GOD, SELF AND OTHERS: A QUALITATIVE DELPHI METHOD OF DEFINING

SPIRITUALITY IN NURSING AND, DEVELOPING TEACHING CONTENT

A Dissertation Proposal
Presented to
the Faculty of Graduate School of
ST. PAUL UNIVERSITY MANILA

In Partial Fulfillment
of the Requirement for the Degree
PhD in Nursing Education Major in Leadership and Management

ALICE JOY M. AQUINO

September 2021
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THE PROBLEM AND ITS BACKGROUND

INTRODUCTION

The Bachelor of Science in Nursing Curriculum (CMO 15.s. 2017) integrated Religion,

Religious Experience and Spirituality in elective subject of Level 4 nursing students to fulfill in

them the mission of God as representatives of His divine presence in the upliftment and

restoration of the bio-psycho-socio-cultural and spiritual wellbeing of the human being

(American Holistic Nurses Association AHNA; 2019 Article 1, section 1 of CMO 15 s.2017,

Murphy and Walker , 2013). Caldeira et al. (2016) emphasized education in spirituality as an

emergent topic that should be threaded in the nursing curriculum throughout graduation,

throughout the nursing program ( Giske & Cone 2012). Students need to learn its fundamental

concepts through purposeful engagement and focused debriefing in spiritual assessment and care,

to be confident and competent (Minton,  Varilek Stadick & Persaud 2018) before they could

enter in the actual, uncomfortable spaces of patients and families with different culture and

spiritual beliefs.

. Numerous spirituality models and tools have been developed in health education and

research, however a gap still exists on conceptual clarity and expression of spirituality among

nurses and healthcare providers (Lalani, 2020). Nurses still find it difficult to interpret and apply

the concepts of spirituality in their practice settings. In response, the proponent utilizes a

contextual approach in analyzing and interpreting the actual meaning of the concepts and

emerging themes of spirituality. This is the initial step of the researcher to create a deeper

understanding of the concept to effectively teach and apply spiritual nursing in the undergraduate

program (Lalani 2020, Monareng 2016). In past studies, themes that emerged from different
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context and cultures were summarized by Ren van Leeuwen and Akkerman (2015), using a

consensus process, finalized the definition of spirituality within the context of a health care

environment. They defined Spirituality as the aspect of humanity that refers to the way

individuals seek and express meaning and purpose and the way they experience their

connectedness and relationship to the moment, to self, to others, to nature, family, community,

society, nature, and the significant or sacred. Critical elements of the definition included

meaning, connectedness to spirituality as an aspect of humanity, and the search for the

significant or sacred. Although there are four (4) interrelated domains of spirituality, factor analysis

showed that two (2) factors such as higher power/universal intelligence and nature collapsed into one

factor (Buck, 2018). This definition seeks to be comprehensive and communicative, however,

according to Walton (2012), the aspect of comprehension is problematic. Here, the researcher

this study, noted that several concepts in the definition, only described the concepts which Buck,

(2017), urged researchers to further pursue and study.

Based from the researcher’s analysis of the above description of spirituality, God,

the Self (human person) and Others emerged to be the three (3) interrelated domains of

spirituality. In other words, the interpretations of the concepts are meanings that are attributed to

God, the Self and Others. Other emerging themes generated from different perspectives

( Puchalski, Hull, &  Reller , 2014), which repeatedly emerged from 1996-2020 ( Lalani, 2020),

literatures and studies may be categorized by the researcher of this study within the context of

God, Self and Others, in developing content of course outlines in spirituality and spiritual care

for all year levels in the nursing program ( Lalani 2020, Dyson, J., Forman, D., & Cobb, M. 2017

CMO 15s.2017). Currently, no new data as to the existence of consensus definition and

fundamental concepts or subtopics constitute spirituality and spiritual care in CMO 15 s. 2017

BSN curriculum, that could guide faculty in teaching nursing students particularly from
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government non sectarian educational institution. In 2006, Ross (Caldeira et al., 2016),

underlined education in spirituality as an emergent topic and on finding that Nurses were

receiving little training in this area, suggests that this topic must be included in the nursing

curriculum throughout graduation. The legal basis of this proposal is anchored to the provision

in section 4 of article III general provision of CMO 15 s.2017, that Higher Education Institutions

are allowed to design curricula suited to their own contexts and missions provided they can

demonstrate that the same leads to the attainment of the required minimum professional and

program outcomes For scientific investigation to occur there has to be a consensus of

meaning with regard to the phenomenon being observed (Bousso, Poles & Montero da Cruz

2014). Therefore the main purpose of the study is to establish a consensus contextual definition

of spirituality and develop course outlines of subtopics for all year levels of nursing program.

REVIEW OF RELATED LITERTURE

This section of the study presents a comprehensive discussion of empirical research and

conceptual papers on the following thematic areas: (1) Contextual meaning of Spirituality (2)

God, Self and Others; (3) Course Content of Spirituality and Religion; (4) BS Nursing Program

The sources of literature come from online data bases such as Research Gate, Elsevier CINAHL,

BNI, MEDLINE. The range of the year of publication is from 2010-2020.

Contextual approach to meaning of Spirituality

According to Merriam Webster dictionary, context is the part of a statement that

surround a word or passage and can throw light on its meaning. For example, in subjective

context (Nouraldeen, 2015), of varied beliefs and opinions on spirituality, Buck, (2018), made a

statement that spirituality is that most human of experiences that seeks to transcend self and find

meaning and purpose through connection with others, nature, and/or a Supreme Being, It is
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noticeable that simply looking at words alone can lead to ambiguity, thus separate words and

sentences alone are not sufficient, but contextualization can provide critical information to

identify the correct meaning of the texts. Contextual approach disambiguate ambiguous

expression through identification of referents as to “what, where and who” in cases when

subjective contexts of feelings, beliefs and opinions are involved (Nouraldeen, 2015).

Contextual approach to meaning is an expression of the same or different normalities of

meaning. Therefore when the definition of Buck (2018), is to be contextualized, the meaning of

spirituality may be simply interpreted by the researcher as seeking meaningful and purposeful

relationship with God, to Self and Others through good works (Ephesians 2:10, KJV “For we are

his workmanship, created in Christ Jesus unto good works, which God has ordained that we

should walk in them”). .

Examining deeply, Spirituality has been derived from the Latin spiritulis

“meaning breath of life, a person of the spirit/spiritual being connected to God as the only source

of life ( Mattoo, Punia, Malik & Khurana 2018). It is interesting to note that in 2006 and 2011,

the Royal College of Nursing and World Health Organization defined spirituality as a person's

deep-seated sense of self, meaning, purpose and connection with self, others and the

transcendent. Similarly, Buck, (2018), defined Spirituality as: that most human of experiences

that seeks to transcend self and find meaning and purpose through connection with others,

nature, and/or a Supreme Being. For 30 years of continued researches in both international and

local sources, data however revealed repeated findings in the lack of clear definition of

spirituality. In fact, articles retrieved from data bases such as CINHAL, MEDLINE, Google

scholar and ProQuest conducted by Galutira, Valenzuela, Basatan and Palaganas, (2020), yielded

the same findings indicating students and nurses’ population difficulty in describing and
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uncertain about their definition of spirituality and spiritual care Disagreement in spirituality is

the result of religious beliefs, practices, experiences, human knowledge and historical-cultural

events that continually affect peoples’ perceptions of the divine. ( Benner et al., 2010; McSherry

& Jamieson, 2011; Ross et al., 2014; Yuan & Porr, 2014; Lewinson et al. 2015;

Caldeira, et al. 2016, Kalkim et al., 2016). Within nursing literature,

there are also huge range and diversity of definitions, some of which appear logical; whereas,

others seem quite different and unconnected (Swinton & Pattensen, 2010). As a result, there has

been a lack of guidance about the nature of spirituality and spiritual care content within nursing

and midwifery curricula. Attarda, Rossb, and Weeks (2019), described to have limited

knowledge and personal sense of inadequacy to teach spirituality and practice of spiritual care.

(Systematic reviews 622 articles 1998 to 2019 BNI, CINAHL (Cumulative Index of Nursing and

Allied Health), and MEDLINE databases (Lewinson, Lesline, McSherry, and Kevern, 2015,

Ferrer, de la Cuesta-Benjumea, Fernández , Pascual, and Ruiz 2019).

Galutira, et. al., (2020), reported factors

contributing to difficulties in integrating spirituality in the nursing curricula due to lack of

ontological integration, lack of phenomenological understanding; lack of environmental support,

and guidance in teaching spirituality and spiritual care (Labine, 2015). .

For that matter, many critics say that the usage of spirituality is emergent, changing,

diffused, and has no legitimate use or value. This vagueness within the nursing literature has led

some to suggest that spirituality is so diverse and meaningless. But are the critics correct in

implying the idea that the vagueness that surrounds spirituality invalidates it as a significant

aspect of nursing care? In response to these controversies, the researcher proposes

contextualization as an approach with respect and recognition of people’s different cultural and
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subjective spiritual beliefs as implied in the definition of R. Daniel Shaw, Danny DeLoach,

Jonathan Grimes and Simon Herrmann 2016; Gilliland 1989 specifically defined

contextualization as “the way in which the word, as revealed in the truths of culture interact in

determining truth for a given people and place”. This is to understand the concept of spirituality

within the interconnections of God, Self and Others as themes which embody the common

ground of multiple culture and spiritual beliefs of people to achieve a consensus definition

(Dyson, J., Forman, D., & Cobb, M. 2017).

In connection to the above context, Demmretch and Huber (2019), concluded that most

multidimensional understandings of spirituality which is connectedness may fall under three

categories: 1) a God-oriented spirituality where thought and practice are premised in theologies,

either broadly or narrowly conceived, higher spiritual being or God; 2) a world-oriented

spirituality stressing one’s relationship with ecology or nature or social environment; or 3) a

humanistic (or people-oriented ) spirituality stressing human achievement or potential, self

transcendence or self-actualization.

The researcher proposes to define Spirituality as the act of loving God supremely

and others as ourselves marked by innate fruits of the Spirit in service to God and humanity

through acts of love, joy, peace, patience, kindness, goodness, hope, faithfulness, gentleness, and

self control. Thus, the real essence of spirituality can be described as an inner connectedness and

individual communion (transpersonal) with the mind of God, intrapesonally (as a connectedness

within oneself) and interpersonal (in the context of others) (Wilhoit, 2019).
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God, Self and Others

Amid the prevailing controversy on spirituality, reflection on the definition reveals that

man’s love and desire to re-connect to God, Self and Others emerged as a unifying theme of

spirituality. Other emerging themes, namely; meaning, hope, relatedness/connectedness,

beliefs/belief systems and expressions of spirituality, can be articulated in the context of God,

Self and Others, considering the cross cultural multidimensional construct posed as a God-

oriented, world oriented and humanistic view of spirituality ( Puchalski,  Hull,  and  Reller

2014).

