DEVOTIONAL EXPERIENCE AND CARING BEHAVIOR

OF STUDENT NURSES

____________________

_______________

In Partial Fulfillment
of the Requirements for the Degree of
MASTER OF ARTS IN NURSING

by

ROSELILY F. COQUILLA

2010
 CHAPTER 1

INTRODUCTION

What is meant by “Devotional”? When you look at the term, you get a definition

like “a short religious service” or a “devotional exercise relating to worship” (Mahoney,

n.d.). In evangelical Protestantism, this refers to a period set aside to study the bible and

pray in an effort to build a stronger relationship with God (“Bible Study,” n.d.). This kind

of religious activity according to Meraviglia is a way of enhancing the spirituality of an

individual. This is one of the elements that make up the Doing (what one does and how

one acts) characteristic of spirituality. From an analysis of the literature, she also defined

spirituality as the experiences and expressions of one’s spirit in a unique and dynamic

process reflecting faith in God or a supreme being; connectedness with oneself, others,

nature or God; and integration of the dimensions of mind, body, and spirit. (as cited in

Harkreader & Hogan, 2005).The inner experience of spiritual feelings and awareness are

integral part of the everyday religious and spiritual lives of many individual .

Spirituality and religiousness are gaining increasing attention as health research

variables. However, the particular aspects examined vary from study to study

(Underwood & Teresi, 2008). Currently, in institutions of higher education around the

country, religious studies and spirituality in particular are beginning to be interwoven into

course work, especially in programs preparing students for the helping professions.

Whether it is medicine, nursing, social work or psychology practitioners notice

that people they reach out have lives that are deeply intertwined with religion
2 Devotional Experience

and matters of the spirit. They reported that the professional must be prepared to deal

with these matters in the people they serve (Heffern, 2001).

Being part of the helping profession is difficult and demanding (Potter & Perry,

2002). In Thinking in the Future Tense: Leadership Skills for a New Age, James

described how tension shuts down the mind and heart. When one is stressed from an

unexpected or unwelcome event, the capacity for altruism is drained (Morton, Fontaine,

Hudak & Gallo, 2005). According to O’neill & Kenny, the human spirit is powerful

force that defines our existence, offers a source of hope and helps to achieve inner

harmony ( as cited in Potter & Perry, 2002). Hope, says Aristotle is a waking dream. As

nurses, we become the source of spiritual hope for the dying patient (Wensley, 2009).

Therefore, the spiritual needs of patients must be recognized as the domain of nursing

care. Expert nursing care involve helping client utilize their spiritual resources as they

identify and explore what is meaningful in their lives as they find ways to cope with the

impact of the ongoing stressors of life (Potter & Perry).

Nursing students are taught throughout their nursing programs about holistic

approach of care yet several studies showed that the spiritual dimension of holistic

nursing is still an area that has been neglected (Lovanio & Wallace, 2008). Holism

requires nurses to consider each client as a unique individual with biological,

psychological, social and spiritual needs. Holism cannot exist without consideration of

the spiritual aspects that create individuality and give meaning to people’s lives

(Mitchell, Bennett and Ledet, 2006). But how can a nurse give something he or she does

not have? Caring must first start with each of us. We cannot give what we do not
3 Devotional Experience

possess (“Nursing as Caring,”n.d.).

Our minds and heart need time to renew and be recharged for the next day of

taking care of critically ill patient and their families. To be truly engaged and energized

requires nurturing ourselves first and then empowering others to do the same

In this study, the Level III student nurses are the target population because they

are the ones that have longer exposure in the hospital which is believed to be the most

stressful area of nursing exposure. Will the students be able to maintain a caring behavior

towards their patient despite of the different needs they are going to address? If this is so,

where do they find the strength to sustain such caring behavior?

It is in this premise that the researcher would want to probe if devotional

experience of student nurses has an effect on their caring behavior in the clinical area. It

also aims to fill the gaps of what is not being met by health care professionals, the

spiritual aspect of care.

