In order for nursing education to prepare nurses for holistic patient care, it is critical that educators become more aware of the religious and spiritual dimensions in patient care and be able to provide adequate knowledge and skills for nurses to offer spiritually-based care in an ethical way. Furthermore, spiritual care is an essential component in the nursing context, as nurses have to care for patients who may often turn to the spiritual dimension to cope and heal. These aspects are important issues to be considered in planning what should be taught as part of spiritual care.
This paper presents findings from a study on nursing practitioners’ views on the role of spiritual care in nursing practice and whether current nursing education has integrated this dimension into teaching.
A descriptive survey using a cross-sectional design with 385 nurses was conducted between December 2012 and February 2013. Participants were recruited through multistage random sampling. Data analysis was undertaken using SSPS 0.20.
All the participants (
The study found that nurses were very accepting of the need for spiritual care as part of their nursing role but that nursing education had not paid adequate attention to integrating this dimension into the nursing curriculum.
Research on health, well-being and spirituality has grown in the Western context, with studies showing that spirituality is an important part of a patient’s life when confronted with illness (Koenig
It has been argued that a failure to incorporate spirituality into nursing care by not addressing the spiritual needs of patients is unethical as spirituality is a part of being human (Miner-Williams
Several authors have noted that nursing education has provided few opportunities for the inclusion of spirituality and spiritual care (
There exists a huge empirical gap in South Africa on spirituality and spiritual care in nursing practice and nursing education. Internationally, however, studies have burgeoned focusing on the views of nursing practitioners and academics with regard to spirituality and spiritual care in nursing practice and education.
This study sought to explore the views of nursing practitioners with regard to the role of spirituality in nursing practice and education. It also sought to explore whether nursing education included spiritual care as part of the academic curriculum for nursing students. This article presents findings on the latter.
The objectives of the study were:
To explore the views of nurses at public hospitals in KwaZulu-Natal regarding the role of spirituality and spiritual care in nursing practice.
To investigate whether nurses utilise spiritually-based activities in nursing.
To investigate whether current education and training has prepared nurses for spiritual care practice.
To meet the spiritual needs of patients, a nurse must be knowledgeable about issues surrounding their religion and spirituality, especially issues that interface with their health, illness and recovery. Incorporating spiritual care into nursing education will effectively prepare nurses to deal with the complexity of providing personalised spiritual care in an increasingly diverse society. Moreover, it will ensure the provision of holistic care that integrates spirituality together with the physical and psychological dimensions of patient care.
Furthermore, spirituality will also be considered as an important pillar alongside the physical and psychological dimensions in nursing care. Spiritual care embraces respect, offering comfort, listening to the patient, instilling hope, prayer and holding the patient’s hand (McSherry & Jamieson
Confronted with helplessness and anxiety experienced as a result of illness many patients seek meaning, hope, love and comfort through human relationships or a transcendent dimension with God (O’ Brien
The present study adopted the Human-To-Human Relationship Model of Travelbee (Hutchinson
Spirituality refers to the presence of a relationship with a Higher Power, a response to a deep and mysterious human yearning for self-transcendence and surrender, a yearning to find our place and the search for existential (McSherry & Jamieson
Research has shown that nurses who are hesitant to provide spiritual care are those who are not in touch with their own spirituality, are confused about the role of the nurse in providing spiritual care, have a lack of knowledge regarding what spiritual care is, and fear imposing their own spiritual or religious preference on patients (Callister et al.
The basic premise underlying the Scope of Practice of the Professional Nurse (R2598 of November 1998, as amended) is that nurses are concerned with the human being as a holistic being (Tjale & De Villiers
Despite a growing body of evidence that indicates the importance of spiritual care in nursing practice, there is little research related to whether spirituality is considered in nursing education (Chism & Magnan 2009:603). A survey was conducted with 223 student nurses in Michigan to investigate their personal level of spirituality and the training received on spiritual care. It was found that 96 (43%) of the student nurses considered themselves spiritual and 190 (85%) acknowledged having a religious affiliation. Only 23 (13%) however indicated being satisfied with their training on spiritual care (Chism & Magnan 2009:600). These findings reflect a void in professional preparedness abroad despite the growing literature that supports the importance of spirituality in nursing care (Chism & Magnan 2009:600; Graham
Graham (
Nathan, Wylie and Marsella (
Amoah (
About 90% of the sample in the current study indicated that the following deserved attention in education, namely, knowledge on whether and how to pray with a patient; appropriate use of therapeutic touch such as holding the patient’s hand; active listening skills; when and how to refer a patient to a priest or religious leader; and how to convey acceptance of the patient’s spiritual beliefs.
