ASSESSMENT OF SPIRITUAL INTELLIGENCE AND COMPETENCES IN

PROVIDING SPIRITUAL CARE AMONG NURSING STUDENTS IN BOWEN

UNIVERSITY TEACHING HOSPITAL,OGBOMOSO

BY

ENIOLA, CHRISTIANAH OLUWADAMILOLA

PRESENTED TO

BOWEN UNIVERSITY

DEPARTMENT OF NURSING SCIENCES

IWO, OSUN STATE

IN PARTIAL FULFILLMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF ‘’REGISTERED

NURSE’’ CERTIFICATE

NOVEMBER, 2022
 DECLARATION

This is to declare that this research project, ASSESSMENT OF SPIRITUAL INTELLIGENCE

AND COMPETENCES IN PROVIDING SPIRITUAL CARE AMONG NURSING

STUDENTS IN BOWEN UNIVERSITY TEACHING HOSPITAL,OGBOMOSO,NIGERIA,

was carried out by ENIOLA, CHRISTIANAH OLUWADAMILOLA is solely the result of my

work except where acknowledged as being derived from other person(s) or resources.

Examination Number: N/22/10147

In the Department of Nursing Science, Bowen University, Iwo.

Signature____________________ Date_____________________

ii
 CERTIFICATION

This is to certify that this research project by ENIOLA, CHRISTIANAH

OLUWADAMILOLA with examination number N/22/10147 has been examined and approved

for the award of Registered Nurse Certificate.

________________________ __________________________
DR. OLATUBI, MATTHEW IDOWU Date
RN, RM, RPHN, HND, BNSc, MSc, PhD
Department of Nursing Science,
Bowen University, Iwo
Project Supervisor

________________________ ____________________________
DR. CHIZOMA M. NDIKOM Date
RN, RM, RNE, ROHN
BSc (Nursing Education)
MSc (Medical Sociology)
MSc (Maternal and Child Health Nursing)
Ph.D. (Maternal and Child Health Nursing), FWACN
Head of Department

_________________________ _____________________________
Chief Examiner Date

iii
 DEDICATION

This research project is dedicated to Almighty God, the Alpha and Omega, who kept me

throughout the period of my study.

I also dedicate this project to all nursing students who responded at Bowen University, who took

out time to fill the questionnaires despite their busy schedules.

iv
 ACKNOWLEDGEMENT

I thank the Almighty God for his guidance and His grace throughout the period of my study. He

alone is glorified forever. I am much grateful to the participants of this study because without

them, this study would not have been a success.

To my Project Supervisor, Dr. Olatubi Matthew Idowu, my sincere appreciation goes to you for

your time, support, encouragement, guidance and corrections. God bless you sir.

My sincere appreciation goes to the management of Bowen University for granting me the

permission to go ahead with the study.

I say a very big thank you to my parents; Mr. J.O. Eniola and Mrs. C.O. Eniola, for their support,

words of encouragement, prayers and financial support. Also, to my siblings; Damilare and

Darasimi Eniola and friends,thank you for the regular support and follow up of this study.

Many more thanks to my course mates for the support. You are cherished!

Thank you all.

ENIOLA, CHRISTIANAH OLUWADAMILOLA

v
 TABLE OF CONTENT

PAGE

COVER PAGE

TITLE PAGE……………………………………………………………………… i

DECLARATION…………………………………………………………………… ii

CERTIFICATION…..……………………………………………………………… iii

DEDICATION………………………………………………………………………. iv

ACKNOWLEDGEMENT…………………………………………………………… v

TABLE OF CONTENT……………………………………………………………….. vi

LIST OF TABLES……………………………………………………………………… xi

LIST OF FIGURES…………………………………………………………………….. x

ABSTRACT……………………………………………………………………………… ix

CHAPTER ONE………………………………………………………………………….. 1

INTRODUCTION………………………………………………………………………… 1

1.1 Background of the study………………………………………………………………. 1

1.2 Statement of the problem……………………………………………………………… 4

1.3 Objectives of the study………………………………………………………………… 5

1.4 Research questions…………………………………………………………………….. 6

1.5 Significance of the study……………………………………………………………… 6

vi
1.6 Scope of study………………………………………………………………………… 7

1.7 Research hypotheses…………………………………………………………………. 7

1.8 Operational definition of terms……………………………………………………… 7

CHAPTER TWO………………………………………………………………………… 9

LITERATURE REVIEW……………………………………………………………….. 9

2.1 Introduction…………………………………………………………………………… 9

2.2 Conceptual review……………………………………………………………………… 9

2.3 Empirical review………………………………………………………………………. 20

2.4 Theoretical review…………………………………………………………………….. 23

CHAPTER THREE……………………………………………………………………… 30

METHODOLOGY………………………………………………………………………… 30

3.0 Introduction…………………………………………………………………………… 30

3.1 Research design……………………………………………………………………… 30

3.2 Research setting……………………………………………………………………. 30

3.3 Target population………………………………………………………………….. 31

3.4 Sampling size and formula………………………………………………………… 31

3.5 Sampling technique………………………………………………………………… 32

3.6 Instrument for data collection……………………………………………………… 32

3.7 Validity of instrument……………………………………………………………… 33

vii
3.8 Reliability of instrument……………………………………………………………. 33

3.9 Method of data collection…………………………………………………………… 33

3.10 Method for data analysis…………………………………………………………… 34

3.11 Ethical consideration……………………………………………………………… 34

CHAPTER FOUR……………………………………………………………………… 36

ANALYSIS AND PRESENTATION OF RESULT…………………………………… 36

4.1 Introduction/table of socio-demographic variables………………………………… 36

4.2 Spiritual intelligence table…………………………………………………………… 37

4.3 Spiritual competence table……………………………………………………………… 41

4.4 Spiritual care table……………………………………………………………………… 46

4.5 Answering of research questions……………………………………………………… 49

4.6 Hypotheses testing……………………………………………………………………… 50

CHAPTER FIVE…………………………………………………………………………… 52

DISCUSSION OF FINDINGS, SUMMARY, RECOMMENDATIONS AND

CONCLUSION………………………………………………………………………………. 52

5.1 Introduction……………………………………………………………………………… 52

5.2 Discussion of findings…………………………………………………………………… 52

5.3 Implications of findings with literature support……………………………………… 54

5.4 Implications of findings to nursing…………………………………………………… 55

viii
5.5 Limitations of the study……………………………………………………………… 56

5.6 Summary of the study…………………………………………………………………… 56

5.7 Conclusion……………………………………………………………………………… 57

5.8 Recommendations……………………………………………………………………… 57

5.9 Suggestions for further studies………………………………………………………… 58

REFERENCES……………………………………………………………………………… 59

APPENDIX………………………………………………………………………………… 63

ix
 LIST OF FIGURES

2.2.3 THE PROCESS OF SPIRITUAL CARE………………………………………… 17

2.4.1 JEAN WATSON’S THEORY OF HUMAN CARING…………………………… 29

x
 LIST OF TABLES

Table 4.1 Socio-demographic characteristics……………………………………………… 36

Table 4.2.1 Spiritual intelligence among the respondents………………………………… 37

Table 4.2.2 Dimensions of spiritual intelligence…………………………………………… 41

Table 4.3.1 Respondent’s spiritual competences…………………………………………… 41

Table 4.3.2 Subscales for spiritual care competence……………………………………….. 46

Table 4.4 Spiritual care provided by the respondents……………………………………… 46

Table 4.5.1 Level of spiritual intelligence………………………………………………… 49

Table 4.5.2 Level of spiritual care competence…………………………………………… 50

Table 4.6.1 Spiritual intelligence and spiritual care………………………………………… 50

Table 4.6.2 Socio-demographic data and spiritual competences…………………………… 51

xi
 ABSTRACT

Spirituality as one dimensions of humans has an important role in health. Assessment of spiritual
intelligence, competence and spiritual care, especially in nursing students as future health
providers, is very important. This study assessed the spiritual intelligence and competences in
providing spiritual care among nursing students in Bowen University Teaching Hospital. A
descriptive cross-sectional research design was used. A sample size of 208 was selected from a
total population of 361 students using convenient sampling method. Data were collected using a
personal demographic information form, Spiritual Intelligence Self-Report Inventory-24
Questionnaire, Spiritual Care Competence Scale Questionnaire and Nurses’ Spiritual Care
Therapeutics scale Questionnaire. Validity and reliability with internal consistency were
assessed. Data were analyzed using descriptive and analytical statistics using the SPSS-25
software. The highest age range of the respondents was 18-20 years (32.2%). It was discovered
that 65.4% of the respondents have a moderate level of spiritual intelligence while 76% have a
greater spiritual care competence level. According to the dimensions of spiritual intelligence,
existence of critical thinking is the highest (mean = 15.60±4.84) and the conscious development
as the lowest (mean = 10.10±4.66). Majority (76%) have a greater spiritual care competence
level. The subscales of spiritual care competence were also noted, with professionalism and
quality improvement of spiritual care being the highest (mean=23.49±3.83) and communication
being the lowest (mean=7.72±1.81).There is significant relationship between spiritual
intelligence and spiritual competence(p<0.05). Conclusively, the study found out that majority
had a moderate level of spiritual intelligence, and a greater spiritual care competence level. The
dimensions of spiritual intelligence and competencies were also identified so, nursing students
should be encouraged to actively attend and participate in conferences and seminars where the
concept of spirituality in Nursing is well addressed.

Keywords: spirituality, spiritual intelligence, spiritual competence, spiritual care,nursing

students, validity.

Word count: 285

xii
 CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Holistic care is a comprehensive model requiring attention to all dimensions of an individual,

including not only mental and physical elements but spiritual elements as well (Booth & Kaylor,

2018; Jasemi, et al., 2017). An integral element of holistic nursing is attention to the spiritual

needs of the patient. Nurses should have an active role in meeting their patients’ spiritual needs

because it has been shown to positively correlate with a better quality of life and improved

patient perception of quality and satisfaction of care (Baldacchino, 2015; Richardson, 2012).

Patients who receive spiritual care also have an increased likelihood for entering hospice care at

the end of their life, reduced depression rates, and lower hospitalization costs (Mamier &

Johnston-Taylor, 2015).

Although holistic care incorporates the physical, mental, and spiritual domains of well-being,

most nurses find that meeting a patient’s spiritual needs is a crucial element in this

comprehensive care (Booth & Kaylor, 2018). Nurses stated that spiritual care demands

“mutuality, trust, ongoing dialogue (talking and listening), and enduring presence” (Tirgari,

Iranmanesh, Ali Cheraghi, & Arefi, 2013). It involves not only trusting their patient, their

feelings, and their abilities but also creating patient trust toward a nurse as both a professional

and a person (Tirgari et al., 2013). Researchers have reported spiritual care education is needed

1
in increasing nurses’ spiritual care competence (Blesch, 2015; Cooper & Chang, 2016; Lovanio

& Wallace, 2007; Ross et al., 2016).

