spiritual care, and

4. Intervention and evaluation of spiritual care.

The standard matrix for spiritual care education was determined to be comprised of four key factors related to the:

1. Students entering into nursing/midwifery education,

2. Teaching and learning environment in the university,

3. Student as a person, and

4. Clinical environment, which is the context in which students develop their spiritual care competences.

The toolkit comprising of educational resources is available at the EPICC Website http://blogs.staffs.ac.uk/epicc/

Implications: A collaboratively developed matrix for spiritual care education facilitates standardized teaching and learning for undergraduate nursing students across diverse cultural and social groups focused on measurable and replicable competencies, which can be utilized globally in nursing.

Conclusions: In order to meet the unmet needs of patients, spiritual care education must be enhanced and the inconsistencies in spiritual care education in Europe addressed. The study results and toolkit inform the process and ease the implementation of enhanced spiritual care education. The provision of the toolkit facilitates spiritual care nursing education throughout Europe and around the world.