Spiritual Care Activities of Nurses Using Nursing
Interventions Classifi'cation (NICj Labels
Roberta Cavendish, PhD, RN, CPN, Lynda Konecny, MSN, RN, Claudia Mitzeliotis, MS, APRN, BC, CASAC,
Donna RUSSO,BS, RN, C, Barbara Kraynyak
- - Luke, EdD, RN, Melissa Lanza BS, RN, Judith Medefindt, BS, RN,
and Mary Ann McPartlan Bajo, RN
PURPOSE. To describe the spiritual care activities of
nurses as subsequently identified in the Nursing
Interventions Classification (NIC) labels.
METHODS. Data were takenfrom a larger study that
used a multiple triangulation research design to
describe spiritual perspectives, in tervenfions, and
attitudes of 1,000 Sigma Theta Tau International
members . Data analysis included descr ipt ive and
multivariate statistics for quantitative items, and
content analysis for responses to questions.
FINDINGS. 97 respondents reported providing 32
spiritual care activities. Ten NIC labels actually
mapped the nurses' spiritual care activities.
CONCLUSIONS. Spiritual care activities involve a
broad spectrum of interventions that may be unique
to each patient. The 32 spiritual care activities
described by the nurses provide new knowledge
regarding core spiritual care activities. The use of NIC
labels can facilitate docunzentation of spiritual care
activifies in diverse practice settings.
PRACTICE IMPLICATIONS. This study SZlppOrtS
greatcr specificity in describing spiritual care
interzvntions to a level that allows replication and
adztancement of knowledge.
Search terms: Nursing activities, nursing
in tervcntions, spiritual care
International Journalof Nursing Terminologiesand Classifications Volume 14, No. 4, OctobepDecember,2003
Soins spirituels: Activites des infirmihres qui
utilisent la classification des interventions de
soins (NIC)
BUT. Fournir des directives pour les soins spirituels
par la description des activitis de soins infirmiers,
ripertoriis sous les titres de la NIC.
M~THODES.Les donnies ont i t i extraites d'une vaste
itude utilisan t un devis triangulaire de recherche
pour dicrire les perspectives interventions et attitudes
spirituelles des 1,000 mernbres de Sigma Theta Tau
International. L'analyse des donnies a it6 faite a l'aide
de statistiques descriptives et multivariies pour les
items quantitatifs et par l'analyse de contenu des
riponses aux questions.
. infirmikres ont dicrit 32 activitis de
R ~ J L T A T S 96
soins spirituels. 10 titres (NIC) incluaient aussi des
activitis de soins spirituels.
CONCLUSIONS. Les activitis de soins spiritztels se
ripartissent sur toute une ganzme d'interventions qui
peuvent ttre uniques pour chaque patient. Les 32
activitis de soins spirituels dicrites par les infirmieres
apportent de nouvelles connaissances concernant le
noyau des soins spirituels. L'utilisafion des titres des
interventions ( N U peutfaciliter l'inscription ati
dossier des activitis de soins spirituels dans des
milieux cliniques varie's.
IMPLICATIONSPOUR LA PRATIQUE. Cette itude itaye
le fait que la description plus pricise des soins
spirituels permet de faire avancer la connaissances et
de conduire la rntme recherche dans d'autres milieux.
Mots-clks: Activite's de soins, interventions de soins,
soins spirituels
Translation by Ckcile Boisvert, MSN, RN
113
Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels

Atividades de cuidado espiritual realizadas por

enfermeiras que utilizam titulos da Nursing
Interventions Classification (NIC)
OBJETIVO. Oferecer um direcionainento para o
cuidado espiritual atrauk da descri@o das atiuidades
de cuidado espiritual realizadas por evlfermeirns, Be
acordo com a sua subsequente identificaqdo nos titulos
da NIC.
METODO. 0 s dados foram coletados a partir de 11\11
estudo mais amplo que utilizou um desenho de
pesquisa de triangulapio multipla para descreuer
perspectiuas, interuenGdes e atitudes de 1,000
membros da Sigma Theta Tau International. A analise
dos dados incluiu estatistica descritiua e multiz~ariado
para 0s itens quantitatiuos e analise de conteiido yarii
as respostas a perguntas.
ACHADOS. 97 respondentes relataram qcie rcaliznm
32 atiuidades de cuidado espiritual. 10 titulos da NlC
realmente abrangeram as atiuidades de criidado
espiritual relatadas.
