Nurses may recognize spiritual needs and believe they are treating the patient holistically, but

without consistent, formal training it is impossible to ascertain whether their patient’s spiritual

needs are actually being met. The findings of this study support what Lewinson and McSherry

(2015) discovered regarding the nurses’ role in the provision of spiritual care. It begs the

question of whether spiritual assessments are actually being taught in nursing education

programs.

In conclusion, the literature and findings in this study support the need for spiritual care

curriculum content to be included in graduate nursing programs, and perhaps nursing programs

overall. It may prove to be more valuable to introduce spiritual care content in undergraduate

nursing programs at the outset, in both the classroom and clinical setting. This may ensure

spiritual care of the patient is not being overlooked by nurses entering practice. Regardless,

including such content in both programs of study can increase both RNs and APRNs confidence

in providing holistic patient care, with the hope of improving patient outcomes. If content is

implemented in undergraduate and graduate nursing programs, more research would be

necessary to judge its effectiveness in the future.

International studies showed

a lack of knowledge regarding nurses’ perceptions of and interventions related to
spiritual care
(Christensen & Turner, 2008; Narayanasamy & Owens, 2001)

In conclusion, it is a need to develop

nursing students’ skills in self-knowledge and in existential themes as well, and to develop reflective learning as
a
way to use personally important experiences and inner intelligence for bridging gap between theoretical
knowledge
and practical skills.

Intension to understand inner experiences

prepares for connection to new knowledge (new existential situation, patient‘s situation) and promotes
reflection on
personal meanings. Inner experience (knowledge, feelings, attitudes) are externalized and comes to interaction
with
new knowledge (rational theories, wisdom through language arts, images of Nature), this step leads to sensing,
what
is here and now, and renews reflection, deepens it. Insight or discovery is a result of spiritual learning and
helps
personality-becoming self. Integrative energy appears in the process of becoming self and leads to health and
wellbeing.

Spirituality cannot be learnt solely from books or

in a classroom; knowledge and understanding
develop through experiences of caring for
patients along with personal life experience.
Therefore post registration education may also
be beneficial as nurses gain experience in
clinical practice.

The importance of meeting patients’ spiritual

needs was discussed in part 1 of this series
(Sartori, 2010). While definitions of spirituality
vary, Speck (2005) described it as “a vital
essence of our lives that often enables us to
transcend our circumstances and find new
meaning and purpose, and that can foster hope”.

Wong and Yau [33] found the

discrepancy between nurses’ theoretical commitment
to the spiritual care and their actual provision
of it as attributable to increased workload, lack of
time, lack of knowledge, and insufficient resources.
She concludes that spiritual care is seen as a low
priority when contrasted against other more lifesaving
methods. Wong KF, Yau SY. Nurses’ experiences in spirituality and spiritual care in
Hong Kong. Appl Nurs Res 2010; 23:242–244.

The majority of literature

acknowledges the
dimensions of knowledge,
skills and attitudes which
support the three
components in
Bloom’s Taxonomy
namely, the cognitive,
aFFective and psychomotor
domains.
In hospitals and community clinics, spirituality and spiritual
care should be routinely and concertedly incorporated into the curriculum of undergraduate and
postgraduate nursing courses, as well as in clinically based vocational training programs to
deliver more effective spirituality-related care.
In educational nursing context Spirituality is seen as power helpful to integrate practical and theoretical
knowledge; to strengthen courage to be with patient facing death, to do the best for patient in hour suffering.
We
have a lack of discussions how to teach nursing students to experience Spirituality and to look at patient as a
whole
human being, and how Spirituality acts on professional competence. Goldberg (1998) thinks that nurses should
be
given more opportunity for reflecting on their practice in order to improve their skills in nursing and spiritual
care.
Chelliach, Arumugam (2011) write that level of reflective thinking did not increase significantly during studies,
suggest promoting of reflective thinking and practice from lecturer guided activities

Cut Zurnali (2008) menambahkan bahwa pengetahuan individual yang muncul merupakan kombinasi

dari informasi, interpretasi, refleksi, dan pengalaman dalam sebuah konteks yang pasti (certain context).

Selanjutnya perlu dipertimbangkan juga pentingnya mengaitkan informasi baru dengan pengetahuan

yang ada.

This was a sample with significant nursing experience, which may reflect that spirituality has
been a part of their nursing care for many years. While this and their own personal spirituality may
have led to a level of comfort in providing spiritually based care, it must be emphasized that many are
doing so despite having no formal training in spirituality and spiritual care interventions. Spirituality
requires specialized knowledge and skill to discern between providing professional nursing care in a
way that is ethical and meets the primary need of patient physical care and well-being. It is therefore
concerning that many provide spiritual care interventions despite a lack of professional training. Given
the large number of patients being encountered who require spiritual care interventions, it is important
to prepare nurses to provide spiritually based intervention in an ethical way that benefits and supports
patient recovery.