Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care: Through Innovative Education and Compassionate Care 3030658872, 9783030658878

This book is the first of its kind, addressing key issues in the teaching and learning of spirituality and spiritual car

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Table of contents :
Foreword
Contents
Chapter 1: The EPICC Project: Inception, Origins and Outputs
1.1 Introduction
1.2 Why EPICC Was Needed?
1.3 Origins and Organisation of the EPICC Project
1.3.1 Origins
1.3.2 European Spirituality Research Network for Nursing and Midwifery
1.3.2.1 A Significant Milestone for Spiritual Care Competencies in Nursing and Midwifery
1.3.3 Organisation and Delivery of EPICC
1.3.3.1 EPICC Strategic Partners and EPICC Project Manager
1.4 Participating Groups
1.4.1 EPICC Participants
1.4.2 EPICC Participants+
1.5 The Key Activities
1.6 Methodology
1.6.1 Action Learning
1.6.2 Intellectual Outputs
1.7 Outputs and Achievements
1.7.1 EPICC Gold Standard Matrix for Spiritual Care Education and Narrative to the Matrix
1.7.2 EPICC Spiritual Care Education Standard
1.7.3 EPICC Adoption Toolkit
1.8 Overview of the Book
1.9 Summary
References
Suggested Reading
Chapter 2: What Do We Mean by ‘Spirituality’ and ‘Spiritual Care’?
2.1 Introduction
2.2 Spirituality: As a Term and Phenomenon
2.2.1 Many Definitions
2.2.2 What the Definitions Are About?
2.2.3 A Working Definition
2.3 Being a Human Being
2.3.1 The Lived Body
2.3.2 Basic Conditions for Human Life
2.4 Spiritual Care: What It Is and How to Do it?
2.4.1 Spiritual Care: Theoretical Perspectives
2.4.2 Meeting Spiritual Needs in Time of Vulnerability
2.5 Spiritual Care: Some Examples from Across Europe
2.5.1 Spiritual Care in the Netherlands
2.5.2 Spiritual Care in Croatia
2.5.3 Spiritual Care in Norway
2.5.4 Summary of European Examples
2.6 Summary
References
Suggested Reading
Chapter 3: Educational Context, Evidence and Exploration of Professional Fields of Nursing and Midwifery
3.1 Introduction
3.2 International Healthcare Policy
3.2.1 Internationally
3.2.2 Within Europe
3.2.3 Nationally
3.2.4 Spiritual Care Guidelines
3.2.5 Spiritual Care Guidance for Nurses
3.3 Nursing and Midwifery Regulatory and Professional Bodies
3.4 Patients and Carers
3.5 Nurses and Midwives
3.6 The Problem
3.7 Responding to the Problem
3.7.1 International Research and Three Landmark European Studies (2010–2016)
3.7.2 The EPICC Project (2016–2019)
3.8 Summary of Main Points for Learning
References
Suggested Reading
Chapter 4: Self-Care
4.1 Introduction
4.1.1 Reflective Exercise
4.1.2 Reflective Exercise
4.2 Communication: Managing Difficult Situations
4.2.1 Reflective Exercise
4.3 Compassionate Self-Care and Resilience
4.3.1 Reflective Exercise
4.4 Where Are You in This? Self-Care and Spirituality
4.4.1 How to Conduct a Spiritual Assessment on Yourself
4.4.2 Reflective Exercise
4.4.3 Reflective Exercise
4.5 You Make the Difference: The Nurse as a Healthy Resource
4.5.1 Reflective Exercise
4.6 Strategies for Self-Care: Self-Discovery, Self-Reflection and Self-Care
4.6.1 Exploration of Self
4.6.2 Reflection on Self and Health: How Am I Doing?
4.6.3 Actions: Self-Care Techniques
4.6.4 Mindfulness
4.6.5 Music and Creative Arts Expression
4.6.6 Meditation
4.6.7 Yoga
4.6.8 Exercise
4.6.9 Practical Time Out Opportunity
4.6.10 Five-Minute Self-Care Time out Break
