Vincensi, Barbara

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Hope CollegeDigital Commons @ Hope CollegeFaculty Presentations3-2013Integrating Spiritual Care into Nurse Practitioners’Practice: Improving Patient Health IndicatorsWhile Limiting CostBarbara VincensiHope College, vincensi@hope.eduFollow this and additional works at: http://digitalcommons.hope.edu/faculty_presentationsPart of the Nursing CommonsThis Presentation is brought to you for free and open access by Digital Commons @ Hope College. It has been accepted for inclusion in FacultyPresentations by an authorized administrator of Digital Commons @ Hope College. For more information, please contact digitalcommons@hope.edu.Recommended CitationRepository citation: Vincensi, Barbara, "Integrating Spiritual Care into Nurse Practitioners’ Practice: Improving Patient HealthIndicators While Limiting Cost" (2013). Faculty Presentations. Paper 125.http://digitalcommons.hope.edu/faculty_presentations/125March 1, 2013.Integrating Spiritual Care into Nurse Practitioners’ Practice: Improving Patient Health Indicators While  Limiting Cost Barbara Baele Vincensi PhD RN FNP  MNRS Spring 2013 Hope College Holland, Michigan Questions • What is the frequency of NPs incorporating spiritual care into their practice?  • Do NPs’ own spirituality influence the ability to provide spiritual care?  • What can be done to help improve the incorporation of spiritual care into NP practice?  Conceptual Framework • Newman’s Theory of Health as Expanding Consciousness – Disease becomes a meaningful aspect of health – Person interacts as an open system with the environment – As health evolves consciousness expands; patterns of relating occur – Person discovers  and recognizes the meaning patterns of relating have on life and health  – Consciousness expands – Transformation, transcendence and expansion of consciousness and health occur Conceptual Framework • Spirituality- an inner resource in times of crises – Relationships (Intrapersonal, Interpersonal, Transcendent) – Human experiences, individually defined, individual journey – Promotes transcending, meaning, purpose, and fulfillment in life – Results in how one views the interconnectedness of the world and self  (a spiritual perspective) • Spiritual Care - Supports another to discern meaning, purpose, & fulfillment in life and illness, to use inner resources – Practice based, inter-personal relationship – Gathering verbal and non-verbal data on spiritual care needs – Providing appropriate spiritual care interventions based on adequate assessment    Methodology & Operationalization  of Concepts • Cross-sectional survey design • Randomized sample (AANP) • Operationalization of concepts – Spirituality : Reed’s Spiritual Perspective Scale (α = 0.95) • Spiritual perspectives (α = 0.87) • Spiritual behaviors (α = 0.95) – Spiritual Care  • Vincensi Spiritual Assessment Tool (VSAT) (α = 0.93)  – Recognizing a specific cue or behavior (α = 0.87) – Further evaluating this cue or behavior (α = 0.89) • Vincensi Spiritual Care Intervention Tool (VSCIT)      (α = 0.92) – GNP initiated spiritual care interventions (α = 0.76) – Client-initiated spiritual-care intervention requests (α = 0.85)   Sample Characteristics Response rate Met inclusion criteria 67% (201) 44% (131) Female 94% (124) Age ≥ 50; m = 52 years 60.9% Working Full-time 71.4% Years in practice as a NP m = 10.42 NP Education:                           MSN                                                   Post-MSN Cert. 71.0% 18.8% Race                                          Caucasian 83.5% Religion:                                   Catholic                                                     Other Christian                                                    Other                                                    Evangelical  38.8% 24.1% 10.5%   8.3% Frequency of Incorporating Spiritual  Care into Practice  Likert Scale: 1 = never;  5 = always    • VSAT (assessing): m = 3.94; sd = 0.64 – Recognizing a specific cue or behavior: m = 4.73; sd = 0.65 – Further assessing  this cue or behavior:  m = 3.92; sd = 0.70  • VSCIT (interventions): m = 3.27; sd = 0.69 – NP- initiated spiritual care interventions: m = 3.28; sd = 0.76                           – Patient-initiated/requested interventions: m = 3.23; sd = 0.85  Other Findings t-tests  VSAT Cues VSAT Further VSCIT GNP VSCIT Patient Graduate Ed              Yes            No               p < 0.05 m = 4.12 m = 3.84 p < 0.009 m = 4.13 m = 3.81 p < 0.05 m = 3.48 m = 3.16 Not significant Other Ed.           