Background: There is agreement across healthcare disciplines that SC is a basic human need and that patients’ outcomes are better when SC is provided. The average person finds meaning through spiritual and religious practices (Neuman 1995; Cavendish et al., 2004; Savel & Munro, 2014). Studies have also shown that nurses derive satisfaction when they provide SC to their patients (Narayanasamy, 2006). Additionally, perceived barriers to nurses administering SC included-limited educational preparation, negative attitudes toward spirituality, confusion about nurses' role, time constraints, perceptions of incompetence, and avoidance of spiritual matters. For this study, provision of spiritual care was conceptually defined as the 1:1 interaction of RN and patient to address patient’s spiritual needs, religious or non-religious. There is consensus that SC goes beyond religious affiliations and is intended to help patients find meaning & purpose in the face of illness, suffering, and death. The Joint Commission, ANA Code of Ethics (2001, 1.3), International Council of Nurses (2006) and the AACN in their Baccalaureate Essentials (2008) have maintained that a spiritual assessment and inclusion of SC be a part of the patient’s plan of care. Despite these stipulations, most nurses are not proficient with providing SC to their acutely ill patients.
Methods: Participants for this descriptive correlational study consisted of a convenience sample of 130 acute care Registered Nurses recruited via the Academy of Medical-Surgical Nurses (AMSN). The Spiritual Variable of Neuman System Model was the theoretical framework for this study. Approval to conduct the study was obtained from Seton Hall University IRB. Approval to recruit participants from the AMSN was obtained from the AMSN Research Coordinator. Data were collected electronically via Survey Monkey® over a six-week period.
Research Instruments:
The concept of spiritual well-being was operationalized by scores on The SWB Scale (Paloutzian & Ellison, 1982). This 20-item instrument was designed to evaluate subjective reports of religious and existential well-being.
The SCP variable was operationalized by the revised SCP Scale (Taylor et al., 1994). The intent of this instrument was to measure the nurses’ attitude regarding the importance of including spiritual care in routine practice, and to rate their perspectives about providing spiritual care.
Provision of SC was measured by the SC Practice Questionnaire (Vance, 2001). This instrument was designed to measure the frequency of assessment and intervention for SC practices, as well as clarify barriers nurses face in providing spiritual care.
Demographic data were collected via an author created questionnaire.
Data Analysis: Instrument reliability based on the data collected for this study indicated Cronbach alpha scores of .92 for the SWBS, .82 for the SCPS-Rv, and .84 for the SCPQ. Data were analyzed using the SPSS, Version 23.0 software. Application of descriptive statistics, ANOVAs, Pearson r correlations, Spearman Rho nonparametric tests, and regression analyses were used for data analysis.
Results: Study sample consisted of 130 RNs employed in acute care settings. Most were female (90.8%) who identified as White/Caucasian (73.1%), with an average age of 46.05 years. Respondents reported they did not frequently provide SC because they felt under-prepared (92%), were not confident (61%), and were not always comfortable (58%) with providing SC. Eighty-nine percent (89%) were committed to their personal spiritual practices. Participants scored well-above average in their sense of spiritual well-being and spiritual care perspectives, but below the ideal mean for provision of spiritual care. There were significant positive correlations between the respondents’ SWB (rs =.27, p = .002), SCP (rs =.63, p < .0001), commitment to personal spiritual practices (rs =.31, p = .0001), and their provision of SC. Nurses committed to their own spiritual practices and those who were more comfortable and confident with providing SC, provided frequent SC. The nurses’ SCP had a significant mediating effect over their SWB, commitment to personal spiritual practices, confidence in providing SC and their actual provision of SC (β = .58, p = .0001).
Conclusions: Conclusions drawn from these findings indicate that steps should be taken to enhance acute care nurses’ SCP, because it is such a significant predictor of the nurses’ provision of SC. Nurses in this study were uncertain about their role in providing SC to acutely ill patients.
Implications: Implications for clinical practice will require clinical nurse educators to: (a) include spiritual care training in orientation programs, (b) provide in-service SC training to RNs who provide direct patient care, and (c) include updates on best spiritual care practices in annual competencies. Furthermore, academic Nurse Educators should provide fundamental preparation and spiritual development to enhance positive SCP and competencies among nursing students at all levels. Further studies are recommended for exploring barriers to provision of SC among nurses who score high on SWB and SCP . Implications for local, state, and nation policies to incorporate core courses in SC would be appropriate steps in bringing nursing curricula and practice in alignment with the requirements of the governing bodies.