A quantitative descriptive design was used to survey professional nurses (
A total of 550 questionnaires were distributed and 385 were returned. The questionnaire included two scales. The first one was The Role of Religion and Spirituality in Social Work Practice, developed by Prof. Sheridan, which was adapted for nurses in this study; whilst the second scale was The Spirituality and Spiritual Care Rating Scale (SSCRS), utilised by McSherry and Jamieson (
These scales, together with the researcher’s own questions gave birth to a new questionnaire. This comprised of closed-ended, open-ended and Likert type matrix questions. The following themes reflected the sub-sections of the questionnaire: demographic details; views with regard to the role of spirituality in nursing practice; the salience of spirituality to patients; spiritual-based interventions; and spirituality in education.
Survey questionnaires were delivered to each of the hospitals by the researcher. Whilst some questionnaires were collected at the end of the same day, some required follow-up visits to collect questionnaires that were completed later. All questionnaires were coded from 1 to 385. Data was entered onto a coded spread sheet using the SPSS version 20.0.
The data was analysed using the statistical software SPSS version 20.0. Descriptive statistics and inferential statistics were applied to the data.
Descriptive statistics describe the organisation and summary of quantitative data and then determine whether the scores on different variables are related to each other (Lind, Marchal & Mason
Pearson’s correlation tests were also conducted. Pearson’s
The population for this study included all 25 440 professional nurses in KwaZulu-Natal who were on the register of the South African Nursing Council (SANC
Multistage random sampling was operationalised in the following way: In stage one KwaZulu-Natal was divided into its 11 districts: eThekwini, uMgungundlovu, UGu, uThukela, uMzinyathi, Amajuba, Zululand, uThungulu, iLembe, Sisonke and uMkhanyakude. Seven of the 11 districts were selected as they have public hospitals that offer practical training for the nursing diploma programme via eThekwini, uMgungundlovu, UGu, uMzinyathi, Amajuba Zululand, and uThungulu.
In stage two, five of these seven districts identified in stage one were selected as these districts have regional/tertiary level public hospitals: eThekwini, uMgungundlovu, uThungulu, UGu and Amajuba. Only one hospital per district was utilised. In the final stage, a sample of 37% of professional nurses per hospital was surveyed as per consultation with the statistician. A total of 550 questionnaires were distributed and 385 questionnaires were returned, which yielded a 77% return rate, which was beyond the norm for a good response rate of between 50% and 60% (Polit & Beck
The survey found that 296 participants (77.1%) received some training on spiritual care in their student years, whilst 88 (22.9%) had received no training at all. Participants were then asked to assess their level of satisfaction with the information received on spirituality. A total of 212 participants (64.2%) reported being somewhat satisfied with the training that they had received on spirituality and spiritual care. However, 118 participants (35.8%) indicated being dissatisfied with the information they received on spirituality during their training.
Nurses were then asked about their training on spirituality and spiritual care after they had qualified. A total of 304 participants (80.2%) indicated that they had no post-qualification training related to spiritual care, whilst 75 (19.8%) indicated that they had received some training or attended workshops that focused on spiritual care.
Participants were asked to comment on what they would like to be included in training. Responses suggested a need for more spirituality workshops and that subject content should include spiritual care content, prescribed and recommended textbooks on spirituality, and seminars on spirituality and spiritual care. As can be seen from
Salience of spirituality to patients.
