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Western Journal of Nursing Research

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Spiritual Perspectives of Nurses in the United States Relevant for Education and Practice
Roberta Cavendish, Barbara Kraynyak Luise, Donna Russo, Claudia Mitzeliotis, Maria Bauer, Mary Ann McPartlan Bajo,
Carmen Calvino, Karen Horne and Judith Medefindt
West J Nurs Res 2004 26: 196
DOI: 10.1177/0193945903260815

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Western Journal of Nursing Research, 2004, 26(2), 196-212

Western Journal of Nursing Research


March 2004, Vol. 26, No. 2
ARTICLE
10.1177/0193945903260815
Spiritual Perspectives of Nurses
in the United States Relevant for
Education and Practice1

Roberta Cavendish
Barbara Kraynyak Luise
Donna Russo
Claudia Mitzeliotis
Maria Bauer
Mary Ann McPartlan Bajo
Carmen Calvino
Karen Horne
Judith Medefindt

The purpose of the current study was to describe nurses spiritual perspectives as they relate to
education and practice. A multiple triangulation research design encompassing a questionnaire
and a descriptive qualitative content analysis were used with the purpose of capturing a more
complete, holistic, and contextual description of nursesspiritual perspectives. Multiple triangu-
lation included two data sources, two methodological approaches, and nine investigators. Using
survey methods, Reeds Spiritual Perspective Scale (SPS) was sent to 1,000 members of Sigma
Theta Tau International Nursing Honor Society (STTI). Results support Reeds premise that spir-
ituality permeates ones life. Regardless of gender, participants with a religious affiliation had
significantly higher SPS scores than those without one. Nurses having a spiritual base use it in
practice. Six themes emerged from the qualitative analysis: Nurses perceive spirituality as
strength, guidance, connectedness, a belief system, as promoting health, and supporting
practice. The integration of spirituality in nursing curriculums can facilitate spiritual care.

Keywords: spirituality; religion; spiritual care; multiple triangulation

The unmet spiritual needs of patients and families are a cause of angst in
health care settings in the United States where a majority of citizens consider
themselves religious or spiritual (Gallup, 1996; Gallup & Castelli, 1989).

DOI: 10.1177/0193945903260815
2004 Sage Publications
196

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March 2004, Vol. 26, No. 2 197

Because of 20th-century medical advances, the focus of nursing care is more


scientific and technology based. Concurrent with changing models of care is
that the spiritual needs of patients are not consistently being assessed by
nurses; instead, they are being delegated to the chaplain or others (Mayer,
1992; Narayanasamy, 1999b). Providing spiritual care is inherent in nursing
(Chadwick, 1973; Macrae, 1995; Simson, 1986). Nursings commitment to
spiritual care, imbued in the theoretical construct of holistic care, is long
standing and universal (Carson, 1989; Shelly & Fish, 1988). In clinical prac-
tice, the individual is viewed as a whole, and that which affects one dimen-
sion affects all others. Nursing scholars concur with the premise that human
beings function as integrated biopsychosocial and spiritual beings, greater
than the sum of their parts (Banks, 1980; Carson, 1989). With the spiritual
dimension considered core (Banks, 1980), spiritual assessments are integral
to nursing care plans (Shelly & Fish, 1988). Education for nurses spiritual
development, and to meet human responses in the spiritual domain, varies
widely in nursing curriculums (Narayanasamy, 1999b; Van Dover & Bacon,
2001). How to provide spiritual care should be inherent in the nursing curric-
ulum as it was in Nightingales model for nursing education (Macrae, 1995;
Nightingale, 1860/1996; OBrien, 1999). The ability to provide spiritual care
can be learned (Piles, 1990). Nurses perceive that they are ill prepared to pro-
vide spiritual care (Cavendish et al., 2000; Dorff, 1993; Highfield, Taylor, &
Amenta, 2000). Nurses perceptions regarding spiritual care need further
investigation, or the unmet spiritual needs of patients and families will
continue to be a cause of angst in health care settings.

