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Research Project: Spiritual Care Provided by Registered Nurses

 And Other Professional Health Care Providers.

 PROBLEM:  According to the holistic paradigm, the human being consists of body, mind, and spirit.  While the body and mind issues are well addressed in health care, it is the spiritual care that often remains a vague and elusive factor.  Holistic health is expected in the 21st century.  It is not only expected by society generally, but also documented in publications by agency accreditation standards and professional codes.  Just adding “holism” to a philosophy statement or establishing spiritual care policies will not solve this problem.  Spiritual care is defined as a relational issue.  It has to do with the way people talk to one another.   A theory guided, evidence based focus for a holistic approach to spiritual care is needed for nurses and other health care professionals.

 LITERATURE REVIEW: There is ample evidence in the literature that spiritual care provides increased resilience and promotes healing.  In a recent study of spiritual care received by terminally ill cancer patients, the 67% of the subjects reported religiousness to be very important, but 59.7% reported none or limited care from doctors, nurses, and chaplains.  In nursing education, spirituality is included in the curriculum, but a survey of faculty reveals uncertainty about what is to be taught.  A model course was not found. The literature shows a debate about whether it should be taught.  A study found nursing textbook pages devoted to spiritual issues ranged from 0% to 13% with few exceptions.  Studies about current nursing practices regarding spiritual care in the United States have not been found in the literature. 

 NEED: Of all groups of patients, the oncology group logically would be the first group one would expect to receive spiritual care.  If this group receives so little, then what of all of the other patients?  What are the barriers?  Educational programs and health care agencies typically are without well designed programs providing guidelines and policies about how nurses are to proceed.    

 PURPOSE: The purpose of this study is two-fold: 1) to survey the nurses from a wide variety of services concerning their rating of the spiritual care they are currently providing, and 2) to determine the degree to which a computer assisted instruction educational intervention influences nurses’ ratings of spiritual care.

 THEORETICAL BASIS: The Theory of Spiritual Care in Nursing Practice (Battey, 2009). Bloomington, Indiana: Xlibris Corp.  IBSN Hardcover; 978-1-4415-2892-6   Softcover; 978-1-4415-2891-9.  Also available in e-book format.

 DESIGN: 1) A survey will be conducted to determine the nurse subjects’ rating of the spiritual care they are currently providing.  The survey tool to be used Spiritual-Communication Satisfaction-Importance (SCSI) Questionnaire (Battey, 2009).

2) The pretest, posttest experimental design will be used to determine the degree to which the educational intervention influences the perspectives of the subjects.  The educational intervention is the Spirituality in nursing practices: A computer assisted instruction program & course manual (Battey, 2010),   Complete Spirituality Computer Course may be purchased at

 SAMPLE: The study will consist of a convenience (volunteers) sample of 30+ Registered Nurse staff from multiple clinical areas at each of several research sites for a total of 200+ subjects.  Criterion for subject selection includes:

1)      Employed full time for one year at the agency research site.

2)      Involved in direct patient care within the past five years.

3)      Speak English as a primary language and English as a second language.

4)      Adhere to any religious/spirituality belief system.

5)      Be available to participate in this research project.

 FUNDING:  Three research sites have completed the research project as a pilot study with 50 subjects, Additional sites & subjects are being sought for the 2014.  Funding and resources are being provided by the research site agencies and by personal funding sources.  Funding has been sought from many foundations and organizational groups, but this study does not fall within current objectives.  Pre-publication findings are available from Dr. Battey.

 PRINCIPLE INVESTIGATOR:  Bonnie W. Battey, Ph.D., R.N., Consultant in Nursing Education. (; Phone 925-706-0442; Fax 925-706-0621; and web site:

 Research Team Members

 The following individuals comprise the research/writing team of “Co-investigators” as well as “Co-authors” on a future research article (2014+) to report findings.

 James R. Acree (“J R” for short) BSN, BSNA, MS, MSN, PhD is a CRNA (Certified Registered Nurse Anesthetist) and a Lieutenant Commander, Nurse Corps, U. S. Navy Retired, who holds a PhD in Holistic Health Sciences.  He happened to be a former nursing student of Dr. Battey’s for his BSN (1976 in Arkansas) and again for his MSN (2004 in California).  He served as a peer/editorial reviewer of the Parish Nurse Computer Assisted Instruction (CAI) course and the Spirituality CAI. He has authored and presented numerous anesthesia presentations at national and regional RN and CRNA conferences and currently practices anesthesia at the Central Arkansas Veterans Hospital, Little Rock, AR. 

