Attitude toward spirituality and spiritual care of nurses in surgical wards

International Journal of Advanced Biotechnology and Research (IJBR) ISSN 0976-2612, Online ISSN 2278 599X, Vol-7, Special Issue3-April, 2016, pp2245-2251 http://www.bipublication.com Research Article Attitude toward spirituality and spiritual care of nurses in surgical wards Marziyeh Zihaghi 1, Esmat Nouhi 2, Toktam Kianian 3, Saman Saber* 4, and Younis Jahani 5 1 Department of Nursing, School of Nursing and Midwifery Iranshahr, Iranshahr University of Medical Sciences, Iranshahr, Iran. 2 Assistant Professor, Department of Nursing, School of Nursing and Midwifery, kerman University of Medical Sciences, Kerman, Iran. 3 Community Nursing Research Center, Department of Community Health Nursing, Nursing and Midwifery School, Zahedan University of Medical Science, Zahedan, Iran 4 Department of Nursing, School of Nursing and Midwifery Iranshahr, Iranshahr University of Medical Sciences, Iranshahr, Iran. ( Corresponding Author). samansaber16@gmail.com 5 Assistant Professor, Department of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran. Corresponding Author: Saman Saber, Department of Nursing, School of Nursing and Midwifery Iranshahr, Iranshahr University of Medical Sciences, Iranshahr, Iran. samansaber16@gmail.com ABSTRACT: Introduction: Spirituality, as the foundation of human existence and its effect on healing and curing people, has received increasing attention in recent years. The spiritual aspects of holistic care are very important just as biological, psychological and social aspects of man. Holistic approach has provided a suitable strategy for professional health workers, especially nurses, to pay attention to all aspects of human existence. Nursing relationship with spirituality in the care of patients is the same as full and comprehensive care of patients. This study aims to determine attitudes toward spirituality and spiritual care of nurses in internal and surgical wardsof hospitals in Zahedan University of Medical Sciences. Methods: This is a descriptive correlational study. The study population are nurses in internal and surgical wards of hospitals inzahedan University of Medical Sciences (Ali EbnAbiTalib Hospital and Khatamolanbiya Hospital),consisting of 100 subjects. Instruments included measures of spirituality and spiritual care (SSCRS). Results: The results showed that the mean score of attitude toward spirituality and spiritual care is 57.64 and standard deviation is 7.01, which is between theaverageleveland the extent desired. A significant relationship was not found between the attitude toward spirituality and spiritual care of nurses with demographic features with the exception of the ward. Conclusion: The most important concern in care centers is the quality of care, and the search for purpose and meaning in work, can be effective in the quality of patient care for nurses. Key words: attitude, spirituality, spiritual care, nursing INTRODUCTION: Spirituality, as the foundation of human existence and its effect on healing and curing people, has received increasing attention in recent years (1). Murray and Zinter (1989) have defined spirituality as the following: Spirituality is a mental quality which is beyond religious

beliefs and motivates peopleand creates emotions like appreciation and respect for God's majesty in a person. A spiritual person is purposeful in life and has realized the meaning of life, even if the person does not believe in the existence of the God, the spiritual dimension makes man to contemplate on creation and the infinite world.this important aspect becomes eminent and significant when man is confronted with emotional distress, severe illness and death (2). World Health Organization has defined health in four physical, mental, social and spiritual aspects and has emphasized considering the opinions and beliefs of patients in healing and professional people's relationship with patients.in this regard, nurses introduce themselves for holistic and can help to maintain the wellbeing of patients (1). Spiritual care is a multidimensional concept and involves training and activities in areas such asrespecting and maintaining the spirituality and dignity of the patient, listening carefully to the patient and helping the patient to understand the meaning of his/her illness on the part of nurses. Spiritual care is an important part of nursing performancebecause the purpose of nursing is health promotion, disease prevention, health maintenance, and pain and discomfort relief that spiritual care contributes to the achievement of this goal (3). Spiritual care