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 Methods and Procedure,
 Results and Discussions
 and Conclusion

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  SPIRITUAL CARE: IMPLICATIONS FOR NURSES’ PROFESSIONAL
RESPONSIBILITY

GILAS 2011 GROUP 29

Luciano O. Coral III, Christopher P. Arth Sengson, Doroteo S. Dizon, Jeremiah S. Buenafe, Dr.
Zenaida S. Fernandez, Milagros C. Si

Adviser: John Smith R.N., M.N.

Key Words: Spritual care, responsibility, spirit, spirituality

Abbreviations: JBLMRH- Jose B. Lingad Memorial Hospital, WHO – World Health

Organization

INTRODUCTION

The needs of the spirit are as critical to health as those individual organs, which make up the body.

-Florence Nightingale

Practicing nurses today are continually confronted with issues of cultural and spiritual
diversity. Although nurses claim to use a holistic approach to patient assessment, the spiritual
aspect is often forgotten and some emphasized that “lack of time”, a focus on physical needs,
low nurse – staffing and high patient acuity also may interfere with the provision of spiritual care
(Taylor, 2002).
Spirituality is an often overlooked, yet still important element of patient assessment and
care. Addressing and supporting patients’ spirituality cannot only make their health care
experiences more positive, but in many cases can promote health, decrease depression, help
patients cope with a difficult illness, and even improve outcomes for some patients (Rieg, 2006).
Spiritual care has long been recognized as an essential component in providing holistic
care to patients. However, many nurses have acknowledged that their education lacked practical
guidelines on how to provide culturally competent spiritual care (Mason, 2006).
Most nurses recognize that spiritual care is an essential component of holistic care.
However, many will acknowledge that it is rarely given the same priority as other dimensions of
care. Not seeing spiritual care as a top priority is cited as a reason for omitting it. However,
another significant barrier that nurses identify is discomfort due to a perceived lack of
competence to provide spiritual care (Page, 2005).
If nurses are expected to provide spiritual care, they must first understand how a person's
worldview relates to his or her personal concept of spirituality. Worldview is defined as a basic
set of beliefs and concepts that work together to provide a more or less coherent frame of
reference for all thought and action. Out of one's worldview, a person evaluates, makes
decisions, and makes meaning and sense of his or her life. Although worldviews may be
categorized in various ways, there are basically two major divisions: theism and naturalism. In
theism, God is the infinite personal Creator and sustainer of the cosmos; in naturalism, it is the
nature of the cosmos itself, which is primary, and God does not exist. Depending on which
worldview a person embraces as the foundation for meaning and purpose in life, it will determine
many of the person's views and beliefs about spirituality, as well as his or her spiritual care needs
(Sire, 1997).
Spirituality is the dimension of a person that involves one's relationship with self, others,
the natural order, and a higher power manifested through creative expressions, familiar rituals,
meaningful work, and religious practices. Spirituality involves finding deep meaning in
everything including illness and death and living life according to a set of values (Cohen, 1993).
Spiritual needs are essential components of spirituality that require development or
reinforcement throughout life. Examples of spiritual needs include hope, meaning in life, and
forgiveness. Spiritual care involves helping people identify and develop their spiritual
perspective and personal awareness of spirituality and its components. Spiritual care is also
helping people meet their spiritual needs (Wright, 1998).
Spirituality is an integral part of being human. An individual's spiritual dimension is
interdependent and interrelated to all other human dimensions including the biological,
psychological, and social. Spirituality as integrated with the physical, social, and emotional is
consistent with the holistic model of nursing. Labun (1988) describes the concept of spirituality
as body, mind, and spirit interrelating to constitute a whole. The characteristics of the spiritual
self-combined with the physical and psychological self respond to situations as a totality instead
of individually, according to Labun. Spirituality is therefore an aspect of a whole person that
influences and interrelates with all other aspects of a person. Spirituality is a much broader
concept than religiosity, although religiosity may be an expression of spirituality. A person's
spiritual dimension may be totally unrelated to religion and not expressed as religious practice
(Preston, 2006). It is also interesting to note that a study found out that doctors who are most
religious are more likely to see the positive influence of religion on their patients (Steenhuysen,
2007).
The aim of the study is to gain insight into the spiritual aspects of nursing care within the
context of health care and to provide recommendations for the development of care and the
promotion of the professional expertise of nurses and evaluate the implications for spiritual care
to nurses’ professional responsibility. Are Filipino nurses, with the noted religiosity of Filipinos,
taking care of the spiritual needs of their patients? With the shortage of nursing manpower and
burgeoning number of patients, are Filipino nurses performing the other planes of their job? With
these questions, the study commences…
The present study aimed to determine the level of spiritual care provided by the nursing staff of
Jose B. Lingad Memorial Regional Hospital (JBLMRH) and its implication for nurses’
professional responsibility.
Specifically, it sought to answer the following questions:
1. How may the nursing staff be described in terms of
1.1 Age
1.2 Gender
1.3 Length of experience as health care provider
2. What is the level of spiritual care provided by the nursing staff of Jose B. Lingad
 Memorial Regional Hospital (JBLMRH)?
3. What is the implication of spiritual care for nurses’ professional responsibility?