Roberta Cavendish, Ph.D., R.N., C.P.N., is a parent-child health expert, a clinical re-
searcher, and an associate professor in the Department of Nursing at the College of
Staten Island City University of New York; Barbara Kraynyak Luise, Ed.D., R.N., is a spe-
cialist in community health nursing and an associate professor in the Department of
Nursing at the College of Staten Island City University of New York; Donna Russo, M.A.,
R.N., N.P.-P. (Nurse Practitioner, Psychiatric), is the clinical educator for behavioral
health at St. Vincent Catholic Medical Centers; Claudia Mitzeliotis, M.S., R.N.C.S.,
C.A.S.A.C., is a psychiatric clinical nurse specialist at the Veterans Administration New
York Harbor Healthcare System; Maria Bauer, R.N., M.S., is a psychiatric mental health
clinical nurse specialist and an adjunct lecturer in the Department of Nursing at the Col-
lege of Staten Island City University of New York; Mary Ann McPartlan Bajo, R.N., is a
staff nurse on the Neurology Unit at Staten Island University Hospital North, Staten Is-
land, New York; Carmen Calvino, B.S., R.N., is a patient care coordinator, Staten Island
University Hospital, Staten Island, New York; Karen Horne, M.S., R.N., is the director of
Health/Mental Health Services at the Edwin Gould Services for Children and Families in
New York City; Judith Medefindt, B.S., R.N., C.I.C., is nurse epidemiologist at Lutheran
Medical Center (LMC) in Brooklyn, New York.

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198 Western Journal of Nursing Research

THE FOUNDATION OF
SPIRITUAL PERSPECTIVES

Societys sustained interest in spirituality correlates with the numbers of


individuals and families who expect that their spiritual needs will be met in
health care settings (Narayanasamy, 1999b). The ability to meet human re-
sponses in the spiritual domain has re-emerged as a critical concern for nurs-
ing (Barnum, 1996). Registered nurses who conduct patient assessments
and hold primary responsibility for developing plans of care infrequently
conduct spiritual assessments or identify spiritual needs (Narayanasamy,
1999b; Taylor, 2002). To provide spiritual care, nurses must have spiritual
self-awareness and a personal spiritual perspective (Danvers, 1998; Dossey
& Keegan, 2000).
According to Clemen-Stone, Eigsti, and McGuire (1995), Nursing be-
gan when humanity began (p. 2), and the care by a specialized group of
people who are ill has existed throughout time. The importance of the spiri-
tual dimension cannot be underestimated. This component is essential for
integrating lifes demands as well as transcending pain and despair. It allows
patients to confront, wrestle with, and reconcile crises. The way suffering is
perceived then becomes essential for healing, wellness, and celebration.
Nursing clearly identifies the spiritual dimension as part of holistic care, yet
the intent to provide that care is often not put into practice. Opportunities
that have the potential to enhance spirituality for the patient and the nurse are
missed (Cavendish et al., 2000, 2001). Some nurses practice with an infre-
quent or nonexistent spiritual base (Oldnall, 1996). Nurses are often unable
to differentiate spiritual needs from religious needs. Patients spiritual needs
are seen as religious rituals, and spiritual care is often delegated to others
(Narayanasamy, 1999a).

Clarification of the Concepts of Spirituality and Religion

A nurse might legitimately question, In assessing this patients holistic


needs, am I identifying a religious need or a spiritual need? The answer
depends on how the community/nurses/institution use the terms. When
essential care-related words are ill-defined, they can confuse caregivers
(Dyson, Cobb, & Forman, 1997). When nurses have different meanings for
spiritual care, they cannot communicate clearly with each other about
related care needs. For some nurses, spiritual care means helping patients
with maintaining their religious practices and worship. For others, it means
helping patients identify what holds the most meaning in their life and then

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March 2004, Vol. 26, No. 2 199

helping them to transcend the pain and suffering that usually accompanies
illness. When the nurse defines spiritual needs as only religious needs
(including worship and practice aspects), they may omit care for patients
transcendent and relational needs. Omission of spiritual care may occur not
because a nurse lacks interest but rather because the nurse defines spiritual
care narrowly.
Nurses and others on the health care team must define key terms, distin-
guish between spirituality and religion, and use them consistently in prac-
tice, research, and education. Religion and spirituality have some overlap-
ping areas and similarities. Spirituality and religion focus on the sacred or
the divine, both focus on beliefs about the sacred, and both focus on the
effects of those beliefs, with practices used to attain or enhance a sense of the
sacred. With this knowledge, differences can be clarified.

