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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 8-12

Perception of spirituality, spiritual care, and barriers to the provision of spiritual care among undergraduate nurses in the University of Lagos, Nigeria


Department of Nursing Science, Faculty of Clinical Science, University of Lagos, Idi Araba, Lagos, Nigeria

Date of Web Publication23-Feb-2018

Correspondence Address:
Dr. Florence F Folami
Department of Nursing Science, Faculty of Clinical Science, University of Lagos, Idi Araba, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_66_17

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  Abstract 


Background: Spiritual care is an important aspect of holistic care in nursing, and as a result, some nursing schools have begun offering courses in spirituality. Even at that, studies in some countries have shown that nursing students' perception on spirituality and spiritual care was not sufficient and most professional nurses still feel inadequately prepared to provide spiritual care, showing the inadequacy of the education that was received, thus, hindering the patients from receiving holistic care. Objectives: This study has the broad objective of identifying the perception of spirituality and spiritual care and barriers to the provision of spirituality care among undergraduate nurses in the College of Medicine, University of Lagos. Materials and Methods: This is a descriptive cross-sectional study, utilizing stratified random sampling technique. A total of 117 out of 157 students of the nursing department, University of Lagos, ranging from 200 level to 500 level participated in the study. Data were collected using structured self-administered questionnaire, with a reliability coefficient of 0.509, which was validated using face and content method. Analyses were done using Statistical Package for Social Services version 14 and presented using tables, percentages, and pie chart. Results: Result shows that of the respondents, 67.9% scored <50% of the questions pertaining to perception on spirituality and spiritual care. This shows that nurses had poor perception regarding spirituality and spiritual care, with majority (68.7%) of them perceiving spirituality as religion. Barriers to the provision of spirituality care were also identified with “lack of confidence” being the most common. Conclusion: The findings of this research showed that nursing students' perceptions of spirituality and spiritual care was poor which had no relationship with their academic level or kind of religion, thus, showing that the education being provided on this part of holistic care is not sufficient, requiring an in-depth adjustment of nurses' educational curriculum on the aspect of spiritual care.

Keywords: Spiritual care, spirituality, undergraduate nurses


How to cite this article:
Folami FF, Onanuga KA. Perception of spirituality, spiritual care, and barriers to the provision of spiritual care among undergraduate nurses in the University of Lagos, Nigeria. J Clin Sci 2018;15:8-12

How to cite this URL:
Folami FF, Onanuga KA. Perception of spirituality, spiritual care, and barriers to the provision of spiritual care among undergraduate nurses in the University of Lagos, Nigeria. J Clin Sci [serial online] 2018 [cited 2018 May 23];15:8-12. Available from: http://www.jcsjournal.org/text.asp?2018/15/1/8/226040




  Introduction Top


Today, all branches of science support the idea of the holistic approach to people, and consider a person as a whole.[1] Holistic nursing is based on a philosophy of living, and it is grounded in caring, relationship, and interconnectedness. A holistic nurse takes mind-body-spirit-emotion-environment approach to the practice of nursing, recognizing and integrating the principles and modalities of holistic healing into daily life and practice,[2],[3] with the spiritual aspect of health care steadily gaining importance.[4]

Spirituality connects one with the profoundly powerful and divine force that is present in this universe.[5] Whether one is looking for worldly success, inner peace, or supreme enlightenment, no knowledge can propel to achieve their goals and provide as effective a plan for living as does spiritual knowledge.[6] “Spirituality” and “religion” are often used interchangeably, but spirituality does not always imply religiosity, as religion is defined as one aspect of spirituality.[4] Other parts of spirituality care include assessing patients' spiritual beliefs pertaining to health and giving full explanation to patient about his/her state of health, listening to patients' spiritual concerns, and providing patient with soul-lifting literatures.[7] Spirituality is also the practice of love-based attitudes which are integrated into an individual's everyday life.[8]

Those without spiritual lives or fragmented spiritual lives tend to be more fearful, anxious, angry, and depressed.[8] Spiritual care has positive effects on individuals' stress responses, spiritual well-being (i.e., the balance between physical, psychosocial, and spiritual aspects of self), sense of integrity and excellence, and interpersonal relationships. Medical and nursing schools have begun offering courses in spirituality and religion, due to studies that demonstrate the connection between spirituality and health improvement.”[2]

