Int Arch Nurs Health Care ISSN: 2469-5823

• Introduction
• Background
• Purpose
• Literature Review
• Methods of Evaluation
• Analysis
• Discussion
• Limitations
• Conclusion
• Figure 1
• Figure 2
• Figure 3
• References

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International Archives of Nursing and Health Care

¹Massachusetts General Hospital, Boston, USA
²Simmons College School of Nursing and Health Sciences, Boston, USA

Introduction

For four years, nurses at Massachusetts General Hospital and Brigham and Women's Hospital have collaboratively offered an annual conference on Spirituality in Nursing Practice. The planning committee developed a process for comprehensive assessment of the meaning of the conference with the participants for the 2012 conference. Two members (the authors) developed pre and post conference surveys, which were sent to all nurses registered for the conference. The purpose of this study was to gain a greater understanding of nurses' expectations of attending and their experiences at the conference. Survey results were compared and analyzed. The qualitative, open-ended responses were analyzed using Content Analysis. Findings indicate that the conference provided an opportunity for nurses to take time for reflection on and appreciation of the caring essence of nursing. Participants further identified presence and self-care as essential for excellent, relationship based care and creating a healing environment for patients, families, and staff. The nurses reported feeling renewed, rejuvenated, inspired, and committed to bringing new knowledge, skills, and an intentional holistic-spiritual perspective to their practice. Several respondents wished there was a stronger connection to religion.

The Spirituality and Nursing Conference: "The Art of Healing Presence: The Essence of Nursing Practice" has been an annual continuing education conference sponsored by the Massachusetts General Hospital and Brigham and Women's Hospital for the past four years. Both institutions employ about 2,000 nurses each. This conference always attracts a certain group of clinicians who are interested in attending spirituality and holistic conferences. A group of nurses from both hospitals collaborated to plan and organize the conferences, which focus on spirituality and holistic approaches to nursing care. Examples of topics that have been considered during the conferences include: The State of Energy Science; Reiki; Therapeutic Touch; Mindfulness; Music Therapy; Acupuncture; Healing Presence; The Healing Power of Positive Emotion; The Healing Power of Grace; Nursing Ethics: Our Covenant with Patients' Spirituality; Nurses Providing Spiritual Care at the Bedside; Compassion Fatigue; and Body as Prayer: Body Based Spiritual Practices.

Background

Each of the conferences attracts many nurses from both of the planning institutions and other institutions as well. A significant number of people attend year after year. The individual nurses' conference evaluations indicate a high degree of satisfaction with attending the conference and describe the value of focusing on spirituality and complementary nursing practices as a way to help their patients during very challenging and difficult illnesses and hospitalizations. However, the authors of this article questioned if the content of the conference met the needs of the attendees and if they were able to incorporate strategies discussed into practice.

Purpose

The purpose of this evaluation was to gain a greater understanding of nurses' expectations of attending and their experiences at the conference. As members of the planning committee, the authors conducted a comprehensive evaluation of the motivations and meanings of attending the 2012 conference by developing pre and post conference questionnaires based on the overall goals of the planning committee, across time, the nursing literature, and the formal and anecdotal feedback received from attendees at the previous conferences. After receiving IRB approval, the authors sent all registered participants the pre-conference survey (Figure 2) several weeks before the conference and the post-conference survey (Figure 3) one month following the conference. Sixty-five nurses attended the conference; 39 responded to the pre-conference survey and 20 responded to the post-conference survey.

Literature Review

The nursing literature is rich with descriptions of the importance of integrating spirituality into the holistic care of patients. Nurse authors have suggested that patients benefit physically and emotionally when spiritual needs are addressed in their care. Jenkins, Wikoff, Amankwa and Trent emphasized that nursing research has demonstrated that health and well being are impacted positively by spirituality and that holistic nursing care that includes an emphasis on spirituality leads to better outcomes for patients [1]. Among the benefits they cited are: finding a sense of peace in times of sorrow and stress; an enhanced sense of meaning and purpose; and a higher likelihood of surviving under stressful circumstances.