God

According to Perkins, (2021), God is a Spirit: and they that worship him must worship him

in spirit and in truth (John 4:24, King James Version). So it is through man’s spirit that he can

worship and connect to God (Shtulman and Rattner 2018). His Spirit was and is working when

all things in the vastness of eternity were created. In Genesis 1:1,2 states that “In the beginning

God created the heaven and the earth. And the Sprit of God moved upon the face of the waters.

And God said, Let us make man in our image, after our likeness. This statement indicates that

God communed with His co-creator during creation. For Christians, the one eternal God has one

nature sharing one relational divine nature God the Father (1Peter 1:2) God the Son ( Acts 20:28)

and God the Holy Spirit (Hebrews 1:8). This implies that the unity of God (Asher 2021), is not

limited to nature but extend to purpose and will (John 6:38). Another vital point to consider is

when God created Man, a portion of him is an inherent spiritual being of a godly nature (Fisher

2011), the inner man or inner most self or the spirit (1Thessalonians 5:23) enabling him to be

aware of his creator and desire to commune with Him (Warren 2021).

Man was formed from the dust of the ground and God breathe into his nostrils the
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breath of life and man became a living soul (Gen 2:1; Numbers 27:16), imparting His Spirit in

the spirit of man which is in him (1Corinthians 2:11; Zech 12:1;Ecclesiastes 3:21; Proverbs

20:27; Job 32:8). For by Him all things were created, both in the heavens and on earth, visible

and invisible, whether thrones or dominions or rulers or authorities-all things have been created

through Him and for Him (Colossians 1:16; Proverbs 8:27; Psalms 33:6; Revelation 4:11). God’s

nature is spiritual, eternal, immutable, immortal, invisible wise God (Perkins 2021). The ONE

True GOD, described from the Bible does not have any variableness, neither a shadow of
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turning. It is impossible for God to lie ( Hebrew 6:18). This same God possesses a very special

quality that makes Him a mighty God that He is (James 1:17 KJV), that God is a versatile God to

us humans (Soriano, 2021).

Love is the substance of God’s character and his being. This means that his love for

humanity is permanent, immutable and eternal. Even though its manifestation within the ever-

changing phenomena of nature and human life may only appear coincidental and momentary, the

love of God can be relied on with certainty because it is the core of his nature. The most common

attributes of God are incommunicable attributes (independence, unchangeable, eternal

omnipresence, unity) and communicable attributes (spirituality, invisibility, omniscience,

wisdom, truthfulness and faithfulness, goodness, the love, mercy, grace, patience, holiness,

peace, righteousness/justice, jealousy, wrath, Will, freedom, omnipotence, perfection,

blessedness, beauty, glory).(Grudem 2018) .

Gruden (2018), further explained that God is independent and self sufficient

because according to Apostle Paul in Acts 17:24-25, KJV, “The God who made the world and

everything in it, being Lord of heaven and earth, does not live in shrines made by human hands,

though he needed anything, since he himself gives to all men life and breath and everything”.
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God is unchangeable in the sense that He is unchanging in his being, perfection and promises.

However, God responds based on his intention and attitude to different situations for instance,” If

My people who are called by My name shall humble themselves, and pray, and seek my face,

and turn from their wicked ways, then will I hear from heaven, and heal their land (2Chronicles

7;14 Psalms 102: 27, Malachi 3:6, James 1:17 and Jonah 3:4,10,). Being eternal, God has no

beginning or end. He is timeless, .In God’s perspective, any long period of time is as it just

happened. 2 Peter 3:8 “With the Lord one day is as a thousand years, and a thousand years as one

day.” It means that God sees and knows all events past, present and future with equal vividness.

Another important attribute of God is omnipresence. There’s nowhere in the entire universe on

land or sea, in heaven or hell, where you can flee and hide from God’s presence. Jeremiah

23:23-24. Can a man hide himself in secret places that I cannot see him?, says the Lord. Do I not

fill the heaven and earth? So when God is unlimited with respect to time, He is unlimited with

respect to space. He is present at every point of space with His whole being. Unity characterizes

God’s whole being as entirely loving, merciful and just. God is light (1John 1:5) God is love

(1John 4:8).

The communicative attributes of God is Spirituality meaning, by nature He is a spirit and

no one has seen God (1John 1:18) except Him who comes from God (John 6:45). He is the King

of ages, who alone has immortality and dwells in unapproachable light, whom no man has ever

seen or can see ( 1Timothy 6:16), invisible, the only God 1Timothy 1:17). 1 John 3:20 testified

that God is all knowing or omniscient. He knows what we need before we ask him (Matthew

6:8). He knows the days of our lives before we are born (Psalms 139:16). On Wisdom, God is

called the only wise God ( Romans 16:27). God’s altruistic character is to be the object of

constant contemplation, because it captures the essential kernel of truth concerning God. Christ
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is “the only medium of connection” and the sole mediator of all blessings and benefits which

people may experience through authentic spirituality. The divine love with its saving intention

was prepared before human fall into sin and the divine acts to save in the course of history.

The concept of having relationship with God has been understood within a

religious framework of restoration and healing of the broken relation between the Triune God

and humanity (Angelican and Communion Office 2015).God the father is the ultimate source of

authority. God the Son was given all authority in heaven and earth to act in the name God. The

son receives and passes on that authority to his disciples to teach and guide others in obedience

to God. God the Holy Spirit enables them to teach with power (Matthew 28:16-20) . The most

evident here is the sense of movement or passing on of authority. Likewise, the Father pours out

his love to the Son and the son gives that love through the Spirit to his disciples. In other words ,

the Father, Son and Holy Spirit embody a holy fellowship of love and sharing that flow to us,

and from us it flows to the entire world, (Meyer 2020) emphasizing God’s initiative in

establishing a relationship with humanity. However, there can be no meaningful relationship

with God unless man responds in like manner with basic trust in the love, goodness, kindness

and compassion of God ( Andrews University Theological Seminary)

In the first place, it is God who calls man to Himself, to revive the lifeless spiritual

capacities of the sinful human heart and leads him to ask God for forgiveness of sins, love and

obey his commandments. The Holy Spirit, through the Holy Scriptures, reveals to men the deep

things of God (1Corinthians 2:9 Romans 10; Ephesians 3:14. Romans 20;4:13), acknowledging

his sinfulness and separation, and his need of the Savior Jesus Christ who took upon Himself the

sins to die in the cross in man’s behalf (John 3:16, Romans 17;16:8 Romans 11).
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Self/Human Person

Understanding the Self (Human nature) is important because it can help the

individual comprehend themselves and other people. It helps man understand the reality of

human behavior and motives, to help him walk in victory over the dark side of his self because

of sin. The Apostle Paul in his message to Romans 7:22-24, stated , “For in my inner being I

delight in God’s law. “But I see another law at work in my body, warring against the law of my

mind and holding me captive to the law of sin that dwells within me. What a wretched man I am!

Who will rescue me from this body of death?” For the flesh craves what is contrary to the Spirit,

and the Spirit what is contrary to the flesh. They are opposed to each other, so that you do not do

what is right (Galacians 5:17), but, Thanks be to God, through Jesus Christ our Lord! So then

with my mind I serve the law of God, but with my flesh I serve the law of sin (Romans 8:2). For

in Christ Jesus, the law of the Spirit of life set you free from the law of sin and death (Roman

8:2). These struggling scenario are the accounts that took place and still presently active and at

work in the human being or self, struggling with sin (Cavins, 2020). From the very beginning, it

was God’s intention to walk with mankind in a love relationship, but this relationship was

disconnected through man’s disobedience. Adam and Eve introduced sin into the human race and

has had repercussions down through the centuries. Out of balance with his maker, yet with the

“desire for God written in the human heart”, because man is created by God and for God; God

never ceases to draw man to himself. Man cannot fully live according to truth unless he freely

acknowledges that love and entrust himself to his Creator, he will always struggle in finding

meaning and purpose in life (Cavins, 2020; Borromeo, 2009 Cathechism of the Catholic

Church). Therefore, God sent his Son, Jesus Christ to save mankind as it is written,“ For God so

loved the world that he gave his only begotten Son, that whosoever believeth in him should not
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perish but have everlasting life “(John 3:16). And thus how the love story of man’s salvation

provided a ransom to restore back humanity from his fallen condition.

Reflecting back from the beginning of creation, God said,

Let us make man in our image, after our likeness (Genesis 1:26), then, The LORD God, formed

man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a

living soul (Genesis 2:7). This foundational passage states that human beings are living souls. In

its broadest sense the soul refers to the whole person, the whole human being with spirit, mind

and body. Soul refers to any of the three facets, body, mind and spirit depending on the context

of the passage (Warren, 2021). Apostle Paul in 1Thesalonians 5:23, “ And the very God of

peace, sanctify wholly, and I pray God your whole spirit, and soul and body be preserved

blameless unto the coming of or Lord Jesus Christ”, “ For the word of God is quick and

powerful, and sharper than any double-edged sword, piercing even to the dividing asunder of

soul and spirit, joints and marrow, and is a discerner of the thoughts and intents of the heart

( Hebrews 4:12), described that the human nature as having three facets- spirit, mind and body.

It is further supported (Warren, 2021), by Paul’s

inspired letter to the Romans 7:18-24. “For I know that nothing good dwells within me, that is, in

my flesh. I want to do right, but I cannot do it. For I do not do the good I want, but the evil I do

not want is what I do. Now if I do what I do not want, it is no longer I that do it, but the sin that

dwells within me. For I delight in the law of God in my inward self(spirit) , but I see in my body

another law at war with the law of my mind, making me captive to the law of sin that dwells in

myself”. Based from the bible verses, Paul mentions his flesh (sinful nature) and stated that

nothing good dwell within it. But he also mentioned about his spirit (inmost self/inward man)

part that delights in the law of God but at war with his mind. These divinely inspired words
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imply that there are three basic parts of human nature, the flesh, mind and spirit. The mind is

caught in a struggle between the other two opposing facets-flesh and spirit.

As noted above, the desires of the

spirit and the lust of the flesh are in conflict. Since both spirit and flesh have desires, they have a

voice, and each person determines which voice he/she will accept to follow. In contrast, our

mind being the center of our being has the power of volition or the will. It is the mind YOU to

live by the spirit or by the flesh, which will in turn determine whether the person is spirit-

controlled of flesh-ruled. It is completely up to YOU. Paul called the born-again human spirit,

the new self, created to be like God in true righteousness and holiness (Ephesians 4:24). Man’s

spirit is like God and is truly righteous and holy, but man can only walk in it as he DECIDES to

live in the spirit and not of the flesh. And that is putting on the new self and putting of the old

self. Likewise, it is interesting to note that Sigmund Freud, the formulator of psychoanalysis, was

able to discover the three basic facets of human nature. The mind is comparable to the ego,

likewise the id coincides with the flesh, and the spirit corresponds to the super ego (Warren,

2021).

