Multiple Case Studies Exploring Integration of Spirituality in Undergraduate Nursing Education in England

Introduction:
Difficulties persist in conceptualising spiritual needs and understanding their relationship to religious needs and wellbeing in healthcare and particularly in nursing education. This research was undertaken to explore approaches and challenges associated with this area in undergraduate nursing education in England.

Methods/Methodology:
Using a systematic approach, a literature review covering the period 1993-2017 was undertaken to explore potential issues and challenges reported.
Applying case-study methodology, data were collected from three university nursing schools from different parts of England. Sources for data triangulation within schools included, curriculum review of undergraduate nursing courses, exploring the views of nursing educators through semi structured interviews and focus group studies with nursing students. Template analysis was used to identify themes in the data.

Findings:
Due to the module based curriculum, the integration of spirituality in nursing education appeared to be treated as a matter of personal choice and convenience rather than as an essential domain of teaching and learning practice in England. Owing to conceptual complexity, addressing religious needs was often considered to be synonymous with addressing spiritual care need. Factors were identified contributing to the difficulties in the issue of educating nurses in this area. These were: lack of clarity in curriculum documents; uncertainty as to how far nurses should address these issues and how far this was a specialist chaplaincy function; fear of being judged or rejected in a multicultural environment; and the dominance of disease-centred care. The participants voiced a desire for developing a shared understanding through developing a more explicit representation of spirituality in nursing education and the recognition of appropriate educational approaches in this area. Based on the findings of this study a learning framework is proposed; SOPHIE (Self-exploration through Ontological, Phenomenological, Humanistic, Ideological, and Existential expressions), to encourage self-awareness and reflexivity among nursing educators and students. SOPHIE aims to bring ontological authenticity and congruency to the forefront of nursing knowledge and practice.

Conclusion:
Constructing knowledge through ontological learning engagements among educators and students is essential to develop role clarity, authenticity and empowerment in understanding and addressing spiritual care needs. A multidisciplinary teaching approach integrating medical anthropology, humanistic psychology and existential phenomenology should be explored as a basis for an integrated nursing curriculum that could explore spirituality in its widest sense.