Recent Nursing
Running Head: RECENT NURSING GRADUATES’ PERCEPTIONS OF EDUCATION
Recent Baccalaureate Nursing Graduates’ Perceptions of Their Education in Spirituality
Ashlee Bowman
The University of Akron
Patrice McCarthy PhD, CNS, RN
1
Recent Nursing
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Abstract
The need for health care providers to effectively address the connection between spirituality and
health is becoming widely recognized, but nurses frequently report not feeling adequately
prepared to meet the spiritual needs of their patients. While nursing education programs seek to
address this aspect of patient care, few studies have explored recent graduates’ perceptions of
how their education prepared them to address the spiritual care needs of their patients. The
purpose of this descriptive study is to explore recent baccalaureate nursing graduates’ perception
of how effectively their education prepared them to deal with the spiritual care needs of patients.
The sample included fourteen graduates of a 2009 baccalaureate of nursing program with an
average of 6-12 months professional work experience. Participants completed two Likert style
surveys, Lemmer’s Spiritual Care Content and McSherry’s Spirituality and Spiritual Care Rating
scale. These tools measured participant perceptions of spirituality related content included in
their nursing education program and their perception of how prepared they are to address the
spiritual care needs of patients. Graduates reported that most topics on spirituality were covered
only briefly and some aspects of spiritual care were not addressed at all. Despite a general
perception that the majority of the aspects related to patient’s spiritual care needs were addressed
to a limited degree, participants reported a high level of comfort about their own ability to
provide spiritual care to their patients.
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According to the American Nurses Association Code of Ethics with Interpretive
Statements (2001), a nurse has the obligation to understand “an individual’s lifestyle, value
system, and religious beliefs …in planning health care with and for each patient” (p. 7). Even
though meeting the spiritual needs of patients is an important nursing measure, many nurses
report not being educated to meet patients’ spiritual needs or to know their responsibilities as
nurses related to dealing with the spiritual care of the individual (van Leeuwen, Tiesiga, Post, &
Jochemsen, 2006). Researchers have explored nurses’ opinions about their effectiveness in
meeting patients’ spiritual needs (Cavendish et al., 2004; van Leeuwen et al., 2006). They have
consistently found that nurses do not feel that their education prepared them on the topic of
spirituality (Baldaccchino, 2008; Cavedish, Luise, Russo, Mitzeliotis, Bauer, & Bajo, 2004;
Wallace, Campbell, Grossman, Shea, Lange, & Quell, 2008).
Lemmer (2002) asked faculty members from various baccalaureate nursing schools how
they felt spirituality was incorporated into their curriculum. The researcher found that very few
programs had program definitions of spirituality and that faculty felt unsure about their
understanding of the spiritual dimension. Studies have also examined nursing student awareness
of spirituality (Baldacchino, 2008; Narayanasamy, 1999; van Leeuwen, Tiesinga, Middel, Post &
Jochemsen, 2008; Wallace et al., 2008), and how a student’s understanding of spirituality
changes as their education progresses (Pesut, 2002). Few studies, however, have explored recent
graduates’ perceptions of how effectively their education prepared them to meet the spiritual
needs of patients. If nurses are expected to holistically care for patients, students need to be
properly educated to provide for the spiritual needs of their patients. Therefore, the purpose of
this study is to explore recent baccalaureate nursing graduates’ perceptions of how effectively
their education prepared them to deal with the spiritual needs of patients, and to compare the
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relationship between what students perceived they learned and how it influenced their beliefs
about dimensions of spirituality and meeting the spiritual needs of their patients. Recent
graduates’ perceptions about the effectiveness of their education may have important educational
and curriculum development implications.
Review of Literature
Researchers have described nurses’ opinions about their ability to care for the spiritual
aspects of patients (Cavendish et al., 2008; van Leeuwen et al., 2006). Van Leeuwen and
colleagues (2006) found that nurses identified how the communication techniques learned in
nursing school were helpful, but they felt that additional information was needed in spiritual
topics, such as personal self awareness and spiritual conversation techniques. Cavendish and
colleagues (2004) concluded that nursing education needs an additional educational component
to teach about the spiritual care of patients and states that “educators cannot assume that nurses
have a spiritual foundation for practice that is effective to meet the spiritual needs of patients” (p.