Spirituality defined. Nursing literature defines spirituality as the essence


or life principle of a person (Colliton, 1981), as a sacred journey (Mische,
1982), as the experience of the radical truth of things (Legere, 1984), as giv-
ing meaning and purpose in life (Burnard, 1990; Legere, 1984), as a life rela-
tionship or sense of connectedness with mystery, a higher power, God, or uni-
verse (Bradshaw, 1994; Granstrom, 1985), as a belief that relates a person to
the world (Soeken & Carson, 1987), as a unique human capacity for self-
transcendence that creates a fulfilling relatedness within oneself, with others,
and to the unseen, God, or power greater than the self, and as a unifying and
healing force that centers on relationships, development, wholeness, integra-
tion, and individual empowerment (Reed, 1992). Spirituality is defined as a
universal human phenomenon that recognizes the wholeness of individuals
and their connectedness to a higher being; it is the integrating factor in the
quest for meaning and purpose in life (Cavendish et al., 2000, 2001). Savett
(1997) stated, Spirituality is humanism and then some. In the clinical set-
ting, it is finding meaning in illness and then exploring that meaning. That
process can be therapeutic and healing for the patient and for the healer
(p. 17). One interesting analogy is that spirituality is a force that can be
equated with no other and is as mystifying as the wind in that it cannot be seen
but is always felt in a spectrum of intensity from still, to tranquil or intense.
Spirituality is different for each of us. Spirituality includes prayers, medita-
tion, and the use of positive affirmations to obtain a release from fears and
worries, finding a purpose and meaning in life, and refocusing on the small
joys of everyday life (Benson, 1997). Spirituality is broad and nondogmatic
and involves learning and changing: Its energy flows from inward out in a
process of subjective growth and connection.

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200 Western Journal of Nursing Research

Religion defined. Religion comes from the Latin word, religare: to tie
together one of the organized systems of beliefs, practices, and worship of a
person, group, or community (OConner, 2001). Its energy moves from out-
ward in. This direction is presented through a religions belief system (e.g., in
myths, doctrines, stories, dogma) and is acknowledged when one partici-
pates in other practices and observances. Religion can also offer guidance
about how to live harmoniously with self, others, nature, and their perceived
god(s). Religion, seen as a system of transcending ideas (Reed, 1992,
p. 35), is complementary to spirituality. Religion provides the methods for
the expression of ones spirituality (Engerbretson, 1996; Labun, 1988;
Mayer, 1992; Oldnall, 1996; Reed, 1992). Religion can be seen as a bridge to
spirituality in that it encourages ways of thinking, feeling, and behaving that
help people to experience this sense of meaningfulness. Religious practice is
also a way for individuals, often in the context of sharing a similar orientation
with others, to express their spirituality. Religion includes spirituality, how-
ever a person can be spiritual and not espouse any particular religion or for-
mal practice of religion. From these definitions, religion is a narrower con-
cept than spirituality.

Spirituality in Education and Practice

Research-based findings consistently suggest that nurses knowledge


and skills related to spiritual care is not adequate because of poor role prepa-
ration. A positive correlation exists between the ability of nurses who have
received spirituality education and their ability to provide spiritual care
(Clifford & Gruca, 1987; Harrison & Burnard, 1993; Narayanasamy,
1999b; Piles, 1990). Clifford and Gruca (1987) stressed the need for nurses
to increase their spiritual awareness, indicating that nurses need to start with
self-reflection of their own spiritual values and attitudes if they are to help
others.
Praill (1995) found that nurses who are present during times of patient
distress are more likely to become involved in a patients spiritual care, and
that nurses offered spiritual care out of the center of their own spiritual expe-
rience suggesting that they must cultivate personal spiritual development to
provide spiritual care.
Ross (1994) studied 685 nurses in an attempt to identify factors associ-
ated with giving spiritual care. She discovered that spiritual care could be
given at various levels of involvement with patients. Nurses who responded
at the deepest levels were aware of their own spirituality, had experienced

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March 2004, Vol. 26, No. 2 201

crises in life, and were sensitive people willing to get involved at a personal
level with their patients. In addition, nurses who belonged to a religious
denomination identified patients spiritual needs better than nurses who had
no religious affiliation.
Research results indicate that the nurses perceptions of his or her own
spirituality influences the degree to which patients spiritual needs are iden-
tified and interventions are planned and implemented. Hall and Lanig
(1993) discovered a positive correlation between nurses self-perception of
Christian values and beliefs and their degree of comfort in providing spiri-
tual care. Chadwick (1973) found that many nurses were aware of the pres-
ence of spiritual needs in some of their patients but expressed that they
would like further education in this area. Simson (1986) concurred with
these findings and acknowledged that limited practical guidance is available
for nurses who wish to understand a patients spiritual needs and practices.

