An open journey approach to spiritual care education

“Life is a Journey” is a common metaphor used around the world. While this is a true picture of life, the journey theme can be useful to express a variety of processes. In healthcare, we talk about the journey through suffering, the journey to health, or the learning journey. The coronavirus pandemic has shown us that the journey often has setbacks and side lanes, and in many cases can lead to loss and grief. Spiritual care is of particular importance in the journey through loss and grief, especially for nurses and other frontline healthcare providers.

An open journey approach to spiritual care education. Atlas of Science

Fig. 1. Open Journey Theory Learning Spiral (Giske & Cone, 2012).

So how do we provide spiritual care? How can nurses give spiritual care when we ourselves are suffering? Globally, nurses are mourning the loss of patients, family, friends, and colleagues. We mourn for the families of our patients who were not able to be beside their loved one as death approached. We mourn our fellow nurses around the world who have lost their lives as they served patients with Covid-19. On this journey, there are strategies that can make the healing path clearer and nursing care more effective.

Open journey theory is a teaching-learning theory developed by merging two theories from the grounded theory research of Dr. Tove Giske and Dr. Pamela Cone among teachers on how they taught spiritual care and among students on how they learned about spiritual care (Cone & Giske, 2018). The teaching theory was “Journeying with students through maturation in spiritual care” (Cone & Giske, 2012) and the learning theory was “Opening up to learning spiritual care” (Giske & Cone, 2012). These two theories describe the basic processes of helping students understand an area of care that can be hard to grasp, and of how students learn by opening up their hearts and minds to things with which they are unfamiliar or uncomfortable.

As we examined our two theories, researchers realized that merging them made sense and created a teaching-learning theory that has broad application. Any private, challenging, or difficult topic can be addressed through the strategic approach of 1-Preparing, 2-Connecting, and 3-Reflecting. The theory is presented as an iterative learning spiral that grows and expands with the engagement of the participant or student, which is shown in Figure 1.

Educators help students prepare for patient care and students prepare on their own by reading specific materials, dialoguing with peers, and writing about what they learn. Moving forward on the journey, connecting is where students begin working with patients and teachers help students build rapport and trust. Teachers encourage students to be fully present with patients through hard times and difficult questions. Finally, after patient care, teachers help students reflect on their patient interactions, and students reflect together on what went well and what could be done better the next time.

An open journey approach to spiritual care education. Atlas of Science

Tab. 1. Strategies for Integrating Spiritual Care across Curricula (Cone & Giske, 2018).

The open journey framework requires both teachers and students to become more aware of personal views, beliefs, and values and to be open to those of patients, whether they are similar or quite different. The Code of Ethics for Nurses (ICN, 2012) mandates nurses to treat patients with dignity and respect, both crucial elements in building trust with patients. As we learn more of ourselves and become more confident in personal views, nurses can serve patients with sincere caring and compassion, and we can be open hearted and honest, providing whole-person, patient-centered care. Time and experience in the profession can bring maturity in the ability to facilitate care of the patient’s spirit as long as the nurse keeps the journey open and remains both teacher and learner. And the journey goes on…

Pamela H. Cone, Giske Tove
Azusa Pacific University, Azusa, CA, USA
VID Specialized University, Bergen, Norway


Integrating Spiritual Care Into Nursing Education and Practice: Strategies Utilizing Open Journey Theory
Pamela H Cone, Tove Giske
Nurse Educ Today. 2018 Dec


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