Spirit Matters: How to Remain Fully Alive with a Life-Limiting Illness
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Individual and focus group interviews were audio-taped and transcribed verbatim. Trustworthiness was ensured through strategies of truth value, applicability, consistency and neutrality. An operational definition of spiritual nursing care based on the findings was that humane care is demonstrated by showing caring presence, respect and concern for meeting the needs not only of the body and mind of patients, but also their spiritual needs of hope and meaning in the midst of health crisis, which demand equal attention for optimal care from both religious and nonreligious nurses.
There is still evidence of a prevailing conceptual disparity, and vagueness and ambiguity in the descriptions authors give for spirituality or spiritual nursing care Villagomeza McSherry and Draper conclude that there is little universal consensus about the meaning of these concepts. According to McEwan , definitions of spiritual nursing care are sparse. Varied themes of spiritual nursing care in the literature represent a variety of world views and the opinions of people from diverse backgrounds.
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The challenge for nursing is to provide a definition of spiritual nursing care that is universal in its approach, taking into account the importance and relevance of the phenomenon in clinical practice, whilst allowing for the uniqueness of individuals and world views Stranahan , Villagomeza Empirical literature provides theoretical, conceptual and operational definitions as experienced in various contexts.
On the other hand, Draper and McSherry contend that an adequate conceptual vocabulary of spiritual nursing care already exists in the literature, but that for the concept to be applied in practice seems to be another matter. Walker and Avant define concept analysis as a means to clarify over-used or vague concepts that are prevalent in clinical practice.
It is a reasonable and logical method that has served the development of science in many disciplines over time. Concept analysis of spiritual nursing care is therefore an essential process to assist in revealing its internal structure and critical attributes. Although other methods of concept analysis were incorporated during this process, the method espoused by Walker and Avant primarily served as a plausible framework to guide the concept analysis process for this article.
The researcher has observed over the years how patients are treated in a mechanical way with no regard or intention to show concern for their spiritual needs. The aim and purpose of this analysis was therefore to identify the defining attributes, antecedents and consequences of spiritual nursing care and to examine its possible implications for nursing practice, education and research.
Definitions of key concepts Existing theories and the literature provide a source of definitions of spiritual nursing care or related concepts that sometimes extend beyond the limits of common linguistic usages. Although there are varied perspectives on matters of spirituality, this article focuses only on religious and existential perspectives to identify differences and similarities between these points of view Table 1. Research method and design. Symbolic interactionism SI was used as a philosophical base that guided data collection and analysis.
SI, according to Blumer , has three underlying premises. Firstly, that humans act towards things based on the meaning that the things have for them. In this context, spiritual nursing care involves objects such as the nurse herself, religious books, the cross, the Bible or other religious artefacts whose meaning influence the actions of both the nurse and the patient. Secondly, the meaning of things is derived from how people interact with one another. Therefore, meanings are continually created, recreated and modified as care is provided, questions answered and hope and meaning provided for patients by the caring presence of the nurse.
Thirdly, meanings are handled through an interpretative process as nurses and patients have an encounter with each other through spiritual dialogue, prayer or singing spiritual songs Blumer — Material People involved in the study were the researcher, participants who were registered nurses, and two professors who were experts in qualitative studies.
Data collection methods A questionnaire was used to collect demographic data. Direct observation and field notes were utilised, especially for data collection and analysis triangulation purposes as some of the categories emerged from them. The researcher was the primary data collection instrument because she had to think of the questions during the interview or make observations and other strategies to get a clear view of what participants understood about spiritual nursing care and how they provide spiritual nursing care to patients in clinical practice Parahoo Entry and access into the research setting was negotiated with the appropriate authorities with permission granted in writing The researcher arranged and communicated the date, time and venues well in advance for both the individual and focus group interviews.
Data analysis Volumes of data were gathered and stored in an organised way for easy retrieval. Data was managed by converting the narrative data into smaller more manageable segments as guided by various qualitative research authors. The transcripts were read and verified against data several days later.
The interviewer listened to the tapes objectively as recommended by Morse and Field and critiqued her own interviewing style. Inconsistencies were noted on how questions were asked and improvements were made in subsequent interviews. Context of the study The study was conducted in an bedded academic hospital in the Gauteng Province in South Africa. Intangible needs have frequently been given a much lower priority than needs which were more obvious and more easily measurable.