Contemporary Practice Guidelines


for Spiritual Care in the United States

The current emphasis on spirituality in society has fueled the demand for
nursing sensitivity regarding the spiritual needs of individuals and families
(Narayanasamy, 1999b). The inconsistency with which nurses provide spir-
itual care is not congruent with the emphasis placed on spiritual care by
nursing codes of conduct and accreditation institutions guides for prac-
tice. Now that expectation for spiritual care has reached global proportions
(Taylor, 2002), the World Health Organization (WHO) (1998) redefined
health. The definition was revised to include spirituality. The four domains
of well-being are physical, mental, social, and spiritual.
In the United States, the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) must accredit all institutions seeking
reimbursement for care rendered for health care organizations. Institution
viability is dependent on satisfactory compliance with JCAHO standards.
The increasing demand for spiritual and religious care prompted the addi-
tion of a spiritual care criterion in accreditation criteria (JCAHO, 2000;
Wright, 1998). This criterion states that (a) institutions must establish guide-
lines for the documentation of assessments of patients spiritual beliefs and
practices, (b) pastoral care must be available for patients who request it, and
(c) hospitals must meet the spiritual needs of dying patients and their fami-
lies. The goal is for the health care provider to assess the importance of spiri-
tuality as it relates to wellness and healing. JCAHO offers sample questions

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202 Western Journal of Nursing Research

to assist nurses in their endeavor to gather necessary information: How


does the patient express spirituality? What are the patients spiritual
goals? and How would the patient describe his or her philosophy of life?
The International Council of Nurses (2000), a federation of national
nurses associations (NNAs), represents nurses in more than 120 countries.
The ICN Code for Nurses serves as the foundation for ethical nursing prac-
tice throughout the world. The American Nurses Association (2002) Code
for Nurses is a guide for nurses ethical conduct in the United States. Both
codes contain congruent statements regarding the nurses role in promoting
an environment of respect for a patients spirituality or religiosity during the
delivery of care. Patients have named nurses as potential spiritual resource
persons (Highfield, 1992; Sodestrom & Martinson, 1987). In the United
States, the American Association of Colleges of Nursing (AACN) (2002)
supports the nursing codes through association mandates to nurse educators.
The how to of spiritual assessments, use of spiritual assessment tools,
nursing diagnoses, interventions, and outcomes are suggested for inclusion
in nursing curriculums. When the dialogue begins in educational programs,
confidence will be gained for articulating patients spiritual needs thereby
raising the nurses comfort level for transferring this theory to practice set-
tings (Altman, 1990).

A Theoretical Guide for Nursing Practice

Parses (1981) model, which is a synthesis of Rogerss (1970, 1980) science


of unitary human beings with concepts from existential-phenomenological
thought, facilitates the explication of lived experiences and the significance
of these experiences to those involved. Parses model is congruent with tri-
angulation methods. Parses man-environment interrelationships facili-
tates the explication of emerging patterns of nurses spiritual perspectives
and participative experiences relating to spirituality in education and prac-
tice. According to Parse, while providing spiritual care the meaning of a
given health situation is guided by the nurse. Appropriate spiritual interven-
tions to meet human responses in the spiritual domain facilitate the patients
process of transcendence. To remain a facilitator of the patients spiritual
health experience, nurses must be aware of their own personal beliefs.
Parse (1993) acknowledged the importance of the nurses being present
in the moment. The interaction between patient, family, and nurse can be a
powerful experience. The goal of spiritual intervention is to enhance quality
of life. One must keep in mind that only the patients can define what qual-
ity is for them: Through true presence in living Parses practice

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March 2004, Vol. 26, No. 2 203

methodology, person and family in the presence of the nurse illuminate


meaning, synchronize rhythms, and mobilize transcendence (p. 18). As the
nurse facilitates the therapeutic process, an ever-changing rhythm will
develop. Through this experience, the patients will be able to share hopes
and dreams as well as their personal belief system.

