Meeting a ‘spiritual’ need can make a big difference in nursing

Professor Linda Ross, Spirituality Research

Professor Linda Ross has been at the forefront of research into spiritual care in nursing since her PhD in the early 90s when she was the first person to explore nurses’ perceptions of spirituality and spiritual care.  She is now working with partners to shape spiritual care in nurse/midwifery education across Europe.

"As an 18-year-old I was working as a healthcare assistant in a care of the elderly hospital in my home town Galashiels, just south of Edinburgh, to get some experience before starting my nursing degree.

"There was an elderly woman who was bed bound and needed total care. She had a dull glazed lifeless expression. She never spoke, except to whimper when being turned. Her world was staring at one wall, the ceiling or the ward, as she was turned twice hourly.

"In my view, her quality of life was minimal. One Saturday, whilst damp dusting the lockers, I found an old Bible stuffed at the back of her drawer. Not sure if I would get into trouble, I asked her if she would like me to read to her.

"I can remember the change in her expression, even now. Her eyes lit up, she reached for my hand and tried to mouth the words as I read. She had a spiritual need, in this case a religious one (it could have been a piece of literature, poem or something else of importance to the person).

"I remember thinking, if meeting a ‘spiritual’ need can make such a big difference, why is spiritual care not part of what a nurse does?

"In my undergraduate dissertation, I looked at what the literature had to say about that and found that, although it was a central part of the nurse’s role in theory, it seemed to be missing in practice.

"I worked as a staff nurse for two years between my first degree and PhD. There I noticed some patients who, despite pretty awful prognoses, were determined to pull through (perhaps to see a grandchild born, or a wedding take place) and survived longer than expected. Others appeared to ‘give up’ and died shortly afterwards.

"This led me to question the power of the ‘will to live’ or ‘hope’, for recovery, wellbeing and quality of life. If hope is so important, how can we as nurses harness that to assist our patients on the road to recovery or to alleviate their suffering?

"I wanted to find out what nurses thought about this, and this led me to my PhD, the first study of its kind."

First study on nurses' views of spirituality

"In my PhD I identified that nurses saw spiritual care as an important part of their role but felt unprepared for it and wanted education.

"Almost two decades later, the Royal College of Nursing (RCN) found that little had changed; in a 2010 survey of over 4000 members, nurses were still saying that spiritual care was important but they needed more training.

"Other researchers from England (Professor McSherry); Norway (Professor Giske), Malta (late Professor Baldacchio) and the Netherlands (Professor van Leuuwen) came on the scene asking similar questions. We sought each other out at international conferences and joined forces to create a research network to look at how we might meet nurses' request for more education in this area.

Professor Linda Ross, Spirituality Research

Landmark study

"USW and RCN funding enabled us to carry out a landmark study (2010-2015) involving over 2,000 students from 21 universities in eight countries to identify what helps students become competent in spiritual care.

"At the same time, Josephine Attard, one of my PhD students, developed the first set of spiritual care competencies for nursing and midwifery students.

"This group, together with Tormod Kleiven (Norway), has led the Erasmus+ funded EPICC Project, the first European collaborative piece of work seeking to make a difference to nurse/midwifery spiritual care education using the best available evidence."

Creating global competencies

EPICC has brought together around 30 nurse/midwifery educators from 24 countries to co-produce a set of spiritual care competencies, an educational matrix and a toolkit containing teaching and learning activities, all housed on the EPICC website.

The competencies and toolkit are being used to enhance spiritual care education in pre-registration nursing/midwifery programmes in different countries.

In Wales, the spiritual care competencies are informing the re-write of pre-registration nursing/midwifery curricula. Students will be assessed on these competencies both in university and in clinical practice. Discussions are underway with Health Education Improvement Wales about the competencies being used in pre-registration education of other health care professionals as well as in upskilling of the current NHS workforce by targeting post-registration education of health care professionals, and in training of ancillary staff.

I think targeting all NHS staff in this way is important in effecting an ethos of care and compassion within the entire organisation.