Spiritualityin Nursing Education

Currently,the perceptions of health have moved from being a passive state to adynamic process required in the achievement of higher wellnesslevels. In practice, nurses globally need to use four domains in thetreatment of patients. These domains are mental, social, physical andspiritual, where the spiritual domain receives the least attention inevery day nursing practice (Narayanasamy, 2006). To change this,nursing organizations around the world have decision to integratespirituality in the nursing schools curriculum. However, preparingthe university nursing students to adopt the spiritual requirementsof patients continues to be a challenge as far as the nursingeducation programs are concerned. There seems to be insignificantliterature evidence needed in the exploitation of the spiritualrequirements of patients from both the nursing faculty and studentsalike. Therefore, effective training is necessary for the developmentand enhancement of spiritual care among practicing nurses and thenursing students. In this paper, I seek to highlight the meaningspirituality within the nursing professional using differenttheorists including Wilfred McSherry, Barbara Stevens Barnum, andJean Watson. Additionally, I will outline the concept of spiritualcare and the spiritual nursing training and education among nursingstudents associated with these theorists. Lastly, I will highlightthe integration of spiritual nursing curriculum in higher educationinstitutions.

Accordingto Tiesinga etal.(2009), patients normally have a broad variety of physical, social,intellectual, psychological, cultural, emotional, developmental andspiritual needs. Due to this, spiritual care becomes a significantcomponent related to nursing. Chandramohan &amp Bhagwan (2015)believe that the nursing profession is greatly driven byspirituality, which aims at nourishing patient’s spirits andimproving their morale. There is significant evidence indicating thatpatients often consider their nurses as good spiritual informationsources enabling them to fulfill their spiritual need. However, tounderstand fully the concept of spiritual care, spirituality mustundergo address through looking at the works of different theorists.

NursingSpirituality Theorists


Accordingto McSherry, Cash &amp Ross (2004), spirituality is mainlyuniversal. It is also deeply individual and personal. Therefore, thisconcept goes beyond the formal concepts of religious or ritualpractice to include the exceptional capacity related to eachindividual. Spirituality is the center of who human being are anddemands that every individual should experience respect and dignity.Ross etal.(2016) further add that it exceeds intellectual capacity, whichensures that the humanity status is elevated. Therefore, McSherrybelieves that nursing should incorporate the spirituality conceptsince nurses will manage to care effectively for their patients.According to McSherry &amp Ross (2012), spiritual care in thenursing profession is a fundamental and legitimate feature related tothe nursing practice. It is apparent that the spiritual aspect of anypatient’s condition is very subjective. Through this, the patients’understanding of spirituality is dependent o their personal view ofexistence and life. Wu, Tseng &amp Liao (2016) point out that thisway spirituality can undergo interpretation as a functional conceptthat covers several underlying concepts of health care. Even thoughspirituality is not defined exclusively in the field of nursing,efforts have come up to define it in this field. An agreement wasestablished relating to spirituality under palliative care. Accordingto McSherry &amp Ross (2012), spirituality under palliative care isan intrinsic and dynamic feature of humanity. Therefore, under this,individuals seek the ultimate purpose, transcendence and meaning, andenjoy relationships related to others, self, nature, family, society.Through this, it is true that spirituality is expressed throughvalues, beliefs, practices and beliefs (McSherry etal.,2008).

Literatureillustrates a positive connection between the perceptions of nursesregarding spiritual care and spirituality (Timmins &amp Neill,2013). However, Cooper etal.(2013) point out that despite spiritual care being relevant intoday’s nursing practice it is not commonly practiced within thefield. It, therefore, calls for the introduction of the practical andcompetence guidelines associated with spiritual care in today’spractice. It is apparent that the religious or spiritual affiliationand age of many practicing nurses and nursing students formbackgrounds for the degree and manner by which nurses eventuallyprovide spiritual care. McSherry &amp Jamieson (2013) stress on thispoint since they claim that the increased society and health caresecularization causes anxiety among several nurses and createuncertainty about professional practice and personal beliefs.

Further,it is true that the nursing community is filled with a broad range ofspiritual affiliation. McSherry &amp Jamieson (2011) proved this byconducting a survey among four thousand and fifty four British nurseswho has a wide and inclusive comprehension of spirituality,acknowledging that there exists a wide spiritual belief spectrum. Agreat majority of participants pointed out that spiritual care andspirituality can undergo classification as central nursing values orprinciple care. Paley (2007) claimed that these nurses accepted thischaracteristic of care as a significant part of their caringpractices. However, these nurses also expressed a particular lack ofcompetence since they needed further educational preparation andguidance. Therefore, it is evident that the nurses today recognizethe need to practice spiritual care but lack the much-neededknowledge to practice it effectively. McSherry and Jamieson (2011)further claim that with the lack of knowledge on spiritual conceptand spirituality, nurses must experience nursing spiritual guidanceand education to equip them for the future.

