Introduction

Nursing has always been recognized as a caring profession where patients’ individual needs are met physically, psychologically and socially. Within recent years, spirituality has been added to nursing curricula, encouraging a holistic approach to the delivery of patient care according to the American Association of Colleges of Nursing [1]. Increased attention to spirituality in education has contributed to widespread acceptance among nursing organizations and health care providers [2]. Although the focus has been to educate students on how to identify and meet the spiritual needs of patients, little attention has been given to faculty’s identification of and sensitivity toward meeting students’ spiritual needs [3]. Could it be that student nurses’ spiritual needs go unnoticed, or perhaps are ignored because faculty feel uneasy with assessing spiritual assessments for students? In pondering these questions, an exploration of spirituality will be discussed as well as the importance of faculty to meet the spiritual needs of nursing students.

Exploring Spirituality

Spirituality is a concept that has been recognized as an important component of human emotion, ability and wellness. Nightingale found spirituality to be essential for healing the mind, soul or spirit and body [4]. To her, spirituality was a “Life Principle,” the “Thinking, motivating, and feeling part of the human experience.” In addition, a common thread of spirituality involves the connection between the mind (psychological), the body (physical), and the spirit [5]. However, there is no clear concise understanding of what spirituality is [6]. Multiple variations of the meaning of the concept have resulted in definitions often resembling the practice of religion - an active participation of expression that is different from spirituality, but often intertwined with its characteristics [7]. According to Dossey, et al. [4], spirituality permeates all aspects of life, interconnecting self with others, nature, and God. It is a multidimensional phenomenon that transcends race, gender, color, and national origin with the basic element of meaning and purpose in life [2]. There are “Many intangible aspects” with personal meanings that differ from person to person. Although different, individuals are capable of connecting, within themselves, with others, with nature, and with the universe through spirituality [8]. Through these relationships humanity is united and deeply connected.

In nursing literature, Reed [9] described spirituality as the developmental capacity for self-transcendence. She elaborated on human characteristics of spirituality espousing the holistic approach to spirituality is essential for cutting through traditional barriers that artificially separates the psychological, social, and physical boundary. Considering the multiple layers of spirituality, she further explained that the meaning of life transcends related dimensions of spirituality and empowers an individual through intrapersonal (inward), interpersonal (outward), and transpersonal (upward) connections. It is both integrative energy and a transcendent quest for meaning and happiness which leads to health and the alleviation of suffering [10] and is equated with human sympathy, tender loving care, and genuine interest in one’s well- being [7]. Watson [8] elaborated on her 1985 theory of human caring through the introduction of transpersonal perceptions which conveys “A connection beyond the ego.” Individuals are capable of connecting with others, with nature and with the universe through spiritual dimensions. These transpersonal relationships bind humanity and promote deep connectedness.

The reciprocal sharing of experiences with others enriches presence [6,11], deepens satisfaction, and promotes spirituality [12]. In nursing programs, the shared experiences of students often occur in the learning environment (i.e., classroom, practice labs, lecture halls, etc.) where connections with faculty and peers are initiated. Group cultures, as seen in the learning environment, strongly influence spirituality that is considered to be an active expression of internal desires [13]. Spirituality, when associated with social support and optimism, promotes psychological adjustment and well-being that allows students to gain a sense of comfort and calm in a demanding learning environment [10]. In addition, when students share spiritual experiences and identify spiritual commonalities with others, their engagement in the learning environment is enriched [3].

The meaning of spirituality is then derived from the foregoing literature review. Spirituality is therefore conceptualized as an ever present vital power that encompasses one’s emotions, beliefs, ability, health, and well-being, and is essential to ones’ own existence, satisfaction, and connections within themselves and with others; [4,5,9,10,12]. To elaborate, spirituality can be metaphorically compared with the wind in that there is no beginning nor ending to where it leads, it is always present, extending in all directions to reach and to touch, and has the capability to gently caress or utterly destroy. Basically, the same can be said about spirituality which cannot be seen but is experienced by all. Spirituality is vital for human existence as daily changes from life experiences, our environment, and personal involvement with others create a continual task of finding meaning and purpose [2,10].

Spirituality and the Student

Nursing literature reveals little evidence of the concept of spirituality with regards to meeting the spiritual needs of nursing students [6,14]. Some studies that address faculty and spiritual needs of nursing students were found to focus more on the students’ ability to assess and/or provide spiritual care [14-17]. It is suggested that the goal of nursing should also be driven by the intention to unite with students on a spiritual level before initiating teaching on how to provide spiritual care.

Taking the opportunity to unite with students means faculty are able to identify when students may be overwhelmed with the rigor of the course and may disconnect from others socially, emotionally, and spiritually [18]. In order for unity and connectedness to occur, faculty should be observant of student activity in the learning environment, particularly when withdrawn behaviors are demonstrated [19]. Faculty who are sensitive and consciously aware of the needs of students understands the importance of creating a learning environment that is supportive and facilitates connection by encouraging and supporting student spirituality and autonomy [4,20,21]. Thus, it is of greater importance for faculty to take time to introspectively reflect on their own spirituality and biases in order to effectively help students [6,22].

