Spirituality as a universal concept: Student experience of learning about spirituality through the medium of art
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.
References (54)
- et al.
The spiritual dimension: why the absence in nurse within nursing curricula?
Nurse Education Today
(1997) ASSET: a model for actioning spirtuality and spiritual care education and training in Nursing
Nurse Education Today
(1999)- et al.
Focus groups in physiotherapy evaluation and research
Physiotherapy
(1996) Nursing, healing and spirituality
Complementary Therapies in Nursing & Midwifery
(1998)- et al.
Learning to look: developing clinical observationalskills at an art museum
Medical Education
(2001) Tacit Knowledge in Organizations
(1999)Nursing practice draws upon several different ways of knowing
Journal of Clinical Nursing
(1998)Teaching spiritual care to nurses: An alternative approach
International Journal of Palliative Nursing
(1997)Qualitative interviews in medical research
British Medical Journal
(1995)- et al.
The Practice of Nursing Research: Conduct
(2001)
Fundamental patterns of knowing in nursing Advanced
Nursing Science
Sharing the Darkness The Spirituality of Caring Darron
Recognizing spirituality
Image-The Journal of Nursing Scholarship
Spirituality: integral to quality care
Holistic Nursing Practice
Caring for ourselves can be funny business
Holistic Nursing Practice
Handbook of qualitative research
Understanding caring through arts and humanities: a medical/nursing humanities approach to promoting alternative experiences of thinking and learning
Journal of Advanced Nursing
The meaning of spirituality a literature review
Journal of Advanced Nursing
Whatever happened to the spiritual dimension?
The Canadian Nurse
Nursing Research: The Application Of Qualitative Approaches
Spiritual care in nursing: a systematic approach
Nursing Standard
Spiritual interventions: how, when and why nurses use them
Holistic Nursing Practice
The Patient’s Charter
Qualitative Research For Nurses
Regaining control: The process of adjustment after myocardial infarction
Heart and Lung
Introducing focus groups
British Medical Journal
Cited by (36)
Memento Mori: Can art assist student nurses to explore death and dying? A qualitative study
2020, Nurse Education TodayCitation Excerpt :Additionally, art has been used as a form of object-based learning encouraging students to actively engage and critically examine objects to stimulate learning (Chatterjee and Hannan, 2015). In nurse education, art, as a form of object-based learning, has been used to explore aging (Wikström, 2000a; Wikström, 2000b), observational and assessment skills and nursing care (Wikström, 2001; Pardue, 2005; Pellico et al., 2009 and Frei et al., 2010), empathy and spirituality (Wikström, 2003; Mooney and Timmins, 2007; Jack, 2012), interpersonal skills (Wikström, 2000b), reflection (Wikström, 2012) and the death and dying process (Rose et al., 2008). While these studies used art to examine the humanistic aspects of nursing practice only Rose et al. (2008) explicitly addressed death and dying.
Developing a spiritual care competency frameworkfor pre-registration nurses and midwives
2019, Nurse Education in PracticeSpirituality in adolescents with cancer
2018, Enfermeria ClinicaCitation Excerpt :Rahnama et al19 said that a relationship with Allah through praying, cultivating an inner relationship with Allah, and talking to Allah are recognized as spiritual practices. Prayer or other rituals related to spirituality or religion have the ability to produce a calming effect, love, or a sense of belonging for one’s self, and this kind of practice is considered to provide health benefits25. The adolescents in this study showed closeness to God through prayer, participation in religious activities, and through reading the holy book.
Studying the old masters of nursing: A critical student experience for developing nursing identity
2017, Nurse Education in PracticeSpirituality in pre-registration nurse education and practice: A review of the literature
2015, Nurse Education TodayCitation Excerpt :The need for spiritual care education is supported by the literature (Simsen, 1988; Ross, 1996; Maddox, 2001; McSherry et al., 2008; Baldacchino, 2011), nonetheless, it is challenging to raise awareness, develop competence and confidence for delivering spiritual care (Catanzaro and McMullen, 2001; McEwen, 2005). Research also shows that a variety of teaching methods should be considered for both classroom and clinical practice (Seymour, 2006; Mitchell and Hall, 2007; Mooney and Timmins, 2007; Taylor et al., 2008; Baldacchino, 2010), in order to enrich content and cater to different learning needs, for example, self-study spirituality programme (Taylor et al., 2008) and experiential spirituality education (Purdie et al., 2008; Baldacchino, 2010). However, experiential learning was limited to a small groups of students and had a religious bias, also there are cost implications of making this available to all students.
Teaching nursing students about spiritual care - A review of the literature
2013, Nurse Education in PracticeCitation Excerpt :In the USA while many universities teach spirituality to health care students there is a both a lack of clarity and lack of consensus about what is actually taught (Koenig et al., 2010). Some authors have outlined their experiences in teaching nursing and midwifery students (Mooney and Timmins, 2007; Mitchell and Hall, 2007), thus indicating an interest in this area, however much of the suggestions for teaching practice are anecdotal and not evidence based. For example Rothman (2009) provides some guidance to the teaching of spiritual care to social workers suggesting that knowledge (of spiritual and religious meanings and traditions), skills (of assessment and care) and developing self awareness and personal growth form the basis of the undergraduate curriculum in this area.