4.7 Cue to Action
4.7.1 Reflective Exercise
4.8 Summary
References
Suggested Reading
Chapter 5: Competence 1: Intrapersonal Spirituality and Its Impact on Person-Centred Spiritual Care
5.1 Introduction
5.2 The Context of Intrapersonal Spirituality
5.2.1 Spirituality and Spiritual Care Within the Holistic Understanding of Healthcare
5.2.2 Intrapersonal Spirituality Embedded Within the Nurse/Midwife–Patient Relationship
5.2.3 The Importance of Consciousness and Impact of One’s Own Spirituality
5.3 The Essence of Intrapersonal Spirituality in Nursing and Midwifery Practice
5.3.1 Presence and Attention
5.4 Availability
5.5 Vulnerability
5.6 Discover Your Personal Intrapersonal Spirituality
References
Suggested Reading
Chapter 6: Competence 2: Interpersonal Spirituality
6.1 Introduction
6.2 Spiritual and Cultural Worldviews, Beliefs and Practices in the Provision of Care
6.3 Effective, Verbal and Non-verbal Interaction between Persons and Carers
6.3.1 Therapeutic Interactions
6.3.2 Verbal and Non-verbal Interactions
6.3.3 What Is Most Important to You Now? How Can We Help?
6.4 Evoking Companionship and Compassionate Care
6.5 Promoting Spiritual Care Attitudes
6.5.1 The Body and Its Centrality to Spiritual Care
6.5.2 Human Relationships, Listening and Attending
6.5.3 Spirituality and Presence
6.5.4 Holistic Meaningful Care
6.6 Summary of the Main Points for Learning
References
Suggested Reading
Chapter 7: Competence 3: Spiritual Care, Assessment and Planning
7.1 Introduction
7.2 Theory, Rationale and Evidence Base for Spiritual Care
7.2.1 Spiritual Care: Fact or Fiction?
7.3 The Knowledge Base for Spiritual Care
7.3.1 Screening
7.3.2 History Taking
7.3.3 Formal Assessment
7.4 The Need for Culturally Sensitive Care: An Example from Thailand
7.4.1 Explanation: Applying Knowledge, Skills and Attitudes Evident in the Scenario
7.5 Importance of Self-Awareness When Planning Spiritual Care
7.5.1 Explanation: Applying Knowledge, Skills and Attitudes Evident in the Scenario
7.6 Why Spiritual Assessment Matters: Thoughts from a Newly Qualified Nurse
7.6.1 Why It Matters?
7.6.2 Developing Patient Awareness
7.6.3 Demonstrating Spiritual Care
7.7 Summary of the Main Points for Learning
References
Suggested Reading
Chapter 8: Competence 4: Spiritual Care, Intervention and Evaluation
8.1 Introduction
8.1.1 What Is a Spiritual Intervention?
8.2 Theory, Rationale and Evidence
8.2.1 Personal Competencies in Spiritual Care
8.2.2 Spiritual Intervention: Presence
8.2.3 Spiritual Intervention: Words
8.2.4 Spiritual Intervention: Actions
8.3 Documentation of Spiritual Care
8.4 Practice Examples to Exemplify Spiritual Care
8.4.1 Case 1: João
8.4.2 Case 2: Jane
8.4.3 Case 3: Anna
8.4.4 Case 4: Carmen
8.5 Conclusion
8.6 Summary of the Main Points for Learning
References
Suggested Reading
Chapter 9: Conclusions of the EPICC Journey and Future Directions
9.1 Introduction
9.2 Innovation
9.3 Intellectual Outputs and Development of Project Resources
9.3.1 Output 1
9.3.2 Output 2 and 3
9.4 Coronavirus Disease 2019 (COVID-19) and Spiritual Disruption?
9.5 The Future
References
Suggested Reading
Afterword: Compassion in Care
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Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care Through Innovative Education and Compassionate Care Wilfred McSherry Adam Boughey Josephine Attard Editors