In the learning environment, faculty serves as responsible role models [23] who are able to demonstrate that they genuinely care about student needs [19], who takes the time to listen, and who finds the opportunity to compliment students, whether they are content or struggling in their abilities. In essence, taking the time to connect does not require a spiritually earthshaking experience. Instead, it is simply an act of caring through, a smile, a pleasant demeanor, a kind word, or by being present [9,24]. Presence is experienced on physical, psychological and spiritual levels and is considered as a necessary component for creating a therapeutic and unified learning environment [6,25]. Faculty who provide presence also recognizes that student qualities should be both valued and nurtured [26]. Communication is important in the learning environment and helps to keep everyone on the same page [5]. Communication from the faculty to the student, and vice versa, can be accomplished verbally or electronically. Students should expect to receive information such as course requirements, documents, updates, and any additional information pertaining to the course in a timely manner [18].

Clear communication should lead to an increased awareness, acceptance, and openness to learn from others’ beliefs, practices, traditions, religions, and spirituality [5]. Faculty, and students alike, who display negative attitudes creates barriers that strain communication and weakens spiritual well-being [27]. At times, the goal of the faculty in the learning environment is to bring conformity rather than creating an atmosphere of belonging. However, making a conscious effort to utilize appropriate verbal and non-verbal communication is central to student motivation and success [3]. Effective communication may not always be successful, requiring both the faculty and the student to make appropriate adjustments in their approach [18]. Examples may be seen in faculty who offers communication through a smile rather than a stern stance, gives a pat on the shoulder rather than a cold shoulder of being ignored, provides a word of encouragement rather than a harsh word of correction or a judgmental accusation, or shows enough emotion to laugh or cry with a student, ultimately creating a spiritual connection.

Helping students spiritually means the learning environment is designed to ensure student success [23]. The learning environment should be devoted towards personal fulfillment, optimism and social support [24,28]. It is in this environment that students seek to be understood and accepted, they also seek encouragement, and desires to know that faculty are confident in their abilities [21,29]. Although faculty may be more accustomed to characteristics of traditional and personal religious practices, in order to help students spiritually, valiant efforts to accept differing practices and self-expressions in the learning environment shows consideration (i.e. amendments to dress codes restrictions regarding tattoos, body piercings, hair styles, jewelry and dress) [13].

Furthermore, to help students spiritually, they must be responsible for doing their part (i.e., attending class on time, preparing for class, asking questions when unsure of the material, and taking advantage of faculty’s assistance). In return, faculty should show interest and enthusiasm when teaching, create an atmosphere that promotes a feeling of well-being [19], such as playing soft music prior to the start of class or a by displaying an inspiring thought of the day during class. Faculty who commits to educating nursing students holistically are able to support the students’ ability to mature personally, professionally, and spiritually [25].

Emerging Thought

What is evident from the literature is that spirituality is a phenomenon that is experienced by all people, of all ages. In nursing education, it involves faculty and students and the respect of one another’s values and beliefs. The relationship between faculty and students is essential for both nurturing and for meeting students’ spiritual needs [4], particularly when students experience highly stressful events. As a result of this review, it can be said that students who are encumbered with cares and concerns are in need of faculty who Take the Opportunity to Unite and Communicate to Help Students Spiritually (TOUCHSS - pronounced as “Touches”). Ultimately, students may be able to better engage in their academic responsibilities with more confidence in their abilities to care for others holistically. Thus, one consideration of what may be central to faculty and students is the thought that nursing faculty who establishes a caring learning environment will also foster student success by meeting their spiritual needs.

In no way does “TOUCHSS” imply physical touch that may be deemed as misconduct in the workplace setting. Instead, a faculty’s presence, like nursing presence with a patient, is all that may be required to spiritually connect. By offering a smile rather than a stern stance or a cold shoulder of being ignored, or by providing a word of encouragement rather than a harsh word of correction or a judgmental accusation, or simply by showing enough emotion to laugh or cry with a student, faculty are able to make a spiritual connection with the student. Frequent, if not daily encounters with students who need someone to talk to, listen to their concerns, and is sensitive enough to know when and how to respond to their needs is not uncommon to faculty. Therefore, it is suggested that the use of this creative idea - “TOUCHSS” can be implemented in a variety of ways including but not limited to electronic communication such as email or text messages, via telephonic communication, in the clinical setting, or perhaps during campus or community events and interactions with students.

Conclusion

The demands of a nursing program may be overwhelming for students. The learning environment is the place where students’ personal fulfillment towards success is supported [3]. Moreover, faculty is to be commended for the work that they do. Taking the time to unite and connect is simply an act of caring and although efforts to effectively communicate may not always be successful, appropriate adjustments in the faculty’s approach, as well as the student’s approach, may be the caveat to helping students academically, and most of all spiritually.