METHODS AND PROCEDURES

This study employed the descriptive method of research. Descriptive method of research
involves collecting numerical data to test hypotheses or answer questions concerning current
status. It reveals conditions on relationships that exist or do not exist, practices that prevail or do
not prevail, beliefs or points of view or attitudes that are held or not held, processes that are
going on or otherwise, effects that are being felt or trends that are developing (Rivera, 1999). In
the process, this study evaluated the implication of spiritual care for nurses’ professional
responsibility.
The study was conducted at Jose B. Lingad Memorial Regional Hospital (JBLMRH)
located in City of San Fernando. The respondents of the study were the 30 selected staff nurses
of Jose B. Lingad Memorial Regional Hospital (JBLMRH) .
The researchers utilized 2 types of research instruments namely: questionnaire and
interview. A structured questionnaire was the main instrument used to gather information
regarding the implication of spiritual care for nurses’ professional responsibility. Items included
in the questionnaire were based from a pre-survey done. Respondents from the pre-survey were
asked to list their perceived spiritual roles that they are implementing during their duties. The list
was then collated, tallied and summarized for final review of items and possible revision by pool
of experts regarding the topic. Several Christian Formation instructors and a statistician were
consulted for the said stage of questionnaire validation. The responses for all items were as
follows: 4 – Always; 3 – Often; 2 – Rarely; 1 – Never done it.
The researchers likewise obtained information on how often does the nurses of do their
independent and interdependent spiritual nursing roles thru an interview. Mutual or reciprocal
exchange of verbal information was done thus obtaining subjective information for the study.
Through this, the researchers can check if the data collected using the first research instrument
which is the questionnaire are really true.
The researchers conducted their study using the questionnaire, with appropriate
instructions and these questionnaires were presented to the respondents after getting their
permission to be part of the study. Data were collated for the subsequent interview. The
questionnaire of each respondent was computer-scored. Then, data gathered were classified,
tallied, analyzed and interpreted. Descriptive statistics were used in assessing the data obtained.
These include frequency distribution and percentage and weighted mean. Interpretations were
also identified for each item. The researchers designed arbitrary set to facilitate analysis and
interpretation of findings. Descriptive ratings include Excellent (3.40-4.00), Very Good (2.80-
3.39), Good (2.20-2.79), Fair (1.60-2.19) and Needs Improvement (1.00-1.59).

RESULTS AND DISCUSSION:

