Elsevier

Nurse Education in Practice

Volume 7, Issue 5, September 2007, Pages 275-284
Nurse Education in Practice

Spirituality as a universal concept: Student experience of learning about spirituality through the medium of art

https://doi.org/10.1016/j.nepr.2006.09.001Get rights and content

Summary

Precise definitions of spirituality can be elusive (McSherry, 2000). This factor together with the increasing class sizes for undergraduate nursing students render the teaching and learning of spirituality in nursing a challenge for both lecturers and students alike (McSherry, 2000). This paper reports on the design, delivery and evaluation of an innovative spirituality program for second year nursing students attending a Bachelor of Science degree at a university in the Republic of Ireland. This teaching program was introduced in 2005 to enhance nursing students’ engagement with the concept of spirituality. The program consisted of a series of lectures on the topic, followed by a visit to the National Gallery of Ireland. The latter involved a structured visit, whereby the students (n = 100) were divided into ten small groups and asked to wander through a section of the gallery and choose a piece of art work that they perceived to be spiritual in nature. Students were then asked to write their subjective impressions and reasons for their choice of painting. A list of themes related to spirituality was provided to the students as a prompt. Students later visited the paintings with both a lecturer and an art gallery guide and their chosen paintings were discussed within the group. Later that day, purposive sampling was used, whereby a selection of nursing students participating in the Gallery visit (n = 21) partook in four recorded focus group interviews following the Gallery visit. Themes emerging from the interviews pertained to the universal and individual nature of spirituality. In keeping with Mc Sherry’s (2000:27) definition of spirituality as a “universal concept relevant to all individuals”, students in the study revealed their surprise at the uniqueness of their colleague’s interpretations. The teaching methodology offered them an opportunity to reflect upon their own understandings and develop a deeper awareness of the meaning of spirituality. It also allowed many of them to understand how spirituality transcends traditional religions and permitted many of them to verbalize their feelings on spirituality for the first time.

Introduction

Attention was recently drawn to the spiritual inclination of the British Population Narayanasamy (2004). It is suggested that large numbers of Britons are practicing within organized religions or are “spiritually inclined” (Narayanasamy, 2004). While conscious not to confuse spirituality with religion, the point that is made that many patients are presenting to health care settings with diverse spiritual needs and yet nurses are often not equipped to deal with this (Narayanasamy, 2004). Indeed several barriers exist to the provision of spiritual care by nurses, including lack of confidence in this area, lack of recognition of the importance and relevance of this aspect of life to patients, uncertainty about personal spiritual and religious beliefs and embarrassment around the subject (Narayanasamy, 2002).

A further barrier that emerges within the literature on the topic is a generalized lack of understanding of spirituality among nurses (Ross, 1997, McSherry, 2000). This difficulty with precise definition and understanding of spirituality is not just true of practicing nurses, but is a reflection of the academic community as well. Spirituality can be a difficult concept to define, and can take on an almost mystical form thus making it elusive in nature (McSherry, 2000). These factors together with the increasing class sizes for undergraduate nursing students make the teaching and learning of spirituality in nursing a challenge for both lecturers and students alike (McSherry, 2000).

While spirituality as a concept has received attention within the nursing literature, there has been less attention to appropriate mechanisms for teaching within this area or student experience of learning on the topic. Educators are hesitant about the use of large formal lectures on this topic, favoring instead small group work and reflection with teacher support (McSherry, 2000). These suggestions have been integrated on this project within the context of learning through art. Observation of art has been noted within medical education as a useful way of enhancing student learning (Bardes et al., 2001). This concept has been integrated within this project for the development of a teaching and learning program concerned with fostering reflection and awareness of the concept of spirituality, outside the formal lecture setting.

Section snippets

Historical context

Historically spirituality has played a major role within the development of nursing (McSherry, 2000). Suggested to have emerged ultimately from the Judeo-Christian ethos, it is thought that nursing “has been steeped and fashioned by Christianity” (McSherry, 2000:4). The worship of God, within the Christian faith was expressed in nursing in the past through the virtues of care, compassion and charity (Ellis, 1980, Nolan, 2005). In the middle ages for example, hospitals such as the Santa Maria

Spirituality and nursing practice

Despite overt religious origins, the nursing profession’s value on spirituality has declined in recent years (McSherry, 2000). However, nurses’ attitudes towards the concept of spirituality remain positive. Nurses’ perception of spirituality has been documented within the literature (McSherry, 1997, McSherry, 1998). In one UK study nurses perceived spirituality to be universal concept applicable to all. Many qualified members of staff (71.4%) were engaged in identifying the spiritual needs of

Teaching spirituality within the undergraduate curriculum

There are no recognized or consistent approaches to the teaching of spirituality to undergraduate nursing students and the extent of teaching is unclear (McSherry, 2000). Some authors hold the view that spirituality learning occurs ultimately in the practice setting (Bradshaw, 1997, McSherry, 2000). Therefore spirituality is viewed as something that is “caught in practice” rather than amenable to being “taught” in the classroom setting (McSherry 2000:160). This tacit knowledge is the basis of

The use of art within nursing education

The use of art within education was earlier described by Dewey (1934,1958) and later proposed by Derbyshire (1994). The literature describes one educational program employed with medical students whereby they attend three sessions at a private art gallery in New York (Bardes et al., 2001). The overall aim of the program was to develop students’ skills in observation. The students are firstly required to examine a projected photograph of a patients’ face and write a description. Then the group

