Spiritual Care Interventions Research Articles

Tendencias de investigación en torno al cuidado espiritual de enfermería: Revisión de la literatura

Introducción. El cuidado espiritual es un área que cada vez cobra mayor relevancia en la práctica de enfermería ante situaciones de salud que generan cambios en la perspectiva de vida y donde la trascendencia y la atención integral son fundamentales. Objetivo. Identificar las tendencias de investigación en torno al cuidado espiritual de enfermería en el periodo comprendido entre 2008-2018. Materiales y métodos. Es una revisión de la literatura, cuya ruta metodológica contempló cuatro fases (búsqueda e identificación, filtro, elegibilidad y exclusión e inclusión). Las unidades de análisis correspondieron a los artículos de estudios cuantitativos, cualitativos y mixtos de 34 artículos que fueron publicados en las bases de datos PubMed, Science Direct, ProQuest y ClinicalKey Nursing. Para la elaboración del artículo y corroboración de la calidad de la presente revisión, se realizó la comprobación de los aspectos propuestos en la declaración PRISMA. Resultados. Emergieron cinco ejes temáticos de la revisión: educación y formación en el cuidado espiritual de enfermería, características de los escenarios y las intervenciones de cuidado espiritual, conceptualización de la dimensión espiritual, participantes en el cuidado espiritual, medición de la espiritualidad y del cuidado espiritual. Conclusiones. Las tendencias identificadas indican que el cuidado de la dimensión espiritual es de gran importancia en el ámbito de la salud y de la enfermería. A la vez, estos resultados son un punto de referencia a nivel latinoamericano e instan a que el conocimiento y formación académica en el área de interés, sea dada desde el pregrado y posgrado, con un impacto en la mejora del cuidado de enfermería desde la disciplina.

Spiritual care in nursing: an overview of the measures used to assess spiritual care provision and related factors amongst nurses.

Background and aim of the work:Spiritual wellbeing has important implications for an individual’s health and wellbeing. Whilst the provision of spiritual care and assessment of spiritual needs is a vital part of the nurse’s role, literature suggests that nurses do not always engage in spiritual care with their patients or assess their spiritual needs. This review aims to ascertain wider reasons for this inconsistent spiritual care delivery by nurses to their patients.Methods:A review of the literature was conducted to identify instruments available relating to nursing professionals spiritual care and assessment.Results:14 measures relating to spiritual care and assessment were identified covering the key domains of: ‘Beliefs and values and attitudes around spiritual care,’ ‘Frequency of provision or extent to which they provide spiritual care or willingness,’ ‘Respondents’ level of knowledge around spirituality and spiritual care,’ ‘Ability to respond to spiritual pain,’ and ‘Multiple Domains: beliefs and attitudes around spirituality and spiritual care, amount of preparation, training and knowledge, spiritual care practices, perceived ability and comfort with provision and perceived barriers to provision.’Conclusions:A lack of standardisation in the conceptualisation and assessment of spiritual care causes challenges in reviewing, however several themes do emerge. In general student and qualified nurses are aware of the importance of providing spiritual care and are hindered by a lack of education about how best to implement such care. The religiosity of individual nurses or their training institutions seems to be of less importance than training in spiritual care interventions. (www.actabiomedica.it)

The Impact of Spiritual Care Education on Anxiety in Family Caregivers of Patients with Heart Failure.

Heart failure (HF) has been emerging as a general health problem over recent decades. Spiritual care is a type of support service provided to patients suffering from HF. Spiritual care intervention in nursing is a unique aspect of care, which cannot be replaced by psychosocial care. Considering the importance of anxiety for caregivers of patients with HF, the present study aimed to examine the effect of spiritual intervention on anxiety in caregivers of patients with HF in Ilam, Iran. This research is a semi-experimental study, 71 caregivers of patients with HF were randomly assigned to experimental group (n = 34) and control (n = 37) group. Beck Anxiety Inventory, which consisted of 21 items and scored based on a 4-point Likert scale ranging from zero to three, was employed to collect data. The scores range from zero to 63 with the higher scores indicating the higher level of anxiety. The experimental group received spiritual intervention over six 45-minute sessions in a period of 2weeks (14days; three times a week; every other day). Data were analyzed using descriptive and inferential statistics run in the SPSS software version 16. The result showed a difference between the level of anxiety in two groups after the intervention (P = 0.001). Anxiety level in the experimental group three weeks after intervention (27.88 ± 7.10) was significant in comparison with before intervention (45.06 ± 5.79) (P = 0.001). According to the results, the spiritual intervention reduced the anxiety level in the caregivers of patients with HF. Nurses are recommended to provide such necessary training to caregivers in order to provide the grounds for reducing their anxiety.