Review of Literature

The journey to preparedness begins with our spiritual walk. Without this important

foundation, we will begin off course or eventually will be led off course by many voices

of our day. Each of these voices may seem like they are telling us the good and right

thing to do (Spiritual Preparation, n. d.). The literature on the importance of prayer is

increasing. Taylor shares the effectiveness of prayer as a coping strategy. Louis

and Alpert’s research compared nurses who were prepared in providing spiritual care
4 Devotional Experience

with nurses who were not prepared in spiritual care. On the section of the survey that

identified “personal sources of spiritual strength” the researchers found that parish nurses

ranked prayer, talking to someone and reading spiritual resources as the three most used

sources for finding strength in coping with their own life struggles. Prayer helps to

alleviate anxiety, and it lifts up the spirit (as cited in Hickman, 2006). Reading the Bible

and turning to God in prayer function as a reality check. Finding or starting a nurses’

fellowship group where they can unload their burdens, pray, study the bible, and stay

accountable is the key to survival in nursing. As they find their identity in Christ, they

will increasingly sense the love of God urging them on, giving them the strength to keep

going in nursing (Shelly, 2008). Rowe (2008) had also emphasized in his book, which is

entitled: On Call: Daily Encouragement for Nurses that nurses need encouragement,

care, and medicine for the soul to be an agent of hope and healing. Bible reading help

nurses gain important insight into their own spiritual health as well as learn how to be

better help others. When God is at work in our hearts, it shows in our countenance- both

inside and out says Walker (2008).

Peale in his book entitled “A Guide to Confident Living” concludes that it is impossible

to create an efficient man unless he has some kind of spiritual experience. Without this

experience, the thing that gives him the final touch of power is lacking (as cited in

Lardizabal, 2006).

In British Virgin Islands and Eleuthera, nursing students took part in daily

devotionals. They often shared a prayer or passage from scripture with them. The

experience offered the students a way of seeing how one can use faith to strengthen
5 Devotional Experience

oneself as a practitioner and share the faith with patients in a way that strengthen them”

(Auchmutey, 2005). Dossey, Lynn, & Guzzetta, concurred that spiritual experience can

enhance feeling of compassion, peace of mind, and harmony with the environment

(Harkreader & Hogan, 2005).

Potter & Perry (2005) on the other hand pointed out that for those people who

find caring a normal part of their life, their caring behavior is a product of their culture,

values, experience and relationship with others. Persons who do not experience care in

their lives, finds it difficult to act in caring ways. This idea coincided to the written article

in Journal of General Intern Medicine (2007) that caring attitudes are feelings and

opinion arising from values that affirm the importance of understanding others as

individual with unique needs, in the context of individual community and cultural

relationship. Warelow, Edward & Vinek (2008) added that caring is neither simply a set

of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined

by the way nurses use knowledge and skills to appreciate the uniqueness of the person

they are caring for.

There were also studies conducted about the influence of sex to the caring

behavior of an individual. In 1986, the official journal of American Psychological

Association, published a review article summarizing hundreds of academic papers on

“Gender and Helping Behavior.” The article confirmed that women are more nurturing

and empathetic than men (www.associatedcontent.com, 2008). However, the above

findings is contradictory to Khademian and Vizeshfar, (2008) result that gender had no

statistically significant influence on students' caring behaviors.

6 Devotional Experience

Nursing is an art .This means that a professional nurse learns to deliver care

artfully with compassion, caring, and respect for each client dignity and personhood

(Potter & Perry 2005). Nursing is a noble profession, but too often, a terrible job (Tee,

2008). Shelly (2008) further elaborated that as the environment where nurses’ work

become increasingly secular, economically driven and impersonal, one can expect

conflict and even persecution. On the other hand, Chambliss described nursing as a

calling, a physically and emotionally challenging, humanly fulfilling moral mission. He

stated that as nurses use the term “care,” it seems to include four meanings, namely: 1)

face-to-face working with patients; nurses believe that nursing care is hands-on. For

example, nurse give baths, catheterize patients, clean the bedcover, etc. They constantly

talk with or listen to patients while doing nursing procedures aside from touching their

patients in intimate ways; 2) dealing with the patient as a whole person. (as cited in Tee,

2008). Javier (2008) agreed to Chambliss description that nurses’ job of caring for

patients is a physical manifestation of caring attitude and calling.

Nightingale in Iowa Association of Nursing Student Update (2007) stated:

‘Nursing is an art; and if it is to be made an art, it requires an exclusive

devotion as hard as a preparation as any painter’s or sculptor’s work . For

what is the having to do with dead canvas or dead marble,compared

with having to do with the living body, the temple of God’s spirit? It is

one of the Fine Arts, I had almost said, the finest of Fine Arts. (p.5)’

Breunig substantiated Nightingales claim by his story of the Zen master who

draws the bow and waits without purpose until the moment of highest tension.
7 Devotional Experience

Her point is that every great artist is a great craftsperson who knows how to draw the bow

perfectly. This story indicates while both art and craft have purpose, art occurs to the

prepared mind as a moment unencumbered by its overriding purpose and open to

possibility and experience (as cited in LeVasseur, 2002).