123

Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care

Wilfred McSherry  •  Adam Boughey Josephine Attard Editors

Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care Through Innovative Education and Compassionate Care

Editors Wilfred McSherry Department of Nursing School of Health and Social Care Staffordshire University University Hospitals of North Midlands NHS Trust Stoke-on-Trent Staffordshire England UK VID University College Bergen/Oslo Norway

Josephine Attard Faculty of Health Sciences University of Malta Msida Malta Adam Boughey Department of Nursing School of Health and Social Care Staffordshire University Stoke-on-Trent Staffordshire England UK

ISBN 978-3-030-65887-8    ISBN 978-3-030-65888-5 (eBook) https://doi.org/10.1007/978-3-030-65888-5 © Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Foreword

In a secular society like the UK there appears to be a reticence by some nurses and midwives to talk to patients/clients about their beliefs, the importance of religious faith and their spiritual well-being as part of the package of care provided to them. This reticence could stem from an anxiety they may offend the person by saying the wrong thing, because they feel ill-equipped to have meaningful conversations or they are unaware they need to provide this aspect of care. The end result of this is that many vulnerable and sick people cannot access the spiritual support they need at a time when they need it most. I have been a nurse for just over 40 years, and it has been a privilege to have supported many sick, frail and vulnerable people during this time. I have experienced joy and sorrow when being with individuals and their families through all kinds of episodes of care, from the joy of birth to the sorrow of death. From my personal experiences, I have learnt that to care effectively for a person you must develop an understanding not just of the person’s physical, emotional and social needs but also what gives meaning to that person’s life. For some people they will find meaning through religious beliefs and will take comfort from the associated religious rituals that accompany that faith; for others, personal beliefs and values that guide the way they live their lives and treat others enable them to give meaning to their lives and experiences. I have observed that how we interact with the world and the meaning we attribute to things change with time and life events, such as becoming a parent, developing a life-limiting disease or losing a loved one. How we deal with the challenges life throws at us is heavily coloured by our beliefs, and I have seen great differences in the way people react to illness, injury or a failing in their health and physical abilities. Providing nursing or midwifery care without acknowledging the spiritual aspect of person’s life ultimately denies something fundamental about the people for whom we provide care. Health and social care services and the models of care provided by professionals are constantly evolving. This evolution reflects the changing expectations and needs of our population as well as embracing advances in medicines and technology. However, while services and care pathways change over time, one thing that should not change is positioning the individual at the centre of care decisions. In recent years, the importance of co-producing care and treatment plans with the people receiving care has risen in prominence. Health professionals must take into account the recipient’s beliefs, expectations, fears and unique living arrangements when v

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Foreword

making care plans. Part of any undergraduate nursing and midwifery education programme must therefore concentrate on what person-centred holistic care means and this must include spiritual care as a facet. While academics and the professional regulator accept the need to include aspects of belief, faith and cultural diversity in any education programme, the question remains however about how best to deliver such material. When I heard about the planned European research project to develop awareness and competency in nurses and midwives to support the spiritual needs of people receiving health and social care, I was determined that Wales would contribute. A significant part of my portfolio in Welsh Government is to ensure a safe, positive patient experience, and as part of this work, the Welsh Government has set standards for the spiritual care of people receiving healthcare. However, I have always been concerned about how the workforce, particularly the nursing and midwifery professionals who provide the majority of care, were interpreting and implementing these standards and whether they had the skill set to do this aspect of care well. Having said that, there are pockets of excellence in Wales and I was pleased that some of these experts were able to contribute to the project. I would like to take this opportunity to express my thanks to them for their willingness to travel and give of their personal time to take part in this project. The ‘Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care through Innovative Education and Compassionate Care’ (EPICC) European project provided the space for international experts to consider how best to promote awareness and provide skills in offering spiritual care. The products from this project include: a spiritual care education standard; a matrix diagram showing the cultural, social and political environment in which spiritual care competency develops with supporting narrative; and core spiritual care competencies for undergraduate nursing and midwifery students. These products not only advise on good practice for teaching and assessment but also help guide student selection decisions. In this book, the findings from this 3-year project (2016–2019), conducted with engagement from over 49 participants (nursing and midwifery educators, in addition to key stakeholders and students) from 21 European countries, are described in detail. Most of the chapters were written/coordinated by one of the EPICC Strategic Partners who led the EPICC project and co-authored by five of the EPICC Participants (those experts who participated in the EPICC project). The chapters set out informed discussion points and are presented in an engaging and interactive way to help build confidence and understanding in the reader. It means that rather than being a typical textbook, this book becomes a resource guide for educators as well as students. One of the most important steps any student can take on their journey to be a well-rounded and competent professional is to begin understanding himself or herself. Some of the concepts in this book will challenge the reader to examine their personal beliefs and prejudices; what role faith and beliefs have in everyday life; and explore some of the existential challenges we all face: for example, hope and despair, questions about identity, and the meaning of life itself. Understanding how our upbringing and the cultural and political environment in which we exist all have