Statement | Agree | Uncertain | Disagree |
---|---|---|---|
All patients have their own belief in spirituality | 93.5 | 3.1 | 3.4 |
As individuals grow, life experiences increase their spiritual maturity | 82.3 | 13.0 | 4.7 |
Spiritual participation helps protect patients against depression | 82.1 | 13.8 | 4.2 |
Patients who are abused or neglected may especially benefit from spiritual beliefs or practices | 81.3 | 13.0 | 5.7 |
Religious beliefs provide guidelines for behaviours that are beneficial to patients | 80.5 | 14.8 | 4.7 |
Some patients are exceptionally spiritually mature or gifted | 78.7 | 15.8 | 5.5 |
Terminally ill patients search for meaning and purpose in life | 69.4 | 18.7 | 11.9 |
It is not unusual for some patients to have spiritual experiences that influence their lives | 67.6 | 19.3 | 13.1 |
Some patients do not have the cognitive abilities to reflect on spiritual matters | 65.8 | 22.2 | 12.0 |
Some patients experience problems or anxiety due to spirituality that goes unnoticed by nurses | 57.9 | 26.5 | 15.6 |
Hospitalisation is a time of spiritual awareness | 52.3 | 24.5 | 23.2 |
As patients grow older, they lose their natural connection to spirituality Appendix 1 | 20.8 | 14.3 | 64.8 |
The correlation value between ‘nursing education should include content related to spiritual diversity’ and ‘nurses should have more knowledge about spiritual care in nursing’ was 0.253. This suggests strong support for the inclusion of spirituality and spiritual care in nursing practice and the need for more knowledge related to issues of spiritual diversity. Spiritual diversity is interrelated, not only with religious diversity and an understanding of the different faith traditions, but also human diversity issues such as gender and sexuality. This was further supported in the correlation found between ‘nursing education should include content related to spiritual diversity’ and ‘It is important for nurses to have knowledge about different religious faiths and traditions’ (a score of 245), which emphasises that nurses need more information, as part of their education, on spiritual diversity and how issues of health and recovery differ across diverse spiritual perspectives. Attention to alternative and indigenous therapies embedded in diverse cultures should also form part of nurses’ education.
A positive correlation was also found between ‘nursing education should include content on how to deal with spiritual issues in nursing’ and ‘I believe nurses can provide spiritual care by showing kindness, genuine concern and cheerfulness when dealing with patients’ (a score of 442). This reflects that kindness and showing genuine concern are important threads of spiritually-based nursing care and should be emphasised as the core values underpinning spiritual care.
The survey also explored the views of nurses with regards to what topics should be included in their education. They indicated that the following topics should be included in their education, namely, information on different religious faiths and traditions; spiritual diversity; the positive/beneficial role of spiritual beliefs and practices in the lives of patients; salience of spirituality to patients; medical personnel responsible for providing spiritual care; spiritual beliefs related to health and illness; physical and social environments that promote spiritual well-being; the role of spiritual healers in spiritual nursing care; and spiritual interventions.
Spiritual care interventions that needed to be integrated into education included how to pray with a patient; providing quiet time and privacy; facilitating and validating of a patient’s feelings; instilling hope and offering comfort; being physically present; showing respect; find meaning in illness; and finding purpose in one’s life. Effective and comprehensive educational programmes lay the foundation for meaningful learning (Lind, Sendelbach & Steen
Scholars such as Ledger and Bowler (
The Institution Research Ethics Committee (IREC) of the Durban University of Technology provided full ethical clearance for the study. Permission was sought from the hospital managers of the hospitals targeted and from the KwaZulu-Natal Provincial Health Research and Knowledge Management Committee. Participants completed an information and consent form which outlined details of the study and confirmed that there was no risk in terms of participating. They were reassured that they were also free to withdraw from the study, with no repercussions. Anonymity was protected as no identifying details were required. The completed questionnaires and consent forms were placed in sealed boxes by the participants. The sealed boxes were later collected by the researcher. The completed questionnaires were locked in a steel locker.
The Role of Religion and Spirituality in Social Work Practice Scale that was readapted for nurses was tested in three prior studies using Cronbach’s alpha. The scale demonstrated high internal consistency across all these studies, with alpha = 0.88 (Bhagwan
The Spirituality and Spiritual Care Rating Scale (SSCRS), which was the second scale used, also demonstrated consistent levels of reliability and validity with an original Cronbach’s alpha coefficient of 0.64 in other studies (McSherry & Jamieson
To assess the face validity of the newly developed questionnaire, it was first piloted with professional nurses to identify possible problems. The questionnaire was found to be clear and unambiguous.
In general the study found high levels of personal religiosity and spirituality amongst professional nurses; a trend evident within the South African population. Statistics South Africa (
The role of spirituality in nursing practice.
More than 80% of the sample (
A study by Bailey, Moran and Graham (
There were several inquiries into whether such spiritual care is being integrated in nursing care and nursing education. A survey amongst nurses (
Ninety-one percent of the present sample and 95.5% of the sample from McSherry and Jamieson’ s (
Spiritual care training should enhance the competencies of nurses, as well as the spiritual support that patients can be given during their illness (Vlasblom et al.
