Quantitative Nursing Research Critique

The aim of the study was to know the degree that the spiritual care perspectives of nursing students influenced their spiritual empathy as proposed by the middle-range theory of spiritual empathy (MTSE). As a relatively new theory, the MTSE requires validation through empirical research within the nursing student population.  In the literature review, relevant articles were used to explain the concept of spiritual care in order to see where spiritual empathy fits in.  Half of the references used in the review were published within the last ten years prior to the study. The elements of providing spiritual care, the reasons why nurses fail to provide this type of care, the impact of nurses’ attitudes, and the effect of demographic characteristics represent what is known about the problem.

The framework of MTSE is based on a theory that is tentative due to lack of sufficient empirical evidence. It was explicitly discussed and illustrated using a diagram showing the concepts, their definitions and their relationships. The framework contributes to the body of nursing knowledge by broadening what is already known about spiritual care. The research objectives were to “explore the relationships among demographic variables, spiritual care perspectives, and expressions of spiritual empathy among nursing students; and determine to what extent nursing students’ spiritual care perspectives account for their expressions of spiritual empathy after controlling for relevant demographic characteristics”. Since it is a study aiming to test a theory, its focus on testing the relationship of concepts in real life is appropriate. The independent variable is spiritual perspectives and the dependent variable is spiritual empathy. Other variables are demographic characteristics and spiritual care.

Spiritual care perspectives are the beliefs and attitudes which influence spiritual empathy and are shaped by the demographic as well as spiritual characteristics of the nurse. These demographic variables are age, gender, ethnicity and level of education. The inclusion of ethnicity is appropriate since spirituality is often associated with ethnicity. Age can also be associated with increased spirituality among older people and its inclusion is likewise appropriate. Level of education is necessary as it may affect awareness and attitudes towards spiritual care. Lastly, spirituality is indicated by religious affiliation, spiritual training and perception of oneself as spiritual.

The design of the study was descriptive correlational (Chism & Magnan, 2006). Since the study’s purpose is to explore the extent that the independent variable influences the dependent variable, the use of a correlational design is justified. Correlation is indicated by the relationship between spiritual empathy scores and spiritual perspectives scores. The study is descriptive as it only aims to describe whether the MTSE holds true in real life; there is no treatment or intervention involved. During sampling, inclusion criteria were undergraduate and graduate level nursing students, currently enrolled in the school of nursing, and aged 18 years or older. Convenience sampling was done wherein students of a midwestern school of nursing’s faculty members were recruited. The participants were selected because of their accessibility and the sample size was 223 which is the minimum number of participants based on a power analysis (Chism & Magnan, 2006). The researchers obtained informed consent and approval by the university’s institutional review board (IRB). Data gathering was done while students were in their classrooms, an environment conducive for answering the three questionnaires.                                                                                                                                                                                                                                                    The measurement instruments used were two self-report questionnaires. The Spiritual Care Perspective Scale (SCPS) is a Likert-type questionnaire while the Expression of Spiritual Empathy Scale 3 is a single-item questionnaire. A demographic sheet was also used to obtain demographic data and a survey on spirituality was done as well. The demographic sheet and spirituality measure nominal data. The SCPS, developed by another author and used with permission, measures ordinal data while the Expression of Spiritual Empathy Scale (ESES), developed by the researcher, measures interval/ratio data. Internal consistency and reliability both in prior studies and the current study was acceptable for both the SCPS and ESES. Since the SCPS obtains self reports on the beliefs, attitudes, level of confidence and comfort of nurses in providing spiritual care, it is useful in measuring spiritual care perspectives. The ESES, on the other hand, measures the frequency that spiritual empathy was expressed and its duration. In this manner, it is a valid tool for measuring spiritual empathy.

Faculty members were approached regarding the study and permission was asked to recruit their students as participants. Consent was obtained from those who wished to participate and the three questionnaires were administered and collected for analysis. Data collection immediately followed recruitment to facilitate a prompt and sure return of questionnaires so that the minimum sample size can be maintained. Descriptive statistics was used to describe the sample. Percentages, ranges and means were calculated to analyze the composition of the sample. ANOVA was employed to determine if there is significance in the wide differences in age, the range being 19-57 years old.

The theory still needs further empiric evidence especially to generate other valid and reliable tools to measure the concepts of the theory. There was a modest but still significant influence of spiritual care perspectives on expression of spiritual empathy. Though limited, this finding helped support the theory. The knowledge gained can still help nurses be able to provide spiritual care through spiritual empathy. Undertaking qualitative research was identified as the next step in generating empirical support. Performing research in other populations, such as nurses in different hospital units, is also needed for theory testing. The study was sufficiently clear in terms of how it was conducted and can be used as a guide in similar and future efforts.

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