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Spiritual care and spirituality in academic nursing training: A scoping review
Cuidado espiritual y espiritualidad en la formación académica en enfermería: revisión de alcance
Cuidado espiritual e espiritualidade na formação acadêmica de enfermagem: revisão de escopo
DOI:
https://doi.org/10.15446/av.enferm.v41n2.108680Keywords:
Nursing, Spirituality, Teaching, Students Nursing (en)Enfermería, Espiritualidad, Estudiantes de Enfermería, Enseñanza (es)
Enfermagem, Espiritualidade, Ensino, Estudantes de Enfermagem (pt)
Objective: To map existing studies in scientific literature addressing spiritual care and spirituality in academic nursing training.
Materials and method: This is a scoping review, whose article search was conducted in July 2023 in the databases Scopus, Medline/PubMed, ScienceDirect, Google® Scholar, and through a manual search of entries in the list of references of selected papers. The following research question was formulated for this study: How are spiritual care and spirituality addressed in academic nursing training? After applying the inclusion and exclusion criteria, the final sample consisted of 45 papers.
Results: The main findings highlight a deficit in academic training, the importance of teachers as facilitators of the teaching-learning process, the essential methodologies to address the issue of spirituality, and the specific competences required in spiritual care, such as communication, empathy, attitude towards the patient’s spirituality, personal support, counseling, and the proper application of the nursing process in this type of care.
Conclusions: This review made it possible to identify how spiritual care and spirituality are addressed in the academic training of nurses, where the insertion of educational resources for spiritual care and approaches based on competences were emphasized. Despite this, spiritual-related teaching is still deficient in academic formation. Studies recommend modifying the curriculum to strengthen competencies related to spirituality and spiritual care in the nursing academy.
Objetivo: mapear los estudios existentes en la literatura científica relacionados con el cuidado espiritual y la espiritualidad en la formación académica en enfermería.
Materiales y método: revisión de alcance realizada en julio de 2023 en las bases de datos Scopus, Medline/PubMed, ScienceDirect, Google® Scholar y por medio de una búsqueda manual en las listas de referencia de documentos seleccionados. Se delimitó la siguiente pregunta de investigación: ¿cómo se aborda el cuidado espiritual y la espiritualidad en la formación académica de enfermería? Tras la aplicación de los criterios de inclusión y exclusión, la muestra quedó conformada por 45 estudios.
Resultados: se identificó un déficit en la formación académica, la importancia de los docentes como facilitadores del proceso de enseñanza-aprendizaje, las metodologías esenciales para abordar el asunto de la espiritualidad y las competencias específicas en el cuidado espiritual, entre las que se cuentan la comunicación, la empatía, la actitud frente a la espiritualidad del paciente, el apoyo personal, el asesoramiento y la correcta aplicación del proceso de enfermería en este tipo de cuidado.
Conclusiones: se identificó la manera en que el cuidado espiritual y la espiritualidad son abordados en la formación de los profesionales en enfermería, donde destaca la adopción de recursos educativos para el cuidado espiritual y el enfoque basado en competencias. No obstante, este tipo de enseñanza aún es deficiente en la formación académica en enfermería. Por ello, algunas investigaciones recomiendan modificar el plan de estudios de los programas en enfermería para fortalecer las competencias relacionadas con la espiritualidad y el cuidado espiritual.
Objetivo: mapear os estudos existentes na literatura científica relacionados ao cuidado espiritual e à espiritualidade na formação acadêmica de enfermagem.
Materiais e método: trata-se de uma revisão de escopo em que a busca foi realizada em julho de 2023 nas seguintes fontes de dados: Scopus, Medline/PubMed, Science-Direct, Google® Scholar e busca manual de documentos em listas de referências dos artigos selecionados. Delimitou-se a seguinte questão de pesquisa: “como o cuidado espiritual e a espiritualidade são abordados na formação acadêmica de enfermagem?”. Após a aplicação dos critérios de inclusão e exclusão, a amostra final foi composta de 45 estudos.
Resultados: os principais resultados encontrados foram o déficit na formação acadêmica; a importância do professor como facilitador do processo ensino-aprendizagem; as metodologias essenciais para abordar o tema, bem como as competências específicas no cuidado espiritual, como a comunicação, a empatia, a atitude perante a espiritualidade do paciente, o apoio pessoal, o aconselhamento e a aplicação adequada do processo de enfermagem nesse tipo de cuidado.