Thus, nursing educators need to include a wide range of content and experiential learning in the basic nursing curriculum (Deal 2008:4). The spiritual aspects of patient are often overlooked as curricula have become crowded, with an emphasis on new technologies and care. Since 2000 there has however been a resurgence of interest in teaching spirituality and spiritual care to nursing students abroad, which suggests that South African educators should begin considering the same.
The strong support for the role of spirituality in nursing care and education may emanate from the fact that this was a mature sample with significant nursing experience. Their personal spirituality may have led to this, together with the fact that with experience comes a level of comfort in providing spiritually- based care. A significant proportion indicated that they had provided spiritual care despite having had no formal training for this. Spirituality requires specialised knowledge and skills to provide certain special spiritual care activities, as well as discerning between providing nursing care in a way that is ethical and meeting the primary need of patient physical care and well-being. Attention to the growing range of spiritual care activities that can be used as part of holistic care should therefore be considered in nursing education. Whilst it may not be possible to offer a specialised course on spirituality, a gradual interweaving of salient aspects should begin in current nursing education in South Africa.
Data collection was confined to the province of KwaZulu-Natal, which may limit generalisability to the entire South African context. Despite poor participation at one hospital there was a high participation rate at the other hospitals. Furthermore, only questionnaires were used to collect data and perhaps interviews might have added richer data on what to teach specifically and the challenges associated with spiritual care.
The study concluded that nurses needed greater academic preparedness related to spirituality and spiritual care. Attention should be focused on providing ethical interventions and on issues related to praying with the patient, spending time with the patient, supporting, reassuring and listening to the patient, and showing respect for the patient’s spiritual/religious beliefs. Referrals to spiritual or religious leaders should also be deliberated upon. These issues would obviate the barriers to providing spiritual care and the uncertainty on what and how to provide spiritual care. Further careful consideration by educators on what and how to teach is critical. An important starting point however is an earnest reflection on gradually interweaving it into current nursing education.
Despite the potential for it to be interweaved into nursing education, especially given the void in the South African literature, spiritual care is undeniably an important part of a patient’s healing and restoration of hope and recovery. The patient profile is however rather different in South Africa, which warrants special consideration of diverse spiritualties and traditional healing interventions. Research that explores the role of spirituality in the context of patients’ lives is recommended so as to better understand what is needed when providing spiritual care. This study should be considered within the context of planning the new curriculum. For this to happen it is critical that there is a paradigm shift in nursing education and practice in South Africa; practitioners and educators should join the growing momentum abroad related to the provision of spiritually-based nursing care.
Prof. Wilfred McSherry and Dr Sheridan for allowing the researcher to reproduce segments of their questionnaire. The KwaZulu-Natal Department of Health and the Nursing Service Managers of the following hospitals: Greys, Madadeni, Ngwelezane, Port Shepstone and the eThekwini District office for supporting the study. Professional nurses who participated in the survey. Deepak Singh for assistance with data analysis.
The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.
S.C. (KwaZulu-Natal College of Nursing) and R.B. (Durban University of Technology) equally contributed to the research and writing of this article.
Questionnaire on spirituality and spiritual care amongst professional nurses in KwaZulu-Natal
Dear participant
Thank you for your willingness to consider participating in this study. I am very grateful for same.
This survey is being conducted to explore spiritual care amongst professional nurses in KwaZulu-Natal. The survey first asks about the spiritual beliefs of nurses and then about the role of spirituality in nursing practice and nursing education. It includes the use of spiritually-based intervention. If you wish to comment on any question, please feel free to use the space in the margins. Your comments will be read and taken into account. You will need an average of 15 minutes to complete the questionnaire.
This survey uses a questionnaire that has been adapted from the instruments used by McSherry (2011) and Bhagwan (
This project has been reviewed by the Faculty of Health Science Research and Higher Degrees Committee and has received ethical clearance from Durban University of Technology Institutional Research Ethics Committee.
Participation in the study is totally voluntary and you may withdraw from the study whenever you wish. Consent to participate is required and you will have to complete the attached consent form to indicate the same. All information received is confidential and your anonymity is guaranteed as your identifying details are not required. Kindly answer all questions. Should you have any queries kindly contact me at the number provided below or alternatively you can email me.
Kindly complete the consent form provided.
Thank you for your time and participation.
The first section includes questions on demographic and various personal and professional background variables. Please indicate the appropriate response.