This emerging thought presents an opportunity for further exploration through concept analysis and nursing studies to determine how these thoughts can be further developed. Qualitative research may also help to determine nursing considerations and meaning. Future research on this emerging thought will help to inform nursing education and practice. Narayanasamy [14] opined that skillful pedagogy regarding spirituality is challenging, not only in instruction, but also in relationships. However, individuals must show sensitivity and tolerance when working with diverse and differing viewpoints. Thus, future research regarding the development, implementation and dissemination of guidelines for faculty serving as spiritual care providers for students are also needed. Starting small with research on the emerging thought, “TOUCHSS” may be the quintessential answer that is needed to bring focus on meeting the spiritual needs of students.

Acknowledgement

This article did not receive any funding from a grant or from any public, commercial or not-for-profit grant funding agency.

References

1. AACN (2010) Nursing shortage fact sheet.
2. Young C, Koopsen C (2011) Spirituality, health and healing: An integrative approach (2^nd Edition). Sudbury, MA: Jones and Bartlett Publishers.
3. Bronson S (2016) Autonomy support environment and autonomous motivation on nursing student academic performance: An exploratory analysis. Nurse Education Today 44: 103-108.
4. Dossey B, Selanders L, Beck D, Attewell A (2005) Florence nightingale today: Healing, leadership, global action. Silver Spring, MD: American Nurses Association.
5. Purnell L (2009) Guide to culturally competent health care (2^nd Edition). Philadelphia, PA: F.A. Davis Company.
6. Cone PH, Giske T (2017) Nurses’ comfort level with spiritual assessment: a study among nurses working in diverse healthcare settings. Journal of Clinical Nursing 26: 3125-3136.
7. Cobb M, Robshaw V (1998) The spiritual challenge of health care. London: Churchill Livingstone.
8. Watson J (2002) Intentionality and caring-healing consciousness: A practice of transpersonal nursing. Holistic Nursing Practice 16: 12-19.
9. Reed P (1992) An emerging paradigm for the investigation of spirituality in nursing. Research in Nursing and Health 15: 349-357.
10. Williams M (2010) Attrition and retention in the nursing major: Understanding persistence in beginning nursing students. Nursing Education Perspective 31: 362-367.
11. Hessel J (2009) Presence in nursing practice: A concept analysis. Holistic Nursing Practice 23: 276-281.
12. Easter A (2000) Construct analysis of four modes of being present. Journal of Holistic Nursing 18: 362-377.
13. Meraviglia M (1999) Critical analysis of spirituality and its empirical indicators: Prayer and meaning in life. Journal of Holistic Nursing 17: 18-33.
14. Narayanasamy A (2014) The challenges of teaching and learning spirituality in nursing. Journal of Nursing Care 3: 189.
15. Daghan S (2018) Nursing students’ perceptions of spirituality and spiritual care; an example of Turkey. Journal of religion and health 57: 420-430.
16. Baldacchino D (2015) Spiritual care education of health care professionals. Religions 6: 594-613.
17. Ross L, Van Leeuwen R, Baldacchino D, Giske T, McSherry W, et al. (2014) Student nurse’s perceptions of spirituality and competence in delivering spiritual care: A European pilot study. Nurse Education Today 34: 697-702.
18. Torregosa MB, Ynalvez MA, Morin KH (2016) Perceptions matter: faculty caring, campus racial climate and academic performance. Journal of Advanced Nursing 72: 864- 877.
19. Reeve K, Shumaker C, Yearwood E, Crowell N, Riley J (2013) Perceived stress and social support in undergraduate nursing students' educational experiences. Nurse Education Today 33: 419-24.
20. Deci E, Ryan R (1985) Intrinsic motivation and self-determination in human behavior (Perspectives in social psychology). New York: Plenum Press.
21. Deci E, Ryan R (2002) Handbook of self-determination research. New York: University of Rochester Press.
22. Wu L, Tseng H, Liao Y (2016) Nurse education and willingness to provide spiritual care. Nurse Education Today 38: 36-41.
23. Beck DM (2015) Incivility and student and faculty relationships: implications for revising mentorship programs for nurse educators. SOJ Nursing and Health Care 1: 1-10.
24. Puchalski CM, Vitillo R, Hull SK, Reller N (2014) Improving the spiritual dimension of whole person care: reaching national and international consensus. Journal of Palliative Medicine 17: 642-656.
25. Rankin EA, DeLashmutt MB (2006) Finding spirituality and nursing presence: The student’s challenge. Journal of Holistic Nursing 24: 282-288.
26. Beckett A, Gilbertson S, Greenwood S (2007) Doing the right thing: Nursing students, relational practice, and moral agency. Journal of Nursing Education 46: 28-32.
27. DePalma J (2006) Evidence regarding cultural competency. Home Health Care Management Practice 18: 405-407.
28. Pashak T, Laughter T (2012) Measuring service-mindedness and its relationship with spirituality and life satisfaction. College Student Journal 46: 183-192.
29. Deci E, Ryan R, Gagne M, Leone D, Usunov J, et al. (2001) Need satisfaction, motivation, and well-being in the work organizations of a former Eastern Bloc country: A cross-cultural study of self-determination. Personality and Social Psychology Bulletin 27: 930-942.