The Kantian account of mechanical explanation of natural ends in eighteenth and nineteenth century biology.

The rise of the mechanistic worldview in the seventeenth century had a major impact on views of biological generation. Many seventeenth century naturalists rejected the old animist thesis. However, the alternative view of gradual mechanistic formation in embryology didn't convince either. How to articulate the peculiarity of life? Researchers in the seventeenth century proposed both "animist" and mechanistic theories of life. In the eighteenth century again a controversy in biology arose regarding the explanation of generation. Some adhered to the view that life is a physical property of matter (e.g. Buffon), others saw living entities as the result of the development of pre-existing germs (e.g. Bonnet). Naturalists, lacked a convincing account that could guide their research. In interaction with leading naturalists of his time Immanuel Kant articulated an approach to explaining generation. Kant's account, delineated in his Kritik der Urteilskraft (Critique of the power of judgment) (1790), is a combination of Newtonian non-reductionist mechanism in explanation, and a concept of natural end comparable to Stahl's formal conception of organic bodies. It consists of two claims: a) in biology only mechanical explanation is explanatory, and b) living entities contain some original organisation, which is mechanically unexplainable. In the nineteenth century this approach influenced naturalists as Müller, Virchow, and Von Baer, in their physiological research. Dissatisfied with a sheer mechanistic or, on the other hand, a sheer teleological approach, they appreciated the Kantian account of mechanical explanation of natural ends. In Germany, in the second halve of the nineteenth century, Ernst Haeckel reopened the debate about abiogenesis, which still continuous.

Moral issues in mentoring sessions.

This article describes the results of research that investigated whether student nurses identified the moral aspects of everyday nursing care situations and, if so, how they dealt with them. We intended to elucidate the role of mentoring situations in moral development. Student written documents reflecting discussions during mentoring situations were analysed quantitatively and qualitatively. The students studied in one of the three nursing schools involved in the research. In only a small proportion of cases (<13%) did the students identify the ethical questions in those situations. The results indicate that the nursing students rarely identified moral issues, implying that there was little conscious moral reflection and deliberation in their mentoring situations dealing with their problematic experiences during their internship. Additional competences will be required for session leaders in order to allow mentoring situations to play a more prominent role in moral development.

The validity and reliability of an instrument to assess nursing competencies in spiritual care.

AIM: This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care. BACKGROUND: Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. DESIGN: Survey. METHOD: The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach's alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109). RESULTS: The spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled: 1 assessment and implementation of spiritual care (Cronbach's alpha 0.82) 2 professionalisation and improving the quality of spiritual care (Cronbach's alpha 0.82) 3 personal support and patient counseling (Cronbach's alpha 0.81) 4 referral to professionals (Cronbach's alpha 0.79) 5 attitude towards the patient's spirituality (Cronbach's alpha 0.56) 6 communication (Cronbach's alpha 0.71). These subscales showed good homogeneity with average inter-item correlations >0.25 and a good test-retest reliability. CONCLUSION: This study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. RELEVANCE TO CLINICAL PRACTICE: The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.

Learning effects of thematic peer-review: a qualitative analysis of reflective journals on spiritual care.

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students' competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are 'inclusion of actual experience' and 'reflecting on this experience'. The phases of 'abstraction of experience' and 'experimenting with new behaviour' are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research.

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care.

AIM: To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. BACKGROUND: Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. DESIGN: Quasi-experimental crossover design (pre-post-test). METHOD: The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t-test procedures (paired-samples t-test). At T(1) vignettes were added to assess the quality of the students' own analyses. These data were analysed by a Mann-Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. RESULTS: Ninety-seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T(1)) and over time for the whole cohort of students on all subscales (T(2)). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. CONCLUSIONS: The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. RELEVANCE TO CLINICAL PRACTICE: The results provide nurse educators with insight into the effects of education in spiritual care on students' competencies and help them consider a systematic place for spiritual care within the nursing curriculum.

Aspects of spirituality concerning illness.

The spiritual dimension of illness, health and care may be seen as a unique aspect in addition to the physical, mental and social dimension. This contribution describes experiences of patients, nurses and hospital chaplains in relation to the spiritual aspects of being ill. Qualitative research was performed with the design of a focus group study, consisting of 13 focus groups with a total of 67 participants. A purposive sample was used comprising patients, nurses and hospital chaplains working in oncology, cardiology and neurology in different institutions and regions in the Netherlands. The qualitative analysis consisted of open coding and the determining of topics, followed by the subsequent attachment of substantial dimensions and characteristic fragments. Data were analysed by using the computer program KWALITAN. Spirituality play various roles in patients lives during their illness. There is a wide range of topics that may have an individual effect on patients. Despite differences in emphasis, the topics play a role in different patient categories. Although the spiritual topics seem to manifest themselves more clearly in long-term care relationships, they may also play a role during brief admittance periods (such as treatment decisions). The spiritual topics that arise from this study offer caregivers a framework for signalling the spiritual needs of patients. The question is not whether spirituality is a relevant focus area in care, but how and to what degree it plays a role with individual patients. Follow up research should aim at further exploration of spiritual aspects in care, the relationship between spirituality and health and at effective training of caregivers.

Spiritual care: implications for nurses' professional responsibility.

AIM: This paper aimed to gain insight into the spiritual aspects of nursing care within the context of health care in the Netherlands and to provide recommendations for the development of care in this area and the promotion of the professional expertise of nurses. BACKGROUND: International nursing literature suggests that caregivers are expected to pay attention to spiritual aspects of patient care. In Dutch nursing literature, the spiritual dimension is increasingly becoming a focus of attention. Despite this, there is a lack of empirical data from professional practice in the Netherlands. METHOD: Data were collected by means of focus group interviews. The sample was made up of the specialist fields of cardiology, oncology and neurology and divided into groups of patients, nurses and hospital chaplains. The interviews took place between May and December 2004. Data were qualitatively analysed using the computer programme Kwalitan. RESULTS: Different spiritual themes emerged from the interviews. There were different expectations of the nurse's role with regard to spiritual aspects. The main themes derived from this research can be recognized as aspects of nursing competencies that are reported in the literature. However, the attention to spiritual aspects in the nursing process is not clear cut. It seems to be highly dependent on personal expression and personal commitment. CONCLUSIONS: The study raises questions about the nurse's professional role in spiritual care. The study shows that different factors (personal, cultural and educational) play a role in the fact that spiritual care is not structurally embedded in nursing care. Further research on the impact of that variable is recommended. RELEVANCE TO CLINICAL PRACTICE: Nursing care implies care for the spiritual needs of patients. To provide this care, nurses need to be knowledgeable regarding the content of spiritual care and the personal, professional, cultural and political factors influencing it. They also need to be able to participate in policy and decision-making discussions of spiritual care in clinical nursing practice.