Spiritual Definitions in Palliative Care

¶ … photo novellas to test the creative aptitude of nurses working in oncology and palliative care. Researchers asked how they defined spirituality and were told to select between four to six photographs out of a photo novella they captured from their work in the field to represent these feelings. The participants in the study included five female oncology and palliative nurses, all working within Atlantic Canada. Researchers claim that "these specialty areas of nursing were selected because of the life-threatening nature of patients' illnesses, end of life issues, and the associated need for spiritual care" (Burke & Evans, 2011). Essentially, nurses within palliative and oncology contexts do often help patients with spiritual care as patients prepare to deal with a variety of end of life issues. Ultimately, the primary purpose was then to test the spiritual aptitude of these nurses in a qualitative context, while also including an exploration of how they engaged in critical and creative thinking, which helps structure other roles for nurses in a variety of health care roles. Ethical procedures were guaranteed by asking for permission to use the nurses' photographs. Moreover, the study was first reviewed by the Ethics Committee board to ensure that there were no personal violations, since the study was conducted in such a personal context.

Unfortunately, the research questions and hypotheses of the study are not as clearly defined as the study purpose. In fact, it is difficult to find research questions or hypotheses within the context of the study at all. After reading the entire study, I had to make assumptions about what the research questions and hypotheses were. Essentially, the study wants to test the ability for nurses in such specialty areas on how they deal with answering and interpreting spiritual questions. I would assume then that the research questions are how well such nurses can respond to such abstract and intense questions, as patients often ask them similar questions while actually working in the field. Yet, there is no mention on how these specialty nurses may differ from nurses in other health care roles. A potential hypothesis could be that nurses in palliative care and oncology tend to have a deeper acceptance of spirituality and can interpret abstract notions more broadly than nurses in other areas of care. Yet, there were no other specialties included in the context of the study, so that could not be a hypothesis. Instead, I feel that the researchers just wanted to test the narrative method using the photo novella to see if it was an accurate method for qualitative research on such abstract concepts. This makes the study more inclined to exploring research methods within the field of nursing, rather than actual nursing practices. Still, this is not directly made clear by the researchers and thus the study could have been more streamlined to present clear research questions and hypotheses that would be helpful in later evaluating the results of the study.

The study used a narrative approach to open ended interviews. Nurses in oncology and palliative care were asked to define what they believed was the definition of spirituality based on their own beliefs and experiences. The nurses were then asked to choose four to six photographs out that they themselves took while working in health care to create a photo novella in order to help interpret their feelings about the subject. According to the researchers, the use of photo novellas is appropriate for qualitative research methods. They believed that photos could help articulate more abstract feelings that are harder to put into words. Apparently, in "recent years, health and nurse researchers have recognized the benefits of photo novella and have utilized photographs as a way to explore and better understand the experiences" of individuals working and experiencing health care (Burke & Evans, 2011). Thus, the method seemed appropriate based on the literature review provided by the researchers. After the nurses were to choose their photographs, they were then subjected to a semi-structured interview. Researchers asked the participants what each photo meant to them and how it represented their definition of spirituality. Open ended questions helped lead the interviews and provided contextual data that was later analyzed using narrative analysis. According to the research, narrative analysis "is a method used to gain access to feelings, thoughts, and experiences and is recognized as a broad approach because it can incorporate other qualitative approaches" (Burke & Evans, 2011). Due to the fact that spirituality is a very abstract concept, narrative analysis proved appropriate because it allowed participants to explore their feelings on a more meaningful level. The data was then transcribed and coded using grounded theory methods to develop key concepts and categories, which were later liked to underlying themes that were apparent in multiple participants. Although grounded theory is a proven research method for qualitative results, the researchers did not include how they ensured data reliability. This could have been improved by having multiple researchers work to independently coding the data separately and then comparing results.

Study findings showed common themes in how spirituality was defined. Many reoccurring themes "described spirituality as an interconnection with family, patients, and with God" (Burke & Evans, 2011). Thus, most images showed individuals expressing love and nurturing for one another, especially for patients in dire circumstances. There was then a conclusion that spirituality meant interconnectedness with those around you, including health care workers, patients, and family. There was also a theme of openness that was prevalant within the nurses' definitions. This coincides with the notion that these nurses are dealing with complex end of life issues and have a greater demand for openness depending on individual patient needs.