 The total number of female respondents is 22 or 73.33% while the remaining 8 or 26.67%
are male. It is interesting to note that a larger proportion (14 out of 30) of the respondents belong
to the 20-30 age bracket while nine (30%) respondents’ ages range from 31 to 40. Only 7 or
23.33% belong to the 41 years old and upper age bracket. The length of service of seven
respondents is for less than a year only while twelve of them have been working in the hospital
for one to five years. Eleven nurse respondents reported working in the institution for six years
or more. It can be noted that the respondents are relatively young in age and in their hospital
experiences.
Table 1 presents how often the staff nurses of Jose B. Lingad Memorial Regional
Hospital (JBLMRH) provide their spiritual care to their patients. As can be gleaned from the
table, item 1 which states “I assess for my client’s religious beliefs and practices” obtained a
weighted mean of 2.83; item 3 which states “I establish environment that promotes free
expression of feelings and concerns, provided calm and peaceful setting” obtained a weighted
mean of 3.10; item 4 which states “ I implement measures to promote a sense of spiritual well-
being is subdivided into 3, item 4.a which states “ I give my client permission to express feelings
and concerns about his/her religious/spiritual beliefs” obtained a weighted mean of 3.13, item 4.b
which states “I maintain a non judgmental attitude about client’s beliefs and any inner conflicts
client is experiencing” obtained a weighted mean of 3.14, item 4.c which states “I encourage the
client to use available spiritual resources” obtained a weighted mean of 2.90. On the other hand,
Item 6 which expresses “I listen to my client’s expression of inability to find meaning in life and
reason for living” obtained a weighted mean of 2.8; item 9 which states “I provide appropriate
spiritual care to my patient” obtained a weighted mean of 2.8; item 12 which states “I give hope
to my patient and his/her family for them to connect with possibilities and realities” obtained a
weighted mean of 2.89; item 13 which states “I allow my patient and his/her family to make their
decisions” obtained a weighted mean of 3.3, and lastly, item 14 which states “I am always
present and respond to the spiritual needs of my patient whether expressed verbally or non
verbally” got a weighted mean of 2.9.
All aforementioned ten statements fall under the “very good” category and this means
that nurses are meeting the spiritual needs of their patients on a high level specially on decision-
making, maintenance of a non-judgmental attitude about client’s beliefs, establishment of a
peaceful environment and the encouragement of their patients to use available spiritual resources
and verbalization of their concerns and feelings.
Other categories were the respondents got “very good” ratings include availability of
their service every time their clients need them, giving hope to their clients and significant
others, lending their ears to listen to their patients’ verbalization of reason of living and the
assessment of their clients’ religious belief and practices.
Item 11 was interpreted “fair”, which means staff nurses of Jose B. Lingad Memorial
Regional Hospital (JBLMRH) do not usually pray with their patient and his/her family.
Nevertheless, if you are going to think of it, it is very easy to do but most of the time, it is usually
overlooked and taken for granted. Items 2, 5, 7, 8, and 10 were all interpreted as “good”
respectively which means staff nurses are doing fine in assessing for signs and symptoms of
spiritual distress. They listen to their client’s expression of anger, concerns oftentimes. They
often assist their client’s in developing goals in dealing with life situations and they often assist
and work closely with their client’s in identifying spiritual needs. But there is still a room for
improvement in this area of care being given by the nurse.
 Table 1. Spiritual Care Provided by Staff Nurses of Jose B. Lingad Memorial Regional Hospital
(JBLMRH) to their patients

4 3 2 1 TO W Interpre
ITEMS TA M tation
F % F % F % F %

1. I assess for my client's religious beliefs and Very

3 10 20 66.67 6 20 1 3.33 30 2.83
practices. Good

2. I assess for signs and symptoms of spiritual distress

(e.g. Verbalization of conflict about beliefs and
relationship with deity, report of anger towards God,
1 3.33 18 60 10 33.33 1 3.33 30 2.63 Good
questioning the purpose of suffering, verbalizing that
illness are a punishment, refusal to participate in usual
religious practices).
3. I establish environment that promotes free
Very
expression of feelings and concerns, provide calm and 9 30 15 50 6 20 - - 30 3.1
Good
peaceful setting.
4. Implement measures to promote a sense of spiritual
being:
a. I give my client permission to express feelings and Very
9 30 16 53.33 5 16.67 - - 30 3.13
concerns about his/her religious/spiritual beliefs. Good

b. I maintain a non judgmental attitude about client's Very

12 40 14 40 4 13.33 2 6.67 30 3.14
beliefs and any inner conflicts client is experiencing. Good

c. I encourage the client to use available spiritual Very

8 26.67 12 40 9 30 1 3.33 30 2.90
resources (e.g., clergy, prayer, religious rituals etc.). Good