Using patient-reported religious/spiritual concerns to identify patients who accept chaplain interventions in an outpatient oncology setting.

The goals of this study were to (1) describe the prevalence and correlates of patient-reported religious/spiritual (R/S) needs in outpatient oncology patients and (2) estimate the associations of R/S concerns with acceptance of an R/S intervention offered by phone. This was a retrospective analysis of data collected from distress screenings and spiritual care interventions at an outpatient cancer center from March 1, 2017 to May 9, 2017. Patients (n = 1249) used a tablet to self-report the following R/S concerns: spiritual or religious concern, isolation, struggle to find hope/meaning in life, concern for family, fear of death, shame/guilt, and doubts about faith. Patients were also screened for anxiety, depression, and distress. A chaplain contacted patients that reported one or more R/S concerns to offer R/S interventions via telephone or in person. Approximately one third (29.9%) of surveyed patients indicated at least one R/S need. Younger age, female gender, anxiety, depression, and distress were associated with indication of specific R/S concerns. Fear of death (OR 1.64 [1.02, 2.66], p = 0.043), struggle to find meaning/hope in life (OR 2.47 [1.39, 4.39], p = 0.002), and anxiety (p = 1.003) were associated with increased odds of intervention acceptance. Effective screening practices are needed for chaplains to prioritize patients most in need. This exploratory study suggests that screening for struggle to find meaning/hope in life, fear of death, and anxiety will help chaplains identify patients who have R/S concerns and will likely accept R/S interventions. Developing effective telehealth practices like this is an important direction for the field.

The Effect of Spiritual Care on Depression in Patients Following Coronary Artery Bypass Surgery: A Randomized Controlled Trial

The aim of this study was to determine the effect of a nurse-delivered spiritual care intervention on depression following coronary artery bypass graft (CABG) surgery. A semi-experimental study was performed in Baqiyatallah al-Azam Military Hospital of Tehran, Iran in 2013. Sixty-eight patients undergoing coronary artery grafts were purposefully selected and randomly assigned into the intervention (n = 34) and control (usual care) groups (n = 34). The intervention group received five sessions of spiritual care lasting between 45–60 minutes using the approach of Bergin Richards (2005). The control group received only routine standard care. The mean depression scores were measured using the depression subscale of the Depression Anxiety Stress Scale (DASS-21). At baseline (p = 0.051), there were no differences in the mean depression scores. Post intervention, statistically significant differences were observed in the mean depression scores between groups (p < 0.001). The results showed that the use of spiritual care can decrease depression in the intervention group. These findings suggested that nurses could use spiritual care to improve psychological care.

Interventions by Hospital Nurses for the spiritual needs of patients in the Eastern Black Sea Region of Turkey.

The aim of this study is to evaluate the spiritual care interventions of the nurses in hospitals. Nurses employed in the 5 hospitals of Eastern Black Sea Region constitute the universe of the research that was planned to be descriptive. 1254 out of 1765 nurses were reached out between 1-30 May 2015 without a sample selection. The data were collected by the researchers is based on face-to-face survey techniques in which sociodemographic attributes built on literature and opinions on spiritual care were evaluated. Permission of the hospitals and nurses were obtained for the study. Number and percentage distributions and Chi-square test were used for statistical analysis. As the nurses' sociodemographic attributes were examined, 29.3% of them belonged to 30-35 age group, 26% of them worked as a nurse manager for 82-161 months, and 56.7% of them worked for 162-300 months. Ninety-one percent of them stated that they never practiced spiritual care-related nursing, 97.5% of them stated that they never received support from hospital clergymen, 93.2% of them stated that they did not talk about spiritual need with the patient since they did not find it necessary. This study showed that there is very little or no interventions directed at the spiritual dimension during the patient's caring process.

Toward a Fully Fledged Integration of Spiritual Care and Medical Care

In this article, we aimed to set out current problems that hinder a fully fledged integration of spiritual and medical care, which address these obstacles. We discuss the following five statements: 1) spiritual care requires a clear and inclusive definition of spirituality; 2) empirical evidence for spiritual care interventions should be improved; 3) understanding patients' experiences of contingency is paramount to deliver effective spiritual care; 4) attention to spiritual needs of patients is a task for every health care practitioner; 5) courses on spirituality and spiritual care should be mandatory in the medical curriculum. Current problems might be overcome by speaking each other's language, which is crucial in interdisciplinary research and in good interdisciplinary collaboration. Using a clear and inclusive definition of spirituality and substantiating spiritual care using medical standards of evidence-based practice is a way to speak each other's language and to increase mutual understanding. Furthermore, including spirituality in the medical curriculum would raise awareness of medical practitioners for their task of attending to patients' spiritual needs and, subsequently, to better and more appropriate referral for spiritual care.

Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients

ContextSpiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context. ObjectivesThe aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL. MethodsA cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0–10). ResultsTwo hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR “private religiosity” score, as well as the HADS “depression” score. ConclusionBoth spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.

Implementing spiritual care interventions.

This article, the third and final in a series of three, discusses the implementation of spiritual care interventions by nurses. It describes how nurses can use clinical reasoning and the nursing process to implement appropriate spiritual care for patients, and outlines the competencies necessary to identify spiritual distress and meet the spiritual needs of patients. Spiritual care interventions are discussed as part of a multidisciplinary team approach to the provision of holistic care.

Spiritual Health: A Concept Analysis.

Spiritual health has attracted a lot of attention in health-related and nursing sciences and numerous researches. Yet, this concept has remained complex and ambiguous, and there is no consensus in this regard. This ambiguity can be challenging for holistic nursing; therefore, clarification of the concept is required for development of nursing knowledge. The present study aimed to explore the concept of spiritual health in health-related and nursing literature. Walker and Avant (Strategies for theory construction in nursing, Appleton & Lange, Norwalk, 1995) concept analysis method was used in this study. The results were categorized as antecedents, attributes, and outcomes of spiritual health. The critical attributes extracted for spiritual health included transcendence, purposefulness and meaningfulness, faithfulness, harmonious interconnectedness, integrative power, multidimensionality, and holistic being. Besides, the antecedents of spiritual health included capability and potentiality for transcendence, and spiritual awareness. Finally, well-being and moral development were the outcomes of spiritual health. Spiritual health is one of the basic aspects of health and providing a clear theoretical definition can result in a common understanding of this concept for nurses. Clarifying this concept would also be useful for provision of spiritual care interventions and development of nursing theories.

INTERVENSI ILMI-SPARE DALAM MENURUNKAN STATUS DEPRESI PADA KELOMPOK LANSIA

One of nursing community intervention to decrease depression level of elderly is ILMI SpaRe. The aim of this report is to show description application of ILMI SpaRe intervention for erlderly with depression in community nursing care. Result shows decreasing level of depression in older people for knowledge by 10,08%, attitude by 8,05 % and 60,8% for skill in spiritual care intervention and progressive muscle relaxation. By result of intervention application of ILMI SpaRe is concluded that spiritual care intervention combined with progressive muscle relaxation can reduce depression in older people group. This research is recommended for decision maker elderly program in community to increase community empowerment, activation self help group for elderly with health problem, especially depression and involving the seniors in community activities as form for appreciations, so older people can live health and healthy

Spiritual Care Intervention and Spiritual Well-Being.

This study explored the frequency of providing aspects of spiritual care intervention and its association with nurses' own spiritual well-being in a convenience sample of 355 Jordanian Arab Muslim nurses. The nurses were recruited from different hospitals, representing both public and private health care sectors in northern and central Jordan. A cross-sectional descriptive and correlational design was used. Results indicated that Jordanian Muslim nurses provided religious aspects of spiritual care intervention to their Muslim patients infrequently and that their own spiritual well-being was positively associated with the frequency of provision of spiritual care interventions. The study concluded that Jordanian Muslim nurses most frequently provided spiritual care interventions that were existential, not overtly religious, were commonly used, were more traditional, and did not require direct nurse involvement. Moreover, the findings revealed that spiritual well-being was important to those nurses, which has implications for improving the provision of spiritual care intervention. The study provides information that enables nurses, nursing managers, and nursing educators to evaluate the nurses' provision of various aspects of spiritual care to their Muslim patients, and to identify aspects of spiritual care intervention where nurses might receive training to become competent in providing this care.

Development of the Arabic Spiritual Care Intervention-Provision Scale.