208).
Nurse researchers have investigated the effect of educational models of teaching
spirituality on students’ awareness of spirituality (Baldacchino, 2008; Narayanasamy, 1999).
Baldacchino (2008) developed a study unit on spirituality, using objectives and teaching methods
based on the ASSET model (Narayanasamy, 1999). The ASSET model (auctioning spirituality
and spiritual care in education and training model) uses the nursing process to teach students
about spiritual care and focuses on the importance of self awareness. Knowing the definition of
spirituality, communication, trust building, and giving hope are important skills necessary to
implement spiritual care (Narayanasamy, 1999). Baldacchino (2008) found that the model
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helped facilitate student awareness of “consistency and continuity in the delivery of holistic
care” (p. 559).
Researchers have also examined the effect of faculty-developed spirituality information
on student awareness (Van Leeuwen et al., 2008; Wallace et al., 2008). Wallace and colleagues
(2008) explored how faculty-developed programs to incorporate spirituality and spirituality care
knowledge into course curriculum affected junior and senior student awareness of spirituality
and spiritual care. They used the Spirituality and Spiritual Care Scale to measure the students’
awareness and found that the varied approaches all significantly increased student awareness.
Van Leeuwen and colleagues (2008) using a quasi-experimental cross over design, measured
student awareness with the Spiritual Care Competence Scale, and found that course-incorporated
knowledge about spirituality and spiritual care enhanced student knowledge.
Researchers have explored the effect of self-study spirituality programs and the effect of
clinical rotations on spirituality (Rankin & Delashmutt, 2006; Taylor, Mamier, Bahjri, Anton &
Petersen, 2009). For example, Taylor and colleagues (2009) studied current nurses and student
nurses and found that a self-study program about spirituality ”improved attitudes toward nurseprovided spiritual care, ability to create and empathetic response to patient expressed spiritual
pain, and even personal spiritual experience” (p. 1136). Rankin and DeLashmutt (2006)
incorporated a clinical rotation for senior baccalaureate students (N=188) at a faith-based
community crisis center, which allowed the students to enhance their spiritual knowledge and
understanding of nursing presence. They found that the students felt changed “personally and
professionally” because of the clinical experience (p. 285). The researchers propose that by
“providing specific experiences, nursing education, and role modeling, the student can know the
phenomena of spirituality and presence” (Rankin & Delashmutt, 2006, p. 287). These studies
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show that students can enhance their learning from education on the topic of spirituality (Rankin
& Delashmutt, 2006; Taylor et al., 2009). Few studies, however, have explored students’
perceptions of how effectively their education prepared them for meeting the spiritual needs of
patients.
Student views of the ethical basis of teaching spirituality and the perceptions of their
own spiritual development throughout school has also been explored by researchers, as well as
the perceptions of faculty members of their undergraduate programs and spirituality in their
curriculums (McSherry, Gretton, Draper & Watson, 2008; Lemmer, 2002; Pesut, 2002).
McSherry, Gretton, Draper, & Watson, (2008) studied nursing student perceptions of the ethical
basis of teaching spirituality and explored how the students viewed ethical concerns raised in the
context of teaching about spirituality. They found that pre-licensure nursing students had some
confusion of the distinction between spirituality and morality. A limitation of the findings from
this study is that the findings are from the first year of a longitudinal study. Pesut (2002)
explored spiritual well-being and the development of spirituality in first and fourth year
baccalaureate students and found that the students rated highly on a spiritual well-being scale.
They also found that the students increased their awareness of their spirituality as they
progressed through the program. Pesut (2002) argues that students develop their own spiritual
awareness as they go through nursing school. Limitations of the findings from this study are that
the researchers studied a small sample of students enrolled at a private Christian school.