requires an understanding of the patients' spiritual beliefs and recognizing his/her spiritual needs and nurses must develop their knowledge and understanding of spirituality and integrate spirituality in their own nursing care and enhance communication with patients and their families. There are three spiritual needs in all human beings: the need for meaning and purpose, the need for love and communication and the need for forgiveness, these needs are common for nurses. While in the assessment of spirituality, the following areas are focused on: the individual's concept of God or divinity; the source of strength and hope in the individual, the importance of religious practices for the individual; the relationship between the individual's perception of his/her own opinions and his health status (4). Spiritual care is a unique aspect of care and addressing the patients' spiritual needs is known as an essential part of holistic care in nursing (5). Sarah et al. conducted a descriptive study in 2006 to assess the spiritual care of nurses in nongovernmental hospitals of North Carolina. The results showed that although the majority of nurses regard spiritual care as an important part of nursing care,73% of them said that they routinely, spiritual care is not a part of their process of care. Based on the results, for holistic care, spiritual care should also be integrated with nursing care and programs must be performed to increase nurses' awareness and skills regarding spiritual care (6). Mazaheri et al. (2008) conducted a descriptive study to determine the attitudes of nurses toward spirituality and spiritual care in Razi Psychiatric medical-educational center. The results showed that the mean score of the attitude toward spirituality and spiritual care is 63/40 with a standard deviation of 7/57 and the scores of the majority of the study population are from 33 to 92 which was the highest score in the questionnaire that indicates they are at a high level. Finally, the researcher proposes that background for spiritual care must be provided by creating a suitable context (5). Fatemi et al. (2011) conducted a study to determine the relationship between nursing staff spirituality and patients' satisfaction with care. Results showed that there is a significant relationship between nurses' levels of spirituality and patients' satisfaction. Nurses' spirituality was highly positive and the relationship between nurses' spirituality and patients' satisfaction was significant (7). Rahnama et al. (2012) conducted a study to identify the perception of patients suffering from cancer of spiritual care. Based on the findings, all participants' caring spiritual needs are not addressed by nurses.such that characteristics and performance of nurses do not fully conformto patients' and their families' expectations of a nurse with a spiritual approach Saman Saber, et al. 2246

and the governing conditions on the ward are not appropriate for this issue. Abedi et al. (2009) conducted a research with the purpose of studying aspects of spiritual care provided by nurses to patients in hospitals. Empathy, giving hope, facilitating worship and communication with families, preserving privacy, respecting the patient, availability, listening, attention, good physical care, and teaching are the aspects of spiritual care in the findings that were identified in the context of nursing of patients (9).Shahrabadi et al. (2012) conducted a study to determine and compare the attitudes of senior nursing students and medical students of seventh year Iran University of Medical Sciences in the field of spiritual care. According to the findings, 56% of nursing students and 51.8% of medical students had a positive attitude toward spiritual care of the patients and there was no statistically significant difference between them. Nursing Students had a more favorable attitude toward considering a superior force or a supernatural existence for spiritual health or treatment team efforts in order to develop spirituality than medical students and medical students had a more favorable attitude toward considering spiritual care as a part of care performance areas than nursing students (10). Markani et al (2010), by a comprehensive review of related literature, focused on the importance of education in spirituality and spiritual care in nursing, while paying attention to its ethical and legal requirements of its integration into educational programs, considered it as a challenge for nursing undergraduate programs in Iran. The literature review showed that spirituality and spiritual care teaching have entered the curricula of the