Best Practice In Spiritual Care Education; Finding A Way Forward

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

What is the EPICC Project: relevance to nursing and midwifery practice and education?
Professor Wilfred McSherry Staffordshire University/University Hospitals of North Midlands, England, United Kingdom And Professor Tove Giske VID specialized University, Bergen, Norway

Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
What to expect Background and why EPICC is necessary Facts and figures from the student project What is the EPICC Project? Our governance systems? Ethics Spirituality in nursing across Europe - What do we know? - what do we need? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Background and why EPICC is necessary
Recent reports about standards in nursing and healthcare EPICC Strategic Partners experiences: practice, education and research Inconsistences in nursing/midwifery pre-registration education RCN survey – nurse asking for more educational preparedness to deal with spiritual issues Erasmus+ KA2 Grant Agreement Number: UK01-KA

Recent Reports Listening to the media and reviewing the vast number of damming reports is enough to strike fear and disgust into the heart of anyone reading them and indeed society. Not everything written in the reports I analysed is bad – there are examples of excellent practice and standards of care. Certainly there is no room or excuse for prejudice, discrimination, abuse or neglect in whatever guise it is manifested. Yet, there must be a sense of balance and portion. It is easy to be swept away on a tide of revulsion and indeed revolution but this emotion needs to be tempered with caution and reality. The media attention and published reports rightly alert the public to some of the shortfalls and failing in the health and social care sectors. Yet, these do very little to raise awareness of the excellent standards of care provided by most individuals within the health and social care sectors. Yet we must explore why for some people the experience of care is not always positive and of the highest standards and quality . The accounts present a picture of institutions, organization and individuals failing to respond to the needs of primarily older people with sensitivity, dignity, care and compassion deprived of the most essential standards of care. I would suggest that the common denominator present in all these reports is a failure to recogise the unique dignity or dare I say the sacredness of each and every human person be it the patient, carer or the healthcare professional. Therefore why is it that we have all this evidence about the importance of spirituality which reinforces the sacredness and uniqueness of each person but it doesn’t seem to be having the desired impact within practice? Erasmus+ KA2 Grant Agreement Number: UK01-KA

National care of the dying audit for hospitals, England
(2014 Pg. 52) Discussions regarding the patient’s spiritual needs were held with patients who were capable of participating in such discussions (52%, n=3,391): Yes 21% (715) No 79% (2,676) Erasmus+ KA2 Grant Agreement Number: UK01-KA

National care of the dying audit for hospitals, England
Discussions between clinicians and patients regarding spirituality in end-of-life care only occurs in 15 per cent of cases, and in an additional 27% of cases, people important to the patient had these discussions. This suggests that only in 42% of cases the patient and those important to them were asked about their spiritual needs A further document I would like to draw your attention to is the findings from the national audit. It is pretty clear from these alarming statistics that this aspect of care is currently not being adequately addressed within end of life care? During my presentation – I would like you to reflect upon – WHY THIS MIGHT BE? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Frequently used terms Individualized care Holistic care Spiritual care Dignity in care Person-centred care Relationship/family centred care Compassionate care Integrated care Evidenced based care I have just gone through the process of revalidation with the Nursing and Midwifery and as one of my 5 pieces of reflection I reflected on my experience of working in the National Health Service and nursing over several decades asking Why in nursing and healthcare have witnessed the introduction of a number of straplines that preface the goal of nursing for example holistic care, individualised care, spiritual care, dignity in care and more recently person-centred care. The common denominator, identifiable within all these terms is that they seek to combat the prevailing medical and scientific model of care that has infiltrated and fragmented nursing care. These straplines seem to offer a more altruistic and humanistic view of individuals highlighting the more subjective, sensitive and arguably contentious elements of nursing such as spirituality. Erasmus+ KA2 Grant Agreement Number: UK01-KA