Finally, the only study exploring faculty perceptions of spirituality education was a study
by Lemmer (2002). Lemmer studied faculty from various baccalaureate schools throughout the
country and asked faculty to rate to what extent spirituality was covered in their nursing
programs. Overall, Lemmer found that faculty members were uncertain about having the
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knowledge to teach spiritual care and about the uncertainty of how spirituality is defined. Many
of the faculty stated they needed more education about the topic and that students seemed
receptive of learning about the topic. Even though researchers have explored the effect of
education on spirituality and spiritual care, how the topic should be taught, and perceptions of
faculty, very few studies have examined recent graduates’ perceptions about the effectiveness of
their education on helping them meet the spiritual needs of patients. The purpose of this study is
to explore recent baccalaureate nursing graduates’ perceptions of how effectively they think they
were prepared through their education to deal with the spiritual needs of patients.
Methods
Design
The design of this quantitative study is exploratory and descriptive. Data was collected
from a survey created on Survey Monkey that was e-mailed to recent graduates asking them their
perceptions about their education in spirituality. Data Analysis was conducted using SPSS to
formulate frequency tabulations of each item and to do a descriptive analysis of demographic
data.
Sample
The target population was the 2009 graduating class from one basic baccalaureate of
nursing program. A convenience sample was used, and the survey was sent out to all 189
students of the 2009 graduating class. Subjects were included regardless of age, gender, or
ethnicity.
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Data Collection
Cross-sectional data was collected with a survey, which consisted of items from the
“Spiritual Care Content Covered and Extent to which Covered in Nursing Programs” tool used in
the Lemmer (2002) study. This scale had a p value set at .5. The Likert style items, however,
were revised to refer to graduates, rather than faculty members. This scale had 25 questions with
a four point Likert scale. In this study, the tool was used to measure the extent to which each
graduate felt the topics related to spirituality were covered during their education. A second tool
titled “Spirituality and Spiritual Care Rating Scale” was used to measure participants comfort
with spirituality and their perceived ability to provide spiritual care to their patients (McSherry,
Draper, and Kendrick, 2002). This scale has an internal consistency reliability of a Cronbach’s
alpha coefficient of 0.64. This scale was also used in the study by McSherry, Gretton, Draper,
and Watson (2008), which explored the perceptions of students concerning the ethical basis of
teaching spirituality. This scale has seventeen items with a five point Likert scale. Participants
were also asked to complete a brief demographic questionnaire.
Results
Of the 189 e-mailed surveys sent out, 54 e-mails were returned due to the fact the e-mails
were not in operation. Of the possible sample of 135 graduates, 14 graduates completed the
survey making the sample size 14 (Appendix I). The sample represented 10.4% of the
population. Majority of the sample was female with 7.1% male respondents. Most subjects had
graduated within one year from the time of the survey. Ninety-two percent of the sample was
employed at the time they completed the survey. The majority (85.8%) of the sample had been
employed a year or less.
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According to the American Nurses Association (ANA), 57.9% percent of nurses work in
hospitals and 8.7% work in a physician’s office (ANA Issue Brief, 2009). This sample had a
higher percent of nurses working in a hospital setting compared to the ANA average; however,
the amount that worked in a physician’s office was close to the average with 7.1%. Also
according to the American Nurses Association (2011), in 2004, 2.4 million of the 2.9 million
nurses were employed. This was comparable to the study sample with 92.9% being currently
employed at the time of the study. The ANA also states that,” 11 percent of men were enrolled in
Baccalaureate of Nursing programs in 2005” (para.3). This percent is slightly higher than the
sample with only 7.1% of this sample being male.