Sample

All students (n = 160) were provided with the teaching and Art Gallery Tour. A Research Executive Officer working within the School of Nursing and Midwifery recruited the participants by contacting all students in the group by email informing of the project two weeks in advance. Students replied to the Officer indicating their intent to partake and names were collected and provided to researchers. Consenting students (n = 21) met with the researchers in a designated venue once the Gallery visit had

Data Collection

Data collection took place after a visit to the Art Gallery, whereby the students in attendance on that day (n = 100) were broken into ten small groups and guided towards a selection of works of art. Students were asked to select one painting that they perceived to be spiritual in nature and asked to write their subjective impressions of that painting giving reasons for their choice. A list of themes related to spirituality was provided to the students as a prompt. Students later visited the

Ethics

The Ethics Committee of the Faculty of Health Sciences within the University granted ethical approval to conduct the study. Participants completed informed consent prior to the focus group interview. The right to withdraw from the study was provided, both prior to and at the commencement of the focus groups interviews. Recruitment and advertising of the focus group interviews was performed by a third party (a Research Executive Officer). Full and detailed explanation of the project was given,

Data analysis

The analysis of focus group data follows the same processes as for other sources of qualitative data (Kitzinger, 1995, Britten, 1995, Holloway and Wheeler, 1996, Burns and Grove, 2001). Robinson (1999) described how discussions of similar recurrent themes are drawn together and compared, and their relationship to variables examined. These repeated themes are grounded in the data, and not imposed onto the data by the researcher.

The interview data was gathered at the four focus group meetings

Rigour

In order to ensure credibility was the interviews were recorded. This ensured that data was collected directly and no data was lost. All steps were taken to preserve the anonymity of the students therefore participants were not invited back to verify the findings or comment on the appropriateness of the themes emerged. Although two interviewers were used in the process, the interview guide served to ensure consistency. Data was transcribed verbatim and all stages of the data collection and

Findings

Five themes emerged from the data: recognising Spiritual dimensions of everyday life, a snapshot of spirituality through others’ impressions of art, developing a deeper awareness of the meaning of spirituality, spirituality transcends traditional religions and spirituality-enhancing the nurses’ role.

Recognising Spiritual dimensions of everyday life

In keeping with the literature on spirituality, students identified aspects of spirituality such as love (Mayeroff, 1971, Narayanasamy, 1999); beauty (Narayanasamy, 1999); hope (Dyson et al., 1997, Narayanasamy, 1999); happiness (Lindholm and Eriksson, 1993) and crying and suffering (Lindholm and Eriksson, 1993) from the artwork that they viewed.

I picked a sculpture called the Homeless Wanderer. I thought it was very sad and poignant. Someone really alone in society and left out in the cold.

A snapshot of spirituality through others’ impressions of art

The findings revealed that students were intrigued about their fellow students comments. They remarked how different they were from their own interpretations:

Why they pick the pictures was definitely interesting. We did find out more about each other. We know each other well but suddenly you see sides to people from the paintings they chose.

Really what stuck me and what made me click to pick the picture and what was interesting to see was how others picked pictures and why they clicked on those.

Developing a deeper awareness of the meaning of spirituality

Students indicated a growing awareness of the meaning of spirituality. It has been suggested that nurses often do recognize spiritual needs of patients, but attribute these to a purely religious dimension, in many cases leaving them to be met by the hospital chaplain (Narayanasamy, 1999). This role delineation is evident within this narrative, but it is clear that students are beginning to think in new ways about spirituality.

I think for me my personal understanding of what spirituality would

Spirituality transcends traditional religions

Uncertainty around ones own religious beliefs can lead to discomfort when providing spiritual care to patients (McSherry, 2000). Furthermore, there is a tendency to confuse spirituality with organised religion (Narayanasamy, 2004). This is particularly relevant for this study, which took place in a country that has been traditionally entrenched in Catholicism. As ones perception of spiritually influenced by personal beliefs and experiences it is likely therefore that the latter religion may

Spirituality-enhancing the nurses’ role

Students while reticent and embarrassed around their role indicated that the teaching experience had enhanced their skills in this area:

I think I would not have had a clue what to do and brushed over it if it hadn’t have been for the series of lectures which has broadened the mind to think that this is an aspect of nursing that you have to deal with and it has to be done.

Indeed one student had already begun spiritual nursing intervention:

I had an experience at the weekend where I was working

Limitations of the study

The study is limited by the use of qualitative methods, which are viewed as subjective. The small sample used further limit the generalisability of the findings. However the study does provide useful and rich insights into this topic that could be further developed within a larger quantitative study now that preliminary data has been obtained.

Conclusion

Many clients experience spiritual needs when facing illness or health related crisis (Narayanasamy, 2004). Although pessimistic about nurses’ responsiveness to spirituality McSherry, 1997, McSherry, 1998, McSherry, 2000 acknowledges a positive attitude by nurses to the topic and indeed many nurses are attempting to address these issues in practice. In contrast to an earlier study (Piles, 1990), where only 11% of nurses felt able to provide spiritual care for patients even though they

Acknowledgements

We would like to thank the National Gallery of Ireland, for their assistance with the Gallery tours. We would also like to thank the Centre for Academic Learning at Trinity College Dublin, who provided a grant towards this project. We also would like to acknowledge the students in this study who gave so enthusiastically of their time and Ms. Caroline Slyne, Executive Officer, who worked so diligently with us on the project.

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