How to recognize and verbalize spirituality in its diverse expressions ?

1. How to recognize and verbalizespirituality in its diverse expressions? 10th AnnualIsraeli Spiritual CareConfernece for professionals 5 – 6 Nov 2013 Tove Giske tove.giske@haraldsplass.no Associate Professor Haraldsplass Deaconess University College Bergen, Norway

2. Giske; How to recognize & verbalize spirituality

3. Bergen, Norway Giske; How to recognize & verbalize spirituality

4. Overviewofpresentation • Theoretical backdrop • How to recognize spiritual concerns & resources • Presentationof spiritual careresearch – howundergraduatenursing students learn • Recommendations for universities and clinicalpractice Giske; How to recognize & verbalize spirituality

5. 1. Theoretical backdrop – help to thinkprofessionally Carl Jaspers Victor Frankl Giske; How to recognize & verbalize spirituality

6. Victor Frankl & Logoterapi • Austrian& American psychiatrist1905 – 1997 • Imprisoned in Auschwitz 2nd world war • Develop LOGO THERAPY:Humans seek and can find meaning through: • Accomplish something • By receiving • An attitude of living through suffering Giske; How to recognize & verbalize spirituality

7. Limit situations - grensesituasjoner Carl Jaspers(1883 – 1969) Germanphilosopher and psychiatrist Somesituations in lifewecannotchange – he callsthem ”limit situations” • Illness • Differentkindsof loss • Death • Threathsofsuchsituations Giske; How to recognize & verbalize spirituality

8. Limit situationscancausepain and suffering - But also make one wonder and reflect… Giske; How to recognize & verbalize spirituality

9. Limit situations make us stop Realisethatlifecannotbe taken for granted That I am vulnerable That my lifeesilycan be over or someone I love/areconnectedwithcan die Giske; How to recognize & verbalize spirituality

10. Limit situationscan Lead us to become more aware of what is important in life Challenge us to reflect more deply about life Mature us ethically and intelectually Giske; How to recognize & verbalize spirituality

11. Have youexperienced ”limit situations”?

12. 2. How to recognize spiritual concerns • Pain • Agony • Questions • Wondering • Rest • Peace • Many expressions – listen to the meaning for the individual person Giske; How to recognize & verbalize spirituality

13. WE HAVE TO LISTEN WITH 2 EARS Giske; How to recognize & verbalize spirituality

14. What is the person’s concern?And how is it expressed?? • Who am I? • Who loves me? • Is there a meaning in what happens? • What about guilt – am I guilty? • How can I live with pain and suffering? • How will my future be? Giske; How to recognize & verbalize spirituality

15. What frame of reference do the person have?? What about • faith • View of life • tradition • cultur Does this person have? Giske; How to recognize & verbalize spirituality

16. Art & Science of Spiritual Care McSherry & Ross (eds.) (2010) Spiritual Assessment in healthcare Practice. M&K Publishing Giske; How to recognize & verbalize spirituality

17. 3. Presentationof spiritual careresearchamongstundergraduatenursing students • AIM:to determine undergraduate nursing students’ perspective on spiritual care and how they learn to practice it • Giske, T. & Cone P.H. (2012) Opening up to learning spiritual care of patients: A grounded theory study of nursing students. Journal of Clinical Nursing, 21(13-14), 2006 - 2015 Giske; How to recognize & verbalize spirituality

18. Participants: • 8 focusgroupswith 42 undergraduate students • 3 1st year • 3 2nd year • 2 3rd year • Average age 25,6 (20 – 45) • Life view • 30 Christian, 2 ”religious”, 1 Cathlic • 3 Agnostic, 3 Atheist, 2 Gnostic, 1 Naturalist Giske; How to recognize & verbalize spirituality

19. Questions to the focus groups: • What is spiritual care? • How do youlearn to practice it? • Tell usaboutyourexperiences Giske; How to recognize & verbalize spirituality

20. Analysis • Interviews transcribed and analysed accoding to Grounded Theory: Constant comparison • Coding • Open coding • Selevtive coding • Theoretical coding Giske; How to recognize & verbalize spirituality

21. Norwegiancontext • 1000 yearsofChristianity • 85 %of 5 million belongingto a Christian demonination • 2nd largestgroup: Muslims (1,9 %) • 3rd Norw. Humanistic Association (1,7 %) • Most Norwegiansbelieve in God • Faith is seen as private.Taboo to talk about Giske; How to recognize & verbalize spirituality

22. Spiritual care – the what • No cleardefinition • Beingconcernedwith the whole person, the soul and whatcould not be seen • Religiousfaith; readingholybooks, prayer • Seen as part ofnursesresponsibility BUT • Poorlydefined in litterature, • Leastfocusedonprofessionally • Whatnursesknewleastabout • Seenfewrolemodels in clinical studies Giske; How to recognize & verbalize spirituality

23. Participants main concern How to create a professionalrelationshipwithpatients and maintain it when spiritual concernswererecognised Giske; How to recognize & verbalize spirituality