When completing Lemmer’s scale regarding “Spiritual Care Content Covered and Extent
to which Covered in Nursing Programs,” the majority of the participants thought most topics
were covered briefly and some topics were not taught at all (Appendix II). Results from items
were grouped within spiritual topics categories including; a) knowledge base related to
spirituality, b) patient assessment, c) types of interventions in patient care, and d) the nurse’s self
knowledge. The major findings related to knowledge base related to spirituality indicate that
50% of graduates felt the topic of the interrelationship of spiritual well-being with physical and
emotional well being was only covered briefly. Regarding the topic of review of health practices
of major religions, 58.3% thought the topic was covered to a moderate degree. Another major
finding indicates that 66.7% of the graduates felt that the topic of crisis situations as triggers for
spiritual questions was only covered briefly. Fifty percent of the recent graduates indicated that
the topic of North American Nursing Diagnoses related to spiritual distress and spiritual well
being was not covered at all. Finally, 83.3% thought the spiritual needs of atheists and agnostics
were not taught at all.
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Related to the category of assessment of spiritual needs, 75% of the graduates felt the
topic of sensitivity of cues that may indicate spiritual needs was only covered briefly. Also, when
asked about the topic assessment of spiritual needs 83.3% of the graduates felt the topic was only
covered briefly. Finally, 58.3% of the graduates felt the use of a formal spiritual assessment tool
was not taught at all.
Major findings related to the topic of spirituality-focused interventions in patient care
related to spirituality include that 50% of graduates felt the topic of provision of privacy and
need for solitude was covered to a moderate degree. Another finding was that 33.3% of
graduates felt the topic of appropriate times to make referrals to clients’ ministers was not taught
at all. Also, when asked about the topic of nurses’ role in support of religious practices, 58.3%
thought the topic was only covered briefly. Concerning active listening as a spiritual care
intervention, 54.5% of graduates felt the topic was covered to a moderate degree.
Lastly, major findings related to the category of nurse’s self knowledge of spirituality
include that 50% of the graduates felt the topic of importance of nurses’ self-knowledge when
addressing clients’ spiritual needs was only covered briefly. Another major finding was that
58.3% of graduates felt the topic of factors related to the appropriateness of sharing spiritual
beliefs with clients was only taught briefly.
Despite the fact that the participants felt a lot of spirituality topics were only covered
briefly, participants scored differently on McSherry, Draper, and Kendrick’s “Spirituality and
Spiritual Care Rating Scale” (Appendix III). When asked “I believe spirituality is about having a
sense of hope in life”, 91.7% agreed with the statement. Concerning the statement, “I believe
spirituality does not apply to atheists and agnostics” 41.7% strongly disagreed and 33.3%
disagreed with the statement. With the statement, “I believe spirituality is about finding meaning
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in the good and bad events in life” 33.3% of the graduates disagreed with the statement.
Regarding the statement “I believe spirituality has to do with the way one conducts one’s life
here and now” 50% agreed with the statement and 25% strongly agreed. Finally, with the
statement, “I believe spirituality is a unifying force which enables one to be at peace with oneself
and the world”, 66.7% agreed with the statement and 25% strongly agreed.
Participants also had strong response rates concerning ways nurses can provide spiritual
care. On the survey, concerning the statement, “I believe nurses can provide spiritual care by
spending time with a patient, giving support, and reassurance especially in time of need”, 54.5%
agreed with the statement and 45.5% strongly agreed. Regarding the statement “I believe nurses
can provide spiritual care by arranging a visit with the hospital Chaplain”, 41.7% agreed with the
statement and 58.3% strongly agreed. With the statement, “I believe nurses can provide spiritual
care by enabling a patient to find meaning and purpose in their illness”, 58.3% agreed with the
statement and 8.3% strongly agreed. Lastly, when asked the statement, “I believe nurses can
provide spiritual care by having respect for privacy, dignity, and religious and cultural beliefs of
a patient”, 33.3% agreed and 58.3% strongly agreed.
A Pearson correlation was calculated to determine the relationship between the Lemmer’s
“Spiritual Care Content Covered and Extent to which Covered in Nursing Programs” scale total
and McSherry, Draper, and Kendrick’s “Spirituality and Spiritual Care Rating Scale” scale total
(Appendix IV). A significant strong positive relationship was found (r(12) = .926, p <.01.
Therefore, there was a significant strong positive relationship between the perception of spiritual
care content covered and spiritual care comfort.
