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Is Spirituality Part of Nursing Care?

Monday June 5, 2006
Sue Polito, RN
Sue Polito, RN
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Or is it a missing spoke in the umbrella of care?

When I worked in the ICU, I watched patients struggle with life and death every day. During those 10 years, however, I realized that there was something intangible that happened while I cared for them. It was difficult to define but it affected my patient relationships deeply. As I reflected on those nursing experiences, I became more aware of the concept of spiritual care in nursing. Although the concept is not new, it is one that is often ignored or overlooked.
Research has shown that many nursing theorists have incorporated spirituality into their nursing models, yet many nurses are still reluctant to address the topic of spirituality with their patients.1 As providers of care, nurses need to assess patients' spiritual needs and desires - and yet few do.
The quality and delivery of spiritual care by nurses has been examined in the literature, and some interesting results have been discovered that may help to identify some of these barriers to providing spiritual care.
Research studies reveal ...
One study explored nurses' concerns about the level of spiritual care they provided to patients. This study centered on one main question - nurses' perceptions of the concepts of spirituality and spiritual care.2 The study examined nurses' understanding of and attitudes about these two concepts.
Investigators wanted to identify whether the nurses felt the spiritual needs of patients were being met and whether the nurses felt they were qualified to meet those needs. Additionally, the investigators examined whether the nurses felt trained to meet the spiritual needs of the patients. Finally, the researchers wanted to explore the association between religion and the nurses' provision of spiritual care to patients.
The results of this investigation indicated that nurses perceive spiritual care not only as a concept that has religious connotations, but also as a universal concept that is experienced by and relevant to all people.2 More than half of the nurses questioned felt that they could identify spiritual needs in patients, yet almost three-quarters of the nurses felt uncomfortable about addressing those needs.
This study indicated that some of the biggest barriers to the provision of spiritual care to patients were lack of time, lack of staff, and lack of adequate education in this field. Similar studies found that spiritual assessment and caregiving were not adequately covered in nursing school curricula, which led to a higher level of inhibition in providing this type of care.
A second descriptive study focused on nurses' perceptions of providing spiritual care and the spiritual activities performed by nurses. The investigators looked at the nurses' personal values and professional relationships related to spiritual care.3 More than three-fourths of nurses surveyed felt that they were integrating their beliefs and values into their practice.
But what makes this study different is the strong correlation between the degree of comfort in providing spiritual care and the amount of integration the nurses reported in their practice. It appears for these nurses to provide spiritual care in the practice setting, they had to have a certain level of comfort within themselves about their own sense of spirituality and spiritual care.
Conclusions and application
to practice
Although these studies represent only a small number of nurses in practice, the results of both studies had some parallel findings and have implications for the general provision of spiritual care in nursing. Whereas both studies showed that nurses were able to identify patients with spiritual needs, they indicated that only a small number of nurses felt adequately prepared to effectively provide spiritual care.
In both studies. the nurses' level of comfort in this type of care was a major indicator of whether they were able to provide it to their patients. Questioning one's own spirituality may also be an impediment to assessing another's spiritual needs. As the nurses' degree of comfort in the concept of spiritual care increased, so did their ability to apply spiritual care into the practice setting.
Several suggestions in the literature help nurses to provide spiritual care. Spiritual assessment instruction should be incorporated into nursing curricula. In addition, nurses who are comfortable when providing this type of care should be encouraged to model this behavior for other health care providers. There are also spiritual assessment tools available to guide patient care providers in performing a spiritual care assessment.1-4
Nurses need to recognize that integrating spiritual care into the practice setting enhances the role they play in their patients' lives. Acknowledging spiritual needs and helping patients to meet those needs is an integral part of health care delivery - and patients realize that we see them as "whole" people.