CONCLUSOES. As atiuidades de ciridado espiritual
envolvem um amplo espectro de interuen@es, que
podem ser exclusiuas para cada paciente. As 32
atividades de cuidado espiritual descritas pelas
enfermeiras oferecem um nouo conhecimen to a
respeito das atiuidades de cuidados espiritual
essenciais. A utilizaqdo dos titulos da NIC pode
facilitar a docurnentagdo das atiuidades de cuidado
41iT2j. t l f ? A , 3 f !J f f 1 7 / L 'r7 (sm espiritual e m diferentes ambientes de pratica
ass is tenc ia I.
I M P L I C A C ~ E SPARA A PRATICA. Este estiido apoia
Translation by Shigemi Kamitsuru, PhD, RN
uma maior especifcidade nu descriqdo de interuenqiies
de cuidado espiritual, a um niuel que permita a
replicapio e auango do conhecimen to.
Palavras para busca: A tiuidades de enfermagem,
cuidado espiritual, interuenqcjes de enfermagenr
Translation by Jeanne Michel, PhD, IIN, a n d
Alba de Barroh, PhD, IIN

InternationalJournalof Nursing Terminologies and Classifications Volume 14, No. 4, October-December,2003

Actividades de cuidados espirituales de
enfermeras que utilizan las etiquetas de la
Nursing Interventions Classification (NIC)
PROPdSITO. Proporcionar directrices para 10s
cuidados espirituales, por medio de la descripcidn de
las actividades del cuidado espiritual de enfermeria,
tras identifcarlas en las etiquetas de la clasifcacidn de
NIC.
MBTODOS. Se tomaron datos de un estudio mayor que
utilizaba un disetio de investigacibn de triangulacibn
multiple, para describir las perspectivas, intervenciones
y actitudes espirituales de 1,000 miembros de Sigma
Theta Tau International. El analisis de 10s datos
incluyo estadisticas descriptivas y multivariables para
10s puntos cuantitativos y anulisis de contenido para
las respuestas a las preguntas.
RESULTADOS. 97 respuestas informaron que propor-
cionaban 32 actividades de cuidados espirituales. 10
etiquetas del NlC describian realmente las actividades
del cuidado espiritual.
CONCLUSIONES. Las actividades de cuidados
espirituales involucran un amplio espectro de
intervenciones, que pueden ser unicas para cada
paciente. Las 32 actividades del cuidado espiritual
descritas por las enfermeras, proporcionaron nuevo
conocirniento con respecto a1 nucleo de las actividades
del cuidado espiritual. El us0 de las etiquetas de la
NIC, puede facilitar el registro de las actividades del
cuidado espiritual en diversos entornos de la practica.
IMPLICACIONESPARA LA PRACTICA. Este estudio
apoya una mayor especifcidad a1 describir
intervenciones del cuidados espirituales, hasta un
nivel que permita la replica y el avance del
conocimiento.
TCnninos de blisqueda: Actividades de enfermeria,
cuidado espiritual, intervenciones de enfermeria
Translation by Mercedes Ugalde, MHS, RN
International Journalof Nursing Terminologiesand Classifications Volume 14, No.4, OdoberDecember,2003
Roberta Cavendish, PhD, RN, CPN, is Associate Professor,
The College of Staten lsland/City, University of New York,
Brooklyn; Lyna'a Konecny, MSN, RN, is Assistant Professor,
New York City Technical College/City University of New York,
Brooklyn; Claudia Mitzeliotis, MS, APRN, BC, CASAC, is a
Psychiatric Clinical Nurse Specialist, Veterans Administration
New York Harbor Health Care, Brooklyn; Donna Russo, BS,
RN, C, is a Clinical Instructor in Behavioral Health, St. Vin-
cent Catholic Medical Center, Staten Island; Barbara Kraynyak
Luise, EdD, RN, is Associate Professor, The College of Staten
lsland/CUW, Staten Island; Melissa Lanza, BS, RN, is Staf
Nurse/Charge Nurse, Augustana Lutheran Home, Brooklyn;
JudithMedtfindt, BS, RN,is Director of Infection Control,
Lutheran Medical Center, Brooklyn; and Mary A n n McPart-
lan Bajo, RN, is StafNurse, Staten lsland University Hospi-
tal, Staten Island, Ny.
I n times of uncertainty related to war, terrorist attacks,
natural disasters, and economic hardships, human be-
ings begin to question their belief system and ideolo-
gies. The healthcare system is a reflection of changing
times. Patients being hospitalized today are very sick.