Nursing as an art of caring requires a great deal of preparation to meet the

demands of today’s health care environment. Caring is a word that seems synonymous

with nursing, but what does it mean? What does it look like when nurses are caring and

what does it look like when they are not caring? Barnum sees caring as having three

discreet meanings. Firstly, taking care, or taking care of, as expressed by actions that

meet the patient’s bodily needs. Secondly, caring as expressed when the nurse has an

emotional investment in the patient’s well being: the nurse cares about the patient. The

emphasis here is on emotion and attitudes, rather than actions. Thirdly, he talks about

caring as expressed in being careful and precise, and acting in a way that makes the

patient safe from injury. This again about attitudes but not necessarily emotions (Stroud,

2008).

Caring has been shown to facilitate healing in clients and to improve client

satisfaction with nursing care (Potter & Perry, 2005). Often times, we hear the common

expression, “I care about you,” or “I will help you overcome this.” What then is in the

care given by a nurse that is so powerful that it can lead to a process of healing? The

caring energy is so powerful that enhances healing combined with the core factors

identified by Watson. These core factors are: 1) faith and hope; 2) humanistic system of

values; 3) sensitivity towards others; 4) trust; 5) expression of positivity and negativity;

8 Devotional Experience

6) problem solving; 7) promotion of learning relationship; 8) provision of support

(spiritually, physically, emotionally, etc.) 9) fulfillment of human needs; and 10)

promotion of transpersonal caring and love (as cited in Javier, 2008).

Moreover, there is power in nursing profession when nurses articulate not only

the core values of “caring” but of advocacy, accountability, autonomy, and collaboration

(Morton, Fontaine,Hudak & Gallo, 2005).

The concept of altruism in nursing is a significant part of nursing history ( Kozier,

Erb, Berman & Synder, 2004). Most nurses still enter the profession of nursing because

of a desire to help others. Caring for others is obviously a positive character trait, but

many nurses have not learned the importance of taking care of themselves in the process

(Slaninka, 2003). Caring must first start with each of us. We cannot give what we do not

possess. Self care is very important and is the key to giving compassionate care to our

patients, families and others who may cross our paths. When you feel good about

yourself, it spills over into every aspect of your life (“ Nursing as Caring,” n.d.).

Caring is central to nursing practice but perhaps it has never been more important

because of today’s hectic health care environment. The pressure and time constraints on

health care workers in most health care settings can result in nurses and other

professionals becoming cold and indifferent to client needs (Potter and Perry, 2005).

Clients quickly know when nurses fail to relate them. It is in this context that some

researchers made a study about the different perception of patient on the care given to

them by the health care provider. This is important because healthcare is placing

emphasis on client satisfaction. In a research conducted by Mayer she learned that

9 Devotional Experience

frequently clients and nurses differ in their perception in caring. For that reason, nurses

must focus on building a relationship that allows them to learn what is important to their

client (as cited in Potter and Perry, 2005).

Chan (2008) stated:

“If we hope to improve the health status of all people, health care and

health system must embrace a more holistic, people centered approach.

Need to address the psychosocial and cultural component – the mind and

the physical component – the body. In essence we need to harmonize

mind and spirit.”

The said statement was supported by Neuman who conceptualized the client as a

unique composite of five interacting variables: physiological, psychological,

sociocultural,developmental and spiritual. These variables function together as the basic

structure energy resources of the client and function to attain, maintain or retain system

stability ( as cited in Hickman, 2006). Jung also asserted that human beings are not only

psychosexual and psychosocial but they are also psycho-spiritual. Hence, he suggested

that healing is not possible without spiritual awakening or addressing issues related to

spiritual distress. For Jung, spiritual perspective is indispensable because intellectual or

moral insights alone are insufficient to address human dilemmas (as cited in Maximo,

2001).

The good news according to Maximo (2001) is that spirituality is already

influencing several helping profession in this contemporary society like counseling,

education, medicine, nursing, psychology, social work, education and addiction

10 Devotional Experience

treatment. However, the study conducted by Wright (2002) showed that the spiritual

needs of patients are still neglected by health care professionals who are already over-

stretched by the physical demands of their role. Furthermore, there is also ignorance of

the spiritual needs of health care professionals especially nurses who may have personal

uncertainties about their own spirituality. This lack of understanding can lead nurses to

burnout and lacks motivation to work.

Furthermore, nurses strive to incorporate holistic care that includes spiritual care

into nursing practice. The concept of providing spiritual care is derived from nursing

theory, that states human are biological-psychological-spiritual beings. The practice of

spiritual care by nurse is often infrequent and underutilized facet of care (Wensley,

2009).

