Volunteers’ spiritual care competence
This study found that volunteers’ mean scores on spiritual care competence were not high and the overall competence needs to be improved. As a social cause, voluntary service embodies the spirit of mutual assistance, cooperation, dedication and great love, which promotes social civilization. Volunteers are an integral resource in palliative care. They play an essential role in improving the quality of the patients’ life and positively affecting their families’ health, whether physical, psychological or spiritual. They can provide various services, including social support, emotional support, informational support, practical support, spiritual support, respite support, physical support and bereavement support. In addition, volunteer services relieve the pressure on medical stuff. It was estimated that there were around 1029 palliative care volunteers in China. At present, the development of palliative care volunteers is in its infancy. The current level of volunteers’ spiritual care is not high, which may be related to the the lack of knowledge and resources. The two items that scored lowest was knowledge of death and palliative care, and spiritual care resources. In addition, spiritual care began relatively late in China. The importance of spirituality has been raised at the national level, but relevant policies are lacking. There is a lack of a unified concept of spirituality. And studies on the spiritual care of the dying in China have not been undertaken widely, with most of researches mainly focusing on medical care. Hospital and nursing institutions are relatively more involved in spiritual care. According to the research by Kichenadasse, most of the medical staff had been exposed to patients’ spiritual need, but only 45% reported that they could satisfy their need. There is a lack of unified education content and curriculum in China. And the planning and supervision standards for spiritual care are still blank. Although volunteers have a passion for palliative care, they do not have a good command of professional knowledge and understand the concept of spiritual care. Thus, there remains an urgent need to clarify the definition of spirituality and develop systematic curriculum and training programs with a view to improving the volunteers’ spiritual care competence.
The spiritual care score of social volunteers is significantly higher than that of college students, which was consistent with the result of this study that age, marital status, religious beliefs were the influencing factors of spiritual care competence. Social volunteers are relatively older and have richer experience on caring and communication. And they are inclined to have a deeper understanding of life. Moreover, 80% of the social volunteers were religious, which could partly explains the results. Fu found that religion could be regarded as a spiritual resource. The religious context can be introduced into palliative care by variable spiritual care strategies, so as to provide spiritual fulcrum for the dying and ease their sense of vulnerability. Religious people usually hold a known belief about death, which helps people eliminate the fear of "unknown" death. Therefore, it is important to pay attention to the value of social volunteers and strengthen the publicity of palliative care in diverse ways, hoping to attract and recruit more volunteers.
Factors affecting volunteers’ spiritual care competence
The results of univariate analysis showed that age, education background, marital status, religious belief are the influencing factors of volunteers’ spiritual care competence. To be specific, an older age, a higher education background, an marital status of being divorced or widowed, being religious indicating a higher level of spiritual care competence. The result of multiple linear regression analysis showed that relative practical experience, education and training are significantly associated with spiritual care competence. Taking care of patients at the end of life is also a process of self-learning and growth. Jiao investigated 80 nurses and found that after systematic spiritual care training, nurses' spiritual health and spiritual care awareness had been significantly improved. Being exposed to spiritual care courses or training will largely improve clinical nurses’ understanding of spiritual care, implementation methods and evaluation of effect. Volunteers who have been exposed to palliative care knowledge and received education and training have a better understanding of the concept and significance of palliative care. It can help them have a correct view of life and death, eliminate the fear of death, treat dying patients more calmly and give them better spiritual care service. Spiritual care education and training also strengthen caregivers' sense of responsibility to provide spiritual care, so as to enhance their spiritual care competence. Zhang found that after systematic training of spiritual care, the cognition, competence and attitude towards palliative care were significantly improved. Spiritual care cognition is positively correlated with spiritual care competence. The content and method of spiritual care are the most urgent contents for volunteers to be trained. It is necessary to focus on the education of spiritual care cognition and develop a training and evaluation system, so as to improve volunteers’ spiritual care competence.
There are abundant spiritual resources in Chinese native culture, such as the harmonious thought of the unity of man and nature, Confucius' philosophy of life, Zhuangzi's inner sanctity realm and meditation. Combined with Chinese and western philosophical concepts, a set of theoretical knowledge of spiritual care suitable for Chinese people can be developed, which can provide theoretical guidance for the development of spiritual care training system. In 2007, Hunan Cancer Hospital launched the first clinical spiritual care program in Mainland China. 26 volunteers, mainly clinical nurses, became the first batch of members through registration, expert recommendation and interviews. In 2009, 24 clinical spiritual care teachers graduated from Hunan Cancer Hospital. At the same time, the international and Taiwan regions have experience in spiritual care training. For example, Chang Gung Hospital arranges spiritual nurses for dying patients to provides death education and spiritual care, so as to improve the quality of their life. Shanghai has also begun to explore spiritual care training for palliative care staff through introduction of teachers from Taiwan. In the context of the extensive implementation of the pilot reform of palliative care in China, it is recommended to develop a variety of forms such as classroom education and continuing training to strengthen the publicity and education of palliative care and spiritual care. On the one hand, the faculty of medical colleges should be used to provide a range of life education and palliative care courses for students. On the other hand, spiritual care training teachers and curriculum systems are supposed be developed to carry out the continue education program for palliative care services and improve the spiritual care competence, so as to systematically improve the quality of palliative care, which will improve the value and the meaning of survival of dying patients and realize physical, spiritual and social peace.
The relationship between attitude towards palliative care and spiritual care competence among volunteers
The study showed that attitude towards palliative care was positively correlated with spiritual care competence (p<0.001), indicating that volunteers who held a positive attitude towards palliative care had a higher level of spiritual care competence. The reason for this relationship may be that volunteers holding a positive attitudes towards palliative care are more passionate and have more interest in caring for the dying, so they take the initiative to learn relative knowledge and can perceive patients’ spiritual need easier. In addition, volunteers holding a positive attitudes towards palliative care may have a positive attitude towards death, which help them understand the spiritual need of patients, convey a positive view of life and death in the process of palliative care. On the contrary, volunteers holding a relatively negative attitudes towards palliative care may be not actively exposed to knowledge about palliative care and spiritual care, and difficult to perceive patients’ spiritual need. At the same time, they may not hold a positive attitude towards death even fear of death, and may be unable to provide spiritual care effectively. Consequently, it is necessary to attach importance to volunteers’ attitude towards palliative care. Selecting standards and training system are supposed to developed to improved the volunteers’ spiritual care competence.