Holistic Nursing American Holistic Nurses Association

Holistic Nursing American Holistic Nurses Association

As an inherent component of human beings, spirituality is an intangible and multidimensional concept that is subjective in nature. It is a universal phenomenon felt by a person according to his or her experiences and beliefs (Galvis & Pérez, 2011). It is a personal inquiry into the meaning and purpose of life and may or may not be related to religion. In addition, it can be influenced by social, cultural, biological, psychological, and religious factors (Batcheller, Davis, & Yoder-Wise, 2013; Sánchez, 2010; Tanyi, 2002). In cases of illness, the demand for spiritual support depends on the severity of the

illness or the impairment it has caused, the social and family support, and the experiences of loss and pain (Castelo-Branco, Brito, & Fernandes-Sousa, 2014).

From the perspective of nursing practice,

626777 JHNXXX10.1177/0898010115626777Journal of Holistic NursingVeloza-Gómez et al. research-article2016

Authors’ Note: Please address correspondence to Mónica Veloza, MSc, Universidad de La Sabana, School of Nursing and Rehabilitation, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá, Chía, Cundinamarca, Colombia; e-mail: mon- ica.veloza@unisabana.edu.co.

The Importance of Spiritual Care in Nursing Practice

Mónica Veloza-Gómez, MSc Lucy Muñoz de Rodríguez, MSc University of La Sabana, Chía-Cundinamarca, Colombia

Claudia Guevara-Armenta, MSc National Vocational Training Service (SENA), Bogotá-Cundimarca, Colombia

Sandra Mesa-Rodríguez, MSc University Foundation of Navarra, Neiva-Huila, Colombia

Purpose: Explore what spiritual care means to nurses who work in emergency care units. Design and Method: Nine nursing professionals from an emergency care unit at a private health institution affili- ated with the Universidad de La Sabana participated in this descriptive qualitative study. Nonparticipant observation, field notes, and in-depth interviews with a question guide were used to collect the data, which were analyzed by means of content analysis. Results: Three themes and their corresponding subthemes were identified with respect to the significance of spiritual care: (1) interpretation of spir- itual care, (2) the patient and the family in spiritual care, and (3) the role of the nurse in spiritual care. Conclusions: These findings provide a deeper understanding of spiritual care in terms of its signifi- cance. They also acknowledge its importance to nursing practice in emergency care units. The signifi- cance of spiritual care is based on theoretical, scientific, and humanistic points of reference (the discipline of nursing) that strengthen the therapeutic relationship between the patient/family–nurse dyad. The study also offers evidence for holistic nursing practice that requires theoretical-academic, administrative, and assistance support.

Keywords: nursing care; spirituality; nursing; holistic nursing; evidence-based nursing; hospital emer- gency care units; qualitative research

Qualitative Research

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Spirituality is related to the holistic notion of care. This idea encompasses all human dimensions and the intensive efforts made to include new approaches that meet the technological skills and the ontologi- cal capabilities that are essential to the maturity and survival of nursing as a profession. (Dezorzi & Crossetti, 2008, p. 213)

Nursing is a practice-based discipline that is inter- ested in the human being (Batcheller et al., 2013). Accordingly, spiritual care promotes the development of therapeutic relationships characterized as being the context and environment where the innate dignity and integral nature of each and every person are recog- nized, as is the vital importance of sensitive and com- passionate practice (Biro, 2012; Meehan, 2012).

Background and Significance

Nursing literature contains studies on the impor- tance of spirituality, spiritual care for nurses and nursing students, and spiritual care in high-depend- ency care settings, such as intensive care units and those dedicated to palliative care. With regard to the importance of spirituality and spiritual care and in light of their broad conceptualization in relation to nursing, further research is needed to clarify and strengthen the practice of spiritual care (Swinton & Patison, 2010). Moreover, the literature on this dis- cipline recognizes that including spirituality in organ- izations helps preserve the meaning of person-centered care in nursing and the assimilation of physical, psychological, and spiritual needs (Batcheller et al., 2013). It is imperative to clarify how nurses can offer spiritual care in practice and to arrive at a model of spiritual values that can be a learning source and help nurses to achieve a common understanding of spirituality and give them a spiritual focus for nurs- ing practice (Meehan, 2012). Spiritual care, as part of holistic nursing, requires a personal spiritual per- spective on the part of clinical nurses who support the needs of patients in their search for meaning and purpose in life. An educational effort supported by continuing education programs is needed to facilitate this process (Wu & Lin, 2011).

