See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/354282121

Assessment of Spiritual Well-being and Nursing Students' Spirituality in a

University in Nigeria

Article · June 2021

CITATIONS READS

0 1,149

9 authors, including:

Matthew Idowu Olatubi Olufemi Oyebanji Oyediran

Bowen University Obafemi Awolowo University
50 PUBLICATIONS 355 CITATIONS 42 PUBLICATIONS 106 CITATIONS

SEE PROFILE SEE PROFILE

Oluwakemi Christie Ogidan Mary Oyenike Ayorinde

Ekiti State University, Ado Ekiti University College Hospital Ibadan
16 PUBLICATIONS 97 CITATIONS 7 PUBLICATIONS 47 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Matthew Idowu Olatubi on 05 July 2022.

The user has requested enhancement of the downloaded file.

Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Assessment of Spiritual Well-being and Nursing Students’ Spirituality in a University in

Nigeria

Matthew Idowu Olatubi1 RN, RM, RPHN, HND, MSc. Nursing

Olufemi Oyebanji Oyediran2 RN, RPON, MSc. Nursing
Iyanuoluwa Oreofe Ojo3* RN, RM, PHN, MSc. Nursing
Oluwakemi Christie Ogidan4 RN, RM, RPHN, MSc. Nursing
Mary Oyenike Ayorinde5 RN, RM, MSc. Nursing

1
Department of Nursing Science, Bowen University, Iwo, Osun State, Nigeria
2
Department of Nursing Science, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
3
Department of Nursing, University of Ibadan, Oyo State, Nigeria.
4
Department of Nursing Science, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria.
5
Department of Clinical Nursing, University College Hospital, Ibadan, Oyo State, Nigeria.

Corresponding Author:
Iyanuoluwa Oreofe Ojo3*
Email: adubiiyanu@gmail.com
Phone no: 08032797187

Authors’ contributions:

This work was carried out in collaboration between all authors.

Olatubi, conceptualized the study, performed the statistical analysis,
Oyediran and Ojo collected the data.
Ojo, wrote the draft of the manuscript and contributed to the intellectual review.
Olatubi and Ojo managed the analyses of the study.
Oyediran, Ogidan and Ayorinde managed the literature searches. All authors read and approved
the final manuscript.

Abstract
Introduction: Spirituality in nursing care cannot be over emphasized in as much as man is a
biopsychosocial being. Nursing students who are pivotal to patients’ care in future need to be
assessed, with a view towards given information on their spirituality and spiritual care.
Therefore, this study assessed the spiritual well-being and spiritual perspective among nursing
students in a Nigeria University.

Methods: Descriptive design was explored. One hundred and seventy-three nursing students
were selected using simple random sampling technique. Study instruments were Spiritual
Perspective Scale and Spiritual Well-being Scale which are used to elicit information about
spiritual well-being, religious well-being and existential well-being of the nursing students.

11
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Descriptive statistics was used to present results and hypotheses were tested with Pearson
correlation p≤0.01

Results: The finding from the study shows that 50.3% of the students had received training in
spiritual nursing during the course of their undergraduate training. And 75.1% of the students
have positive spiritual well-being while 81.5% and 68.2% had a positive religious and existential
well-being respectively. Correlation exists among the three groups in spiritual well-being,
existential well-being and religious well-being respectively.
Conclusion: The study provides an outlook of the nursing curricula in Nigeria. Therefore,
spirituality in nursing training should be encouraged both in education and practice in order to
improve the quality of care giving to patient.

Keywords: Spiritual well-being; spiritual perspective; religious well-being, nursing students.

Introduction
Recently, holistic approach to people is supported by all branches of science which consider a
person as a whole (Chandramoha and Bhagwan, 2015). Holistic nursing which is grounded on
caring, relationship and interconnectedness is founded on a philosophy of living. A nurse who is
holistic takes a mind–body -spirit-emotion- environment approach into the practice of nursing
and also recognizes and integrate the modalities and principles of holistic healing into practice
and daily life (Barlow, 2011; Wu, Liao & Yeh, 2012) as the spiritual aspect of health care is
steadily gaining importance (Kalkim, Midilli & Baysal, 2016).