Their lengths of stay are short. Are nurses able to pro-
vide "total" care incorporating the mind, body, and
spirit into their hectic schedules? Spiritual needs that
are present in each person are made manifest by the un-
certainty of events in one's life (Cavendish et al., 2000).
Life events are defined as unique incidents or occur-
rences that evoke a spiritual response (Cavendish et
al.). Nurses are often present during life events such as
illnesses, births, and deaths. Life events that elicit a
spiritual response in patients can be opportunities for
the nurse to provide spiritual care (Cavendish et al.).
With nursing defined as the diagnosis and treatment of
human responses (American Nurses Association
[ANA], 2003), nurses should be providing spiritual care
to their patients. This article reports study findings on
the spiritual care activities of nurses in the United
States. The findings reported are drawn from a larger
study to describe the spiritual interventions, practices,
and attitude of nurses in the United States.
115
Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels
Literature Review
Readiness for Enhanced Spirituality
In the United States people who were once seeking
the ultimate carefree, good life are now searching for
meaning (Dyson, Cobb, & Forman, 1997). Lifestyle
changes that have been noted include a renewed value
placed on family, friends, home, volunteerism, and on
that which relates to the spirit (Taylor, Lin, Snyder, &
Eggleston, 1998). The events of September 11, 2001,
transformed the world into a global community domi-
nated by uncertainty, a state that has transformed the
way many individuals perceive their lives.
According to a Gallup poll conducted in 1996, a ma-
jority of Americans consider themselves religious or spir-
itual. Gallup and Castelli (1989) reported that spirituality
is the most important aspect of existence for more than a
third of the US. population, and spirituality as a strength
is central to the lives of disadvantaged people of color.
Spiritual renewal among diverse individuals in the
United States has reached new heights in the 21st cen-
tury. The power of prayer has been debated and studied
(Simpson, 2002). Spirituality has been linked with heal-
ing, health, and wellness (Banks, 1980; Benson, 1997;
Dossey & Keegan, 2000). As compelling evidence of the
benefits of spiritual care emerge, it is important to assess
if nurses are providing interventions for spiritual care or
if they are they delegating spiritual care to chaplains and
others (Emblen & Halstead, 1993; Narayanasamy, 1999b).
In this study, spirituality is defined as a universal
human phenomenon that recognizes the wholeness of
individuals and their connectedness to a higher being.
It is the integrating factor in the quest for meaning and
purpose in life (Cavendish et al., 2000).
Factors That Affect Practice
Meeting a patient‘s spiritual needs should be a con-
cern of nursing. Th~sis supported by the Joint Commis-
sion on Accreditation of Health Care Organizations’
(2000) establishment of patient standards on spiritual
116 International Journalof Nursing Terminologies and Classifications Volume 14, No. 4, OctoberDecember,2003
care. Although nurses conduct nursing assessments rou-
tinely, assessments of spiritual needs are usually not
done and spiritual care is often delegated (Broten, 1997;
Cavendish et al., 2001). Spirituality has an increasingly
wide range of interpretations; the delivery of spiritual
care interventions can understandably be equally di-
verse, comprising existential and religious components
(Byme, 2002). The nurse with an existential perspective
interprets spirituality as that which gives meaning, ful-
fillment, satisfaction, a will to live, a belief in self, and
connectedness with self, others, nature, and a higher
power. The nurse with a religious perspective perceives
spirituality as indulgence in rituals and specific religious
practices for integration of self with a deity (Broten).As a
result of economic constraints, inadequate staffing, and
high-tech care, the focus of nursing care is on the physi-
cal domain rather than the spiritual. If nurses are per-
forming spiritual care activities, the types and frequency
of these interventions are not known because spiritual
care is infrequently documented (Broten).
Nursing Activities and Interventions
Nursing activities are measures or actions the nurse
provides in the delivery of patient care (McCloskey &
Bulechek, 2000). Interventions are specific actions taken
by the nurse to promote the health of an individual, fam-
ily, or community (Van Dover & Bacon, 2001). Within the
framework of the nursing process, nursing intervention
activities flow from problem identification. The basis for
how interventions are selected and the activities associ-
ated with the intervention performed depends on (a) ex-
pected patient outcomes; (b) the literature regarding evi-
dence-based practice associated with the intervention; (c)
likelihood of effectively implementing the intervention;
(d) the receptiveness of the intervention to the individ-
ual, family, or community; and (e) the competence of the
nurse (Bulechek & McCloskey, 1996). How do these fac-
tors affect spiritual care interventions?
