Aru Narayanasamy

An investigation into the spiritual needs of neuro-oncology patients from a nurse perspective

BackgroundSpiritual needs of cancer patients should be assessed and discussed by healthcare professionals. Neurosurgical nurses need to be able to assess and support neuro-oncology patients with their spiritual needs from diagnosis and throughout their hospital stay.MethodsData were collected through questionnaires using a Critical Incident Technique (CIT) from neurosurgical nurses, findings were analysed using thematic analysis.ResultsNurses reported some awareness of their patients’ spiritual needs during their stay on neurosurgical units although some used expressions approximating what could be described as spiritual needs. Patients’ spiritual needs were identified as: need to talk about spiritual concerns, showing sensitivity to patients’ emotions, responding to religious needs; and relatives’ spiritual needs included: supporting them with end of life decisions, supporting them when feeling being lost and unbalanced, encouraging exploration of meaning of life, and providing space, time and privacy to talk. Participants appeared largely to be in tune with their patients’ spiritual needs and reported that they recognised effective strategies to meet their patients’ and relatives’ spiritual needs. However, the findings also suggest that they don’t always feel prepared to offer spiritual support for neuro-oncology patients.ConclusionsThere is a need for healthcare professionals to provide spiritual care for neuro-oncology patients and their relatives. Although strategies were identified that nurses can use to support patients with spiritual needs further research is required to explore how effective nurses are at delivering spiritual care and if nurses are the most appropriate professionals to support neuro-oncology patients with spiritual care.

The application of performance indicators to nurse education (Part 2)

In Part 1 of this paper the focus was on Performance Indicators (PIs) related to staff performance, teaching methods and learning environment, and it was argued that notions of student reports, student reviews and student perceptions would be useful as PIs when Colleges of Nursing are evaluated for effectiveness. In Part 2 the failure to apply indicators such as unit costs, student/staff ratio (SSRs), wastage and completion rates and value-added scores is discussed. Further argument is advanced to justify the application of these indicators to nurse education. The conclusion of this paper is that until concepts such as unit-costs, SSRs, wastage and completion rates and value-added scores are developed into PIs in nurse education, Colleges of Nursing are not sufficiently evaluated for their effectiveness.

Diversity project: mapping of diversity teaching and learning in nurse education curriculum

Diversity and inclusivity in higher education and health care have gained prominence in recent years and this means that institutions’ educational programmes need to incorporate teaching and learning that is responsive to diversity. This paper reports findings from a diversity teaching and learning mapping project. The aim of the mapping project was to map out when and how the various themes on diversity in all course curricula are addressed in a university’s School of Nursing. The project adopted the following methodologies: documentary reviews of curriculum documents, handbooks and timetables, followed by qualitative interviews with module leaders and teachers. The documentary reviews provided a map of where diversity teaching and learning tended to occur and the interviews yielded six major themes central to diversity: definition, importance, confidence, challenges, resources and future implications. The results suggest that mapping does provide an important way of comparing courses and highlighting aspects which need attention. The results provide directions for curriculum development teams to ensure that diversity issues are transparently addressed in all courses in the School of Nursing. Furthermore, the insights derived from the findings steered the project team to develop Web CT resources on some of the diversity themes such as an introduction to diversity and inclusivity, spirituality, ethnicity and diversity. Plans are in place to develop further diversity teaching and learning resources in the light of findings which will be used in staff development programmes.

Reflexive account of unintended outcomes from spiritual care qualitative research

This paper presents a discussion of the reflexive accounts of research experience of the author when conducting data collection and analysis of an investigation into spirituality and culture in nurse education. Aims To offer insights into the unintended outcomes of research and personal transformation that may occur as a consequence of the research. Background Whilst extensive qualitative research prevails in nursing and nurse education, with some making a significant impact upon the practice and epistemology of nursing, reflexive accounts of unintended outcomes of research are rather scanty in the literature. Data Sources This paper draws on the reflective diary and field notes maintained by the researcher throughout the trajectory of the research involving a series of studies into spiritual care in nurse education. Discussion Reflective frameworks offer opportunities for honest reflexive accounts which may be quite revealing. The paper illuminates some salient features of unintended outcomes of the research involving participants who shared narratives of coping mechanisms using spiritual resources as they faced critical junctures such as illness in their lives. Conclusion The encounters between the researcher and the participants could lead to transformation and growth for both. Implications for practice Reflexive accounts of unintended outcomes should be integral to the qualitative research process and they could be transformative for both the researcher and the participants. The reflections on the unintended outcomes may provide valuable insights into patients’ experiences in order to produce a more comprehensive understanding of the phenomena being investigated. Summary statement What is already known about this topic Qualitative research produces rich and dense data impacting nursing. Qualitative research contributes to the epistemology of nursing. Reflexive accounts shed valuable insights about the qualitative research process. What this paper adds A structured approach to reflexive accounts may produce some interesting insights into the research process related to spirituality studies addressed in this paper. Unintended outcomes of spirituality research could be identified and theorised as integral to the whole research. Researchers need to invest time and attention into the unintended outcomes of research as they could be transformative for both the researcher and participants. Implications for practice and/or policy Reflexive accounts and unintended outcomes of research could be valuable for the researchers and participants’ transformation and growth. Further theories may evolve from unintended outcomes of research adding further insights into the unpredictable dimensions of humanity.