Spirituality is the manner of practicing loved-based attitudes which are integrated into an into an
individual's everyday life. Kurus, (2016) report that spirituality as the possibility of making
meaning through the individual’s intrapersonal, interpersonal and transpersonal relationships
which empowers such individual to transcend. Also, she further clarified that spiritual
perspectives are the degree to which spirituality saturates their lives and they take part in
spiritually-related interactions (Reed, 1987). It is therefore spiritual perspectives that direct
decisions, provide support, and articulates personal values / morals. And help cope with illness,
pain, sorrow, and loss. To Vaillot (1970), Spirituality is “the quality of those forces which
activate us or are the essential principle influencing us.

Spiritual care is defined as the care that nurses provide to meet patient’s spiritual needs and/ or
problems (van Leeuwen, Tiesinga, Middel, Post & Jochemsen, 2009). Spiritual care is not often
included as a central element of holistic and multidisciplinary care (Layhwa, 2011; Vlasblom,
van der steen, Knol & Jochemsen, 2011). Over the years, spiritual care was a key component of
holistic nursing care. Sadly, many major medical and educational programs have not yet
provided spiritual care as part of their standardized or core curricula, (Shih, Gau, Man, Chen &
Lo, 2011). Nurses regularly perform nursing assessments, but typically no examination of
spiritual needs is performed which often results in lack spiritual care. The International Council
of Nurses Code acknowledges the spiritual aspect of nursing and offers spiritual care to all
nurses as an important duty (Pesut, 2001). Health care professionals accept the role of spiritual
health care in the overall health and well-being of clients (Pesut, 2001; van Leeuwen, Tiesinga,
Middel, Post, Jochemsen, 2009.

12
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

According to Tomasso, Beltrame & Lucchetti, (2011), educating nursing students is one of the
most important items for their future careers and developing a sense of spirituality in nursing
students can provide patients with the safest means of providing spiritual care. Their study shows
that positive attitudes and perceptions of nurses’ own spirituality may foster a delicate sensitivity
to other spiritual issues and an elevated understanding of spirituality that might be useful in the
evaluation process (Vincensi, 2011).

Also, some studies done on spiritual care include a study carried out in South Africa by
(Chandramohan and Bhagwan, 2015), on faith and spiritual care in the sense of nursing
education in 2015, which found that 77.1% of participants remembered having some spiritual
care training in their student years, but most practicing nurses are still inadequately trained to
provide spiritual care, suggesting that the education provided was insufficient (Chandramohan
and Bhagwan, 2015). In another study carried out in Turkey, it has been shown that nursing
students do not have sufficient perception of spirituality and spiritual care, thus recommending
improvement of educational curricula with regard to spirituality and spiritual care in order to
improve the perception of spirituality and spiritual care among nursing students. In a study
carried out in Philippine, obstacle to the provision of spirituality treatment such as lack of time,
inadequate awareness and different beliefs of both patients and nurses were discovered. A study
was carried out by Kimmot, Caranto & David, (2015) exploring how student nurses
conceptualize and provide spiritual care. They found out that providing clients with basic
spiritual nursing care does not require consent or agreement, but consent may be necessary in
providing spiritual nursing care involving belief systems, theological worldviews or doctrinal
practices. They also submitted that the most popular and simplest type of spiritual songs. The
spiritual care constraints highlighted include lack of time, and guidance or not provided with the
spiritual principles during their learning experiences and lecture (Kimmot, Caranto & David,
2015).

Hsiao, Chiang & Chien, (2010), posit that spiritual care is a holistic type of care and is therefore
designed to reach the deep but intangible human needs that are vital for the promotion of good
health, such as inner strength and peace. Even at that, Folami and Onanuga, (2018), stated that
studies in some countries have shown that nursing students' understanding of spirituality and
spiritual care is not appropriate and that most practicing nurses are still inadequately trained to
provide spiritual care, suggesting that the education provided is insufficient, thus preventing
patients from receiving holistic treatment. Therefore, if nurses can evaluate spiritual needs and
establish approaches to help patients meet their spiritual needs, they can help promote quality of
life and minimize patient distress (Barber, 2008).