Research findings indicate that a dichotomy exists be-
tween patient expectations of spiritual care and the per-
ceptions of nurses (Cavendish et al., 2000). Patients and
their families expect that their spiritual needs will be met
(Narayanasamy, 1999a). Nurses are often not comfort-
able providing spiritual care (Cavendish et al., 2001;
Narayanasamy 199913))and they may not be able to dis-
tinguish spiritual needs from religious needs. The provi-
sion of spiritual care has been linked to higher levels of
wellness (Burgess, 1997). Spiritual care activities are not
clearly defined in the nursing literature, and few spiri-
tual care interventions are described to guide nursing
Care.
Purpose
This article reports the spiritual care activities de-
scribed by a group of nurses in the United States. These
findings are drawn from a larger study to describe
nurses’ spiritual perspectives, interventions, and atti-
tudes. The spiritual care activities were subsequently
identified using the Nursing Interventions Classification
(NIC)labels to provide direction for spiritual care. NIC, a
standardized approved classification system, is a compi-
lation of 486 interventions, a taxonomy with 7 domains
and 30 classes that compose the art and science of nurs-
ing. Research conducted to codify nursing interventions
began in the early 199Os, when a core group of nurse re-
searchers conceptualized a standardized language that
was subsequently labeled the Nursing Interventions
Classification.It was first published in 1992, with three
subsequent editions in 1996,2000, and 2003.
Methods
Design
This nonexperimental, descriptive study used multi-
ple triangulation methodology to describe the spiritual
perspectives, interventions, and attitudes. The use of a
multiple triangulation research design encompassing a
questionnaire and descriptive qualitative content analy-
sis captures a complete, holistic, and contextual descrip-
tion of nurses’ spiritual care interventions, attitudes, and
perspectives (Thurmond, 2001). Multiple triangulation,
International Journalof Nursing Terminologiesand Classifications Volume 14, No. 4, OctoberDecember, ulo3
more than one data source and methodology, and eight
investigators served to strengthen the research findings
and reduce bias in all phases of the study (Polit & Hun-
gler, 1995; Thurmond; Woods & Catanzaro, 1988).The
complementary skills of the researchers support choice
of data source triangulation.
Sample
A cover letter, questionnaire, demographic form, and
stamped return envelope were sent by first-class mail to
a national random sample of 1,000 Sigma Theta Tau In-
ternational (STTI)Nursing Honor Society members. Fol-
lowing the criteria for honor society membership, all
nurses had achieved the minimum of a bachelor’s de-
gree. Nurses were drawn from a pool of medical-surgical
nurses who were STTI members. There were no limita-
tions regarding age, sex, race, or religious affiliation. In-
stitutional review board approval was obtained. Retum
of a completed survey implied consent to participate.
Instruments
This study employed two tools that had both quanti-
tative and qualitative components. Quantitative data
were obtained from the nurses’ responses on a demo-
graphic data form and on two questionnaires on spiritu-
ality: Reeds (1992) Spiritual Perspective Scale (SPS) and
Highfield’s (1992) Nurses’ Spiritual Care Perspectives
Scale (NSCPS).
The quantitative part of the SPS is a 10-item question-
naire that uses a &point Likert scale to measure spiritual
perspective. The tool measures an person’s spiritual per-
spective to the degree that spirituality permeates one’s
life and how one engages in spiritually related interac-
tions. Reed (1992) reported the Cronbach’s alpha coeffi-
cient of .90 by comparing an arithmetic mean of the re-
sponses. Scores range from 1 (low spiritual perspective)
to 6 b g h spiritual perspective).
The qualitative part of Reed’s survey tool asks: ”Do
you have any views about the importance or meaning of
spirituality in your life that have not been addressed by
117
Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels
the previous questions?” With an overall response rate of
404 (40%,),there were no significant qualitative data find-
ings from the SPS.
Part 1 of the NSCPS is a 12-statement questionnak that
uses a 4point Likert scale to measm spiritual practices and
interventions. Part 2 is a 13-statement questionnaire that
uses a 5point Likert scale to measure attitudes about pro-
viding spiritual care. A mean score is tabulated for each
item. Reliability and valldity coefficients for the NSCFS were
not available.The data presented in this article were elicited
from the qualitative component of the NSCPS, which asked:
“Can you list other spiritual care activities or interventions
that you have found helpful in your practice?”
