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


Findings from this study demonstrated a positive relationship between mindfulness and spiritual care practice. Mindfulness explained 4.5% of the variance in spiritual care practice, with nurses having a somewhat high degree of mindfulness with a mean score of 4.33 on a scale of 1 to 6 for the MAAS. This finding supports Watson's[23] assertion that a caring relationship is fostered by being present. No other studies investigating the relationship between nurses' mindfulness and spiritual care exist to date. The current study results are comparable to the findings of Beach et al[21] that clinicians' mindfulness impacted care. Clinicians with high mindful scores were more likely to have more patient-centered patterns of communications and were given higher scores for overall satisfaction by their patients. These researchers posited that mindfulness may free attention, and therefore the clinicians could better focus on the patient's experience and be less likely to distance themselves from distressing situations.

Hospice and palliative nurses frequently encounter stressful and difficult situations. Nurses with higher mindful scores may have more ability to be "attentive to and aware of what is taking place in the present"[8] (p822) and not distance themselves from what is happening for patients and families. Consequently, this mindful attribute may then facilitate provision of spiritual care.

No statistically significant relationships were found between mindfulness and spiritual perspective or mindfulness and key demographics. This study assessed baseline trait mindfulness of the nurses, whereas other researchers have examined the relationship between mindfulness and spiritual perspective after mindfulness programs.[19] The increase in spiritual perspective in that study may be due to the active cultivation of mindfulness rather than how mindful a person is in general (trait mindfulness). There were no correlations found between mindfulness and key demographics, suggesting an individual's ability to be mindful may not be impacted by age, years or type of nursing experience, professional role, having a religious affiliation, or prior spiritual care education.

In this study, no statistically significant correlations were found between spiritual care practice and key demographics of years and type of nursing experience, professional role, having a religious affiliation, or education in spiritual care. However, other researchers have found that certain demographics have impacted spiritual care practice: years of nursing experience,[15] clinical area,[13,14] shift worked,[13] and having education in spiritual care.[13] As compared with nurses in these studies, this sample of hospice and palliative nurses was older and highly educated and with more nursing experience. The demographic differences may have accounted for the differences or utilizing different instruments to measure spiritual care practice. Future research utilizing the NSCTS to measure spiritual care with diverse samples may determine if certain demographics influence practice.

Statistically significant relationships were found between spiritual perspective and certain demographics. Age, years of experience as an RN, and having a religious affiliation were positively correlated with spiritual perspective. Ronaldson et al[14] found similar findings with years of experience impacting spiritual perspective in palliative care RNs.

No statistically significant relationship was found between spiritual perspective as measured by the SPS and spiritual care practice as measured by the NSCTS. This is an unexpected finding because prior research has shown statistically significant relationships between these 2 variables. However, not all studies used the same instruments to measure spiritual perspective and/or spiritual care practice.[13–15]

There is a broad range of conceptualizations regarding spiritual perspective, and lack of agreement regarding definitions makes research challenging.[27] Mamier[13] measured spiritual perspective with an instrument that evaluated how often an individual experiences the transcendent (God, the divine or holy) in daily life and his/her perception of the transcendent. Vance[15] examined spiritual perspective with 2 instruments. The first instrument assessed perception of a relationship with God and a sense of life purpose and satisfaction, whereas the second instrument measured activities and beliefs. Although several common themes, such as forgiveness and prayer, can be found among the instruments, some items focus more on a relationship with God or the divine and include other aspects of spirituality, such as the ability to apologize and find meaning from suffering. Assessing different aspects of the nurses' spiritual perspective may have contributed to the nonsignificant findings between spiritual perspective and spiritual care in the current study.

Prior studies,[14,15] with the exception of Mamier,[13] utilized other instruments to measure spiritual care. Each instrument contained a Likert-type scale but with different anchor points. The NSCTS's anchors used in the current study and the one by Mamier[13] contained subjective and objective terms (ie, "often, about 7–11 times"). The Spiritual Care Practice Questionnaire used by Vance[15] and Ronaldson et al[14] used the subjective "very seldom" to "very often." Given each nurse may interpret the subjective terms differently, the frequency of care provided may not be consistent across instruments, making comparisons problematic. In addition, in this study and Mamier's[13] study, nurses were asked to consider the past 72 or 80 hours of patient care when considering frequency of spiritual care provision, but no such requirement was given for the other studies.[14,15]

The NSCTS evaluates the frequency of 17 therapeutics a nurse may use in order to provide spiritual care. Taylor et al[28] reported on the frequency of spiritual care using the NSCTS with US nurses from multiple locations (including the current study). The hospice and palliative nurses' NSCTS scores were the highest, followed by nurses in a Christian health care system (mean, 37), nurses mainly enrolled from nursing journal Web sites (mean, 34.8), and mostly ICU nurses from Ohio (mean, 32.5). Higher spiritual care practice scores for the hospice and palliative nurses are not unexpected, given that spiritual care is an essential component of hospice and palliative care.[3,4] Prior research has also found higher provision of spiritual care in hospice and palliative nurses compared with nurses in other specialties.[14]