This study develops a new instrument, the Spiritual Care Intervention-Provision Scale, and assesses its psychometric properties in an Arab Muslim nurse sample. The Spiritual Care Intervention-Provision Scale was developed to measure the frequency with which nurses provided aspects of spiritual care. Most of the available spiritual care instruments were developed in the West and reflect a predominantly Christian tradition. A review of the literature on spiritual care in nursing revealed that no instrument exists for measuring spiritual care interventions provided by nurses to Arab Muslim patients. A cross-sectional descriptive and correlational design. Following an extensive literature search, review by an expert panel and a pilot study which included patients' views regarding aspects of spiritual care provided by nurses, the final version of the Spiritual Care Intervention-Provision Scale was tested in a convenience sample of 360 Jordanian Arab Muslim nurses. Correlational and factor analysis were used. The internal consistency of the Spiritual Care Intervention-Provision Scale was high, with α coefficient of 0·85. The exploratory factor analysis supported a two-factor structure for the Spiritual Care Intervention-Provision Scale as hypothesised. A significant positive correlation between the Spiritual Care Intervention-Provision Scale and religiosity was in the expected direction though small in magnitude. This study initiates the development of an instrument for the provision of spiritual care intervention by nurses that balances the religious and existential dimensions of spirituality. The Spiritual Care Intervention-Provision Scale exhibited acceptable evidence of internal consistency and validity among Jordanian Arab Muslim nurses. Further work was suggested to firmly establish all aspects of this new scale. This culturally specific instrument contributes to the evaluation of the provision of spiritual care by Jordanian Muslim nurses to their patients, to guide them in providing a comprehensive and appropriate spiritual care interventions and to examine the effect of spiritual care on various aspects of patient's quality of life.

The challenge of consolation: nurses' experiences with spiritual and existential care for the dying-a phenomenological hermeneutical study.

BackgroundA majority of people in Western Europe and the USA die in hospitals. Spiritual and existential care is seen to be an integral component of holistic, compassionate and comprehensive palliative care. Yet, several studies show that many nurses are anxious and uncertain about engaging in spiritual and existential care for the dying. The aim of this study is to describe nurses’ experiences with spiritual and existential care for dying patients in a general hospital.MethodsIndividual narrative interviews were conducted with nurses in a medical and oncological ward. Data were analyzed using a phenomenological hermeneutical method.ResultsThe nurses felt that it was challenging to uncover dying patients’ spiritual and existential suffering, because it usually emerged as elusive entanglements of physical, emotional, relational, spiritual and existential pain. The nurses’ spiritual and existential care interventions were aimed at facilitating a peaceful and harmonious death. The nurses strove to help patients accept dying, settle practical affairs and achieve reconciliation with their past, their loved ones and with God. The nurses experienced that they had been able to convey consolation when they had managed to help patients to find peace and reconciliation in the final stages of dying. This was experienced as rewarding and fulfilling. The nurses experienced that it was emotionally challenging to be unable to relieve dying patients’ spiritual and existential anguish, because it activated feelings of professional helplessness and shortcomings.ConclusionsAlthough spiritual and existential suffering at the end of life cannot be totally alleviated, nurses may ease some of the existential and spiritual loneliness of dying by standing with their patients in their suffering. Further research (qualitative as well as quantitative) is needed to uncover how nurses provide spiritual and existential care for dying patients in everyday practice. Such research is an important and valuable knowledge supplement to theoretical studies in this field.

Religiosity and Spirituality During Cardiac Rehabilitation: A LONGITUDINAL EVALUATION OF PATIENT-REPORTED OUTCOMES AND EXERCISE CAPACITY.

This study is a longitudinal evaluation of religiosity/spirituality (R/S) and religious coping in post-myocardial infarction and post-coronary artery bypass surgery patients during a 12-week cardiac rehabilitation program. This study examines change in R/S and the relationship between R/S and psychosocial outcomes and exercise capacity over time. Cardiac rehabilitation patients (N = 105) completed measures of R/S, religious coping, quality of life (QOL), self-efficacy (SE), and energy expenditure (EE) at the beginning (baseline) and end of a 12-week program. Relationships between R/S and religious coping and QOL, SE, and EE were evaluated. A negative relationship emerged between baseline measures of R/S and religious coping and QOL, SE, and EE. There were significant increases in Good Deeds Coping, QOL, SE, and EE from baseline to end of program (Ps < .05). Baseline measures of Interpersonal Religious Support Coping were positively correlated with the change in EE from baseline to end (r = 0.21; P = .059), and there were positive correlations between the change in Experiential Religiosity (r = 0.32; P = .004) and Overall Religiosity (r = 0.25; P = .024) with the change in EE. The demonstrated relationships between R/S and Religious Coping and outcomes in cardiac patients provide compelling support for the development of spiritual care interventions for cardiac patients and evaluation of the impact of these interventions on physiological, medical, and psychological outcomes in these patients.