Reports from practitioners and published literature clearly indicate that spirituality should be

integrated into nursing care and that its marginalisation can negatively impact on the quality of

care. An assessment of spiritual health seems to be as necessary as physical or psychosocial

assessment. A comprehensive care plan should include a holistic approach to the patient, taking

into account their spiritual needs. Many studies have shown that medical staff providing spiritual

care to patients substantially contributes to their overall well-being, which has a positive impact

on the human immune functions. Having nursing staff include spirituality in their care plans can

help patients find hope and meaning in the course of an illness or crisis. Nurses, on the other

hand, may find that spirituality helps them find meaning and purpose in their work. Therefore,

the authors of many publications argue that nursing should address spirituality in its clinical

practice.

It is worth noting that nurses need special skills such as self-awareness, communication, trust

hope and to be a catalyst for spiritual growth in order to provide spiritual care and achieve

optimal results in patient’s health. In addition, the spiritual self-awareness of nurses improves the

provision of spiritual care. Therefore, spiritual intelligence as a deep self-awareness can lead to

improvements in the provision of this kind of care. Spiritual intelligence is a framework for

identifying and organizing the skills and performance compatibilities needed to use spirituality

and can develop an individual’s ability to solve problems and achieve goals. Faith, humility,

appreciation, the ability to integrate, to control one’s feelings, ethics and ethical behavior,

forgiveness and love are characteristics of spiritual intelligence.

2
Nurses, as the biggest members of healthcare team, who spend more time with their patients than

do other healthcare providers, must recognize the spiritual needs of patients as a domain of

nursing care. Some studies have shown that the way a nurse relates to his/her own spirituality is

an important factor of the quality of the spiritual care he/she will provide. Nurses’ perception of

spirituality can directly influence on how to behave, how to deal with their patients, and how to

communicate with them in favor of providing spiritual care. The importance of nurses’ abilities

to understand their own perception of spirituality before assessing others spiritual needs has to be

stressed. Positive attitudes and perceptions of nurses own spirituality might promote a delicate

sensitivity to others spiritual concerns and an elevated consciousness regarding spirituality,

which could be potentially helpful in the assessment process.

The education of nursing students is one of the most important items for their future career and

developing a sentience of spirituality in nursing students may deliver the surest way to provide

spiritual care for patients. When nurses are accurately educated about spiritual meaning, they

may be more likely to understand how to provide spiritual care and the role of spiritual

interventions. As spirituality is an essential concept related to nursing education and practice, it

can be integrated into patient care as well as nursing education.

Regarding the importance of spiritual care and the relationship between spiritual intelligence and

nursing students' competences, this study was conducted to assess spiritual intelligence and

competences in providing spiritual care among Nursing students in Bowen University Teaching

Hospital, Ogbomoso.

3
1.2 STATEMENT OF THE PROBLEM

Attard et al. (2014) reported the desirability of nursing students in providing spiritual care;

however, the results of the study by Adib Hajbagheri and Zehtabchi (2017) indicated that nurses

did not have a good professional competence in providing spiritual care due to the lack of

education in this regard.Also, in a study conducted by Balboni et al. (2014), it was clarified that

although most nurses and doctors (76%) attempted to provide spiritual care, only 39% of them

managed to provide it. This research reported the lack of time and inadequate education as

causes of the weaknesses in providing spiritual care.

Lundberg (2010) acknowledged that in order to provide holistic care, nursing education

programs should increase nurses’ understanding and awareness of spiritual issues in order to

meet the spiritual needs of patients. However, a review of the literature suggests that nurses do

not receive adequate education regarding spiritual care. Studies on competence in spiritual care

are mostly descriptive, and the evidence which is aimed at improving the nurses’ competence is

limited. In line with factors affecting competence in spiritual care, Ross et al. (2016) stated that

the personal spirituality of nursing students is effective in understanding their competence in

spiritual care.

Despite its benefits, several factors prevent nurses from providing spiritual care. Johnston

Taylor, Mamier, Ricci-Allegra, Foith (2017) reported that nurses do provide spiritual care;

however it is infrequent. However, once nurses use spiritual care therapeutic interventions, they

are more likely to continue doing so with increased frequency(Johnston-Taylor et al., 2017).

Some of the main reasons nurses do not provide spiritual care included the belief that the patients

spirituality is a private matter, feelings of not having enough time to provide spiritual care,

4
difficulty meeting the patients needs when they are different from their own, and a fear of

proselytizing (Gallison et al., 2013; Selman et al., 2018).

In addition, a lack of spiritual care education is a crucial barrier preventing nurses from

providing spiritual care (Cooper & Chang, 2016).A lack of education about spiritual care

provision is one of the most important barriers to overcome. Previous research indicated that

spiritual care education in undergraduate nursing programs positively affects knowledge and

ability to provide spiritual care (Cooper & Chang, 2016; Lewinson, McSherry, & Kevern, 2015).

There is limited literature discussing whether students’ spiritual care competence is increased

following spiritual care education.

Nursing educational system in Nigeria has not yet incorporated spiritual care as part of its

comprehensive or core curriculum. No studies have specifically been done on the subject we

have been concerned about. Bowen University Teaching Hospital is faith based teaching hospital

which is expected to incorporate spiritual care into her activities. It is therefore important to

assess the level of spiritual intelligence and competence among nurses in the hospital and

determine their level spiritual care.

1.3 OBJECTIVES

The broad objective is to assess spiritual intelligence and spiritual competences in providing

spiritual care among nursing students in Bowen University Teaching Hospital (BUTH).The

specific objectives are:

1. To assess the spiritual intelligence of Nursing students in providing spiritual care in

Bowen University Teaching Hospital, Ogbomoso.

5
 2. To assess the spiritual competences of Nursing students in providing spiritual care in

Bowen University Teaching Hospital, Ogbomoso.

3. To assess the level of spiritual care provided by Nursing students in Bowen University

Teaching Hospital, Ogbomoso.

1.4 RESEARCH QUESTIONS

In a bid to achieve the objectives stated above, the following questions are addressed:

1. What is the spiritual intelligence of nursing students in providing spiritual care in Bowen

University Teaching Hospital, Ogbomoso?

2. What is the spiritual competences of nursing students in providing spiritual care care in

Bowen University Teaching Hospital, Ogbomoso?

3. What is the level of spiritual care provided by nursing students in Bowen University

Teaching Hospital, Ogbomoso?

1.5 SIGNIFICANCE OF THE STUDY

The results of this study are relevant to both nursing education in particular and nursing in

general. The outcome gives nurse educators deeper insight into the content of education in

spiritual care, the educational methods used and the possible effects on students ability to

provide spiritual care. It can help educators to consider a more systematic place for spiritual care

within the nursing curriculum.

The study can be used for practical, educational purposes to assess students and fully qualified

nurses’ competencies in the provision of spiritual care at a group level. Assessment can provide

information about the areas in which nurses should receive training to become competent.

6
For nursing in general, this study contributes to the need for a debate on the real place of spiritual

care and the required competencies that student nurses need to develop. Education does have an

impact on the development of competencies in spiritual care, but spiritual care does not yet have

a systematic place in the practice of the nursing curriculum; therefore, it is presented to student

nurses as theory.

1.6 SCOPE OF STUDY

The study on assessment of spiritual intelligence and competences in providing spiritual care

would be carried out on Nursing students of Bowen University Teaching Hospital, Ogbomoso,

Oyo State..

1.7 RESEARCH HYPOTHESIS

Based on the research objectives and research questions the following hypotheses will be tested

in the study:

1. There is no significant relationship between spiritual intelligence and spiritual care among

nursing students in BUTH Ogbomosho.

2. There is no significant relationship between sociodemographic data and spiritual competences

among nursing students in BUTH, Ogbomosho.

1.8 OPERATIONAL DEFINITION OF TERMS

 Spiritual intelligence: Spiritual intelligence is related to the relationship between man

and the universe, the world of creation, and existence in the world. Spiritual intelligence

7
 is the attitude of self-awareness as well as our relationship with God, each other, and all

creatures.

 Competence: It is the ability of the nursing students to assess for and provide

interventions to care for a patient’s spiritual needs. It is defined by the knowledge, skills,

and attitudes needed for delivery of spiritual care.

 Spiritual care: Spiritual care is an aspect of health care that supports the inner person

(spirit/soul) to help deal with the health challenges that a person or loved one is facing.

 Nursing student: It is an individual who is enrolled in a professional nursing or

vocational nursing education program.

8
 CHAPTER TWO

LITERATURE REVIEW

2.1 INTRODUCTION

This chapter consists of the various concepts which include, concepts of spiritual care, spiritual

intelligence and spiritual competence. It also consists of empirical review and theoretical

framework.

2.2 CONCEPTUAL REVIEW

2.2.1 CONCEPT OF SPIRITUAL INTELLIGENCE

Intelligence

Intelligence is our ability to learn, understand and incorporate new skills in life. This helps us

tackle different situations in the best way possible.

Dimensions of Intelligence

There are three dimensions of spiritual intelligence. They are;

Cognitive intelligence(it is our ability to learn, remember, reason, solve problems, and make

good judgments),emotional intelligence(it is our ability to perceive, manage, and regulate

emotions) and spiritual intelligence(it is our ability to be conscious of ourselves, our

environment, and our ability to tap into a higher source of wisdom).This is related to knowing

that we are all connected no matter who we are, where we are from, what our beliefs are, or how

we perceive ourselves.

9
Spiritual Intelligence

Spiritual intelligence is a term used by some philosophers, psychologists, and developmental

theorists to indicate spiritual parallels with IQ (intellectual quotient) and EQ (emotional

quotient).Spiritual intelligence is a higher dimension of intelligence that activates the qualities

and capabilities of soul, in the form of wisdom, compassion, integrity, joy, love, creativity, and

piece.

Characteristics Of Spiritual Intelligence

The characteristics of spiritual intelligence are; a high degree of self-awareness, having the

capacity of flexibility (active and spontaneous adaptation), having the capacity of dealing with

pains and its development and getting inspired of the imaginations and values.

Importance of Spiritual Intelligence

The importance of spiritual intelligence include; to find and use the deepest inner resources from

which comes the capacity to care and the power to tolerate and adapt, to develop a clear and

stable sense of identity as an individual in the context of relationships, to identify and align

personal values with a clear sense of purpose and to live those values without compromise and

thereby demonstrate integrity by example

Procedures To Increase Spiritual intelligence

They are; allocating time for thinking, and reviewing our behavior, using daybook to record daily

events, allocated time for open discussion, planning to integrate our studies, studying life of

spirituality finder, the use of social drama and processing of discussions

Components of Spiritual Intelligence

10
There are about 7 components of spiritual intelligence and they are: caring, enlightenment,

divinity, spirituality in childhood, ultra-sensory perception, psychological trauma and paying

attention to community.

Methods to Learn and Develop Spiritual Intelligence

There are certain methods to unlearn the illusions and misperceptions which stop one from

seeing who you are and being true to oneself. The more these methods are practiced, the faster

the realization and the deeper the development of the spiritual intelligence. They are; meditation,

detached observation, reflection, connecting, practice and seeing.

2.2.2. SPIRITUAL COMPETENCE

Competence

Competence is defined as a set of traits and characteristics which form the basis for optimal

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

management, motivation, education, culture, ethics, spirituality, research and information

technology, and working with devices. The competence of a nurse is effective in guaranteeing

the quality of care services provided for patients and their satisfaction, and a key factor in the

competition intense world for the survival of hospitals.

