Spiritual Perspective, Mindfulness, and Spiritual Care Practice of Hospice and Palliative Nurses

Patricia Ricci-Allegra, PhD, RN, CPNP-AC/PC


Journal of Hospice and Palliative Nursing. 2018;20(2):172-179. 

In This Article

Literature Review

Both qualitative and quantitative methodologies have been used to examine the relationship between nurses' spiritual perspective and provision of spiritual care. Positive correlations were found between spiritual perspective and spiritual care in registered nurses (RNs) and nurse practitioners from various settings.[13–15] However, the majority of the studies' samples contained predominately white Christian female subjects. Various instruments to measure spiritual perspective and spiritual care were used in these studies, yet all found positive correlations between spiritual perspective and spiritual care, with the exception of Ronaldson et al,[14] who did not find a correlation in acute care nurses. Findings from qualitative studies indicate that spiritual self-awareness enhanced spiritual care practice.[16,17]

Researchers have found that spiritual perspectives have been enhanced as a result of participating in mindfulness programs. Individuals vary on their degree of mindfulness, which can be enhanced through regular disciplined practice.[18] Cancer patients who participated in a mindfulness-based stress reduction program had an increase in mindfulness, which in turn led to an increase in their spiritual perspective.[19]

Not only have mindfulness programs been shown to impact spiritual perspectives, but also participants in these programs have developed skills necessary for spiritual care provision. Health care providers report development of skills such as self-awareness, listening, and being fully present.[20] Participants also had increased scores on measures of empathy.[20]

Although researchers have evaluated the impact of mindfulness programs on health care providers, there is a paucity of research evaluating clinician mindfulness and patient care. In an observational study, Beach et al[21] evaluated self-reported clinician mindfulness and quality of patient care. The study found that clinicians with higher mindfulness scores were more likely to have patient-centered patterns of communication and high overall patient satisfaction. Brady et al[22] found patient satisfaction increased and patient safety incidents decreased (patient aggression, falls, and medication errors) after implementation of a 4-week mindfulness-based stress reduction program for staff on an inpatient psychiatric unit. However, this study used a small convenience sample (N = 16) without a control group, limiting generalizability of findings. This emerging body of evidence suggests that clinician mindfulness may play a role in measureable outcomes of patient care.

In summary, a nurse's spiritual perspective has been recognized as an influencing factor in spiritual care, with researchers finding positive correlations between spiritual perspectives and spiritual care provision. Findings from studies have shown an increase in spiritual perspective as a result of participation in programs designed to develop mindfulness, as well as develop skills necessary for spiritual care practice. Empirically evaluating relationships that may affect nurses' spiritual care could impact practice and education and offer new areas of inquiry for research in an area of hospice and palliative nursing that is often misunderstood.