G239 Understanding the spiritual and religious needs of young people with cancer and their families to enhance holistic care

Aim To identify spiritual and religious needs of adolescent oncology patients and their families with the intention of providing an evidence base for appropriate spiritual and religious care interventions to be developed in a future study. Methods Small scale phenomenological study, 9 patients, 7 parents, semi-structured interviews with initial approach made by the lead nurse, 2 staff focus groups, thematic analysis of data by multidisciplinary team and tested out with staff in a focus group. A systematic literature review demonstrated the lack of research in this field. Results Spiritual needs were clustered under the following headings: protection vs autonomy; desire to make a difference; personal issues including loss, privacy, finding a new normal; relationships and attitude including the need to be listened to and opportuniites for empowerment and consent where they could have control; environment including a need for conducive physical and emotional space and a focus on building community; difficult emotions and resilience; need for supportive presence; cultural differences. Religious needs were ritual; hope; questioning and doubt; worldview; language; balance between parent and patient’s needs. Inverted transition was noted as an issue to explore further. Conclusion Practice implications include; need for ongoing assessment and appropriate assessment strategies; articulating spiritual care practices and opportunities; offering normalising activities; importance of culture setting, building community and enhancing the environment; providing space for parents to express emotion and loss; self care for staff; education on religious beliefs and impact on care. A process of inverted transition was noted where young people who would usually be becoming more independent were thrust back towards a dependence on their parents who were often very present on the wards. Perhaps the most valuable thing that can be offered to patients and their families are acts of kindness and remembrance, such acts were disproportionately appreciated in relation to the act.

The importance of spiritual care in nursing.

Dear editor, As nurse researchers, we were studying Iranian nurses’ competencies in spiritual care recently. Using a self-directed instrument, we surprisingly found that nurses have low acquaintance with the spirituality concept and how to provide spiritual care. Similar to other caring activities and procedures, spiritual care improves people’s spiritual well-being and performance as well as the quality of their spiritual life. Spiritual care has positive effects on individuals’ stress responses, spiritual well-being (ie, the balance between physical, psychosocial, and spiritual aspects of self), sense of integrity and excellence, and interpersonal relationships (1). Spiritual well-begin is important for individual's health potential and the experience of illness/hospitalization can threaten optimum achievement of this potential. Professional nursing embraces spiritual care as a dimension of practice. There are many indications that spiritual care is considered to be a nursing responsibility but there is a lack of role clarity. There is no agreed definition of what is meant by “spiritual”, “spiritual need”, and “spiritual care”; moreover, there are few guidelines for spiritual caring in nursing practice (2). Nurses’ practice patterns in the area of spiritual care can be grouped into two categories including religious and nonreligious interventions. Religious interventions include treating patients’ religious beliefs without prejudice, providing them with opportunities for connecting with God and expressing their values and beliefs, helping them practice their religion, and referring them to clerical and religious leaders. Nonreligious interventions include nurses’ presence for patients and their families, making direct eye contact when communicating with patients, sympathizing with patients and their families, listening to patients and their families attentively, and having love and enthusiasm for patients (3). Despite importance of spiritual care, nurses have expressed a need to learn how to provide spiritual care. Integrating spiritual care into nursing curricula could meet that need during the nurse formation process (4). Nurses' knowledge of spiritual care is poor and they need specific information on how to meet patients’ spiritual needs. The freely expressed experiences suggest that nurses do aim to provide spiritual care; however, it is often adversely affected by several physical, professional, and personal barriers. Expressed difficulties regarding the provision of spiritual care include lack of education, time constraints, and being too busy. In addition to being a valuable part of total patient care, spiritual care interventions promote a sense of well-being for nurses; however, the concept of spirituality needs to more clearly articulated and increased knowledge is required in order to identify patients’ spiritual needs (3). Educators may have an important role in the learning process; thus, preparedness of the educators in the teaching of this dimension of care is necessary at both faculty and clinical practice. Reflective teaching methodology including group discussions, critical incident analysis, keeping diaries, role-play, online discussions to allow ongoing mentoring of students beyond class hours, and self-reflection are recommended. In fact, they enable transferring learning into clinical practice with the potential of minimizing the divergence between the theory and practice of spiritual care (5). Spiritual care education in Iranian nursing is subtle, ambiguous, informal, and nonprogrammable. In a recent study in Iran, Tazakori et al. reported that due to the lack of relevant contents in the nursing curriculum, educators are trying to be role models for their students; in turn, nursing student also experience and understand spiritual care informally with continuous presence in clinical practices and observing the behaviors of the educators and others (6). Therefore, we propose to integrate the spiritual care concept in the nursing curriculum in Iran.