A study carried out in South Africa by Chandramohan and Bhagwan, on spirituality and spiritual care in the context of nursing education in 2015, showed that 77.1% of the participants acknowledged receiving some training on spiritual care in their student years, but most professional nurses still feel inadequately prepared to provide spiritual care, showing the inadequacy of the education that was received.[1] Furthermore, a study carried out in Turkey by Kalkim et al. in 2016[4] showed that nursing students' perception on spirituality and spiritual care was not sufficient, thus recommending educational curricula improvement with respect to spirituality and spiritual care to improve nursing students' perception on spirituality and spiritual care. Barriers to the provision of spirituality care such as lack of time, insufficient knowledge, and different beliefs of both patients and nurses were discovered in a study carried out in Philippine. The study was carried out by Kimmot et al. to explore how student nurses conceptualize spiritual care and render such care.[9]

This study has the objective of identifying the perception of spirituality and spiritual care of undergraduate nurses to help determine the adequacy of the present curriculum with respect to spirituality and spiritual care and barriers to the provision of spirituality care to patients among undergraduate nurses in the College of Medicine, University of Lagos, thus, giving an insight to the problems that needs to be tackled to improve the provision of this care.


  Materials and Methods Top


This is a descriptive cross-sectional study. The study was conducted in Nursing Science Department, College of Medicine University of Lagos, Nigeria. One hundred and seventeen students were recruited using stratified random selection. The students were further divided into stratum based on their level of study, giving a total of 5 strata. The number of participants to be recruited from each stratum was achieved using a proportionate sampling formula.[10]



Where; nh is the calculated sample size

N is the total population size students from 200 to 500 level

Nh is the size of each stratum

After which, the participants were recruited using a random sampling method. Each participant was informed about the objective of the study and their right to decline or accept participation. A structured, self-reported questionnaire was used to collect data, consisting of three tools: tool to elicit information on undergraduate nurses' sociodemographic characteristics which was developed by the researcher, spirituality and spiritual care scale which was adopted from a standard tool, which was used in a research study in 2016 on investigations of perceptions and practices of nursing students regarding spirituality and spiritual care by Kalkim et al., and tool to elicit information on barriers to the provision of spiritual care which was developed by the researcher. The validation was done by the previewing, correction, and evaluation of the instrument by the researchers' supervisor for face and content validity. Due to the fact that the instrument was adapted, a pilot study was carried out to test the reliability of the tool (questionnaire). Ten percent of the sample size was used, arriving at a size of approximately 12. Split-half method was used to calculate the reliability. A reliability coefficient of 0.509 was ascertained.

The questionnaire included sections on sociodemographic characteristics, perception on spirituality and spiritual care, and barriers to the provision of spirituality care. Participants' perception on spirituality and spiritual care was graded based on their individual scores, each correct answer carried one (1) mark and every wrong answer carried zero (0) out of the sixteen (16) questions. Scores <50% was graded as poor perception of undergraduate nurses regarding spirituality and spiritual care while scores above 50% was graded as good perception of undergraduate nurses regarding spirituality and spiritual care. Analysis of the data was done using Statistical Package for Social Sciences (IBM SPSS) 14.0 version. United States; 2009. Chi-square was used to analyze the relationship between some of the demographic characteristics of the students and their perception on spirituality and spiritual care.

An ethical approval was received from the ethical committee at Lagos University Teaching Hospital with the proposal for the purpose of seeking permission. The Health Research Committee (HREC) Assigned Number was: ADM/DCST/HREC/APP/1156.


  Results Top


A total of 117 questionnaires were distributed to assess the perception of spirituality and spiritual care in nursing among undergraduate nursing students of the Department of Nursing. A response rate of 96% was achieved (n = 112) which was adequate for analysis. The result was presented following the study objectives.