Data Analysis
The eight researchers who conducted the larger study
performed the data analysis. These researchers are mem-
bers of the Research Committee of the Mu Upsilon S’ITI
chapter. They are experts on the topic of spirituality and
experienced with the research methods. The qualitative
data analysis method used included constant compari-
son of the conceptual linkages, theme identification,
theme reduction, and theme validation (Munhall &
Oiler-Boyd, 1993).Data were coded by extracting nurses’
verbatim responses to the qualitative question that de-
scribed their spiritual activities. Data were analyzed and
grouped for pattern recognition of spiritual activities
(Bodgan & Bilken, 1982). Each of the researchers pre-
sented their data analyses to the research committee. The
interrater reliability of activity recognition was achieved
through agreement and confirmation. Interrater reliabil-
ity was obtained by computing the number of member
agreements divided by the number of agreements plus
disagreements, for a coefficient of 375 (Polit & Hungler,
1995)- that is, seven of the eight researchers were in
agreement with the findings.
Findings
A total of 404 (40%) of the surveys were returned.
The age of participants ranged from 21 to 61 years.
118 International Journalof NuIsing Terminologiesand Classifications Volume 14, No. 4, OctobepDecernber,2003
The majority of participants were female ( n = 384,
96%), had completed a bachelor’s degree ( n = 330,
83%), and worked full-time (71 = 262, 68%). Most par-
ticipants reported a religious affiliation ( n = 388, 98%,),
including Protestant ( n = 163, 43$%),Catholic ( n = 137,
41%), Jewish ( n = 16, 4%), and Buddhist ( n = 12, 3%).
Ten respondents said they were agnostic (3%).The
majority of participants identified themselves as
white ( n = 360, 90%), married ( n = 276, 69%), with
children ( n = 247, 62%), and in good health ( n = 397,
99%).
Ninety-seven (18%)reported providing 32 spiritual
care activities for patients and 2 spiritual care activities
for themselves, including the use of petitional prayer
to meet the nurse’s personal spiritual needs. With little
evidence-based literature against which to compare
the spiritual care activities, the researchers elected to
use labels from NIC (McCloskey & Bulechek, 2000) as
an identifying map to identify. Because NIC is a classi-
fication system of interventions that the nurse per-
forms for patients, the two activities that were used by
nurses personally were not located and thus were
dropped from consideration. The researchers used the
nurses’ direct quotes to describe the spiritual care ac-
tivities for patients and matched them with NIC label
activities. After two rounds of review, the final NIC la-
bels were selected based on a consensus among the re-
searchers. Nurses’ spiritual care activities were catego-
rized u n d e r 10 NIC labels: “spiritual growth
facilitation,” “spiritual support,” ”presence,” “active
listening,” “humor,” “touch,” ”therapeutic touch,”
“self-awareness enhancement,” ”referral,” and ”music
therapy” (McCloskey & Bulechek). The majority of
spiritual care activities reported by participants were
found in two NIC labels that directly address the spir-
itual domain ”spiritual growth facilitation” and ”spiri-
tual support.” In addition, several spiritual care activi-
ties were considered as complementary therapies such
as “music therapy” and ”therapeutic touch.” Finally,
nurses’ spiritual care activities and their correspond-
ing NIC activities were ranked according to frequency
of use (Table 1).
NIC Label and Definition
Spiritual Growth Facilitation (5426)
Facilitation of growth in patient‘s capacity
to identify, connect, and call on the source
of meaning, purpose, comfort, strength,
and hope
Spiritual Support (5420) Assisting the
patient to feel balance and connection with
a greater power
aRationale for congruence with NIC activity is provided only when not apparent.
International Journalof Nursing Terminologiesand Classifications Volume 14,No. 4, OctoberDecember,2003
NIC Activity
Encourage conversation that assists the pa-
tient in sorting out spiritual concerns.
Offerindividual and group prayer sup-
port, as appropriate.
Encourage participation in devotional
services, retreats, and special prayer /
study programs.
Promote relationshipswith others for fel-
lowship and service.
Encourage use of spiritual celebration and
ritual.
Provide an environment that fosters a
meditative/ contemplative attitude for
self-reflection.
Refer to support pups, mutual self-help or
spiritually based programs, as appropriate.
Refer to pastoral care or primary spiritual
caregiver as issues warrant.
Encourage chapel service attendance, if
desired.
Encourage the use of spiritual resources, if
desired.
Nurses’ Spiritual Care Activities
“I questioned patients to discover spiri-
tual concern.”
”Encourage a patient by praying for them
at home.“
”I’ll keep you in my prayers.”
”Have family pray for patient.”
”I have lifted a patient‘s health concerns up
for prayer to my clergy.”
“Encourage family /friends to pray.”
”I have asked friends and family to help
meet the spiritual needs of the patient.”
