Correspondence: Frans Cilliers, Department of Industrial and Organisational Psychology, PO Box 392, UNISA 0003, South Africa.Correspondence: Frans Cilliers, Department of Industrial and Organisational Psychology, PO Box 392, UNISA 0003, South Africa. Tel: � 27.83.709.8776. Fax: � 27.12.429.8368. E-mail: firstname.lastname@example.org
The role of spirituality in coping with the demands of the hospital culture amongst fourth-year nursing students
FRANS CILLIERS 1 & LANDA TERBLANCHE 2
1 Department of Industrial and Organisational Psychology, University of South Africa, Pretoria, South Africa, and 2 School of Nursing, Trinity Western University, Langley, Canada
Abstract The aim of this research was to describe the role of spirituality in coping with the demands of the hospital culture amongst fourth-year nursing students. Qualitative, descriptive, hermeneutic interpretive research was done. A case study of 14 female Canadian nursing students was asked to write an essay on their experiences of the demands of the hospital culture. Con- tent analysis was used and positive psychology served as the interpretive lens. Trustworthiness and ethicality were ensured. The fi ndings indicated that although the nursing students expressed themselves in religious and spiritual words, they did not signifi cantly illustrate the theoretically associated intra-, interpersonal and sacred behaviours to be referred to as being spiritual in their experience as a care giver in the hospital culture. They also did not illustrate behaviours linked to other positive psychology constructs such as sense of coherence, resilience, engagement or emotional intelligence. Rather, the nursing students experienced identity crises. Recommendations for the inclusion of mentoring in the curriculum of nursing students were formulated.
Organizational culture can be defi ned as the customs, ways, rituals, rules and regulations implemented by a system to preserve its identity (Robbins et al., 2009). As institutions, hospitals are seen as different from most other types of orga- nizations because of their unique primary task of attending to illness, pain, dying and death (Katz & Kahn, 1978). This has resulted in a worldwide hos- pital culture of strict hierarchy and control in order to preserve order in reporting lines, obedience to methodology and technique, and cleanliness and sterility for the survival of patients, their families, communities and hospital staff. Menzies ’ (1993) research on hospital organizational dynamics found that hospitals as systems compensate for manifest- ing institutionalized survival anxieties (amongst patients) and performance anxieties (amongst staff) by enforcing strict personnel and procedural con- trol mechanisms.
It is generally accepted in the nursing fraternity that student nurses experience emotional diffi culty upon entering the hospital culture (Lanzette, 2010). As little information is available on their spiritual experiences, this study investigated how they cope from a spiritual perspective.
Nursing science views and studies nurses as whole people, and it is believed that their professional and work performance depends on the level of inte- gration of their physical, psychological (including cognitive, emotional, motivational), social, cultural, environmental and spiritual functioning (Duke, 2013; Lanzette, 2010; Meier et al., 2005; Reimer- Kirkham et al., 2012; Young & Koopsen, 2005). Of these domains, research on spirituality is limited and controversial (Wissing & Fourie, 2000) due to the multidimensionality of spirituality, its confusion with religiosity or religious activities, as well as the diverse research methodologies being applied.
Spirituality input has been studied amongst vari- ous patient groups (Bauer & Barron, 1995; Brillhart, 2005; Hampton & Weinert, 2006; Lovanio & Wallace, 2007; Meraviglia, 2004; Reynolds, 2006; Tuck et al., 2001). Although the results are inconsistent, it has been shown to facilitate patients in coping with pain, hopelessness and despair. Research on the spiritual- ity of nursing students showed that the women especially regard themselves as having high levels of spirituality characterized by religious activities (discussions, church attendance) and experiencing meaning in life (Shores, 2010). Spiritual sensitivity
International Review of Psychiatry, June 2014; 26(3): 279–288
ISSN 0954–0261 print/ISSN 1369–1627 online © 2014 Institute of Psychiatry DOI: 10.3109/09540261.2014.890922
280 F. Cilliers & L. Terblanche
increases with age and experience (Callister et al., 2004), especially after inputs containing self- refl ection (Catamzaro & McMullen, 2001), and increases the nurse ’ s competence in patient care- giving (Mitchell et al., 2006; Pesut, 2002). Nursing students ’ spirituality at Christian universities does not differ signifi cantly from students at public universities (Garner et al., 2002).