Debate in context 2015 adult inpatient survey The proportion of respondents who said they were ‘always’ treated with dignity and respect has been rising slowly but steadily from 80% in 2011 to 84% in 2015 Published June 2016 (Revised September 2016) Not everything is bad on the contrary there is evidence that demonstrates that health care professionals and my own nursing profession do care and are caring and that the general public do have confidence in the vast majority of nurse. The National summary of the results for the 2014 Inpatients survey provides valuable evidence that counteracts the negativity offering a more positive and realistic impression: These findings affirm that the vast majority of nurses and health care professionals make a valuable and significant contribution to health care that is valued by a large section of the general public. Furthermore these findings do not present a picture of a health care system in melt down or a system that is failing and not caring. There is a need to present a more balanced and perspective of the situation However, the survey reveals that a small percentage of patients do not have confidence and trust in the nurses (health care professionals) caring for them – so what can we do to improve the patient experience and patient satisfaction? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Educational preparedness (RCN, 2010)
79.3% of nurses felt that nurses do not receive sufficient education and training in spirituality (McSherry, 1997 which found that 71.8%). 79.9% indicate that spirituality and spiritual care should be addressed within programmes of nurse education I want to explore the issue of educational preparedness. The findings from the RCN survey suggest that despite all the evidence and activity and energy I have been referring to during my presentation Many nurses (students and HCAs) still feel that they lack sufficient educational preparedness in meeting their patients’ spiritual needs. Of the nurses surveyed the majority of respondents indicated that they first qualified between the 1970 and 1990’s Since the late 1980’s and 1990’s nurse education has undergone a major restructuring, shifting from Colleges and Schools of Health into the Higher Education Sector (in keeping with many other countries) with a change of emphasis from the apprentice style training to a greater focus on academic and theoretical credibility. Also in this timeframe there has been an explosion of interest in the spiritual dimension. However, the results from this survey indicate that there has been very little change in nurses’ confidence to meet and provide spiritual care to their patients and 79.3 % agreed that nurses do not receive sufficient education and training in spirituality. Similarly , 79.9% disagreed with the statement that spirituality and spiritual care should not be addressed within programmes of nurse education reinforcing the fact that nurse feel very strongly that these concepts should be an integral aspect of professional education. These findings are very similar to those of McSherry, 1997 which found that 394 (71.8) of nurses felt that they did not receive sufficient training into spiritual aspects of care. This raises the question why? One explanation may be that matters of spirituality receive insufficient attention within pre and post registration programmes of nurse education and that the Nursing and Midwifery Council (UK) or our professional regulatory bodies are not being directive and specific enough with regards to matters of spirituality and spiritual care. Erasmus+ KA2 Grant Agreement Number: UK01-KA

New Nursing and Midwifery Council (NMC) Code
There is no mention of the word ‘spiritual’ Discrepancies between Code of practice and other documents such as Guidance for pre-registration nursing programmes In January the NMC in the UK published its new code of Nursing Practice. Despite all the evidence and debate about the importance of the spiritual dimension – the word does not even feature in the new Code that came in to effect on 31st March. Dr Linda Ross and myself have written to the Chief Executive and Registrar of the NMC raising some serious concerns about this omission. We published a edited version of our letter in the Nursing Standard and we have had a reply from the NMC indicating that the spiritual dimension of care is addressed under the broader heading of Human Rights. We have also started a campaign and had several response from colleagues supporting our attempts to have the word spiritual explicit in the code. We are arguing that clause 3 which reads “make sure that people’s physical, social and psychological needs are addressed and responded to – failure to make explicit reference to the spiritual means that only a bio-psychosocial model of nursing is being promoted – it is not in keeping with all the conceptual and theoretical developments of nursing? This may also explain why nurses are uncertain and do not engage with the spiritual aspects of the person. There is also discrepancies because in the guidance provided by the NMC for pre-registration nursing explicit reference is made to the spiritual – this implies that you need the education about spirituality but once you become a registered practitioner it doesn’t matter – the campaign continues? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Who is taking part The EPICC project is structured around three main groups co-operating together and these are defined as follows: EPICC Strategic Partners – you have met us! EPICC Participants: a group of nurse educators (25) drawn from countries and institutions across Europe. The group is small is to provide an intense programme of peer-support, mentorship and coaching. This level of support will build trust and respect and prevent attrition in the project. It will also ensure the project maximises local and national impact. EPICC Participants +: a group that will comprise of key stakeholders, representatives from allied health professionals, patient and public groups, students and professional regulatory bodies. They will attend activities and events ensuing these are informed by a wide range of cultural, ethnic and religious worldviews. Erasmus+ KA2 Grant Agreement Number: UK01-KA

Countries represented
United Kingdom: England, Scotland, Wales, (Northern Ireland) Croatia Norway Netherlands Poland Turkey Ireland Malta Denmark Germany Belgium Ukraine Greece China Malaysia Thailand Erasmus+ KA2 Grant Agreement Number: UK01-KA

How it will be organised
Transnational Steering Group Meetings: 1) 12th and 13th January 2017 – Viaa Zwolle, 2) 11 – 12 April 2018 – Viaa Zwolle 3) 6 – 7 February 2019 – Viaa Zwolle Multiplier Events: 1) 19th and 20th April 2017 – Staffordshire University 2) 1st and 2nd July 2019 – University of South Wales Teaching and Learning Events: 1) 30th October – 3rd November Zwolle , Netherlands 2) 24th – 28th September 2018 – University of Malta Erasmus+ KA2 Grant Agreement Number: UK01-KA

