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
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2. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Nurses’ and Midwives’ acquisition of spiritual care competency:
A Focus on Education: Dr. Josephine Attard PhD
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3. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467

4. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
PATIENT’S CHARTER
One has the right:
1. To be treated as an individual. One should expect that the healthcare provider demonstrates dignity, patience, empathy, tolerance and courtesy.
2. To receive care in a way that is respectful to one’s age, colour, disability or illness, gender, marriage, civil partnership, maternity, race, religion or belief, sex or sexual orientation, nationality, or social status.
3. To request spiritual and/or religious support when admitted into a healthcare establishment……………………………….
Published final report on 6 February 2013. It told a story of appalling suffering of many patients within a culture of secrecy and defensiveness.
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5. Acquiring spiritual care competence
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6. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
THE AIM OF THE STUDY
Design, develop and validate a framework of competencies (Knowledge, skills and attitudes)
in spiritual care to guide pre-registration nursing/midwifery education.
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7. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Competency approach
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8. Defining spirituality (Attard, 2015)
The intrapersonal aspect of spirituality
The interpersonal aspect of spirituality
The transpersonal
(or transcendent) aspect
concerned with peoples’ values, morality, belief and faith in self, others and higher power, meaning and purpose, hope and strength.
concerned with: peoples’ sense of ’connection through relationships involving ‘love, presence, compassion, empathy, forgiveness and trust.
concerned with: peoples’ sense of ‘wholeness/integration, awe and wonder, creativity/self expression.
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9. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Eclectic approach: Three phase strategy using a Mixed methods research approach
Phase 1
DEVELOPMENT of competency framework through IDENTIFICATION and FORMULATION of competency domains and competency items in spiritual care utilising: LITERATURE REVIEW and FOCUS GROUPS
Phase 2
VALIDATION of competency domains and competency items utilising:
A MODIFIED DELPHI STUDY
Phase 3
FORMULATION, EVALUATION and initial DISSEMINATION of competency framework:
CONSULTATION PROCESS
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10. PHASE 3 Phase 1 Focus groups Suggested
DEVELOPMENT of competency framework through IDENTIFICATION and FORMULATION of competency domains and competency items in spiritual care utilising: LITERATURE REVIEW and FOCUS GROUPS.
PHASE 3
Suggested
Spiritual care curricular contents
Focus groups
Chaplains and spiritual leaders
10 participants
Educators in Nursing / Midwifery
11 participants
Nurses & midwives
9 participants
Parents & carers
Clients of Nursing/Midwifery
PHASE 1
Overview of the literature on spirituality and spiritual care
PHASE 2
Spiritual care in nursing/midwifery education
PHASE 3
Suggested
Spiritual care curricular contents
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11. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Validation of competency items in spiritual care identified in Phase 1 of the study was performed using a two phase modified Delphi study, by 241 expert panellists using Descriptive, inferential, non parametric statistics and Exploratory Factor analysis
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12. Clinical midwifery educators of clients’ organisations
Phase 2
A MODIFIED DELPHI STUDY: Expert panellists (n=241) recruited on their knowledge and experience guided by the theories: ‘fundamental ways of knowing’ (Carper, 1978), ‘from novice to expert’ (Benner, 1984) and the ‘Spiritual Care Competency Scale’ (SCCS) (van Leeuwen et al., 2008).
PANEL OF EXPERTS
Faculty midwifery
educators
(n=3)
Clinical nurses (n=50)
Clinical midwifery educators
(n= 12)
Policy makers (n=30)
Clients
(n=23)
Spiritual leaders
(n=25)
Faculty
nursing educators (n=20)
Clinical nursing
Clinical midwives
(n=37)
Representatives
of clients’ organisations
(n=16)
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13. PANEL OF EXPERT PARTICIPANTS: R1 (n= 241) R2 (n= 205)
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14. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
R2 % of agreement set at a threshold of 75% or greater in both the modified Delphi rounds achieved by the scores within the highest region of a 7-point Likert scale (5, 6, or 7).
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15. Obtain a pragmatic perspective of views on the identified domains
Phase 3
FORMULATION, EVALUATION and initial DISSEMINATION of competency framework: through a CONSULTATION PROCESS WITH 107 INTERNATIONAL EXPERTS IN SPIRITUAL CARE to:
Obtain a pragmatic perspective of views on the identified domains
and 54 competency items
Identify competencies essentially acquired at PRE-registration level, POST-registration level competencies are not essential at either level.
Identify factors that may enhance or hinder implementation of the framework in education, research and /or clinical practice.