Materials and Methods

Research Setting
The study was conducted in the Department of Nursing, Obafemi Awolowo University, Ile Ife.
Osun State, Nigeria. The University is strategically located in Southwest Nigeria. The University
is the major institution of higher learning in the city and one of the leading academic institutions
in West Africa.

13
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Sample and Sampling Technique

The total population was 251 clinical nursing students, of these, 92 students in their 3 rd year, 86
in their 4th year and 73 in their 5th year. However, a total of 173 questionnaires were fit for
analysis.
Inclusion Criteria
1. Clinical nursing students who were in their third, fourth and fifth year.
2. The clinical nursing students must have had a foundation of nursing course during his or her
training.
Exclusion Criteria
The clinical first- and second- year were exempted.

Instrumentation
The recruitment of nursing students from the university was possible through self-administration
by the head of the departments and class coordinators. The questionnaires were administered to
the students at the close of lectures to ensure that they were relaxed. Data collection spans a
period of three weeks. Information was collected using related questionnaires. These included
elements produced by Palutzian and Ellision (1998) on the Spiritual Well-being Scale (SWB)
and Reed’s Spiritual Perspective Scale (SPS) (1986) and a demographic information sheet.
Spiritual Well-being Scale is a magnitude of 20 items. Each of the 20 items on SWB scale is
scored from one to six in a Likert –type format; the highest score possible for the SWB scale is
120. The classification of score is as follows: low 20-40, moderate 41-99, and high spiritual well-
being 100-120. Reed’s Spiritual Perspective Scale consists of 10 items graded in a 6-point Likert
response format, ranging from strongly disagreeing to strongly agreeing on questions of spiritual
values and from not at all to about once a day on questions of spiritual experiences. For the SPS
and each of the two subscales, the average score is calculated as the arithmetic mean across all
aspects, and can range from one to six, representing spiritual values or spiritual experience.
Samples greater or better spiritual viewpoint reflect higher numbers than the mean score
obtained between 1 and 6(3/5). For the overall scale the highest possible sum score is 60, and for
each of the subscales the highest possible sum score is 30. Furthermore, the validity of the scale
was evaluated by spirituality care and religious studies experts and Cronbach Alpha for
reliability were (SWB= 0.7; SPS= 0.8) in the present study; The participants completed the
questionnaire within 10-20 minutes.

Data Analysis
Data were analysed using version 16.0 of the Statistical Package for Social Sciences. Descriptive
such as frequency and percentage were used to present the data and inferential statistics, Pearson
correlation were used to test the hypotheses at significance level of P< 0.05.
Ethical Consideration
Permission was taken from the Head of Department, Nursing Science, Obafemi Awolowo
University, Ile Ife. Osun State before the study commenced. The researchers adhere to the ethical
principles that guided the study which are the principles of informed consent, respect for persons,
beneficence, non-maleficence, and justice. All of these were done to ensure that the participation
was voluntary and that respondents were aware of confidentiality and anonymity. Confidentiality
was maintained by not giving out participant’s information obtained during the study. Also, the
participants were to write their names or endorse them with any identifier. Participants were made

14
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

to know that they are free to withdraw their consent at any time and end their participation in the
research without any fear of retribution or withdrawal of privileges.

Results
The response rate was achieved at 68.92 per cent (N=173 out of 251). There was 59(34.1%) third
–year students, 62(35.8%) fourth –year students and 52(30.1%) fifth –year students. Most
participants in total were females 144(83.3%).

Table 1. Socio-demographic characteristics of the participants N=173

Frequency Percentage (%)
Age in years 16 – 20 16 9.2
21 – 25 119 68.8
26 – 30 31 17.9
31 and above 7 4.0
Mean = 23±3.19
Sex Male 29 16.8
Female 144 83.2
Marital status Married 22 12.7
Single 151 87.3
Religion Christianity 155 89.6
Islam 16 9.2
Traditional 2 1.2
Denomination Catholic 16 10.3
N = 155 Orthodox/Protestant 31 20.0
Pentecostal 108 69.7
Level in school Part three 59 34.1
Part four 62 35.8
Part five 52 30.1
Ethnicity Yoruba 148 85.5
Hausa 1 0.6
Igbo 10 5.8
Benin 5 2.9
Others 9 5.2
It is important for nurses to Yes 151 87.3
offer patients spiritual No 22 12.7
assistance
Receive training on Yes 87 50.3
spiritual nursing during No 86 49.7
undergraduate course
Receive training on Yes 8 4.6
spiritual nursing during No 165 95.4
seminal/workshop