Spiritual Competence

Spiritual competence in spiritual care refers to a set of skills which are used in the clinical

nursing processes. If nurses become aware of their spiritual condition, they will be aware of the

spiritual state of their patients. This awareness and spirituality in nurses is a prerequisite for

11
creating commitment in the spiritual care process. According to the standards, nurses should

have the required skills for meeting the spiritual needs of patients.

Spiritual care competencies in nursing involve a set of skills used in professional nursing practice

and within the framework of the nursing process, resulting in a positive outcome (Van Leeuwen

et al. 2009). Studies show that nurses lack confidence and competence in providing spiritual care

(Ruder 2013; Taylor 2012). Additionally, in the Netherlands, Van Leeuwen & Almutairi (2015)

indicated that nurses in mental health and home care settings have a generic view of spirituality

and are more competent in delivering spiritual care than nurses in hospital settings.

In Iran, Adib-Hajbaghery et al. (2017) found that three-fourths of Iranian nurses in teaching

hospitals included in their study demonstrated unfavorable competence in spiritual care. As Van

Leeuwen & Almutairi (2015) pointed out, spiritual care competence may be related to individual

characteristics such as age, gender, working experience, and personal views of spirituality, which

can lead to variations in their competence of providing spiritual care.

Tools used in Assessment of Spiritual Care Competence

There are several tools allowing the assessment of nurses’ competence to provide spiritual care,

e.g. Spiritual and Religious Care Competencies for Specialist Palliative Care, Spiritual Care

Competence Questionnaire, Nurses’ Spirituality and Delivery of Spiritual Care, and Spirituality

and Spiritual Care Rating Scale. One of them is the Spiritual Care Competence Scale(SCCS)

developed by van Leeuwen and colleagues. The tool is a reliable tool with good internal

consistency and appropriate correlations between items. Additionally, it has been often applied in

international studies .

12
Ways of Enhancing Nursing Students' Competence in Spirituality and Spiritual Care

The provision of relevant experiences and support to the students' holistic vision of nursing are

important considerations in the development of spiritual care competence (van Leeuwen,

Tiesinga, Middel, Post & Jochemsen, 2008). In addition, modeling of spiritual virtues by the

faculty members and clinical mentors are fundamental ways to promote spirituality and spiritual

care competence among nursing students (Brown et al., 2019).

2.2.3. SPIRITUAL CARE

Definition

Spiritual care is a set of skills used in the professional field or nursing process which include

therapeutic relationships between the nurse and patients, being accessible for patients, active

listening, showing empathy, providing religious facilities for patients with certain religious

beliefs, helping patients, etc. Spiritual care is most simply defined as care that enables persons to

meet three central universal sacred requirements that have the potential to make people

concurrently resourceful and vulnerable. Spiritual care has also been set forth as the care nurses

offer to meet the spiritual wants and/or problems of clients.

Purpose of Spiritual Care

The purpose of spiritual care is to ease patients’ difficulties at the spiritual level and help them

find the meaning of life, self-actualization, hope, creativity, faith, trust, peace, comfort, prayer,

and the ability to love and forgive in the midst of suffering and disease. Additionally, spiritual

care seeks to help patients to face their fears of death, mitigate the uncertainty and discomfort of

the treatment process, and regain their inner peace.

13
In clinical work, spiritual care education and training helps nurses to understand patients’ senses

of honour, values, and experience to express kind concern for their patients, ease patients’ stress

and tension, provide them with spiritual well-being and serenity and let them find meaning and

purpose amidst adversity. Under this care, patients can explore strategies to overcome their

illnesses as well as strengthen their physical, social, and psychological health, thereby improving

their quality of life and state of health.

Spiritual care is a core element of holistic nursing and has already been incorporated into nursing

education and practice. In addition, the ability to provide spiritual care to patients is increasingly

considered a major occupational skill for nurses.

The Process of Spiritual Care

The process of spiritual care is illustrated as starting by identifying spiritual needs. Phase 1 is

then combined with phase 2 – the MMM, which leads to phase 3 – developing the spiritual care

treatment plan and locating the relevant HCP’s to be involved. Phase 4 is then the actual

provision of spiritual care. Phase 5 is the evaluation that should take place to ensure that the

spiritual care provided is living up to expectations. The arrow going from “phase 5: Evaluation”

and back to the previous phases illustrates that spiritual care should be continuously evaluated

and the spiritual care treatment plan adjusted according to the findings of the evaluation.

Phase 1: Identifying Spiritual Needs and Resources: Identifying spiritual needs becomes part of

the relationship between patient, Health Care Practitioner (HCP), and other involved parties such

as relatives and friends. They can be identified as part of the daily interaction between patient

and HCP, through conversation or observation. From this perspective spiritual needs are not

necessarily identified when the patient is diagnosed or hospitalized, but becomes part of

14
relationship-building between patient and HCP (Steenfeldt, F. 2019), and thereby partly

dependent on both the empathy of the HCP and the willingness of the HCP to engage in this

work.

The nurse or social worker is likely to be in a good position to both identify spiritual needs and

resources and provide spiritual care, considering that relationship is a central part of providing

spiritual care. The general practitioner, who often knows the patient prior to severe illness, is also

in a position to identify spiritual needs and resources, but is often not in a position to offer

spiritual care, simply because of time limitation in general practice (Assing H. et al., 2017). This

does not mean that spiritual care cannot be part of general practice.

Phase 2: The Meaning-Making Matrix: Once spiritual needs have been identified, it is necessary

to locate the nature of the spiritual needs. Involving the MMM will help to clarify whether the

identified needs are of a secular, spiritual, or religious kind, whether there are cultural variances

that need to be taken into consideration, and whether the needs are of a cognitive or practical

nature, or a combination of this.

Phase 3: The Spiritual Care Treatment Plan: Having identified spiritual needs and reached an

understanding of these needs in relation to the patients ontological grounding, it should enable a

point from which to develop a plan for the provision of the spiritual care. Who is qualified to

develop this plan? A chaplain, a general practitioner, a psychologist, a nurse, a relative, or is it a

joint effort? We propose that this is a joint effort, as spiritual care is best practiced as a teamwork

effort, and as part of holistic and patient centered healthcare it could potentially involve all

concerned parties, as an interprofessional endeavor (Puchalski et al., 2006, 2019; Bandini et al.,

2018). The particular spiritual care treatment plan will reflect the patient in relation to the

15
ontological grounding and whether the nature of the identified spiritual needs is of a secular,

spiritual, or religious character, and whether the needs are of a cognitive, practical, or emotional

kind, or a mix. The spiritual care treatment plan should reflect the interventions included and

how the actual provision of spiritual care should be implemented; who should be involved to do

what, when, and where?

Phase 4: Providing Spiritual Care: Providing spiritual care is implementing the spiritual care

treatment plan. Interestingly, even though many spiritual care instruments exist, approaches for

providing spiritual care through the provision of a spiritual care treatment plan seem scarce

(Harrad et al., 2019; Damberg Nissen et al., 2020). This might be because, as we have argued,

spiritual care is an individual and relational process and therefore difficult to put into stringent

formulae; it must be developed at the local level with the individual patient in mind.

Phase 5: Evaluation: It should be included as part of the spiritual care treatment plan and take

place continuously in order to secure that the care is being provided according to plan, and that

effect be measured ongoingly in order to adjust the spiritual care treatment plan if necessary.

Evaluating a process can be done in many ways but should be integratable with the

identification/assessment of spiritual needs to enable effect evaluation.There are instruments

made to specifically assess the effect of an intervention, such as the Service-user Recovery

Evaluation Scale (SeRvE) from England, which is a patient reported outcome measure developed

to monitor interventions, which also highlights the importance of spiritual care for

patients(Barber et al. 2018).

16
Figure 1:THE PROCESS OF SPIRITUAL CARE

Nursing Role in Spiritual Care

To provide spiritual care, the nurse needs to be able to conduct a spiritual assessment; recognize

the difference between religious and spiritual needs; identify appropriate spiritual care

interventions; and determine when it is appropriate to deliver spiritual care. The most important

aspect for the nurse is to maintain a broad understanding of spirituality to be able to relate to

many different types of people with different belief systems. In addition to these skills, the nurse

must also be able to stay involved and positive to empower patients and their significant others

who may be facing death.

Nursing skills essential for effective spiritual care include commitment to the therapeutic

relationship, good communication skills, trust, empathy, self-awareness, and acknowledgment of

broad beliefs. Within the therapeutic relationship, the nurse practices active listening to spoken

and unspoken words. Nurses use relationships and therapeutic communication to meet the needs

17
of the mind, and physical therapeutic interventions such as medications or procedures to meet the

needs of the body; but, nurses often find the ability to meet the needs of the spirit challenging.

Situational barriers to providing spiritual care

Situational barriers to providing spiritual care include insufficient time, the belief that patient’s

spirituality is personal, complexity in distinguishing proselytizing from spiritual care, and

difficulty in meeting needs when spiritual beliefs were not the same as the nurse’s beliefs.

Additionally, studies indicate that some of the other barriers include lack of colleague and

management backing, lack of privacy to sustain patients’ wishes, and insufficient

education.Studies indicate that there is confusion among nurses over whose responsibility it is to

offer spiritual attention. Nurses are inclined to identify that it is the duty of the chaplain and state

the job and purpose of the two fields in spiritual care are not clear. These factors in total may

impede supporting a client’s faith as one component of holistic nursing care of clients.

Expressions of spiritual care and interventions

Nurses are in a unique position to augment spirituality by considering the human experience of

every person. This can be accomplished through a therapeutic connection typified by the ability

to be present and give of self. Meaningful spiritual interventions that have been identified by

patients include care, comfort, coping, connectedness, listening, reassurance, presence, and

prayer.Even if prayer has not been a characteristic part of their daily way of life, people who face

a health emergency or disaster may turn to prayer for console.

Reports verify communication about spirituality to be a vital element of spiritual care. Nurses

repeatedly recognize therapeutic conversation, empathic listening, and facilitation of client

articulation of spiritual beliefs and outlook as important aspects of spiritual care. Communication

18
is a central part of spiritual communications, while nurses identify numerous other

‘interventions’ in their collection of spiritual care therapeutics.

The range of spiritual interventions also includes mindfulness and related cognitive therapies,

reflective reading, art, music, opportunities for prayer and religious worship, and referral for

specialist help from chaplaincy services.It is inevitable that these interventions will sometimes be

implemented by colleagues who are unconvinced or even antagonistic to this approach.

Nonetheless, the goal remains that the importance of spirituality and addressing spiritual needs

will be incorporated in the pathway of care regardless of a caregiver’s negative views.

Wright and Neuberger (2017) see spiritual care as part of enhancing the healing environment. A

context where patients see gardens, feel pets, watch flowers bloom, look at beautiful paintings,

are cared for in a calm and restful atmosphere all enhance spiritual care. All nurses can call for

the improvement of the physical environment for patients and staff. One study noted how

institutions are implementing new graduate nurse residency programs to increase the skills and

comfort of the novice nurse as they move to practice. These programs could further support and

sustain novice nurses with considering the significance of spirituality. Being present and

listening to patients was clearly identified as a struggle by these nurses.

A possible approach to empower nurses and increase spiritual care is through education and

providing skills to practice holistically. One skill would be for nurses to finish spiritual

assessments as a piece of the nursing admission history. These assessment questions have the

potential to allow for genuine communication to assist the nurse in engaging the client and

focusing on spiritual needs.