It is in this hopeless situation, that Christ’s love for each human being is unfathomable,

that he gave himself as the ultimate ransom for humanity. For this reason all human beings are

God’s property, on the basis of the price paid for their rescue. Ideas regarding human value and

dignity, applys that principle to the quality of our response to people’s needs. Another equally

basic criterion stated to support the value of humanity is the fact that God has created them

according to His image, as the most valuable element in all of creation. Therefore, the love of

God is not only a factor in the formation of individual spirituality, but it also moulds social

concerns and relationships as well as our modes of interaction through connectedness of self, to
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strengthen one another’s ability to engage in generative activities, to belong to another, and to

achieve a sense of purpose in order to experience a sense of fulfillment. This insight is

significant in the search for ontological and existential meaning of one’s life, in deriving a

purpose for existence and in constructing one’s identity and self-worth. According to Withers A,

Zuniga K, and Van Sell SL (2017); Cavendish R, Luise BK, Russo D, Mitzeliotis C, Bauer M, et

al. (2004) the human being is a spiritual and a physical being that interacts with an external

environment. Spirituality recognizes humans related to the environment and to a higher being,

which help individuals find their purpose

. This search for meaning and purpose in life is the result of the common human

condition caused by sin, unfortunate life experiences which create our inner state yearning for

God and his grace. Guilt, for instance, is normally a result of one’s own mistakes or

shortcomings. Repentance, confession, and consecration become an integral part of enduring

connection with God (Ps 32:1; Joel 2:12). This is a process obtained through connectedness.

Connectedness with self according to Jaberi, Momennasab, Yektatalab, Ebadi and Cheraghi

(2017) is described as introspection (examination of one’s own thoughts and feelings), reflection

(ideas formed as a result of quiet thought), and deliberation (careful thought and discussion to

make a decision. Thus, attributes of personal values such as altruism and compassion are part of

the spiritual experience process and the result of personal reflection, accompanied by spiritual

striving leading to spiritual transformation or the desire to be renewed in the image of God’s

purity”.

As a result, the repentant sinner experiences blessedness and joy (Ps 1:1; 32:1 ;

Rom 4:7; Phil 4:4) peace with God (Rom 5:1) assurance of salvation (Rom 8:1), no fear of

judgment before God (Isa35:4; Dan 7:22; Luke 1:74, 75; John 5:24; 1 John 2:28; 4:17 R18), and
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love for one another (John13:35).Upon invitation, the Holy Spirit causes a spiritual person to

walk in all the commandments of the Lord (Ezek 36:26; John 14:15) which otherwise are

impossible to observe (Josh 24:19) without faith.

Spiritual growth then follows in the presence of the fruit of the Spirit and spiritual

gifts bestowed by the Holy Spirit in service to others (Gal 5:22, 23; 1 Cor 12; Col 3:12R15;

2Pet1:4). It springs into a desire to surrender self to God in faithful obedience, heartfelt worship,

and unselfish service to others (Isa 6:1; Matt 25:31).

Others

In relationships with others, the personal journey connects with that of other

travelers (Buck, 2017). Connecting with others includes a sense of community, compassion,

altruism, and sharing with and helping others ( Momennasab ,Yektatalab, Ebadi and Cheragh

2017). This requires the acquisition and generation of knowledge that can be applied in service to

others. Validate love as the researcher’s philosophical basis of spirituality. The love of God is the

standard in estimating the worth of other people which provides the foundation of spirituality and

ministry. Rich and poor, high and low, free and bond, however degraded have cost too much to

be treated with coldness or contempt, but rather adopted compassion as the primary approach to

Christian spirituality. The gospel calls people to live by compassion, kindness, humility and

patience. Compassion and kindness should be directed inward, ( self compassion) and outward,

(compassion to others). Self compassion is expressing the same kind of concern for our own pain

and well being as we would show for other human beings ( Wilhoit, 2018).

For instance, Riu, Cho, Chang, Ko, , Yi, Noh, Cho and Park, (2021), found in previous

studies that self confidence of women, particularly older people (more than 76 years old),

showed that poor housing, depression, emergency department visits and loneliness hinder self
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confidence to live alone, while having religion, a higher income, independent earning, higher

educational level and satisfaction with the condition of housing, facilitates AIP ( Ageing in

Place), defined as meeting the desire and ability of people through the provision of appropriate

assistance, to remain living independently in his own home or in other appropriate housing

facilities.

Selfconfidence was also facilitated by activities in daily living, interactions with family

members, support and access to social services. An increased will to live in those who believed

in themselves and others, links hope and one’s relationships with others. To give and receive

human elements, such as touch, listening and committed presence in relationships with others,

individual’s need for love, honest, genuine and trust as the most fundamental ingredient of any

relationship. These associated factors suggest that the Will to Live (WTL) like quality of life is at

the very core of a person and is the summation of his or her biopsychosociospiritual dimensions

(Bornet, Bernard, Jacques, Truchard, Boracio & Jax , 2021)

In addition, the sense of transcendence or beyond self is a calling through one’s work or

being called vocationally which facilitates social connection or membership in a way that

provides feelings of compassion and joy in serving others and derives meaning and purpose in

life. Many people seek not only competence and mastery to realize their full potential through

their work but also a sense that work has some social meaning or value (_Ericho 2020; Ebertz,

2015). The two essential dimensions in this aspects of calling and connection for spiritual

survival are interlocked, universal, and common to the human experience. Calling represents a

specific set of tasks to be carried out in the world. All activity in the world is a search for

meaning, which is a search for purpose and ultimately for relationship with others. In this regard,

this requires the acquisition and generation of knowledge that can be applied in service to others.
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Moreover, professionals in general gain expertise in a specialized body of

knowledge, ethics centered on selfless service to others, clients/customers, an obligation to

maintain quality standards within the profession, commitment to calling to their field, a

dedication to their work, and a strong commitment to their careers. Coupled with hope and

commitment to spiritual family and God, is the genuine foundation of its expression, to survive

the conflicts and tribulation of the world (Summers, 2021). Membership encompasses the

cultural and social structures one immersed in and seeking, what William James, the founder of

modern psychology, man’s most fundamental need is to be understood, accepted and

appreciated. Having a sense of being understood and appreciated is largely a matter of

interrelationship and connection through social interaction.

Spiritual Care in Nursing

Spiritual care, though not fully understood by all health care providers, is a necessary

component of holistic nursing practice (South, 2017). Spirituality plays an important role in

health, particularly in times of crisis or severe illness, as it is foundational and links the bio-

psycho-social dimensions as an integrated whole (Fisher 2016). Spirituality has been described

as critical for patients’ health and for healthcare practice (Timmins & Caldeira,2017).

Spiritual distress is a nursing diagnosis that has been listed in NANDA International

(NANDA-I) since 1978 (Herdman & Kamitsuru, 2014), and is defined as “a state of suffering

associated with the meaning of his/her life, affecting connection to self, others, world, and God”

(Caldeira et al. 2013). Spiritual care has been described as a distinct type of care defined by acts

of listening, compassionate presence, open-ended questions, prayer, use of religious objectives,

talking with clergy, guided visualization, contemplation, meditation, conveying a benevolent

attitude, or instilling hope (Chan, 2010). Nurse practitioner defined spiritual care as listening,
 18

holding the patient’s hand, using music and caring ( Taylor, Highfied & Amenta, 2017). But the

most commonly reported activities on spiritual care among nurses are referring to pastors or

priests, encouraging the patient to pray, and talking about a spiritual topic.

Spiritual care is helping the patient make meaning out of his/her experience or find hope.

It involves caring for the soul in a special kind of engagement that goes beyond seeing the

physical patient in front of us; it is observation of the entire patient with the entire nurse. This

has been described as holistic nursing ( Montgomery, Keegan, 2016 & Keegan, 2012).

Florence Nightingale in its historical Notes on Nursing, states that “caring for the whole

person including one’s spiritual needs has been at the heart of the nursing discipline since it was

founded ”(Reinert & Koenig, 2013). The deep comfort she provides emerges from Presence,

referring both to the divine presence of God, and the nurse in caring for those who are ill. It

involves serving the whole person – the physical, emotional, social, and spiritual” (Murphy &

Walker , 2013).

The Christian nurse, while administering treatment for the restoration of health, should

pleasantly and successfully draw the mind of the patient to Christ, the healer of the soul as well

as of the body. They should be ever ready to blend spiritual healing with physical healing. They

need ever to remember that in the discharge of their daily duties they are serving the Lord Christ

(EG White Estate ).

Teaching Content of Spirituality

Baldacchino in 2008, developed and co-taught (with a chaplain) a 28-hour study unit for

Maltese nursing students in their final semester ( Taylor,Testerman &Hart 2016). The aim was to

define spirituality and spiritual care, learn about spiritual distress and needs related to illness

(especially for meaning and purpose), learn how to support spiritual coping, and reflect on
 19

personal spirituality. Course content included how to use the nursing process to give spiritual

care, spiritual assessment, and ethical issues influencing spiritual care. Teaching methods used

were primarily lectures and discussion time in a classroom setting. Engaging techniques included

small group work, sharing clinical experiences, personal reflective exercises, and case studies. A

final whole day session allowed students to give formal case presentations. This presentation,

along with a term paper, was the means for evaluation. Teaching at a state university during the

1980s, Carson and Gerardi (2013) developed a spiritual care course for junior students. This one

course approach in a semester involved lectures, small group discussions and projects, student

presentations, and guest lecturers (e.g., representatives from different faith traditions and work

settings). Case studies and interventions (e.g., use of self, scripture, prayer) were discussed.

However, 20 years later, Carson and Gerardi (2013) observed that spiritual care

education has not changed much. Carson and Gerardi (2013) stress the need to continue to

educate students with the ability to be therapeutically present, and advocate for the weaving of

spiritual care training throughout a curriculum. In fact over the last thirty years there have been a

number of calls to integrate spiritual care into nursing education across the curriculum (Ali,

Snowden,Wattis & Rogers 2018). There is no consensus about how this can be done (Ross .

2016; Benner et al., 2010; McSherry & Jamieson, 2011;). No data as to the existence of

guidelines on how spirituality is taught, neither a consensus about the content or methods of

such education (Varilek,  Stadick & Persaud, 2017). This may be related to its relative neglect

in nurse education over the past three decades (Kalkim et al., 2016; Ross et al., 2014).

In the review results of over 30 years, 231 articles included reports on spirituality in

nursing education (1986-2016) management (2011-2015), assessment tools in spirituality (2006-

2017), oncology and palliative care (1994-2016), nursing diagnosis and validation on spirituality
 21

(1997-2016), and spiritual care (1986-2016). When comparing the years 2010 and 2016, within a

timeframe of six years, the number of studies has duplicated. Many authors came up to the same

findings that the concept of spirituality has several meanings thus a consensus has been difficult

to achieve (Evangelista, Lopes, Costa, Batista, Batista, and Oliveira. 2016).

According to section 4 of article III general provision of CMO 15 s.2017, HEIs are

allowed to design curricula suited to their own contexts and missions provided that they can

demonstrate that the same leads to the attainment of the required minimum professional

outcomes, provided that the curriculum delivery facilitates the attainment of the program

outcomes.