Yes               No p < 0.002 m = 4.17 m = 3.78 p < 0.02 m = 4.12 m = 3.84 p < 0.001 m = 3.67 m = 3.13 p < 0.05 m = 3.48 m = 3.15 Gender        Female             Male p = 0.007 m = 3.96 m = 3.33 p = 0.008 m = 3.97 m = 3.29 Not significant Not significant Spiritual Perspectives’ Relationship to Provision of Spiritual Care  Likert Scale 1 = not at all/ strongly disagree;  6 = about once a day/strongly agree • Spiritual Perspectives:  m = 4.73; sd = 1.01 – Influenced by religious affiliation (p = .000)                       & race (p = .003) • No correlations between: – VSAT subscales or the VSCIT subscale of NP initiated interventions and NPs spiritual perspectives • Significant but weak correlation between: – the VSCIT subscale of patient-initiated interventions and NPs spiritual perspectives (r =.203; p < .05)  (1 = never; 5 = always) 1. Appears to have lost meaning or purpose in life.  Cues *m=3.97 sd=0.91 Further *m=3.93 sd=1.02 2. Displays a sense of helplessness.  *m=3.76 sd=0.97 *m= 3.84 sd= 0.99 3. Is having difficulties accepting forgiveness.  *m=3.57 sd=0.99 *m=3.53 sd=0.99 4. Displays a sense of hopelessness.  *m=3.81 sd=0.87 *m=3.54 sd=1.02 5. Appears to have become disconnected from relationships.  *m=3.59 sd=0.93 *m=3.87 sd=0.95 6. Is grieving over various losses, including health losses.  m=4.07 sd=0.87 *m=3.56 sd=0.98 7. Expresses that life has no meaning or purpose now. m=4.05 sd=0.96 *m=3.98 sd=0.99 8. Tells you they no longer are involved with spiritually or     religiously related activities or rituals which have brought them peace, comfort, or a sense of connection in past.  m=4.00 sd=0.91 m=4.01 sd=0.89 9. Mentions directly they are interested in talking about their spiritual needs with someone.  m=4.59 sd=0.74 m=4.63 sd=0.73 Spiritual Assessment (VSAT) (1 = never; 5 = always) 1. I have encouraged patient to talk about their spiritual concerns.  m=3.97 sd=0.78 2. I have encouraged patients to talk about their recent spiritual insights as     related to health and chronic disease. m=3.16 sd=0.86 3. I have encouraged patients to talk about their spiritual difficulties of living with     chronic disease. m=3.18 sd=0.91 4. I have encouraged patients to talk about what gives their life meaning and     purpose in the midst of chronic disease m=3.55 sd=0.83 5. I have encouraged patients to think about ways to heal relationships in which     they are experiencing dissonance m=3.42 sd=0.85 6. I have encouraged patients to talk about how chronic disease affects their     relationship with God or a Higher Power m=2.91 sd=1.03 7. I have documented the spiritual care I provided in patients’ charts.  m=2.64 sd=1.18 8. I have discussed a patient’s spiritual care needs with other health care     providers as it impacts the patient’s health m=3.03 sd=1.12 9. I use touch appropriately as spiritual needs arise with patients m=3.64 sd=1.08 10. I have encouraged patients to talk about their grieving as it relates to their health,       chronic disease, and spiritual well-being  m=3.87 sd=0.78                  NP-Initiated Spiritual Care Interventions (VSCIT) In the primary care setting with the patient’s permission: (1 = never; 5 = always)  11. I have discussed with patients potential spiritual resources in the community to help meet their spiritual care needs.      m= 3.46 sd=1.18 12. I have provided support for patients’ spiritual practices.  m=3.45 sd=1.03 13. I have arranged for a visit or made a referral to patients’ clergy or spiritual mentors.  m=3.53 sd=1.11 14. I have offered to pray with patients.  m=2.51 sd=1.18 15. I have encouraged patients to cope using spiritual practices or spirituality.  m=3.31 sd=1.02 Patient-Initiated Interventions (VSCIT)  Implications • Education – Development of new programs to test the effects of education on spiritual care  • Research – Continue to test and refine the VSAT and VSCIT tools  • Practice – Fully integrate spiritual care within relationship-based care with our patients 

Integrating Spiritual Care into Nurse Practitioners’ Practice: Improving Patient Health Indicators While Limiting Cost

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Integrating Spiritual Care into Nurse Practitioners’ Practice: Improving Patient Health Indicators While Limiting Cost

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