Conclusões: os resultados desta revisão permitem identificar como o cuidado espiritual e a espiritualidade são abordados na formação acadêmica de enfermagem, em que se destaca a inserção de recursos educacionais para o cuidado espiritual e abordagens baseadas em competências. No entanto, esse ensino ainda é deficiente na formação acadêmica. Por isso, alguns estudos recomendam modificar o currículo acadêmico de enfermagem a fim de fortalecer competências relacionadas à espiritualidade e ao cuidado espiritual.
Recibido: 2 de mayo de 2023; Aceptado: 25 de agosto de 2023
ABSTRACT
Objective
To map existing studies in scientific literature addressing spiritual care and spirituality in academic nursing training.
Materials and method
This is a scoping review, whose article search was conducted in July 2023 in the databases Scopus, Medline/ PubMed, ScienceDirect, Google® Scholar, and through a manual search of entries in the list of references of selected papers. The following research question was formulated for this study: How are spiritual care and spirituality addressed in academic nursing training? After applying the inclusion and exclusion criteria, the final sample consisted of 45 papers.
Results
The main findings highlight a deficit in academic training, the importance of teachers as facilitators of the teaching-learning process, the essential methodologies to address the issue of spirituality, and the specific competences required in spiritual care, such as communication, empathy, attitude towards the patient's spirituality, personal support, counseling, and the proper application of the nursing process in this type of care.
Conclusions
This review made it possible to identify how spiritual care and spirituality are addressed in the academic training of nurses, where the insertion of educational resources for spiritual care and approaches based on competences were emphasized. Despite this, spiritual-related teaching is still deficient in academic formation. Studies recommend modifying the curriculum to strengthen competencies related to spirituality and spiritual care in the nursing academy.
Keywords
Nursing, Spirituality, Teaching, Students Nursing.RESUMEN
Objetivo
Mapear los estudios existentes en la literatura científica relacionados con el cuidado espiritual y la espiritualidad en la formación académica en enfermería.
Materiales y método
Revisión de alcance cuya búsqueda se realizó en julio de 2023 en las bases de datos Scopus, Medline/PubMed, ScienceDirect, Google® Scholar y por medio de una búsqueda manual en las listas de referencia de documentos seleccionados. Se delimitó la siguiente pregunta de investigación: ¿cómo se aborda el cuidado espiritual y la espiritualidad en la formación académica de enfermería? Tras la aplicación de los criterios de inclusión y exclusión, la muestra final estuvo conformada por 45 estudios.
Resultados
Los principales resultados señalan un déficit en la formación académica, la importancia de los docentes como facilitadores del proceso de enseñanza-aprendizaje, las metodologías esenciales para abordar el asunto de la espiritualidad y las competencias específicas en el cuidado espiritual, entre las que se cuentan la comunicación, la empatía, la actitud frente a la espiritualidad del paciente, el apoyo personal, el asesoramiento y la correcta aplicación del proceso de enfermería en este tipo de cuidado.
Conclusiones
Esta revisión permitió identificar la manera en que el cuidado espiritual y la espiritualidad son abordados en la formación académica de los profesionales en enfermería, donde destaca la adopción de recursos educativos para el cuidado espiritual y el enfoque basado en competencias. No obstante, este tipo de enseñanza aún es deficiente en la formación académica en enfermería. Por ello, algunas investigaciones recomiendan modificar el plan de estudios de los programas en enfermería con el fin de fortalecer las competencias relacionadas con la espiritualidad y el cuidado espiritual.
Palabras clave
Enfermería, Espiritualidad, Enseñanza, Estudiantes de Enfermería.RESUMO
Objetivo
Mapear os estudos existentes na literatura científica relacionados ao cuidado espiritual e à espiritualidade na formação académica de enfermagem.
Materiais e método
Trata-se de uma revisão de escopo em que a busca foi realizada em julho de 2023 nas seguintes fontes de dados: Scopus, Medline/PubMed, ScienceDirect, Google® Scholar e busca manual de documentos em listas de referências dos artigos selecionados. Delimitou-se a seguinte questão de pesquisa: "como o cuidado espiritual e a espiritualidade são abordados na formação acadêmica de enfermagem?". Após a aplicação dos critérios de inclusão e exclusão, a amostra final foi composta de 45 estudos.
Resultados
Os principais resultados encontrados foram o déficit na formação acadêmica; a importância do professor como facilitador do processo ensino-aprendizagem; as metodologias essenciais para abordar o tema, bem como as competências específicas no cuidado espiritual, como a comunicação, a empatia, a atitude perante a espiritualidade do paciente, o apoio pessoal, o aconselhamento e a aplicação adequada do processo de enfermagem nesse tipo de cuidado.