The existing literature on spirituality does not pro- vide a clear and comprehensive conceptualization or clear behavioural characteristics on the construct (Pargament, 2013a; 2013b). It was therefore decided to create a profi le from the existing positive psychol- ogy literature.
Psychology in general and organizational psy- chology specifi cally, has for a long time ignored, pathologized and reduced spirituality as a part of many underlying psychological functions (Snyder & Lopez, 2009). Organizational psychology is increas- ingly exploring the role of spirituality in leadership, ethical behaviour, communication, motivation and sustainability (Pargament, 2013b). Since the popu- larization of positive psychology (Seligman & Csik- szentmihalyi, 2000), spirituality was recognized as a psychological construct (Pargament, 2013a; 2013b). Positive psychology is defi ned as the scien- tifi c study of strengths, virtues, positive emotions, traits and values towards enabling individuals, orga- nizations and communities to thrive, and positive organizational psychology as the study of the nature of and enhancement of coping behaviour (Azar, 2011; Linley & Joseph, 2004; Lopez & Lyubomir- sky, 2008; Seligman & Csikszentmihalyi, 2000; Seligman et al., 2005; Sheldon & King, 2001; Shel- don et al., 2011; Snyder & Lopez, 2009; Str ü mpfer, 2005). Coping behaviour is operationalized in con- structs such as respect, mindfulness, emotional intelligence, happiness, hardiness, resilience, engage- ment, self-effi cacy, sense of coherence and learned resourcefulness as well as some less well-known constructs such as positive character strengths, pos- itive emotions, fl ourishing, curiosity, hope, and joy (Snyder & Lopez, 2009).
Spirituality is derived from the Latin spiritus , mean- ing breath, and refers to the essence of who and how people are in life. As a multidimensional phenome- non, spirituality has no universally accepted defi ni- tion (Duke, 2013; Meier et al., 2005; Young & Koopsen, 2005). The World Psychiatric Association (Verhagen et al., 2010) defi nes spirituality as a per- sonal belief in ideas of religious signifi cance such as God, the soul or heaven. The Canadian Nursing Association (CNA, 2010) endorsed Wright ’ s (2005) defi nition, namely that spirituality refers to whatever
or whoever gives ultimate meaning and purpose to one ’ s life that invites particular ways of being in the world in relation to others, oneself and the universe. Pargament (2013a; 2013b) presents an impressive, extensive and recent rendition of the history and psy- chology of spirituality with reference to relevant paradigms, social contexts, methodological and psy- chometric data.
In positive psychology, spirituality is defi ned as a pervasive, basic human, personal, individualistic, subjective, life-enhancing and growth-stimulating force indicative of psychological well-being, in search of the sacred (Linley & Joseph, 2004; Meier et al., 2005; Pargament, 1999; 2013a; 2013b; Peterson & Seligman, 2004; Snyder & Lopez, 2009; Young & Koopsen, 2005). The search refers to the ongoing life journey and process of discovery of something sacred (such as personal accomplishments or revelations), conservation (holding on to the discovery, building and sustaining the connection) and transformation (the purifi cation and reframing of the individual ’ s tie and connectedness to the sacred). Sacred refers to what is set apart from the ordinary, worthy of ven- eration and respect, the individual ’ s concept of God as well as the manifestations of the divine. Individu- als experience transcendence (the felt presence of a reality or a being that is wholly different from ordi- nary experience), immanence, boundlessness and ultimacy (the experience of something as fundamen- tal to the nature of reality, at the heart of the mystery of the universe and of all human experience).
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