Wilfred McSherry

The ethical basis of teaching spirituality and spiritual care: A survey of student nurses perceptions

BACKGROUND There is a professional requirement for student nurses to achieve competence in the delivery of spiritual care. However, there is no research exploring students nurses perceptions of being educated in these matters. AIM This paper explores the ethical basis of teaching student nurses about the concepts of spirituality and spiritual care by reporting the findings from the first year of a 3 year investigation. DESIGN An exploratory longitudinal design was used to obtain student nurses perceptions of spirituality and spiritual care as they progressed through a 3 year programme. METHOD A questionnaire incorporating the Spirituality and Spiritual Care Rating Scale was distributed to 176 pre-registration nursing students undertaking either the Advanced Diploma or Bachelor of Science degree programmes. RESULTS A response rate of 76.7% was obtained. Findings reveal that the majority of student nurses perceived spirituality to be a universal phenomenon of a type that can be associated with existentialism. Some students were very uncertain and apprehensive about being instructed in spiritual matters. CONCLUSION A cohort of student nurses held similar understandings of spirituality to those presented in the nursing literature. However the results also suggest an overwhelming majority felt it was wrong for spirituality to imply that some people are better than others and most were uncertain whether spirituality was related to good and evil. RELEVANCE TO NURSE EDUCATION: The investigation reveals that there are a number of ethical concerns surrounding the teaching of spirituality to student nurses that need to be resolved.

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

AIM The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. BACKGROUND The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. KEY ISSUES Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. CONCLUSIONS Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. IMPLICATIONS FOR NURSING MANAGEMENT The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management20, 7–19 The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim  The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background  The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues  Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions  Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management  The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.

Spirituality in pre-registration nurse education and practice: A review of the literature

Spirituality is known to be an integral part of holistic care, yet research shows that it is not well valued or represented in nurse education and practice. However, the nursing profession continues to make efforts to redress the balance by issuing statements and guidance for the inclusion of spirituality by nurses in their practice. A systematic literature review was undertaken and confirms that nurses are aware of their lack of knowledge, understanding and skills in the area of spirituality and spiritual care, and desire to be better informed and skilled in this area. Consequently, in order for nurses to support the spiritual dimension of their role, nurse education has a vital part to play in raising spiritual awareness and facilitating competence and confidence in this domain. The literature review also reveals that studies involving pre-registration are few, but those available do provide examples of innovation and various teaching methods to deliver this topic in nursing curricular.

The Ability of Hospital Staff to Recognise and Meet Patients’ Spiritual Needs: A Pilot Study

Objectives: We conducted an online cross-sectional survey to determine the understanding of spirituality and spiritual care among clinical and non-clinical staff caring for people with chronic and terminal conditions. Background: As health care moves towards a more person-centred approach, spiritual care has become more important in patients’ care. Recent evidence shows positive associations between addressing patient spiritual needs and health outcomes. Methods: We administered an adapted Spirituality and Spiritual Care Rating Scale (SSCRS), used by the Royal College of Nursing, to hospital and community-care staff (n = 191) in Sydney, Australia. This survey examines perceptions of spiritual care and participant abilities to meet patients’ spiritual needs. Results: The response rate to the SSCRS survey was 84 of 191 eligible participants (44%). Agreement was high on items describing talking to and observing patients and their loved-ones to identify spiritual needs (mean – 90%). However agreement was low concerning items describing the use of data collection tools and talking with colleagues to identify patients’ spiritual needs (mean – 43%). Participants recognised patients’ spiritual needs (mean – 86%), but when asked if they were able to meet these spiritual needs, only 13% (n = 11) stated they were always able to do so. Hence, there was strong agreement on actions for guidance and support for staff dealing with patients’ spiritual and religious issues (n = 71, 85%) and that spiritual care education and training is required (n = 64, 76%). Conclusion: We have identified strong agreement of the importance of delivering spiritual care but uncertainty in the ability to recognise and meet spiritual needs of patients by clinical and non-clinical hospital staff. Our results also show that spiritual care training for hospital staff is now required. Therefore, evidence-based models of spiritual care education and training require further study.

Spiritual care training is needed for clinical and non-clinical staff to manage patients’ spiritual needs

ABSTRACT As health-care moves towards a more person-centred approach, spiritual care has become more important in patients’ care. Recent evidence shows positive associations between both recognizing and addressing patient spiritual needs and health outcomes. Thus, we conducted a cross-sectional survey to determine levels in understanding of patients’ spiritual needs and spiritual care among clinical and non-clinical staff working with people with chronic and terminal conditions. We administered an adapted version of the Royal College of Nursing online Spirituality and Spiritual Care Rating Scale (SSCRS) to hospital and community-care staff. In total, 437 of 2845 eligible staff (15%) responded to the survey. Most participants agreed that spiritual care is fundamental to health care (n = 322, 88%) and that care-giving organizations should provide support for dealing with patients’ spiritual needs (n = 311, 85%). Dementia care staff encountered patient spiritual needs most often (p = 0.0001). While participants recognized patients’ spiritual needs (mean-81%), only 51 (14%) stated they were always able to do so. We show that spiritual care training is needed for all staff having contact with people suffering chronic or terminal conditions. While respondents can identify definitions of spiritual needs, their ability to recognize associated behaviours and meet these needs is uncertain. The findings provide support for further studies to develop an evidence-based model of spiritual care training.

