1. Best Practice In Spiritual Care Education; Finding A Way Forward
Coming together from across Europe to shape the future of spiritual care education and to enhance compassionate care
Erasmus+ KA2 Grant Agreement Number: UK01-KA

2. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
OUR STUDIES 
Student nurses’/midwives’ perceptions of spirituality/spiritual care, spiritual care competency and factors contributing to perceived competency
Dr Linda Ross, Reader, University of South Wales
Dr Annemiek Schep-Akkerman, Researcher, Viaa Christian University of Applied Sciences
We want to present just a few findings from our research over the past 7 years.
Looking at
How students view spirituality & spiritual care
How competent they think they are
Factors contributing to development of competency.
Erasmus+ KA2 Grant Agreement Number: UK01-KA

3. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Dr Linda Ross (Wales, UK)
Prof. Wilfred McSherry (England, UK)
Dr Annemiek Schep-Akkerman (Netherlands)
Prof Rene van Leeuwen (Netherlands)
Prof Tove Giske (Norway)
Prof Donia Baldacchino (Malta)
Dr Aru Narayanasamy (England UK)
Dr Tibertius Koslander (Sweden)
Erasmus+ KA2 Grant Agreement Number: UK01-KA

4. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Dr Vibeke Ostergaard Steenfeldt (Denmark)
Dr Jenny Hall (England, UK)
Dr Beth Seymour (Scotland, UK)
Dr Paul Jarvis (UK, Statistics)
Erasmus+ KA2 Grant Agreement Number: UK01-KA

5. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
2 STUDIES
Pilot Study: 2010, 6 universities, 4 countries, Funded by USW
Cross-sectional, multinational, survey design
We would like to tell you about the 2 studies we have conducted since 2010.
The pilot study: you have copies of these 2 publications
Erasmus+ KA2 Grant Agreement Number: UK01-KA

6. 2. Main study: 2011-15, funded by RCN
Longitudinal, multinational, survey
2193 undergraduate nurses/midwives
22 universities in 8 countries
(Wales UK, England UK, Scotland UK, Malta, Netherlands, Norway, Sweden, Denmark)
And the main study.
Analysed the data but have not yet published.
We’re sharing the findings with you ahead of publication (headline findings sheet), but
Please note the disclaimer and copyright.

7. Research Questions
1.How do student nurses’/midwives’ perceive spirituality and spiritual care and how does this change over time?
2. How competent do they perceive themselves to be in spiritual care delivery and how does this change over time?
3.What factors contribute to spiritual care competency?

8. What? Item to be measured Measure selected Individual characteristics
Demographic questionnaire
Perceptions of spirituality & spiritual care
Spirituality & Spiritual Care Rating Scale (SSCRS, McSherry 1997, 2002)
Competency
Spiritual Care Competency Scale (SCCS, van Leeuwen et al 2009)
Spiritual wellbeing
JAREL Spiritual well-being Scale (Hungelman et al 1996)
Connectedness to self, environment/ others, transcendent
Spiritual Attitude and Involvement List (SAIL, Meezenbroek, Garssen & van der Berg, 2008)
So students completed a pack of questionnaires chosen to best answer the study questions:
-demographic
-view of spirituality & spiritual care – SSCRS
-perceived spiritual care competency – SCCS
-about their own spirituality (the literature had suggested this was an important factor) – JAREL, SAIL

9. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
The samples
Pilot study: 618 students present on day, 531 completed (86%), 4 countries Main study: (8 countries) 2193 students (from possible 3175) took part in yr 1 (69%) 595 students (from possible 1821) took part at end (33%) (non-paired) 351 students took part both at start and end (paired)
Dropout were due to:
Not all students present on the days of data collection
2 centres dropped out (England yr1, Scotland yr2) both staff retired
Students being difficult to reach at the end of the course – placements
Incomplete questionnaires
Erasmus+ KA2 Grant Agreement Number: UK01-KA