Spirituality should be present throughout the nursing program ( Giske & Cone 2012)

allowing students to learn the fundamental concepts of spirituality and be able to apply

theoretical knowledge in their spiritual care clinical practice. Nursing curriculum must include

purposeful engagement and focused debriefing in spiritual assessment and care. Thus, Nurses

can be confident and competent ( Minton,  Varilek   Stadick & Persaud 2018) before they could

enter in uncomfortable spaces with patients/families. Therefore, addressing spiritual care content

as a clinical and educational priority requires further reshaping of nursing curricula, policies,

guidelines and assessment tools.

SYNTHESIS

Similarity and uniqueness of the researcher’s study from all other studies

The similarity of the present study from the rest of past studies is the intent of better

understanding spirituality in relation to spiritual nursing practice of attending to the spiritual

needs of patients. The uniqueness of the study which is lacking in previous studies is a

contextual approach of defining spirituality in terms of the interconnectedness of God, self and
 22

others in a bond of love relationship (Villani, Sorgente, Lannello and Antonnietti, 2019). The

contexts of Love and relatedness is connected to the first and great commandment in (Matthew

12:36-40 The Holy Bible King James Version). Connectedness to God is Primary whereas

Connectedness to others is Secondary. Personal connectedness, connectedness to others,

connectedness to the surrounding, and connectedness to God, or a Supreme Being, are some of

the characteristics of spirituality mentioned in the literature presented by (Mattoo, Punia, Malik

& Khurana 2018;  Neto et al., 2018 Paul et al., 2010; White et al., 2011). The spiritual dimension

is also addressed as emotions such as love, hope, peace, trust, inspiration, and faith (Yeşilçınar et

al., 2018). Thus the researcher simply define spirituality as loving God supremely and others as

one’s self and that other themes generated from different worldviews, are interpreted and

categorized within the context and relationship of the three key elements. Finding meaning and

purpose of life in loving service to fellowmen (Sharon K. Hull,  and  Reller 2014). The Holy

Word states that “If I give all that I possess to the poor and surrender my body to the flames, but

have not love, I am nothing” (1Corinthians 13:3.KJV). This review helps the researcher to

enhance understanding on spirituality

 23

Conceptual Framework

The Enhanced Conceptual framework of Spirituality in Nursing derived from Reed’s Integrated

Spirituality and Well Being: transpersonal, interpersonal and intrapersonal interconnectedness to

God, Self and Others (Wolhoit 2019).

The philosophical basis of the researcher’s conceptual framework of spirituality is based

from the virtue of God’s Love to sinful humanity (John 3:16, Pike 2011; Sadat huseini, AK;

Rzaghi, N; Panah, A H K; Nayeri, ND 2019). Love is the binding tie that reconciles God to Self

and Self to Others, and Others to God, embracing all races and culture as one to restore and heal

the broken relation between the Triune God and humanity. The concept of having relationship

with God begins with connection within the individual to self ( personal integration;

intrapersonal awareness; personal desperation (Buck 2018), real sorrow for sin, genuine

repentance, honesty and readiness to assume responsibility for one’s sins. It is also known as

Self-compassion respecting one’s value as being created in the image of God, opening oneself

to God’s compassion to receive the love of God more fully, so that we can comfort others

(friendship, trust),through the ministry of the Spirit with the comfort we ourselves receive from

God (2 Corinthians 1:3-4; Wilhoit 2018). In practical application, it follows that the nurse being

able to experience healing may draw the minds of his patients to Christ as the healer of body,

mind and spirit.

A circle has been chosen for its symbolism of eternity and healing. The terms integration

and connection reoccur throughout the nursing literature on spirituality. Connection is defined as

a joining, coupling, or union, whereas integration denotes making whole or complete by bringing

parts together. And so in the conceptual framework, connection is placed within the circles, and

the whole model is called integrated In connection, The tripartite themes Reed’s model are also
 24

termed self-discovery (intrapersonal), relationships (interpersonal), and eco-awareness

(transpersonal). Self-discovery encompasses the personal journey in search of meaning and

purpose in life. In relationships with others, the personal journey connects with that of other

travelers. In eco-awareness, the personal journey connects with nature and God. Factor analysis

showed that two (2) factors higher power/universal intelligence and eco-awareness collapsed into

one factor (Buck, 2018)..

Intrapersonal connection.

Connectedness with self according to Jaberi, Momennasab, Yektatalab, Ebadi and

Cheraghi (2017) is described as introspection (examination of one’s own thoughts and feelings),

reflection (ideas formed as a result of quiet thought), and deliberation (careful thought and

discussion to make a decision. This requires acknowledging oneself’ as a sinner, helpless and

sensing one’s need for help for cleansing, forgiveness and mercy from God.

Interpersonal

The nurse, while administering treatment for the restoration of health, pleasantly

perform her duties with caring to successfully draw the mind of the patient to Christ, the healer

of the soul as well as of the body. They should be ever ready to blend spiritual healing with

physical healing. They need ever to remember that in the discharge of their daily duties they are

serving the Lord Christ

Transpersonal

The transpersonal connection shows the response of a repentant human heart and mind to

the loving heart and mind of God marked by innate fruits of the Spirit in acts of (Interpersonal

connection) love, expression joy, peace, patience, kindness, goodness, faithfulness, gentleness,

and self-control toward his fellowmen. The Son Jesus Christ is the connecting link between God
 25

and sinners and confirms his love for humankind that requires for spiritual exercises in man’s

part.

Thus the uniqueness of this study from other studies conducted is to establish a consensus

definition of spirituality that will determine the teaching content of theory and application of

spiritual care inclusive to all students with different cultural background.

A strong emerging theme from the literature is the centrality of the relationship between

God, Self and others. (Dyson & Cobb (1997), Fish & Shelly, (1988), and Morrison (1990),

identify the importance to spiritual well-being of `right' relationships between these three key

PURPOSE OF THE STUDY

Therefore, the main purpose of the study is to achieve a consensus on contextual

definition of spirituality in nursing and developing teaching content. The basis of this proposal is

anchored to the provision in section IV of article III general provision of CMO 15 s.2017, that

Higher Education Institutions are allowed to design curricula suited to their own contexts and

missions provided that they can demonstrate that the same leads to the attainment of the required

minimum professional outcome

STATEMENT OF THE PROBLEM

This study aims to achieve a consensus on the contextual definition of Spirituality in

nursing and developing teaching content of course outline and religion common to all year levels

of the BSN Curriculum (CMO 15s.2017). Specifically the study will answer the following

research questions

1. How do the following stakeholders define contextual meaning of spirituality in terms of their
relation to God (transpersonal), self (intrapersonal) and others (Interpersonal) as to:
1.1 faculty;
1.2 staff nurses;
 26

1.3 nursing students; and

1.4 higher education leaders?
2. Which of the following themes such as searching for purpose and meaning of life,
transcendence, relationships to self, family, others, community, society, nature, and the
significant or sacred are categorized by the participants within the context of God (transpersonal)
Self (interpersonal) and Others (intrapersonal)?
3. What teaching content of course outline on spirituality and religion can be taught to all year
levels of BSN Curriculum may be proposed?
4.What is the level of endorsement of nursing students, faculty, staff nurses, parents, religious
and higher education leaders on the contextual definition of spirituality and subtopics, that will
constitute the course outline of spirituality and religion in nursing as to:
4.1. spirituality means loving God supremely and our neighbor as ourselves,
4.2. Introduction to The Holy Bible;
4.3. The Life and Teachings of Jesus Christ;
4.4. Ministry of Healing; and,
4.5. Man as a living soul: body, mind and spirit

SCOPE AND LIMITATION OF THE STUDY

This study aims to achieve a consensus on the contextual definition of Spirituality

in nursing and to develop a course outline of spirituality and religion in CMO 15s.2017 through a

qualitative Delphi technique. The panel of experts are representatives of faculty, staff nurses,

nursing students, religious institutions represented by Catholic priests and Pastors and

Commission on Higher Education leaders.

Inclusion Criteria

The Criteria for selecting the participants are as follows:

The panel of experts will compose two (2) Faculty of instruction especially those who are

or will be teaching theoretical foundation of spirituality and religion, (2) two Staff nurses with

five to ten years and above service in the base hospital and had direct contact with patients
 27

considering their level of maturity, spirituality and spiritual care experiences in their respective

roles as supervisors, head nurses, or staff nurses. Two (2) parents will represent the community

group. Criteria in selecting the parents include, commitment to participate in the study from start

to finish, knowledgeable and skilled in exchanging messages using own email address, with

stable internet connection and functional cellphone or tablet that is able to download and answer

the research questionnaires in a timely manner.

A total of (8) eight representatives from Level 1, 2, 3 and 4 nursing students are selected

as participants of the study because spirituality/religion will be part of their regular elective

subjects to acquire the fundamental knowledge of spirituality and the skills as Christ’s

representative in providing comfort of body, mind and spirit filled faith in God which is the goal

of nursing program or the Bachelor of Science in Nursing curriculum.

A total of four representatives from among Religion or religious group include Catholic

priests, Ministers and or Pastors of other denominations as panel of experts in decision making in

spiritual aspect of education and two (2) representatives from Commission on Higher Education

will be invited as panel members of experts who are authorized in the aspect of integrating

spirituality in curriculum development. There are 20 total number panel of expert participants in

the study coming from (4) four groups; namely, student nurses and staff nurses, including

Nurses in the faculty of instruction, Religious group representatives, Commission on Higher

Education leaders, and the community group represented by parents.

Exclusion Criteria of each group of Participants

Exclusion criteria are defined as features of the potential study participants who meet the

inclusion criteria but present with additional characteristics that could interfere with the success

of the study or increase their risk for an unfavorable outcome. Exclusion criteria as to:
 28

identification of group member representatives that has an indication of the following: Any

health problem/s that would prevent them to fully commit their time to finish the entire process

of (4) four iterative rounds in answering questions during the data collection process, indications

of having little or no interest in the research topic and inaccessible internet connection for online

communication and other technical issues in using the computer or other (ICT) Internet

Communications Technology issues.

SIGNIFICANCE OF THE STUDY

The result of the study will benefit the following:

Nursing Education

Faculty who will be teaching the theoretical foundation of spirituality will be encouraged to

teach the subject competently. Further, students will be equipped with knowledge and techniques

to be aware of their own spirituality and develop confidence before entering the actual

uncomfortable space of clients with different culture and spiritual beliefs.

Nursing Practice

Nursing students and registered nurses will appreciate nursing as a noble

profession because in the discharge of their daily duties they are serving the Lord Christ in the

upliftment and restoration of the bio-psycho-socio-cultural and spiritual wellbeing of the human

person

Staff nurses

Staff nurses will cooperate more with students and clinical instructors as they work

together in harmonious relation in providing spiritual nursing care to clients

Community
 Parents will experience high level of satisfaction knowing that their children will learn to29

be more faithful to God, law abiding and morally upright in service to God and fellowmen.

Spiritual nursing practice

Spiritual care is considered to be a nursing responsibility but there is a lack of role

clarity. There is no agreed definition of what is meant by spiritual, spiritual need, and spiritual

care. Obtaining a consensus on contextual definition of spirituality will make comprehension

clear and simple.

Nursing Administration

The result of the study would help achieve one of the missions of the academic institution

which is to develop God fearing employees, students and would be graduates of the College.