From the struggle of defining to the understanding of dignity: A commentary on Barclay (2016) “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”

We were pleased to see that Barclay (2016) very recently addressed the important issue of dignity in health care. In the paper entitled “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”, the author (Barclay, 2016:136) promotes an understanding and sensitivity for patients’ dignity as ‘core’ outlining critical responsibilities of health care practitioners. This enticing title left us very curious to know more about the philosophical perspective of dignity in health care that the paper purports to offer

The representation of service users' religious and spiritual concerns in care plans

Purpose – The aim of this study was to evaluate the efficacy with which care plans capture and make use of data on the spiritual and religious concerns of mental health service users in a UK Health and Social Care Trust. Design/methodology/approach – A questionnaire was given to service users (n=71) and the findings compared with the information held on their behalf by the relevant Health and Social Care Trust at three key points in the care planning process. Findings – The study found that the importance that many service users accorded to spirituality and religion was not reflected in the electronic records, that some information was wrong or wrongly nuanced when compared with the patients self-description and that service users themselves were often mistaken regarding the type and quality of information held on record. Practical implications – The implications of these findings are discussed in relation to the process of information gathering, to the training and support of Care Coordinators and to th...

“Chaplains for Wellbeing” in Primary Care: A Qualitative Investigation of Their Perceived Impact for Patients’ Health and Wellbeing

Although Health Chaplaincy services are well-established in hospitals in the United Kingdom and across the world, Primary Care Chaplaincy is still in its infancy and much less extensively developed. This study explored the impact the introduction of a Primary Care “Chaplains for Wellbeing” service had upon patients’ experience and perceived health and well-being. Sixteen patients participated in one-one interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA). Patients reported circumstances that had eroded perceived self-efficacy, self-identity, and security manifesting as existential displacement; summarized under the superordinate theme of “loss.” “Loss” originated from a number of sources and was expressed as the loss of hope, self-confidence, self-efficacy, and sense of purpose and meaning. Chaplains used a wide range of strategies enabling patients to rebuild self-confidence and self-esteem. Person-centered, dignified, and responsive care offered in a supportive environment enabled patients to adapt and cope with existential displacement.

A reflective qualitative appreciative inquiry approach to restoring compassionate care deficits at one United Kingdom health care site

BACKGROUND Following declining health care practices at one UK health care site the subsequent and much publicized Francis Report made several far-reaching recommendations aimed at recovering optimal levels of care including stringent monitoring of practice. The aftermath of these deliberations have had resounding consequences for quality care both nationally and internationally. DESIGN A reflective qualitative appreciative qualitative inquiry using a hybrid approach combining case study and thematic analysis outlines the development and analysis of a solution-focused intervention aimed at restoring staff confidence and optimal care levels at one key UK hospital site. Personal diaries were used to collect data. DATA ANALYSIS Data were analysed using descriptive thematic analysis. DISCUSSION The implications of the five emerging themes and the 10-step approach used are discussed in the context of understanding care erosion and ways to effect organisational change. CONCLUSION A novel approach to addressing care deficits, which provides a promising bottom-up approach, initiated by health care policy makers is suggested for use in other health care settings when concerns about care arise. It is anticipated this approach will prove useful for nurse managers, particularly in relation to finding positive solutions to addressing problems that surround potential failing standards of care in hospitals.

Searching for Life Meaning: Spiritual Discourses in Dementia Leadership Using Interpretative Phenomenological Analysis

Background: Dementia is a significant challenge to modern-day health and social care, especially given a rapidly expanding and ageing population. Provision of effective and quality care for people living with dementia and their families is testing health and social care systems that are already financially stretched, with staff shortages and high turnover, while being subjected to higher levels of regulation and scrutiny. Aim: To explore ways in which health and social care professionals understand notions of spirituality in relation to dementia care. Methods: A qualitative phenomenological investigation was undertaken involving a group of 17 health and social care professionals who had completed a Dementia Leadership Programme. Individuals were invited to participate in a semi-structured interview. Participants were presented with a dementia-based scenario detailing a hypothetical patient living with dementia, with their family in crisis. Interpretative phenomenological analysis was utilised to ascertain idiographic, phenomenological insights into each healthcare professionals notion of quality care and addressing higher-level goals for the hypothetical person living with dementia. Results: Spirituality was presented as a major theme in the way participants strove to provide person-centred care. Spirituality was expressed through ensuring the patient remained central to all care provision and care management and by addressing spiritual aspects of care within the initial assessment and providing holistic care and support for the patients family. Person-centred care was considered essential to operationalise priorities of maintaining care at home through innovative and adaptive care, thus promoting patient happiness and quality of life. Conclusion: Participants acknowledged that the challenges associated with providing ‘truly’ holistic and person-centred care can be overcome by focusing specifically upon the personal narrative, biography and story of the individual living with dementia searching through their life meaning and discourse to gain understanding and insight into the uniqueness of the person.