Phone: 501-605-8482.  E-mail:  jracrna <> 

 Barry Collins, PhD. is Professor Emeritus, Psychology, from UCLA who is serving as statistician for the study and advisor about interpreting the data. He has taught statistics and research design at both the graduate and undergraduate levels.  He is in the process of developing a “monkey survey” program to facilitate data collection and transfer of data to the SPSS statistical program.  He will be available to consult with agencies. Phone: Business 310-582- 7023; Fax; 866-206-8503


 Paul D. Kraus, D. Min., is Director, Department of Pastoral Care. Austin State Supported Living Center, Austin, Texas.  He is also an Associated Professor with the Seminary of the Southwest, Austin, Texas.   He has written 17 published articles, taught 14 different academic courses in graduate and undergraduate degree programs, and has presented on over 20 different topics in seminar/workshop settings on topics related to the discipline of Pastoral Care and Counseling in three different countries.  He is author of “Pastoral Care” (In Press) Computer Assisted Instruction for Nursing and Allied Health.  He served as an Instructor and Partnership Coordinator of the Texas-Mexico Pastoral Care and Counseling Conferences sponsored by Hospital Mexico Americano, Guadalajara, Mexico. He served as a peer/editorial reviewer of Dr. Battey’s Parish Nurse CAI and the Spirituality CAI.  He also served on the planning committee for the 2012 Texas Workshop on Implementing Spiritual Care within the Interdisciplinary Clinical Team for which Dr. Battey served as keynote speaker. 

Phone: Office – 512-374-6438; Cell: 512-348-5307.


 Judy G. Myers, MSN, PhD (Sociology), RN is an Associate Professor of Nursing at the University of Indiana South East.  She is am currently the Primary Investigator for a multidisciplinary team studying the clinical and biochemical effects of massage therapy on fatigue and insomnia among women receiving radiation therapy for breast cancer.  A large part of her work involves health planning and development of sustainable partnerships between the university and a variety of community groups.  She serves on the board of Hospice and a member of a group creating a hospice house and center for arts, healing and spirituality in rural Indiana, and many other projects.  She holds memberships in American Holistic Nurses Association and the American Nurses Association.  She recently completed a two year fellowship with the IU Academy for Leadership and Diversity and.  She has collected most of the data for this current spirituality project.  Dr. Myers used the CAI on Spiritual care to teach a course to RN to BSN nursing students. 

Phone: Business: 812-941-2695: Cell: 502-939-6165. 


 Jeanette Lee Plodek, MSN (Clinical Specialist in Holistic Nursing), Ph.D. (Human Science), RN is currently adjunct faculty at University of West Florida, Excelsior College, and Simmons College Nursing in Boston She is an active member of The Society of Rogerian Scholars, American Nursing Association,  Sigma Theta Tau, as well as holding leadership position as Research Grant Coordinator in American Holistic Nursing Association.   She is owner and operator of Heavenly Oasis for Wellness and Stress Management. She has completed several research studies using Reiki for Stress Management in nurses and nursing students and in hypnosis for birthing.  Currently she is assisting in recruiting participants, collecting data, submitting grant proposals, and filing for the national NEIRB for this spiritual care research project, as well as being helpful in providing information regarding the IRB approval process to other research sites.

Phone: 405-496-8902.   E-mail: 

Jerry N. Raskin, B.A., President, A.S.K. Data Systems, Inc., Manchester, Mo., is our computer and IT expert.  He recruits authors to write courses for computer assisted instruction programs, develops and markets the CAI material.  Recently has been recruiting schools and hospitals for our research sites and subjects.  He also keeps our research schedules and keeps things on track.

Phone: 800-292-7211.   E-mail: Website:

 Bonnie Weaver Battey, Ph.D., R.N. serves as Principle Investigator and is a nursing consultant in private practice, serving nursing education clients nationally and internationally.  With undergraduate BS studies in Nursing at Valparaiso University and Wagner College; she earned a MSN in Nursing Education at Vanderbilt University and a Ph.D. at the University of Kansas, Lawrence, majoring in Speech Communication and Human Relations.  A tenured professor at East Carolina University, Dr. Battey taught all levels of Medical Surgical or Adult Health clinical nursing courses as well as nursing leadership, theories, research, education, curriculum development, and death and dying; she also taught interdisciplinary speech and ethics/philosophy courses.  She served as an administrator of associate degree, baccalaureate, and master’s programs in nursing, and initiated an ADN and a BSN program in nursing.  She served as an accreditation visitor for the National League of Nursing for over 25 years for undergraduate and graduate programs.  Memberships include Sigma Theta Tau International, American Association of Holistic Nurses, Health Ministries Association, and the Society for Spirituality, Theology and Health, and Faith Community Nursing.  Volunteer community services have included eight years as Parish Nurse and four years as a Lay Chaplain in the Chaplaincy Program of INOVA Alexandria Hospital, Alexandria, Virginia.  She has served as a proposal reviewer for Dr. Plodek’s AHNA Research Grant committee.   Having recently authored several articles and books about spiritual care in nursing, Dr. Battey has written the CAI course on spiritual care which is the focus of this research project.  She has also written the questionnaire to serve as the pre-post research tool to test the degree of influence the CAI spiritual care course has on the subjects’ perspective.  Phone: 925-706-0442.  Fax: 925-702-0621.

