Nursing students' perceptions and attitudes about spirituality and spiritual care in practice

Abstract

Background: Spiritual care, a central element of holistic and multidisciplinary care, is not often integrated into practice. In order to assess the ability of the nursing profession to offer spiritual care, one could begin with student nurses as the next generation of clinicians. However, there has been little exploration of student nurses? perceptions and attitudes towards spirituality and spiritual care.

Purpose: This exploratory study investigated nursing students? perceptions and attitudes about spirituality and spiritual care.

Method: A mixed-method study was conducted over two phases. In-depth interviews with a convenience sample of 16 final-year students were conducted. Findings from the interviews and a systematic literature review were used to construct a tool to survey a representative sample of final-year student nurses (response rate of n=745, 61.9%).

Results: Phase 1 revealed three emerging themes for each major concept. Themes relating to spirituality were being human, spiritual well-being, and spiritual awareness. Themes of spiritual care were antecedents for spiritual care, forms of spiritual care, and nursing role. Themes relating to factors influencing spiritual care in practice were personal attributes, system factors, and patient factors. In Phase 2, the Spiritual Care-Giving scale (SCGS) was developed and tested to be valid and reliable (cronbach alpha=0.96), comprising five factors: Attributes for Spiritual Care, Spirituality Perspective, Defining Spiritual Care, Attitudes to Spiritual Care, and Spiritual Care Values. Concurrent validity showed moderate correlation with two other theoretically relevant scales, Spirituality and Spiritual Care Rating Scale (SSCRS) and Student Spiritual Care Survey (SSSC).

Correlation analyses showed positive correlations between SCGS, age and programme type. Multivariate analyses testing the relationships between nationality, race, and institution where respondents were enrolled showed positive association between SCGS scores and institution, (F(df=2772)=5.557; p<0.004) but no main effects observed between SCGS score, race, nationality, and age. Post-hoc analysis showed a significant interaction effect between race and institution (F(df=5772)=2.547; p<0.027). It showed that race was not a main effect but was dependent on the institution where the students were studying.

Discussion: Many findings echoed studies conducted in Western Europe and North America with students and practising nurses. Differences were identified however in relation to students? perceptions of spirituality and attributes to deliver spiritual care. Students participating in interviews perceived spirituality as universal, innate, an important aspect of being human. Survey findings indicated that students? demographic details, programme type, and academic environment influenced their perceptions and attitudes about spirituality and spiritual care. The results also supported the theoretical coherence between the three constructs proposed in the conceptual framework (see Fig. 3.1). However, the assumed relationship that understanding spirituality will translate into practice needs to be tested in future research.

Conclusion: The SCGS is the first validated composite tool developed and tested in a cosmopolitan and multicultural Asian society. Spirituality and spiritual care need to be explicitly taught in pre-registration nursing education programmes and requires concerted effort and support by management and regulators to integrate such practices in nursing practice and education.