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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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What is This?
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.
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
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.
THE FOUNDATION OF
SPIRITUAL PERSPECTIVES
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.
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.
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.
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
PURPOSE
METHOD
Design
Sample
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
RESULTS
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.
DISCUSSION
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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