Additionally,Timmins &amp McSherry (2012) place emphasis on the importance oforganizational factors in tackling spiritual care and spirituality inhealthcare. According to these scholars, spiritual care andspirituality possess the capacity to transform the values, attitudes,and cultures of organizations (Çetinkaya, Altundağ Dündar &ampAzak, 2013). Therefore, once nursing educational institutionsimplement nursing spiritual education into their curricula, they willensure that the nursing students develop not only in theirprofessional knowhow but also in their spiritual values, cultures andattitudes. The educational institutions must exhibit a sense ofmanagement and leadership when approaching the integration ofspiritual healthcare (Draper &amp McSherry, 2013). Through this,they will ensure that their nursing students perform effectivespiritual care while caring for their patients in real worldsituations.

BarbaraStevens Barnum

Inagreement with Barnum (2010), religion and spirituality are ofteninterconnected. However, it is integral that nurses recognize thevariations that exist between the two concepts. Lewinson, McSherry &ampKevern (2015) claims both spirituality and religion need differentapproaches when it comes to handling them. Barnum (1996) definesspirituality as having a sense of transcendent since it deals withvalues that exceed material world, as well as, it individual-servinggoals. Therefore, spirituality is existential, experimental, andfocuses on the inner most feelings associated with human beings. Onthe other hand, religion is highly personal and despite its point oforigin, it develops in the social institution (Bowers &amp Rieg,2014). According to Barnum (2010), religion constitutes anorganization, which binds individuals together in various ways thatmay include shared beliefs, partly from membership to the communityand shared rituals. Even though this is true, some of these parts mayalso be the component known as spirituality.

Accordingto Barnum (2010), when patients are checking-in in a hospital, theyindicate their religion in the check-in form posing some sort ofsignificance for the individuals caring for them. Even when peoplehave quit going to the church, mosque, temple, or synagogue theynormally list their earlier life religion. With such indications,nurses who practice spirituality have an idea as to how they can carefor the patients since they handle the patient’s unique individualmeaning. Furthermore, this is the same spiritual conviction thatholds individuals without religious affiliations. Even though a nurseencounters an agnostic or atheist, they have humanistic values, whichoffer analogous, but not matching, values in their lives. Thetheories related to spirituality are quite complex making itdifficult for nurses to practice effective spiritual care. Inagreement with Tiew etal.(2013), there are numerous spirituality levels. Individuals havedifferent understanding and sophistication levels related tospirituality. Regularly, such levels manifest in the strategiesindividuals take towards the exercising of their religions. Fornurses to perform effective spiritual care, they should understandthe variant spirituality levels, which will make the patient feelrespected when receiving their care. According to Barnum (2010), thepatients have a sense of respect whenever a nurse connects with them,truly listens and assures the patients that they are being heard.

Despitethe obvious advantages associated with spiritual care, many nurses inpractice have difficulties exercising spiritual care and spiritualitydue to the confusion it presents. They do not have the much-neededexpertise to offer sound advice needed in accompanying their patientson their journey to spirituality (Abbasi etal.,2014). Therefore, it is important for the integration of thespiritual care and spirituality in nursing education since they willexpose the students to the skills needed in handing the spiritualityof their patients. Without a nurse’s knowledge of spirituality,they will not help their patients handle their spiritual journeysmaking it difficult to provide health care.


Watson’stheory underwent development in the period of 1975-1979 emerging fromher own nursing perspective, as well as, her doctoral studies insocial, clinical, and educational psychology (Watson, 1988). Throughher theory, Watson strived to bring emphasis and focus to nursingpractices that involve their values, philosophy, ethic, knowledge andhuman caring. Therefore, the theory of human caring not onlyemphasizes on the physical perspective but the intersubjective,inner, and subjective meaning related to health care. According toWatson (2009), she described human caring practices known as the tencarative factors, which implemented traditional medicine. Over theyears, the theory of human caring has embraced a spiritual focusassociated with transpersonal caring moment. Therefore, spiritualityis the ability to use one spirit to interact with another person(Bani Melhem etal.,2016). With this, Watson believes individuals have the body, soul andminds as the three elements existing within them, which experienceinfluence by self (Watson, 2009). In other words, an individual isboth a spiritual and physical being who is characterized by theirexistence and experience. Achieving harmony in an individual’sbody, soul, and mind can describe health, which entails unifying selfwith the environment and others (Watson, 2009).

Subsequently,Watson describes four primary conceptual components of the emergentand original theory. They include the ten carative factors, caring ofothers and self, transpersonal caring relationship, caring moment,meditative approach, various perspective of knowing (Watson, 2009).Additionally the theory claims caring modifies individuals, othersand environmental cultures, and is circular, inclusive, andexpansive. These conceptual components form the background ofspiritual caring because they employ ethical and moral commitments,which enhance and protect human dignity. They also initiate innerharmony, which helps people to develop relationships that areauthentic and meaningful. According to Watson (1988), spiritualcaring mainly involves caring for everyone found in the universewithout limit and showing love, compassion, and kindness towardspatients in any environment. Through this, the practice of spiritualcaring is capable of establishing healing environments at every levelwith the potential of comfort, peace, beauty, dignity, and wholeness.Hogan, 2009) states nurses need to shape the healthcare system into amore just, equitable, caring, and efficacious care. Therefore, Watsonbelieves that a spiritual conscious nurse can establish healing andcaring environments. With this, the nurse manages to practiceenvironmental regulation ensuring that every healing factor includingprotection, spirituality, and support is present (Nardi &amp Rooda,2011).

