Barriers to Provide Patients Admitted to Hospitals in Kashan with Spiritual Care: Nurses’ Viewpoints

Background and Aim: Spiritual care is an essential part of holistic nursing care. It refers to a set of nursing care practices which help patients adapt better to the crises. Spiritual care can also lead to patient’s comfort, reduction of physical and emotional pain, reduction of anxiety, a deeper communication between the patient and the nurse, and a sense of relief in the patient’s family. In fact, the overall welfare condition of the patient and his/her family is a product of comprehensive care, an important aspect of which is the spiritual care, as the spiritual dimension encompasses other human dimensions and is a complement to individual’s health. Although most nurses recognize spiritual care as an important part of the holistic care, only about one third of them consistently provide this type of care and it is ignored in most cases. The present study, therefore, aimed to determine the barriers to provide patients admitted to hospitals in Kashan with spiritual care from the viewpoint of the nurses. Materials and Methods: This cross-sectional study was carried out on 306 nurses working at hospital affiliated with Kashan University of Medical Sciences in 2015. Quota sampling was chosen to select the participants. To begin, in collaboration with the nursing offices in the hospitals affiliated with Kashan University of Medical Sciences, a list of all nurses in each hospital was prepared and used as the sampling frame. Then, according to the number of nurses in each hospital, the appropriate sample size for each hospital was calculated. To collect the data, the researcher attended the clinical sections of the hospitals at different working shifts for two months collecting the samples from among those available. Explaining the study objectives and the approximate time to respond to the questionnaire (about 30 minutes) to the nurses, the researcher handed the questionnaire out to them if they were willing to participate in the study. About half an hour or an hour later, the researcher referred to the nurses to collect the completed questionnaires. In case the participants had not been able to complete the questionnaires during the allotted time, they were asked to set a time on the same day to hand the completed questionnaires back, or to submit the completed questionnaires to the section’s secretary later. Then, the researcher collected the questionnaires at as soon as possible. In a few cases where data collection was at the same time as the hospital training classes, the researcher referred to some of the nurses at the end of the classes, and- if they were willing to participate, she asked them to complete the questionnaires and to set a time and place to hand the completed questionnaires back. The data collection instrument were a researcher-made questionnaire designed through library research and reviewing various articles. For the validity of the questionnaire, qualitative and quantitative content validity were used to calculate its Content Validity Ratio (CVR) and Content Validity Index (CVI) of the instrument. Using Cronbach's alpha coefficient and through measures of internal consistency, the reliability of the instrument was also calculated. Alpha value was 0.78 for the entire instrument, 0.91 for the spiritual and religious support section, and 0.86 for the barriers to spiritual care section. Running descriptive and inferential statistics in SPSS 16 statistical software, the data were analyzed using t-test, one-way ANOVA, and Tukey’s post hoc test. Ethical Considerations: The present study was approved by both Research Council and Ethics Committee of Kashan University of Medical Sciences’. All ethical considerations in research were observed. Having obtained the permission from the university and hospital officials, the data were collected. Participation in the study was voluntary. After explaining the purpose and the nature of the research to all the participants, their informed consent to participate in the research was obtained. The questionnaires were anonymous and the participants were assured that their personal information will remain confidential. Results: The mean and standard deviation for the age of the nurses were 31.94 ± 6.53 years old. Most of the participants (78.3%) were females, and 93.8% of them had a bachelor's degree. The mean and standard deviation for their work experience was 8.66 ± 6.27 years. 68.2% of the nurses mentioned that they had not received any training concerning the concept of spiritual care. However, 72.5% of the nurses expressed their interest in acquiring spiritual care. In the nurses’ point of view, the major barriers to spiritual care were reported to be the lack of a sufficient number of staff to provide comprehensive care (78.1%), lack of private space for having a dialogue with the patient (70.3%), heavy workload and its related fatigue (67.4%), inadequate training (66.3%), dedication of more attention to the physical needs (66.3%), lack of organizational support (62.8%), insufficient time (62.7%), inability to communicate (56.9%), nurses and patients’ sexual differences (56.2%), and the belief in a better spiritual care by clergymen and psychologists (54.3%). t-test did not show a significant difference between the scores for the barriers to provide spiritual care in the two genders and the scores for the willingness to learn spirituality. In addition, the analysis of variance did not indicate a significant difference between the scores for the barriers to provide spiritual care and different ages and work histories. There was also no significant difference between the individual’s spirituality and religiosity and the impact of religious and spiritual beliefs on work. However, the analysis of variance revealed a significant difference between the scores for the barriers to provide spiritual care in different sections and different levels of education. Tukey’s post hoc test indicated that oncology nurses’ and surgical nurses' scores were significantly different (P=0.03) so that oncology nurses’ scores were lower than those of the other sections. Tukey’s post hoc test also showed that there was a significant difference between the scores of nurses with the bachelor’s degree and those with the associate's degree (P=0.03) in such a way that the scores of nurses with the bachelor’s degree were higher than those of the nurses with the associate's degrees. Conclusion: The results of the study pointed to the lack of a sufficient number of staff to provide comprehensive care and the lack of private space for having a dialogue with the patient as the most important barriers to provide spiritual care. Meanwhile, most nurses were not trained on how to provide spiritual care. In addition, oncology nurses and nurses with associate degrees received lower scores in providing spiritual care. It is recommended that health planners take the barriers into account to provide the patients with spiritual care, adopt appropriate measures to address them in order to improve the quality of holistic nursing care, and increase the patient and nurse satisfaction.  Please cite this article as: Adib-Hajbaghery M, Saeadnejad Z. Barriers to Provide Patients Admitted to Hospitals in Kashan with Spiritual Care: Nurses’ Viewpoints. Med Ethics J 2016; 10(37): 49-59.