Lisa Burkhart

An Experiential Theory of Spiritual Care in Nursing Practice

Spiritual care has been recognized as integral to nursing care for centuries, as described by Florence Nightingale, and has been studied in both medicine and sociology. Health care institutions, particularly faith-based health systems, also have recognized the importance of spiritual care. Both qualitative and quantitative research support the importance of spirituality in patient health. Although the profession, health care institutions, and research support spiritual care, there is no empirically derived theoretical framework to guide research in spiritual assessment and spiritual care. We used focus group data from registered nurses who care for the chronically ill (n = 25) in a large Midwestern academic health center to generate a grounded theory of spiritual care in nursing practice. What emerged from this study was a beginning theoretical framework to guide future spiritual care research.

Development and psychometric testing of the Spiritual Care Inventory instrument

AIM This article is a report of the development and psychometric testing of the Spiritual Care Inventory. BACKGROUND Research supporting the positive association between spirituality and health has lead to interest in providing spiritual care in healthcare settings. Few instruments exist that measure the provision of spiritual care. METHOD In February/March 2007, a convenience sample of 298 adult and paediatric acute care, ambulatory, home health, hospice staff and rehab nurses at two hospitals (n = 248) and graduate students at a school of nursing (n = 50) completed a 48-item initial version of the Spiritual Care Inventory. In study 2 from July through August 2007, 78 staff nurses at one hospital (n = 30) and a different cohort of graduate students at a school of nursing (n = 48) completed the 18-item second version of the Spiritual Care Inventory. RESULTS Exploratory factor analysis in study 1 supported a 3-factor solution (spiritual care interventions, meaning making and faith rituals) with internal consistency measures for the subscales above 0·80. In study 2, internal consistency remained high. CONCLUSION Factor structures identify that spiritual care is a process of intervention, meaning making and faith rituals.

Being a Female Veteran: A Grounded Theory of Coping With Transitions

Female veterans, the fastest growing segment in the military, have unique pre-military histories and military experiences that are associated with post-military physical and mental health service needs. Successful treatment is contingent on a clearer understanding of the processes underlying these experiences. Data from 20 female veterans who served post–Gulf War were analyzed to generate a substantive theory of the process of women who entered, served in, and transitioned out of the military. Coping with transitions emerged as the basic psychosocial process used by female veterans. The Coping with transitions process is comprised of seven categories: Choosing the Military, Adapting to the Military, Being in the Military, Being a Female in the Military, Departing the Military, Experiencing Stressors of Being a Civilian, and Making Meaning of Being a Veteran-Civilian. The results of this study provide a theoretical description of the process female veterans experience when transitioning from a civilian identity, through military life stressors and adaptations, toward gaining a dual identity of being a veteran-civilian.

Validating Domains of Patient Contextual Factors Essential to Preventing Contextual Errors: A Qualitative Study Conducted at Chicago Area Veterans Health Administration Sites

Purpose “Patient context” indicates patient circumstances and characteristics or states that are essential to address when planning patient care. Specific patient “contextual factors,” if overlooked, result in an inappropriate plan of care, a medical error termed a “contextual error.” The myriad contextual factors that constitute patient context have been grouped into broad domains to create a taxonomy of challenges to consider when planning care. This study sought to validate a previously identified list of contextual domains. Method This qualitative study used directed content analysis. In 2014, 19 Department of Veterans Affairs (VA) providers (84% female) and 49 patients (86% male) from two VA medical centers and four outpatient clinics in the Chicago area participated in semistructured interviews and focus groups. Topics included patient-specific, community, and resource-related factors that affect patients’ abilities to manage their care. Transcripts were analyzed with a previously identified list of contextual domains as a framework. Results Analysis of responses revealed that patients and providers identified the same 10 domains previously published, plus 3 additional ones. Based on comments made by patients and providers, the authors created a revised list of 12 domains from themes that emerged. Six pertain to patient circumstances such as access to care and financial situation, and 6 to patient characteristics/states including skills, abilities, and knowledge. Conclusions Contextual factors in patients’ lives may be essential to address for effective care planning. The rubric developed can serve as a “contextual differential” for clinicians to consider when addressing challenges patients face when planning their care.

Development and Psychometric Testing of Two Tools to Assess Nurse Practitioners’ Provision of Spiritual Care

Purpose: The purpose of this study was to develop and evaluate the psychometric properties of two tools measuring the frequency nurse practitioners (NPs) assess for spiritual need and provide spiritual interventions. Spiritual care provided by NPs has the potential to improve health indicators without increasing costs. Design: Survey design Methods: Concept analysis of the literature supported each item developed for the new assessment and intervention tools. Content validity was tested with six subject matter experts using Lawshe’s method of content validity ratios (CVR). Inter-item correlations further supported convergent and divergent validity of the items with 133 practicing NPs. Cronbach’s alpha supported internal consistency of the tools and subscales. Findings: CVR analysis provided data supporting revision of the original tools. Convergent and divergent validity were also supported for each item. Both the assessment and intervention tools had high Cronbach’s alpha’s that met the required 0.70 for the entire scale and subscales. Conclusions: Both tools and their subscales showed evidence of validity and reliability. Continued research to refine the tools is needed. Implications: The tools can be valuable for assessing NP practice regarding spiritual care within relationship-based and patient centered care.

Impact of patient-centered care innovations on access to providers, ambulatory care utilization, and patient clinical indicators in the veterans health administration

Background: The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement. Methods: This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease. Results: Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site. Conclusion: Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.