Administrators are influential leaders of honesty in words and deeds and reflect character and

integrity among its members in school and in the community

DEFINITION OF TERMS

BSN Curriculum

Lists of general education and major nursing subjects from 1 st year to 4th year that need to be

completed before graduation.

Consensus

Percentage of panelist agreement or endorsement on rankings which ranges from 51% to a

more cautious 70%.

Contextual definition

Something written or spoken that immediately precede, or follows a word or passage that

influence or contribute to its full meaning.

The Delphi Approach

 30

A systematic process which aims to gather information on a specific issue, involves a

group of experts that reach consensus through iterative rounds with the use of self administered

open ended questionnaires (Sekaye & Kennedy, 2017). Expert panelists do not meet physically

and maybe geographically dispersed

LEVEL 1,II, III AND IV NURSING STUDENTS

Nursing students who are enrolled in general education subjects, and affiliating in 1

secondary hospital in Region IV-B from 1st semester and second semester School year 2021-

2022.

Spiritual Care –. Refers to activities that help the patient make meaning out of her/his

experience. It includes listening, physical presence, praying and teaching topics such as the

healing

( paralytic, blind and lame, and other worst diseases of body and spirit) ministry of Jesus Christ

from the New Testament Bible, that will direct the minds to God as the healer of the soul, body,

mind and spirit

Spirituality – Connectedness to God, Self and Others

 CHAPTER 2

METHODOLOGY

This chapter presents the research design, population and sampling, participants of the study,

research instruments, validation of the instrument/s, data gathering procedure, ethical

considerations and data analysis tools that will be employed in the treatment and analysis of data

Research Design

The researcher will utilize a qualitative Delphi approach to have greater range of

perspective about the topic. A qualitative approach is useful because it preserves more of the

nuance or subtle distinction from the initial narrative brainstorming about the topic throughout

the entire process. The narrative data from Round 1 loses some of its distinctiveness as the data

are treated quantitatively for the ensuing rounds. To demonstrate the proposed method, there are

four rounds process of data collection that will be utilized in the study (Sekaye & Kennedy

2017). Round 1, consists of individual participant open-ended brain storming that is the basis of

the questionnaire presented in a series of statements about the topic via electronic means.

Processing of the gathered raw data consist of the following steps: 1. Use Open coding to label

statement ( Strauss, 1987). It involves initial sorting of the data by assigning descriptive labels

for small segment of texts 2. Use Axial coding to analyze and group statements (Strauss, 1987).

This step is more analytical as judgment are by the researcher about how the descriptive code fits

together to make meaning. Step 3. Generation of the list of statements using the categories

generated from the axial coding process. This step requires some rewording of individual

statements to create a composite group response. Round 2 is the presentation of the list of
 32

statements to the participants (Panel of experts). This involves collection of narrative comments

on the statements from participants, compilation of modifications by the researcher and creation

of revised and or new statements by the researcher. Round 3. Presentation of the final statements

to the panel for endorsement. Panelists would designate statements as strongly, moderately or

minimally endorsed with narrative description to promote consistency in the meaning of the

rankings. Round 4. Presentation of findings. A total of sixteen Panel of experts will use (%)

percentage for strongly endorsed to present the final result. The entire steps are challenging but

well understood by the researcher and it is more convenient in administering and following up

online data gathering in four rounds of different levels of questions through open coding, axial

coding and final statements, to reach a consensus.

Population and Sampling

This study will use non-random, purposive sampling technique composed of panel of

expert stakeholders regardless of its location. Purposive sampling refers to the sample being

selected purposely and depends on the researcher’s judgment, in line with the aim of the study,

regarding whom he/she judges to be typical of the population and is particularly knowledgeable

about the issues being studied (Laerd Dissertation 2018; Crossman 2018, Shariff 2015). The

representative participants comes from groups of nursing students from four year levels, faculty,

staff nurses, religious group, and higher education leaders : Two (2) for Level 1, two (2) for

Level 2, two (2) for level 3 and two (2 ) from Level 4 nursing students, two (2) staff nurses and

two (2) faculty on instruction, two (2) two parents, four (4) religious group representatives, and

two (2) Higher Education leaders. A total of 20 participants from 4 groups.

Research Instrument
 33

Prior to actual data collection, the questionnaire will be submitted to three experts for

clarity and understanding. The data collection instrument is a self-administered open ended

(Burns & Grove, 2015), questionnaire designed to solicit information about a topic of interest,

using sixteen expert panelists for qualitative Delphi method, to provide sufficient diversity of

perspective by the use of written or encoded questions or statements. The data solicited are self-

reported by the panelist representing their knowledge, perception or experience on the topic

(Sekaye & Kennedy 2017 ). In presenting the research instrument for Round 1 to Round 4 of the

qualitative Delphi method, a self administered open ended questions are rephrased

topics/brainstorm prompts taken from the Statement of the Problem and research questions,

formatted according to Sekaye and Kennedy (2017), sample table ( see Appendix D Research

Instrument) utilized by former nursing students advisee in their Phd dissertation. The fourth

round aims to achieve an endorsement on the contextual definition of spirituality and proposed

subtopics of a course outline on spirituality and religion being an elective subject of all year

levels in CMO 15s.2017. The themes of spirituality are taken from summary of systematic

reviews conducted by researchers from year 1996-2020.

1. How do you express spirituality and religion in terms of your relationship to God, to Self and

Others?

2. Which of the following themes of spirituality as to:

searching for purpose and meaning of life, transcendence, relationships to self, family, others,

community, society, nature, and the sacred are referring to the context of God (transpersonal)

Self (interpersonal) and Others (intrapersonal)?

3. Rate whether highly endorsed, moderately endorsed or not endorsed the proposed definition of

spirituality and subtopics below that are associated to God, Self and Others as component of a

course outline of spirituality and religion being an elective subject in CMO 15 s.2017.

3.1. Spirituality means Love God supremely and our neighbor as ourselves 34
3.2. Introduction to the Bible of Old and New Testament
3.3. The Life and Teachings of Jesus Christ

3.4. Ministry of Healing

3.5. Man as a living soul with body, mind and spirit

The instrument of the study is a self-administered questionnaire that contains an open

ended questions. Refer to Appendix D. In round 1 the responses of the panelists are presented in

the first column of the table; the open code for the response follows in the second column (one

for each response, even if repeated); the third column includes the axial code (which reflects one

or more open codes); the final column is the statement that results from the data. This round is

qualitative in the conventional version of Delphi, but guidance is not provided on how to analyze

the raw data and convert them to statements to be presented for participant feedback. This

modification provides instruction on how to reduce the data and create statements that represent

the nuance of the original data.

In round 2, the statement resulting from the round 1 process is presented to the

participants. In this round, participants have the opportunity to offer narrative comments on

each statement. Participants’ comments are either integrated into the statement or, if different

enough, are developed into a new statement. As in Round 1, narrative feedback allows the

preservation of nuance in the qualitative data. Table 2 includes the sample results of this

process.

In round 3, the researcher either integrates the participants’ narrative comments into the

original statement or uses the comments to create a new statement. All participants are given
the revised and/or new statements to endorse. Value is added in this qualitative version of the

process as the narrative feedback can result in new and more detailed statements for

participants’ consideration. This qualitative process results in findings that are more refined. In

the original process the feedback for this Round takes the form of participants reviewing one
35
another’s Likert-type responses and deciding whether or not to change their own.

In the fourth and final round, the first two statements from Round 3 Table 3 (see worked

sample of Sekaye and Kennedy 2017 in Appendix A), would be presented as findings as

moderately and strongly endorsed. The third statement should be noted in an appendix, to the

report for interesting but not endorsed statements or presented as a recommendation for future

research consideration. In either case, the explanation for the moderately or not endorsed

categories are presented alongside the data; this is value added in this modification of Delphi.

Note that each participant is asked to offer an endorsement decision on all statements regardless

of his/her role in providing and/or revising it.

Validation of Instrument

Content Validity

Refers to the judgment of the panel of experts on the extent of which the content of the

questionnaire appears logical and comprehensive which includes all the characteristics of the

domain being explored. Content validity can be improved through the following: developing data

collection instrument that is informed by published literature, pretesting the tool, carefully

analyzing the data from the first questionnaire, and including expert panelist who are

knowledgeable on the topic being studied. Furthermore Rounds 2 and 3 should confirm the

validity and concepts by giving the panel of experts an opportunity to review

Reliability
 This refers to the ability of the instrument to yield similar results when repeating the

same study using similar conditions, and produce the same or similar consistent results. Keeney,

Hasson and McKenna (2011) suggest that Delphi survey enhances reliability because in decision

making process the members of the expert panel do not meet face to face, which eliminate group
36
bias or group thinking. Panel size and iterative rounds increase the reliability

Data Gathering Procedures:

Before the actual gathering of data, the research paper will be submitted to

institutional ethics review committee of St. Paul University, Manila for final screening and

approval. The database with the current information pertaining to the expert panelists needs to be

created, to help the researcher determine whom to include in the study, with attention to

accomplishing the objectives of the study. Seek permission and request informed consent from

the panel of experts. Before the actual data gathering, the questionnaire will be submitted to three

experts for clarity. If clear and understandable, will proceed to data collection through four (4)

rounds of qualitative Delphi method with a total of (20) twenty participants coming from four (4)

groups. Data on contextual definition of spirituality and its course content narrative responses are

subject to open coding, axial coding, and final statement.

The expert panelists can be contacted before the start of the study to gauge their interest

and ability to participate, as it does require time and effort. Questionnaires can be posted or

emailed. Follow up of expert panelists is important does impact the number of individuals who

will finally be part of the study. The first round of questions will be sent to the final set of

committed expert panel participants. Following the first round, the questionnaires are analyzed

by the researcher according to specified instructions using Modified Qualitative Delphi

procedure by Sekaye and Kennedy (2017), from Round 1 until Round 4 iterations. The process
 37

of data collection for the second and third rounds is identical to the first round. Then, the second

questionnaire is developed based on the strong themes and ideas that are identified from round 1.

The third questionnaire is modified depending on the cumulative responses to the second

questionnaire. Areas where there was no consensus in the second round can be omitted from the

third round. Consensus ranges from 51% to a more cautious 70% ( Polit & Beck, 2017). The

second questionnaire is sent to the participants who responded to the first questionnaire. Some

studies are known to include the entire sample (initial sample); even those who did not respond.

In other studies, only those who participated in the previous round are included in the

subsequent round. The rationale being that those who do not return questionnaires may have not

responded because they may not have enough knowledge about the topic (Khodyacov, Grantt,

Denger, Kinnett, Martin Peay, and Coultier, 2019). In this study, the researcher will just include

the participants who responded the previous questionnaire.