Conclusões
Os resultados desta revisão permitem identificar como o cuidado espiritual e a espiritualidade são abordados na formação acadêmica de enfermagem, em que se destaca a inserção de recursos educacionais para o cuidado espiritual e abordagens baseadas em competências. No entanto, esse ensino ainda é deficiente na formação acadêmica. Por isso, alguns estudos recomendam modificar o currículo acadêmico de enfermagem a fim de fortalecer competências relacionadas à espiritualidade e ao cuidado espiritual.
Palavras-chave
Enfermagem, Espiritualidade, Ensino, Estudantes de Enfermagem.Introduction
Spiritual care is often conceptualized as a form of assistance aimed at addressing and satisfying the existential and spiritual demands and dilemmas associated with illness and crisis situations. Spirituality is defined as a set of beliefs and experiences of an abstract nature, based on the quest to understand the purpose of life in a context that surpasses the limitations of conventional understanding, which may or may not be associated with belief systems or religious practices (1, 2).
A study shows that the incorporation of the spiritual dimension in health care practice strengthens the deployment of an integral approach, thus upgrading the levels of humanization in health. Considering the potential impact of spirituality on improving disease conditions and a patient's quality of life, it becomes essential that nursing professionals are trained to explore this aspect within the scope of care (3).
Nurses are the closest care providers to the patient. Consequently, they are more likely to find patients with spiritual needs. It is necessary for these professionals to perform spiritual assessments, identify spiritual suffering, and provide spiritual support to patients to achieve the best nursing outcomes. However, nurses find it difficult to provide spiritual care due to the lack of nursing education and training in this dimension (4).
Being aware of the importance of a comprehensive approach to care, it is essential to understand the reasons for this dimension to be neglected. Nursing education still lacks an ongoing discussion on how students can learn to evaluate and address patients' spiritual needs. As reported by some studies, the academic population of nursing courses is characterized by an insufficient emphasis on spirituality, both in nursing education and in clinical practice. In addition, health care nurses have also reported a lack of knowledge and skills to provide spiritual support to their patients (5, 6 ).
The nursing classification and diagnosis system known as NANDA-International, which qualifies care and is part of the training base of the nursing academy, describes and allows the operationalization of important diagnoses related to spiritual care, such as risk for spiritual distress (00067), readiness for enhanced spiritual well-being (00068), and Spiritual distress (00066) (7). This reinforces the scientific and care relevance of teaching about spiritual care and spirituality for future nurses.
In this context, it is necessary to discuss and study the approach of spiritual care and spirituality in academic training based on research evidence and reviews that seek a better understanding not only of the concepts, but on how spiritual care can be taught, what competences are necessary for its teaching, and what studies and research on this subject are actually valid (8 ).
Accordingly, the objective of this research is to map out the existing studies in scientific literature in relation to spiritual care and spirituality in academic nursing training.
Materials and method
Design
The scoping review was developed following the recommendations in the JBI Manual for Evidence Synthesis and using the criteria set out in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (9, 10). The study in question was registered on the Open Science Framework study platform and a corresponding Uniform Resource Locator sequential identifier (https://osf.io/qc364/) was generated (11).
This type of review enables mapping the main concepts that support research in a given area, in addition to clarifying the definitions of work and/or the conceptual limits of a given subject in the available scientific production (9, 12 ).
The review was guided by a research protocol and consisted of the following steps: I. Identification of research questions; II. Identification of relevant studies by searching the literature using electronic data sources, documents that are found with a broad search based on keywords and a parallel list of references; III. Selection of studies, with the establishment of the eligibility criteria; IV. Data analysis; and V. Data synthesis and presentation (9).
Identifying the research questions
In step I, the research question was defined based on the PCC strategy (P: Population – nursing; C: Concept – spiritual care and spirituality; C: Context – academic training). Accordingly, this part of the process had the following guiding question: How are spiritual care and spirituality addressed in academic nursing training?
Identifying relevant studies
In step II, the search was conducted based on the strategy described in the Joanna Briggs Institute's Scoping Review Manual, divided into three parts, in order to identify published and unpublished primary studies (gray literature) and existing reviews (9).
Three databases were consulted, namely: Scopus (Elsevier), Online Medical Literature Review and Retrieval System (Medline), through the National Library of Medicine National Institutes of Health (PubMed) and ScienceDirect (Elsevier), since these are databases of qualified publications in the health area. The last access date for all of them was July 30, 2023.