A spiritually adept individual has adequate self object relations which make it

possible for him to be serene despite the lures of materialism, emotionally-loaded events,

objects, persons and exposure to what is intolerable and difficult.

Nursing today acknowledges that the needs of the spirit are as important as

physical needs for a person’s well being. Increased awareness and preparation together

with a united approach to this dimension of nursing practice, will be shown to enhance

the quality of our care and strengthen our contribution to the ongoing development of our

profession (Hutchinson, 2009).

Finally, prayers, religious practices, meaningful relationships with others and

enjoying music and arts are activities that nurture the mind and spirit, it contributes to the

person’s
11 Devotional Experience

spirituality (Potter and Perry, 2005). Spirituality according to Underwood (2002) can call

us beyond self or concern and compassion to others.

Theoretical/ Conceptual Framework

Jean Watson’s theory of caring introduced the concept of clinical caritas

processes, which have now replaced her carative factors that results in the satisfaction of

certain human needs (as cited in Octaviano & Balita, 2008). The philosophy underlying

her theory involves concepts of psychic energy and love, and her expectation is that

nurses wishing to work authentically with it need develop life practices such as

meditation, prayer, yoga and connection with nature (To Touch on Caring, n.d.). It is also

cited in Potter and Perry (2005) that Watson’s view of caring becomes almost spiritual

and application of such caring model in practice can enhance nurse’s caring practice.

Patricia Benner speaks of the “power” of caring. Her description of the caring role

involves the concepts of transformative power, integrative caring, advocacy, healing

power, participative/affirmative power and problem solving (as cited in Fly, 2008). Her

work together with Wrubel, the theory of connectedness emphasized that thoughts,

feelings and actions are all important to the conception of caring behavior ( “To touch on

Caring”, 2002).

Kristen Swanson’s Theory of caring describes caring as a nurturing way of

relating to a valued other toward whom one tells a personal sense of commitment and

responsibility. In presenting her theory, Swanson described the five caring processes as
12 Devotional Experience

Benner and Watson’s theories have made significant contribution which

enhance the value of professional caring. They have helped to create an atmosphere

within the nursing profession which values the wholeness of human beings including

their psychosocial and spiritual needs which is the focus of this study. Many of their

beliefs can be accepted and affirmed by nurses who developed a strong relationship with

God through Jesus Christ.

Swanson’s theory on the other hand can help to provide a meaningful base for

student nurses to manifest a caring behavior that can be perceived as nurturing or helpful

to the patients.

Independent Variable Dependent Variable

Devotional Experience Caring Behaviors

Scripture Reading Physiological
Bible sharing Psychosocial
Prayer Spiritual
Exhortation

Demographic Profile
Age
Sex
Religion
Civil Status

Intervening Variables

Figure 1. Conceptual Model: Devotional Experience and Caring Behavior of

Student Nurses
13 Devotional Experience

It is a common knowledge that nursing is a tough job. Most nurses need some

form of reassurance from others that they are doing a good job. Praise from the patients,

colleagues and supervisors keeps them going. But in today’s health care scene, nurses

according to Shelly ( 2008), don’t often received that affirmation. Nurses need to draw

from a deeper source for them to become effective in rendering care to the clients.

The conceptual model as illustrated above shows that devotional experience such

as scripture reading, bible sharing, exhortation and prayer has influence on the physical,

psychosocial and spiritual aspect of caring behavior apparent to the student nurses.

Age, religion, sex and civil status are other mediating variables that intervene in

the relationship between the independent and dependent variable.

Statement of the Problem

The study aims to determine the relationship between devotional experience and the

caring behavior of student nurses.

Specifically it aims to answer the following questions:

1.What is devotional experience?

2. What are the caring behaviors of nurses in terms of:

2.1 physiological

2.2 emotional

2.3 spiritual

3. Is there a significant relationship between daily devotionals and the caring

behavior of student nurses in terms of :

3.1 age
14 Devotional Experience

3.2 sex

3.3 civil status

3.4 religion

Hypothesis

H0 There is a significant relationship between devotional experience ad the

caring behaviors of student nurses in terms of:

• age

• sex

• Civil status

• religion
 CHAPTER II

METHODS

This chapter of the research process contains a comprehensive description of the

research designs, research locales, samples and the sampling technique, the subjects,

research instruments, data gathering procedures and the statistical tools, treatments and

limitation of the study.

