Essay: Spirituality and nursing

Spirituality is at the core of nursing professional identity (Hensel & Laux, 2014). It was reported that nursing students perceived high personal levels of spirituality (Shores, 2010). However, it is essential to include spirituality in nursing curricula to meet the demands of the profession (Wallace et al., 2008), as nursing students experience stress to meet their academic demands and clinical requirements (Jimenez, Navia-Osorio, & Diaz, 2010). Essentially, spiritual well-being is considered as an internal resource that helps an individual to cope well with stress (Landis, 2009). Besides which spiritual health is negatively related to stress and depression among nursing students (Lee, 2014), whilst spiritual health is positively correlated with health-promoting behaviors (Hsiao, Chien, Wu, Chiang, & Huang, 2010), health (Espinha, de Camargo, Silva, Pavelqueires, & Lucchetti, 2013) and academic success among student nurses (Beauvais, Stewart, DeNisco, & Beauvais, 2014).

As mentioned earlier, spirituality and spiritual care should be part of the nursing curriculum to provide quality nursing care to the patients (Wu, Liao, & Yeh, 2012; Cooper, Chang, Sheehan, & Johnson, 2013). Nevertheless, spirituality education program equips student nurses to identify their inner strength & resource to provide holistic care to the patients (Wallace et al., 2008). This not only improves the psychological well-being of a nurse but also her therapeutic nursing skills (White, 2014). Previous studies, have shed light on importance of spiritual well-being among nursing students.

Spiritual well-being is a multi-dimensional concept, the National Interfaith Coalition on Aging’s (1975) has defined spiritual well-being (SWB), as “the affirmation of life in a relationship with God, self, community and environment that nurtures and celebrates wholeness.” The instrument that we have used in our study, is in line with the definition of spiritual well-being. Although there were many instruments to measure spiritual well-being, questionnaire developed by Fisher (2010), Spiritual Health and Life-Orientation Measure (SHALOM) can be considered as an appropriate instrument to assess spiritual well-being (de Jager Meezenbroek et al., 2012). Here spiritual well-being is measured on four domains based on person’s relationship with self, intra-personal (personal), others (communal), nature (environmental) and with God (transcendental).

The following variables, mindfulness, self-compassion, and satisfaction with life were also part of this study. Mindfulness is being aware of the present moment, to one’s own experiences (Brown & Ryan, 2003). This increases an ability to be in the present moment with attention, acceptance, and awareness. According to Neff, self-compassion is being warm and caring at times of hardship, being kind to self, accepting suffering or unpleasant experiences as they are and being non-judgmental. And satisfaction with life is a subjective judgment about a person’s life (Diener, Emmons, Larson, & Griffin, 1985). However nursing students have reported high level satisfaction in life (Ratanasiripong & Wang, 2011).

The following studies reveal the relationship between variables studies in our study. There was a significant association between satisfaction with life and spiritual well-being i.e. religious well-being (relationship with God) and existential well-being (a person’s life purpose and meaning in life) (Jafari et al., 2010), and personal spirituality i.e. the degree to which an individual integrates spirituality into daily life i.e. practicing prayer or engaging in sacred rituals (Fabricatore, Handal, & Fenzel, 2000). A study conducted among Turkish university students reported, significant correlation between spiritual experiences (connection with the transcendent in daily life) and self-compassion (Akin & Akin, 2015). The following study revealed, that mindfulness (state and trait) and spirituality (Meaning and peace in life and Faith) were significantly correlated (Carmody, Reed, Kristeller, & Merriam, 2008).

As all these variables are related to each other, and are focused on the individual’s inner resource. As mentioned earlier, equipping nursing students with internal resource helps them to cope with the demands of the profession. Hence, this study was designed to evaluate the correlates and predictors of spiritual well-being among nursing students.

DISCUSSION:

Study’s aim was to illustrate the correlates and predictors of spiritual well-being among nursing students. Considerably, there was a positive correlation between spiritual well-being (overall and four-domains), mindfulness, satisfaction with life, and self-compassion in our study. as mentioned earlier, our results are in coherence with the previous studies.

Our study was successful in eliciting the predictors of spiritual well-being. The results of regression analysis revealed, satisfaction with life (13%), mindfulness (8%), and self-compassion (3%) significantly explained 24% of variance on the Spiritual Well-being (overall).