Commentary on Chan MF (2009) Factors affecting nursing staff in practising spiritual care. Journal of Clinical Nursing 19, 2128–2136

In recent times, when criticism is levelled at nursing for accepting spirituality unchallenged, Chan’s (2009) paper is timely as it appears to address these concerns, adding to the research on nursing and spiritual care. Having explored existing studies on nurses’ personal characteristics and their association with spiritual care, Chan’s research offers some interesting findings on nurses’ attitudes to practising spiritual care. Chan (2009) concludes that the results are indicative that current spiritual care practices where the study took place were positively correlated with spiritual care perceptions. Chan’s (2009) study found a significant association between the demographic variables and the spiritual care practice scores. In line with the finding of Cavendish et al.’s (2004) study, married people attained higher scores than singles on the spiritual care scales. The implications of Chan’s findings are that spirituality should be prominent in nurse education as an integral feature of holistic care. If nurse education promotes student engagement with spirituality, including the debates about the nature of spirituality and its significance to patients as they face critical junctures in their lives (Narayanasamy 2002), it then makes sense to assume that nurses are likely to transfer this acquired knowledge to practice. Poignantly, Chan (2009) acknowledges the debate and tensions surrounding spirituality, including the lack of consensus about what spirituality really means and in doing so makes a striking comment that spirituality refers to ‘a family of different, yet connected meanings’ in terms of meaning making in one’s life (Chan 2009, p. 2129). This resonates with several perspectives, including one where ‘spirituality is the essence of our being and one that gives us meaning and purpose to our very existence’ (Narayanasamy 2010, p. 37). In this regard, if nurses are dismissive of spirituality as patients’ lived experience, especially when they are facing critical junctures in their lives, then they are neglecting an important dimension of humanity and hence leave a person in a state of dispiritedness or brokenness. Attention to the body, mind and spirit is likely to restore the holistic nature of the person. Despite mounting evidence that spirituality is integral to health, some fail to acknowledge the ontology of spirituality as a human experience and that spirituality is the only lifeline for some when everything fails, including medicine and its perceived power to heal. However, protagonists of spirituality in nursing draw attention to the importance of spirituality in the light of empirical evidence from studies based on patients and nurses. While it is unequivocal that spirituality is important to people’s lives, it is less clear whether it is the nurse’s sole responsibility to address all aspects of spirituality in practice. Given the concerns in the literature about nurses’ knowledge and competence in spiritual care, this is possible because of the impoverished nurse education in this area. In this regard, although Chan’s (2009) paper strongly suggests the potential of nurse education in addressing nurses’ professional development in spirituality and spiritual care, it is doubtful whether nurses should be given the task of dealing with spirituality in practice. In line with numerous studies, Chan’s (2009) study requires nurse educators to know the ‘why’ about spirituality, but they need to consider how best to ensure that spirituality is embedded in the nursing curriculum. To achieve this, we need to consider ‘what’ and ‘how’ in the teaching of spirituality for nursing. As acknowledged by Chan (2009), the lack of consensus about what constitutes spirituality

Principles of Spiritual Care in End-Of-Life Care in India: A Historical-Cultural Investigation

Background Understanding the principles of spiritual care in end-of-life care pertaining to the Indian context is crucial for the development of an appropriate approach to spiritual care for Indian palliative care. The rich and diverse spiritual and cultural traditions around the care of the dying in the country provide useful resources for such a perception. Aims This study seeks to examine the features of the care of the dying that were prevalent in the past in South India in order to understand the values and principles of spiritual care in the care of the dying in India. Methods Taking a historical-cultural perspective, in-depth oral history interviews were conducted with thirty older adults belonging to different religions and none. Participants were recruited using purposive and snowballing sampling technique from Kanyakumari district, South India. Results Several religious and cultural care practices that were customary in the care of the dying and beliefs about good death that prevailed over a couple of decades 40 years ago emerged from the data. ‘Union with the divine’, ‘being at peace’ and ‘preserving dignity’ were the three core principles that were found to be at the heart of these practices and beliefs. All these practices and beliefs were found to have meanings and values attached to them that relate to these core principles. Conclusions Care practices around the care of the dying and beliefs about good death are clearly characterised by spiritual beliefs. Perspectives on the present Indian scenario suggest that the above said principles play a vital role in shaping the current understanding of death and ideas of good death. Considerable contextual changes in the Indian society have caused the breakdown of traditional patterns of intergenerational dissemination of these practices and their meanings making these core principles hard to achieve.