19
2.3. EMPIRICAL REVIEW

Hossein, E. et al. (2017) showed that the scores for nurses' spiritual care competence were

between 38 and 135, with a mean of 95.2 ± 14.5, which indicates that the perception of nurses of

providing spiritual care for patients is average. Most nurses who participated in this study gained

an average score. In another study, the mean spiritual care competence of nurses was 97.5 ± 13.6

which is consistent with the study. Of course, these results are expected for our society which has

religious and spiritual values. However, there is a need for promoting spirituality in nurses. On

the other hand, religious attitudes in Iran may be effective on responses to the questions of the

scale, and individuals might be evaluated themselves in higher level. The results of the present

study showed that the mean score for each category of the Spiritual Care Competence Scale was

higher than average. The highest score was related to religious state of the patient which

indicated that nurses respect the beliefs of patients even if their beliefs were different from theirs.

The lowest score was observed for the referral category, and most nurses stated that they did not

have the required knowledge. The communication score was 7.8 (1.4), and most nurses stated

that their shifts were busy and they did not have enough time for establishing relationships with

patients.

Sabsevari et al. (2018) showed that the students' competence of spiritual care was higher than

that of nurses, which may be caused by the higher knowledge of students compared to nurses

regarding spiritual care. On the other hand, nursing students did not have to deal with issues such

as work pressure, lack of time, and routine programs.Alshehry et al.(2018) examined nurses'

competencies in providing spiritual care to patients in one study in Saudi Arabia. They evaluated

the spiritual care competency of 302 nurses using the Spiritual Care Competence Scale and

reported that the nurses were competent in providing spiritual care to their patients. In another

20
study, (Abell et al. 2017) examined the competencies of a group of American nurses in providing

spiritual care to patients. In their study, the Spiritual Care Competence Scale was used to

evaluate the nurses' spiritual care competency. Similar to the results of Alshehry et al.(2018), the

nurses reported a desirable level of competence in providing spiritual care.

In one study conducted in 2014 in Iran, Adib-Hajbagheri et al. (2014) examined the competence

of 239 nurses in providing spiritual care to patients. The results of this study, contrary to the

results of those of the above-mentioned studies, indicate that most of the nurses had moderate

and sometimes inadequate competence in providing spiritual care.The difference between the

results of Alshehry et al.(2018) study and that of Adib-Hajbagheri et al.(2014) can be attributed

to two factors. First, different tools were used for the evaluation of spiritual care competency

between the two studies. In the present study, Spiritual Care Competence Scale was used to

evaluate the nurses' competencies in providing spiritual care, whereas in Adib-Hajbagheri et al.

(2014) study, a researcher-made questionnaire was used. Furthermore,over the past few years,

there has been increasing attention to holistic nursing care, and it has been recommended by

many studies that nursing educators incorporate holistic care to nursing students' curriculum and

training programs for nurses in Iran.This might have increased the awareness of spiritual care. In

the second part of the study, the relationship between the nurses' spiritual care competency and

the level of their spiritual wellbeing was investigated. Nurses who reported a higher level of

spiritual wellbeing felt more competent in providing spiritual care compared with the nurses who

reported low level of spiritual wellbeing.

The results of the study by Adib Hajbagheri et al. (2014) also showed that the nurses’

competence in spiritual care (NCSC) was moderate. However, Attard et al. (2014), offered

students the desire to provide spiritual care. This difference in the competence of spiritual care in

21
students and nurses can be attributed to the importance given by universities’ nursing courses to

the category of spirituality and spiritual care in recent years.On the other hand, nurses received

about 80% of score of attitude to spirituality and spiritual care indicating that they have a good

attitude toward spiritual care. Investigating evidence also indicated a positive attitude of nurses

toward spiritual care. However, 89% of the participating nurses said they had not received

training on spiritual care. In a study by Wu et al. (2016), it was also found that 87.5% of

participants did not receive proper education and expressed the need for further education .In this

regard, many studies have found that nurses are not adequately trained in this field, which is one

of the important reasons for neglecting spiritual care.

Although an empirical study to improve the nurses’ competence in spiritual care (NCSC) was not

found, studies related to spiritual intelligence training and nursing care, such as Kaur et al.

(2013), show that spiritual intelligence is a key element of nursing care behaviors .Other

descriptive studies also show a positive relationship between spiritual intelligence and health

and nurses’ happiness .The study of Charkhabi et al. (2014) also showed that with the provision

of spiritual intelligence training, the mental health of students increased. Participating nurses

considered barriers to providing spiritual care including inadequate shifts, inadequate staff,

cultural differences, high workload, lack of nursing education, lack of motivation, inadequate

nursing skills, lack of facilities, lack of understanding of spiritual needs, non-compliance with

the adaptation plan and the language barrier. Nurses considered factors such as lack of

managerial support, lack of encouragement from authorities, lack of periodic breaks and timely

payments to be a cause for their lack of motivation.

22
2.4 THEORETICAL FRAMEWORK

2.4.1. JEAN WATSON’S THEORY OF HUMAN CARING (THEORY OF

TRANSPERSONAL CARING)

Jean Watson’s “Philosophy and Theory of Transpersonal Caring” mainly concerns how nurses

care for their patients and how that caring progresses into better plans to promote health and

wellness, prevent illness and restore health. Caring is the essence of nursing and connotes

responsiveness between the nurse and the person; the nurse co-participates with the person.

Watson contends that caring can help the person gain control, become knowledgeable, and

promote healthy changes. Watson’s Philosophy and Science of Caring is concerned with how

nurses express care to their patients. Her theory stresses the humanistic aspects of nursing as they

intertwine with scientific knowledge and nursing practice.

The nursing model states that “nursing is concerned with promoting health, preventing

illness, caring for the sick, and restoring health.” It focuses on health promotion, as well as

the treatment of diseases. According to Watson, caring is central to nursing practice and

promotes health better than a simple medical cure. She believes that a holistic approach to health

care is central to the practice of caring in nursing.The nursing model also states that caring can

be demonstrated and practiced by nurses. Caring for patients promotes growth; a caring

environment accepts a person as they are and looks to what they may become.

Assumptions

Watson’s model makes seven assumptions:

(1) Caring can be effectively demonstrated and practiced only interpersonally.

23
(2) Caring consists of carative factors that result in the satisfaction of certain human needs.

(3) Effective caring promotes health and individual or family growth.

(4) Caring responses accept the patient as he or she is now, as well as what he or she may

become.

(5) A caring environment offers the development of potential while allowing the patient to

choose the best action for themselves at a given point in time.

(6) The science of caring is complementary to the science of curing.

(7) The practice of caring is central to nursing.

Major Concepts

The Philosophy and Science of Caring have four major concepts: human being, health,

environment or society, and nursing.

Society

The society provides the values that determine how one should behave and what goals one

should strive toward. Watson states:

“Caring (and nursing) has existed in every society. Every society has had some people who have

cared for others. A caring attitude is not transmitted from generation to generation by genes. The

culture of the profession transmits it as a unique way of coping with its environment.”

Human being

24
Human being is a valued person to be cared for, respected, nurtured, understood, and assisted; in

general, a philosophical view of a person as a fully functional integrated self. A human is viewed

as greater than and different from the sum of his or her parts.

Health

Health is the unity and harmony within the mind, body, and soul; health is associated with the

degree of congruence between the self and the self as experienced. It is defined as a high level of

overall physical, mental, and social functioning; a general adaptive-maintenance level of daily

functioning; and the absence of illness, or the presence of efforts leading to the absence of

illness.

Nursing

Nursing is a human science of persons and human health-illness experiences mediated by

professional, personal, scientific, aesthetic, and ethical human care transactions.

10 Carative Factors

Watson devised 10 caring needs specific carative factors critical to the caring human experience

that need to be addressed by nurses with their patients when in a caring role. As carative factors

evolved within an expanding perspective, and as her ideas and values evolved, Watson offered a

translation of the original carative factors into clinical caritas processes that suggested open ways

in which they could be considered.

The first three carative factors are the “philosophical foundation” for the science of caring, while

the remaining seven come from that foundation. The ten primary carative factors with their

corresponding translation into clinical caritas processes are listed below.

25
 S/N Carative Factors Carative Processes
1 The formation of a humanistic-altruistic Practice of loving-kindness and equanimity
system of values. . within the context of caring consciousness
2 The instillation of faith-hope Being authentically present and enabling
and sustaining the deep belief system and
subjective life-world of self and one being
cared for.
3 The cultivation of sensitivity to one’s self Cultivation of one’s own spiritual practices
and others and transpersonal self-going beyond the
ego-self.
4 ‘’Development of a helping-trust Developing and sustaining a helping
relationship” became “development of a trusting, authentic caring relationship.
helping-trusting, human caring relation.’’
5 The promotion and acceptance of the Being present to, and supportive of, the
expression of positive and negative feeling. expression of positive and negative feelings
as a connection with deeper spirit and self
and the one-being-cared for.
6 ‘’The systematic use of the scientific Creative use of self and all ways of
problem-solving method for decision knowing as part of the caring process; to
making” became “systematic use of a engage in the artistry of caring-healing
creative problem solving caring process.’’ practices.
7 The promotion of transpersonal teaching- Engaging in genuine teaching-learning
learning. . experience that attends to the unity of being
and meaning, attempting to stay within
others’ frame of reference
8 Engaging in genuine teaching-learning Engaging in genuine teaching-learning
experience that attends to the unity of being experience that attends to the unity of being
and meaning, attempting to stay within and meaning, attempting to stay within
others’ frame of reference. others’ frame of reference.

9 Creating healing environment at all levels The assistance with the gratification of
(physical as well as the nonphysical, subtle human needs. Assisting with basic needs,
environment of energy and consciousness, with an intentional caring consciousness,
whereby wholeness, beauty, comfort, administering ‘human care essentials,’
dignity, and peace are potentiated)” which potentiate alignment of mind-body-
spirit, wholeness, and unity of being in all
aspects of care.
10 The allowance for existential- Opening and attending to spiritual-
phenomenological forces” became mysterious and existential dimensions of
“allowance for existential- one’s own life-death; soul care for self and
phenomenological spiritual forces’’ the one-being-cared for.

Watson’s Hierarchy of Needs

26
With the gratification of human needs, Watson’s hierarchy of needs begins with lower-order

biophysical needs or survival needs, the lower-order psychophysical needs or functional needs,

the higher-order psychosocial needs or integrative needs, and finally, the higher-order

intrapersonal-interpersonal need or growth-seeking need.

Lower Order Biophysical Needs or Survival Needs

Watson’s hierarchy of needs begins with lower-order biophysical needs or survival needs. These

include the need for food and fluid, elimination, and ventilation.

Lower Order Psychophysical Needs or Functional Needs

Next in line are the lower-order psychophysical needs or functional needs. These include the

need for activity, inactivity, and sexuality.

Higher-Order Psychosocial Needs or Integrative Needs

The higher-order psychosocial needs or integrative needs include the need for achievement and

affiliation.

Higher-Order Intrapersonal-Interpersonal Need or Growth-seeking Need

The higher-order intrapersonal-interpersonal need or growth-seeking need is the need for self-

actualization.