Spirituality and Religion
within the context of God
Delphi survey procedures
1. Pre tested 1st round
questionnaire to identified
Panel of Experts (PE)
2. Send out round 1 Quests
to PE (thesis)
3.Analysis of Returned
Questions and Formulate
2nd Questions
4. Send out Round 2
Questions to PE
(antithesis)
5. Analysis of Returned
Questionions and
Formulate Round 3
Questions
7. Send out Round 3
Questions to PE
(antithesis)
8. Analysis of Returned
Quests and Formulate
Round 4 Quests (Syntehsis)
9. Consensus
Identification of 20 expert
panelist on the topic
38
Course outline on
Self and Others
Contextual definition of
spirituality endorsement
Data Analysis Procedures
Round 1 – Individual
participant open ended
brainstorming on the
topic via electronic
Delphi Qualitative means.
Approach: Round 2 – Presentation of
the list of statements to
the participants (panel of
experts)
ethics approval on the Round 3 - Presentation of
dissertation proposal the final statements to the
panel for endorsement
Round 4 Presentation of
Findings. Narrative
responses are analyzed
through open code, axial
Submit application for code and final statement
title/proposal validation to (Sekaye &Kennedy 2017)
SPUM
Formulation of research
Literature review informs
proposal, study questions
the research questions and
and design
methodology
 Submit 3 titles of the study
to St. Paul university and
Adviser
I

R
Figure 2. Shows the data gathering flow chart and data analysis procedures in qualitative Delphi39
B
Method.

Data Analysis Procedure

In order to analyze and interpret the data that will be gathered, a Delphi method will be

utilized to collect information on a specific issue, from selected panel of experts/participants to

reach a consensus through iterative rounds with the use of self administered questionnaire

(Appendix D. Round 1 of no. 1 question, Sekaye & Kennedy, 2017), whose opinions are

anonymous, may not meet physically and may be geographically dispersed.

Final statement

open axial

endorsement/consensus Code

Narrative responses

4 rounds of data analysis

 34

Figure 3. Data Analysis for Qualitative Delphi technique

Figure 3 shows the four (4) steps in qualitative Delphi method including four (4) rounds of data
40
analysis, open and axial coding, and the final statements leading to consensus using Thurtone

Scaling of Strongly endorsed, Moderately endorsed and Not endorsed ( Sekaye 2017,Thurstone
40
& Chave, 1929).

These steps utilize qualitative analysis computer packages or done manually. The

similarities and differences are identified. Words and phrases can be grouped by cutting and

pasting the Word document into clusters of similar ideas and concepts and highlighting in

different codes. This helps in grouping similar concepts together and identifying the most

commonly occurring concepts. The analysis of this phase can be undertaken independently by

the researcher; the notes will be compared to validate the concepts that occur. The concepts that

most commonly occur are then developed into close ended questions which will then be

developed into the 2nd questionnaire and succeeding rounds.

Ethical considerations

To ensure that the study maintains high ethical standards before the data gathering

procedure, the approved proposal will be submitted for ethical clearance to research and ethics

boards of St. Paul University Manila. Once approved, the following activities will be followed:

writing a letter to the Dean of St. Paul University Graduate School asking for permission to

present the study to panel of experts for proposal and research instrument validation. Refer to

Figure 2. Data gathering flow chart and data analysis procedures in qualitative Delphi method).

Right to Autonomy and Informed Consent

The participants’ rights are safeguarded by explaining the benefits, rights and

risks that are involved in the research study, by writing and securing consent indicated in the
front cover of the questionnaire, sign it and return it to the researcher. A cover letter that
41

explains the purpose of the study at every round of the study is also attached. In addition, the

researcher’s contact information will be available to the participants so they that have the

opportunity to contact the researcher for any questions. These measures support the ethical41

principles of respect and the right to self determination and of obtaining an informed consent

Right of Self Determination

Participants choose what information they share with the researcher; and they are free to

withdraw. However, participants should be informed beforehand that once the aggregate or total

number of the group are finally collected, withdrawal from the study is highly discouraged

because data are no longer individual but in aggregate group summaries.

Anonymity and Confidentiality

Anonymity is a key feature of Delphi survey, described as the concealment of the

identity of the participants in all documents resulting from the research which serves four

fundamental purposes: It assures the expert panelists’ rights; prevents group think; prevents

dominance by influential or high profile individuals; and encourages independents decision-

making ( Shariff 2015). The participants’ individual responses may never meet each other or

know who has participated in the process. Furthermore, there is the guarantee of anonymity of

the participants’ individual responses and these are never known to one another (Davidson,

2013). Anonymity can be achieved by the following: Participants may be completely unknown

to each other; furthermore there should be no other panelists to respond, raise opinion to other

panelist and their identities should not be revealed. In highly specialized areas the panelists may

determine who the others are, though their judgments and opinions are anonymous, and this is

called quasi-anonymity. The nature of the Delphi survey requires that the researcher follow up
expert panelist, which prevents total anonymity from that aspect as well, rendering it quasi-

anonymous. Confidentiality is maintained by delinking the data from the person and assigning

codes or numbers for returned questionnaires.

42

unstr

Appendix A.Worked Example of Qualitative Delphi (Sekaye and Kennedy 2017)

Using data created by Sekayi, Table 1 presents an example of round 1 of the modified
qualitative Delphi method. The topic and brainstorm prompt regards how doctoral students
experience the dissertation writing process. The responses of the panelists, comprised of doctoral
students in a college of education in the midst of writing the dissertation, are presented in the
first column of the table; the open code for the response follows in the second column Dia Sekayi
and Arleen Kennedy 2017 (one for each response, even if repeated); the third column includes the
axial code (which reflects one or more open codes); the final column is the statement that results
from the data. This final round is modified qualitative in the conventional version of Delphi
which provides instruction on how to reduce the data and create statements that represent the
nuance of the original data. Ways on how to analysis of data is specifically stated in each round
of iterations

Table 1. Round 1 Topic and Brainstorm Prompt:

How do doctoral students experience the dissertation writing process?
_____________________________________________________________________________
Narrative
Responses Open code axial code final statement___

I felt dumb the Always felt dumb Feeling of inadequacy

whole time

It seemed that no
matter what I wrote, Constant criticism Belief in ability before
my advisor tore it
apart

I thought I was
admitted to the Capable upon entry I felt confident in
doctoral program my ability and
because I was seen intellect before
as capable entered the program
but the constant
criticism throughout
the process led to feelings
 of inadequacy
Our charge was to Ability to produce
write a document original research
that reflected
original research. I
believed I could do
it.
43
There was constant constant criticicm
Demeaning criticicm
Constant criticism
My adviser was constantly constant criticism
Making notes to cite this
or that

Am I not capable of challenge to intellect Feeling of inadequacy

Original thought

Table 2. Round 2 Sample Narrative Comments and Modifications___________________

Statement Narrative comments Narrative Comments Narrative comments
Panelist 1 panelist 2 panelist 3_____
I felt confident Add “relatively” It wasn’t just the The cohort structure was
In my ability and before confident constant criticism supportive, on the one
Intellect before I throughout the process hand, but made me feel
Entered the program that made me feel inadequate when I
But the constant inadequate; I found struggled and had to
Criticism throughout other elements of the retake one of the classes
The process led to structures of the program with a different cohort.
Feelings of inadequacy demeaning. At one point, Because of the structure,
I had to quit my job to everyone knew I was not
to have any real chance in their cohort, they
of finishing since in were nice enough but I
internship was required felt small

Table 3. Round 3 Endorsement of Statements______________________________________

Statement____Endorsement/Panelist1__Endorsement/Panelist2 Endorsement/panelist_
I felt relatively moderately strongly endorsed strongly endorsed
Confident in my endorsed (no modifications) (no modifications)
Ability and (only experienced
Intellect before constant criticism
I entered the no other elements
Program, but of program
The constant structure led to feelings
Criticism and/ of inadequacy)
or other elements
of the program
Structure through
out the process led
to inadequacy 44

The cohort structure strongly endorsed strongly endorsed strongly endorsed

was supportive

The cohort structure

Came with added
Pressure to perform not endorsed not endorsed strongly endorsed
(has no experience with not endorsed strongly endorsed
with the subject of
this statement or
does not agree with
the statement on any
level)
 45

Appendix B. Letter to the Dean

September 2021

Dr. JENNIFER JOY OLIVAR

Dean, College of Nursing and Health Sciences
St. Paul University Manila, Graduate School

Dear Dean Olivar;

Greetings of Peace and Abiding Presence of the Lord! This is to formally request Dr. Lily F.
Famadico as my Dissertation adviser with the title “ God Self and Others: A Qualitative Delphi
Method of Defining Spirituality in Nursing and Teaching Content I believe that her expertise will
guide the researcher in her chosen topic.

Respectfully,

ALICE JOY M. AQUINO, RN. MN.

Phd Nursing Education Student

Recommending Approval

Dr. JENNIFER JOY OLIVAR

Dean, College of Nursing and Health Sciences
St. Paul University Manila

Adviser

Dr. LILY F. FAMADICO

SPUM-Faculty

10

46

Appendix C. Letter to Participants

Aug 2021

Dear Participants:

The undersigned is a student of Doctor of Philosophy Nursing Major in Leadership and

Management in St. Paul University Manila Graduate School. She is presently working on her

dissertation entitled “ God, Self and Others: A Qualitative Delphi Method of Defining

Spirituality in Nursing and Developing Teaching Content”. The study aims to achieve a

consensus on the contextual definition of Spirituality and teaching content of course outline and

religion common to all year levels of the BSN Curriculum (CMO 15s.2017). Specifically the

study will answer the following research questions

How do the following stakeholders define contextual meaning of spirituality in terms of

their relation to God (transpersonal), self (intrapersonal) and others Interpersonal) as to:
1.1 faculty;
1.2 staff nurses;
1.3 nursing students; and
1.4 higher education leaders?
Which of the following themes such as searching for purpose and meaning of life,
transcendence, relationships to self, family, others, community, society, nature, and the
significant or sacred are categorized by the participants within the context of God (transpersonal)
Self (interpersonal) and Others (intrapersonal)?
 What teaching content of course outline on spirituality and religion can be taught in all
year levels of BSN Curriculum may be proposed?
. What is the level of endorsement of nursing students, parents, faculty, clinical instructors,
hospital nurses, religious and higher education leaders on the contextual definition of spirituality
and subtopics, that will constitute the course outline of spirituality and religion in nursing as to:49
4.1. spirituality means loving God supremely and our neighbor as ourselves
4.2. Introduction to The Holy Bible; 47
4.3. The Life and Teachings of Jesus Christ; and

4.4. Ministry of Healing

4.5. Man as a living soul: body, mind and spirit

In this regard, you have been chosen as one of the panel of experts to answer 4 round

questions and modify as necessary, endorse or recommend, in order to arrive at a consensus, in

terms of contextual definition of spirituality and Course content Outline of Spirituality and

Religion for CMO 15 s.2017. Rest assured that your answers will be handled with utmost

confidentiality and limited only to the main objective of the study. Attached is a worked example

guide of four round process with an example on how to completely fill up the tables with

answers.