majority of universities in Eastern and Western countries, but for various reasons, nurses are still not prepared to identify and meet the spiritual needs of patients and need more academic teaching. No research has been conducted in Iran on the necessity of entering spirituality and spiritual care in nursing undergraduate curriculum. Nursing instructors play an important role in preparing nursing students to identify and address the patients' spiritual needs. Principles of spirituality and spiritual care must be entered in nursing undergraduate curriculum and it must be taught in nursing schools (11). While spiritual interventions have a significant impact on the process of improvement and health and patients request such interventions, many nurses do not pay enough attention in providing spiritual care (5). Given that little research has been done in this regard, a study was conducted to determine attitudes toward spirituality and spiritual care of nurses in internal and surgical wards of hospitals in Zahedan University of Medical Sciences. MATERIALS AND METHODS: This is a descriptive -correlational study. The study population are nurses in internal and surgical wards of hospitals in Zahedan University of Medical Sciences (Ali EbnAbiTalib Hospital and Khatamolanbiya Hospital), consisting of 100 people. Inclusion criteria for nurses was having over six months work experience in that ward. Nurses with work experience of less than 6 months were excluded. To collect data in this study, the moderated questionnaire (McSherry, 2002) (Spirituality and Spiritual Care Rating Scale = SSCRS) which contains 23 questions on pain, spirituality and spiritual care is used, the rating of which is based on the 5-point Likert scale (from strongly agree=4 to strongly disagree= 0). Reliability and validity of the questionnaire has been confirmed in the study by Mazaheri et al.(2008) with Content Validity Method (α=0.85). Scores from 63 to 92 are considered as high and favorable, 32 to 62 as average scores and somewhat favorable, and scores from 0 to 31 as low and unfavorable. For data analysis, SPSS software version 20 was used. Data were reported based on frequency distribution tables (number and percent), and according to central distribution and dispersion (mean and standard deviation). In accordance with the objectives of the plan, statistical tests, Spearman correlation coefficient, and equivalent nonparametric tests (Mann Whitney U and Kruskal-Wallis) were used. Saman Saber, et al. 2247

Findings: Frequency distribution of nurses in internal and surgical wards of hospitals in Zahedan University of Medical Sciences broken down to demographic features Demographic Frequency Features 8 Male Gender 92 Female 16 29 11 11 17 1 15 50 50 Mediacal 1 Medical 2 Medical 3 Internal Neurology Medical Ward Khatam Surgery Khatam Surgery Single Married Ward Marital Status According to the above table, most nurses in Medical and Surgical wards of hospitals in Zahedan UniversityMedical Sciences are female. And the number of nurses in internal 2 is more than other wards. In terms of marital status, they are equal. Range of scores of attitudes toward spirituality and spiritual care of nurses in medical and surgical wards of hospitals affiliated to Zahedan University of Medical Sciences is from 39 to 74 with a mean of 57. 64 and standard deviation of 7.01. The average age of nurses in internal and surgical wards of hospitals in Zahedan Medical Sciences University was 29.25 and average work experience of nurses was 7/8. The average score of attitude toward spirituality and spiritual care among male and female nurses were 54.12 and 57.94, respectively. The average score of attitude toward spirituality and spiritual care of single and married people were 56.8 and 58.48, respectively. Average scores of attitude toward spirituality and spiritual care of nurses in medical ward 1 is (55.18), in medical ward 2 (56), in medical ward 3 (62), in medical Neurology ward (61), in KhatamMedical ward (53.52), in surgery ward 70 and inkhatam surgery ward (61.6), respectively. Average scores of attitude toward spirituality and spiritual care of nurses are higher in internal Neurology ward and lower in KhatamMedical ward. Kolmogorov Smirnov test is used to check the normality status of the attitude toward spirituality and spiritual care, age, and work experience. P-value, all three cases were p=0.000 and less than 0.05. Therefore, distribution of attitude toward spirituality and spiritual care, age and work experience is not normal. Therefore, in order to investigate the relationship between age and work experience with the