Watson’s Theory and The Nursing Process

The nursing process in Watson’s theory includes the same steps as the scientific research

process: assessment, plan, intervention, and evaluation. The assessment includes observation,

identification, and review of the problem and the formation of a hypothesis. Creating a care plan

27
helps the nurse determine how variables would be examined or measured and what data would

be collected. Intervention is the implementation of the care plan and data collection. Finally, the

evaluation analyzes the data, interprets the results, and may lead to an additional hypothesis.

2.4.2. Application of Jean Watson’s Theory of Human Caring to the Study

Watson’s theory is applied through what are called carative factors or caratas processes. There

are ten carative factors and these are the following. Briefly, the application of the theory is

demonstrated as the practice of loving-kindness, equanimity, authenticity, enabling, cultivating a

spiritual practice; developing a relationship that is helping-trusting; enabling the expression of

both positive and negative feelings; having a caring-healing practice; a willingness to learn for

the caring experience; being able to engage in a teaching-learning experience that is genuine;

enabling and creating environments that are healing; caring for basic needs, both spiritual and

physical; and, being open to spirituality (Watson Caring Science, 2017, 2). In practice, this

means that a nurse practitioner engages his/her own emotions in the caring relationship, not

being closed to new spiritual and emotional experiences while looking after the physical and

health needs of the patient.

Watson describes a healing practice that cares for the spirit or soul of the patient by being in

authentic relation during that space in time(Watson 2008).Therefore, compassion is a necessary

element of the care patients require at the end of life and nursing students are expected to provide

competent, compassionate and culturally sensitive care for patients and their families at the time

of diagnosis of a serious illness through the end of life.

A key factor in Dr. Watson’s work is the importance of self-care. Nurses must develop healthy

self-care practices to support the intensity of care they provide for their patients(Watson

28
2008).The ability to care for the self allows the nursing student to participate in a caring moment

with the patient more readily. Jean Watson describes the caring moment as a deep connection to

the patient on a human level transcending space and time. This spirit to spirit connections

involves compassion, presence and authentic listening and the creation of a healing environment.

Therefore, the theory serves as a framework for the development of caring and healing practices

that can facilitate spiritual care.

Figure 2:JEAN WATSON’S THEORY OF HUMAN CARING

29
 CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION

This chapter consists of the research design, research setting, sampling size and formula,

sampling technique, instrument for data collection, validity and reliability of the instrument,

method of data collection, method of data analysis and ethical considerations.

3.1 RESEARCH DESIGN

A descriptive cross-sectional study was employed because it observes and describes the three

variables. In this study, a quantitative research approach was used to assess spiritual intelligence

and spiritual competence in providing spiritual care among nursing students,therefore, enabling a

generalization to the wider undergraduate student population. A quantitative approach was used

because it describes, determines and examines the student’s intelligence and competences and

the relationship between them in providing spiritual care.

3.2 RESEARCH SETTING

This study was conducted in Bowen University Teaching Hospital. Bowen University is located

at Ogbomoso, Oyo state, Nigeria. The University is a Private Baptist Christian University located

in Ogbomoso, Oyo State, Nigeria. It was established on March 18,1907 and transformed to a

teaching hospital in 2009.It has over 800 staffs and a multidisciplinary facility. The mission of

Bowen is to provide qualitative, functional, morally sound education in the most cost-effective

manner, to all people irrespective of race, colour, ethnicity or religion.The Department of

30
Nursing,Ogbomoso contains over 180 students and the School of Nursing,Ogbomoso contains

over 150 students in which both population consists of both male and female students.

3.3 TARGET POPULATION

The target population comprises of a total of 361 Nursing students studying at Bowen University

Teaching Hospital and School of Nursing which were picked from 100,200,300,400 and 500

level.The results were analyzed together.

3.4 SAMPLING SIZE AND FORMULA

The sample size was calculated using the Taro Yamane’s formula (1967):

Yamane’s formula;

n=N/1+N(e)2

n= Sample size

N= Size of population

e= Margin error

N=83+69+81+63+65=361

e=0.05

Therefore;

n=361/1+361(0.05)2

n=361/1+361(0.0025)

n=361/1+0.9025

n=361/1.9025

n=189.75

No response rate= 10%

sample size/100 x 10= 189.75/100 x 10= 18.975

31
No response rate + sample size= 189.75+18.975= 208.725

Therefore, a total of 208 questionnaires were distributed.

3.5 SAMPLING TECHNIQUE

3.5.1 Method

The population involved in this study are 100-500 level Nursing students studying at Department

of Nursing, Bowen University Teaching Hospital and School of Nursing students.(n=361).In this

study, a convenient sampling method was used to administer questionnaires which enabled the

researcher recruit respondents for the questionnaires. The present study is a descriptive type

research.

3.5.2 Description

The respondents that participated are undergraduate students, both males and females that are

studying at Bowen University Teaching Hospital only.

3.6 INSTRUMENT FOR DATA COLLECTION

Quantitative data collection was done using a standardized questionnaire which was used to

gather data on the assessment of spiritual intelligence and spiritual competence in providing

spiritual care among Nursing students of Bowen University Teaching Hospital, Ogbomoso. A

questionnaire which is divided into four sections was used in the data collection.

Section A includes the socio-demographic information consisting of age,school,level

gender,religion, ethnicity, marital status and department.

Section B include the Spiritual Intelligence Self-Report Inventory-24, which consists of 24 items.

Each item was rated on a five-point Likert scale ranging from not at all true of me to completely

true of me.

32
Section C include the Spiritual Care Competence Scale, which consists of 27 items and six

subscales. Each item was rated on a five-point Likert scale ranging from strongly disagree to

strogly agree.

Section D include the Nurses’ Spiritual Care Therapeutics scale, which measures the frequency

of providing spiritual care.

3.7 VALIDITY OF INSTRUMENT

A copy of the questionnaire was submitted to my supervisor for content validity. The face

validity was ascertained when the instrument was read through and approved by my supervisor.

All questionnaires were related to the topic at hand. The items included in the questionnaire were

ensured to be appropriate for the study. The questionnaires were administered and the

appropriate number was also administered to the undergraduate students based on the calculated

sample size.

3.8 RELIABILITY OF INSTRUMENT

A pilot study was conducted among 10 undergraduate students of Bowen University Teaching

Hospital who share similar characteristics with the sample population. The questionnaire was

reviewed accordingly. The cronbach alpha was 0.72 after coding and analyzing with the

Statistical Package for Social sciences(SPSS) version 25.

3.9 METHOD OF DATA COLLECTION

The research study was conducted by administering standardized questionnaires to 208 students

to collect information from participants and informed consent was gained. This was done to

effectively reach the target population and give them a convenient time to fill and submit the

questionnaires. The questionnaires were collected after they had been correctly filled by nursing

33
students. The data was collected over a period of 2 months. On completion,all questionnaires

were gathered for analysis.

3.10 METHOD FOR DATA ANALYSIS

The questionnaires distributed were retrieved and data was analyzed using computer-based

Statistical Package for Social Science (SPSS), version 25 because the software package can take

data from almost any type of file and use them to generate tabulated reports, charts, descriptive

statistics and conduct complex statistiscal analyses. Descriptive

analysis(frequencies,means,standard deviation and percentages) was used to analyze the

demographic data and to provide answers to the questions of the research study and inferential

methods was also used in the analysis of the data. Pearsons Chi-Square was used to test the

hypothesis.

3.11 ETHICAL CONSIDERATION

The research study was conducted in line with principles of ethical practice. The researcher

obtained approval from the Bowen University Health Research Ethical Committee

(BUHREC).The purpose of this was to ensure that this study conforms to acceptable scientifical

principles and also to protect the dignity of the research participants. The undergraduate students

were educated on the purpose of research and consent was obtained before their participation.

Anonymity was ensured throughout the research study as code numbers were used for the

questionnaires in which the researcher was the only one who gained access to them. No student

was coerced to participate and all other ethical principles were considered and respected such as;

34
Beneficence to Participant: This study was of importance to the general undergraduate student

wellbeing and the future health status of themselves as well as their significant others. The

respondents are protected in identity.

Non-Maleficence to Participant: Precautions were taken to ensure that in the process of

investigating the subjects, the process will cause minimal discomfort to the participants.

Confidentiality: During the process and after, respondents did not have a traceable means of

identification, and all information will be strictly treated confidential.

35
 CHAPTER FOUR

ANALYSIS AND PRESENTATION OF RESULTS

4.1 INTRODUCTION

This chapter presents the results of the analysis of the study of spiritual intelligence and
competences in providing spiritual care among Nursing Students in Bowen University Teaching
Hospital Ogbomosho, Oyo state. The findings from the study were discussed. A total of 208
questionnaires were retrieved and analyzed using the statistical package for social sciences
(SPSS) version 25 and presented in frequency tables, percentages, mean and standard deviation.
The findings of the study are presented below.

4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS

Table 4.1.1: Respondents’ sociodemographic data
Frequency Percentage
Variables (n=208) (100%)
Age 18-20 113 54.3
21-23 67 32.2
24-26 26 12.5
27-29 2 1.0
Mean±StD 20.80±0.597
Gender Male 42 20.2
Female 166 79.8
School SONO 60 28.8
BUTH 148 71.2
Level 100 18 8.7
200 15 7.2
300 47 22.6
400 106 51.0
500 22 10.6
Religion Christianity 187 89.9
Islam 19 9.1
Others 2 1.0
Ethnicity Yoruba 189 90.9
Igbo 11 5.3
Hausa 2 1.0
Others 6 2.9
Department Nursing 208 100.0
Marital status Single 140 67.3
Married 5 2.4
In a relationship 63 30.3

36
Table 4.1 shows that 113(54.3%) are within the age range 18-20, 67(32.2%) within the age range

21-23, 26(12.5%) within the age range 24-26 and lastly 2(1.0%) within the age range 27-29.

20.2% are males while 79.8% are females. Majority of the respondents are Christians (89.9%).

Furthermore, over three-quarter of the respondents are Yorubas (90.9%), 11(5.3%) are Igbos,

6(2.9%) are from other ethnic group while only 2(1.0%) are Hausas. 140(67.3%) are single,

5(2.4%) are married while 63(30.3%) are in a relationship.

