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Research Project: Spiritual Care Provided by Registered Nurses

& All Professional Health Care Practitioners.

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 (and other AHP later) 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. It is also available in e-book format.

DESIGN: A single group, pretest, posttest design with two objectives: 1) to obtain test-retest correlations for individual items that will reflect test-retest reliability. The elimination of items with low reliability will imply refinement of the questionnaire (e.g. drop the item or rewrite it.). The survey tool to be used Spiritual-Communication Satisfaction-Importance (SCSI) Questionnaire (Battey, 2009). 2) To assess the impact of the CAI intervention. The educational intervention is the SPIRITUALITY IN NURSING and Allied Health Professional Practice: A computer assisted instruction program & course manual (Battey, 2010). The Spirituality Computer Course description may be viewed at New England Institutional Review Board approval has been obtained, Study # 14-182.

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 in professional practice.

  2. Involved in direct patient care within the past two years.

  3. Speak English as a primary language or as a second language.

  4. Adhere to any religious/spirituality belief system.

  5. Be available to participate in this research project. The final enrollment date is May 31, 2017 and the study must be completed by June 30, 2016 for Domestic U.S. Participants. Non-US participants' final enrollment date is to be announced.

  6. INVITATION TO PARTICIPATE: The study requires taking a pre- and post- survey, an on-line course of 8 lessons (about 8 hours), and an examination with an e-book course provided. Course design is also appropriate for Classroom or Independent Study for upper division RN to BSN, RN to MSN or graduate levels for ALL Allied Health Disciplines.

FUNDING: Three research sites have completed the research project as a pilot study with 50 subjects, Additional sites & subjects are being sought until the published completion date of May, 2016. Funding and resources are being provided by the research site agencies and by personal funding sources. Pre-publication analysis shows numerous statistically significant findings and are available as a pre-publication summary from Dr. Battey.

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

Logic Model for Spiritual Care Project


  1. Accreditation evidence for hospitals regarding 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 “SPIRITUALITY IN NURSING PRACTICE and Allied Health Professionals: A computer assisted instruction program & course manual (Battey, 2010, 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

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

    2. Approval by the New England Institutional Review Board (#14-182).

    3. 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. This CAI on-line course has been approved by theApproval by the American Holistic Nursing Association for 10 CNEs. New England Institutional Review Board has been obtained (Study #14-182).


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

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

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

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

    4. 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

Publications on Spiritual Care by Bonnie W. Battey

1. (2008) Administrator’s guide to implementing spiritual care into nursing practice. Bloomington, Indiana: Xlibris Corp. IBSN Hardcover 978-1-4415-2892-6 Softcover 978-1-4415-2891-9

2. (2009). Theory of spiritual care for nursing practice. Bloomington, Indiana: Xlibris Corp. IBSN Hardcover 978-1-4415-2892-6: Softcover 978-1-4415-2891-9.

3. (2009). Humanism, nursing, communication, and holistic care: A position paper. Bloomington, Indiana: Xlibris Corp. SN Softcover 978-1-4415-3362-3.

4. (2009). Manual for nursing communication observation tool (NCOT): Designed for research & teaching of humanizing nursing communication theory. Bloomington, In.: Xlibris Corp. IBSN Softcover 978-1-4415-2279-5.

5. (2010) Manual for job-communication satisfaction-importance (JCSI) questionnaire. Bloomington, In.: Xlibris Corp. TXU 426 203 April 24, 1990. Xlibris 2010 edition: IBSN Softcover 978-1-4500-5462-1; EBook 978-4500-4522-3.

6. (2010) Spirituality in nursing practice: a computer assisted instructional program and course manual. Available from author. IBSN 978-09831245-0-4

7. (2010) The spiritual dimension of holistic care. Beginnings: American Holistic Nurses Association, 8-9. (2010, Summer)IBSN 978-09831245-0-4

8. (2011) Spiritual-communication-satisfaction-importance (SCSI) questionnaire manual. Available from author. IBSN 978-09831245-0-4

9. (2012). Perspectives of spiritual care for nurse managers. Journal of Nursing Management, Doi: 10.1111/j.1365-2834.2012.01360.x

10. (2012) Implementing Spiritual Care within the Interdisciplinary Clinical Team. Recordings of five keynote lectures on concept, “collaboration,” presented at the Texas Chaplains Workshop, October 22-25 at Hunt, Texas. $150.00

11. (In Press for 2016). Collaboration: Implementing Spiritual Care within the Interdisciplinary Clinical Team. Coauthored by Chaplain Paul Kraus & B.W. Battey.

iCitations & References

i Battey, B. W. (2010, Summer). The spiritual dimension of holistic care.

Beginnings:American Holistic Nurses Association, 8-9.

iiii 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:

iii 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]

iv 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.