10. Overview of the samples
Pilot study %
Main study %
Female 85 88
Nursing 95 96
Under 21 yrs 57 56
Secular universities 62 73
Religious 87 67
Christian 80
Practised life view daily/weekly
??? 59
Any life event
55 (83% negative)
57 (54% negative)
Majority of participants in both studies were:
Female nurses under 21
From secular universities
Majority were religious, mainly Christian and practised their faith
Over half had experienced life events, mainly negative
One of our recommendations of our pilot study was the need to see if the findings still applied in student samples from more diverse cultural backgrounds.
We included 16 more universities and 4 more European countries in the main study:
-we got fewer participants who were ‘religious’ and ‘Christian’
But not significantly greater cultural diversity.
Seems to reflect the student nursing/midwifery profile in Europe
Tried to find European demographic data to compare our with
UK- got NSS statistics – our sample was similar (62% Christian compared with 44%, 3% Buddhist compared with 2%, 2 % muslim compared with 9%
Erasmus+ KA2 Grant Agreement Number: UK01-KA

11. Research Question 1
How do student nurses’/midwives’ perceive spirituality and spiritual care and how does this change over time?

12. Perception spirituality/spir care (SSCRS) (n=351, p<0.01)
1.How do student nurses’/midwives’ perceive spirituality and spiritual care and how does this change over time?
Students started their courses with a broad view (5 point scale)
(Main study mean 3.8/3.9, pilot mean 3.99)
So not just seeing it in religious terms but also existential elements (M&P, peace)
Small but significant broadening of perception over the course (+0.2 in 595, +0.1 in 351)
And in the subscales:
Existential spirituality (meaning, purpose, peace, value, creativity)
Religiosity
Spiritual care (rituals, kindness)
Personal care (dignity, beliefs/values)

13. Research Question 2
How competent do they perceive themselves to be in spiritual care delivery and how does this change over time?

14. Spiritual care competence(SCCS) (n=351, p<0.01)
2. How competent do they perceive themselves to be in spiritual care delivery and how does this change over time?
In both studies started off just marginally competent (5 point scale)
Pilot -mean 3.74, cut-off >3.5
Main – mean 3.6 in both samples
Encouraging because just starting.
Small but significant increase over time (+0.4) in both samples.

15. Subscales spiritual care competence
This was also true in all subscales
Especially in the more specialised ones
-assessment & implementation (+0.6)
-referral (+0.5/0.6)
-‘professionalisation and improving the quality of spiritual care’ and ‘personal support and patient counselling’ +0.4/0.5
‘attitude towards patients’ spirituality’ and ‘communication’ showed
minimal improvement and 0.2, but mean scores were high to start with (4.4 and 4.5 respectively)
compared with the other subscales where the mean scores were lower to start with ( )
Spiritual care competency can be learned.

16. Research Question 3
What factors contribute to spiritual care competency?

17. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Table 3a. Correlations between personal factors and score SCCS every year in total *p-value < 0.05 **p-value <0.01
Start study
(n=2020)
N=2193
Start yr2
(n=1182)
Start yr3
(n=736)
End study
(n=595)
Country
0.10**
-0.01
0.03
0.06
Type of university
-0.07**
0.06*
0.07
0.05
Gender
0.01
0.00
0.04
Age (< 20 / > 20 yr)
0.07**
0.07*
-0.04
Education (high / low)
0.05*
0.02
0.08
Health Care Exp (Y / N)
0.11**
Life event (Y / N)
0.09**
-0.09*
Life event Pos (Y / N)
Life event Neg (Y / N)
0.08**
Life view (rel / non rel)
Practice prayer
0.13**
0.16**
Practice meditation
0.08*
0.09*
Practice reading rel book
-0.06*
0.19**
0.10*
Practice religious meeting
-0.03
Practice art
0.15**
Practice rest in nature
Practice voluntary work
0.17**
SSCRS
0.32**
0.35**
0.49**
0.55**
SAIL
0.29**
0.38**
0.41**
0.40**
JAREL
0.30**
0.33**
2 factors highly and significantly correlated with competency in both studies
1. Holding a broad view of spirituality/spiritual care
-having high SSCRS scores
-strongly correlated in both studies ( ) and highly significant.
2. Personal spirituality of the student
-having high sp wellbeing scores (JAREL) – correlations p<0.01, all points
-having high SAIL scores – correlations p<0.01
We thought the practice of spiritual practices was also important (and it may be) but no consistent or strong message
e.g. in pilot art, rest in nature, reading rel books, prayer, attending rel meetings were related to competency.
In main study only 2 of these featured: rest in nature 3 time points
reading rel books 4 time points
Plus different ones e.g. meditation
Correlations weak.
Erasmus+ KA2 Grant Agreement Number: UK01-KA