Nursing as a profession is more concerned about implementation of principles, policies, protocols and other professional acts, but this finding brings to light that showing love and concern for patients is part of the treatment given to patients for holistic care. This finding was supported extensively in literature. Ethical considerations. Protecting the right to withdraw from the study was enforced by informing the participants that they could refuse to participate or withdraw after signing the consent form or at any time during the research process without penalty.
Respect for human dignity was shown by how questions were posed and the participants were allowed to express themselves fully without interruption unless where necessary. Difficult questions were rephrased and made simpler for the participants to respond to without feeling humiliated. Focus groups were also held in an office designated for the interviews. Their religious views, opinions and beliefs were not divulged to unauthorised persons. Credibility was maintained through prolonged engagement. During data collection the researcher spent an extended period of time with the participants whilst she conducted unstructured and semi-structured interviews.
The participants were allowed to verbalise their feelings without being hurried or interrupted. Questions in some instances were repeated for more clarity. The interviews were conducted until data saturation. During data analysis, tape recordings were listened to over and over again, transcripts were written and re-written, read and re-read to understand the data obtained. Following analysis, interpretations were taken backwards and forwards to some of the participants for validation. The researcher therefore immersed herself in the data from the time data collection commenced to completion of this report.
Applicability was ensured by providing detailed descriptions of the research design and methodology for possible application of the study in other settings. The thick descriptions continued in tapes, transcripts, observations and field notes which were presented for use by other researchers.
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Consistency was made possible by establishing an audit trail, which was a detailed report on the exact method of data gathering, context of the interviews, data analysis and interpretation. Data obtained from the interviews were coded and checked by two advanced qualitative researchers. Results were then compared and any differences in themes, categories and subcategories were noted Krefting To ensure the open nature of the interviews according to Kaufmann[ 20 ], the researcher intervened only minimally.
Interviews were audio-taped, transcribed, and anonymized. Any additional information relevant to our study was captured in written interview protocols; reflective notes were taken on different issues that emerged when conducting the study.
This might appear as a very primitive way of interpreting data; however, thematic analysis is a key methodology when it comes to detecting new patterns and generating hypotheses and theories[ 24 ]. Besides identifying patterns that are communicated directly, thematic analysis allows to detect themes that are 'non-observable' in terms of language use e. For this study one researcher PP , who conducted all interviews and was actively involved in transcribing the recorded data, constantly moved back and forth between conducting the interviews and analysing the data in-vivo coding and categorization until no new patterns emerged.
The simultaneous data collection and data analysis process allowed asking questions that helped to elicit the significance of a specific issue in subsequent interviews e. During the coding process the understanding of findings and their relevance changed, expanded, and deepened, which resulted in creating the theoretical categories.
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To ensure the consistency of findings, a second investigator JB double-checked the transcripts and in-vivo codings before proposing the final categories. Qualitative data analysis software MaxQDA 12 was used. For reasons of limited space, the main focus of this paper is on the migration-specific themes. Three overarching themes 1, 2, 3 were repeatedly expressed by both migrant and non-migrant patients.
From the subsequent themes, 1a-2c were expressed by study participants from both groups while 3a-d were specific for participants with a migration background. Themes 1a-d are predominantly health-care related while 2a-c consist of more personal and psycho-social issues; however, there is considerable overlap. This was mostly due to curative treatment preferences or misconceptions of what palliative and hospice care were offering.
At times they refused support by health care services home care nursing, mobile palliative care teams despite progressive fatigue, weakness, and lack of endurance. At the same time, however, they admitted to be tired of therapeutic interventions which were aggressive, burdensome, and repetitive. This ambiguity repeatedly was triggering conflicts in patients and their families. This lack of knowledge led to misconceptions and under-use of palliative and hospice care. Thus, EoL issues were reluctantly addressed, and preferences regarding EoL decision making were expressed only with great cautiousness.
Then you have always got the feeling … that you rather want to die. It became evident that patients were most afraid of what would happen to them in the EoL phase before the final salvation. Therefore, EoL discussions and decision making were regarded as difficult. Frequently, concerns and worries were expressed only between the lines e. Individualized advance care planning, arranging the funeral, deciding on financial matters, and addressing other social, existential or spiritual issues seemed to be a source of comfort to these patients. However, also the opposite was recorded in some cases, i.
He is When asked for their own migration background, they revealed complex personal migration histories—e.