The descriptors indexed in each database were: 1 # (Spiritual care; Cuidado espiritual), 2 # (Spirituality; Espiritualidade), and 3 # (Student, nurses; Estudantes de enfermagem). The crossings were performed using the Boolean operator AND namely: #1 AND #3; 2# AND 3#. A standardized search was used according to the available strategies in each database.
The second part of the search took place on Google® Scholar, using the index and synonym terms (keywords) identified in the studies of the first part of the search: "Spiritual care", "Cuidado espiritual", "Spirituality", "Espiritualidade", "Student, nurses", "Estudantes de enfermagem".
The last access date on this data source was July 31, 2023. The search strategies defined in each data source are described in Chart 1 below. Throughout the research, quotation marks were used as a resource in order to limit studies that used the compound term.
Chart 1: Search strategies in different data source
Selection of studies
Two researchers performed, independently and at the same time, the initial selection of studies based on the reading of titles and abstracts. During this process, disagreements between researchers were decided by consensus. Studies that met the eligibility criteria were read in full, and those that did not were excluded. Duplicates were counted only once.
The third part of the scoping review took place according to a reverse search through the references identified in the selected articles, thus allowing the capture of valid materials for the study, but which are not seen in the data source. The reverse search allows the final sample of this research to appreciate an even greater number of articles than just an integrative review, providing a more comprehensive understanding of how the study process takes place on a given subject (9).
In order to select the studies, the inclusion criteria were complete studies, referring to spiritual care and spirituality in academic nursing training, and available in the data source in any language. Editorials, letters to the editor and abstracts were excluded.
Data analysis
Data extraction and analysis was performed using a data extraction form addressing the study's identification, methodological aspects, main results, and themes, as well as the main limitations pointed out by the studies and conclusions essential for this scoping review.
Summarizing and reporting results
Results were presented in a descriptive manner in tables with the characterization and synthesis of the target studies.
Results
A total of 45 articles were included in the final sample. Figure 1 shows the final sample after eligibility criteria were applied.
Most of the 45 articles in the final sample were published between 2013 and 2017 (37.7%), the most frequent methodological design was the cross-sectional type (35.5%), and the most used approach was the quantitative one (64.4%). In relation to the continent of origin, Europe stood out (48.8%), and the most frequent language was English (88.8%), as exposed in Chart 2.
Chart 3 describes the mapping of studies identified in this review, according to title, authors, study population, sample, and main conclusions of the study.
The studies that refer to education in spiritual care and spirituality had the highest percentage in the sample (68.8%), followed by studies related to education/practice (15.5%), and the clinical practice itself (15.5%), whether during curricular internships or in actual nursing care.
Figura 1: Flowchart of searching the literature and selecting articles,
according to the PRISMA-ScR guidelines
Chart 2: Characterization of the studies analyzed in the review (n = 45)
Chart 3: Mapping of the studies identified in the review (n = 45)
Discussion
After analyzing the studies identified in the scoping review, it is observed that the main approaches deal with educational resources for spiritual care and on competencies. Still, results such as the deficit in academic training; the importance of the teacher as a facilitator of the teaching-learning process; the essential methodologies to address the theme, as well as specific skills in spiritual care such as communication, empathy, attitude towards the patient's spirituality, personal support, counseling, and the proper application of the nursing process in this care were found in the studies.
The scientific productions published in the last years stand out, which shows the contemporaneity of the subject. This is due to the position adopted by the care references that have reported on the importance of the requirement of nurturing spiritual care and recommendations regarding a greater consideration of the spiritual dimensions of care at a national and international level such as the European Commission, the World Health Organization (WHO), and the International Council of Nurses (ICN). However, it is also worth noting the studies found during the period from 1995 to 2004, which makes visible the view that there were already scientific inquiries regarding spiritual care in recent decades (21).
Although the WHO considers spirituality as one of the intrinsic components of good health care practices, few public policies are specific to spiritual care. Corroborating the findings of our study, research highlights the need to raise awareness among doctors and health professionals about the benefits of providing spiritual care, especially with regard to academic training (58).
In Europe, where most of the studies in this scoping review were published, spiritual care has been used since academic training to try to reduce the academic teaching deficit on the subject, which is unanimous in the research found. From this perspective, it is possible to think of novel approaches for clinical and care practice (32). Studies indicate that this becomes necessary and paramount because the spiritual needs of patients are not effectively met (59).
In Brazil, researchers have already shown interest in addressing spirituality in teaching and nursing care. They list the following barriers at the national level: lack of time for care; lack of academic training, which is also explained in the absence of teaching guidelines that address spirituality and spiritual care; lack of professional training (39). Research confirms the results of our study by recognizing the importance of teachers as facilitators in the learning process, so that spiritual care can be transferred from scientific evidence to nursing care practice (60).