18. Exploring perception of spirituality and spiritual care further
Spiritual practises? No
Experience of life events? No
Previous healthcare experience? No
Being from a secular university? No
We had a look to se if other factors were correlated with perception of spirituality
-practices
meditation, art, rest in nature - weakly correlated in both studies
Prayer, religious books weakly correlated in main study only
-Life events
Weakly correlated in main study but not in pilot
-previous healthcare experience
Weakly correlated in pilot but not in every year in main
-secular uni
Related in pilot but reversed in main
Erasmus+ KA2 Grant Agreement Number: UK01-KA

19. Factors contributing to learning (n=351)
What factors contribute to learning about spiritual care?
- Students say the key things that help them are:
-caring for patients (clinical encounters) (63-78% said this in main study)
-events in their personal life (39-58% said this in main study)
-university linked activities helped, but less so (such as teaching/discussions (36-49%
said this in main study))
Positive life events is less important than we thought (not significant in pilot study and only weakly correlated at some time points in main study)
Erasmus+ KA2 Grant Agreement Number: UK01-KA

20. Do students who start with low competency improve?
Yes, their scores increase by 0.8 And they almost catch up with the high scoring students
Erasmus+ KA2 Grant Agreement Number: UK01-KA

21. Differences between students with low and high competency scores at start of study (n=351) 
Low scoring students
High scoring students
Curriculum items helping to learn deliver spiritual care
Caring for patients
Events in personal life
Discussion/ teaching in university
View of spirituality/ spir. care (SSCRS)
Start: 3.7
End: 3.9
Start: 4.0
End: 4.1
Personal spirituality (SAIL)
3.7
4.0
4.1
Personal spirituality (JAREL)
4.4
Some differences in scores questionnaires.
Erasmus+ KA2 Grant Agreement Number: UK01-KA

22. Do students who start with narrow view spir. improve?
Yes, their scores increase by 0.4 However, they do not catch up with the high scoring students
Erasmus+ KA2 Grant Agreement Number: UK01-KA

23. Do students who start with low pers. spirituality improve?
Yes, slightly; but they do not catch up with the high scoring students
Erasmus+ KA2 Grant Agreement Number: UK01-KA

24. Do students who start with low SCCS subschales improve?
Yes, they show marked improvement, almost to high scoring group
Erasmus+ KA2 Grant Agreement Number: UK01-KA

25. Differences between students with low and high score on SCCS subschales at start of study (n=351) 
Low scoring students
High scoring students
Curriculum items helping to learn deliver spiritual care
Caring for patients
Events in personal life
Discussion/ teaching in university
View of spirituality/ spir. care (SSCRS)
Start: 3.7/3.8
End: 3.9/4.0
Start: 3.9/4.0
End: 4.0/4.1
Personal spirituality (SAIL)
3.7
4.0/4.1
4.1/4.2
Personal spirituality (JAREL)
4.1/4.4
4.3/4.4
Some differences in scores questionnaires; almost catch up.
Erasmus+ KA2 Grant Agreement Number: UK01-KA

26. Differences between countries in SCCS?
Erasmus+ KA2 Grant Agreement Number: UK01-KA

27. Can spiritual care competency be predicted?
Maybe, models in pilot and main study not stable, but…
Important factors are…
Personal interest in spirituality
Broad view of spirituality
School factors / curriculum items
Caring for patients
Erasmus+ KA2 Grant Agreement Number: UK01-KA