15
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Also, as reflected in Table 1, the mean age of study participants 23±3.19 with over half (68.8%)
of study participants in the age range 21 and 25 years. The vast majority (83.2%) were female
while 87.2% were single. The religious background of the students in the analysis showed that
89.6% were Christians and 85.5% Yoruba’s. Also, 50.3% of the students show that they had
received spiritual training during the undergraduate course. Further, majority 87.3% said it is
important for nurses to offer spiritual assistant to their patients/ clients. Half (50.3%) of the
students show that they had received spiritual training during the undergraduate course. Further,
the majority 87.3% said it is important for nurses to offer spiritual assistant to their patients/
clients.
Table 2. The result of the participants on spiritual well-being, religious well-being, and
existential well-being
Negative Positive X̄ (SD) F P
Spiritual Well-being 43 (24.9) 130 (75.1) 102.03±9.98 0.19 0.30

Existential Well-being 55 (31.8) 118 (68.2) 49.95±5.31 1.35 0.26

Religious Well-being 32 (18.5) 141(81.5) 52.08±5.51 0.61 0.55

As reflected above, the majority of the students (75.1%) have positive spiritual well-being of the
mean score 102.03±9.98 while 68.2% and 81.5% had positive existential and religious well-
being respectively.

Table 3: Result showing correlation between the students’ spiritual health and their
spiritual perspective
Spiritual Well- Spiritual Perspective
being
Pearson Correlation 1 .402**
.000
N 173 173

As shown above, the students’ spiritual well-being was found to be high related to their spiritual
perspective (correlation = 0.402, P=0.00).

Discussion of Findings
Results of this study showed that half of the students had received training in spiritual nursing
during the course of their undergraduate training and majority said it is important for nurses to
offer spiritual assistant to their patients/clients. This is smaller than what was reported in findings
of a study conducted in South Africa (Chandramohan and Bhagwan, 2015) on spirituality and
spiritual care in the context of nursing education in 2015, showing that 77.1% of participants
acknowledged receiving some spiritual care training in their student years, but that most
professional nurses are still inadequately prepared to provide spiritual care, showing that the
education they received was inadequate ( Chandramohan and Bhagwan, 2015). In another related
study carried out by (Kalkim, Midilli & Baysal, 2016) for Turkey nursing students were shown

16
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

to receive training in their education on spirituality and spiritual care. The findings of this study
are close to that of Bayan, Amani & Mohamed, (2018) which reported that nurses had a spiritual
outlook and valued the value of providing their patients with spiritual care Hussey, (2009). A
similar study conducted in Nigeria Folami and Onanuga, (2018) also indicates that spirituality
and spiritual care have training in spiritual care in order to offer spiritual assistant to their
patients or clients. However, only a few of the students in this study had undergone such training
in any seminar or workshop. In contrast, a study in Iran revealed the Iran’s nursing education
program has yet to integrate spiritual care into its extensive curriculum (Abbasi et al., 2014).
Despite having established that nurses have more spiritual awareness and close relationships with
patients after nursing training programs on spiritual care and feel more capable of providing
spiritual care (van Leeuwen et al., 2009; Hubbell; Woodard, Barksdale, Brown & parker, 2006).
Findings of this study showed that the majority of the students have positive spiritual well-being
with a mean score of 102.03±9.98, while 68.2% and 81.5% had positive existential and religious
well-being respectively. This is contrary to the findings of Abbasi et al., (2014) study where all
students ' spiritual well-being was in moderate score range. These findings are similar to the
results of the study Pesut, (2001), in that there was a high range score in spiritual well-being in
both groups. Overall, students in Pesut, (2001) study had a strong sense of personal spirituality
and a high spiritual health level. This could be because student nurses are worried about their
own spiritual health, then it was easy to provide the patients with adequate spiritual treatment.
Such results are not shocking, since virtually all Nigerian communities are religious.

