Studies investigating spirituality and spiritual care

Additionally, research that targets the spiritual care practices of specialist practitioners has been undertaken – for example, Taylor, Highfield and Amenta (1994) used a questionnaire to determine what spiritual care practices oncology nurses used in their dealings with patients. Frequent practices identified in this investigation were praying with patients, referring to chaplains, and use of presence as well as listening and talking to patients. Taylor et al. (1994) were concerned with the findings because a question mark was raised about the nurses’ commitment to, or confidence in, providing spiritual care, suggesting that this was not as strong as it could be.

Stranahan (2001) examined the spiritual perceptions and practices among nurse practitioners working in a range of clinical situations; interestingly, the term nurse practitioner was not defined. This is important because the term practitioner can have many meanings, given the proliferation in specialist roles. Like Taylor et al.’s (1994) study, this investigation also established that practitioners felt uncomfortable in performing spiritual care. Stranahan (2001, p.100) writes, ‘More than half (57%) of respondents rarely or never provided spiritual care…’

The findings of all these investigations, if taken literally, imply that, despite all the attention and presumed advancement in this area, health care professionals are still struggling to recognize and engage with the concepts. However, these findings may be explained by the fact that many of the practitioners may have been providing spiritual care but not labelling it as such. The danger with elucidating and defining spiritual care is that this area of practice is fragmented and viewed as something separate to the everyday practices that health care professionals perform (Carroll 2001).

While the empirical studies provide a valuable insight into how spirituality may be perceived and defined by specific populations, there was a noticeable lack of comparative studies, comparative in this instance meaning simultaneously contrasting the perceptions of two or more groups of participants – for example, nurses, patients, chaplains, physicians; or studies that have compared the perceptions of the same professional group – for example, nurses working in a variety of specialities such as critical care, palliative care, mental health, learning disabilities. It seems that many of the studies undertaken have targeted a specific group – for example, Narayanasamy, Gates and Swinton (2002) obtained critical incidents from learning disability nurses in an attempt to understand how they meet the spiritual needs of the people for whom they care. This type of research is valuable in that it provides insights into the perceptions and practices of a specific professional group. However, the results cannot be generalized to a wider audience (Carroll 2001).

Reed (1991) used a questionnaire to explore preferences for spirituality related to nursing interventions with terminally ill and non-terminally ill hospitalised adults, contrasting their views with those of well adults. The findings of this investigation emphasized the need for nurses to be sensitive to the spiritual needs of all patients, not just those with a religious belief. Highfield (1992) investigated the spiritual health of oncology patients by contrasting nurses’ and patients’ perspectives. The study revealed that gender differences may be influential in undertaking an assessment of a patient’s spiritual health, because males were less inclined to talk about spiritual issues. Emblen and Halstead (1993) used a descriptive qualitative design to collect interview data to establish how patients, nurses and chaplains defined spiritual needs and interventions. The findings demonstrate a need for nurses and chaplains to work collaboratively in meeting patients’ spiritual needs.

Most of the comparative studies described have been conducted in the US employed quantitative or qualitative methods, or a combination of both, with the exception of Emblen and Halstead (1993) who used grounded theory. Comparative investigations are important because they shed light on the disparities and commonalities in understanding between participant groups. In addition, they provide researchers with an opportunity to explore possible reasons, explanations and potential solutions. The literature search indicates that no additional comparative studies have been undertaken in the US. The literature search reveals also that none was identified that originated within the UK. This is interesting because Ross (1997, p.714), who identified a need for such research having undertaken a pilot study of elderly patients’ perceptions of their spiritual needs and care, writes:

It appears that there is an urgent need for comparative studies to investigate the discrepancies that exist between health care professionals’ and patient groups’ perceptions of spirituality and spiritual care. The results of such investigations could be used to inform future policy initiatives and guidelines that surround spiritual care.

There is a growing expectation in the empirical literature that the composition of study samples should reflect the ethnic and religious diversity that exists within a pluralistic society. With regards to investigating the spiritual dimension, there is a growing realization by researchers that the insights previously developed may not have meaning for individuals from many of the Eastern religions’ traditions who, it seems, have been underrepresented in earlier research. My interpretation of this situation is that there has not been a conscious attempt to exclude such groups. On the contrary, one plausible explanation may be that the samples used have reflected the majority population working or residing in those areas at the time of conducting the investigation.

Besides, there may well have been difficulties in identifying and recruiting individuals from diverse ethnic groups due to language barriers. Other sociological factors may have been operational also – for example, perceptions of authority, how the information will be used and confidentiality if researchers are from the same ethnic group. Having stated this, there is now a pressing need to ensure that future investigations into spirituality and spiritual care do reflect the ethnic and religious diversity that exists within those regions. By including the perceptions of the minority ethnic, religious groups, a richer insight into the concept of spirituality will be gained.

Enhancement of spiritual care practices

One of the central themes identifiable within the empirical literature is linked to the enhancement of spiritual care practices. As indicated, several of the investigations have focused primarily upon the spiritual care interventions of health care professionals who were primarily nurses. The empirical literature appears judgmental of health care professionals who do not demonstrate a familiarity and fluency with the language of spirituality and the practice of spiritual care (Taylor et al. 1995). Enhancement of spiritual care practices can be explained by two subcategories. First, there are those investigations that

Several of the studies reviewed that explored health care professionals’ perceptions of spirituality and spiritual care assume that deficits in relation to the provision of spiritual care may be remedied through education (Harrington 1995; Kuuppelomaki 2001; Taylor et al. 1994, 1995). It is assumed education will remove the discomfort and unease that some health care professionals feel when addressing spiritual needs. However, what is not explored in the educational debates is whether it is ethical to change health care professionals’ perceptions of spirituality. Neither is there any real exploration of the economic or emotional cost of providing spiritual care (Walter 2002). Furthermore, an assumption seems to be made that all health care professionals want to attend, and should be attending to the spiritual needs of service users.