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16. 39 competency items in spiritual care elicited
7 Domain Pre- registration framework of competencies in spiritual care for nurses/midwives
7 Domain
39 competency items in spiritual care elicited 39
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17. 16 competency items in spiritual care elicited
4 Domain Post- registration framework of competencies in spiritual care for nurses/midwives
4 Domain
16 competency items in spiritual care elicited
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18. DOMAIN 1: Body of knowledge in spiritual care
Addresses the ambiguities in defining spirituality and spiritual care, while highlighting the positive relationship between spirituality/religiosity/health and well-being.
At point of registration nurses/midwives should be able to demonstrate knowledge in:
The concept of spirituality
Relationship between spirituality/religiosity and health
Holistic individualised (personalised) care
World major faiths/religions, cultural beliefs and practices influencing decisions about care
Loss, grief and end of life issues
Dealing with existential questions
Support systems and agencies for the client and family
Complementary therapies and prayer.
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19. DOMAIN 2: Self-awareness and the use of self
Refers to how well nurses/midwives understand themselves, their strengths, weaknesses, beliefs and values in order to better address clients’ needs with trust, empathy and compassion
At point of registration nurses/midwives should :
Be aware of own spirituality and use of self
Avoid imposing own spirituality on clients
Respect clients’ diverse cultural worldviews , beliefs and practices
Consult members of the MDT as deemed necessary Address personal inner feelings.
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20. DOMAIN 3: Interpersonal relationships and communication
Addresses effective reciprocal verbal and non-verbal interaction, forming trustful therapeutic nurse/midwife-client relationships while developing spiritual compassionate care skills
At point of registration nurses/midwives should be able to demonstrate competence to
Understand and communicate the principles of the ministry of ‘WORDS’ AND ‘PRESENCE’
Assess barriers to effective communication in providing spiritual care (e.g. Fear, anger)
Active listening, empathy and/or referral to members of the multi- disciplinary team.
Therapeutic trustful nurse/midwife-client relationship
Maintaining professional boundaries (abiding by the professional ethical/ legal codes of conduct).
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21. DOMAIN 4: Ethical and legal issues in spiritual care
Addresses the ethical and legal principles for the safety of clients’ and practitioners.
At point of registration midwives should be able to demonstrate competence in:
Appreciate uniqueness of each person
Respect for diversity in clients’ and right to decline spiritual care
Respect for the client’s autonomous and diverse health care decisions/ choices influenced by religious/spiritual beliefs.
Safeguarding clients’ privacy, safety and security guided by the ethical code of conduct
Maintain clients’ dignity (self-esteem and self-respect ) and integrity
Document and communicate spiritual/religious information to the MDT while maintaining confidentiality.
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22. DOMAIN 5: Assessment, implementation and evaluation of spiritual care
Addresses the need for nurses/midwives to identify and respond to the spiritual needs of clients and their family
At point of registration midwives should be able to demonstrate ability to:
Use formal and informal methods of assessment to
identify spiritual needs/distress in clients and family (e.g. pain, anxiety, guilt, anger at God )
Plan spiritual care in order to find meaning and purpose
and meet the clients’ needs holistically
Facilitate family participation in the care
Identify coping resources to restore spiritual integrity displayed through internal peace, acceptance and meaningful behaviour
Acknowledge the role of chaplains and spiritual leaders as experts and collaborators
Timely referral to members of MDT ensuring follow up.
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23. DOMAIN 6:Quality assurance in spiritual care
Addresses the need for guidelines and quality standards that put clients in the centre of the decision making, integral to holistic care
At point of registration midwives should be able to:
Acknowledge nursing/midwifery as a vocational calling
Identify spiritual care towards self-growth and emotional intelligence
Provide supervision and emotional support of professionals, students and members of the team engaged in spiritual care
Initiative participation in CPD, research, innovations and teaching activities to bring about practice improvement.
Create spiritual healing work environments to lessen stress, improves clients’ outcomes and increases job satisfaction to professionals.
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24. DOMAIN 7: Informatics in spiritual care
Addresses the application of informatics theory to spiritual care in order to facilitate a virtual learning environment (VLE) for students and qualified staff and guide documentation of identified spiritual needs and interventions provided
At point of registration midwives should be able to:
Identify the importance of information technology to enhance knowledge on spiritual care
Use information technology to inform and guide nurses’/midwives’ future evidence-based practice
Acknowledge the use of information technology as a means of documenting spiritual care delivered.
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25. Erasmus+ KA2 Grant Agreement Number: 2016-1-UK01-KA203-024467
Conclusion: Re-thinking healthcare through attention to the spiritual dimension of care
Thank you
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