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Discussion
Overall, the participants believed that most topics related to the spiritual care needs of
patients were only covered at the minimal level (Appendix II). Participants reported teaching
related to religion, culture, death and dying, active listening as a spiritual intervention and
privacy were covered more than minimally. Most of the participants felt topics concerning
spiritual knowledge such as spirituality related to physical and emotional well being was only
covered minimally. Also, the majority of the participants felt the spiritual needs of atheists and
agnostics were not taught at all. Participants felt topics related to assessment of spiritual needs
of clients was either covered minimally or not covered at all, and more than half thought the use
of a formal spiritual assessment tool was not taught at all. Lastly, a third of the participants felt
the appropriateness of when to make referrals to ministers was not taught at all.
McSherry, Draper, and Kendrick’s “Spirituality and Spiritual Care Rating Scale” looked
at understanding the dimension of spirituality and spiritual care. Concerning the topic of
spirituality, most of the participants agreed with the statements and believed they were an
important part to the spiritual dimension (Appendix III). Topics of spirituality related to hope in
life, spirituality bringing peace with oneself and the world, and spirituality as the need to forgive
and be forgiven were generally statements that participants agreed were important dimensions of
spirituality. Most of participants believed spirituality does apply to atheists and agnostics, despite
the fact they thought the topic was not covered in school. When asked statements related to
spiritual care, participants agreed or strongly agreed with these statements as above, despite the
fact they felt ways to assess for spiritual needs was not taught in school. If a nurse does not know
how to assess for spiritual needs, then how are they able to know when a patient actually needs
spiritual care? The majority of the participants felt nurses could provide care by arranging a visit
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with the hospital chaplain, even though a third of graduates felt the topic was not covered in
school.
Findings from Lemmer’s “Spiritual Care Content Covered and Extent to which Covered
in Nursing Programs” tool that was given to recent graduates in this study are similar to the
findings from Lemmer’s study using the tool with faculty members (Appendix II). In Lemmer’s
study using faculty members, the faculty reported content covered briefly in their programs
included prayer, use of scriptures, and needs of atheists and agnostics. The graduates reported
similar findings, in that these same topics the graduates felt were covered briefly or not at all.
Also in Lemmer’s study, faculty felt the topics of “spirituality as a search for meaning and
purpose in life, as a search for hope for the future, and as the dimension concerned with
individual’s relationships with self and others, including the need for forgiveness” were topics
covered briefly (p.486). Lemmer’s findings in this area are also similar to what the graduates
reported were covered briefly. Topics related to death and dying, culture and spirituality, and
respect for clients families were generally topics faculty felt were covered more both at regular
institutions and more faith-based orientated institutions (Lemmer, 2002). Graduates also felt
these topics were covered more than minimally; however, faculty felt topics related to spiritual
assessment were content items more addressed and the graduates in this study felt assessment
topics were not taught at all or covered minimally.
Van Leeuwen and colleagues (2006) findings were also comparative to how graduates
scored on Lemmer’s “Spiritual Care Content Covered and Extent to which Covered in Nursing
Programs (Appendix II). In their study, nurses felt communication skills in school were helpful,
which could be evidenced in this study with communication topics such as active listening
graduates felt were covered more. Narayanasamy (1999) felt knowing the definition of
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spirituality, and topics of communication, trust building, and giving hope were important skills
necessary to implement spiritual care. The participants felt topics of giving hope and definitions
of spirituality were topics covered only briefly, which could be a potential problem if the
knowledge of these topics are important to provide spiritual care.
Graduates reported a high level of comfort on the Spirituality and Spiritual Care Rating
Scale despite the fact they felt topics were covered only briefly during their education.