Foreword

vii

a part to play in how we see the world around us. Recognising that the recipients of our care may well have had very different experiences to us and therefore hold different values and beliefs is essential. The work of a nurse or midwife can be challenging, and clinical environments can be busy demanding places in which to work, and it can be all too easy to rush from one job to another and forget about the person receiving care. For them it is anything but routine and is uniquely stressful. The content of this book reminds the reader that even in a busy clinical environment it is essential to make time to connect with the human being receiving care and have meaningful conversations with that person about what matters to them. This is the art of caring: to see past the tasks and see the person beneath. I hope you enjoy reading and interacting with the material presented in this book. April 2020

Jean White Chief Nursing Officer Office of the Chief Nursing Officer Nursing Directorate Health and Social Services Group Welsh Government Wales, UK

Contents

1 The EPICC Project: Inception, Origins and Outputs��������������������������    1 Wilfred McSherry, Adam Boughey, and Josephine Attard 1.1 Introduction��������������������������������������������������������������������������������������    1 1.2 Why EPICC Was Needed?����������������������������������������������������������������    2 1.3 Origins and Organisation of the EPICC Project ������������������������������    4 1.3.1 Origins����������������������������������������������������������������������������������    4 1.3.2 European Spirituality Research Network for Nursing and Midwifery����������������������������������������������������������������������    4 1.3.3 Organisation and Delivery of EPICC������������������������������������    6 1.4 Participating Groups ������������������������������������������������������������������������    8 1.4.1 EPICC Participants ��������������������������������������������������������������    8 1.4.2 EPICC Participants+ ������������������������������������������������������������    9 1.5 The Key Activities����������������������������������������������������������������������������   10 1.6 Methodology ������������������������������������������������������������������������������������   10 1.6.1 Action Learning��������������������������������������������������������������������   10 1.6.2 Intellectual Outputs��������������������������������������������������������������   13 1.7 Outputs and Achievements����������������������������������������������������������������   13 1.7.1 EPICC Gold Standard Matrix for Spiritual Care Education and Narrative to the Matrix ������������������������   14 1.7.2 EPICC Spiritual Care Education Standard ��������������������������   14 1.7.3 EPICC Adoption Toolkit������������������������������������������������������   15 1.8 Overview of the Book ����������������������������������������������������������������������   16 1.9 Summary ������������������������������������������������������������������������������������������   16 References��������������������������������������������������������������������������������������������������   17 2 What Do We Mean by ‘Spirituality’ and ‘Spiritual Care’?����������������   21 Tormod Kleiven, Bart Cusveller, Marianne Rodriguez Nygaard, Štefica Mikšić, Adam Boughey, and Wilfred McSherry 2.1 Introduction��������������������������������������������������������������������������������������   22 2.2 Spirituality: As a Term and Phenomenon ����������������������������������������   23 2.2.1 Many Definitions������������������������������������������������������������������   23 2.2.2 What the Definitions Are About?������������������������������������������   25 2.2.3 A Working Definition������������������������������������������������������������   26

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2.3 Being a Human Being����������������������������������������������������������������������   27 2.3.1 The Lived Body��������������������������������������������������������������������   27 2.3.2 Basic Conditions for Human Life ����������������������������������������   28 2.4 Spiritual Care: What It Is and How to Do it?������������������������������������   29 2.4.1 Spiritual Care: Theoretical Perspectives ������������������������������   31 2.4.2 Meeting Spiritual Needs in Time of Vulnerability����������������   32 2.5 Spiritual Care: Some Examples from Across Europe ����������������������   33 2.5.1 Spiritual Care in the Netherlands������������������������������������������   33 2.5.2 Spiritual Care in Croatia ������������������������������������������������������   34 2.5.3 Spiritual Care in Norway������������������������������������������������������   35 2.5.4 Summary of European Examples�����������������������������������������   35 2.6 Summary ������������������������������������������������������������������������������������������   36 References��������������������������������������������������������������������������������������������������   37 3 Educational Context, Evidence and Exploration of Professional Fields of Nursing and Midwifery����������������������������������   39 Linda Ross, Janet Holt, Britt Moene Kuven, Birthe Ørskov, and Piret Paal 3.1 Introduction��������������������������������������������������������������������������������������   40 3.2 International Healthcare Policy��������������������������������������������������������   40 3.2.1 Internationally ����������������������������������������������������������������������   40 3.2.2 Within Europe ����������������������������������������������������������������������   41 3.2.3 Nationally������������������������������������������������������������������������������   41 3.2.4 Spiritual Care Guidelines������������������������������������������������������   42 3.2.5 Spiritual Care Guidance for Nurses��������������������������������������   42 3.3 Nursing and Midwifery Regulatory and Professional Bodies����������   46 3.4 Patients and Carers����������������������������������������������������������������������������   49 3.5 Nurses and Midwives������������������������������������������������������������������������   50 3.6 The Problem��������������������������������������������������������������������������������������   50 3.7 Responding to the Problem��������������������������������������������������������������   51 3.7.1 International Research and Three Landmark European Studies (2010–2016)��������������������������������������������   51 3.7.2 The EPICC Project (2016–2019)������������������������������������������   54 3.8 Summary of Main Points for Learning ��������������������������������������������   54 References��������������������������������������������������������������������������������������������������   55 4 Self-Care ��������������������������������������������������������������������������������������������������   57 Anthony Schwartz, Kath Baume, Austyn Snowden, Jyoti Patel, Nicky Genders, and Gulnar Ali 4.1 Introduction��������������������������������������������������������������������������������������   58 4.1.1 Reflective Exercise����������������������������������������������������������������   59 4.1.2 Reflective Exercise����������������������������������������������������������������   60 4.2 Communication: Managing Difficult Situations������������������������������   61 4.2.1 Reflective Exercise����������������������������������������������������������������   61