Similarly, 24% of variance was explained on the personal domain of SHALOM by satisfaction with life (14%), self-compassion (8%) and mindfulness (2%). Personal domain assesses spiritual well-being of an individual based on his/her sense of identity, self-awareness, joy in life, inner peace and meaning in life (Fisher, 2010). Earlier studies, have explained relationship between spiritual well-being on personal domain and self-compassion and satisfaction with life.

Likewise, 17% of variance was predicted by self-compassion (13%), and mindfulness (4%) on the communal domain of SHALOM. Love, forgiveness, trust, respect for others and kindness toward other people are measures in the communal domain of SHALOM (Fisher, 2010). Both self-compassion and compassion are related to each other (Neff & Pommier, 2013), When an individual is self-compassionate he/she can be compassionating towards others. A fMRI study found that brain neural activity is similar in both being compassion towards self and towards others (Longe et al., 2010). Role of mindfulness in connectedness with others needs to be explored.

Notably, nursing students had moderate spiritual well-being, in which connectedness towards others was high and their religious attachment was less (Hsiao, Chiang, & Chien, 2010). Also, high level of spiritual well-being (religious and existential well-being) was reported among nursing students (Pesut, 2002). Findings of our study reported nursing students experienced high level of spiritual well-being on all the four-domains of spiritual well-being refer to the Table-2.

Moreover, mindfulness (9%), and satisfaction with life (3%) explained 12% variance on the environmental domain. Connection with nature, with harmony, sense of awe and magic in the environment are measure in environmental domain of SHALOM (Fisher, 2010). The instrument used in the study FMI, measures mindfulness on unidimensional factor i.e. being present. Though mindfulness and satisfaction with life has its role on the environmental domain of SHALOM, this needs to need to be explored in the future studies.

Substantially, satisfaction with life alone explained 12% variance on the Transcendental domain of SHALOM with statistical significance. Personal relationship with the Divine/God, worship of the Creator, oneness with God, peace with God and prayer in life was measured in the transcendental domain of SHALOM (Fisher, 2010). Previous studies also have reported role of life satisfaction in connecting with the Divine. Females are generally more spiritual and have faith than males (Saxena, 2006). Majority of the participants in our study are females.

In contrast, among Turkish university students 21% of variance was explained on spiritual experiences (connection with the transcendent in daily life) by self-compassion i.e. 15% by overidentification, 4% common humanity and 2% by Self-judgment (Akin & Akin, 2015). However, religious well-being alone explained 31% of variation in satisfaction with life, whereas, spiritual well-being (religious and existential well-being) and hope explained 40% of changes in satisfaction with life among cancer patients (Jafari et al., 2010). In addition, stressors, personal spirituality and interaction between stressors and personal spirituality significantly predicted 21% of variance in satisfaction with life. The same study reported role of personal spirituality in maintaining satisfaction with life while coping with stressors (Fabricatore et al., 2000).

Overall, findings of our study illustrate the role of satisfaction with life and self-compassion on personal, communal, and transcendental domains of spiritual well-being.

Limitations of this study, firstly, small sample size, though prior to the commencement of the study sample size was calculated, later it was realized during analysis of data as we could have divided participants into groups according to religion. As many studies have reported significance of religion and spirituality, we could not tap the area of religion. Secondly, only self-reported questionnaires were part of this study. Thirdly, design of this study can be a limitation, as we cannot generalize the results.

Future study can be designed keeping in mind limitation of this study. In future, studies can be planned with both variables psychological and physical (example- Body Mass Index)/ biochemical (example- salivary cortisol)/ neurobiological (example- fMRI). Analyze data for each batch separately. Suitable intervention studies can be conducted that can increase spiritual well-being or self-compassion or satisfaction with life among nursing students.

Overall, our results indicate the importance of spiritual well-being, mindfulness, self-compassion, and satisfaction in life among nursing students.

CONCLUSION

Previous studies have provided an insight into academic and clinical demands of nursing students and relationship between satisfaction with life and self-compassion on personal, and transcendental domains of spiritual well-being. However, our study was successful in eliciting correlates and predictors of spiritual well-being. Substantially, satisfaction with life, and self-compassion play significant role in personal, communal, and transcendental domains of spiritual well-being. Therefore, an appropriate intervention that can enhance spiritual well-being or self-compassion or life satisfaction should be included in the nursing curriculum to equip them with an internal resource to be an effective health care provider.

ACKNOWLEDGEMENTS

We would like to thank all the nursing students for their participation in our study.

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