attitude toward spirituality and spiritual care, nonparametric Spearman correlation test was used. The results showed no significant statistical relationship between age and work experience with attitude toward spirituality and spiritual care. In order to investigate the relationship between gender and marital status with the attitude toward spirituality and spiritual care in nurses, Mann-Whitney U test was used. P=0.5 in both cases showed that there is no statistically significant relationship between gender and marital status with the attitude toward spirituality and spiritual care in nurses. In order to compare attitudes toward spirituality and spiritual care of nurses in different wards, Kruskal-Wallis test was used. P=0.000 showed that there is a statistical relationship between the attitude toward spirituality and spiritual care of nurses and different wards. To compare the wards two by two in terms of the attitude toward spirituality and spiritual care of nurses, Dunns test was used. Results showed that there are significant relationships between the attitude toward spirituality and spiritual care of nurses and the following wards: medical ward 1 and Khatam surgery with p=0/01, Khatam surgery and Saman Saber, et al. 2248

KhatamMedical ward with p=0.01, internal ward 3 and Khatammedical with p=0.03, and medical ward 2 and Khatam surgery with p=0.03. DISCUSSION: In studying the attitude toward spirituality and the spiritual care of 100 nurses, 92 women and 8 men, 50 of them were married and 50 were single. The least work experience was 1 year and the most was 29 years with an average work experience of 7.8. The age range of nurses participating in the study was between 21-50 years with an average of 29.25 years. Average attitude toward spirituality and spiritual care of is 57.64 with a standard deviation of 7.01, which is at a medium level and to some extent favorable. Investigating the relationship between age and the attitude toward spirituality and spiritual care, r=0.031 and p=0.75, investigating the relationship between work experience with the attitude toward spirituality and spiritual care, r=0.003 and p=0.97, investigating the relationship between gender and attitude to spirituality and spiritual care, p=0.59, and investigating the relationship between marital status with the attitude toward spirituality and spiritual care, p=0.50,showed that there is no statistical relationship between age, work experience, gender and marital status with the attitude toward spirituality and spiritual care. Studying the attitude toward spirituality and spiritual care of nurses in different wards( p=0.001), showed a statistically significant relationship. Attitude toward spirituality and spiritual care of nurses in surgical wards with an average of 70 and Medical 3 with an average of 62 was higher and in KhatamMedical ward was lower with an average of 53.52. In this regard, Mazaheri et al. (2008) carried out a study entitled "Attitude of nurses toward spirituality and spiritual care". The results showed that the mean score of the attitude toward spirituality and spiritual care was 63.40 with a standard deviation of 7.57. This indicates that the attitude toward spirituality and spiritual care of nurses in Razi Psychiatric medical-educational center is on a high positive level (5). According to a study conducted by Amjad that is entitled the "attitude to spirituality and spiritual care on nursing students of Sharoud University of Medical Sciences, mean attitude toward spirituality and spiritual care in nursing students was 56.84. The majority of nursing students had an average and almost favorable attitude toward spirituality and spiritual care (12).In a study conducted by Jafari et al. (2012) the mean scores of spiritual care of students were 46.91 ±4.97 and nurses' were 45.37 ±4.39 and there was a significant difference between the two groups of nurses and nursing students. This shows that the views of students and nurses on spiritual care is on a medium level which is partly favorable (13). According to the findings of a study carried out by Shahrabadi et al (2012) 56% of nursing students and 51.8 percent of medical students had a positive attitude toward the spiritual care of the patients and there was no statistically significant difference between them (10).In a study conducted by Fatemi et al., there was a significant relationship between the level of nurses' spirituality and patients' satisfaction. Spirituality of nurses is high and positive, the relationship between nurses' spirituality and patients' satisfaction is significant (7). In a study by Farhani Nia et al. (2005) entitled "the spiritual health of nursing students and their views on spirituality", spiritual level of nursing students was on an average level (14).Rahimi et al (2012) conducted a study entitled "Studying spiritual intelligence and spiritual health of nursing and midwifery students at Razi University of Kerman University of Medical Sciences and their attitude toward spirituality and spiritual care". The results showed: Average of spiritual intelligence and spiritual health and attitude toward spirituality and spiritual care were 150.07±16/98 and 93.01±13.78, respectively. Results suggest that spiritual intelligence and spiritual health of nursing and midwifery students are at an optimum level which can originate from students' ideological backgrounds and religious beliefs. But the attitude toward spirituality and spiritual care was on an average level (15). Of course, such results are not unexpected for our society that has a Saman Saber, et al. 2249

tendency toward religion and spiritual values. Factors such as the individual's religion and culture have caused such results. Thus, the spiritual dimension must be considered in presenting nursing care and in clinical settings, spiritual needs of patients must be considered along with the patients' physical and emotional needs and spiritual care must be considered in nursing care plans and the opportunity must be given to individuals to acquire conventional care skills along with the necessary capabilities of spiritual care. In this study, there is no statistical relationship between the attitude toward spirituality and spiritual care and demographic characteristics (age, experience, gender and marital status). Studying the attitude toward spirituality and spiritual care of nurses in different wards(p=0.001), showed a statistically significant relationship. Attitude toward spirituality and spiritual care of nurses in surgical wards with an average of 70 and internal 3 with an average of 62 was higher and in KhatamMedical Ward was lower with an average of 53.52. In a study by Jafari&Sabzevarititled the relationship between scores of students' views with individual characteristics, no significant difference was observed with the rest variables (gender, marital status, education level) except for participation in ethics workshops (13). In a study by Rahimi et al, among the demographic variables, only gender was significantly related to spiritual health. The age variable also had a significant relationship with the attitude toward spirituality and spiritual care (15). Also, the results of the study by Mazaheri showed that there is no significant difference between variables of the attitude toward spirituality and spiritual care and variables such as education level and clinical experience, work experience in psychiatric wards and overtime work (5).As reported by Vance (2001), there is no significant relationship between spirituality and spiritual care with teaching and work experience (16). The results of the study bymazaheri et al have shown that there is a significant relationship between attitude toward spiritual care and wards with work experience. These findings are consistent with the present study that considered the type of ward as effective in recognition of patients' spiritual needs (5). As reported bynabiamjad in a study entitled the "attitude toward spirituality and spiritual care in nursing students of Shahroud University of Medical Sciences, there was no significant relationship between the attitudes toward spirituality and spiritual care and demographic features (12). Nurses have a positive attitude toward spirituality and spiritual care; thus, it is necessary to include the training of this aspect at all levels of nursing education, particularly clinical and teaching. CONCLUSION: In this study, the attitude toward spirituality and spiritual care of nurses was average and somewhat favorable. The majority of the nurses in the study, regardless of having each of the different demographic and occupational features, have the same approach toward spirituality and spiritual care;it is perhaps due to the importance and value of spirituality in all aspects of life in Islamic community of Iran; this means that spirituality is considered as highlighted and beyond the influence of any particular underlying variable. Another important point is that Iranian Muslim nurses' attitude toward spirituality and spiritual care is greatly consistent with the contents of resources of the conducted researches. It is hoped that in the future, by considering the importance of spirituality and spiritual care, needed attention to be devoted