The relationship between nurses’ perceived spiritual care and their attitudes towards delivery of spiritual care to critically ill patients in ICU

Abstract

Background: The term ‘spirituality’ is highly subjective, and there is no commonly accepted universal definition. There is also a lack of clarity in literature on spiritual forms and foundations. Nurses’ perceptions and attitude towards spirituality and spiritual care may thus affect their ability to offer spiritual care to their patients. Indeed, nurses have to reconcile with their own spirituality and beliefs before delivering spiritual care to patients. Purpose: This study aimed to investigate the relationship between the perceived spiritual care of nurses working in Intensive Therapy Unit (ITU) and Cardiac Intensive Care Unit (CICU) and their attitudes towards the delivery of spiritual care to critically ill patients, while exploring any associations between their attitudes.

Methods: To achieve the study’s objectives, a mixed-methods sequential explanatory design was adopted. In the quantitative phase (n=85), ICU nurses were assessed for their level of perceived spiritual care, using the Spirituality and Spiritual Care Rating Scale. Their attitude towards the delivery of spiritual care was further assessed using the Spiritual Attitude and Involvement List. Data was analysed using the Statistical Package for the Social Science (SPSS) version 25. The qualitative phase (n=9) included a focus group discussion, adopting purposive sampling with nurses working in ITU and CICU. Its objective was to explore the nurses’ experiences in delivering spiritual care and associations in attitudes and perceptions of the delivery of spiritual care to critically ill patients in ICU. This data was analysed using the Thematic Analysis framework (Braun & Clarke, 2006). Results: Participants scored significantly high (p=0.001, f=7.578) in spiritual activities and in transcendental experiences (p=0.008, f=5.061). Their frequency in practising prayer was statistically significant (p=0.000, f=7.175) in spiritual activities and meditation (p=0.042, f=2.858) in the subscale ‘trust’. It can thus be concluded that the participants had a positive attitude towards meditation and prayer. It was further reported that the majority of the participants view spirituality in relation to religiosity. According to the demographic data, participants who claimed to be Christians scored the highest percentage (80%), while those who claimed to be Atheists lagged far behind with 8.2%, and other life views stood at 11.8%. Females obtained significantly high scores (p=0.001, f=11.349) in connectedness with nature and caring for others (p=0.008, f=7270). For their part, older participants scored significantly higher in spiritual activities (p=0.019) than their younger counterparts. Therefore, it can be concluded that older nurses perceive themselves as spiritual and deliver spiritual care to others with a positive attitude. In the quantitative findings, 3 main themes emerged. In Creating a supportive environment, the nurses disclosed that physical workload, communication barriers, and lack of privacy hinder the delivery of spiritual care to patients. In Education and professional development, the nurses divulged that they need further education on spirituality and spiritual care, while emphasising the need for collaboration and guidance from other members of the interdisciplinary team, such as, chaplains. Spiritual care and religious belief revolves around personal spirituality, religion, and connection with others. Conclusion: The nurses accentuated the need for further education, support, training, and guidance. Furthermore, they focused on spirituality through their personal experiences of spirituality, while perceiving it in terms of religiosity. Future research should thus be conducted to improve nurses’ perceptions and attitudes towards the delivery of spiritual care to critically ill patients in ICU, possibly with the integration of chaplains and patients in the studies.