Patients hope for an opportunity to discuss their spiritual perspectives [2]. Nurses are in unique positions to develop relationships with their patients that allow for reflection on spirituality and feelings associated with spiritual perspectives [3]. It is essential that nurses be able to assess, describe, and integrate patients' spiritual needs in their practice.

Mariano [4] emphasized the value of holistic nursing care practices in helping patients to find meaning in their experiences. The importance of nurses addressing the evolving needs of patients seeking healing in traditional and non-traditional holistic approaches, including spiritual care, is evident in the recent co-publication by the American Nurses Association and the American Holistic Nurses Association Holistic Nursing: Scope and Standards of Practice [5].

In relation to nurses' needs, Puchalski and Guenter [6] described spirituality as a way for clinicians to deal with the stress of care giving themselves, and assist nurses to find greater meaning in their professional lives, especially as they care for patients who are suffering.

A review of the nursing literature underscores the importance of: defining spirituality in nursing practice comprehensively; the distinctions between spirituality and religiosity; identifying standards for spiritual practice; the integration of spirituality into practice; recognition of the difficulties related to meeting the spiritual needs of patients; and the vital need for education and support for incorporating spirituality in nursing practice. Authors of the literature clearly support the goals and foci of the Spirituality and Nursing conferences.

Methods of Evaluation

Participants were asked, several weeks before and one month after the conference, to respond to the same ten quantitative questions presented in a visual analog scale format and three different open-ended qualitative questions (Figures 1, 2).

Data from the two surveys were collected in an online anonymous format. Mixed method analysis was used to evaluate the results between pre and post conference attendance. Quantitative data were analyzed using SPSS version 15. A paired t-test was used to analyze pre-post quantitative data and the open-ended questions were analyzed qualitatively using Content Analysis.

Analysis

Of the sixty-five nurses who attended the conference, thirty-nine responded to the pre-conference survey and only twenty responded to the post-conference survey. The response rate to the post-conference survey was lower than anticipated, but those who did respond provided rich and meaningful information. Quantitative analysis yielded non-significant results, however all of the means moved in a positive way indicating that attendees had benefitted from attending the conference. Additionally, as with all continuing education offerings in both medical center settings, an on-site evaluation was conducted with all participants on the day of the conference. The on-site evaluations were very positive, as they have been for each of the preceding Spirituality and Nursing conferences. The follow-up post-conference surveys validated the positive responses for the on-site evaluations on the day of the conference.

The analysis of the open-ended questions revealed three key findings. The nurses were seeking renewal and inspiration for sustaining depth in their clinical practice. They described, in moving ways, the importance of caring for themselves so that they could bring intentional presence to address the needs of their patients more fully. Each of the key findings is presented below a long with a description of pre-conference and post-conference responses.

The open-ended questions were analyzed using Content Analysis, a widely used technique for analyzing qualitative data. The specific strategies for Content Analysis as outlined in a classic article by Downe-Wamboldt [7] were used to identify key findings embedded in the qualitative, open-ended questions within the surveys.

The authors independently analyzed the responses to each question, and considered each sentence line-by-line, for an initial identification of categories and findings. The authors considered their independent findings together and then synthesized the data and identified major categories, and refined three key findings. In the final phase of analysis, they returned to the data, independently, to assure confirmation of the mutually agreed upon findings within the data. The key findings were related to renewal, impact on practice, and professional development.

Key finding one: Renewal is essential for ongoing inspiration and rejuvenation for the demands of practice

In the pre-conference survey, participants described seeking inspiration, connection, reflection, and enhancing understanding of how to increase incorporation of spiritual and holistic perspectives in care in order to combat compassion fatigue and the many stresses associated with nursing practice. Their hopes were to expand knowledge, gain insights, engage in self-reflection, and to better understand practicing in the present moment. One participant described the hope that the conference would help her to foster a positive attitude leading to new ways to help herself, her patients, and her colleagues. Another said she was motivated to attend the conference because: "{she was} feeling emotionally burdened at work due to the poor prognosis, death and dying we see on my unit. . .feelings of burn out and compassion fatigue".