Thank you very much

Sincerely yours,

Alice Joy M. Aquino

 48

Appendix D. Research instrument

_____________________________________________________________________________.
Table 1. Round 1 Question to 20 Participants
English: How do you define contextual meaning of spirituality in terms of their relation to
God (transpersonal), self (intrapersonal) and others Interpersonal)
Tagalog: Paano mo ipinapahayag ang iyong spiritualidad at relihion sa pamamagitan ng
iyong relasyon sa Diyos, sa sarili mo at sa ibang tao?
Instruction: Write your answer under the narrative response column only
Tagubilin: Isulat lamang ang inyong kasagutan sa hanay ng Narrative Responses column

Narrative Responses Open coding by the Axial coding by Final statement by

column of Panelist/s No.__ researcher the researcher the researcher
Relationship to GOD
Relasyon sa Diyos

Relationship to Self
Relasyon sa sarili

Relationship to Others
Relasyon sa Ibang tao
 49

Round 2 Question to 20 Participants on Research Problem No. 1 with Narrative

Comments and Modifications
English: How do you define contextual meaning of spirituality in terms of their relation to
God (transpersonal), to Self (intrapersonal) and others Interpersonal)
Expert Participants may add or integrate narrative comment/s from
summary
statement of Round 1 or if different, developed into a new statement?
Tagalog: Paano mo ipinapahayag ang iyong spiritualidad at relihion sa pamamagitan ng
iyong relasyon sa Diyos, sa sarili mo at sa ibang tao?
Ang mga ekspertong kalahok (expert participants) ay may kalayaang mag dagdag
o gumawa ng bagong pangungusap hango sa summary (buod) ng Round 1.
Instruction: Write your answer under the narrative comments column/panelist. Write
your number under narrative comment for recording purpose
Tagubilin : Isulat lamang ang sagot sa hanay ng narrative comments/panelist. Isulat din
ang inyong numero upang maitala ng tama.

Table 2.
Round 1 Summary Statement of the Researcher Narrative Comments/Panelist Number ___
Buod ng pangungusap ng Researcher Komento ng mga Panelist
Relationship to GOD Relasyon sa Diyos

Relationship to Self Relasyon sa sarili

Relationship to Others Relasyon sa Ibang tao

 50

Round 3. Endorsement Statements from 20 Participants on Research Problem Number

1
English: How do you define contextual meaning of spirituality in terms of their relation to
God (transpersonal), self (intrapersonal) and others Interpersonal)?
Expert Participants may add or integrate narrative comment/s from summary
statement of Round 2 or if different, developed into a new statement, and rate the
revised or new statement as to: not endorsed, moderately endorsed (with
modification) or strongly endorsed (no modification).
Tagalog: Paano mo ipinapahayag ang iyong spiritualidad at relihion sa pamamagitan ng
iyong relasyon sa Diyos, sa sarili mo at sa ibang tao?
Ang mga ekspertong kalahok (expert participants) ay may kalayaang mag dagdag
o gumawa ng bagong pangungusap hango sa summary (buod) ng Round 2 at
bigyan ng marka (grade) kung: hindi pinahihintulutan, may katamtamang
pahintulot ngunit may dapat baguhin o idagdag na kataga, at mataas na pahintulot
(walang pagbabago).
Instruction: Write your level of endorsement under the column of narrative
comment/panelist. Write your assigned number for recording purposes
Tagubilin: Isulat ang antas ng inyong pahintulot sa hanay ng Narrative
Comment/ panelist. Palagiang isulat ang inyong numero upang ma itala nang
tama
Table 3
The Researcher integrates the Narrative Comments/Panelist Number _____
participants/panelist’ narrative level of Endorsement
comments from Table 2 into the
original statement or uses the
comments to create a new
Statement/s on
Integration of all participants
narrative comment on
Relationship to GOD:

Integration of all participants

narrative comment on
Relationship to Self

Integration of all participants

narrative comment on
Relationship to Others
 51

Round 4. Level of Endorsements, Analysis and Interpretation of Final findings on

Research question number 1

In the 4th and final round, all levels of endorsement marked by 20 panel of experts from 4

groups of participants will be processed by tallying the results one by one (Calmorin, 2016) for

succeeding rounds of problem statements. The first two or three statements from Table 3 with

say for example moderately and strongly endorsed level of endorsements, will be presented as

the final findings. In instances when the third or fourth statements will receive a grade of not

endorsed and strongly endorsed, it should be noted as interesting but not endorsed statements or

presented as a recommendation. See example table 4 below

Table 4. Contextual meaning of Spirituality based on Round 3

20 PARTICIPANTS IN GROUPS OF 4 (four)

Statements Strongly X/% Moderately X/ % Not endorsed X/ % Final Findings

endorsed endorsed statement
statement
Relationship
to GOD:

Relationship
to Self

Relationship
to Others

Scale:

= Strongly endorsed = Not endorsed with recomendations

= Moderately endorsed
 52

Round 1 Question to 20 Participants on Research Problem number 2

English: Which of the themes below do you attribute the words to God
(transpersonal), Self( intrapersonal), and Others ( interpersonal)?
searching for purpose and meaning of life, transcendence, relationships to self,
family, others, community, society, nature, and the significant or sacred
Tagalog Alin sa mga sumusunod na salita ang may kaugnayan o nauukol sa Diyos, sa
Sarili at sa ibang tao?
Humahanap kung ano ang layunin at kahulugan ng buhay; kataastasan(transcendence);
, relasyon sa Diyos; pamilya; ibang tao; communidad; lipunan; kalikasan; at
banal na bagay
Instruction : Write your answer and assigned number as participant/s on the narrative
response column
Tagubilin : Isulat ang inyong kasagutan at numero bilang tanda ng participant/s sa
hanay ng narrative response

Table 1
Participant No.___ Open coding by Axial coding by the Final statement by
Narrative response the researcher researcher the researcher
within the context of
Relationship to God
(transpersonal)
relasyon sa Diyos

Relationship to Self
relasyon sa sarili
(intrapersonal)

Relationship to Others
relasyon sa kapwa tao
(interpersonal)

53
Round 2 Question to 20 Participants with Narrative Comments and
Modifications on Research Problem number 2
English: Which of the following themes do you attribute the following words to God
(transpersonal), Self( intrapersonal), and Others ( interpersonal)?:
searching for purpose and meaning of life, transcendence, relationships to self,
family, others, community, society, nature, and the significant or sacred
Expert Participants may add or integrate narrative comment/s from summary
statement of Round 1 by the researcher or if different, developed into a new
statement.
Tagalog: Alin sa mga sumusunod na salita ang may kaugnayan o nauukol sa Diyos, sa Sarili
at sa ibang Tao? :
Humahanap kung ano ang layunin at kahulugan ng buhay;
kataastasan(transcendence);
, relasyon sa Diyos; pamilya; ibang tao; communidad; lipunan; kalikasan; at
banal na bagay.
Ang mga ekspertong kalahok (expert participants) ay may kalayaang mag dagdag
o gumawa ng bagong pangungusap hango sa summary (buod) ng Round 1 na
isinulat ng researcher.
Instruction : Write your answer and assigned number as participant/s on the narrative
Comments/panelist column
Tagubilin : Isulat ang inyong kasagutan at numero bilang tanda ng participant/s sa
hanay ng narrative response

Table 2.
Round 1 Summary Statement of the Researcher Narrative Comments/Panelist Number ___
Buod ng pangungusap ng Researcher base sa Round 1 Komento ng mga Panelist
God (transpersonal):

Self (Intrapersonal):

Others (interpersonal):

54

Round 3. Endorsement Statements from 20 Participants on Research Problem number

 2
English: Which of the following themes do you attribute the following words to God
(transpersonal), Self( intrapersonal), and Others ( interpersonal)?
searching for purpose and meaning of life, transcendence, relationships to self,
family, others, community, society, nature, and the significant or sacred
Expert Participants may add or integrate narrative comment/s from summarized
statements made by the researcher from Round 3 Narrative comment/s or if different,
are developed into new statement and rate the revised or new
statement as to: not endorsed, moderately endorsed (with modification) or strongly
endorsed (no modification).
Tagalog: Alin sa mga sumusunod na pananalita o kataga ang may kaugnayan o nauukol sa
Diyos, Sa Sarili at sa ibang tao? :
Humahanap kung ano ang layunin at kahulugan ng buhay;
kataastasan(transcendence);
, relasyon sa Diyos; pamilya; ibang tao; communidad; lipunan; kalikasan; at
banal na bagay.
Ang mga ekspertong kalahok (expert participants) ay may kalayaang mag dagdag
o gumawa ng bagong pangungusap hango sa summary (buod) ng Round 3 na isinulat
ng researcher. at bigyan ng marka (grade) kung:
hindi pinahihintulutan, may katamtamang pahintulot ngunit may dapat
baguhin o idagdag na kataga, at mataas na pahintulot (walang pagbabago).

Instruction: Write your level of endorsement under the column of narrative

comment/panelist. Always write your assigned number for recording purposes
Tagubilin: Isulat ang antas ng inyong pahintulot sa hanay ng Narrative
Comment/ panelist. Palagiang isulat ang inyong numero bilang palatandaan sa
Table 3 record ng Participants.
The Researcher integrates the participants’ Narrative Comments and level of endorsement
narrative comments from Table 2 into the original /Panelist Number: ____
statement or uses the comments to create a new
Statement/s on
Integration of all participants narrative comment
on themes about :God (transpersonal)

Integration of all participants narrative comment

on themes about Self( intrapersonal)

Integration of all participants narrative comment

on themes about Others (interpersonal) 55

Round 4

. In the 4th and final round, all levels of endorsement marked by 20 panel of experts from 4

groups of participants will be processed by tallying the results one by one (Calmorin, 2016) for
succeeding rounds of problem statements. The first two or three statements from Table 3 with

say for example moderately and strongly endorsed level of endorsements, will be presented as

the final findings. In instances when the third or fourth statements will receive a grade of not

endorsed and strongly endorsed, it should be noted as interesting but not endorsed statements or

presented as a recommendation. See example table 4 below

Table 4. Attributes/themes of Spirituality based on Round 3

20 PARTICIPANTS IN GROUPS OF 4 (four)

Statements Strongly X/% Moderately X/ % Not endorsed X/ % Final Findings

endorsed endorsed statement
statement
Themes about God
(transpersonal)

Themes about Self

( intrapersonal)

Themes about Others

(9nterpersonal)

Scale:

= Strongly endorsed = Not endorsed with recommendations

= Moderately endorsed

56

Round 1 Question to 20 Panelists Narrative comments on Research Problem Number 3

English: What teaching content of course outline on spirituality and religion can be taught in
all year levels of BSN Curriculum may be proposed?
Expert Participants may add or integrate narrative comment/s on each statement or
if different, are developed into a new statement of the proposed definition of
spirituality, the subtopics and description that is included in the course outline of
spirituality and religion in CMO15s.2017. .
Tagalog Ano ang mga aralin na nakapaloob sa course outline ng spiritualidad at
relihiyon na maaaring ituro ng sabayan sa lahat ng antas ng BSN
 Curriculum ang nais ninyong imungkahi?
Ang mga expertong kalahok ay kailangang mag dagdag ng mga comment sa bawat
pananalita o kaya ay mag likha ng mga bagong pananalita ukol sa iminungkahing
kahulugan ng spirituality at mga aralin na maaaring isama upang bumuo sa course
outline ng spiritusality at relihion ng CMO 15s.2017.
Instruction: Write your answer under the narrative response column only. Always write
your number to distinguish individual records of participants
Tagubilin: Isulat lamang ang inyong kasagutan sa hanay ng Narrative Responses column
Palagiang isulat ang inyong numero bilang palatandaan sa record ng Participants.
Table 1
Researcher’s Narrative Responses Open coding Axial coding Final statement
Proposed Definition of Panelist/s Number
of Spirituality ___
Spirituality is
defined as loving
God supremely and
our neighbor as
ourselves
Introduction to Old
and New Testament
of the Holy Bible
This course describes
this wonderful and
beautiful universe where
God created man. It
quicken the senses of
students and marvel as
the Bible reveal how the
earth, though small
among the planets, was
given to him as a place
of habitation 57
The Life,Teachings and
Ministry of Jesus Christ

This course is a study of

the life, ministry, and
teachings of our Lord
Jesus Christ as portrayed
in the gospels. This
course attempts to
interpret the significance
and relevance of the life
and teachings of Christ
in the present historical
situation .