McSherry, Draper, and Kendrick (2002), also found that nurses are aware of the principles of
spiritual care when given the Spirituality and Spiritual Care Rating Scale. They also found that
all stages of nurses were able to distinguish what practices are related to spiritual care. These
findings are also similar to what the graduates felt, in that the graduates were able to distinguish
principles of spirituality and spiritual care (Appendix III). McSherry, Draper, and Kendrick also
found that nurses viewed religion and spirituality as not being synonymous, and the graduates in
this study also agreed. When McSherry, Gretton, Draper, and Watson (2008) used the
Spirituality and Spiritual Care Rating Scale on student nurses to look at the ethical basis of
teaching spirituality, the researchers also found that the students scored similarly. In their study,
they also found that students have their own ideas about spirituality and students believe their
own beliefs are their own business. Students did however think differently when their beliefs
caused conflict with a patient (McSherry et al., 2008). This could be related to the graduates’
responses on the Spirituality and Spiritual Care Rating Scale; in that maybe new graduate nurses
are pulling on their own ideas of spirituality rather than their education.
Nurses’ beliefs about responsibility to provide for patient’s spiritual care despite the
limited depth of attention to spiritually related content suggests graduates are drawing from other
resources than their professional education (Appendix III). This could be a potential problem in
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that nurses are using their own knowledge which could be incomplete, and this could impact the
ability to provide holistic care. Also, participants may have picked the socially acceptable answer
for what care the nurse should provide and what spirituality is, but in fact, they do not really
recognize when to provide spiritual care with their clients. Graduates may also equate the caring
aspect of nursing care as the same as spiritual care which could be a reason for their responses on
the Spirituality and Spiritual Care Rating Scale.
Limitations
There are some limitations to this study. First, the sample size was small and may not be
representative of the population of the 2009 graduating class. Despite the small size, important
trends were found from the graduates responses that need further exploration. Another limitation
to this study is that 54 emails that were sent were inoperable which decreased the potential
sample size. An additional limitation to this study would be the fact that the survey was sent out
in the summer, which could be a reason graduates did not respond. Lastly, another limitation
would be that the graduates may have not been able to give correct answers concerning content
due to the fact they forgot if the topics were covered in school due to time span since graduation.
Nursing Implications
This study has implications for nursing practice, research, education, and curriculum
development. Spirituality is becoming an important dimension in nursing practice. The Joint
Commission on Accreditation requires, “The hospital performs a learning needs assessment for
each patient which includes patient’s cultural and religious beliefs” (2009, p.13). In addition, the
Joint Commission requires, “The hospital plans the patient’s care, treatment, and services based
on needs identified by the patient’s assessments, reassessment, and results of diagnostic testing”
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(2011, p. 11). If making a care plan is an important part of a patient’s hospitalization, then nurses
need be prepared in the use of formal spiritual assessment tools and the nursing diagnoses related
to spirituality. Without the ability to properly assess a patient for their spiritual needs, nurses
then are limited in their ability to holistically care for their patients. Overall, graduates in this
study felt that curricular content related to spiritual care needs is very limited. Faculty should
review their curriculum and explore additional opportunities to include more assessment and
planning techniques to care for the spiritual needs of patients. This study also has implications
for future nursing research. More research is needed to explore the link between spiritually
related content of educational programs and how graduates develop in their ability to provide for
the spiritual care needs of patients. Future research should also be done comparing the spiritual
care knowledge of the beginning nursing student and the recent graduate nursing student.
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References
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Nursingbooks.org
American Nurses Association. (2011). More about RNs and advance practice RN. Retrieved February 15,
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students: the content and teaching methods. Nurse Education Today, 28(5), 550-562. Retrieved
June 9, 2009, from CINAHL Plus with Full Text database.
Cavendish, R., Luise, B., Russo, D., Mitzeliotis, C., Bauer, M., Bajo, M., et al. (2004, March). Spiritual
perspectives of nurses in the United States relevant for education and practice... including
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baccalaureate nursing programs. Journal of Nursing Education, 41(11), 482-490. Retrieved June
9, 2009, from CINAHL Plus with Full Text database.
McSherry, W., Draper, P., & Kendrick, D. (2002). The construct validity of a rating scale designed to
assess spirituality and spiritual care. International Journal of Nursing Studies, 39(2002), 724-734.
Retrieved February 15, 2010, from CINAHL Plus with Full Text database.
