How to recognize and verbalize spirituality in its diverse expressions?

How to recognize and verbalize spirituality in its diverse expressions?10th Annual Israeli Spiritual Care Confernece for professionals5 6 Nov 2013

Tove Gisketove.giske@haraldsplass.no Associate ProfessorHaraldsplass Deaconess University CollegeBergen, Norway

2Giske; How to recognize & verbalize spirituality2

Bergen, Norway

3Giske; How to recognize & verbalize spirituality3Overview of presentationTheoretical backdropHow to recognize spiritual concerns & resourcesPresentation of spiritual care research how undergraduate nursing students learn Recommendations for universities and clinical practiceGiske; How to recognize & verbalize spirituality4

1. Theoretical backdrop help to think professionally5

Victor FranklCarl JaspersGiske; How to recognize & verbalize spiritualityVictor Frankl & LogoterapiAustrian & American psychiatrist1905 1997Imprisoned in Auschwitz 2nd world warDevelop LOGO THERAPY:Humans seek and can find meaning through:Accomplish somethingBy receivingAn attitude of living through suffering

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Giske; How to recognize & verbalize spiritualityLimit situations - grensesituasjonerCarl Jaspers (1883 1969)German philosopher and psychiatrist

Some situations in life we cannot change he calls them limit situationsIllnessDifferent kinds of lossDeathThreaths of such situations

7Giske; How to recognize & verbalize spirituality7- But also make one wonder and reflect

8Giske; How to recognize & verbalize spiritualityLimit situations can cause pain and suffering8Limit situations make us stopRealise that life cannot be taken for grantedThat I am vulnerable

That my life esily can be over or someone I love/are connected with can die

9Giske; How to recognize & verbalize spirituality9Limit situations can

Lead us to become more aware of what is important in life

Challenge us to reflect more deply about life

Mature us ethically and intelectually10Giske; How to recognize & verbalize spirituality10Have you experienced limit situations?112. How to recognize spiritual concernsPainAgonyQuestionsWonderingRestPeaceMany expressions listen to the meaning for the individual person12

Giske; How to recognize & verbalize spirituality1213WE HAVE TO LISTEN WITH 2 EARS

Giske; How to recognize & verbalize spirituality13

What is the persons concern?And how is it expressed??Who am I?Who loves me?Is there a meaning in what happens?What about guilt am I guilty?How can I live with pain and suffering?How will my future be?

14Giske; How to recognize & verbalize spirituality14What frame of reference do the person have??What aboutfaithView of lifetraditionculturDoes this person have?

15Giske; How to recognize & verbalize spirituality15Art & Science of Spiritual Care16

McSherry & Ross (eds.) (2010) Spiritual Assessment in health care Practice. M&K Publishing

Giske; How to recognize & verbalize spirituality

3. Presentation of spiritual care research amongst undergraduate nursing students

AIM:to determine undergraduate nursing students perspective on spiritual care and how they learn to practice itGiske, T. & Cone P.H. (2012) Opening up to learning spiritual care of patients: A grounded theory study of nursing students. Journal of Clinical Nursing, 21(13-14), 2006 - 2015

17Giske; How to recognize & verbalize spirituality17Participants:8 focus groups with 42 undergraduate students3 1st year3 2nd year2 3rd yearAverage age 25,6 (20 45)Life view30 Christian, 2 religious, 1 Cathlic3 Agnostic, 3 Atheist, 2 Gnostic, 1 Naturalist18Giske; How to recognize & verbalize spirituality18Questions to the focus groups:What is spiritual care?

How do you learn to practice it?

Tell us about your experiences19Giske; How to recognize & verbalize spirituality19AnalysisInterviews transcribed and analysed accoding to Grounded Theory: Constant comparison

CodingOpen codingSelevtive codingTheoretical coding20Giske; How to recognize & verbalize spirituality20

Norwegian context1000 years of Christianity85 % of 5 million belonging to a Christian demonination2nd largest group: Muslims (1,9 %)3rd Norw. Humanistic Association (1,7 %)Most Norwegians believe in God