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4.3 Compassionate Self-Care and Resilience ����������������������������������������   62 4.3.1 Reflective Exercise����������������������������������������������������������������   62 4.4 Where Are You in This? Self-Care and Spirituality��������������������������   62 4.4.1 How to Conduct a Spiritual Assessment on Yourself������������   63 4.4.2 Reflective Exercise����������������������������������������������������������������   63 4.4.3 Reflective Exercise����������������������������������������������������������������   64 4.5 You Make the Difference: The Nurse as a Healthy Resource����������   65 4.5.1 Reflective Exercise����������������������������������������������������������������   66 4.6 Strategies for Self-Care: Self-Discovery, Self-Reflection and Self-Care������������������������������������������������������������������������������������   67 4.6.1 Exploration of Self����������������������������������������������������������������   68 4.6.2 Reflection on Self and Health: How Am I Doing? ��������������   68 4.6.3 Actions: Self-Care Techniques���������������������������������������������   68 4.6.4 Mindfulness��������������������������������������������������������������������������   69 4.6.5 Music and Creative Arts Expression������������������������������������   69 4.6.6 Meditation ����������������������������������������������������������������������������   69 4.6.7 Yoga��������������������������������������������������������������������������������������   69 4.6.8 Exercise��������������������������������������������������������������������������������   70 4.6.9 Practical Time Out Opportunity��������������������������������������������   70 4.6.10 Five-Minute Self-Care Time out Break��������������������������������   71 4.7 Cue to Action������������������������������������������������������������������������������������   72 4.7.1 Reflective Exercise����������������������������������������������������������������   73 4.8 Summary ������������������������������������������������������������������������������������������   73 References��������������������������������������������������������������������������������������������������   74 5

Competence 1: Intrapersonal Spirituality and Its Impact on Person-Centred Spiritual Care����������������������������������������������������������   77 René van Leeuwen, Gørill Haugan, Melanie Rogers, Åsa Roxberg, Joanna Zolnierz, and Anto Čartolovni 5.1 Introduction��������������������������������������������������������������������������������������   78 5.2 The Context of Intrapersonal Spirituality ����������������������������������������   80 5.2.1 Spirituality and Spiritual Care Within the Holistic Understanding of Healthcare������������������������������������������������   80 5.2.2 Intrapersonal Spirituality Embedded Within the Nurse/Midwife–Patient Relationship������������������������������   81 5.2.3 The Importance of Consciousness and Impact of One’s Own Spirituality ����������������������������������������������������   82 5.3 The Essence of Intrapersonal Spirituality in Nursing and Midwifery Practice��������������������������������������������������������������������   84 5.3.1 Presence and Attention����������������������������������������������������������   85 5.4 Availability����������������������������������������������������������������������������������������   88 5.5 Vulnerability�������������������������������������������������������������������������������������   88 5.6 Discover Your Personal Intrapersonal Spirituality����������������������������   89 References��������������������������������������������������������������������������������������������������   92