in the field of care and treatment. While spiritual interventions have a significant impact on the process of improvement and health and patients request such interventions, many nurses do not pay enough attention in providing spiritual care. Research suggests that in treatment of diseases, in addition to the disease, the patient must be considered and in order to facilitate the treatment and recovery, the hidden aspect of human existence must be considered as well, in such a way that spiritual care interventions also be entered in treatment and care. For this purpose, it is necessary that nurses provide spiritual support for patients. Care such as; an open attitude toward expression Saman Saber, et al. 2250

of loneliness and patients' weakness, using techniques in order to clarify values to help the patient in clarifying beliefs and values properly, empathy with the patients' feelings, providing assurance to patients in the nurse's company at the time of suffering and pain, and so on. Therefore, spiritual care is a kind of psychosocial care which becomes possible with regard to the patients' spiritual beliefs. Therefore, the inclusion of spirituality and spiritual care in educational program of those who are trained to provide health and treatment services seems essential and educational planners and educational authorities should pay more attention to this matter. ACKNOWLEDGMENTS This article is the result of a thesis that was accepted at the Kerman University of Medical Sciences.Hereby, we thank all relevant authorities and colleagues and hardworking nurses of Zahedan University of Medical Sciences hospitals who helped and cooperated us in conducting this study. REFERENCES: 1. Baldacchino DR. Teaching on the spiritual dimension in care to undergraduate nursing students: The content and teaching methods. Nurse Education Today 2008; 28(5): 550-562. 2. Tabaraei AR, Sheikh Shoaei R. The integration of religion and psychology in the treatment of issues and recommendations. Research and The Seminary 2006; 7(1): 184-69. (Persian) 3. Lavassani GA, Keyvanzade M, Arjmand, N. Spirituality, job stress, organizational commitment, and job satisfaction among nurses in Tehran. Contemporary Psychology 2009; 3(2): 61-73. (Persian) 4. Hills P, Francis LJ, Argyle M, Jackson CJ. Primary personality trait correlates of religious practice and orientation. Personality and Individual Differences 2004; 36(1): 61-73. 5. Mazaheri M, FallahiKhoshknab M, BagherMaddah S S, Rahgozar M. Nursing attitude to spirituality and spiritual care. Payesh, 2009;1 (1):37-1. (Persian). 6. Hubbell SL, Woodard EK, J. Barksdale D. Spiritual care practices of nurse practitioners in federally designated nonmetropolitan areas of North Carolina. Int J American Academy of Nurse Practitioners 2006; 18 (8): 379-385 7. Fatemi MM, Nazari R, Safavi M, Naeini MK, Savadpour MT. Its spirituality on patients' satisfaction with nursing care nurses. Journal of Medical Ethics 2011; 5(17): 141-59. (Persian) 8. Rahnama M, FallahiKhoshknab M, SeyedBagherMadah S, Ahmadi F. Cancer patients perception of spiritual care. Ijme 2012; 5 (3):64-80. (Persian) 9. Abedi H, Elahi K. Manifestations of spiritual care in nursing. Second Congress of Qualitative Research in Health Sciences in Kerman, January,2009: 28-30. (Persian) 10. Shahrabadi R, Masroor D, Hadjizadeh S, Hosseini F. Comparison of the attitudes of the last-year nursing and medical students about spiritual care. Cardiovascular Nursing Journal 2012; 1 (1) :30-34. (Persian) 11. KhoramiMarekani A, Yaghmaie F, Izadi A. Instruction of spirituality and spiritual care in nursing: A challenge in curriculum development. Journal of Nursing and Midwifery 2010; 20(68):41-9. (Persian) 12. NabiAmjad R, Moghadasi M. Attitude to spirituality and spiritual care in nursing students anymore. Proceedings of the Eighth Congress of Medical Sciences, University of the East 2013. (Persian) 13. Jafari M, Sabzevari S. Compare the attitude and competence of pastoral care nurses and nursing students of Kerman University of Medical Sciences. [MSc Thesise] 2011. (Persian) 14. Farahaninia M, Abbasi M, Givari A, Haghani H. Nursing Students Spiritual Well-Being and Their Perspectives Towards Spirituality and Spiritual Care Perspectives. IJN 2006; 18 (44):7-14. (Persian) 15. Rahimi N, Esmat N, Nakhaei N. Check moral intelligence and spiritual health nursing and midwifery students of Razi University of Medical Sciences attitude to spirituality and spiritual care. [MSc Thesise], 2012. (Persian) 16. Vance DL. Nurses' attitudes towards spirituality and patient care.medsurg Nursing 2001; 10(5): 264 Saman Saber, et al. 2251