PURPOSE

This research study describes nurses spiritual perspectives as they relate


to education and practice. The study objectives were to describe the spiritual
perspectives of nurses, identify the educational needs of nurses related to the
spiritual domain, and discuss spiritual care practices.

METHOD

Design

A multiple triangulation research design encompassing a questionnaire


and a descriptive qualitative content analysis were used with the purpose of
capturing a more complete, holistic, and contextual description of nurses
spiritual perspectives (Knafl & Breitmayer, 1989; Thurmond, 2001). Multi-
ple triangulation, more than one data source, methodologies, and nine inves-
tigators served to strengthen the research findings and reduce bias in all
phases of the study (Polit & Hungler, 1995; Thurmond, 2001; Woods &
Catanzaro, 1988). Complementary skills support the data source triangula-
tion methodology. Survey methods (Babbie, 1990; Dillman, 1978) were
used for data collection. The nurses responses to the question, Do you
have any views about the importance or meaning of spirituality in your life
that have not been addressed by the previous questions? constituted the
qualitative data.

Sample

Permission was obtained from Sigma Theta Tau International (STTI)


Nursing Honor Society for a national random sample of 1,000 members. A
cover letter, questionnaire, demographic form, and stamped return envelope
were sent by first-class mail. Data were coded, aggregated, and analyzed as

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204 Western Journal of Nursing Research

group data to maintain confidentiality. Institutional Review Board (IRB)


approval was obtained.
With the N of 545, 55%, the descriptive statistics were run on the demo-
graphic variables. Data analysis indicated that age of participants ranged
from 21 to 61 years. The majority of participants were women (women: n =
533, 97.8%; men: n = 11, 2%) and had completed a BS degree (n = 442,
81%), followed by more than a BS degree (n = 103, 19%). Participants
reported a religious affiliation (n = 541, 99%) that constituted agnostic (n =
14, 2.6%), Buddhist (n = 6, 1.1%), Catholic (n = 201, 37%), Jewish (n = 4,
0.7%), Protestant (n = 222, 40%), and individuals who were self-described
as other (n = 94, 17.2%). The majority of the participants were White (n =
497, 91%), then African American (n = 18, 3.3%), Asian/Pacific Islander
(n = 115, 2.8%), Native American/Alaskan (n = 6, 1.1%), Hispanic (n = 4,
0.7%), and other (n = 4, 0.7%). Marital status reported married (n = 396,
73%), single (n = 96, 17.6%), living with significant other (n = 12, 2.2%),
and (n = 346, 63.6%) had children. Good health status was reported by
almost all (n = 542, 99.4%).

Data Collection

Reeds (1986), Spiritual Perspective Scale (SPS) was used. The SPS is a
10-item questionnaire that uses a 6-point Likert-type scale to measure ones
spiritual perspective. The SPS tool measures an individuals spiritual per-
spective to the degree that spirituality permeates ones life and how one en-
gages in spiritually related interactions, reporting a reliability of Cronbachs
alpha coefficient of .90. Computing an arithmetic mean of the responses
scores the SPS. Scores range from 1 (low spiritual perspective) to 6 (high
spiritual perspective).
The nurses responses to the question Do you have any views about the
importance or meaning of spirituality in your life that have not been ad-
dressed by the previous questions? constituted the qualitative data.

Data Analysis

A Windows 2000 computer program was used for quantitative data entry.
Data were entered as an ASCII file, data cleaning was done, and data were
transformed as indicated. The data were analyzed using the SPSS (Ver-
sion 10.0 for Windows). Parametric and nonparametric statistics were con-
ducted for data analysis. Descriptive statistics were tabulated noting

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March 2004, Vol. 26, No. 2 205

frequencies, percentages, independent sample t tests, and one-way


ANOVAs on demographic data. All statistical analyses were judged based
on the predetermined .05 level of significance.
The qualitative data were derived from the nurses response to the ques-
tion Do you have any views about the importance or meaning of spirituality
in your life that have not been addressed by the previous questions? Quali-
tative data analysis methods included constant comparison of the conceptual
linkages, theme identification, theme reduction, and theme validation
(Munhall & Oiler-Boyd, 1993). Data were coded by extracting verbatim
phrases used to describe spiritual perspectives, spirituality education, and
spiritual practices. Data were analyzed for pattern recognition of concepts.
Each researcher presented written documentation to the research committee.
Themes emerged from the data as commonalities among the codes devel-
oped. Two rounds of analysis were conducted for data reduction and theme
validation by nine nurse researchers who were experienced in the research
method and experts on spirituality.