The results also found that there was no significant difference in moral well-being between the
three classes (1.09, 0.34; 1.35, 0.26; & 0.61, 0.55 respectively). This is similar to a study
conducted in Iran in the sense of personal well-being, faith and spiritual treatment for nursing
students in which it was assumed that there were no significant differences in spiritual
perspective and spiritual care perspectives between the two groups (Abbasi et al., 2014). Finally,
the results show that the students’ spiritual well-being was found to be high related to their
spiritual perspective (Correlation =0.402, P=0.00). The Stranhan, (2001), however, contrasted
with the findings of this study in that there was no significant difference in their faith and
spiritual treatment experience between the two classes.

Conclusion
The research concluded that majority of the students have positive spiritual well-being with more
having positive religious well-being than existential well-being, perhaps it could be because the
student nurses are worried about their own spiritual health. Also, Nigeria’s rich culture and
beliefs offer a valuable opportunity for students to reflect on their religious traditions and on
their personal spiritual journeys. This research provides tentative insights into the prospects of
spiritual well- being, spirituality and spiritual care for nursing students. This study is limited to,
nursing students in year three, four and five respectively and available literature. However, this
does not invalidate the outcome of this study.

Consent and Ethical Approval

Permission was taken from the Head of Department, Nursing Science before the study
commenced. Consent was sought from the participant and only those that volunteered were
recruited. Anonymity and confidentiality were ensured.

17
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Recommendations
 It is recommended that including spiritual care in the curriculum of nursing students’
courses at all levels will add to their understanding and provision of spiritual care.
 Strategies should be made on how to improve the understanding of nursing students’
existential well-being thereby enhancing, providing and carry out spirituality care.
 Further studies need to be undertaken to gain more insight into longitudinal investigations.
 Also, we suggest more studies on identifying the spiritual care facilitators and barriers to
promote nursing students’ skills regarding spiritual well-being.
Competing Interests
Authors have declared that no competing interests exist.

References
Abbasi Mojgan, Marhamat Farahani-Nia, Neda Mehrdad, Azam givari, and Hamid Haghani
(2014). Nursing students’ spiritual well-being, spirituality and spiritual care. Iran Journal
of Nursing Midwifery Research. 9(3):242-7

Barber JR. Nebraska (2008). Nursing students’ perception of Spiritual awareness after
participating in a Spirituality. A Dissertation Presented to the Faculty of College of Saint
Mary

Barlow A. (2011). Spirituality in Nursing; Available from: http://www.allnurses.com/nursing-

and-spirituality/spirituality-in-nursing-646693.html. [Last accessed on 2018 June, 10].

Bayan Kaddourah, Amani Abu-Shaheen & Mohamad AL-Tannir (2018). Nurses’ Perceptions of
Spirituality and Spiritual Care at Five Tertiary Care Hospitals in Riyadh, Saudi Arabia: A
Cross-Sectional Study. Oman Medical Journal 33(2): 154–158.

Callister LC, Bond AE, Matsumura G, & Mangum S. (2004). Threading spirituality throughout
nursing education. Holistic Nursing Practice. 18:160–6.

Carron, R. & Cumbie, S.A. (2011). Development of a Conceptual Nursing Model for the
Implementation of Spiritual Care in Adult Primary Healthcare settings by Nurse
Practitioners, Journal of the American Academy of Nurse Practitioners. 23:552-560.

Chandramohan S, Bhagwan R. (2015). Spirituality and spiritual care in the context of nursing
education in South Africa. Curationis; 38:53-9.

Chandramohan, S., & Bhagwan, R. (2016). Utilization of spirituality and spiritual care in nursing
practice in public hospitals in KwaZulu-Natal, South Africa. Religions, 7(3), 23.

Folami F Florence, Onanuga Adenike Khadijah (2018). Perception of spirituality, spiritual care,
and barriers to the provision of spiritual care among undergraduate nurses in the
University of Lagos, Nigeria. Journal of Clinical Science. 15(1):8-12.