4.2 SPIRITUAL INTELLIGENCE

Table 4.2.1: Spiritual intelligence among the respondents
Statement Mean±StD
I have often questioned or pondered the nature of reality 2.10±1.012
I recognize aspects of myself that are deeper than my physical body 2.21±1.096
I have spent time contemplating the purpose or reason for my existence 2.39±1.170
I am able to enter higher states of consciousness or awareness 1.84±1.175
I am able to deeply contemplate what happens after death 1.97±1.208
It is difficult for me to sense anything other than the physical and material 1.18±0.974
My ability to find meaning and purpose in life helps me adapt to stressful situations 2.74±0.959
I can control when I enter higher states of consciousness or awareness 1.92±1.133
I have developed my own theories about such things as life, death, reality, and 1.77±1.317
existence
I am aware of a deeper connection between myself and other people 2.19±1.059
I am able to define a purpose or reason for my life 2.70±0.996
I am able to move freely between levels of consciousness or awareness 1.99±1.259
I frequently contemplate the meaning of events in my life 2.37±1.013
I define myself by my deeper, non-physical self 2.00±1.324
When I experience a failure, I am still able to find meaning in it 2.70±1.001
I often see issues and choices more clearly while in higher states of 2.04±1.171
consciousness/awareness
I have often contemplated the relationship between human beings and the rest of the 2.49±1.127
universe
I am highly aware of the nonmaterial aspects of life 2.51±1.026
I am able to make decisions according to my purpose in life 2.99±1.083
I recognize qualities in people which are more meaningful than their body, 2.83±1.161
personality, or emotions
I have deeply contemplated whether or not there is some greater power or force (e.g., 2.51±1.376
god, goddess, divine being, higher energy, etc.)
Recognizing the nonmaterial aspects of life helps me feel centered 2.13±1.058
I am able to find meaning and purpose in my everyday experiences 2.68±1.110
I have developed my own techniques for entering higher states of consciousness or 2.31±1.384
awareness

37
The table above shows that ‘I am able to make decisions according to my purpose in life’ had the

highest mean±SD of 2.99±1.083 while ‘It is difficult for me to sense anything other than the

physical and material´ had the lowest mean±SD of 1.18±0.974. I recognize qualities in people

which are more meaningful than their body, personality, or emotions was the second highest with

mean±SD of 2.83±1.161

Table 4.2.2: Dimensions of Spiritual intelligence

Dimensions Mean SD

Existence of critical thinking 15.60 4.837

Discovery of personal meaning 13.81 3.855

Spiritual/Spiritual awareness 15.05 4.640

The conscious development 10.10 4.658

The above table shows the four dimensions of spiritual intelligence. Existence of critical thinking

has a mean ± SD of 15.60 and 4.837 respectively, Discovery of personal meaning (13.81±

3.855), Spiritual/Spiritual awareness (15.05± 4.640) and the conscious development (10.10±

4.658)

38
4.3 Spiritual Competence
Table 4.3.1: Respondents’ spiritual competence
Statement Mean±StD
I show unprejudiced respect for a patient's spiritual/religious beliefs regardless of his 3.75±1.166
or her spiritual background
I am open to a patient's spiritual/religious beliefs, even if they differ from my own 3.84±0.932
I do not try to impose my spiritual/religious beliefs on a patient 4.06±0.896
I am aware of my personal limitations when dealing with a patient's spiritual/religious 3.93±0.978
beliefs
I can listen actively to a patient's "life story" in relation to his or her illness/handicap 3.84±1.072
I have an accepting attitude in my dealings with a patient (concerned, sympathetic, 3.88±0.922
inspiring trust and confidence, empathetic, genuine, sensitive, sincere and personal)
I can report orally and/or writing on a patient's spiritual needs 3.66±1.152
I can tailor care to a patient's spiritual needs/problems in consultation with the patient 3.74±0.993
I can tailor care to a patient's spiritual needs/problems through multidisciplinary 3.68±0.936
consultation
I can record the nursing component of a patient's spiritual care in the nursing plan 3.83±0.845
I can report in writing on a patient's spiritual functioning 3.80±0.848
I can report orally on a patient's spiritual functioning 3.86±0.947
I can effectively assign care for a patient's spiritual needs to another care 3.93±0.877
provider/care worker/care discipline
At the request of a patient with spiritual needs, I can in a timely and effective manner 3.89±0.841
refer him or her to another care worker (e.g. a chaplain/the patient's own priest/Imam)
I know when I should consult a spiritual advisor concerning a patient's spiritual care 3.80±0.955
I can provide a patient with spiritual care 3.91±1.024
I can evaluate the spiritual care that I have provided in consultation with the patient 3.70±0.889
and in the disciplinary/multidisciplinary team
I can give a patient information about spiritual facilities within the care institution 3.74±0.890
I can help a patient continue his or her daily spiritual practices 3.73±0.832
I can attend to a patient's spirituality during the daily care 3.70±0.810
I can refer members of a patient's family to a spiritual advisor/pastor,etc.if they ask 3.63±0.928
me and/or if they express spiritual needs
Within the department, I can contribute to quality assurance in the area of spiritual 3.93±0.963
care
Within the department, I can contribute to professional development in the area of 4.06±0.796
spiritual care
Within the department, I can identify problems relating to spiritual care in peer 4.03±0.836
discussions session
I can coach other care workers in the area of spiritual care delivery to patients 3.80±0,838
I can make policy recommendations on aspects of spiritual care to the management of 3.75±0.860
the nursing ward
I can implement a spiritual-care improvement project in the nursing ward 3.92±0.905
The above table shows that ‘I do not try to impose my spiritual/religious beliefs on a patient’ and

‘Within the department, I can contribute to professional development in the area of spiritual care’

39
had the highest mean at 4.06±0.896 and 4.06±0.796 respectively while ‘I can refer members of a

patient's family to a spiritual advisor/pastor,etc.if they ask me and/or if they express spiritual

needs’ had lowest mean of 3.63±0.928.

Table 4.3.2: Subscale for spiritual care competence

Subscale Mean SD

Assessment and implication of spiritual care 22.56 4.399

Personal support and patient counseling 22.41 4.168

Referral to professionals 11.63 2.194

Attitude toward the patient’s spirituality 15.58 3.217

Communication 7.72 1.807

Professionalism and quality improvement of 23.49 3.831

spiritual care

Table 4.3.1 depicts the mean and standard deviation of the subscale for spiritual care

competence. Professionalism and quality improvement of spiritual care had the highest mean

(23.49± 3.831) and communication was the lowest (7.72± 1.807).

40
4.4 SPIRITUAL CARE
Table 4.4: Spiritual care provided by the respondents

Statement Mean±StD
Asked a patient about how you could support his or her spiritual practices 2.42±1.101
Helped a patient have quiet time 2.44±1.136
Listened actively to patient's story of illness 3.08±1.128
Assessed a patient's spiritual beliefs and/or practices that are pertinent to health 2.87±0.952
Listened to a patient talk about spiritual concerns 2.85±0.999
Encouraged patient to talk about how illness affects relating to God-or his or her 2.90±3.161
transcendent reality
Encouraged patient to talk about his or her spiritual coping 2.69±0.984
Documented spiritual care you provided in a patient's chart 2.67±1.134
Discussed a patient's spiritual care needs with colleagues 2.60±1.112
Arranged for a chaplain to visit a patient 2.61±1.162
Encouraged a patient to talk about what gives his or her life meaning amid illness 2.78±1.058
Encouraged a patient to talk about the spiritual challenges of living with illness 2.85±1.073
Offered to pray with a patient 2.85±1.029
Offered to read a spirituality nurturing passage (e.g., patient's holy scripture) 2.66±1.147
Told a patient about spiritual resources 2.85±1.085
After completing a task, remained present just to show caring 24.38±306.1
Table 4,4 shows that ‘After completing a task, remained present just to show caring’ had the

highest mean±SD of 24.38±306.1 while ‘Asked a patient about how you could support his or her

spiritual practices’ had the lowest mean±SD of 2.42±1.101.

41
4.5 ANSWERING OF RESEARCH QUESTIONS
4.5.1. What is the spiritual intelligence of nursing students in providing spiritual care in

Bowen University Teaching Hospital, Ogbomosho?

4.5.1: Level of spiritual intelligence

Level of spiritual intelligence Frequency Percentage

(n=208) (100%)

High level 57 27.4

Moderate level 136 65.4

Low level 15 7.2

Table 4.5.1 shows that 57(27.4%) have a high level of spiritual intelligence, 136(65.4%) have

moderate level of spiritual intelligence, and only 15(7.2%) have a low level of intelligence. Each

item is rated from ‘not at all true of me to completely true of me’ ranging from 0 to 4. The

maximum score is 96 points. The higher the score is, the higher the level of spiritual intelligence.

Total scores that range from 0 to 32 points are considered to reflect a low level of spiritual

intelligence, scores of 33 to 64 indicate moderate level of spiritual intelligence and scores of 65

to 96 indicate high level of spiritual intelligence.

42
4.5.2. What is the level of spiritual care competence provided by nursing students in Bowen

University Teaching Hospital, Ogbomosho?

4.5.2: Level of spiritual care competence

Level of spiritual care competence Frequency Percentage

(n=208) (100%)

Lower spiritual care competence 50 24.0

Greater spiritual care competence 158 76.0

Table 4.5.2 shows that 50(24.0%) have a lower spiritual care competence, while 158(76.0%)

have greater spiritual care competence. Each item is rated from ‘strongly disagree to strongly

agree’ ranging from 1 to 5. The higher the score is, the greater the spiritual care competence and

the lower scores indicate a lower spiritual care competence. Total scores that range from 55 to 95

points are considered to reflect a lower spiritual care competence, while scores of 96 to 135

indicate greater spiritual care competence.

43
4.6 HYPOTHESES TESTING
4.6.1. There is no significant relationship between spiritual intelligence and spiritual care

Table 4.6.1: Spiritual intelligence and spiritual care

Level of spiritual
competence
Lower Higher Total X2 df p-value
level of spiritual Low 11 4 15 27.306 2 0.001
intelligence Moderate 34 102 136
High 5 52 57
Total 50 158 208
From table 4.6.1 above, it can be deduced that level of knowledge of spiritual intelligence

(0.001) is lesser than 0.05 so, the null hypothesis will be rejected. There is significant

relationship between spiritual intelligence and spiritual competence.

44
4.6.2. There is no significant relationship between socio-demographic data and spiritual

competences.

Table 4.6.2: Socio-demographic data and spiritual competences.

Spiritual competence
Lower Greater Total X2 df p-value
Gender Male 2 40 42 10.709 1 0.001
Female 48 118 166
School SONO 18 42 60 1.641 1 0.200
BUTH 32 116 148
Religion Christian 48 139 187 12.605 2 0.002
Muslim 2 19 21
Ethnicity Hausa 2 0 2 10.094 3 0.018
Igbo 0 11 11
Others 2 4 6
Yoruba 46 143 189
Marital status Single 27 113 140 8.679 2 0.013
Married 0 5 5
Relation 23 40 63
Level 100 0 18 18 19.506 4 0.001
200 0 15 15
300 20 27 47
400 24 82 106
500 6 16 22
From table above, it can be deduced that gender (p=0.001), religion (p=0.002), ethnicity

(p=0.018), marital status (p =0.013) and level (p=0.001) are all lesser than 0.05 so, there is a

significant relationship between socio-demographic characteristics and the level of spiritual

competence among nursing students in BUTH and SONO.

45
 CHAPTER FIVE

DISCUSSION OF FINDINGS, SUMMARY, RECOMMENDATIONS AND CONCLUSION

5.1 INTRODUCTION

This chapter focuses on the discussion of the study as analyzed previously in chapter four in

relation to the previous studies conducted. The chapter also provides report on the findings in

this research project derived from the analysis of the acquired data, these findings are described

in relation with the empirical findings and literature review. The study was done to assess the

spiritual intelligence and competencies in providing spiritual care among nursing students in

Bowen University Teaching Hospital, Ogbomoso, Oyo State. The chapter also explains the

implication of research findings on the observed result, suggestions and recommendations were

also put forward based on the problems observed in the study.

5.2 DISCUSSION OF FINDINGS

5.2.1 Sociodemographic characteristics

The main objective of this study is to assess the spiritual intelligence and competences in

providing spiritual care among nursing students in Bowen University Teaching

Hospital,Ogbomoso. Sociodemographic findings revealed that the highest age range of the

respondents was 18-20 years, with majority being females, Christians, and of the Yoruba ethnic

group.