RESULTS

There was no significant difference in SPS score by gender, t(10.2) =


.571, p = .580, or by age looking at age 40 as a divider t(543) = 1.551, p =
.122, or as age 30 as a divider t(543) = .860, p = .390. In the variable ethnic-
ity, there was no significance in SPS score F(5.538) = .595, p = .704. Look-
ing at White vs. non-White, there was no significant difference t(52.6) =
.288, p = .775. When looking at the variable health in the questionnaire,
there was a significant difference t(2.996) = 8.419, p = .004. By combining
the unhealthy categories, as there are only three total participants between
the two unhealthy categories, there was a significant difference in the SPS
scores of healthy and unhealthy nurses, such that the healthy nurses are less
spiritual t(2.996) = 8.419, p = .027. Marital status was significant. Married
persons show a higher SPS score F(5.539) = 2.558, p = .027, than a single
person or a person living with a significant other (the mean difference of
SPS score is .8219, p = .042). Young (younger than 40 years) and older
(older than 41 years) nurses with a religious affiliation had a higher SPS
score than their counterparts without a religious affiliation, F(5.535) =
17.689, p = .001. A Tukeys post hoc comparison was conducted: The find-
ings indicate that agnostics are significantly lower in spirituality than every
other group in the questionnaire.

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206 Western Journal of Nursing Research

Older nurses are not more likely to have a religious affiliation (approxi-
mately 98% of the participants in the younger and the older categories had a
religious affiliation). The existence of a religious affiliation was more influ-
ential on the SPS score than age for younger (40 years or younger) t(308) =
5.792, p = .001; and for older (41 years or older) t(229) = 6.813, p = .001.
Men and women with a religious affiliation have a significantly higher SPS
score than their same gender counterparts without a religious affiliation.
Religious affiliation was more important for women t(5.28) = 8.102, p =
.001; than for men t(8) = 4.641, p = .002. There is no significant difference in
the SPS score in the variables nursing degree completed, degree type, length
of STTI membership, or years of experience. Findings support Reeds work
that spirituality permeates ones life. The arithmetic mean score for par-
ticipants was (4.9164); standard deviation (.9911); range (1 to 6); and
Cronbachs alpha coefficient (.9459).
Qualitative methods used to analyze the written responses included con-
stant comparison of conceptual linkages, theme identification, theme reduc-
tion, and theme validation. The research question asked, Do you have any
views about the importance or meaning of spirituality in your life that have
not been addressed by previous questions? A total of n = 165, 30.2%, pro-
vided responses to the aforementioned question. Six themes relating to
nurses spiritual perspectives emerged: Spirituality is strength for accep-
tance; spirituality is a belief system; spirituality is guidance; spirituality is
connectedness; spirituality promotes health; spirituality supports practice.
The scientific rigor of qualitative research methods is determined not in
terms of reliability and validity but in terms of creditability, confirmability,
auditability, and fittingness. Creditability is dependent on the researchers
ability to bracket his or her own perspective and on the credibility of the
informants (Bogdan & Bilken, 1982). Research meeting minutes were taken
to log changes and decisions that were made during the analysis process.
Transcriptions of participants comments were reviewed for accuracy. The
criteria for confirmability and creditability were met because the nine expert
nurse researchers analyzed the participants statements and comments. The
criterion for auditability was met because the participants own words have
been explicated from the transcripts to validate the themes.
Trustworthiness was enhanced by nurse researchers consensus for data
reduction and theme development (Guba & Lincoln, 1981). Secondary data
analysis substantiated the results found on the original analysis. The audit
trail was established that consisted of the typed and coded transcripts,
research meeting minutes, the data reduction, and data analysis notes includ-
ing the codes and themes.