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McSherry, W., Gretton, M., Draper, P., & Watson, R. (2008, November). The ethical basis of teaching
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Pesut, B. (2002, February). The development of nursing students' spirituality and spiritual care-giving.
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The Joint Commission. (2011). Standards revisions related to the centers for medicare and medicaid
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van Leeuwen, R., Tiesinga, L., Middel, B., Post, D., & Jochemsen, H. (2008, October 15). The
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Appendix I
Table 1.1
Demographic Characteristics of Participants N=14
Characteristic
n
%
Age at time of survey (years)
21-25
1
7.1%
26-30
6
42.9%
31-35
2
14.3%
36-40
3
21.4%
40+
2
14.3%
Female
13
92.9%
Male
1
7.1%
1
12
85.7%
1.5
2
14.3%
Yes
13
92.9%
No
1
7.1%
0-3
2
14.3%
4-6
2
14.3%
7-9
4
28.6%
10-12
4
28.6%
>1
2
14.3%
Gender
Time since graduation (years)
Currently Employed
Length of Employment (months)
20
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Table 1.1 Continued
Characteristic
n
%
Acute Care
6
42.9%
Critical Care
3
21.4%
Children’s’ Hospital
2
14.3%
Doctor’s Office
1
7.1%
Other
1
7.1%
Adults
3
21.4%
Geriatrics
3
21.4%
Community
4
28.6%
Children
3
21.4%
Employment Setting
Population of employment setting
21
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Appendix
II
Table 1.2
Lemmer’s “Spiritual Care Content Covered and Extent to which Covered in Nursing
Programs”
Covered to a
Not taught Covered
Covered in
Measure
moderate
at all
briefly
depth
degree
The interrelationship
of spiritual well-being
1
with physical and
0.0%
50.0%
41.7%
8.3%
emotional
well being.
2
3
4
5
6
7
Sensitivity to cues
that may indicate
spiritual needs (e.g.,
presence of
religious articles,
verbalization about
God).
Assessment of
spiritual needs (i.e.,
how to identify
spiritual needs of
clients and families).
Spiritual needs of
dying individuals and
their significant
others.
Review of influence
of cultural beliefs and
values on spiritual
care.
Provision of privacy
for clients’ and
families’ need for
solitude.
Recognition of
clients’ definition of
spirituality.
8.3%
75.0%
16.7%
0.0%
0.0%
83.3%
16.7%
0.0%
0.0%
41.7%
41.7%
16.7%
0.0%
25.0%
41.7%
33.3%
0.0%
33.3%
50.0%
16.7%
8.3%
50.0%
33.3%
8.3%
22
Recent Nursing
8
Importance of nurses’
self-knowledge when
addressing clients’
spiritual needs.
0.0%
50.0%
25.0%
25.0%
33.3%
41.7%
16.7%
8.3%
10
Nurses’ role in
support of religious
practices (e.g.,
medicine man,
sacraments).
0.0%
58.3%
33.3%
8.3%
11
Spirituality as clients’
relationship with a
higher power as
individual
clients define it (e.g.,
God).
8.3%
58.3%
33.3%
0.0%
0.0%
27.3%
54.5%
18.2%
0.0%
33.3%
58.3%
8.3%
8.3%
66.7%
25.0%
0.0%
50.0%
25.0%
25.0%
0.0%
9
12
13
14
15
Appropriate times and
methods of making
referrals to pastoral
care or
clients’ ministers.
Active Listening as a
spiritual care
intervention.
Review of beliefs and
health practices of
major religions (e.g.,
birth/dying rituals,
dietary requests).
Crisis situations as
triggers for spiritual
questions and
concerns.
North American
Nursing Diagnosis
Association diagnoses
related to
spiritual distress and
spiritual well being.
23
Recent Nursing
16
Spirituality as the
search for meaning
and purpose in life.
0.0%
83.3%
8.3%
8.3%
17
“Being with/presence
to” as a spiritual care
intervention.
