Symposium II

Framework of Competencies in Spiritual Care for Nurses and Midwifes: A Modified Delphi Study

Josephine Attard

Aim: The purpose of this study was to develop a framework of competencies (knowledge, skills and attitudes) in spiritual care that guides nursing and midwifery education to ensure that new recruits in the profession will be equipped to meet the clients’ holistic needs.

Background: In spite of the constant call for competence in the provision of holistic care as an essential professional skill (WHO, 1998; Human Rights Act 2000; NMC 2010; QAAHE 2001), the area of acquiring competence in spiritual care has largely been neglected in nursing and midwifery education and clinical practice. The development and validation of competencies in spiritual care is therefore important and recommended.

Method: The study utilized a mixed method approach using an eclectic framework through three main phases. The first phase involved the identification and formulation of spiritual care competency items and the development of the research tool from an in depth literature review and 5 focus group discussions with stakeholders and consumers of spiritual care. The second phase involved a consensus seeking process utilizing the modified Delphi methodology. The generated 55 generic competencies were scrutinized by a panel of experts in spiritual care using a variety of sampling techniques in a 2-round Modified Delphi study. Response rates in round 1 was 75.78% (N=318, n=241) and in round 2 85.06% (N=241, n=205). Non respondents equated to 14.93% (n=36). Consensus was determined as having the proportion of experts who rated the item within the highest region of the scale on a 7-point ‘Likert’ form scale (5, 6 or 7) and equated to be 75% threshold or greater. The third phase of the study involved a consultation process with international and local experts in the field (N= 285, n=107) to obtain a pragmatic perspective of views on the identified domains and competency items in spiritual care, identify which competencies in spiritual care should essentially be acquired at PRE-registration level (i.e. at point of registration), which competencies should essentially be left at POST-registration level (i.e. after graduation as qualified staff), and which competencies are not essential at either level. Thematic analysis sought to identify factors that may enhance or hinder implementation of the framework in education, research and/or clinical practice.

Results: The results for phase 2 of the study which will be presented. These were based on the response of 241 modified Delphi participants in ten different groups in round 1 of the study and 205 participants in round 2 (85.06%). 54 competency items out of the 55 presented achieved the pre-determined 75% level of consensus by the end of round 2. The majority of items (27) scoring above 90% and 25 items scoring above 80% level of agreement.

Cronbach’s Alpha indicated total competency domains and competency items have reliability coefficients of 0.97 and each of the 7 domains and competency items have coefficients of between 0.79 and 0.93 indicating good to strong internal consistency. Spearman’s test indicated very high correlations (0.9 to 1) for 23 items and high correlations (0.7 - 0.89) for 31 competency items. Only one item had a moderate correlation coefficient (0.5 - 0.69) (Item 35 rs =0.554).

Results for the exploratory factor analysis showed good fit of five factor model of Assessment and Implementation of spiritual care, ethical and legal issues in spiritual care, body of knowledge in spiritual care and Informatics in spiritual care. Items in the domain self-awareness and the use of self and items in the communication and interpersonal skills domain were not defined as these loaded on the various other factors. Items relating to referral to chaplains and spiritual leaders loaded as a separate factor. Only 2 items (item 8 and item 24) cross loaded on another factor while 5 competency items scored

Conclusion: The developed framework of competencies in spiritual care among the modified Delphi ‘experts’ in general, demonstrated to be a valid and reliable tool. Further testing is recommended in relation to the construct validity of the tool in particular to the use of confirmatory factor analysis is suggested.

Slides:

From the Empirical Study of Religion/Spirituality to Practical Assessment in Treatment: Linking Research with Practice

Constantin Klein

In recent years numerous studies have deepened our understanding of the relation of religion/spirituality with mental and physical health (Koenig, King & Carson, 2012). Several pathways like social support provided by religious communities, a positive relationship with God, or religious/spiritual coping strategies which contribute to well-being and better health have been identified while different kinds of religious/spiritual struggles have been found to affect health to the worse (Klein, Silver & Zwingmann, submitted). The majority of such studies have used the methods of quantitative empirical research. Thus, the findings can be interpreted in terms of statistical probabilities. Yet the question remains how such rather abstract research results can be helpful for the assessment of a patient's individual religious/spiritual history and for dealing with her or his concrete religious/spiritual needs in treatment. To answer this question it is important to be aware of the type of measure of religion/spirituality which has been used in a particular area of the empirical research because each type of measure relates to an underlying, more general question, e. g.: How important is a patient's religion/spirituality for her or him? Does the patient hold beliefs which are helpful for her or him to find meaning or which worry her or him? Is the patient member of a religious community, and does she or he receive support from the community? How do the patients’ religious/spiritual beliefs influence the subjective theory of her or his illness? Has the patient religious/spiritual needs which should be considered to improve her or his well-being? (cf. Albani & Klein, 2011). Asking questions like these in the communication with a patient provides the opportunity to address and integrate the patient's religion/spirituality in clinical practice in a way that can be fruitful both for the patient's satisfaction with treatment and for the treatment outcome. The paper 1) gives an overview over the most important lines of research on religion/spirituality and health and 2) illustrates how the particular research topics are related to the more general questions which could (or should) be addressed in the direct communication with a patient. The possible consequences of such an assessment of religion/spirituality will be discussed, too.

Keywords: Assessment, Exploration, Measures, Empirical Findings.

Assessing Religion/Spirituality with the Faith Development Interview

Heinz Streib & Constantin Klein

The paper gives an introduction into the assessment of an individual's worldview, in particular its religious/spiritual facets, with the Faith Development Interview (FDI). The FDI is a semi-structured interview which has been originally been developed in James Fowlers (1981) research about stages of faith development. In its revised editions (Fowler, Streib & Keller, 2004; Keller & Streib, 2013) the FDI has been used for the exploration of faith biographies in numerous studies at Bielefeld University (Streib, Hood, Keller, Csöff & Silver, 2009; Streib & Hood, in preparation). By asking questions which explore the patient’s life review, relationships, values and commitments, and religion/worldview, it offers space for reflection on one’s life and its existential foundations (Keller, Klein, Streib & Hood, 2013). We regularly make the observation that research participants respond to this offer and appreciate it as opportunity to self-exploration. Our research results show that the FDI permits the identification of salutogenic resources as well as of pathologic tendencies related to religion/spirituality. The growing acknowledgment of the importance of religion/spirituality for mental health suggests considering the FDI as a diagnostic tool in clinical and psychotherapeutic contexts and as an orientation for pastoral counseling (Keller, Klein & Streib, 2013). The potential and limits of the FDI are discussed, drawing on examples from our current research.
Keywords: Assessment, Interview, Faith Development, Biography, Self-Exploration