ASSESS THE NURSES COMPETENCY LEVEL IN PROVIDING

SPIRITUAL CARE TO THE CANCER PATIENTS

SYNOPSIS
Submitted to Eternal University, Baru Sahib

In partial fulfillment of the requirements for the

Degree of

M.Sc. NURSING

(Medical Surgical Nursing)

By

SAPNA CHAUHAN (BS19MHNS017)

Department of Nursing

Akal College of Nursing

Eternal university, Baru sahib, Sirmour, (HP)
MAY 2020
Name of the student: SAPNA CHAUHAN

Registration no: BS19MHNS016

Specialty: Medical Surgical Nursing

Major advisor: Mrs. Sangeeta Sharma (Assistant Professor)

Name of department: Department of nursing

Name of the college: Akal College of nursing

TITLE: ASSESS THE NURSES COMPETENCY LEVEL IN

PROVIDING SPIRITUAL CARE TO THE CANCER PATIENTS.

1. INTRODUCTION OF THE STUDY

The World Health Organization reported in 2011 that mortality resulting from cancer would
be higher in the future than from all types of cardiovascular diseases and strokes. Studies
have shown that the incidence of cancer is higher in low and middle income countries. (1)

Cancer is a large group of diseases that can start in almost any organ or tissue of the body
when abnormal cells grow uncontrollably, go beyond their usual boundaries to invade
adjoining parts of the body and/or spread to other organs. The latter process is called
metastasizing and is a major cause of death from cancer. A neoplasm and malignant tumour
are other common names for cancer.2

Spiritual care also consists of nursing methods or activities that rely on the provision of
company or care, listening, or religious activities that correspond to patients’ beliefs to help
them to achieve better physical, mental, social, and spiritual health and comfort. The purpose
of spiritual care is to ease patients’ difficulties at the spiritual level and help them find the
meaning of life, self-actualization, hope, creativity, faith, trust, peace, comfort, prayer, and
the ability to love and forgive in the midst of suffering and disease.2

Spiritual beliefs affect how individuals face a cancer diagnosis, both for those in long-term
survivorship or those facing their own mortality. Nurses play a significant role in assessing
and attending to spiritual needs, as they support patients and families throughout the
trajectory of a cancer diagnosis, treatment, and transition to end of life. Nurses play a
significant role in assessing and attending to spiritual needs, as they support patients and
families throughout the trajectory of a cancer diagnosis, treatment, and transition to end of
life. Most professionals, including nurses, are not well prepared to assess or respond to
spiritual needs and nursing education has not prepared nurses sufficiently.3
Meeting the psychosocial, emotional, and spiritual needs of people with cancer presents a real
challenge to health professionals and, in particular, nurses, who spend more time with
patients when they access health services. The challenge for nurses lies in meeting the
mental, social, cultural, spiritual, and developmental needs arising from patients' emotional
responses to their diagnoses and complexities of treatment.In practice, nurses are increasingly
encouraged in caring the whole person, including the four domains: Physical, mental, social,
and spiritual. Of these four domains, spiritual domain is the most neglected in daily nursing
practice. Although recent developments in health care show a growing awareness of the
importance of patients' spiritual needs, While the nurses acknowledged that spiritual care was
a part of their role, in reality, they responded less well and most studies attributed this to
nurses feeling inadequately prepared to give spiritual care and respond to patients' spiritual
needs. Some nurses reported responding personally, e.g. by listening/being there, but many
were uncomfortable in doing so.4

A descriptive study (2018) was conducted in tumor unit care of Lontara 2 Dr. Wahidini
Suirohsodo hospital to assess the nurses Spiritual care competencies to patients with end
stage breast cancer and found that 50% nurses who were working in oncology department
have low competencies level.5

1.1 BACKGROUND OF THE STUDY

Worldwide:

According to WHO 2018, cancer is the second leading cause of death globally, accounting
for an estimated 9.6 million deaths, or one in six deaths. Approximately 70% of deaths from
cancer occur in low- and middle-income countries.

Tobacco use is the most important risk factor for cancer and is responsible for approximately
22% of cancer deaths.1

According to 2018 report, lung cancer was the most common cancer in men worldwide,
contributing 15.5% of the total number of new diagnosed cases. The top three – lung, prostate
and colorectal cancers – contributed 44.4% of all cancers (excluding non-melanoma skin
cancer). Other common cancers contributing more than 5% were stomach and liver.