What are we trying achieve
Three named outputs: O1 - Establishing and sustaining the EPICC project – lunching the EPICC Network O2 Developing a Gold Standard Matrix for Spiritual Care Education and Adoption Toolkit O3 Refining and disseminating the Gold Standard Matrix for Spiritual Care Education and Adoption Toolkit Erasmus+ KA2 Grant Agreement Number: UK01-KA

Establishing the EPICC Network
Currently European Spirituality Research Network for Nursing and Midwifery (informally) Will become the EPICC network How should we so this? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Project Governance Budget control and time management are the prime responsibility of the lead partner. A project plan outlining the designated responsibilities and milestones for each partner will provide a baseline against which tracking will take place. Communication is key to the successful management of this project, therefore various methods are being utilised by the EPICC Strategic Partners. A risk and issue log will be utilised to identify and address any risks to delivery. Dissemination and exploitation strategy will be established. Communication with National Agency. Budget control and time management are the prime responsibility of the lead partner. And this is something that Staffordshire University has a proven track record in. We will lead on the returns that are required by the funder, ensuring that all costs are eligible, and that evidence is held to demonstrate compliance. A project plan outlining the designated responsibilities and milestones for each partner will provide a baseline against which tracking will take place. This will allow us to monitor the work packages, and to ensure that they are being delivered to time, and to budget. Where there is any deviation from the agreed plan, appropriate actions can be taken. Communication is key to the successful management of this project, therefore various methods are being utilised by the Strategic Partners. Methods are both formal and informal, but include 3 transnational meetings, monthly Skype meetings, and other ad hoc communications as required, for example . A risk register will be utilised to identify and address any risks to delivery. An initial risk audit was completed at the beginning of the project, and this will continue to be reviewed during the lifetime of the project. New risks will be assessed according to probability and potential impact, and a mitigation strategy implemented to reduce any negative impacts. Dissemination and exploitation strategy will be established. This will ensure that significant outputs are targeted at the relevant stakeholders. The EPICC website and a social media presence will also ensure that stakeholders are kept well informed of the project’s progress. Communication with National Agency. We have been assigned a Grant Officer at the British Council who will be our first point of contact. If we do have any queries regarding the grant, we will clarify with the National Agency to ensure that we are being absolutely compliant with the requirements of the funding. Erasmus+ KA2 Grant Agreement Number: UK01-KA

Ethics Is this research or curriculum review and evaluation? Qualitative evaluation based upon the principles of Action Learning and Co-Production Ethical approval gained from Staffordshire University School of Health and Social Care, Ethics Panel What data are we gathering and what should we intend to do with this? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Spirituality in nursing across Europe
What do we know? What do we? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Europe states million inh % of the worlds population - many languages - diverse history - difference in economy, social structure, political systems Erasmus+ KA2 Grant Agreement Number: UK01-KA

International Council of Nurses (ICN)
Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. (ICN, 2012 p2) Erasmus+ KA2 Grant Agreement Number: UK01-KA

NHS Scotland can aid us:
Spiritual care is care which recognizes and responds to the needs of the human spirit when facing with trauma, ill health or sadness & can include the need for meaning, for self worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging the human contact in compassionate relationship, and moved in whatever direction need requires. National Health Service Education for Scotland (2009) Spiritual Care matters: An Introductory Resource for all NHS Scotland Staff. NES, Edinburgh. Erasmus+ KA2 Grant Agreement Number: UK01-KA

Spiritual care definition by Weathers et al. 2015
Conceptual definition: Spirituality is a way of being in the world in which a person feels sense of connectedness to self, others , and/or higher power or nature: a sense of meaning in life; a transcendence beyond self, everyday living and suffering Erasmus+ KA2 Grant Agreement Number: UK01-KA

Is existential/spiritual/religious concerns of relevance for Europeans?
How is it related to health? Erasmus+ KA2 Grant Agreement Number: UK01-KA

What does it mean to be ill?
Does illness and threat of death bring forth existential questions? Does it differ phenomenologically around Europe? Does expectations to health care differ? Does the role of family and church differ around Europe? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Nursing education: learning a new way of thinking
Professional identity Understanding of role and responsibility In our society Towards patients Towards other professions Learning professional language – what can we talk about? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Diagnostic questions for nurse educators:
HOW IS SPIRITUALITY COVERED IN Teaching – if yes, who teach Introductory/general nursing books Assignments related to spirituality Assessment guides for nursing Nursing documentation Erasmus+ KA2 Grant Agreement Number: UK01-KA

Is spirituality in nursing related to numbers?
Romanian nurses Norwegian nurses Ukraine nurses Erasmus+ KA2 Grant Agreement Number: UK01-KA