5.2.2 Spiritual intelligence

With respect to the spiritual intelligence of nursing students, majority of the respondents are

completely able to make decisions according to their purpose in life. The following are very true

46
about the respondents; ability to define a purpose or reason for their lives, and ability to find a

meaning even in their experience of failure. In addition they somewhat; questioned or pondered

the nature of reality, recognize aspects of themselves that are deeper than the physical body,

spend time contemplating the purpose or reason for their existence, believe that finding meaning

and purpose in life helps them adapt to stressful situations, deeply contemplate what happens

after death, and enter higher states of consciousness or awareness). The dimensions of spiritual

existence among the respondents include existence of critical thinking (the highest), discovery of

personal meaning, spiritual or spiritual awareness, and the conscious development (the lowest).

Many of the respondents have a moderate level of spiritual intelligence. Similar to this is the

study of (Kaur et al. 2013), it was stated that spiritual intelligence is a key element of nursing

care behaviors. Other descriptive studies also showed a positive relationship between spiritual

intelligence and health and nurses’ happiness. A study conducted in Iran by (Adib-Hajbagheri et

al. 2014) showed that Nurses who reported a higher level of spiritual wellbeing felt more

competent in providing spiritual care, compared with the nurses who reported low level of

spiritual wellbeing. This study agrees with (Kaur et al. 2013), and also showed that the

dimensions of spiritual existence among the respondents include existence of critical thinking,

discovery of personal meaning, spiritual or spiritual awareness, and the conscious development.

Majority of the respondents also have a moderate level of spiritual intelligence.

5.2.3 Spiritual competence

With respect to the spiritual competences of Nursing students, the respondents agreed to ability

to record the nursing component of a patient's spiritual care in the nursing plan, be open to a

patient's spiritual or religious beliefs even if they differ from theirs, not impose personal spiritual

or religious beliefs on a patient, give a patient information about spiritual facilities within the

47
care institutions, have an accepting attitude in dealing with a patient, tailor care to a patient's

spiritual needs or problems in consultation with the patient, and multidisciplinary consultation,

identify problems relating to spiritual care in peer discussions session, implement a spiritual care

improvement project in the nursing ward, make policy recommendations on aspects of spiritual

care to the management of the nursing ward, report orally or in writing on a patient's spiritual

needs, evaluate the spiritual care provided in consultation with the patient and in the disciplinary

or multidisciplinary team, and contribute to professional development and quality assurance in

the area of spiritual care. The subscales of spiritual care competencies among the respondents

include assessment and implication of spiritual care, personal support and patient counseling,

referral to professionals, professionalism and quality improvement of spiritual care (highest), and

communication (lowest). Majority have a greater spiritual care competence level.

This study is somewhat similar to that of Hossein, E. et al. 2017 which indicates that the

perception of nurses of providing spiritual care for patients is average. Most nurses who

participated in this study gained an average score. In another study, the results revealed that

mean score for each category of the SCCS was higher than average. The highest score was

related to religious state of the patient which indicated that nurses respect the beliefs of patients

even if their beliefs were different from theirs. The lowest score was observed for the referral

category, and most nurses stated that they did not have the required knowledge. The

communication score was 7.8 (1.4), and most nurses stated that their shifts were busy and they

did not have enough time for establishing relationships with patients.

5.2.4 Spiritual care

48
As touching the spiritual care provided by the respondents, they occasionally; assessed a patient's

spiritual beliefs and/or practices that are pertinent to health, listened to a patient talk about

spiritual concerns, offered to pray with a patient, encouraged patient to talk about his or her

spiritual coping, discussed a patient's spiritual care needs with colleagues, remained present just

to show caring after completing a task, documented spiritual care provided in a patient's chart,

and listened to a patient's story of illness. In addition, they seldom asked how they could support

a patient's spiritual practices, and arranged for a chaplain to visit a patient. The study of Attard et

al. (2014) indicated a positive attitude of nurses toward spiritual care. Charkhabi et al. (2014)

stated in their study that participating nurses considered barriers to providing spiritual care to

include inadequate shifts, inadequate staff, cultural differences, high workload, lack of nursing

education, lack of motivation, inadequate nursing skills, lack of facilities, lack of understanding

of spiritual needs, non-compliance with the adaptation plan and the language barrier. This study

agrees with (Attard et al. 2014), and revealed the different forms in which nursing students

provide spiritual care to the patients.

5.3 IMPLICATIONS OF FINDINGS WITH LITERATURE SUPPORT

In a study conducted by (Kaur et al. 2013), it was stated that spiritual intelligence is a key

element of nursing care behaviors. Other descriptive studies also showed a positive relationship

between spiritual intelligence and health and nurses’ happiness. A study conducted in Iran by

(Adib-Hajbagheri et al. 2014) showed that Nurses who reported a higher level of spiritual

wellbeing felt more competent in providing spiritual care, compared with the nurses who

reported low level of spiritual wellbeing. This study agrees with (Kaur et al. 2013), and also

showed that the dimensions of spiritual existence among the respondents include existence of

critical thinking, discovery of personal meaning, spiritual or spiritual awareness, and the

49
conscious development. Majority of the respondents also have a moderate level of spiritual

intelligence.

The findings of (Hossein et al. 2017) showed that the scores for nurses' spiritual care competence

were between 38 and 135, with a mean of 95.2 ± 14.5, which indicates that the perception of

nurses of providing spiritual care for patients is average. The results of another study showed that

the mean score for each category of the SCCS was higher than average, the highest score was

related to nurses' respect for the beliefs of patients despite the differences, and the lowest score

being communication score. Alshehry et al. (2018) reported that the nurses had a desirable level

of competence in providing spiritual care. This is consistent with the findings of this study,

where the highest competence was revealed to be professionalism and quality improvement of

spiritual care, and the least competence was communication. However, majority of the

respondents in this study have a greater level of spiritual care competence.

Attard et al. (2014) indicated a positive attitude of nurses toward spiritual care. Charkhabi et al.

(2014) stated in their study that participating nurses considered barriers to providing spiritual

care to include inadequate shifts, inadequate staff, cultural differences, high workload, lack of

nursing education, lack of motivation, inadequate nursing skills, lack of facilities, lack of

understanding of spiritual needs, non-compliance with the adaptation plan and the language

barrier. This study agrees with (Attard et al. 2014), and revealed the different forms in which

nursing students provide spiritual care to the patients.

5.4 IMPLICATIONS OF FINDINGS TO NURSING

The findings of this study revealed that 65.4% of the respondents have a moderate level of

spiritual intelligence, and 76% have a greater spiritual care competence level. Majority of the

50
respondents are somewhat able to respond to spiritual intelligence matters. The dimensions of

spiritual existence among the respondents were also identified, with the existence of critical

thinking as the highest, and the conscious development as the lowest. With respect to the

spiritual competencies of nursing students, the respondents agreed to ability to perform the

different competencies identified, and the different ways by which spiritual care is provided by

the respondents were also identified. The subscales of spiritual care competence were also noted,

with professionalism and quality improvement of spiritual care being the highest, and

communication being the lowest. The findings reveal that there is a need for spiritual care

intelligence and competence to be integrated into the nursing education curriculum. This is

necessary to equip nursing students with the adequate skills needed to provide spiritual care as

appropriate to the clients. Also, the concept of spirituality in nursing should be emphasized

during health conferences and seminars to ensure circulation of information. In addition,

evidence stemming from the latest research should be published and circulated to healthcare

professionals, particularly nurses.

5.5 LIMITATIONS OF THE STUDY

The main limitation of this study was that most students were reluctant to fill the questionnaire

with the complaint that the questions were a lot. Some were reluctant to fill because of other

works they have filled before that may have taken their time and concentration.The limitation of

this study also include lack of access to relevant literatures with respect to the target population,

that is, nursing students.

5.6 SUMMARY OF THE STUDY

51
The main purpose of this study was to assess the spiritual intelligence and competencies in

providing spiritual care among nursing students in Bowen University Teaching Hospital,

Ogbomoso. The research instrument was a questionnaire which was distributed to 208 nursing

students.

It was discovered that 65.4% of the respondents have a moderate level of spiritual intelligence,

and 76% have a greater spiritual care competence level. Majority of the respondents are

somewhat able to respond to spiritual intelligence matters. The dimensions of spiritual existence

among the respondents were also identified, with the existence of critical thinking as the highest,

and the conscious development as the lowest. With respect to the spiritual competences of

nursing students, the respondents agreed to ability to perform the different competences

identified, and the different ways by which spiritual care is provided by the respondents were

also identified. The subscales of spiritual care competence were also noted, with professionalism

and quality improvement of spiritual care being the highest, and communication being the

lowest.

5.7 CONCLUSION

In conclusion, this study was able to assess the level of spiritual intelligence and competences in

providing spiritual care among nursing students in Bowen University Teaching Hospital. 65.4%

had a moderate level of spiritual intelligence, and 76% had a greater spiritual care competence

level. The dimensions of spiritual intelligence and competencies were also identified.

5.8 RECOMMENDATIONS

Based on the findings of this study, the following recommendations were suggested:

52
 1. More emphasis should be laid on the importance of providing spiritual care as a part of

holistic nursing care.

2. Nurses should be well equipped with the spirituality aspect of nursing, so that the right

knowledge can be passed across to nursing students on how to implement spiritual care

during ward postings.

3. More attention should be paid to spiritual care intelligence and competence as a part of

the nursing education curriculum.

4. Nursing students should be encouraged to actively attend and participate in conferences

and seminars where the concept of spirituality in Nursing is well addressed.

5. Evidence stemming from the latest research should be published and circulated to

healthcare professionals, particularly Nurses.

6. The hospital should encourage and make facilities available to further implement spiritual

care a s a component of nursing care.

5.9 SUGGESTIONS FOR FURTHER STUDIES

This study was carried out based on the researcher’s knowledge in which the researcher should

have covered a broader scope. In view of this and other aforementioned limitations, the

following suggestions were made for further studies.

1. The research should be carried out among a larger population of nursing students.

2. More researches should be conducted on the factors contributing to spiritual intelligence

among nursing students.

3. Also, the factors contributing to spiritual care and competences among the students

should be studied.

53
54
 REFERENCES

Abbasi, M., Farahani-Nia, M., Mehrdad, N., Givari, A., Haghani, H. (2014). Nursing students’

spiritual well-being, spirituality and spiritual care. Iranian Journal of Nursing and

Midwifery Research, 19, 242-7.

Alexis, G., Kim-Godwin, Y.S. & Jones, C.W. (2020). Perceptions of Spiritual Care Education,

Competence, and Barriers in Providing Spiritual Care Among Registered Nurses. Journal of

Holistic Nursing, 38, 1.

Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition. Maryland

Heights: Mosby-Elsevier.

Alshehry, A.S. (2018). Spirituality and Spiritual Care Competence among Expatriate Nurses

Working in Saudi Arabia. Religions, 9, 384.

Appleby, A, Wilson, P, Swinton, J. (2018). Spiritual Care in General Practice: rushing in or

fearing to tread? An integrative review of qualitative literature . Journal of Religion &

Health,57(3),1108–24.