Inagreement with Callister etal.(2004), multiple scholars support Watson’s framework that expressestranspersonal relationships, spirituality, and caring fitappropriately within the modern sets of beliefs. Surprisingly,spiritual caring is not an emerging concept. Even though it appearsin the nursing field, it is also unique. Multiple experts andeducators believe spiritual care is an integral component of anursing curriculum (Chiang etal.,2016). Incorporating spiritual care into the nursing higher educationis exclusively significant in the current healthcare environmentbecause of advancements in technology and high patient relationshipthreatens the relationships between nurses and their patients. Whenany university or college adopts the theory of human caring, nursingstudents obtain education, which involves spiritual caring making ita central aspect in the whole curriculum (Ramezani etal.,2016). Therefore, Watson’s model and the concepts found within theframework are utilized in several nursing curriculums presently.Subsequently, when exploring the educational philosophies associatedwith nursing school, they make a common reference to spiritualcaring. Expectedly, Watson’s model of human caring has been adoptedin the University of Colorado. The university is one which Watsonprovides lectures. Therefore, the college is known to belief that thenursing professional is an evidence-oriented practice that istheory-guided and focuses on relationship-centered, holistic caring,which facilitates healing and health. Other universities such as TheCatholic University of America have used the human caring frameworkas a focal point forming their individual theories around her centralbeliefs (The Catholic University of America, 2016). The universityutilized the Quality Caring Framework by Dr. Duffy, which is amid-range model that reflects on a nurse’s unique role associatedwith a health care multidisciplinary system that focuses on a nurse’scaring relationship. Therefore, it is evident that Watson believes inthe integration of spiritual care in nursing education. When this isexercised, students are more likely to develop holistic skills, whichwill ensure that their patients experience harmony in their body,mind and spirit.

SpiritualNursing Integration in Higher Education Institutions

Inthe recent years, the health care institution has recognized theeffectiveness of spirituality in providing healthcare to patients.They have however realized that many of the nurses in practice lackthe awareness of spirituality as far as handling patients areconcerned (Cooper &amp Chang, 2016). To counter this problem, thegovernment has urged higher education institutions to integrate aspiritual care and spirituality curriculum in their normal degreeprograms. According to Dahlin (2015), the availability of spiritualcontent in the nursing education can aid nursing students as well aspracticing nurses to meet the spiritual needs of patients. Thenursing community, therefore, advocates for curricula that helpsnursing students evaluate their individual spirituality, recognize,and come up with interventions needed to help patients experiencingspiritual distress. Similarly, Cone &amp Giske (2013) claims nursingstudents should have lessons that touch on spirituality for them tounderstand the concept greatly. Additionally, the integration ofspirituality in the curricula equips the nursing students withresources and information required for dealing with spirituality(Bani Melhem etal.,2016). Through this, the higher education institutions will enhancetheir nursing student’s ability to offer their patients with themuch-needed spiritual need later in their nursing practice.

Withthe much-popularized need of spirituality in health care, nursingstudents need to have a significant knowledge of spirituality.Therefore, Wynne (2013) claims they should experience significantexposure on the concept both clinically and didactically to meettheir patients spiritual care. Therefore, universities such as theUniversity of Colorado are using Watson’s framework of human caringin their curricula hence preparing their students for theirprofessional career. Despite this, the integration of spirituality inthe nursing education is experiencing some challenges since not onlythe students but also the faculty know so much concerning thespirituality concept (Tiew, Creedy &amp Chan, 2013). Therefore, thenursing institution as a whole should extend their training to thestaff and faculty members so that they properly pass on the desiredinformation to the nursing students. Du Plessis (2016) claims whenthe faculty have proper preparation in the topic of interest,spiritual care will experience proper incorporation within healthcareand ensure that patients are happy with the results. Due to thestress of importance on the spiritual curricula in nursing education,other universities such as the Catholic university of America haveused components of Watson’s theory to develop their individualnursing principles amongst their students. They mainly encouragenurses to grow in a catholic background, thereby, increasingspirituality and eventually ability to care for their patients.According to Wordsworth, Moore &amp Woodhouse (2016), parish nursesmanage to integrate their religious earned spirituality with healthcare meeting the needs of any patient’s spirituality.

Inclosing, despite different interpretations of the concepts ofspirituality care between different theorists, they all agree thatspirituality gives an individual meaning to their life ensuring thatthey feel respected during their time of care. However, with theminimal integration of the spirituality concept, most nurses fail toget in touch with their spirituality and that of their patients.Despite this, the nursing community has considered spiritual nursingintegration to as an essential aspect to health care. Therefore, theyhave look at approaches of incorporating the concept so that nursingstudents develop into holistic nurses.


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