Sociodemographic characteristics

[Table 1] describes the sociodemographic characteristics of the 112 students that participated in the study, of which majority, i.e. 104 (92.9%) were within the age range of 17–26 years and most of them, i.e., 67 (59.8%) were from the Yoruba tribe. About one-third of the participants, i.e. 41 (36.6%) were from 400 level class.
Table 1: Sociodemographic characteristics of the students

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Perception on spirituality and spiritual care

[Table 2] shows that most (84%) of the respondent agreed that nurses can provide spiritual care by inviting a religious official in the hospital on patients' demand while 14.2% disagreed and 1.8% were indifferent. Majority (95.6%) of the respondent agreed that nurses can provide spiritual care by acting in a compassionate, concerned, and positive manner while giving care with 0% disagreement to this statement and 4.4% being indifferent. Most (67%) of the respondents disagreed that spirituality is only concerned with a need to forgive and be forgiven, while 20.5% agreed to this and 12.5% were indifferent. [Table 2] shows that majority (80.4%) of the respondents disagreed to the statement “spirituality is not concerned with belief in God or a supreme power and worship” while 13.4% were in agreement and 6.2% were indifferent. Most 83.9% of the respondent were also in disagreement that spirituality involves only going to a place of worship (mosque/church), while 8.0% were indifferent to this. Majority (71.5%) of the respondent were in agreement that spirituality is concerned with finding meaning in the good and bad events of our lives, while 16.1% disagreed to this and 12.4% of them were indifferent. [Table 2] shows the overall perception of nurses regarding spirituality and spiritual care; from the [Table 3], 36 (32.1%) scored above 50% while 76 (67.9%) scored less than 50%, respectively. This shows that nurses have poor perception regarding spirituality and spiritual care.
Table 2: Distribution of respondents' response on perception of spirituality and spirituality care

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Table 3: Overall grade for perception

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Barriers to the provision of spiritual care

[Figure 1] shows that 91% of the respondents agreed that time constraint was a barrier to the provision of spiritual care with only 9% in disagreement to this.
Figure 1: Respondents' response on time constraints as a barrier to the provision of spiritual care

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  Discussions Top



  It Is of Great Importance for Nurse Educators to Know the Spiritual Perspectives of Their Students in Order to Ensure a Connection between What Is Being Taught in Class and What Is Being Practised in the Clinical Area. Top


The result of this study showed that the perception of student nurses on spirituality and spirituality care was poor, which is contrary to a previous study which stated that those who received spiritual care lectures were reported to have higher levels of spirituality and spiritual care [Table 4],[11] which could be as a reason of insufficient information given to the students by the lecturers. Nursing students have a need for more information on spiritual care; this was similar to the result of a study on evaluating nursing students' perception of spirituality and spiritual care carried out in Turkey.[4] When the items in the scale of this study that are related to spirituality were evaluated, it was seen that nurses' perception of spirituality was centered on religion, as majority (68.7%) of the participants agreed that spirituality does not apply to those who do not have a belief in God/supreme power and majority believed that spirituality does not involve areas such as as art, creativity, self-expression (53.6%), and morality (56.2%), respectively, which could be as a result of their lack of adequate information on the definition of spirituality; this finding is in line with studies that had earlier been reported.[12],[13]
Table 4: The relationship between student's religion, academic level, and perception of spirituality and spiritual care

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There was no relationship between the academic level of the participants and their perception on spirituality and spiritual care, implying that even though spirituality had been taught to undergraduate nurses at a particular academic level, it did not change their perception on spirituality and spiritual care, which could be due to the fact that the mode of teaching the topic or the content of the topic being taught is not adequate; this was in contrary to a previous study which showed that nurses with higher educational level had higher perception of spirituality and spiritual care.[12]

Furthermore, there was no relationship between the religion of the students and their perception of spiritual and spirituality care showing that the students' perception on spirituality and spiritual care was independent of the religious group they belonged to, either Islam, Christianity, or any other religious group and as such religious group cannot be seen as a factor that affects or determines their perception on spirituality and spiritual care which was in agreement with a previous study carried out in Iran on Iranian care nurses and spiritual care in 2013.[14]

Previous studies have shown that lack of time,[15] which is a result of reduced nurse-patient ratio, lack of confidence, diversity of patients' spiritual needs, and lack of knowledge in this regard [16] were barriers to the provision of spirituality care to patients, which was consistent with results of this study, with majority (92%) agreeing to the fact that they lack confidence in providing spiritual care to the patients and which could be due to the fact that the knowledge they have on spirituality and spiritual care is not robust enough to boost their confidence in providing this care to the patients, thus, pointing out areas that need more attention, in order to improve the provision of spirituality care, thereby giving patients the opportunity of getting holistic care from the nurse.