Design

The study will use the post-test descriptive correlational design to compare the

caring behavior of student nurses who have devotional experience and those that do not

have devotional experience. The caring behavior of students will be measured using a

post test which will be administered to both the control and the experimental.

To enhance the validity of the quantitative results, the investigator would like to use

qualitative analysis to understand what is about the devotional experience that affect the

caring behavior of student nurses.

X ------------ O1

------------------- O2

Whereas:
16 Devotional Experience

X – devotional experience

O1 – post-test result of experimental group

O2 - post-test result of control group

------- - post test

Setting

The proposed location of this study will be at Brokenshire College

SOCSKSARGEN, Inc. It is located along Ced Avenue, Lagao National Highway,

General Santos City occupying almost one hectare of land. BCSI has gained its

independence from an extension of Brokenshire College in Davao in the year 2005,

however, it will remain as part of the Brokenshire Educational system.

BCSI is already on its sixth year of operation offering six courses namely: Bachelor of

Science in Hotel and Restaurant Management, BS Accountancy, Bachelor of Science in

Elementary Education major in Special Education, BS Psychology, BS in Nursing of

which it comprises majority of student population, midwifery and the six months

caregiving program.

As an evangelical institution, one of the charter of BCSI commits its educational

efforts to the cause of Christian education, the development of christian character and

personal discipline among students. Presently, the college still keep on working out a

methodology of teaching, a system of learning valuation that will cultivate social

responsibility and action guided by Christian values.

17 Devotional Experience

Participants

The participants/respondents of this study will be regular Level III student nurses

of BCSI.This is particularly because Level III student nurses have longer hours spent in

17 Devotional Experience

the hospital as compared to other levels. It is also believed that hospital duties are

considered the most demanding and stressful area of exposure for student nurses. Thusthe

likelihood of stress affecting their caring behavior towards their patients is great.

Measures

The researcher then will be using two sets of questionnaires for this study. The

first one is a self-administered questionnaire, which is divided into two parts. The first

portion contains the demographic questions. The aim is to collect data as regards to the

participant’s characteristics. For the second part, a researcher-made questionnaire will be

utilized to measure the caring behavior of student nurses.

Another self-made questionnaire is going to be used in which the items will

attempt to measure experience of participants to the transcendent (God, the divine) in

which the element of life may influence emotion, cognition and behavior of student

nurses. The measure includes 10 items statements. Each item is scored using a modified

Likert scale, in which response categories are many times a day, everyday, once in a

while and never. Higher scores, reflect more frequent experience with God’s presence.

The statistical instrument to be used in this study are Mean and Spearman’s rank order

correlation to describe the intensity and direction of independent and dependent

18 Devotional Experience.

variables.Lastly, Collaizzi’s method will be employed to analyze the verbatim transcripts

on the qualitative part of the study. Meanings will be formulated and the statement will

be categorized into theme clusters.

Procedure

As soon as approval for this, propose study will be granted:

Pre-experimental phase

1. The researcher-made questionnaire will be shown to the mentor for checking and

approval.

2. The instrument will undergo validation by experts and reliability testing will also

be done.

3. Once approval from the mentor is secured, a cover letter will be sent to the Chief

Executive Officer of BCSI and Dean of the College of Nursing, explaining the

detail and the benefits of the study.

4. Two groups that consist of twelve students for each group will be selected by

cluster random sampling using Fish Bowl Technique where samples will be

drawn out from eight RLE groupings of Level III students with identifying marks.

A group who will be able to pick the letter O1 will be considered as experimental

group and for the group who picks O2 will be considered as control group.

5. Once the sample has been determined, cover letters and consent forms will be

distributed to selected groups

19 Devotional Experience

Experimental stage

6. During pre-conference, a 15 minute-devotional will be conducted to the

experimental group prior to deploying them to their area of assignment. At the

end of their second week of rotation in the same area with the same clinical

instructor , the questionnaire will be given at school during consultation time by

the investigator herself and will be collected immediately after they have

completely answered the items. Same procedure will follow to the controlled

group but they will not be having devotional during their pre-conference.

7. All the data gathered would be tallied and tabulated then will be analyzed and

interpreted with the help of a statistician.

8. For the qualitative aspect of the study,. A focus group discussion will be

conducted to the experimental group. The discussion will be took place in a

private, quiet room in the vicinity of BCSI.I will be recorded and transcribed

verbatim. The guide questions for the students are the following:

• In your own words, describe what devotional experience means to

you?

• Do you think that devotional experience is significant in your

practice as a student nurse? Why or why not?

• In what ways have you shown caring to your client?

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