Spiritual care in nursing : a grounded theory analysis.

Abstract

There is scientific evidence that the spiritual well-being of a person can influence the quality of life lived and the general responses to life's crises of illness, pain, suffering and even death (Ross, 1994). The problem that was identified in this study was the absence of an explicit description or the phenomena of spirituality and spiritual care in nursing within a South African context. Concept clarification was imperative ifnurses, patients/clients in South Africa were to realize spirituality and spiritual care within a broader context of holistic nursing. The purpose of the study was to conceptualize the phenomena of spirituality and spiritual care from the perspectives of nurses and patients/clients with an aim of generating a middle range theory of spiritual care in nursing that explained the phenomena by utilizing data that were grounded in the participants' experiences. A qualitative mode of inquiry using a grounded theory method was applied. A sample of 56 participants composed of 40 nurses, 14 patients and 2 relatives of patients was recruited by theoretical sampling procedure from two hospitals, and one hospice settings. Data were collected by utilizing focus groups interviews followed by one to one in depth interviews and observations. An audio tape recorder was used to record the conversation, field notes and memos were also kept to strengthen the data, and to ensure trustworthiness. Data were collected and analyzed simultaneously. A software called Nvivo was used to code data into different levels of coding. The results were rich descriptions of the phenomena in question and a development of a theoretical model for spiritual care. The concept of spirituality was described as a unique individual quest for a transcendent relationship by establishing and maintaining a dynamic relationship with self, others and with God as understood by the person. The ability to establish and maintain a meaningful transcendent relationship seemed to be related to the person's beliefs, faith or trust. 99% of the participants expressed their quest for a transcendent relationship through organized religion while I % claimed to have their spiritual fulfilment outside an organized religion. The phenomena of spirituality and spiritual care were conceptualized as occurring in phases which begin with a comfortable zone, trigge r-response and spiritual caring. The nurses role in spiritual care was perceived as based upon the principles of ubuntu. compassion for human suffering and pain and acceptance of a patient/client as a unique being. Nurses carried their spiritual care roles by accompanying, helping, presencing, valuing and intercessory roles. The outcomes of spiritual care were cited as hope, inner peace, finding meaning and purpose in life, illness, and in death.