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6 Competence 2: Interpersonal Spirituality ��������������������������������������������   95 Josephine Attard, Mohd Arif Atarhim, Beata Dobrowolska, Julie Jomeen, Joanne Pike, and Jacqueline Whelan 6.1 Introduction��������������������������������������������������������������������������������������   96 6.2 Spiritual and Cultural Worldviews, Beliefs and Practices in the Provision of Care������������������������������������������������������������������������������   96 6.3 Effective, Verbal and Non-verbal Interaction between Persons and Carers����������������������������������������������������������������������������   99 6.3.1 Therapeutic Interactions�������������������������������������������������������  100 6.3.2 Verbal and Non-verbal Interactions��������������������������������������  101 6.3.3 What Is Most Important to You Now? How Can We Help?��������������������������������������������������������������  102 6.4 Evoking Companionship and Compassionate Care��������������������������  103 6.5 Promoting Spiritual Care Attitudes��������������������������������������������������  105 6.5.1 The Body and Its Centrality to Spiritual Care����������������������  105 6.5.2 Human Relationships, Listening and Attending ������������������  106 6.5.3 Spirituality and Presence������������������������������������������������������  106 6.5.4 Holistic Meaningful Care������������������������������������������������������  107 6.6 Summary of the Main Points for Learning ��������������������������������������  108 References��������������������������������������������������������������������������������������������������  108 7 Competence 3: Spiritual Care, Assessment and Planning�������������������  111 Wilfred McSherry, Karnsunaphat Balthip, Chris Swift, Olga Riklikienė, Sarah McKay, and Yanping Niu 7.1 Introduction��������������������������������������������������������������������������������������  112 7.2 Theory, Rationale and Evidence Base for Spiritual Care ����������������  113 7.2.1 Spiritual Care: Fact or Fiction?��������������������������������������������  114 7.3 The Knowledge Base for Spiritual Care ������������������������������������������  115 7.3.1 Screening������������������������������������������������������������������������������  116 7.3.2 History Taking����������������������������������������������������������������������  116 7.3.3 Formal Assessment ��������������������������������������������������������������  117 7.4 The Need for Culturally Sensitive Care: An Example from Thailand������������������������������������������������������������������������������������  118 7.4.1 Explanation: Applying Knowledge, Skills and Attitudes Evident in the Scenario����������������������������������  120 7.5 Importance of Self-Awareness When Planning Spiritual Care ��������  121 7.5.1 Explanation: Applying Knowledge, Skills and Attitudes Evident in the Scenario����������������������������������  123 7.6 Why Spiritual Assessment Matters: Thoughts from a Newly Qualified Nurse������������������������������������������  125 7.6.1 Why It Matters?��������������������������������������������������������������������  126 7.6.2 Developing Patient Awareness����������������������������������������������  126 7.6.3 Demonstrating Spiritual Care ����������������������������������������������  126 7.7 Summary of the Main Points for Learning ��������������������������������������  127 References��������������������������������������������������������������������������������������������������  128

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8 Competence 4: Spiritual Care, Intervention and Evaluation��������������  131 Tove Giske, Aliza Damsma-Bakker, Sílvia Caldeira, Gracia M. González-­Romero, Wilson C. de Abreu, and Fiona Timmins 8.1 Introduction��������������������������������������������������������������������������������������  132 8.1.1 What Is a Spiritual Intervention?������������������������������������������  133 8.2 Theory, Rationale and Evidence ������������������������������������������������������  134 8.2.1 Personal Competencies in Spiritual Care������������������������������  134 8.2.2 Spiritual Intervention: Presence��������������������������������������������  135 8.2.3 Spiritual Intervention: Words������������������������������������������������  136 8.2.4 Spiritual Intervention: Actions����������������������������������������������  136 8.3 Documentation of Spiritual Care������������������������������������������������������  138 8.4 Practice Examples to Exemplify Spiritual Care��������������������������������  140 8.4.1 Case 1: João��������������������������������������������������������������������������  140 8.4.2 Case 2: Jane��������������������������������������������������������������������������  141 8.4.3 Case 3: Anna ������������������������������������������������������������������������  143 8.4.4 Case 4: Carmen ��������������������������������������������������������������������  145 8.5 Conclusion����������������������������������������������������������������������������������������  147 8.6 Summary of the Main Points for Learning ��������������������������������������  147 References��������������������������������������������������������������������������������������������������  148 9 Conclusions of the EPICC Journey and Future Directions ����������������  151 Adam Boughey, Wilfred McSherry, Linda Ross, Tove Giske, Josephine Attard, René van Leeuwen, and Tormod Kleiven 9.1 Introduction��������������������������������������������������������������������������������������  152 9.2 Innovation ����������������������������������������������������������������������������������������  154 9.3 Intellectual Outputs and Development of Project Resources������������  155 9.3.1 Output 1��������������������������������������������������������������������������������  155 9.3.2 Output 2 and 3����������������������������������������������������������������������  160 9.4 Coronavirus Disease 2019 (COVID-19) and Spiritual Disruption?������������������������������������������������������������������  166 9.5 The Future����������������������������������������������������������������������������������������  167 References��������������������������������������������������������������������������������������������������  168 Afterword: Compassion in Care������������������������������������������������������������������������  171