24. Preparing for connection Connecting with and supporting patients Reflecting on experiences Students solvethisconcern by • Opening up for learning spiritual care • 3 intertwinedphases • Learningdevelopeas a spiral throughout the nursingtraining Giske; How to recognize & verbalize spirituality

25. Giske; How to recognize & verbalize spirituality

26. 4. RecommendationsUniversities: • Separate and clearthemes in teaching at university • Repeated focus with increasing complexity throughout the study • Choose methods that promote self-awareness, understanding own spirituality and values • Use interactive methods - Share examples, use role play, reflect in a safe environment with the support of fellow students and teacher • Requirements to read literature - theories and research related to spirituality. Be part of exams Giske; How to recognize & verbalize spirituality

27. Recommendations for clinical studies • Teachers can be key person to help students recognize possibilities for learning related to spiritual care • Use the rich possibilities for learning the uniqueness in diverse situations • Teachers work together with supervisor in practice to emphasize data collection and interventions including spirituality • Facilitate for students to experience role models • Support & challenge students to involve themselves with patients in a respectful manner • Create time & room for reflection in and afterpractice Giske; How to recognize & verbalize spirituality

28. Baldacchino D (2006) Nursing competences for spiritual care. Journal of Clinical Nursing 36(7), 14-15. Catanzaro AM & McMullen KA (2001) Increasing nursing students’ spiritual sensitivity. Nurse Educator26(5), 221-226. Cone, P.H. & Giske T. (2012) Teaching Spiritual Care – A Grounded Theory Study among Undergraduate Nursing Educators. Journal of Clinical Nursing, doi: 10.1111/j.1365-2702.2012.04203.x Frankl, V. (2006) Man’s search for meaning. An Introduction to Logotherapy. Boston, MA,Beacon Press. Giske, T. (2012) How undergraduate nursing students learn spiritual care in clinical studies – a review of literature. Journal of Nursing Management, 20, 1049–1057 Giske, T. & Cone P.H. (2012) Opening up to learning spiritual care of patients: A grounded theory study of nursing students. Journal of Clinical Nursing, 21(13-14), 2006 - 2015 Highfield MEF, Johnston Taylor E & Amenta MO (2000) Preparation to care: The spiritual care education of oncological and hospice nurses. Journal of Hospice and Palliative Nursing 2, 53-63. Hoffert D, Henshaw C & Mvududu N (2007) Enhancing the ability of nursing students to perform a spiritual assessment. Nurse Educator32(2), 66-72. ICN (2000) Code of Ethics. International Council of Nurses [ICN]. Jaspers, K. & Schilpp, P. (1981) The philosophy of Karl Jaspers. La Salle, Open Court. Lemmer C (2002) Teaching the spiritual dimension of nursing care: A survey of U.S. baccalaureate nursing programs. Journal of Nursing Educatio,41(11), 482-490) McSherry W (2006) Making sense of spirituality in nursing and health care practice. An interactive approach (2nd ed.). Jessica Kingsley Publishers, London. McSherry W, Gretton M, Draper P & Watson R (2008) The ethical basis of teaching spiritual care: A survey of student nurses perception. Nurse education Today, 28, 1003-1009. Mitchell DL, Benett MJ & Manfrin-Ledet L (2006) Spiritual development of nursing students: Developing competence to provide spiritual care to patients at the end of life. Journal of Nursing Education 45(9), 365-370. NarayanasamyA (1999) ASSET: A model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today19, 274-285. Narayanasamy A & Owens J (2001) A critical incident study of nurses’ responses to the spiritual needs of their patients. Journal of Advanced Nursing33(4), 446-455. Ross L (2006) Spiritual care in nursing: an overview of the research to date. Journal of Clinical Nursing 15, 852-862. Salmon B, Bruick-Sorge C, Beckman SJ & Boxley-Harges S (2010) The evolution of student nurses’ concepts of spirituality. Holistic Nursing Practice, 24(2), 73-78. Tanyi RA (2002) Towards clarification of the meaning of spirituality. Journal of Advanced Nursing, 39(5), 500-509. Taylor E J (2007) What do I say? Talking with patients about spirituality. Templeton Foundation Press, Philadelphia, PA. Taylor EJ, Mamier I, Bahjri K & Petersen (2009) Efficacy of a self-study program to teach spiritual care. Journal of Clinical Nursing18(8), 1131-1140. van Leeuwen R & Cusveller B (2004) Nursing competences for spiritual care. Journal of Advanced Nursing48, 234-246. van Leeuwen R, Tiesinga LJ, Middel B, Post D & Jochemsen H (2008) The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care. Journal of Clinical Nursing 17, 2768-2781. Wallace M, Campbell S, Grossman SC, Shea JM, Lange JW & Quell TT (2008) Integrating spirituality into undergraduate nursing curricula. International Journal of Nursing Education Scholarship, 5(1), article 10. Giske; How to recognize & verbalize spirituality