Among women breast cancer was the most common cancer worldwide, contributing 25.4% of
the total number of new cases diagnosed in 2018. The top three – breast, colorectal and lung
cancers – contributed 43.9% of all cancers (excluding non-melanoma skin cancer). Cervical
cancer was the fourth most common cancer in women, contributing 6.9% of the total number
of new cases diagnosed in 2018.6

India:

The National Cancer Registry Programme Report 2020, released by the Indian Council of
Medical Research (ICMR), estimates there will be 13.9 lakh cases of cancer in India in 2020,
and that this number is likely to rise to 15.7 lakh by 2025.The estimates are based on data
retrieved from 28 Population-Based Cancer Registries (PBCRs) and 58 Hospital-Based
Cancer Registries (HBCRs) from across India, between 2012 and 2016.7

India is likely to have over 8.8 lakh deaths due to the disease by 2020 with cancers of breast,
lung and cervix. Cancer of breast with estimated 1.5 lakh (over 10 per cent of all cancers)
new cases during 2016, is the number one cancer overall. Cancer of the lung is the next with
estimated 1.14 lakh (83,000 in males and 31,000 in females) new cases during 2016 and 1.4
lakh cases in 2020.

Cancer of the cervix is the third most common cancer with estimated 1 lakh new cases in
2016 and about 1.04 lakh during 2020. Cancers associated with the use of tobacco account
for about 30 per cent of all cancers in males and females," the ICMR said.

Estimated number of people living with the disease is around 2.5 million Every year, new
cancer patients registered over 7 lakh.8

Himachal Pradesh

In the year 2012, Himachal Pradesh had 23,241 cancer patients, which included 179 cases of
oral cancer, 478 of digestive track, 623 cases of respiratory and intra-thoracic organ cancer,
302 of bone, skin and breast cancer, 519 cases of genito-urinary organ and 370 of other types
of cancer.9

In Himachal Pradesh, the most common cancer in males is that of lungs, whereas it is cervical
cancer in females. Majority of cancers cases are known to occur in the age group between 30-
69 years (71%).The yearly incidence of cancer (years 2011–2015) ranged from 86.6 to 93.5
for males and 87.2 to 90.9 for females, whereas the overall incidence for both sexes was
87.2–90.9/lakh population.10

1.2 NEED OF THE STUDY

The nature of cancer increases the spiritual needs of patients and necessitates the provision of
holistic care for them. By trying to meet the spiritual needs of patients, oncology nurses can
help them adapt, gain inner peace, and develop positive thoughts and attitudes.Spiritual
interventions may improve spiritual well-being and quality of life, and reduce depression,
anxiety, and hopelessness for patients with cancer14

A review of related literature shows that spirituality is a human dimension and an internal
phenomenon that is related to individual excellence, consciousness, sensitivity, and meaning
in one's life. This concept is described by believing in God or a higher being and in
communication with others. Committed provision of holistic nursing to a patient sensitizes
nurses to meeting the spiritual needs of a patient. Learning to live with a chronic disease like
cancer is a process. Health-care providers can benefit from spirituality to emphasize the
meaning and goal of a patient's life, inner faith, connection to a higher being, and cooperation
with others. Thus, nurses as spiritual and psychological consultants are a valuable source of
help and hope during the course of the disease. They can set the framework for adaptation by
providing spiritual care and meeting the spiritual needs of their patients.15
Nurses in Oncology Department are important to provide spiritual care for near the end of
life conditions to find ways to be present in crisis situations of life-threatening patients.
Spiritual care is one of the treatment management strategies towards the end of life in the
hospital within the Nursing Intervention Classification. Although the patients with end-stage
breast cancer told that it become important, there is no data that showed nurses spiritual care
competencies at oncology department in Dr. WahidinSudirohusodo hospital. Therefore it
takes research to investigate the competence of nurse’s spiritual care in patients with
advanced breast cancer.3

Few studies have examined the consequences of spiritual care for cancer patients. Previous
studies have shown that spiritual care involved positive experiences for both the nurse and the
patient. Zamanzadeh V, Rassouli M, Abbaszadeh A, Abbaszadeh A Akbari found that
patients and nurses have an interactive and positive effect on one another. 16 Phelps 
introduced the benefits of spiritual care as good support and effective and emotional presence
of nurses for patients with cancer. The greater the good spiritual sense of nurses, the greater
was the expectation of spiritual care as part of their performance. Nurses as spiritual and
psychological consultants are a valuable source of help and hope during the course of the
disease. They can set the framework for adaptation by providing spiritual care and meeting
the spiritual needs of their patients.15