Respondents who had attended the conference in prior years left the conferences feeling energized and inspired. One participant stated: "[I] left last year's presentation recharged and ready to care for the patient, my co-workers, and myself". Another wrote: "I try to attend this conference yearly, to bring my spirit to a quieter place, especially at my workplace". Others described previous conferences as helpful, motivating, and inspiring.

Following the conference, participants described the value of attending the conference in terms of renewal and broadened perspectives. One participant commented: "The conference offered me renewal and validation of my views on relationship-based care." Another described the meaning of the conference to her as: "[The] importance of taking care of yourself in order to take care of others". A participant described her take away messages from the conference as: "Don't forget to take care of ourselves as nurses; being in the present moment is vital. Life is a lot easier with a sense of spirituality."

Key finding two: Impact on practice: Power of presence in the moment at the bedside

Participants had many patient-care related goals for attending the conference. Many described hoping to increase knowledge that could be of direct benefit to patients. Participants shared the following comments:

"I would like to learn more ways to help my patients heal other than through primarily medication."

"Further knowledge and gain different perspectives in my field."

"Interest in improving relationship-based care on my unit."

"I am interested in finding spiritual and emotional ways on how to help my patients cope with their illness for total body healing."

"Enhanced awareness and strategies to integrate spirituality into my practice."

"Share with nurses the importance of including spirituality in our nursing care and our self-care. Hear experts in the field."

One participant, describing the meaning of attending previous conferences, commented: "The conference validated many perceptions I have always had of nursing as a profession of healing. I have used these concepts as well on a daily basis."

Following the conference, participants stated, with one exception, that their goals for attending the conference had been achieved. They highlighted their learning in relation to improving relationship-based care, focusing on a more holistic way of caring, advancing knowledge in relation to alternative and complementary strategies, generally, and therapeutic touch and reiki, specifically. One participant stated: "[The conference] broadened my perspective on how alternative therapies can help both patients and caregivers". Another noted: "Wonderful to stop the rush of the day and to think holistically". Still another participant shared: "The conference offered me renewal and validation of my views on relationship-based care".

One participant expressed disappointment with the conference. She noted: "Don't understand in Reiki where the entity for healing is coming from. I understand touch can be reassuring and calming for a patient, but the hands on? . . .I thought that it (the conference) would be more God centered and not new age stuff."

Overall, participants described the value of the conference for them while responding to the question asking for the top three take away messages from the conference. 1. "I need time to process experience at the bedside". 2. "Need to have the 'intention' of caring before entering the room." 3. "Alternative therapies are helpful." "No care without self-care; reflection, and the role of experiential learning." "Importance of self-care, alternative therapies and their impact on patients, spirituality and its place in nursing."

Key finding three: The value of holistic professional development

The benefits of the conference for practice and professional development are interwoven and impossible to separate distinctly. In addition to the specific patient-related benefits discussed above, participants also often described a renewed appreciation for the value of being present to themselves, their colleagues, and their patients. The recognition by participants of the essential need to care for the self is captured in responses such as: "Need to enrich myself to be able to enrich others"; "Importance of taking care of yourself in order to take care of others"; "Don't forget to take care of ourselves as nurses. Being in the present moment is vital. Life is a lot easier with a sense of spirituality". One participant's perspective about the top messages taken away from the conference underscores the art of healing presence: the essence of nursing practice. She stated: "Who we are makes a difference, being present is healing, connection is everything for the patient and for me."

Discussion

Nurses attending the conference reported that they found a holistic perspective and focus, along with learning more about specific complementary strategies, to be beneficial for helping patients deal with stressful illnesses and as ways to help themselves deal with the stresses and challenges of practice. The qualitative responses highlight how the conference helped the nurses renew and deepen their understandings of self-care, reflection, and presence in terms of optimizing nursing care and collegial relationships. All but one of the participants found that the conference met their personal goals and needs for attending. The participant who stated that the conference did not meet her personal goals indicated that she was seeking a more God-focused orientation, rather than a more expansive approach to spirituality. Her disappointment highlights the importance of clarity, as organizers describe and advertise conferences related to spirituality in nursing.