Staffing – practicing nurses/1000 pop. OECD 2009
Finland nurses/1000 Norway nurses/ 1000 Denmark nurses/ 1000 Netherlands - 10 nurses/1000 Germany nurses/ 1000 UK - 8 nurses/ 1000 Portugal - 5 nurses/1000 Spain - 4 nurses/1000 Greece - 3 nurses/1000 George, E.K. & Meadows-Oliver, M. (2013) Searching for collaboration in international nursing partnership: a literature review. International Nursing Review, 60, Grootjas, J. et al. (2013) The relevance of globalization to nursing: a concept analysis. International Nursing Review, 60, WHO Bemanning Det speler ei rolle kor mange pasientar ein sjukepleiar har ansvar for – kva ein sjukepleiar KAN gjere av oppgåver. Forventningane frå pasient og pårørande er relatert til antal sjukepleiarar som er tilgjengeleg Det er stor sjukepleiemangel i mange land. For ein del land er sjukepleiarutdanning billetten ut til vesten eller USA og til ei anstendig lønn. Filipinane er vel den største eksportøren av sjukepleiarar til verden – østen & vesten. Tenk på kor mykje nokre utanlandske sjukepleiarar forsakar for å kunne brødsfø, sikre utdanning og viss velstand for familien heime. Kanskje du har ein kollega som jobber her for å kunne sende penger heim til familen sin?? Erasmus+ KA2 Grant Agreement Number: UK01-KA

Numbers & payment – relevance for content of nursing?
Nurses pr 1000 inh Payment pr month Finland 20 2700 Euro Norway 14 3600 Euro Netherland 13 Denmark 12 3100 Euro UK 8 1900 Euro Ukraina 170 Euro Portugal 5 1000 Euro Spania 4

Care and money Level of salary - How many jobs do you need to survive?
”Extra” payment “I don't know how it is in other countries but corruption is a factor here. Worse in some hospitals, a little less in others but corruption is everywhere. If you want the bedpan, an IV etc, the patient will slip money into the nurses lap coat pocket. The same is for the doctor except, of course, the amount is larger.” STOR utfordring at sjukepleiarar tener så dårleg i mange land at dei ikkje kan brødføe seg og familien på ei lønn. I Ukraina tener både legar og sjukepleiarar om lag like dårleg – US$ 150/mnd Ei nyutdanna spl. Med BSN frå Nigeria tener US$ 500/mnd som kokk på den nigerianske ambassaden. Same i Sierra Leone US$ 150/mnd. Kva betyr det? Td. At ein sjukepleiar har 2 jobber – ikkje uvanleg i Afrika. Og kva betyr det å ha 2 jobber med normert arbeidstid minst 40 t/veke for kvaliteten på arbeidet? At dei jobber duble vakter eller er på jobb i 24 t. I tillegg er det i mange land mykje korrupsjon – Distriktsjordmor i JOS, Nigeria fortalde om alle dei NGO’s – Non governmental Organisations som arbeidde i landet og som hadde mykje penger med seg. Pengane gjekk i stor grad i lommene på dei ansatte, og det var liten interesse for å utdanne fødselshjelparar som kunne jobbe ute i landsbyane og virkeleg gjere ein forskjell for gravide og fødande. Men det er også mange plasser at både sjukepleiarar og legar forventer betaling i lomma for å gi behandling og omsorg. I Ukraina er det veldig utbredt – og ein lege vil ikkje kunne arbeide som lege utan å bli ”betalt” av pasientane sine. Claudia fortel om sine erfaringer frå Romaina. Dersom ein pasient ikkje betaler legen ved innlegging, blir dei behandla, men det blir huska til neste gang dei treng innleggelse, og då er det ikkje like lett. Av eiga erfaring fortel ho: Pasientane/pårørende gir meg pener når dei blir lagt inn på avdelinga mi. Eg ønsker ikkje å ta imot, men om eg ikkje gjer det så trur dei at dei er så dårlege at dei kjem til å dø. Derfor har eg brukt å ta imot pengane, men å gi dei tilbake når dei blir utskreven. Som kristen ønsker eg ikkje å vere ein del av dette. Claudia jobber no i Canada og er usikker på om ho reiser heim til Romania på sikt eller ikkje.

SUMMING UP Spirituality in nursing in Europe
In general Illness and death opens up for existential questions Meaning & hope is related to how we live and cope Huge diversity in nursing education Huge diversity in staffing and payment of nurses The understanding of nursing differs in different countries, and expectations differs to the role of nursing

CONCLUSION What we need in Europe for spiritual care
Nursing students & nurses who are mature spiritually themselves Support each other Personal contact Collaboration: north – south – east – west Multinational research Teaching Developing our professional language also in spirituality Sharing resources & experience People Knowledge Material All this is built into the EPICC project!!

Best Practice In Spiritual Care Education; Finding A Way Forward

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Best Practice In Spiritual Care Education; Finding A Way Forward

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