With respect to spiritual care in high-depend- ency care settings, such as intensive care units, a multiplicity of meanings as part of the multidimen- sional nature of spirituality and its influence on the practice of care has been identified when studying

the significance of spirituality in these scenarios (Penha & Silva, 2012). Therefore, taking spirituality into account is important in order to unify scientific knowledge, in practice, with an expression of human sensitivity and a deep awareness of the human being (Dezorzi & Crossetti, 2008).

A group of nurses in Thailand who work in intensive care units offer spiritual care through psy- chological support. This is done by facilitating reli- gious rituals and cultural beliefs, communicating with the patient and the family, valuing the spiritual needs of patients, showing respect, and facilitating the family’s participation in patient care (Lundberg & Kerdonfag, 2010).

A comparative study on the practice of spiritual care in palliative and intensive care units identified two differentiating factors with respect to empathy in the delivery of spiritual care: the nurse’s educational profile and age. More of a spiritual perspective and advanced practice of this type of care were identified in the group of nurses from palliative care units. The highlights included more available time and privacy to offer spiritual care and other aspects in this pallia- tive care scenario, such as end-of-life care. The situ- ation can be different in high-dependency care units, such as intensive care units or emergency care units, where barriers such as a lack of privacy with the patient and limited time for care were identified (Ronaldson. Hayes, Aggar, Green, & Carey, 2012). However, the study suggests that nurses who have far more time with patients demonstrate integrity and awareness of the importance of spiritual care as part of professional practice (Chan, 2009).

Regarding education, the participants in a study conducted with nurses working in low-dependency care settings in Hong Kong expressed feelings associ- ated with their inability to offer spiritual care due to increased workloads, lack of time, inadequate resources, and insufficient knowledge in that regard (Wong & Yau, 2010). However, in another study undertaken with nursing students, a broad vision of spirituality related to greater capacity to offer spirit- ual care was reported. This level of competence can be achieved at the undergraduate level by taking into account the factors that contribute to the acquisition of skills and aptitudes for spiritual care (Ross et al., 2014).

A study conducted with a group of Turkish nurses regarding their perception of spirituality and spiritual care identified demographic variables,

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cultural beliefs, years of work experience, level of training, and the area of work as factors that influ- ence the way spiritual care is provided. Educational level was the variable with the greatest positive impact on their perception of spirituality and spiritual care (Ozbasaran, Ergul, Temel, Aslan, & Coban, 2011).

The importance of spiritual care in nursing and its impact on the quality of care and the promotion of best practices are recognized at the administrative level in health care institutions. There is ample knowl- edge of this theme, and nurses’ involvement to make use of that knowledge and thereby empower motiva- tion in this respect and identify adequate training in spiritual care is recommended (Cockell & McSherry, 2012). The development of nursing education pro- grams on spiritual care can have positive effects, not only in terms of the care nurses provide but also in eliciting greater satisfaction in the exercise of their profession. The development of these types of pro- grams also allows for recognition of the importance of spiritual care as part of the “identity” of a health insti- tution (Vlasblom, Steen, Knol, & Jochemsen, 2011).

The advancement of knowledge on spiritual care is evident, as is the nature of how nurses provide holistic care through a therapeutic relationship that is person and family-centered, namely, one that consid- ers their physical and psychological needs. The litera- ture also suggests the need for spiritual care in practice scenarios where the therapeutic relationship might be compromised, as in the case of high- dependency settings, taking into account the specific technologies involved, the complexity of the contexts, the dependency on care, the patient’s privacy, and education on this topic. Spiritual care is necessary to achieve a positive impact on the well-being of patients, families, nurses, and health institutions. Thus, researching the significance of spiritual care to nurses in emergency care units, which are characterized by high-dependency care, a hi-tech environment, and a context that limits privacy and individuality in care, is necessary. This study also is required because a better understanding of the practice of spiritual care will benefit nursing education and research.

Materials and Method