Carrying hope: a grounded theory study of pre-registration nursing students' understanding and awareness of their spirituality from experiences in practice

Spirituality is a phenomenon integral to health and wellbeing and a fundamental element of nursing care. Nonetheless, empirical evidence suggests that spirituality is a frequently ignored aspect of care provision. While there is evidence that examines the relevance of providing spiritual care to service users, minimal research has been undertaken that examines the spiritual needs of pre registration nursing students. This study used a Glaserian grounded theory design to explore and explain pre registration nursing students’ personal understanding of their own spirituality and the relationship between experiences in clinical practice and spiritual awareness. Participants comprised seven pre-registration nursing students undertaking a three-year educational programme. Data was collected between 2008 and 2013 through two focus groups, twelve one-to-one interviews and theoretical sampling of a variety of literature and media, including artefacts created by the participants. The findings identified that pre-registration nursing students’ awareness of spirituality can be explained in three main Basic Social Processes [BSPs]: struggling, safeguarding and seeking. When their spirit was at risk of becoming broken by negative experiences in clinical practice, then their hope to carry on was at risk and struggling, safeguarding and seeking were evident. These three concepts are integral to the theory that emerged from the findings: a theory of carrying hope that explains participants’ resolve between clinical experiences and spiritual awareness. This study highlights that the challenges associated with spiritual awareness may impact on attrition from pre-registration nursing programmes. If students’ spiritual needs and awareness are not adequately nurtured and supported there are implications linked to the aspiration of nursing to recapture the 6Cs (DH 2012). Recommendations from this study include the identification of role models in clinical practice and the implementation of a model of pastoral care for tutors supporting pre-registration nursing students. Further research is required to examine how role modelling and pastoral care can enhance spiritual awareness in pre registration nursing students. While this study focused on nursing, implications for other vocational professions are identified