“Include the family of patient in spiritual
care.”
”Joinin prayer that spiritual advisor has
started.”
“Participatein patient’s family prayer.”
‘Visualization.”
”Pleasant thoughts.”
“Breathing.”
“Music therapy, relaxing music.”
“Playing religious hymns / music.”
“Sending cards to patients.”
“Facilitatinga life review.”
”Pet therapy.”
Alternate modalities provide an enuironnient
for selfreflection.a
“Hospice referral.”
Hospice is a spiritually based supporLa
“Provide time for prayer or clergy visits
prior to surgical procedurrs.”
“I directed family members to the hospital
chaplain when dealing with devastating
news such as deaths or serious illness.”
“Contact hospital chaplain.”
”Spiritual care counselor employed by the
hospital.”
“Took patients to the Sunday hospital
chapel service.“
”Remind patient of Mass, offered on TV.”
“Try inspirational care for agnostics.”
”Offered spiritual care to families.”
“Askingif they want spiritual/religious
leader.”
continued
119
Table 1. continued
NIC Label and Definition
Spiritual Support (5420)
contin ired
Presence (5340) Being with another,
both physically and psychologically,
during times of need.
aRationale for congruence with NIC activity is provided only when not apparent.
120
NIC Activity
Provide desired spiritual articles, accord-
ing to patient preferences.
Facilitate patient‘s use of meditation,
prayer, and other religious traditions and
rituals.
Listen carefully to patient‘s communica-
tion, and develop a sense of timing for
prayer or spiritual rituals.
Ass- patient that the nwse will be avail- ”Suggested spiritual exercise to reduce
able to support patient in times of suffering. pain.”
“In grave illness I comforted my patients.”
Be open to patient‘s feelings about illness
and death.
Demonstrate accepting attitude.
Verbally communicate empathy or under-
standing of the patient‘s experience.
Establish trust and a positive regard.
Listen to the patient‘s concern.
Touch patient to express concern, as
appropriate.
Be physically available as a helper.
International Journalof Nursing Terminologiesand Classifications Volume 14, No. 4, OctobeFDecernber, 2003
Nurses’ Spiritual Care Activities
”I’ve mated an environment that is sup-
portive of the patients/ families spiritual /
religiousneeds (e.g., arranged for family
to sleep over in room, bring in own food,
where own clothes of customs importance,
and took down crucifix when asked to).”
”Bring religious items to patients (rosary,
statue, tapes, books).”
”Discussed using meditation.”
”Allow “PO’ patients (surgery) to re-
ceive communion (Host).”
”Listen to my patient‘s beliefs.”
”Thosewho need / practice openly usually
have frequent visits from their own re-
sources. I just assist by giving privacy.”
“Facilitateany spiritual need but only of if
initiated by the patient/ family.”
”It is then that I listen to their concerns,
comfort and promise to pray for the pa-
tient and family.”
”Discuss death/dying, after life issues.”
“Afterlifewhen patients die (heaven);an-
gels as guides for dying patients.”
’’I acknowledge my clients’ unique spiri-
tual practices.”
”See the patient as a spiritual being.”
“Talk with family.”
“See each person as an individual -treat
justly.“
“I offer emotional support to family mem-
bers of very ill or dying patients, letting
them take the lead; invariably, the discus-
sions turn to faith in God and spiritual
matters, as families grieve and search for
answers to explain suffering and pain and
death.“
“Physical reinforcement-e.g., tears,
hugs, stroking, forehead, holding hands.”
“Act as advocate for non-Christian
patients.”
As an advocate the niuse is physically nziail-
able to hEIp t k patient and familv.”
NIC Label and Definition
Presence (5340) continued
Active Listening (4920) Attending
closely to and attaching significance to a
patient’s verbal and nonverbal messages
Humor (5320) Facilitating the patient to
perceive, appreciate, and express what is
f u ~ yamusing,
, or ludicrous in order to
establish relationships, relieve tension,
release anger, facilitate learning, or cope
ith painful feelings
Touch (5460) Providing comfort and
communication through purposeful
tactile contact
Therapeutic Touch (5465) Attuning to
the universal healing field, seeking to act
as an instrument for healing influence,
and using the natural sensitivity of the
hands to gently focus and direct the
intervention process.
Self-Awareness Enhancement (5390)
Attuning to the universal healing field,
seeking to act as an instrument for
healing influence, and using the natural
sensitivity of the hands to gently focus
and direct the intervention process.
