Spiritual Care: A mixed method study among Norwegian nurses

Aim/Purpose:  This purpose of this Mixed Method study on spiritual care, with phase one among nurses, is to understand Norwegian nurses' perspective of spirituality and spiritual care and how comfortable they are providing it to patients in the hospital setting. The long-term goal is to inform nursing education and clinical practice relating to spiritual care.

Background/Conceptual Basis/Rationale: Providing or facilitating spiritual care to patients is part of holistic nursing care, but nurses around the world report that caring for the body is their primary focus (McSherry et al., 2008; Ross, 2006). Evidence reveals that providing care that strengthens the spirit also enhances healing of the body and mind (Koenig et al., 2012; Koenig, 2007). While nurses globally believe that they should provide spiritual care, they report varying comfort levels with addressing this area with patients, and most do not include the spiritual in regular care of hospitalized patients (Cone & Giske, 2013; Fowler et al., 2012; van Leeuwen et al., 2006).

Method:  This Mixed Method two-phase study includes a quantitative approach using a questionnaire developed by E.J. Taylor (2012) and a qualitative approach using the Classical Grounded Theory methodology (Glaser, 1978;  Glaser, 2005). Taylor’s survey instruments, both the nurse and the patient versions, were translated by permission into Norse for use in a Norwegian private hospital. The quantitative aspect of the first phase, which has been completed and is being reported here, was conducted through the collection of survey data from nurses (n=172) with subsequent focus group interviews (n=20). The second phase followed with the same survey for patients and individual patient interviews to determine the perspective of hospitalized patients regarding spiritual care. The focus of this presentation is the quantitative aspect of the nurse phase. These data were entered into a SPSS statistical program and analyzed using t-tests and ANOVA to examine differences as well as Chi Square and Correlations to examine relationships between the variables.

Results: Nurses stated that education was the most significant factor in their preparation for spiritual care. Other factors include life experience and experience in the clinical setting related to spirituality as well as maturity, both in age and in professional practice. Moreover, nurses state that the work setting and the time of day influence the facilitating of spiritual care. Barriers to spiritual care include the work setting, busy schedules and limited time, and a lack of emotional “room” or a closed attitude on the part of leadership toward caring for the spirit of the patient.

Implications: Findings from this mixed method study confirmed previous findings about spiritual care among nursing students and teachers that have informed educational practices in teaching and learning spiritual care giving. They are also being used to inform the preparation of a handbook on spiritual care for nurses that will assist them in caring more effectively for the spiritual needs and concerns of patients. Nurses who are better informed will be able to recognize the cues for spiritual concerns and intervene to promote health and improve patient outcomes.