Modern nursing practice has focused more and more on treating the whole person, through four domains (Chan, 2009). These are physical, mental, social, and spiritual. Of the four, the spiritual domain is the most neglected. A retrospective study recently found that nurses with religious beliefs are more likely to extend spiritual care. The greater their spiritual perceptions, the more frequently they include a spiritual dimension to their care of patients (Chan). However, not many nurses are able to extend care in this domain.
Jean Watson's Theory of caring is applied as theoretical framework. Her concept sees caring as a process of transpersonal caring. It is something exceeding the self and recognizing the relationship as "mutual and reciprocal (Goliath, 2008)." It is in this environment that the nurse connects with the patient under his specific circumstances. Watson uses 10 carative factors in applying her theory.
This critique compares Fa Chan's article with other literature on the lack of formal nurses' training in a Dublin hospital, infrequency of the provision and 5 themes of spiritual care, 5 barriers to spiritual care, provision for pediatric cancer experience, and implications of spiritual care for nurses professional responsibility.
Literature Review and Analysis
Lack of Formal Training
Dr. Fiona Timmins of Trinity College in Dublin, Ireland recognized the significance of spiritual care as illness brings patients and others to their faith and spirituality (Independent, 2011). In addition to a decline in religious observance and spirituality in modern Ireland, she noted a greater mix of different religious beliefs in the hospital. In determining how prepared the nursing staff was in responding to these situations, she surveyed more than 500 nurses on their attitudes towards spirituality. She found that most of the nurses had positive views about their role in extending spiritual care to patients. They perceived this role as including showing concern and kindness, giving time to patient and family. Although most of them are able to fulfill this role, they do so mostly out of their personal experiences rather than out of formal training. They often delegate the spiritual aspect of their functions to particular specialists in the hospital, like the hospital chaplain, instead of recognizing it as an integral part of total care. Dr. Timmins concluded that the nurses had not received appropriate training or instruction in the initial phases of their professional preparation (Independent).
Helpful in Crisis but Infrequently Given
A pilot study yielded similar findings. While spiritual and religious resources provide extra source of strength for patients' coping, nurses do not often offer spiritual care (Deal, 2010). The phenomenological study reviewed the lived experiences of respondent nurses who extend spiritual care. It also identified 5 themes, which underlie spiritual care. These themes are spiritual care is patient-centered; an important part of nursing; can be simple to provide; not expected but welcomed by patients; and is given by culturally diverse caregivers (Deal).
Respondent nurses said that the patient should determine and initiate the spiritual aspects of care (Deal, 2010). It should be patient-centered rather than nurse-centered. Spiritual care benefits the patient when there is a shared belief between him and the nurse. It can also be in the form of spending time with them, listening and praying with them. They perceive spiritual care as an integral part of nursing (Deal).
Barriers to Provision of Spiritual Care
A descriptive co-relational assessment on the spiritual care provided by 425 acute care nurse respondents revealed the barriers to providing the care and their attitudes towards it (Vance, 2001). The respondents worked at the divisions of critical care, medical/surgical, women's health and behavioral health nursing at a community teaching hospital at a large Midwestern city. Current literature lists 3 elements as defining the concept of spirituality. These are an inter-connectedness with God or a god being; the purpose and meaning of life; and the ability to transcend the self. Most of the surveyed nurses see themselves as highly spiritual persons. Yet only a fourth of them provide adequate spiritual care to patients (Vance).
Barriers are time, the lack of education, lack of confidence, differences in faith between nurse and patient, and the confusion between pontificating and spiritual care (Vance, 2001). Health care funding cutbacks and shortened length of hospital stays compel nurse to do more with fewer resources. The situation makes spiritual care a low priority or a luxury to a hospitalized patient. As to the lack of education, 65% of the respondents feel they have not received adequate education or training for the requirement. The last three barriers may be eliminated by providing appropriate education to the nurse (Vance).
This study reveals clear needs. The first consists of continuing nursing education programs on spiritual care; overcoming the gap between assessing spiritual need and follow-ups; the adoption of a multidisciplinary approach; the use of a mix of healthcare professionals and support staffs; and patients' perceptions and comments on how well their spiritual care needs are met (Vance, 2001). The study suggests that spiritual care should receive a higher priority in the acute care setting than it does now (Vance).
For Pediatric Cancer Patients and Their Families (Nascimento 2008)
Their life crisis specifically requires the provision of spiritual care. Family members, especially the parents, tend to seek the meaning for the disease, become extremely sensitive and question values (Nascimento, 2008). Oncology nurses possess the specific qualifications for the provision of spiritual care. A study conducted on parents with children with cancer revealed their need for spiritual orientation from a spiritual counselor. Most of them take recourse to faith when their children's health or lives are threatened. During the crisis, many of them also question their beliefs. Oncology nurses can join in the parents' spiritual practices and prayer if they are comfortable with these (Nascimento).
Religion and spirituality are chief sources of comfort and hope for families, especially parents, acutely need during this crisis (Nascimento, 2008). An oncology nurse can provide these to help them better accept their children's condition. She can help strengthen their coping mechanisms while maintaining health. The sense of insecurity among oncology nurses, however, presents as a current issue. This sense comes from a lack of knowledge and instability to deal with the crisis. But their position of advantage remains as they are posited close to the family at the time of crisis. They can and have the responsibility to identify as best they can the right time to intervene and determine the most appropriate spiritual care strategies. They are, thus, obligated to commit and become willing to extend spiritual care (Nascimento).
These are marital status, religious beliefs, the hospital department where the nurse works, past hospitalization experiences, and perception of spiritual care (Chan, 2009). Nurses who are most likely to extend spiritual care are married, have past hospitalization experiences, work at the obstetrics and gynecology department and have higher perception levels towards spiritual care. The hospital is more likely to promote this awareness among its nurses in order to improve the quality of spiritual care provided as part of overall nursing (Chan),
Summary and Overall Comment
The hospital in Dublin found that its nurses did not receive adequate formal training in spiritual care. In other hospitals and health care facilities, it is not often provided. Nurses see this as coming under 5 themes. Other studies came up with barriers like time and the lack of nurse education on spiritual care. Oncology nurses possess the qualifications to respond to the unique needs of pediatric cancer experiences but likewise lack the education to address their sense of insecurity to handle crises. And nurses who are inclined to provide spiritual care are likely to be married, observe certain religious beliefs, belong to the obstetrics and gynecology department, have past hospitalization experiences and perceive the need for spiritual…
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