Referral (8100) Arrangement for
services by another care provider or
agency
Music Therapy (4400) Using music to
help achieve a specific change in
behavior, feeling, or physiology
aRationale for congruence with NIC activity is provided only when not apparent.
InternationalJournalof Nursing Terminologiesand Classifications Volume 14, No. 4, OctoberDecember, 2003
NIC Activity Nurses’ Spiritual Care Activities
Remain physically present without ex- “‘Being there’ fully with my patients as
pecting interactional responses. they express their spiritual needs.”
EstablLsh the purp”e for the interaction. ”I let them talk about themselves-not
focus on their being sick and who they are
as an individual.”
Display an awareness of and sensitivity to “I encourage them- to lift their spirits.”
emotions. Within the context of providing spiritual care,
the nurse is aware ofpatient‘s affect and pro-
vides supp0rt.a
Determine the meaning of the message by “Initiate discussion about things, which
reflecting on attitudes, past experiences, are uncertain in order to see if their spiri-
and current situation. tual life plays a big part in coping.”
The nurse conducts a spiritual assessment via
discussion to identi& the part that spirituality
plays in their life and the present il1ness.a
Select humorous materials that create ”I use humor to make them smile.”
moderate arousal for the individual. “Tell amusing story.”
Hold patient‘s hand to provide emotional ”Hold patient’s hand.”
support.
Begin by moving hands in a very gentle “Passing on positive energy through
downward movement through the pa- touch.”
tients energy field thinking of the patient Touch was a spiritual care activity that was
as a unitary whole and facilitatingan performed by nurses with the intent to be
open balance energy flow. therapeutic.a
Assist patient to identify source of “Positive beliefs.”
motivation. Positive beli@ are identified as a source of
motivation .a
Identify nursing/health care required. “I assessed my clients spiritual needs.”
“Address the spiritual needs of the patient
on admission.”
Assessment of client needs by the nurse helps
to identzfi nursing/hedth care re9uired.a
Faditate the patient‘s active participation ”Singing spiritual songs with or to calm a
(e.g., playing an instrument or singing) if ttus patient.”
is desired and feasible within the setting.
121
Spiritual Care Activities of Nurses Using Nursing Interventions Classification (NIC) Labels
Discussion
Hayakawa and Hayakawa’s (1990) theory of lan-
guage and its effect on people, as well as Parse’s (1981)
model (a synthesis of Rogers’ [1970,1980]Science of Uni-
tary Human Beings) provided the theoretical framework
to support these study findings. In the theory of lan-
guage, a map analogy is used to describe the effect of
language on the thinking of individuals. The purpose of
developing nursing nomenclature as standardized inter-
ventions is to clarify the language used to describe what
nurses do when they care for patients. Standardized lan-
guages can serve as maps for the identification of inter-
ventions used to provide spiritual care. Subsequently,
standardized language can communicate performance
outcomes to the public.
Parse’s (1981)model facilitates the explication of lived
experiences and the significance of these experiences to
those involved. Parse’s man-environment interrelation-
ship facilitates the explication of emerging patterns of
nurses’ spiritual care interventions in practice. According
to Parse, the nurse has the opportunity to guide the
meaning of a given health situation while providing
spiritual care. Appropriate spiritual interventions to
meet human responses in the spiritual domain facilitate
the patient’s process of transcendence.
Nurses are challenged to communicate the scope of
services they provide (Hegyvary, 2003). This is accom-
plished through the use of the nursing process, which
provides direction for nurses‘ action (OConner, 2001).
Using the nursing process helps ensure that the plan of
care for the patient is goal specific and individualized.
When NIC is used within the nursing process, it pro-
vides a wide range of interventions applicable to cultur-
ally diverse populations in atl nursing settings. Spiritual
care activities need to be identified, and NIC may help
articulate them. As spiritual care needs may differ for
each patient, the nurse can simply ask, “What are your
spiritual beliefs?” or “How can I help you meet your
spiritual needs during this hospitalization?”
Broten (1997) noted that if nurses are providing spiri-
tual care, it is not being documented. Perhaps nurses
122 International Journalof Nursing Terminologies and Classifications Volume 14, No. 4, October-December, 2003
have been providing spiritual care as was reported in
this study but its documentation gets lost along the way.
Perhaps some nurses do not document that they pro-
vided spiritual care because they do not know how. Ac-
cording to Byrne (2002), nurses require support and
guidance on how to approach spiritual care and under-
stand a concept that appears resistant to language as a
basis for communication.The private nature of spiritual-
ity and the ambiguous role of the nurse as provider of
spiritual care may be reasons that spiritual interventions
are neither articulated nor communicated among inter-
disciplinary healthcare members (Van Dover & Bacon,
2001). We found that NIC facilitates identifying the spiri-
tual care activities that are a part of nursing practice, thus
clarifying the language used to describe spiritual care.
