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Spiritual Care Matters. Making Connections with Spiritual Care Perth, Scotland, 18th May 2010 Dr Beth Seymour and Dr Dorothy Grosvenor. Project Design. An educational activity which took place at Glasgow Caledonian University, 2009/10.
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Spiritual Care Matters Making Connections with Spiritual Care Perth, Scotland, 18th May 2010 Dr Beth Seymour and Dr Dorothy Grosvenor
Project Design • An educational activity which took place at Glasgow Caledonian University, 2009/10. • Five chapters from the Spiritual Care Matters resource book were used teaching and learning about spirituality and spiritual care. Four classes of undergraduate nursing students were introduced to the selected chapters as part of their learning experience. • Module leaders and teaching staff were involved at an early stage of this project. Both paper and electronic copies of the resource book were used. • Evaluation tools were developed and used to ascertain the value of the resource.
Matching Process A selection of chapters from the Spiritual Care Matters resource was matched to the content of specific modules. These chapters and modules were: • Chapter 9 Spirituality, Equality and Diversity matched to Fundamentalsof Nursing 1, year one (n=530) • Chapter 6 Looking after one’s own Spiritual Wellbeing matched to Care of Adults with Complex Needs, year three (n=270) (analysis in progress) • Chapter 1 Introduction and Chapter 2 Spiritual Care: a key concept matched to Spiritual, religious and emotional Health, year three (n=42) • Chapter 5 Spiritual history taking and the use of stories matched to Caring through the arts and humanities, year four (n=18)
Year one The nursing students’ experience of the resource (n=530) : • Lecture October - Students were introduced to Chapter 9 of the resource book in a lecture titled, ‘Foundations of Equality and Diversity’ • Lecture posted on Blackboard – students were able to access lecture with links to chapter 9 as ‘additional material’. • Tutorial October - Chapter 9 was required reading for tutorials (groups n=12) Students were required to have read Chapter 9 to facilitate their participation in the discussion on human values, equality, diversity and spirituality within the two hour session. • Evaluation took place following six weeks of nursing practice. Students were invited to complete the electronic evaluation form and submit it by mid December in a designated box on campus (84 respondents).
Year 4 Chapter 5 ‘Spiritual history taking and use of stories’ was matched the Module ‘Caring through the Arts and Humanities’. Evaluative questions: • What ideas are evident from this chapter? • What have you learned if anything? • How might you use this learning in practice? • Do you see any problems with the ideas/contentin this chapter?
Year 4 Findings • Overall the students felt this chapter was helpful in learning about the importance of spiritual/emotional well-being. • Listening and acting on peoples’ narrative was so important in health care that the whole of the Spiritual Care Matters book should be devoted to it! • Students felt that staff involved in core nursing care/personal care were much more likely to spend time with patients who would tell their stories. • Conversely they felt that the more senior/experienced nurses had too little time available for narrative work with patients as they were busy with technical care and management issues.
Year 4 Continued • Patients’ needs expressed in narratives were often ignored e.g. patients said “I think I am dying” or, “I want to die”. • Listening to narratives “opens up a Pandora’s box...” of personal concerns and professional issues such as competencies, professional accountability and responsibility, time and expertise. • What could nurses deal with themselves and when should they refer people to senior staff or specialists. • Worried that nurses were seen as ‘soft touch’.
Year 4 Continued • Further dilemma: What is spiritual in a person’s narrative? There was no clear understanding of spiritualities. • Students felt “...mental well-being equalled spiritual” • Spiritual not necessarily religious but complex when it was – e.g. Free Church patient was offended when seen by a Roman Catholic chaplain. When spirituality was religious, it was very important not to offend. • Specific education about differing religions/denominations needed.
Continued • However students thought that only about a third of patients gave their religion on admission, the rest said they were atheists. • Students recognised that communication and counselling skills were needed in narrative work. • “How are you...?” a basic communication skill which needs to be used more frequently [as spiritual care]
Spirituality, Equality and Diversity Questionnaire Following 6 weeks of nursing practice an electronic questionnaire to year 1 students asked them to evaluate the following: • Q1. What were you aware of in relation to spirituality, equality and diversity while in practice? • Q2. Spirituality is an integral part of holistic nursing care. What aspects of spirituality did you see in placement?
Continued Students responses 84 (n= 530) were collated under the following broad headings of spiritualities as follows: • 1 Cultural/ religious beliefs and practices; • 2 Specific care needs, especially dying death and bereavement and anxieties about treatment and prognosis; • 3 Nursing care as spiritual care.
Spiritualities as related to Religions beliefs/practices • Many students said they had not seen spirituality in the traditional sense and that it had been hard to see spirituality within placement. • Where people have anxiety with diagnosis and prognosis it was chaplains and other clergy and representatives of other faith traditions involved in spiritual care as follows: • I clearly remember a female patient in and out of the ward who asked to see a minister of the Church [who came to see the patient]. This gave me a real insight into seeing how somebodyʼs spirituality can help them through their diagnosis and prognosis. • A Buddhist, used his spirituality to meditate and chant to enable him to accept his hip replacement into his body.
Continued Nearly all 84 respondents merged spirituality with ethnic diversity and religions generally as follows: • There were multinational patients on the ward with different languages, cultural/religious beliefs with Kosher, Vegetarian & Halal diets required; • This made spiritualities complex. • Spirituality was related to facilitating prayer, attendance at religious services and visits from hospital chaplains or other faith representatives, for example: - one patient asked for a visit by the priest a few times. - local parish news letter sent and read to her (as she could no longer read) and the minister visiting regularly. - the hospital had a quiet room at the hospital chaplaincy.