Faith is seen as private.Taboo to talk about

21Giske; How to recognize & verbalize spirituality21Spiritual care the whatNo clear definitionBeing concerned with the whole person, the soul and what could not be seenReligious faith; reading holy books, prayerSeen as part of nurses responsibility BUTPoorly defined in litterature,Least focused on professionallyWhat nurses knew least aboutSeen few role models in clinical studies22Giske; How to recognize & verbalize spirituality22Participants main concernHow to create a professional relationship with patients and maintain it when spiritual concerns were recognised23Giske; How to recognize & verbalize spirituality23Students solve this concern byOpening up for learning spiritual care3 intertwined phases Learning develope as a spiral through out the nursing training24Preparing for connectionConnecting with and supporting patientsReflecting on experiencesGiske; How to recognize & verbalize spirituality2425Categories Three iterative phasesSub-categories of each phase 1 Preparing for connectionKnowing oneself more deeplyPreparing in class and on your own2 Connecting with and supporting patientsConnecting in mutual vulnerabilitySupporting patients respectfully3 Reflecting on experiencesThinking through what you didSharing experiences with othersGiske; How to recognize & verbalize spirituality4. Recommendations Universities:Separate and clear themes in teaching at universityRepeated focus with increasing complexity throughout the studyChoose methods that promote self-awareness, understanding own spirituality and valuesUse interactive methods - Share examples, use role play, reflect in a safe environment with the support of fellow students and teacherRequirements to read literature - theories and research related to spirituality. Be part of exams26Giske; How to recognize & verbalize spiritualityRecommendations for clinical studiesTeachers can be key person to help students recognize possibilities for learning related to spiritual careUse the rich possibilities for learning the uniqueness in diverse situationsTeachers work together with supervisor in practice to emphasize data collection and interventions including spiritualityFacilitate for students to experience role modelsSupport & challenge students to involve themselves with patients in a respectful mannerCreate time & room for reflection in and after practice

27Giske; How to recognize & verbalize spiritualityBaldacchino D (2006) Nursing competences for spiritual care. Journal of Clinical Nursing 36(7), 14-15.Catanzaro AM & McMullen KA (2001) Increasing nursing students spiritual sensitivity. Nurse Educator 26(5), 221-226.Cone, P.H. & Giske T. (2012) Teaching Spiritual Care A Grounded Theory Study among Undergraduate Nursing Educators. Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2012.04203.xFrankl, V. (2006) Mans search for meaning. An Introduction to Logotherapy. Boston, MA, Beacon Press.Giske, T. (2012) How undergraduate nursing students learn spiritual care in clinical studies a review of literature. Journal of Nursing Management, 20, 10491057Giske, T. & Cone P.H. (2012) Opening up to learning spiritual care of patients: A grounded theory study of nursing students. Journal of Clinical Nursing, 21(13-14), 2006 - 2015Highfield MEF, Johnston Taylor E & Amenta MO (2000) Preparation to care: The spiritual care education of oncological and hospice nurses. Journal of Hospice and Palliative Nursing 2, 53-63.Hoffert D, Henshaw C & Mvududu N (2007) Enhancing the ability of nursing students to perform a spiritual assessment. Nurse Educator 32(2), 66-72.ICN (2000) Code of Ethics. International Council of Nurses [ICN]. Jaspers, K. & Schilpp, P. (1981) The philosophy of Karl Jaspers. La Salle, Open Court.Lemmer C (2002) Teaching the spiritual dimension of nursing care: A survey of U.S. baccalaureate nursing programs. Journal of Nursing Educatio,41(11), 482-490) McSherry W (2006) Making sense of spirituality in nursing and health care practice. An interactive approach (2nd ed.). Jessica Kingsley Publishers, London.McSherry W, Gretton M, Draper P & Watson R (2008) The ethical basis of teaching spiritual care: A survey of student nurses perception. Nurse education Today, 28, 1003-1009.Mitchell DL, Benett MJ & Manfrin-Ledet L (2006) Spiritual development of nursing students: Developing competence to provide spiritual care to patients at the end of life. Journal of Nursing Education 45(9), 365-370.Narayanasamy A (1999) ASSET: A model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285.Narayanasamy A & Owens J (2001) A critical incident study of nurses responses to the spiritual needs of their patients. Journal of Advanced Nursing 33(4), 446-455.Ross L (2006) Spiritual care in nursing: an overview of the research to date. Journal of Clinical Nursing 15, 852-862.Salmon B, Bruick-Sorge C, Beckman SJ & Boxley-Harges S (2010) The evolution of student nurses concepts of spirituality. Holistic Nursing Practice, 24(2), 73-78.Tanyi RA (2002) Towards clarification of the meaning of spirituality. Journal of Advanced Nursing, 39(5), 500-509.Taylor E J (2007) What do I say? Talking with patients about spirituality. Templeton Foundation Press, Philadelphia, PA. Taylor EJ, Mamier I, Bahjri K & Petersen (2009) Efficacy of a self-study program to teach spiritual care. Journal of Clinical Nursing 18(8), 1131-1140.van Leeuwen R & Cusveller B (2004) Nursing competences for spiritual care. Journal of Advanced Nursing 48, 234-246.van Leeuwen R, Tiesinga LJ, Middel B, Post D & Jochemsen H (2008) The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care. Journal of Clinical Nursing 17, 2768-2781.Wallace M, Campbell S, Grossman SC, Shea JM, Lange JW & Quell TT (2008) Integrating spirituality into undergraduate nursing curricula. International Journal of Nursing Education Scholarship, 5(1), article 10.

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