5. I listen to my client's and his/her significant other's

3 10 19 63.33 4 13.33 4 13.33 30 2.7 Good
expression of anger, concern, alienation of God etc.
6. I listen to my client's expression of inability to find Very
3 10 19 63.33 7 23.33 1 3.33 30 2.8
meaning in life and reason for living. Good

7. I assist my client to develop goals for dealing with

1 3.33 20 66.67 9 30 - - 30 2.73 Good
life situations.
8. I give immediate attention to the spiritual needs of
2 6.67 20 66.67 7 23.33 1 3.33 30 2.77 Good
my patient.
9. I provide appropriate spiritual care to my patient. 4 13.33 16 53.33 10 33.33 - - 30 2.8
Very
Good
10. I work closely with my patient in identifying
1 3.33 15 50 13 43.33 1 3.33 30 2.53 Good
his/her spiritual needs.
11. I pray with my patient with his/her family. - - 9 30 12 40 9 30 30 2 Fair

12. I give hope to my patient and his/her family for Very

4 1.33 20 66.67 5 16.67 1 3.33 30 2.89
them to connect with the possibilities and realities. Good

13. I allow my patient and his/her family to make their Very

15 50 11 36.67 2 6.67 2 6.67 30 3.3
decisions. Good

14. I am always present and respond to the spiritual

Very
needs of my patient whether expressed verbally or non 5 16.67 17 56.67 8 26.67 - - 30 2.9
Good
verbally.

CONCLUSIONS AND RECOMMENDATIONS:

 Based on the findings of the study, the nurse-respondents are not poor in giving spiritual
care to their patients and this can be attributed to the fact that Philippines is the only Christian
country here in Asia and Filipinos are also known for being spiritually inclined. The nurse-
respondents faired well from all the statements about spirituality except joining the patient and
their family in praying. The nurse-respondents got extremely high ratings in allowing their
patients to make their own decisions, in maintaining a non-judgmental attitude towards their
beliefs and in permitting their patient to express their feelings and concerns about spiritual
beliefs.

Based on the findings also, the researchers found out that spiritual care is an area too
often overlooked. Based from interview of the respondents, lack of education and training into
the spiritual dimension of nursing were major concerns. The provision of spiritual care was seen
as a part of the nurse's role. However, staff nurses did not feel that they had a monopoly over the
situation. It must be emphasized that nurses do have a key role to play in the identification,
assessment, and planning of spiritual care because of their continuous presence in wards.
Therefore, there is a need for providers of health care to develop a team approach in the
provision of spiritual care.

The spiritual dimension needs to be placed firmly within existing nursing curricula.
Nurses should perceive spirituality, as a universal concept, which they feel, is relevant to all
individuals. Nurses should be always be prepared to participate in the provision of spiritual care,
emphasizing the need for a team approach; no individual member of the multidisciplinary team
should have a monopoly in respect to this aspect of care. There should be a fundamental need for
more research investigating nurses' and patients' perceptions of spirituality in order to validate
existing findings and to generate new knowledge and understanding of spirituality. Without
intruding into their personal beliefs and the rule regarding confidentiality in research, nurse
respondents’ religion and involvement to religious activities be factors to be considered in future
studies of this kind.
REFERENCES:

WEBSITES:

http://p-c-f.org/what_we_do/spiritual.php

http://nursesource.org/hospice.html

http://acperesearch.net/spiritual_needs

http://netofcare.org/content/yourneeds/spiritual_needs

Steenhuysen,Julie
http://news.yahoo.com/s/nm/20070409/us_nm/religion_doctors_dc&printer=1;_ylt=AhOa8_
BieRTDgyfPN2CmX6wXIr0F

BOOKS:

Robinson, Simon, Spirituality and The Practice of Healthcare, Palgrave Macmillan, 2003

Wright, Andrew, Spirituality and Education, Routlegde Falmer, 2000

Bantillan, Mary Luz, Filipino Spiritual Culture: Social Transformation and Globalization,
Quezon City: Discalced Carmelite Nuns Monastery of St, Therese, 2003