Research has shown that the enhancement of nurses’ spiritual health not only boosts their
personal satisfaction with life, but also reduces job burnout and assists them with providing
spiritual care to patients in their clinical work. Nurses are the chief providers of spiritual care
to patients, and a close relationship exists between nurses’ attitude and ability to provide
spiritual care to patients and their perceptions of spirituality and spiritual health. Spiritual
care seeks to help patients to face their fears of death, mitigate the uncertainty and discomfort
of the treatment process, and regain their inner peace.16

Spiritual care places the cancer patient and the oncology nurse on the path to spiritual growth.
The achievement of peace by the patient and the nurse was a common consequence of
spiritual care. It helps the nurse promote comfort and a sense of peace in the patient and
eventually to obtain inner satisfaction. Considering the transcendental effects of spiritual
care, a systematic plan should be devised to enhance sensitivity in oncology nurses and
encourage them to make spiritual care a component of interventional plans.14

Nurses should think about providing spiritual care to patients. Although spiritual dimensions
have considerable effects on different aspects of human life and providing spiritual care is
one of the duties of nurses, it is not fully considered. Understanding this dimension of
patients is very important for nurses since nursing is a profession which looks at all
dimensions of the patient and spiritual care is an indispensable part and the core of holistic
care. The holistic view requires that nurses consider individuals as biological, psychological,
and social creatures with a core (of spirituality). Therefore, nurses are expected to accept the
spiritual care of patients and establish appropriate relationships with patients.17

The dimensions of competence relate to knowledge, skill, attitude, communication,

management, motivation, education, culture, ethics, spirituality, research and information
technology, and working with devices. The competence of a nurse is effective in
guaranteeing the quality of care services provided for patients and their satisfaction, and a
key factor in the competition intense world for the survival of hospitals. Spiritual competence
in spiritual care refers to a set of skills which are used in the clinical nursing processes. If
nurses become aware of their spiritual condition, they will be aware of the spiritual state of
their patients. This awareness and spirituality in nurses is a prerequisite for creating
commitment in the spiritual care process.18

1.3 STATEMENT OF THE PROBLEM:

A study to assess the nurses competency level in providing spiritual care to the cancer
patients with a view to develop an information booklet in selected hospital, H.P.

1.4 AIMS:

a) to explore nurses working in oncology ward perception of spirituality and spirituality ca.

b) to investigate the relationship between their perception and some variables.

1.5 OBJECTIVES:

1. To assess the nurses competency level in providing spiritual care to the cancer
patients.

2. To find out the association of competency level with selected socio demographic
variables.

1.6 OPERATIONAL DEFINITION

 Assessment: In this study assess refers to the estimation or evaluation of nurses

competency level in providing spiritual care to the cancer patients.
 Competency: In this study competency refers to capability of staff nurse in providing
spiritual care to the cancer patients.
 Spiritual care: In this study spiritual care refers to ability of the staff nurse to fulfill
religious and emotional need of the patient to enhance inner healing of cancer patient.
 Cancer patients: It refers to the patients clinically diagnosed with cancer.

1.7 ASSUMPTIONS:

The researcher assumes that:

 Nurse working in oncology ward knows the importance of spiritual care

 They may have some short of knowledge regarding the spiritual care
 They may not use spiritual believes in their routine care
 There are many factor which may influence the spiritual believes.

1.8 HYPOTHESIS:

 H1: nurses will be competent to provide spiritual care to cancer patients.

  H2: There will be significant association association of competency level with
selected socio demographic variables.

1.9 DELIMITATIONS:

The study will be helpful only in oncology patients. It will only assessing the nurses
competencies level in oncology patients. We will not assessing whether they actually
providing services to the patients or not.

1.10 CONCEPTUAL FRAMEWORK:

A conceptual framework is defined as the analytical tool or visual representation which helps
to illustrate the expected relationship between cause and effect. Conceptual framework is also
known as conceptual model or research model. Conceptual framework is used to make
conceptual distinctions and to bring different ideas together. Strong conceptual framework
leads to actual realization of the intended objectives.19

I will apply Imogene king’s goal attainment theory in my theory that is to evaluate cognitive
ability, orientation to ethical/ legal practices, and collaboration with health care workers.

2.EXPECTED KNOWLEDGE:
It is expected that nurses have poor knowledge regarding the spiritual care and they
are not adding it in their care.

3. REVIEW OF LITERATURE:
A literature review is a comprehensive summary of previous research on a topic. The
literature review surveys scholarly articles, books, and other sources relevant to a particular
area of research. The review should enumerate, describe, summarize, objectively evaluate
and clarify this previous research.20

According to Polit and Hungler (1995), “Review of literature is defined as an extensive,

exhaustive and systematic examination of publication to the research project”. Review of
literature is a critical summary of research on a topic of interest generally prepared to put a
research problem in context or to identify gaps and weakness in prior studies so as to justify a
new investigation.