The best teaching methodologies to be addressed during academic training are the discussion of the concept of spiritual care and holistic care, the use of the arts to express complex concepts about spiritual care, participation in research groups involving the student in the dynamic contact with patients, visits to the community, learning based on experiences, reflection exercises and reflective writing. These conclusions show that it is possible for any educational institution to address spiritual care and spirituality during the academic cycle (53).
Researchers describe that the competences found in spiritual care are developed in undergraduate nursing students and that the students' perceptions and biographical experiences about personal spirituality contribute to their development. A valid instrument for these perceptions to be captured is called the Spiritual Care Competency Scale (SCCS), developed with the purpose of analyzing the spiritual dimensions and understanding of individuals about spirituality (17, 18, 32).
Academic spiritual education is guided by the understanding of what spirituality is and continues with the learning of techniques for raising awareness of spiritual perception, appropriate knowledge, and skills. This understanding is important so that specific competences for spiritual care can be formed, such as communication, the attitude towards a patient's spirituality, personal support and counseling, evaluation and implementation of spiritual care and evaluation of the same (25, 61).
Other authors have already added three more unique characteristics of the competences necessary for spiritual care: self-knowledge of oneself, legal ethical issues in spiritual care and information technology in spiritual care. Nevertheless, that same study shows the need for more rigorous research so that the necessary competences for spiritual care can be improved (19, 24).
One of the findings of this review that draws attention and raises questions, as it permeates all the studies identified, is the fear of approaching spirituality and religiosity in academic teaching and in nursing care. Accordingly, it is necessary to emphasize the concept of spirituality, instead of religiosity, since this can help to unblock resistance due to the spiritual care presenting its own references that are not necessarily linked to religion (21 , 39). Confirming the findings of this review, a study recommends further research on the clinical efficacy of spiritual care interventions, with a view to promoting results that can sensitize health professionals (58).
In one of the articles, the fact that the formation of Brazilian nursing has a religious root with profound ramifications in the very history of the profession in the country was addressed. This can be a factor that promotes a more integrative view of the human being in the national setting. However, as mentioned above, it can also entail a difficulty in the academic environment, due to the fact that in a conformation of scientific studies there is still confusion in relation to concepts of spirituality and religiosity (52, 62).
An academic training that addresses the spiritual care of patients and allows for continuous reflection under the vision of spirituality can generate students with their own positive spiritual well-being and develop professionals who are aware and sensitive to the full range of needs their patients may present during nursing care (46, 63 ).
Moreover, during clinical practice, a spiritual care framework can promote a true culture, instilling commitment, and guidance to improve standards of spiritual care, not only for patients, but allowing nursing students to learn and adopt a multidisciplinary team spirit and continuous professional and personal development (32, 64).
The results of this study expose a deficit in relation to spirituality in academic nursing education. Therefore, since nursing is the professional team that is more directly and more frequently involved in providing care, it is necessary to improve the training in spiritual care and spirituality. In this way, it is possible that the competences evidenced become a practical dimension of care.
The practical implication of strongly recommending educational institutions to include the theme of spirituality and spiritual care in the curriculum of nursing courses is highlighted, as well as in the training of other health professionals. As verified in this research, the proper implementation of this aspect in the training of professionals enables comprehensive and holistic health care.
This study has limitations that may be related to the data sources selected for the identification of related studies on the subject, which could have favored that other relevant research on the topic addressed were not considered. Furthermore, the level of evidence of the selected studies was not classified, therefore, practical implications cannot be classified.
Conclusions
Spiritual care and spirituality should be linked to the academic training of nursing so that, during their internships, when students are faced with the spiritual needs of their patients, they know how to provide holistic and comprehensive nursing care. It is the role of educational institutions, as well as the teachers responsible for this training, to adopt an approach that goes beyond the walls of the fundamentalist theory of this profession.
Our findings made it possible to identify how spiritual care and spirituality are addressed in the academic training of nurses, where the insertion of educational resources for spiritual care and approaches based on competences were highlighted. However, this teaching is still deficient in academic formation. Studies recommend modifying the curriculum to strengthen competencies related to spirituality and spiritual care in the nursing academy.
Most studies are cross-sectional studies and non-systematic reviews. In this sense, it is suggested that new research be conducted with studies with methodologies with a prominent level of evidence, such as systematic reviews and experimental studies for a better scientific basis.
References
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