Nurse religiosity and spiritual care.

To describe how the religiosity of Christian nurses motivates their practice and manifests during patient care, especially spiritual care. Nurses around the world are often religious. This religiosity inherently affects nursing practice. Ethical codes, however, direct that nurses ought to never proselytize their religion while caring for patients. Little is known about how the religion of nurses affects their nursing practice. Cross-sectional phenomenological study. Data were collected during semi-structured interviews in 2009-2011 with 14 Christian nurses in the USA. Data were coded and thematically analysed after transcription. Informants described how they approached patients with religious conversation or spiritual care interventions that were overtly Christian in nature. With some awareness of the potential for harm in presenting their Christian beliefs and practices, these nurses also observed for patient cues before raising religious discourse and maintained caution so as to respect patient autonomy. Religiosity also was a personal resource for these nurses as they cared for very ill patients. The following themes were described: religious determinants and influences, perceptions of divine promptings and protection, religious approaches to spiritual care, respecting patient spirituality/religiosity and religious preparation for daily work. Understanding these religious motivations and religious spiritual care practices of Christian nurses provides evidence that can stimulate debate for policy makers and scholars. It can also inform educators teaching spiritual care and administrators supervising religious nurses.

How Christian nurses converse with patients about spirituality

To describe the experience of conversing with clients to provide spiritual care from the perspective of Christian nurses identified as exemplary spiritual caregivers. More specifically, findings presented here describe the goals and strategies of these nurses when conversing with patients about spirituality. Although verbal communication is pivotal to most spiritual care interventions recognised in the nursing literature, there is scant empirical evidence to inform such spiritual care. There is evidence, however, that many nurses have discomfort and difficulty with conversations about spirituality. Cross-sectional, descriptive, qualitative design framed by phenomenology. Semi-structured interviews were conducted with 14 southern California registered nurses working in varied clinical settings. Data were coded and thematically analysed by three researchers who established equivalency. Methods to support the trustworthiness of the findings were employed. Themes providing structure to the description of how nurses converse with patients about spirituality included assessing and establishing connection, overt introductions of spirituality, finding spiritual commonality, self-disclosure, spiritual encouragement, spiritual advice or religious teaching, and prayer. Requisite to any spiritual care conversation, however, was 'allowing them (patients) to talk'. Informants tread 'gently and softly' in approaching spiritual discourse, assessing for any patient resistance, and not pushing further if any was met. Findings illustrate compassionate nursing with specifiable goals and strategies for conversations about spirituality; they also raise questions about how nurse religious beliefs are to ethically inform these conversations. The Invitation, Connection, Attentive care, Reciprocity mnemonic is offered as a means for nurses to remember essentials for communication with patients about spirituality.

Research Priorities in Spiritual Care: An International Survey of Palliative Care Researchers and Clinicians

ContextSpiritual distress, including meaninglessness and hopelessness, is common in advanced disease. Spiritual care is a core component of palliative care, yet often neglected by health care professionals owing to the dearth of robust evidence to guide practice. ObjectivesTo determine research priorities of clinicians/researchers and thus inform future research in spiritual care in palliative care. MethodsAn online, cross-sectional, mixed-methods survey was conducted. Respondents were asked whether there is a need for more research in spiritual care, and if so, to select the five most important research priorities from a list of 15 topics. Free-text questions were asked about additional research priorities and respondents' single most important research question, with data analyzed thematically. ResultsIn total, 971 responses, including 293 from palliative care physicians, 112 from nurses, and 111 from chaplains, were received from 87 countries. Mean age was 48.5 years (standard deviation, 10.7), 64% were women, and 65% were Christian. Fifty-three percent reported their work as “mainly clinical,” and less than 2.5% stated that no further research was needed. Integrating quantitative and qualitative data demonstrated three priority areas for research: 1) development and evaluation of conversation models and overcoming barriers to spiritual care in staff attitudes, 2) screening and assessment, and 3) development and evaluation of spiritual care interventions and determining the effectiveness of spiritual care. ConclusionIn this first international survey exploring researchers' and clinicians' research priorities in spiritual care, we found international support for research in this domain. Findings provide an evidence base to direct future research and highlight the particular need for methodologically rigorous evaluation studies.