Spirituality in specific care needs • Students observed spirituality to be positively helpful in nursing people who were dying or bereaved, as well those with anxieties over diagnosis and prognosis: spirituality was more noticeable in residents at the end stages of life. • A student commented that their spirituality was all the patients had to comfort them . • In a recent bereavement a client relied heavily on his faith to help him through.
Spiritual care as nursing care Spirituality was frequently merged with nursing measures as follows: • Part of wellbeing is spiritual and its care is something that is not easy to separate as it comes entwined with other nursing tasks. • In a stroke ward people of 50-90 years old with dementia & learning disabilities no-one outwardly practised religion. • It was felt strongly that nurses shouldTake time to understand-the patient must feel they are a real person, as though they are special and belong.
Spiritual care is ethical care Spiritual care in placements was often merged with ethical aspects such as respect, dignity, not imposing own beliefs, being sensitive, as follows: • [Lots of people had] substance abuse problems (mainly alcohol). • Jehovah Witness signing to refuse blood in a procedure. • Respecting these individual needs posed ethical dilemmas for the students and demonstrate that ethical aspects are frequently integrated with spiritual care.
Q 5 On a scale of 1-10 with I least important and 10 the most important students were asked to list behaviours see see they had seen demonstratedinpractice as follows: Reassurance, Comfort, Peace, Happiness,Forgiveness,Dealing with Guilt, Feeling Valued, Self esteemListening and Being listened to. Results are presented in the pie chart as follows:
Studentresponses Q 5 sample 13 (n= 84)
Level 3 Specialist module: Spiritual, Religious and Emotional Health. Contents Chapter 1. Introduction • 1.1 The spectrum of spirituality • 1.2 Quotations • 1.3 National healthcare policy in Scotland • 1.4 Purpose of document • 1.5 Why spiritual care is necessary and important • 1.6 Spiritual care – is happening already Chapter 2: Spiritual care: a key concept
Level 3 Spiritual, Religious and Emotional Health: Questionnaire Chapter 1. 1.What are the two 21st century extreme points of view about spirituality? 2.Where would you position yourself in the spiritual spectrum and why? 3.Think about the last time that you attended a wedding, funeral, baptism or naming ceremony. In what sense was it meaningful to you? 4.Read the quotes on spirituality on p7 and 8. Which quote do you like best? 5.What are the key ideas underpinning the SGHD publications? 6.Do any of the recent initiatives outlined on pp10-11 help inform your area of practice? Which? Chapter 2. 1.Are there concepts in this chapter that have helped you to clarify your understanding of spirituality? Which? 2.Read the examples in the dark blue boxes in chapter 2. Did they help trigger any examples of spiritual stories in your own experience (either personally or professionally?) Yes/No (please circle) 3.Did you find reading chapters 1 and 2 helpful in learning about spirituality and spiritual care?Ch 1:Yes/No (please circle) Ch 2:Yes/No (please circle)
Q1 and 2: The spiritual spectrum Students were asked to identify from chapter 1 the two 21st century extreme points of view about spirituality (raw materialism and fundamentalist/literalist religion) and position themselves on the spiritual spectrum: • 24 replied they were agnostic and on the materialist side where some expanded to include rational secularism. • Some included they nevertheless felt themselves to be spiritual and to believe in higher powers. • Though these students did not belong to or believe in any religion they respected religion(s). • 11 students said they were fundamentalist though some appeared to confuse being a fundamentalist with being religious. • Others put themselves in the middle of the spectrum as they believed in religion. Three of these students described themselves as Christians. • One student believed in masonic truth, brotherhood & fellowship searching between darkness and light to receive further light.
Q3: The meaning of ceremonies • 9 students attached spiritual/religious meanings to human ceremonies. • Two found Humanist celebrations meaningful. • One student left this question blank and another said there had been no meaning in these ceremonies • The remainder regarded these events as social gatherings where meaning was found and expressed in human relationships as follows: welcoming new babies; celebrating the love of a couple in their commitment to each other; celebrating human love and commitment.
Questions related to Chapter 2 Which concepts in Chapter 2 helped you clarify your understanding of spirituality and spiritual care? • Students said that what helped them to understand/clarify their understanding was that wholeness and relationships related to inner life. • Some mentioned integration of spirituality with religion and some the stories in blue boxes and the cartoons (pp. 20-1).
Q5: Key ideas underpinning the SGHD publications The NHS should implement health board policies on spiritual care and provide: • A spiritual care service; • Spiritual education for all NHS staff; • Improved quality of spiritual care; • Spiritual care to people of faith and no faith; • Culturally competent staff; Students learned that policy makers recognised that: • spiritual care is integral to holistic healthcare; • spiritual care incorporates ethical practice such as respecting dignity, individuality, humanity; compassion
Finally………. Question 3 Did you find reading chapters 1 and 2 helpful in learning about spirituality and spiritual care? • 32 of the 35 students said they had found Chapters 1 and 2 helpful in learning about spirituality and spiritual care. (though of these, three appeared undecided as they circled both Yes and No re Chapter 1)
CONCLUSIONThe students in this study appear to demonstrate the value of the SCM Booklet. They recognised its usefulness in education about spiritual and emotional well-being. Concerns were expressed about defining spiritual care and of professional boundaries and resource limitations. These findings are consistent with current research. As a small study it cannot be generalised more widely. Further research is necessary.