  Conclusion Top


The research findings were that nursing students' perceptions of spirituality and spiritual care was poor which had no relationship with their academic level or religion, thus, showing that the education being provided on this part of holistic care is not sufficient, with lack of confidence being the barrier to the provision of spiritual care that was agreed upon by majority of the participants.

Recommendations

  • It is recommended that changes should be made to the educational curricula to improve nursing students' perceptions of spirituality and spiritual care and increase their knowledge on spiritual care to boost their level of confidence in this aspect of nursing care
  • Strategies should be made on how to improve the nurse-patient ratio, to improve the quality of time spent with each patient, thereby providing time to carry out spirituality care.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandramohan S, Bhagwan R. Spirituality and spiritual care in in the context of nursing education in South Africa. Curationis 2015;38:53-9.  Back to cited text no. 1
    
2.
Barlow A. Spirituality in Nursing; 2011. Available from: http://www.allnurses.com/nursing-and-spirituality/spirituality-in-nursing-646693.html. [Last accessed on 2016 Oct 10].  Back to cited text no. 2
    
3.
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[PUBMED]    
4.
Kalkim A, Midilli T, Baysal E. An investigation of the perceptions and practices of nursing students regarding spirituality and spiritual care. Religions 2016:7:101-13. [Doi: 10.3390/rel7080101].  Back to cited text no. 4
    
5.
Klebanoff N, Hess D. Holistic nursing: Focusing on the whole person. Am Nurse Today 2013;8:1-3.  Back to cited text no. 5
    
6.
Janis S. Exploring the Meaning of Spirituality; 2015. Available from: http://www.m.+-Dummies.com/how-to/content/exploring-the-meaning-of-spirituality.html. [Last accessed on 2016 Dec 16].  Back to cited text no. 6
    
7.
Mamier I. Nurses Spiritual Care Practices: Assessment, Type, Frequency and Correlates; 2011. Available from: https://www/reserachgate.net/publication/268157691_NURSES_SPIRITUAL_CARE_PRACTICES_ASSESSMENT_TYPE_FREQUENCY_AND_CORRELATES. [Last accessed on 2016 Nov 20].  Back to cited text no. 7
    
8.
Kurus M. Physical, Emotional, Mental and Spiritual Health; 2015. Available from: http://www.mkprojects.com/fa_ PEMHealth. [Last accessed on 2016 Dec 29].  Back to cited text no. 8
    
9.
Kimmot H, Caranto L, David J. Spiritual care of BSU student nurses. Int J Nurs Sci 2015;5:53-9.  Back to cited text no. 9
    
10.
Salkhind N. Proportionate sampling. Encyclopedia of Research Design: 2010. Available from: http://methods.sagepub.com/Reference/encyc-of-research-design. [DOI: http://dx.doi.org/10.4135/9781412961288].  Back to cited text no. 10
    
11.
Melhem GA, Zeilani RS, Zaqqout OA, Aljwad AI, Shawagfeh MQ, Al-Rahim MA, et al. Nurses' perceptions of spirituality and spiritual care giving: A comparison study among all health care sectors in Jordan. Indian J Palliat Care 2016;22:42-9.  Back to cited text no. 11
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12.
Ozbasaran F, Ergul S, Temel AB, Aslan GG, Coban A. Turkish nurses' perceptions of spirituality and spiritual care. J Clin Nurs 2011;20:3102-10.  Back to cited text no. 12
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Wong KF, Yau SY. Nurses' experiences in spirituality and spiritual care in Hong Kong. Appl Nurs Res 2010;23:242-4.  Back to cited text no. 13
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Tirgari B, Khandani BJ, Forouzi MA. Spiritual care; Iranian care nurses' perception. Asian J Nurs Educ Res 2013;3:262.  Back to cited text no. 14
    
15.
Rushton L. What are the barriers to spiritual care in a hospital setting? Br J Nurs 2014;23:370-4.  Back to cited text no. 15
    
16.
Zakaria Kiaei M, Salehi A, Moosazadeh Nasrabadi A, Whitehead D, Azmal M, Kalhor R, et al. Spirituality and spiritual care in Iran: Nurses' perceptions and barriers. Int Nurs Rev 2015;62:584-92.  Back to cited text no. 16
    


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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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