Limitations

An important limitation of the evaluation is the overall low response rate to both surveys: 39/65 participants for the pre-conference survey and 20/65 for the post-conference survey. The response rate for the second survey is particularly concerning. There are two potential explanations for the low response rate for the survey sent after the conference. One is the timing of the conference and the second is the request for a second evaluation of the conference by the attendees. The conference was held just before the Thanksgiving holiday and the follow up survey was sent in December. The proximity to the holiday season may have influenced the response rate. As well, all attendees completed an on-site evaluation on the day of the conference and the second survey may have seemed redundant to them.

Demographic data were not requested of the participants. While anecdotally, the conference planners have noted a wide range of clinical settings and years of experience in nursing among the attendees, documenting specific information on the participants could yield important information to help inform future conferences. In the absence of demographic data, it is challenging to describe the sample well.

Recommendations for the future

The evaluation process utilized by the authors to gain a greater understanding of the experiences of nurses attending a spirituality conference yielded important information that will help in the planning of future conferences. The understandings gained through this comprehensive evaluation also provide insights into how the authors can enhance the evaluation process of future conferences with a focus on spirituality. For example, incorporation of demographic data and areas of practice for nurse participants will offer valuable information about the nurses who choose to attend the conferences. Surveying the attendees at several points in the six-months following the conference could offer information about the attendees' experiences over time. A longitudinal approach to evaluation of the conferences, comparing year-to-year responses could offer important information over time and provide valuable direction for subsequent conferences. As well, refining the surveys so that two areas of interest, that is, the value of spirituality to clinical practice, and the value of spirituality on a personal level, related to self-care of the nurses, may enhance the coherence of the surveys for the participants. Finally, avoiding the holiday season for the surveys and offering a small incentive for the completion of both surveys, such a CD with inspirational quotes and a brief meditation (recorded by a conference planning committee member) may improve response rates.

Conclusion

Careful consideration of the participants' expectations and experiences before the Spirituality and Nursing Conference: "The Art of Healing Presence: The Essence of Nursing Practice" and comprehensive evaluation of the meaning and goals achieved as result of attending the conference revealed the value of the spirituality conference for the participants. The nurses who participated in the conference and responded to the survey left feeling renewed, rejuvenated, more knowledgeable, and inspired to integrate spiritual perspectives into their practice. This innovative approach to complement the on-site evaluations on the day of the conference validated the importance and value of the conference to the participants. The surveys before and after the conference, and careful evaluation of the qualitative responses, offered a more comprehensive understanding of the meaning of the conference and will inform planning for future conferences.

References

1. American Nurses Association (2013) Holistic Nursing: Scope and Standards of Practice, 2nd ed. Silver pring, MD: ANA.
   


2. Downe-Wamboldt B (1992) Content analysis: method, applications, and issues. Health Care Women Int 13: 313-321.
   


3. Jenkins ML, Wikoff K, Amankwaa L, Trent B (2009) Nursing the spirit. Nurs Manage 40: 29-36.
   


4. Mariano C (2009) Holistic nursing: Scope and standards of practice. Palliative Care Nursing: Quality to the End of Life. 2nd ed. (pp. 67-69). New York: Springer Publishing Company.
   


5. Molzahn AE, Sheilds L (2008) Why is it so hard to talk about spirituality? Can Nurse 104: 25-29.
   


6. Puchalski CM, Guenther M (2012) Restoration and re-creation: spirituality in the lives of healthcare professionals. Curr Opin Support Palliat Care 6: 254-258.
   


7. Richardson P (2012) Assessment and implementation of spirituality and religiosity in cancer care: effects on patient outcomes. Clin J Oncol Nurs 16: E150-155.