Chapter 1

The EPICC Project: Inception, Origins and Outputs Wilfred McSherry, Adam Boughey, and Josephine Attard

Learning Objectives This chapter will: 1. Provide a summary of the EPICC project and why this was necessary to advance nursing and midwifery, practice, research and education. 2. Introduce, the key outputs arising from the EPICC project, demonstrating how these can be used within nursing and midwifery education. 3. Offer an overview of the book, discussing the contribution this will make to nursing and midwifery practice, research and education.

1.1  Introduction The EPICC project has laid the foundations to help reduce the gap and disconnect between professional regulatory bodies’ statements and aspirations for high-quality spiritual care and actual practice. Recent definitions of spirituality suggest that

W. McSherry (*) Department of Nursing School of Health and Social Care, Staffordshire University, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent Staffordshire, England, UK VID University College, Bergen/Oslo, Norway e-mail: [email protected] A. Boughey Department of Nursing, School of Health and Social Care, Staffordshire University, Stoke-on-Trent, Staffordshire, England, UK e-mail: [email protected] J. Attard Faculty of Health Sciences, University of Malta, Msida, Malta e-mail: [email protected] © Springer Nature Switzerland AG 2021 W. McSherry et al. (eds.), Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care, https://doi.org/10.1007/978-3-030-65888-5_1

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spirituality is multidimensional and unique to every person [1]. It is broader than religious beliefs and is about meaning in life, connection to self, others and/or higher power or nature [2]. It provides ways to transcend everyday living and suffering [3]. Murgia et al. ([4], p. 14) conclude a recent concept analysis of spirituality in nursing by stating: To this end, nurses need sound theoretical foundations to recognise the different spiritual meanings of important periods of life for patients as birth, death and suffering, and link them to ethical issues in the practice of care.

This recommendation affirms that the concept of spirituality is important at all key life events including birth emphasising the fundamental role this dimension also plays in midwifery practice. The importance of ensuring that nurses and midwives have a ‘sound theoretical’ knowledge base was one of the major aspirations of the EPICC project. The EPICC objectives were to: 1. Develop a sustainable network of educators in nursing/midwifery in Europe to share experiences on person-centred and compassionate healthcare working according to European standards. 2. Disseminate knowledge amongst stakeholders (policymakers, regulatory bodies and educational bodies) across Europe to enable the EPICC Gold Standard Matrix to be incorporated into ongoing nursing/midwifery education.

1.2  Why EPICC Was Needed? The spiritual dimension of healthcare over the course of several decades has been a source of contention and viewed with a degree of scepticism. Part of the reason for this may stem from the subjectivity of the concept and the misconceptions associated with the meaning and interpretation of this word. However, in recent times, there has been a growing realisation of the importance and significance of this dimension for the health and well-being of individuals with many governments now valuing the contribution this makes to the health of their citizens [5], especially those facing key life events such as birth, illness and/or death [6–10]. There is also an emerging evidence base that reinforces the potential benefits to general health, well-being, quality of life and coping with conditions such as anxiety/depression [11–13]. It has been suggested that spiritual care is that care which responds to people’s personal, religious and spiritual beliefs and needs emphasising how this may be important to accessing healthcare [14–17]. This means this dimension of care must be taken seriously by those providing services [18–20] but is often overlooked [14, 16, 21]. Despite a recognition of the importance of this dimension to the delivery of

