Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study

Abstract

Background: End-of-life care is becoming more prevalent in the Emergency Department. Quality end-of-life care includes spiritual support. As spirituality is a relatively vague concept, understanding healthcare professionals' spiritual perspectives is important.

Aims: To explore the perspectives of Emergency Department doctors and nurses in (i) spirituality, (ii) spiritual care domain in end-of-life care and (iii) factors influencing spiritual care provision in the Emergency Department.

Design: A sequential explanatory mixed-method design was used.

Setting: An Emergency Department of a tertiary teaching hospital in Singapore, which treats more than 120,000 patients annually.

Participants: This study involved Emergency Department doctors and nurses who meet the eligibility criteria. In phase one, 64 doctors and 112 nurses were recruited. In phase two, 14 doctors and 15 nurses participated.

Methods: The quantitative phase was conducted first using a socio-demographic form and validated Spiritual Care-Giving Scale on all potential participants. The Spiritual Care-Giving Scale explores one's perspectives of spirituality and spiritual care. Using a six-point Likert scale, participants would indicate their degree of agreement towards the statements. The qualitative phase was then conducted using focus group discussions on a convenience sample of 14 doctors and 15 nurses.

Results: Overall, participants had positive attitudes and understanding of spirituality and spiritual care, as the mean total Spiritual Care-Giving Scale score was 167.87 (SD=24.35) out of 210. Some knowledge deficits were observed in the focus group discussions as several participants equated spirituality to religion and had limited understanding about spiritual care. Significant differences between the spiritual perspectives of doctors and nurses were reported in Spiritual Perspectives (p-value=0.018) and Spiritual Care Values (p-value=0.004) of the Spiritual Care-Giving Scale. Scores by nurses were higher than those of doctors.

Conclusion: The study findings emphasized the need for education regarding spirituality and spiritual care across different cultures. This may help healthcare professionals feel more competent to broach such issues and cope with the emotional burden when providing spiritual care.

Keywords: Doctors; Emergency Department; End-of-life care; Nurses; Perspectives; Spiritual care; Spirituality.