E-mail:   Website:

 Logic Model for Spiritual Care Project


1)      Accreditation evidence for providing spiritual care to patients.

2)      Nurses fear speaking to patients about spirituality, being reported, and receiving poor evaluations and job loss.[i] 

3)      Report lack of administrative support, guidelines, and policies.

4)      Research – 80% terminal cancer patients report no spiritual care.[ii] [iii]

5)      Limited evidence of spiritual care is being provided. iv 

6)      A theory guided, evidence based focus for a holistic approach to spiritual care is needed for nurses and other health care professionals.


1) Survey questionnaire has been developed for RN staff to rate the quality of spiritual care provided and the communication about spiritual care among staff and administrators.  Spiritual-communication-satisfaction-importance (SCSI) questionnaire manual.  (Battey, 2011).   IBSN 978-09831245-0-4  Available from author.

 2) A Computer Assisted Instruction (CAI) program “Spiritual Assessment in Nursing Practice” (Battey, 2011).  IBSN 978-09831245-0-4.   Currently this program is being tested in a research project that has been developed as an educational intervention to provide information, direction and guidelines for providing spiritual care.  A test on the CAI provides individual nursing staff members a) a score for personal information and b) professional performance review evidence.  Theoretical basis is  Theory of spiritual care for nursing practice. (Battey, 2009). Bloomington, Indiana: Xlibris Corp.  IBSN Hardcover 978-1-4415-2892-6;  Softcover   978-1-4415-2891-9.  Also available as an e-book.  


1)      Strategies – 3 phases

     a)      A pilot study was conducted to test survey tool & CAI with RN subjects.

     b)      Effective May 12, 2014, approval by the New England Institutional Review Board (#14-182) has been obtained for    individual members of Sigma Theta Tau International Honor Society of Nursing (STTI), American Holistic Nursing Association (AHNA), American Nursing Association (ANA), National Black Nurses Association (NBNA) or the American Nursing Foundation (ANF).

     c)      Continuing national individual site studies through local hospitals and universities. With each research site associates to seek approval from their local/own IRB

2)      Conduct research to test impact of CAI with RN subjects.   Data analysis is currently in process.

3)      Revise and update as appropriate all materials for surveying other Health Care Professional personnel similar to the approach used by Balboni, et al. (2009). 2  


1)      Report research results to show quality and impact of CAI for multiple sites as well as individual research sites.

2)      Personal scores on testing.

3)      Ratings of RN staff members’ evaluation of the spiritual care they provide.


1)      Short-term - Increased support by administrators of RN staff.

2)      Short-term - Increase of RN staff knowledge & skill in providing spiritual care.

3)      Long-term – Seeking ANCC, Continuing Nursing Education (CNEs) through the American Holistic Nursing Association for completing the CAI Spirituality educational modules.


1)      Provide evidence on spiritual care quality for accreditation requirements with survey tool and CAI test score.

     a)      Ability to track RN staff rating of own spiritual care year over year.

     b)      Ability to relate RN rating with patient evaluation on exit evaluations.

     c)      Revision of questionnaire to be applicable to other health care professional groups.

     d)     Ability to track ratings year over year to meet accreditation criteria regarding spiritual care.

2)      Implementation of Nursing and other Health Care Professional Administrator’s spiritual care Task Team, Committee or Advisory Board to establish seminars, conferences, guidelines and policies to support all Allied Health staff implementation of spiritual care. [iv]  


[ii] Balboni, T. A., Paulk, M. E., Balboni, M. J., Phelps, A. C., Loggers, E. T., Wright, A. A., Block, S. D., Prigerson, H. G. (2009). Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology, 24, 1-8. doi:


i[ii] Balboni, T. A., Sullivan, A., Enzinger AC et al. (2014).  Nurse and physician barriers to spiritual care provision at the end of life.  Journal of Pain & Symptom Management.

            2014 Jan 28. pii: S0885-3924(13)00669-6. doi: 10.1016/j.jpainsymman.2013.09.020. [Epub ahead of print]


Battey, B. W.  (November, 2012).  Perspectives of spiritual care for nurse managers.  Journal of Nursing Management, 20. 1012-1020  DOI: 10.1111/j.1365-2834.2012.01369.

PRINCIPLE INVESTIGATOR: Bonnie W. Battey, Ph.D., R.N., Consultant in Nursing Education. (; Phone 925-706-0442; Fax 925-706-0621)

 To visit Bonnie Battey's own website click Here


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