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March 2004, Vol. 26, No. 2 207

TABLE 1: Qualitative Findings

Themes and Participants Direct Quotes

Spirituality is strength for acceptance


I have been through several incidents in my life where I should have died, so I
believe I am here for a reason. I believe that things happen the way they are
suppose to according to Gods plan.
When a new life arrives, one knows, there must be a God! However, at times of
death, disease, pain, makes me question why usually with no answer.
Spirituality is a belief system
To me its a philosophy about living and enters into my decisions and outlook on
life.
Spirituality can be very personal as well as very important and does not require
a group.
Spirituality is guidance
Spirituality is what helps me get through the difficult times in my life. It gives me
hope.
If it were not for prayer and my faith I wouldnt have been able to cope with some
of my personal challenges in life. Christ is peace.
Spirituality is connectedness
The meaning of spirituality in my life has had a serious impact on all of my
relationships.
My spiritual connection is my personal relationship with Jesus Christ.
Spirituality promotes health
I feel very strong about the relationship between health and spirituality. They are
related.
Spirituality provides balance and enriches my life.
Spirituality supports practice
My spirituality affects the focus of my care.
Spirituality is an important part of my practice and a part of my inner strength.

DISCUSSION

The current study demonstrated congruence between nurses who re-


ported having a religious affiliation and their ability to meet patients spiri-
tual needs. These nurses had higher SPS scores supporting Reeds (1986)
work that spirituality becomes intrinsic to ones life. The nurse participants
who acknowledged having a spiritual base used it in practice. Because spiri-
tual care has re-emerged as a critical concern for nursing (ONeill & Kenny,
1998), the knowledge of nurses spiritual perspectives can provide a base to
(a) develop and support spirituality educational initiatives in the nursing

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208 Western Journal of Nursing Research

curriculum and (b) strengthen a nurses ability to use information related to


this phenomenon within the nursing process. As facilitator of the patients
nursing care plan, nurses are expected to provide spiritual care. In the United
States, nurses must demonstrate compliance with the JCAHO standards for
spiritual care evaluation and provide evidence via documentation in patient
records. Ethical codes for nursing conduct mandate an environment that
respects diverse beliefs and practices.
The current study supports the integration of an educational component
on spirituality in the nursing curriculum. Educators cannot assume that
nurses have a spiritual foundation for practice that is effective to meet the
spiritual needs of patients. Patients and families report that spiritual needs
are poorly met in health care settings (Carson, 1989; Narayanasamy,
1999b). The majority of participants stated that they do not feel comfortable
dealing with spiritual aspects of care (Granstrom, 1985; Piles, 1990). They
are reluctant to provide spiritual care even though patients may expect spiri-
tual interventions, and such interventions may affect the healing process
(Dossey & Keegan, 2000). The nurses scope of practice supports spiritual
care (Carson, 1989; Oldnall, 1996).
The strength of the current study is the support for Parses (1993) theory
as relevant to guide spiritual care. One of Parses assumptions is that a per-
son who agrees to participate in a study about a particular experience can
share a description of that experience with the researcher. The nurse partici-
pants were able to describe living the experience. Parses theory facili-
tates spiritual care through the use of presence meaning to be with
(Emblen & Halstead, 1993). Presence is a form of spiritual care as it pro-
vides the nurse with a window of opportunity to enter the world of the
patient to give care in the form of empathy and compassion (Gardner, 1992).
There are times during nurse-patient interactions when presence is the only
therapeutic form of intervention that the nurse can provide (Osterman &
Schwartz-Bancrott, 1996). Presence is a purposeful, intended act. The intent
to provide spiritual care was evident in the nurses who were aware of their
spiritual beliefs.
Conclusions from this research reveal that nurses with religious affilia-
tions have higher SPS scores. Nurses having a spiritual base are more likely
to use it in practice. This supports Reeds (1986) work that spirituality per-
meates ones life. One cannot assume nurses have a foundation to provide
spiritual care. The addition of an educational component to the nursing cur-
riculum can facilitate spiritual care for patients and families. Teaching spiri-
tual care concepts to practicing nurses is key to this process. Nurses in the
United States perceive spirituality as strength, guidance, connectedness, a

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March 2004, Vol. 26, No. 2 209

belief system, as promoting health, and as supporting practice. The perspec-


tives identified in the current study can be a catalyst for opportunities to
enhance spirituality in practice settings.

NOTE

1. The members of the Sigma Theta Tau Mu Upsilon Research Committee would like to
express their appreciation to the following: the College of Staten Island Department of Nursing
and the City University of New York for partial funding from a grant provided by the Professional
Staff Congress.

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