Brennan, F. (2013). Holistic palliative care approach – physical, spiritual, religious and

psychological needs. Nephrology,329(1),423–35.

Chen, J, Lin. Y, Yan, J, et al. The effects of spiritual care on quality of life and spiritual well-

being among patients with terminal illness: a systematic review. Palliat Med.

2018;32(7):1167–79.

Chiang, Y.C, Lee, H.C, Chu, T.L, et al. (2016). The impact of nurses' spiritual health on their

attitudes toward spiritual care, professional commitment, and caring . Nurse

Outlook,64(3),215–24.

55
Connerton, C.S.,Moe, C.S. (2020). The Essence of Spiritual Care.Creative Nursing,24(1)

https://doi.org/10.1891/1078-4535.24.1.36

Emamgholian, F., Hosseinabadi, F., Mohammad, J., Keshavarz, M. (2017). The Relationship

Between Spiritual Intelligence And Competences In Providing Spiritual Care In Nursing

Students. Iranian Journal of Psychiatric Nursing (IJPN),5(5 ),57-62.

Francesca, F.(2021). How To Develop Spiritual Intelligence.

Gemma, D.G,Valenzuela, J.P, Christian, J.B,Erlinda, P. (2020). Spirituality and Spiritual Care in

Nursing: A Literature Review. R e s e a r c h A r t i c l e 22 PJN,89 ,1.

Holmes, C. (2018). Stakeholder views on the role of spiritual care in Australian hospitals: an

exploratory study . Health Policy.

Hossein, E., Hossein, N.A., Soraya, G.K. (2017). Health Care Providers' Perception of Their

Competence in Providing Spiritual Care for Patients. Indian J Palliat Care,23(1),57-61.

Hu, Y.L, Tiew, L.H, Li,F. (2019).Psychometric properties of the Chinese version of the spiritual

care-giving scale (C-SCGS) in nursing practice . BMC Med ResMethodol.,19(1),21.

Hubert, P.M. (2018). Application of Jean Watson 's Theory of Transpersonal Caring in Nurses

Practicing in a Pain Center. https://scholarship.shu.edu/final-project

Jafari, M, Fallahi-Khoshknab, M. Competence in providing spiritual care and its relationship

with spiritual well-being among Iranian nurses. J Edu Health Promot [serial online] 2021

[cited 2022 May 3];10:388. https://www.jehp.net/text.asp?2021/10/1/388/329415

56
Karimi, M.H,(2015). Relation between spiritual intelligence and clinical competency of nurses in

Iran. Iranian Journal of Nursing and Midwifery Research, 20(6),665-669.

Mackinlay, E., Trevitt, C. (2010).Living in aged care: using spiritual reminiscence to enhance

meaning in life for those with dementia. Int J Ment Health Nurs,19(6),394–401.

Margaret, C. (2018). Watson’s Caritas Processes as a Framework for Spiritual End of Life Care

for Oncology Patients. International Journal of Caring Sciences,11(2),640.

Meyreme, A., Gulay Ipek, C.,(2017). Nursing Students’ Perceptions of Spirituality and Spiritual

Care . International Journal of Caring Sciences,10(3),1136.

Michał, M., René van, L. , Dorota, O., Krzysztof, J., Sylwia, B. & Beata D. (2022). The level of

spiritual care competence of Polish nurses and the psychometric properties of the spiritual

care competence scale (SCCS). BMC Nursing,21:106.

https://doi.org/10.1186/s12912-022-00889-z

Nissen, R.D, Viftrup, D.T & Hvidt, N.C. (2021). The Process of Spiritual Care.Front. Psychol.

12:674453.

https://doi.org/10.3389/fpsyg.2021.674453

Rene Van, L., Tiesinga, L.J., Middel, L.J. & Jochemsen, H. (2009). Towards nursing

competencies in spiritual care.

Ryan, L.(2017). The Journey to Integrate Watson’s Caring Theory with Clinical Practice.

http://www.watsoncaringscience.org/images/features/library/Ryan_JourneytoIntegrate.pdf

57
Seid, K., Abdo, A. (2022). Nurse’s spiritual care competence in Ethiopia:A multicenter cross-

sectional study. PLoS ONE 17(3):e0265205.

https://doi.org/10.1371/journal.pone.0265205

Somayeh, R., Fateme, G. , Shirin, H. , Hasan, A., Farzad, E. & Zahra, D.(2018). Assessing the

Effect of Spiritual Intelligence Training on Spiritual Care Competency in Critical Care

Nurses. Journal of Medicine and Life,11(4),346–354.

https://doi.org/10.25122/jml-2018-0056

Timmins, F, Caldeira, S. (2017). Understanding spirituality and spiritual care in nursing . Nurs

Stand,31(22),50.

58
 APPENDIX
QUESTIONNAIRE
CODE:
Dear Respondent,

I am ENIOLA CHRISTIANAH, a 400 level student from the department of Nursing Science,
Bowen University, Iwo. I am conducting a research to assess spiritual intelligence and
spiritual competence in providing spiritual care among nursing students in BUTH. Thank
you for accepting to voluntarily participate in this study. Kindly give answers to the questions
below. This will help me get the right information from you. PLEASE, DO NOT WRITE
YOUR NAME OR NUMBER ON THIS SHEET. All information provided will be kept with
strict confidentiality. Thank you for your precious time and cooperation.

ENIOLA CHRISTIANAH O.

SECTION A: SOCIO-DEMOGRAPHIC DATA (Please, write the correct answers)

1. Age (in years)________________

2. Gender: Male ( ) Female ( )
3. School: SON ( ) Bowen University ( )
4. Level: 100 ( ) 200 ( ) 300( ) 400( ) 500( )
5. Religion: Christian ( ) Muslim ( ) Others ( )
6. Ethnicity: Yoruba ( ) Igbo ( ) Hausa ( ) Others ( )
7. Department________________
8. Marital Status: Single ( ) Married( ) In a relationship( )
SECTION B: SPIRITUAL INTELLIGENCE SELF-REPORT INVENTORY-24
Not Not Somewhat Ver Completely
at all very true of me y true of me
true true (2) true (4)
of of of
me me me
(0) (1) (3)
9. I have often questioned or pondered
the nature of reality
10. I recognize aspects of myself that are
deeper than my physical body
11. I have spent time contemplating the
purpose or reason for my existence
12. I am able to enter higher states of
consciousness or awareness
13. I am able to deeply contemplate
what happens after death
14. It is difficult for me to sense
anything other than the physical and

59
 material
15. My ability to find meaning and
purpose in life helps me adapt to
stressful situations
16. I can control when I enter higher
states of consciousness or awareness
17. I have developed my own theories
about such things as life, death,
reality, and existence
18. I am aware of a deeper connection
between myself and other people
19. I am able to define a purpose or
reason for my life
20. I am able to move freely between
levels of consciousness or awareness
21. I frequently contemplate the
meaning of events in my life
22. I define myself by my deeper, non-
physical self
23. When I experience a failure, I am
still able to find meaning in it
24. I often see issues and choices more
clearly while in higher states of
consciousness/awareness
25. I have often contemplated the
relationship between human beings
and the rest of the universe
26. I am highly aware of the nonmaterial
aspects of life
27. I am able to make decisions
according to my purpose in life
28. I recognize qualities in people which
are more meaningful than their body,
personality, or emotions
29. I have deeply contemplated whether
or not there is some greater power or
force (e.g., god, goddess, divine
being, higher energy, etc.)
30. Recognizing the nonmaterial aspects
of life helps me feel centered
31. I am able to find meaning and
purpose in my everyday experiences
32. I have developed my own techniques
for entering higher states of
consciousness or awareness

60
SECTION C: SPIRITUAL CARE COMPETENCE SCALE

S/ QUESTIONS Strongly Disagree Neither Agree Strongly

N Disagree (2) agree nor (4) Agree
(1) disagree( (5)
3)
33. I show unprejudiced respect for a patient's
spiritual/religious beliefs regardless of his or
her spiritual background
34. I am open to a patient's spiritual/religious
beliefs, even if they differ from my own
35. I do not try to impose my spiritual/religious
beliefs on a patient
36. I am aware of my personal limitations when
dealing with a patient's spiritual/religious
beliefs
37. I can listen actively to a patient's "life story"
in relation to his or her illness/handicap
38. I have an accepting attitude in my dealings
with a patient (concerned, sympathetic,
inspiring trust and confidence, empathetic,
genuine, sensitive, sincere and personal)
39. I can report orally and/or writing on a
patient's spiritual needs
40. I can tailor care to a patient's spiritual
needs/problems in consultation with the
patient
41. I can tailor care to a patient's spiritual
needs/problems through multidisciplinary
consultation
42. I can record the nursing component of a
patient's spiritual care in the nursing plan
43. I can report in writing on a patient's spiritual
functioning
44. I can report orally on a patient's spiritual
functioning
45. I can effectively assign care for a patient's
spiritual needs to another care provider/care
worker/care discipline
46. At the request of a patient with spiritual
needs, I can in a timely and effective manner
refer him or her to another care worker (e.g. a
chaplain/the patient's own priest/Imam)
47. I know when I should consult a spiritual
advisor concerning a patient's spiritual care

61
48. I can provide a patient with spiritual care
49. I can evaluate the spiritual care that I have
provided in consultation with the patient and
in the disciplinary/multidisciplinary team
50. I can give a patient information about
spiritual facilities within the care institution
51. I can help a patient continue his or her daily
spiritual practices
52. I can attend to a patient's spirituality during
the daily care
53. I can refer members of a patient's family to a
spiritual advisor/pastor,etc.if they ask me
and/or if they express spiritual needs
54. Within the department, I can contribute to
quality assurance in the area of spiritual care
55. Within the department, I can contribute to
professional development in the area of
spiritual care
56. Within the department, I can identify
problems relating to spiritual care in peer
discussions session
57. I can coach other care workers in the area of
spiritual care delivery to patients
58. I can make policy recommendations on
aspects of spiritual care to the management of
the nursing ward
59. I can implement a spiritual-care improvement
project in the nursing ward

SECTION D: NURSES’ SPIRITUAL CARE THERAPEUTICS SCALE (FREQUENCY

OF PROVIDING SPIRITUAL CARE)

QUESTION Very Seldom Occasionally Often Very

Seldo (2) (3) (4) Often
m(1) (5)
1. Asked a patient about how you could
support his or her spiritual practices
2. Helped a patient have quiet time
3. Listened actively to patient's story of
illness
4. Assessed a patient's spiritual beliefs
and/or practices that are pertinent to

62
 health
5. Listened to a patient talk about spiritual
concerns
6. Encouraged patient to talk about how
illness affects relating to God-or his or
her transcendent reality
7. Encouraged patient to talk about his or
her spiritual coping
8. Documented spiritual care you provided
in a patient's chart
9. Discussed a patient's spiritual care needs
with colleagues
10. Arranged for a chaplain to visit a patient
11. Encouraged a patient to talk about what
gives his or her life meaning amid illness
12. Encouraged a patient to talk about the
spiritual challenges of living with illness
13. Offered to pray with a patient
14. Offered to read a spirituality nurturing
passage (e.g., patient's holy scripture)
15. Told a patient about spiritual resources
16. After completing a task, remained present
just to show caring

63
64