Research Project: Spiritual Care Provided by Registered Nurses
And Other Professional Health Care
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
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.
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
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
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
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,
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:
Employed full time for one year at the agency research site.
Involved in direct patient care within the past five years.
Speak English as a primary language and English as a second language.
Adhere to any religious/spirituality belief system.
Be available to participate in this research project.
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. (firstname.lastname@example.org;
Phone 925-706-0442; Fax 925-706-0621; and web site:
following individuals comprise the research/writing team of “Co-investigators”
as well as “Co-authors” on a future research article (2014+) to report findings.
(“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
Phone: 501-605-8482. E-mail:
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
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.
(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
Business: 812-941-2695: Cell: 502-939-6165.
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.
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: email@example.com
Jerry N. Raskin,
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:
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.
Model for Spiritual Care Project
Accreditation evidence for providing spiritual care to patients.
Nurses fear speaking to patients about spirituality, being reported, and
receiving poor evaluations and job loss.[i]
Report lack of administrative support, guidelines, and policies.
Research – 80% terminal cancer patients report no spiritual care.[ii]
Limited evidence of spiritual care is being provided. iv
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
Spiritual-communication-satisfaction-importance (SCSI) questionnaire manual.
Available from author.
Computer Assisted Instruction (CAI) program “Spiritual
Assessment in Nursing Practice” (Battey, 2011).
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;
978-1-4415-2891-9. Also available
as an e-book.
Strategies – 3 phases
A pilot study was conducted to test survey tool & CAI with RN subjects.
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).
Continuing national individual site studies through local hospitals and
universities. With each research site associates to seek approval from their
Conduct research to test impact of CAI with RN subjects.
Data analysis is currently in process.
Revise and update as appropriate all materials for surveying other Health Care
Professional personnel similar to the approach used by Balboni, et al. (2009).
Report research results to show quality and impact of CAI for multiple sites as
well as individual research sites.
Personal scores on testing.
Ratings of RN staff members’ evaluation of the spiritual care they provide.
Short-term - Increased support by administrators of RN staff.
Short-term - Increase of RN staff knowledge & skill in providing spiritual care.
Long-term – Seeking ANCC, Continuing Nursing Education (CNEs) through the
American Holistic Nursing Association for completing the CAI Spirituality
Provide evidence on spiritual care quality for accreditation requirements with
survey tool and CAI test score.
Ability to track RN staff rating of own spiritual care year over year.
Ability to relate RN rating with patient evaluation on exit evaluations.
Revision of questionnaire to be applicable to other health care professional
Ability to track ratings year over year to meet accreditation criteria regarding
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.
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.
of Clinical Oncology,
1-8. doi: 188.8.131.52
Balboni, T. A., Sullivan, A., Enzinger AC et al.
Nurse and physician barriers to spiritual
care provision at the end of life.
Journal of Pain & Symptom Management.
2014 Jan 28. pii:
10.1016/j.jpainsymman.2013.09.020. [Epub ahead
Battey, B. W. (November, 2012).
Perspectives of spiritual care for nurse
managers. Journal of Nursing Management,
20. 1012-1020 DOI:
PRINCIPLE INVESTIGATOR: Bonnie W. Battey, Ph.D.,
R.N., Consultant in Nursing Education. (firstname.lastname@example.org; Phone
925-706-0442; Fax 925-706-0621)
To visit Bonnie Battey's own website click