This is especially significant to the phenomenon of spiri-
tuality and the meeting of spiritual needs in practice set-
tings across the life span. Using an approved classifica-
tion system provides a more concrete way to identify the
spiritual needs of the patients and to document them.
This documentation, in turn, can prove that the nurse‘s
efforts and interventions are necessary, beneficial, and
successful.
Patient-Centered Spiritual Care Activities
Spiritual care nursing interventions imbedded in
practice are included in the activities associated with “ac-
tive listening,” ”presence,” and “referral” (Oldnall, 1996;
Sellers & Haag, 1998) and ”facilitation and validation of
clients’ feelings and thoughts,” “conveying acceptance,”
and “instilling hope” (Sellers & Haag). Although nurses
may engage in these activities every day, they are not
considered spiritual care activities unless the nurse has
the intent to provide spiritual care after having recog-
nized the patient’s spiritual needs through a spiritual as-
sessment (Harrison & Burnard, 1993).Study findings in-
dicate that nurses are providing spiritual care. Because
nurses often think on several levels at once, they may on
occasion be providing various spiritual care activities but
frequently lose the spiritual domain within the high-tech
care focus of the physical domain.
Factors That Affect Practice
To facilitate compliance with the JCAHO standard re-
garding spiritual care, open dialogue on spiritual care can
provide opportunities for education and the development
of practice protocols. Such discussions have been known
to raise the comfort level of staff as providers of spiritual
m(Hall & Lanig, 1993).Some nurses feel uncomfortable
with the personal nature of the subject (Narayanasamy,
1999b).In addition, the use of NIC provides a clearer, PR-
cise picture of the nursing activities that are provided
(Hegyvary 2003). The results of this study indicate that di-
alogue and implementation of a standardized classifica-
tion system support nurses as providers of spiritual care.
NIC provides direction for the provision of spiritual care.
Conclusion
Limitations of this study are that the perception of the
spiritual care activities delivered by the nurse may not be
a perception of a spiritual care activity by the patient. This
is because in this study it could not be determined if a
spiritual assessment was conducted prior to the nurses’
spiritual care activity. A limitation of the study is the
study sample is limited to STTI members who hold at
least a baccalaureate d e w and are predominantly white
and Christian. Research with a more diverse groups of
nurses caring for a variety of types of patients is needed.
Disseminating the findings of this study is important
for nursing. The reported spiritual care activities identi-
fied using NIC are a starting point for learning the scope
of spiritual care activities provided in healthcare settings.
Outcomes for meeting the spiritual needs of patients and
their families can be documented through the use of
NIC. Now that a JCAHO spiritual care standard needs to
be met, spiritual assessments should be more compre-
hensive, using assessment tools that have been devel-
oped (Narayanasamy, 1999b). In order to facilitate a pa-
tient’s spiritual health experience, nurses must be aware
of a patient’s spiritual beliefs, one’s own spiritual beliefs,
and have the available resources within their facilities to
support spiritual growth (Wright, 1998).
InternationalJournalof Nursing Terminologiesand Classifications Volume 14, No.4, OctoberDecembeq2003
Nurses need an awareness of the wide range of activi-
ties that are included in spiritual care and the ease with
which they can provide it (Sellers & Haag, 1998).Nurses
who have been providing spiritual care and support are
in the minority (Kuuppelomaki, 2002) and those who
provide spiritual care are not documenting it (Broten,
1997).The literature cites that some nurses do not realize
that complementary activities, such as back massage,
music, and spiritual practice, are used for patient care
and personal well-being (Taylor et al., 1998).
The results and implications of this study suggest
several areas for continuing research, such as (a) pa-
tients’ perceptions of nurses as providers of spiritual
care, (b) factors that may affect diagnostic ability in the
spiritual domain, and (c) how spiritual care activities
promote positive health outcomes. The NIC labels have
provided a framework to explicate the spiritual care ac-
tivities described in this study. These findings help ex-
pand the knowledge base regarding spiritual care activi-
ties and documentation. This knowledge will help
nurses to successfully promote the delivery of holistic
care.
Acknowledgment. This study was partially funded by a
grant from the Professional Staff Congress of the City
University of New York
Author contact: RCavendish@prodigy.net,with a copy to the
Editor: rose-mary@earthlink.net
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