3.Ministry of Healing
The Ministry of
Healing course provides
a well-rounded look at
the principles of
healthful living,
beginning with the
ministry of Jesus and
extending to the life and
ministry of nurses as
they care for their clients
across the lifespan
Man as a living
soul: body, mind
and spirit
The topic focus on the
Human being as a living
soul consisting of spirit,
mind and body animated
by the breath of life from
God. The human spirit is
the only spiritual side of
our being that desire to
connect with God

58

Round 2 Question to 20 Panelists on Research Problem number 3 with Narrative

Comments and Modifications
English :What teaching content of course outline on spirituality and religion can be taught
in all year levels of BSN Curriculum may be proposed?
Tagalog : Ano ang mga aralin na nakapaloob sa course outline ng spiritualidad at
relihiyon na maaaring ituro ng sabayan sa lahat ng antas ng BSN
Curriculum ang nais ninyong imungkahi?
Instruction : Expert Participants may add or integrate narrative comment/s from summary
statement of Round 1 or if different, developed into a new statement.
 Write your answer in the panelist’s narrative comments/modifications
Column with your assigned number as participant
Tagubilin : Ang mga ekspertong kalahok (expert participants) ay may kalayaang mag dagdag
o gumawa ng bagong pangungusap hango sa summary (buod) ng Round 1.
Isulat lamang ang sagot sa hanay ng narrative comments/panelist. Isulat din
ang inyong numero bilang palatandaan ng participant/s

Table 2
Round 1 Summary Statement of the Researcher Narrative Comments/Panelist Number ___
Buod ng pangungusap ng Researcher Komento ng mga Panelist
Proposed Definition of Spirituality Statement
Spirituality is defined as loving God supremely
and our neighbor as ourselves

Introduction to Old and New Testament of the

Holy Bible
This course describes this wonderful and beautiful universe
where God created man. It quicken the senses of students and
marvel as the Bible reveal how the earth, though small
among the planets, was given to him as a place of habitation

The Life,Teachings and Ministry of Jesus Christ

This course is a study of the life, ministry, and teachings of

our Lord Jesus Christ as portrayed in the gospels. This course
attempts to interpret the significance and relevance of the life
and teachings of Christ in the present historical situation .

59
3.Ministry of Healing

The Ministry of Healing course provides a well-rounded look

at the principles of healthful living, beginning with the
ministry of Jesus and extending to the life and ministry of
nurses as they care for their clients across the lifespan

Man as a living soul: body, mind and spirit

The topic focus on the Human being as a living soul
consisting of spirit, mind and body animated by the breath of
life from God. The human spirit is the only spiritual side of
our being that desire to connect with God

60

ROUND 3. Question to 20 Panelists on Research Problem number 3 with Narrative

Comments and Endorsement statements.
English: What teaching content of course outline on spirituality and religion can be taught
in all year levels of BSN Curriculum may be proposed?
Expert Participants may add or integrate narrative comment/s on each statement or
if different, are developed into a new statement, and rate the revised or new
statement to either not endorsed, moderately endorsed (with modification) or
strongly endorsed (no modification).
Tagalog Ano ang mga aralin na nakapaloob sa course outline ng spiritualidad at
relihiyon na maaaring ituro ng sabayan sa lahat ng antas ng BSN
 Curriculum ang nais ninyong imungkahi?
Ang mga expertong kalahok ay kailangang mag bigay ng (grade) marka kung:
hindi pinahihintulutan, may katamtamang pahintulot ngunit may dapat
baguhin o idagdag na kataga, at mataas na pahintulot (walang pagbabago).
Instruction: Write your level of endorsement under the column of narrative
comment/panelist. Write your assigned number for identification and
recording purposes in space provided under narrative comment/panelist
Tagubilin: Isulat ang antas ng inyong pahintulot sa hanay ng Narrative Comments/
panelist. Isulat and inyong numero upang maging palatandaan sa pag record.
Table 3
The Researcher integrates the Narrative Comments/Panelist Number __
participants/panelist’ narrative comments
from Table 2 into the original statement or
uses the comments to create a new
Statement/s as:
Proposed Definition of Spirituality Statement
Spirituality is defined as loving God supremely Level of endorsement
and our neighbor as ourselves

Introduction to Old and New Testament of

the Holy Bible
This course describes this wonderful and beautiful Level of endorsement
universe where God created man. It quicken the senses of
students and marvel as the Bible reveal how the earth,
though small among the planets, was given to him as a
place of habitation

The Life,Teachings and Ministry of Jesus Christ

This course is a study of the life, ministry, and teachings Level of endorsement
of our Lord Jesus Christ as portrayed in the gospels. This
61
course attempts to interpret the significance and relevance
of the life and teachings of Christ in the present historical
situation .

3.Ministry of Healing

The Ministry of Healing course provides a well-rounded

look at the principles of healthful living, beginning with
the ministry of Jesus and extending to the life and
ministry of nurses as they care for their clients across the
lifespan

Man as a living soul: body, mind and spirit

The topic focus on the Human being as a living soul
consisting of spirit, mind and body animated by the
breath of life from God. The human spirit is the only
spiritual side of our being that desire to connect with God
 62

ROUND 4

In the 4th and final round, all levels of endorsement marked by 20 panel of experts from

4 groups of participants will be processed by tallying the results one by one (Calmorin, 2016) for

succeeding rounds of problem statements. The first two or three statements from Table 3 with

say for example moderately and strongly endorsed level of endorsements, will be presented as

the final findings. In instances when the third or fourth statements will receive a grade of not

endorsed and strongly endorsed, it should be noted as interesting but not endorsed statements or

presented as a recommendation. See example table 4 below

Course Content of Spirituality based on Round 3

 Table 4 20 PARTICIPANTS IN GROUPS OF 4

Statements Strongly X/% Moderately X/ % Not endorsed X/ % Final Findings

endorsed endorsed statement
statement
Proposed
Definition of
Spirituality
Statement
Spirituality is
defined as loving
God supremely
and our neighbor
as ourselves
Introduction to
Old and New
Testament of
the Holy Bible
This course
describes this
wonderful and
beautiful universe
where God created
man. It quicken the
senses of students
and marvel as the
Bible reveal how the63
earth, though small
among the planets,
was given to him as
a place of habitation
The Life,Teachings
and Ministry of
Jesus Christ

This course is a
study of the life,
ministry, and
teachings of our
Lord Jesus Christ as
portrayed in the
gospels. This course
attempts to interpret
the significance and
relevance of the life
and teachings of
Christ in the present
historical situation .
3.Ministry of
Healing
The Ministry of
Healing course
provides a well-
rounded look at the
principles of
healthful living,
beginning with the
ministry of Jesus
and extending to the
life and ministry of
nurses as they care
for their clients
across the lifespan
Man as a living
soul: body,
mind and spirit
The topic focus on
the Human being as
a living soul
consisting of spirit,
mind and body
animated by the
breath of life from
God. The human
spirit is the only
spiritual side of our
being that desire to
connect with God
64
Scale: = Strongly endorsed = Not endorsed with recommendations

= Moderately endorsed

Appendix E. Teaching Content of Spirituality

Course ELECTIVE 1: Spirituality and Spiritual Care Nursing

Name

Course Elec 1
Code

Course This course deal with, history, philosophy, theory, principles, process, modes and
description intervention of spiritual care. Emphasis is made on the contextual definition of
spirituality, process of spiritual formation through interconnectedness of God
(transpersonal) Self (intrapersonal) and Others (interpersonal) relationship. and
the role of the nurse in providing spiritual care.

Course 2 units lecture

Credit

Contact 36hrs/sem
hours/sem

Pre-requisite none

Placement All year levels 1st semester

Course
Objectives Given relevant situations/conditions, the student will be able to
1.Define spirituality in the context of God, Self and Others relationship
65 the
2.Apply principles, theories and strategies of spiritual care that meets
individual spiritual needs of clients
from
3. Demonstrate traits and characteristics of the nurse that reflects wholistic
spiritual development
Course
Outline 1.Definition of spirituality in the context of
1.1. God (Transpersonal)
1.2. Self (Interpersonal )
1.3. Others ( Intrapersonal )
2.The Nature of Spirituality in Man as a bio-spirit-psycho-socio-cultural
being
3.Spiritual Need
3.1. Clarifying spiritual needs in 3 dimensions .
. 3.1.1. physical/biological .
. 3.2.2. spiritual .
. 3.2.3. psycho-socio-cultural
4. History of Spiritual care in Nursing
4.1 Pre-Christian era
4.2 Christian Era
4.3 Post Reformation Era
5. Nursing views of spirituality and spiritual care (1960-70s.to present)
6. Nursing Theorists Concepts, Theories, The Bible and application in the
care of the human spirit
6.1 Introduction to the Holy Bible
6.2 Virginia Henderson
6.3 Faye Abdella
. 6.4 Joyce Travelbee
6.5 Betty Newman
6.6 Parse
6.7 Jean Watson
Appendix E. Teaching Content of Spirituality
7. Ethics in Spiritual Care Nursing
8. The Life and Teachings of Jesus and Nurse Role in Spiritual Care
8.1 Understanding own spirituality and spiritual needs
8.2 Resolving ones spiritual concern and conflicts
8.3 Recognizing ones spiritual strengths and weaknesses/limitations
8.4 Mobilizing patient’s expressed needs through transpersonal, interpersonal and
 intrapersonal connections with God Self and Others
8.5 Establishment of nurse-client trusting relationship
8.6 Respect for client’s culture. social and spiritual preferences
9. The Ministry of Healing and Patient’s Needing Spiritual Care
9.1 Patient in Acute Illness
9.2 Older Adult with Chronic Illness
9.3 Children and Families
9.4 Dying and Bereavement
9.5 During disasters
9.6 During emergencies
10. Personal Reflection on spiritual development
11. Meeting the Challenge
11.1 The therapeutic use of self in the restoration of body mind and spirit
11.2 The need for love and relatedness, meaning and purpose in life

66

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