To aid you in responding to the following questions, respective definitions of spirituality and religion are provided.
Spirituality is defined as ‘the search for meaning, purpose, and connection with self, others, the universe, and ultimate reality, however one understands it. This may or may not be expressed through religious forms or institutions’.
Religion is defined as ‘an organized structured set of beliefs and practices shared by a community related to spirituality’.
When both spirituality and religion are referred to in one question, answer if either applies, or consider spirituality as inclusive of both religious and non-religious perspectives.
The role of spirituality in nursing practice
The following questions ask your views about the role of spirituality in nursing practice.
Please rate your level of agreement or disagreement with each statement by circling the one number that best reflects your opinion on the five-point scale
Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree
1. Spirituality is a basic aspect of being human.
1
2
3
4
5
2. Nurses should have more knowledge about spiritual care in nursing.
1
2
3
4
5
3. It is important for nurses to have knowledge about different religious faiths and traditions.
1
2
3
4
5
4. Religious concerns are outside of the scope of nursing practice.
1
2
3
4
5
5. Spiritual concerns are outside of the scope of nursing practice.
1
2
3
4
5
6. Nursing practice with a spiritual component has a better chance to empower clients than practice without such a component.
1
2
3
4
5
7. Knowledge of patients’ spiritual beliefs is important for effective nursing practice.
1
2
3
4
5
8. Nurses should be able to assess the positive or
beneficial role of spiritual beliefs and practices in their patient’s
lives.
1
2
3
4
5
9. Nurses should be able to assess the negative or harmful role of spiritual beliefs and practices in their patients’ lives.
1
2
3
4
5
10. The use of spiritual language and spiritual concepts in nursing practice are inappropriate.
1
2
3
4
5
11. The spiritual background of patients does not particularly influence nursing practice.
1
2
3
4
5
12. A nurse’s use of scripture or other spiritual texts in nursing practice are appropriate.
1
2
3
4
5
13. It is against nursing ethics to ever pray with a patient.
1
2
3
4
5
14. The use of spiritual concepts in nursing practice is inappropriate.
1
2
3
4
5
15. It is sometimes appropriate for a nurse to share his or her spiritual beliefs with a patient.
1
2
3
4
5
16. Addressing a patient’s spiritual beliefs is necessary for holistic nursing care.
1
2
3
4
5
17. Nursing education should include content related to spiritual diversity.
1
2
3
4
5
18. Nursing education should include content on how to deal with spiritual issues in nursing.
1
2
3
4
5
For each question please circle one answer which best reflects the extent to which you agree or disagree with each statement.
Strongly Disagree
Disagree
Uncertain
Agree
Strongly Agree
1. I believe nurses can provide spiritual care by arranging a visit by a hospital priest or the patient’s spiritual/religious leader.
1
2
3
4
5
2. I believe nurses can provide spiritual care by showing kindness, genuine concern and cheerfulness when giving care.
1
2
3
4
5
3. I believe spirituality is concerned with a need to forgive and a need to be forgiven.
1
2
3
4
5
4. I believe spirituality involves only going to church/place of worship.
1
2
3
4
5
5. I believe spirituality is not concerned with a belief and faith in a God.
1
2
3
4
5
6. I believe spirituality is about finding meaning in the good and bad events of life.
1
2
3
4
5
7. I believe nurses can provide spiritual care by enabling a patient to find meaning and purpose in their illness.
1
2
3
4
5
8. I believe spirituality is about having a sense of hope in life.
1
2
3
4
5
9. I believe spirituality has to do with the way one conducts one’s life here and now.
1
2
3
4
5
10. I believe nurses can provide spiritual care by spending time with a patient, giving support and reassurance in time of need.
1
2
3
4
5
11. I believe nurses can provide spiritual care by listening to and allowing patients time to discuss and explore their fears, anxieties and troubles.
1
2
3
4
5
12. I believe spirituality is a unifying force which enables one to be at peace with oneself and the world.
1
2
3
4
5
13. I believe spirituality does not include areas such as art, creativity and self-expression.
1
2
3
4
5
14. I believe nurses can provide spiritual care by having respect for privacy, dignity and religious and cultural beliefs of a patient.