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care within the UK, there have been an increasing number of reports that shed light on significant failings in the quality and standards of care [22–27]. Reviewing the failings suggests that care was lacking in compassion, meaning individuals were not treated with dignity and respect. These attributes [dignity and respect] have been shown to be synonymous with spirituality [28–30]. Sir Robert Francis, who led the 2013 Public Inquiry into The Mid Staffordshire NHS Foundation Trust, stated high-­ quality care ‘puts the patient first’, ensuring that they are the focal point for the provision of all care, services and treatments. A consequence of not focusing and building services around the needs of the ‘person’ whether this be the patient, carer or staff is that they are at risk of fostering cultures, values, attitudes and behaviours that may lead to dignity violations since there is a failure to recognise the humanity and dignity of each person. As stated, the European Commission [5] highlights the need for all those involved in the caring professions to be prepared to support the spiritual, religious and cultural needs of people. This is also reflected and endorsed by some of the nursing and midwifery regulatory and educational bodies who stress the importance of providing holistic and person-centred care especially at the point of registration [31–34]. Despite this recognition within the nursing and midwifery professions, there is still a great deal of uncertainty about what spirituality is and how to provide spiritual care [35]. The notion of spirituality and spiritual care is explored in Chap. 2. The specific focus and context of this chapter, and indeed the work of the EPICC project, were on developments within Europe involving nursing and midwifery. The EPICC project sought to address several gaps identified (Table 1.1) in the existing knowledge base and practice of spiritual care.

Table 1.1  Gaps in nurse/midwifery spiritual care educationa 1. It was not clear what spiritual care competency looked like or how it might be assessed; there were no spiritual care competencies 2.  It was unclear how learners might acquire spiritual caring skills 3. Spiritual care teaching within undergraduate nurse/midwifery education programmes was inconsistent, and in some places non-existent [36, 37] 4. Practising nurses/midwives reported over several decades that they felt inadequately prepared for spiritual care and in need of further education [35, 38, 39] 5. Whilst some educational materials were available for practising nurses/midwives (e.g., Royal College of Nursing (RCN) [35], online educational resources), the evidence on which to base them was scant, and no educational materials were publicly available for pre-registration nurses/midwives a Table 1.1 reproduced with kind permission from Taylor and Francis from the article McSherry W, Ross L, Attard J, van Leeuwen R, Giske T, Kleiven T, Boughey A, and the EPICC Network (2020) Preparing undergraduate nurses and midwives for spiritual care: Some developments in European education over the last decade Journal for the Study of Spirituality 10(1) 55–71 doi: https://doi. org/10.1080/20440243.2020.1726053

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1.3  Origins and Organisation of the EPICC Project 1.3.1  Origins The publication of this book detailing the inception, origins and achievements of the EPICC project should not be viewed as a single point in time. The completion of this book denotes a significant milestone for many of the contributors. Since this work builds on many of the authors’ pioneering and seminal research spanning several decades. This book is essentially not the culmination of a programme of work but the continuation of a journey seeking the advancement of spiritual care education, research and practice. This journey commenced many decades earlier with passionate individuals who held a shared vision of ensuring that our nursing and midwifery professions, indeed the whole of healthcare, were truly person-­ centred and holistic.

1.3.2  E  uropean Spirituality Research Network for Nursing and Midwifery A landmark meeting took place at Staffordshire University on 20 August 2009, where the decision was taken to set up an informal network titled ‘European Spirituality Research Network for Nursing and Midwifery’. The aim of this network was to: • Advance collaborative research into spirituality within nursing and midwifery across Europe and beyond. And the objective was: • Through scholarly activity and collaborative research explore the relevance of spirituality within nursing and midwifery practice and education. At this inaugural meeting, one of the actions was for the network to undertake an international study provisionally titled ‘Cross-cultural investigation of student nurses’ perceptions of spirituality and preparedness to deliver spiritual care’. This research was built on an earlier work undertaken by [40] that explored the ethics of teaching spirituality to undergraduate student nurses. This research involved two phases: 1. Pilot study [41, 42] which was undertaken during 2010. The pilot involved a cross-sectional study of 531 pre-registration nursing/midwifery students from six universities in four European countries (Wales, Norway, Netherlands, and Malta). The main findings from this pilot phase were:

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(a) Students held a broad view of spirituality (measured by the Spirituality & Spiritual Care Rating Scale [SSCRS]; [43]). (b) Students considered themselves to be more competent than not in spiritual care (measured by Spiritual Care Competency Scale [SCCS]; [44]) at the start of their studies.

2. The main study [45] was conducted between 2011 and 2016, comprising a longitudinal prospective follow-on study of 2193 (dropping to 595) students from 21 universities in eight European countries. The results:

(a) Confirmed the findings from the pilot study; personal spirituality of the student (high spirituality scores preferable [SAIL p