8.3%
50.0%
25.0%
16.7%
16.7%
41.7%
33.3%
8.3%
41.7%
41.7%
8.3%
8.3%
16.7%
58.3%
25.0%
0.0%
16.7%
58.3%
25.0%
0.0%
41.7%
33.3%
25.0%
0.0%
83.3%
16.7%
0.0%
0.0%
100.0%
0.0%
0.0%
0.0%
58.3%
25.0%
16.7%
0.0%
18
19
20
21
22
23
24
25
Use of touch as a
spiritual care
intervention.
Spirituality as the
search of hope for the
future.
Factors related to the
appropriateness of
sharing nurses’
spiritual
beliefs with clients.
Spirituality as the
dimension concerned
with one’s
relationships with
self and others,
including the need for
forgiveness.
Times and ways of
praying with patients
and/or families.
Spiritual needs of
atheists and agnostics.
Use of scriptures.
Use of a formal
spiritual assessment
tool.
24
Recent Nursing
25
Appendix III
Table 1.3
McSherry, Draper, and Kendrick’s “Spirituality and Spiritual Care Rating Scale”
Strongly
Strongly
Measure
Disagree Uncertain Agree
disagree
Agree
I believe nurses can provide
spiritual care by arranging a
visit by the
1
hospital Chaplain or the
0.0%
0.0%
0.0%
41.7%
58.3%
patient’s own religious leader
if requested
well being.
2
3
4
5
6
7
I believe nurses can provide
spiritual care by showing
kindness,
concern and cheerfulness
when giving care
I believe spirituality is
concerned with a need to
forgive and a need to
be forgiven
I believe spirituality involves
only going to Church/ Place
of worship
I believe spirituality is not
concerned with a belief and a
faith in a God
or a Supreme Being
I believe spirituality is about
finding meaning in the good
and bad
events of life
I believe nurses can provide
spiritual care by spending
time with a
patient, giving support, and
reassurance especially in
time of need
0.0%
0.0%
8.3%
33.3%
58.3%
0.0%
16.7%
8.3%
50.0%
25.0%
91.7%
8.3%
0.0%
0.0%
0.0%
41.7%
16.7%
25.0%
16.7%
0.0%
0.0%
33.3%
16.7%
41.7%
8.3%
0.0%
0.0%
0.0%
54.5%
45.5%
Recent Nursing
8
9
10
11
12
13
14
15
16
I believe nurses can provide
spiritual care by enabling a
patient to find
meaning and purpose in their
illness
I believe spirituality is about
having a sense of hope in life
I believe spirituality is to do
with the way one conducts
one’s life here
and now
I believe nurses can provide
spiritual care by listening to
and allowing
patient’s time to discuss and
explore their fears, anxieties,
and troubles
I believe spirituality is a
unifying force which enables
one to be at
peace with oneself and the
world
I believe spirituality does not
include areas such as art,
creativity, and
self expression
I believe nurses can provide
spiritual care by having
respect for
privacy, dignity, and
religious and cultural beliefs
of a patient
I believe spirituality involves
personal friendships,
relationships
I believe spirituality does
not apply to Atheists or
Agnostics
0.0%
16.7%
16.7%
58.3%
8.3%
0.0%
8.3%
0.0%
91.7%
0.0%
0.0%
8.3%
16.7%
50.0%
25.0%
0.0%
0.0%
8.3%
41.7%
50.0%
0.0%
8.3%
0.0%
66.7%
25.0%
33.3%
58.3%
8.3%
0.0%
0.0%
0.0%
0.0%
8.3%
33.3%
58.3%
0.0%
0.0%
0.0%
66.7%
33.3%
41.7%
33.3%
25.0%
0.0%
0.0%
26
Recent Nursing
17
I believe spirituality includes
people’s morals
0.0%
25.0%
0.0%
58.3%
16.7%
27
Recent Nursing
Appendix IV
Table 1.4
Means, Standard Deviations, and Correlations of Spirituality Scales
Measure
Mean
SD
Correlations
Lemmer’s Scale
47.57
21.918
.926**
McSherry’s Scale
50.93
22.082
.926**
Note. **p<.01
28