1
2
3
4
5
15. I believe spirituality involves personal friendships and relationships.
1
2
3
4
5
16. I believe spirituality does not apply to those who are unsure of God or do not believe in God.
1
2
3
4
5
17. I believe spirituality includes peoples’ morals.
1
2
3
4
5
Listed below are several beliefs about patients’ spiritual capacity and the role of spirituality in their lives. Please rate your level of agreement or disagreement with each statement by circling the one number that best reflects your opinion on the five-point scale.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
1. Hospitalisation is a time of spiritual awareness.
1
2
3
4
5
2 All patients have their own belief in spirituality.
1
2
3
4
5
3. Some patients do not have the mental abilities to reflect on spiritual matters.
1
2
3
4
5
4. Terminally ill patients search for meaning and purpose in life.
1
2
3
4
5
5. Spiritual participation helps protect the patient against depression.
1
2
3
4
5
6. It is not unusual for some patients to have spiritual experiences that influence their lives.
1
2
3
4
5
7 As patients grow older, they lose their natural connection to spirituality.
1
2
3
4
5
8. Some patients are exceptionally spiritually mature or gifted.
1
2
3
4
5
9. Some patients experience problems or anxiety due to spirituality that go unnoticed by nurses.
1
2
3
4
5
10. Religious beliefs provide guidelines for behaviours that are beneficial to patients.
1
2
3
4
5
11. As individuals grow, life experiences increase their spiritual maturity.
1
2
3
4
5
12. Patients who are abused or neglected may especially benefit from spiritual beliefs or practices.
1
2
3
4
5
Please indicate the frequency of which you practice the following in your daily nursing care. Circle one most correct response for each question.
1. Gather information on the patient’s spiritual background.
Never
Rarely
Sometimes
Often
2. Assess a patient’s spiritual interest.
Never
Rarely
Sometimes
Often
3. Recommend spiritual books or writings.
Never
Rarely
Sometimes
Often
4. Pray privately for a patient.
Never
Rarely
Sometimes
Often
5. Pray or meditate with a patient.
Never
Rarely
Sometimes
Often
6. Recommend meditation.
Never
Rarely
Sometimes
Often
7. Use spiritual language or concepts.
Never
Rarely
Sometimes
Often
8. Help a patient verbalise their spiritual values.
Never
Rarely
Sometimes
Often
9. Recommend participation in a spiritual support system, programme, or activity.
Never
Rarely
Sometimes
Often
10. Recommend participation in volunteer social activities.
Never
Rarely
Sometimes
Often
11. Refer a patient to others for spiritual counselling, e.g., minister, priest, rabbi, chaplin or traditional healer.
Never
Rarely
Sometimes
Often
12. Recommend the use of a spiritual diary or journal.
Never
Rarely
Sometimes
Often
13. Recommend spiritual forgiveness, confession.
Never
Rarely
Sometimes
Often
14. Discuss with a patient the role of a spiritual belief system in relation to a significant others.
Never
Rarely
Sometimes
Often
15. Assist a patient to talk about their personal spiritual beliefs or practice.
Never
Rarely
Sometimes
Often
16. Help a patient consider the spiritual meaning of his/her current life situation.
Never
Rarely
Sometimes
Often
17. Help a patient reflect on his/her beliefsabout what happens after death?
Never
Rarely
Sometimes
Often
18. Help a patient reflect on his/her beliefs about death.
Never
Rarely
Sometimes
Often
19. Encourage a patient to discuss spiritual ritual as a
practice intervention. (e.g., house blessings; remembering ancestors;
celebrating life transitions; healing rituals).
Never
Rarely
Sometimes
Often
20. Participate in a patient’s spiritual rituals.
Never
Rarely
Sometimes
Often
21. Encourage patients to consider if spiritual beliefs and practices are helpful.
Never
Rarely
Sometimes
Often
22. Help patients to consider if spiritual beliefs and practices are harmful.
Never
Rarely
Sometimes
Often
23. Share your own spiritual beliefs or views.
Never
Rarely
Sometimes
Often
24. Collaborate with outside spiritual practitioners on behalf of patient.
Never
Rarely
Sometimes
Often
25. Encourage or recommend spiritual expression by the patient e.g. poetry, painting, or music.
Never
Rarely
Sometimes
Often
26. Listen to spiritual experiences or mystical experiences, reported by patient.
Never
Rarely
Sometimes
Often
27. Encourage the patient’s family to support any spiritual interest by the patient.
Never
Rarely
Sometimes
Often
28. Assess if the physical and social environment promotes or prevents the spiritual well-being of the patient.
Never
Rarely
Sometimes
Often