Opening up to learning spiritual care of patients: a grounded theory study of nursing students.

AIM: To determine undergraduate nursing students' perspectives on spiritual care and how they learn to assess and provide spiritual care to patients.

BACKGROUND: Nursing is concerned with holistic care. Systematic teaching and supervision of students to prepare them to assist patients spiritually is a growing focus. However, there is limited consensus about the competences students need to develop and little is written related to students learning processes.

DESIGN: Grounded theory was used to identify students' main concern and develop a substantive grounded theory.

METHOD: Data collected during semi-structured interviews at three Norwegian University Colleges in eight focus groups with 42 undergraduate nursing students were analysed through constant comparison of transcribed interviews until categories were saturated.

RESULTS: The participants' main concern was 'How to create a professional relationship with patients and maintain rapport when spiritual concerns were recognised'. Participants resolved this by 'Opening up to learning spiritual care'. This basic social process has three iterative phases that develop as a spiral throughout the nursing programme: 'Preparing for connection', 'Connecting with and supporting patients' and 'Reflecting on experiences'.

CONCLUSION: Nurses need a wide range of competences to fulfil the nursing focus on holistic patient care. Nursing education should prepare students to recognise and act on spiritual cues. A trusting relationship and respectful and sensitive communication assist students to discover what is important to patients. An educational focus on spiritual and existential themes throughout the nursing programme will assist students to integrate theoretical learning into clinical practice.

RELEVANCE TO CLINICAL PRACTICE: Study participants reported seeing few role models in clinical settings. Making spiritual assessment and interventions more visible and explicit would facilitate student learning in clinical practice. Evaluative discussions in clinical settings that include spiritual concerns will enhance holistic care.