18
Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Hsiao C, Chiang HY, Chien LU. (2010). An exploration of the status of spiritual health among
nursing students in Taiwan. Nurse Education Today. 30:386–92.

Hubbell SL, Woodard EK, Barksdale-Brown DJ, Parker JS. (2006). Spiritual care practices of
nurse practitioners in federally designated no metropolitan areas of North Carolina.
Journal of America Academic Nurse Practice.18:379–85.

Hussey, T. (2009). Nursing and spirituality. Nursing philosophy, 10(2), 71-80. in Partial
Fulfillment of Requirements for the Degree of Doctorate in Health Education with Health
Professional Education. Published 25th July, 2008.

Jenkins ML, Wikoff K, Amankwaa L, Trent B. (2009). Nursing the Spirit. Nursing Management
8:29–36.

Kalkim A, Midilli T, Baysal E (2016). An investigation of the perceptions and practices of

nursing students regarding spirituality and spiritual care. Religions. 7:101-13.

Katherine L, Cooper Kl, Chang E, Sheehan A, Johnson A (2013). The impact of spiritual care
education upon preparing undergraduate nursing students to provide spiritual care. Nurse
Education Today 33:1057–61.

Kimmot H, Caranto L, David J (2015). Spiritual care of BSU student nurses. International
Journal of Nursing Science 5:53-9.

Kurus M. (2016). Physical, Emotional, Mental and Spiritual Health. Available from:
http://www.mkprojects.com/fa_ PEMHealth. [Last accessed on 2018 June 7].

Layhwa L. (2011). Thesis for the Degree of Doctorate of philosophy (Nursing) Singapore:
National University of Singapore Nursing students’ perceptions and attitudes about
spirituality and spiritual care in practice.

Pesut B. (2001). The development of nursing Students’ spirituality and spiritual care-giving.
Nurse Education Today. 22:128–35.

Reed, P.G. (1987). Spirituality and well-being in terminally ill hospitalized adults. Research in
Nursing and Health, 10(5), 335-344.

Seymour B (2009). What do nurse students understand by spirituality and spiritual care? Scott
Journal of Healthcare Chaplain. 12:38–46.

Shih FJ, Gau ML, Mao HC, Chen CH, Lo CH (2001). Empirical validation of a teaching course
on spiritual care in Taiwan. Journal of Advance Nursing 36:333–46.

Stranhan S (2001). Spiritual perception, attitudes about spiritual care, and spiritual care practices
among nurse practitioners. West Journal of Nursing Research. 23:90–104.

19
View publication stats

Journal of Positive Psychology and Counselling, Vol. 8 June 2021

Tiew LH, Drury V (2012). Singapore Nursing Students’ Perceptions and attitudes about
spirituality and spiritual care in practice: A qualitative study. Journal of Holistic
Nursing.30:160–9.

Tomasso CS, Beltrame IL, Lucchetti G. (2011). Knowledge and attitudes of nursing professors
and students concerning the interface between spirituality, religiosity and health. Rev Lat
Am Enfermagem. 19:1205–13.

Vaillot M.C. (1970) The spiritual factors in nursing. Journal of Practical Nursing 20(9):30-31.

van Leeuwen R, Tiesinga LJ, Middel B, Post D, Jochemsen H (2009). The effectiveness of an
educational programme for nursing students on developing competence in the provision
of spiritual care. Journal of Clinical Nursing 17:2768–81.

van Leeuwen R, Tiesinga LJ, Post D, Jochemsen H (2006). Spiritual care: Implications for
nurses’ professional responsibility. Journal of Clinical Nursing. 15:875–84.

Vincensi BB (2011). Illinois: Loyola University Chicago; Spiritual care in advanced practice
nursing. Dissertations paper for the degree of doctor of philosophy program in nursing.

Vlasblom JP, van der Steen JT, Knol DL, Jochemsen H (2011). Effects of spiritual care training
for nurses. Nurse Education Today 31:790–6.

Wu LF, Liao YC, Yeh DC (2012). Nursing student perceptions of spirituality and spiritual care.
Journal of Nursing Research. 219-27.

20