According to ANA (2000), “A literature review is a body of text that aims to review the
critical points of knowledge on a particular topic of research”. 21

REVIEW OF LITERATURE DIVIED INTO FOLLOWING HEADINGS:

 RESEARCHES RELATED TO ASSESSING NURSES COMPETENCIES

LEVEL IN DELIVERYING SPIRITUAL CARE:

 RESEARCHES REALATED TO FATORS AFFECTING SPIRITUAL CARE

PRACTICES:
  RESEARCHES RELATED TO PERCEPTIONS OF SPIRITUAL CARE
EDUCATION, COMPETENCE, AND BARRIERS IN PROVIDING
SPIRITUAL CARE:

3.1 RESEARCHES RELATED TO ASSESSING NURSES COMPETENCIES LEVEL

IN DELIVERYING SPIRITUAL CARE:

Donia R Baldacchino, J Clin nurs. (2006) conduct a descriptive exploratory study

investigated nurses' competencies in the delivery of spiritual care to patients with myocardial
infarction in Malta. Data were collected by means of an open-ended questionnaire on
qualified 77 nurses followed by an in-depth interview on a stratified random sample 14
nurses from the same respondents and found that the study will enable them to empower
regarding the spirituality care.22

Pateet R John, balboni J Micheal (2013) conduct a study to study on Spirituality and religion
in oncology despite the difficulty in clearly defining and measuring spirituality, a growing
literature describes its importance in oncology. Religious/spiritual beliefs influence patients'
decision-making with respect to both complementary therapies and aggressive care at the end
of life. Studies show that while clinicians such as nurses and physicians regard some spiritual
care as an appropriate aspect of their role, patients report that they provide it infrequently.
Challenges remain in the areas of conceptualizing and measuring spirituality, developing and
implementing training for spiritual care, and coordinating and partnering with chaplains and
religious communities.23

Taylor Johnston Elizabeth, Petersen Cheryl, Oyedele oladele , Haase Joan (2015) conduct a
study to assess Spirituality and Spiritual Care of Adolescents and Young Adults with Cancer
and fund that there is a paucity of research specifically investigating AYA spirituality and
lack of AYA-sensitive instruments to measure spirituality. Research that applies robust
scientific methods to the study of AYA spirituality is needed. Research that provides
evidence on which to base best practices for spiritual care that supports AYA spiritual well-
being is likewise necessary.24

Elk Ronit, hall J. Eric, graham Dennis Hughes P. Brian (2017) conduct a study to assess the
role of nurses in providing spiritual care to patient and found that Although the provision of
spiritual care by nurses has been strongly recommended, lack of such training as part of the
nursing curriculum, has resulted in lack of competence and expertise in providing such care.
The significant gap in research into methods for developing spiritual care competencies in
nursing students must be addressed.25

Puchalski M. Christina, Sbarana Andrea, Ferrell betty, Antonuzz Andrea, Falcone Alfredo et
al.(2019) conduct a study on improving the quality f spiritual care as a dimension of palliative
care: the report of the consensus conference and said that Spiritual care is recognized as an
essential element of the care of patients with serious illness such as cancer. Spiritual distress
can result in poorer health outcomes including quality of life. The American Society of
Clinical Oncology and other organizations recommend addressing spiritual needs in the
clinical setting. This paper reviews the literature findings and proposes recommendations for
inter professional spiritual care.26

3.2 RESEARCHES REALATED TO FATORS AFFECTING SPIRITUAL CARE

PRACTICES:

Moosavi Soolmaz, Rohani Camelia, Brhani Fariba , Akbari Esmaeel (2019) conduct a
qualitative study on Factors affecting spiritual care practices of oncology nurses conducted
using a conventional content analysis based on semi-structured interviews with 25
participants, including cancer patients and their family members, oncology nurses,
physicians, psychologist, and spiritual researcher-therapists. The results showed that the two
main themes of the study, "spiritual competency" and "spiritual inefficiency" in healthcare
organization, were two major factors in implementing spiritual care practices for cancer
patients by oncology nurses. The findings of this study emphasize the necessity of developing
coherent spiritual care programs in hospitals and removing administrative barriers. Teaching
spiritual care in nursing courses at schools and continuing education programs for training of
healthcare team members are necessary.16

3.3 RESEARCHES RELATED TO PERCEPTIONS OF SPIRITUAL CARE

EDUCATION, COMPETENCE, AND BARRIERS IN PROVIDING SPIRITUAL
CARE:

Odwin kim soo yeoun, alexis green, jones W. Carolyn (2019) conduct a descriptive, cross-
sectional study on Perceptions of Spiritual Care Education, Competence, and Barriers in
Providing Spiritual Care among Registered Nurses included demographic questions, the
Spiritual Care Competency scale, the Nurses’ Spiritual Care Therapeutics scale, the Spiritual
Care Practice questionnaire subscale II, and three open-ended questions. Online survey was
completed by 391 RNs enrolled in post licensure programs at a public state university in
southeastern United States. A majority of participants reported not feeling prepared to
provide spiritual care. There were strong associations between receiving spiritual care
education in pre licensure programs or at work, and self-reported feelings of preparedness, as
well as overall SCC. The level of SCC was positively correlated with spiritual care frequency
and number of years working as an RN.27

4. RESEARCH METHODOLOGY
4.1 Research Methodology: Research methodology is defined as the description of the
methods and tools of how to conduct investigation by the investigator in which data is
collected, analyzed, and interpreted.

4.2 Research approach: Quantitative research approach

4.3 Research design: non-experimental design (Descriptive)
4.4 Variables:
 DEMOGRAPHIC VARIABLES:
Gender, marital status, spiritual course, age, working area

4.5 Research setting: the study will be conducted among staff nurses working in
selected wards in selected hospitals in H.P
4.6 Population:
 Target population: staff nurses working in selected wards in selected
hospitals in H.P
 Accessible population: staff nurses present during the time of data collection.
4.7 Sample: staff nurses who are working in selected wards in selected hospitals in
Himachal Pradesh and who are present at the time of data collection.
4.8 SAMPLE SELECTION CRITERIA:
 Inclusion criteria:

The study includes staff nurses who are

I. Working in the selected hospital

II. Willing to participate
III. Present or available at the time of data collection
 Exclusive criteria:

The study excludes staff nurses who have

I. Language difficulty
II. Nursing aids/ assistants who do not come under the group of registered nurse.
III. Nursing staff working in operation theatre, central sterile supply departments and
ward in-charge nurses.

4.9 Sampling Technique: Non probability sampling technique (Convenient sampling

technique) will be used.

4.10 Sample Size: The formula used for sample size calculation is-

n= NZ2 p (1-p)
d2 (N-1) + Z2 p (1-p)

Where, N= Population

d= precision

Z= Statistics

p= expected prevalence or proportion

Sample size will be calculated after review of literature and after conducting pilot study.

4.11 Research Tools: The tools consist of 2 sections:

Section A Socio-demographic data

 Section B Spirituality and spiritual care rating scale (SCCRS)

4.12 Methods of data collection: standardized Spirituality and spiritual care rating scale
(SCCRS) will be used for methods of data collection.

 Perception of spirituality and spiritual care: measured with the Spirituality and
spiritual care rating scale. The SCCRS has 17 statement scored on a 5 point scale
ranging from “strongly disagree” (1) to “strongly agree” (5). This scale has four
subscales: existential spirituality, religiosity, spiritual care and personal care. A
high overall score indicates a more generic view of spirituality (inclusive both
religion and existential elements) and spiritual care.

4.13 Analysis and interpretation of data: The data obtained will be tabulated and analyzed
in terms of the objectives of the study by using descriptive and inferential statistics. The plan
of data analysis is as follows:

DESCRIPTIVE STATISTICS-
Frequency and percentage distribution and Mean, mean percentage and standard deviation
will be used to analyze selected socio- demographic variables.

INFERENTIAL STATISTICS-
1. Chi- square test will be used to find the association of competency level with selected
socio demographic variables.

4.14 Work Plan/ Time Schedule:

 Synopsis will be submitted in the last week of the month May 2020.
 Tool will be prepared by the month of September 2020.
 Pilot study and its presentation will be done in the month of December 2020.
 Data will be collected in the month of February 2021.
 Data analysis will be done in the month of March and April 2021.
 Final thesis will be submitted in the month of May 2021.

4.15 Budget:

Sr. No. Purpose of budget Minimum Maximum

expenditure expenditure
1. Travelling Rs. 3000 Rs. 6000

2. Print out (included thesis) Rs. 4500 Rs. 7500

3. Total Rs.7500 Rs.13,500

COLLABORATION

Step 1

1. The formal permission will be obtained from principal of Akal college of nursing to conduct
the study.
2. The formal permission will be obtained from Principal of IGMC Shimla to conduct the study.
3. The formal permission will be taken from the HOD.

Step 2

1. The investigator will explain the purpose of the study and will take written consent from the
participants.

Step 3

1. The investigator will administer spirituality and spiritual care rating scale to assess the
competency level in providing spiritual care to the cancer patients.

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