Effectiveness of Transformative Learning on Spirituality in Palliative Care among Nursing Students: A Mixed Methods Study

Main Article Content

Pilaiporn Sukcharoen
Nanchatsan Sakunpong
Kantita Sripa


This study aimed to investigate the impact of transformative learning on spirituality in palliative care among nursing students in Thailand by applying an embedded mixed methods research design. The experimental group (n = 24) received the intervention based on the transformative learning to enhance spirituality in palliative care which was conducted group discussion after completing each transformative learning session. Meanwhile, the control group (n = 24) received a regular instructional model. The instrument’s reliability (Cronbach’s alpha) was .80. From the main quantitative analysis, the two-way repeated measures ANCOVA revealed that the level of spirituality in palliative care of the experimental group was higher than the control group after the experiment, and also two months after the experiment (p < .05). From the qualitative analysis, three themes of learning experience that emerged were- ability to develop awareness and faith, acceptance and compassion for fellow human beings, and spiritual nursing behavior. The outcome of the study was a model of transformative learning to enhance spirituality in palliative care, associated with the experience of nursing students. These findings could be applied to develop an instructional model of palliative care for nursing students.

Article Details

How to Cite
Sukcharoen, P., Sakunpong, N., & Sripa, K. (2020). Effectiveness of Transformative Learning on Spirituality in Palliative Care among Nursing Students: A Mixed Methods Study. The Journal of Behavioral Science, 15(3), 19-33. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/203591
Research Articles


Amann, W., & Stachowicz, A. (2013). Integrity in organizations: Building the foundations for humanistic management. Palgrave Macmillan.

Arisanti, N., Sasongko, E., Pandia, V., & Hilmanto, D. (2019). Implementation of palliative care for patients with terminal diseases from the viewpoint of healthcare personnel. BMC Research Notes, 12(1), 1-5. https://doi.org/10.1186/s13104-019-4260-x

Ballesterosa, M., Centeno, C., & Arantzamendi, M. (2014). A qualitative exploratory study of nursing students' assessment of the contribution of palliative care learning. Nurse Education Today, 34(6), 1–6. https://doi.org/10.1016/j.nedt.2013.12.010

Creswell, W. J., & Clark, P. V. (2011). Designing and conducting mixed methods research. SAGE Publication, Inc.

Creswell, W. J., & Poth, N. C. (2018). Qualitative inquiry research design: Choosing among five approaches. SAGE Publication, Inc.

Dimoula, M., Kotronoulas, G., Katsaragakis, S., Christou, M., Sgourou, S., & Patiraki, E. (2019). Undergraduate nursing students' knowledge about palliative care and attitudes towards end-of-life care: A three-cohort, cross-sectional survey. Nurse Education Today, 74(1), 7-14. https://doi.org/10.1016/j.nedt.2018.11.025.

Doyle, M. (2008). Transformation of nursing students’ attitudes, assumptions, and beliefs on death and dying: A mixed methods study (Doctoral dissertation). Capella University, Minnesota.

Emanuel, L., & Librach, L. S. (2007). Palliative care core skills and clinical competencies. Saunders Elsevier.

Gillan, C. P., Van, D. P., & Jeong, S. (2014). End of life care education, past and present: A review of the literature. Nurse Education Today, 34(3), 331–342. https://doi.org/10.1016/j.nedt.2013.06.009

Gilliland, I. (2015). Effects of a community-based hospice, experience on attitudes and self-perceived, and competencies of baccalaureate senior nursing students. Journal of Nursing Education, 54(6), 335-338. https://doi.org/10.3928/01484834-20150515-04

Hold, L. J., Blake, J. B., & Ward, N. E. (2015). Perceptions and experiences of nursing students enrolled in a palliative and end-of-life nursing elective: A qualitative study. Nurse Education Today, 35(6), 777–781. https://doi.org/10.1016/j.nedt.2015.02.011

Jiang, Q., Lu, Y., Ying, Y., & Zhao, H. (2019). Attitudes and knowledge of undergraduate nursing students about palliative care: an analysis of influencing factors. Nurse Education Today, 80(1), 15-21. https://doi.org/10.1016/j.nedt.2019.05.040

Kear, M.T. (2013). Transformative learning during nursing education: A model of interconnectivity. Nurse Education Today, 33(9), 1083–1087. https://doi.org/10.1016/j.nedt.2012.03.016

Klobucar, R. N. (2016). The role of Spirituality in transition to parenthood: Qualitative research using transformative learning theory. Journal of Religion and Health, 55(1), 1345–1358. https://doi.org/10.1007/s10943-015-0088-4

Lewinson, P.L., Mcsherry, W., & Kevern, P. (2015). Spirituality in pre-registration nurse education and practice: A review of the literature. Nurse Education Today, 35(6),806–814. https://doi.org/10.1016/j.nedt.2015.01.011

Lin, C. C., Han, C. Y., Pan, I. J., & Chen, L. C. (2015). The teaching learning approach and critical thinking development: A qualitative exploration of Taiwanese nursing students. Journal of Professional Nursing, 31(2), 149–157. https://doi.org/10.1016/j.profnurs.2014.07.001

Meesuaisint, M., Pathumcharoenwattana, W., & Boonprakob, P. (2017). Krabūankān plīanplǣng parithat phư̄a sœ̄msāng kān hen khunkhā thǣ nai tonʻēng khō̜ng yaowachon chāi thī kratham phit khadī khwāmrunrǣng [The process of perspective transformation for enhancing authentic self-esteem among violent male juvenile delinquent]. Warasan Phuettikammasat, 23(1), 1-20.

Mezirow, J. (1991). Transformative dimensions of adult learning. Jossey-Bass Inc., Publishers.

Ozveren, H., & Kirca, K. (2018). Influence of palliative care training on last-year nursing department students’ perception on regarding spirituality and spiritual care: A Single group pretest–posttest intervention study. Journal of Religion and Health, 58(1), 860–869. https://doi.org/10.1007/s10943-018-0701-4

Paganini, C. M., & Bousso, S. R. (2015). Nurses’ autonomy in end-of-life situations in intensive care units. Nursing Ethics, 22(7), 803–814. https://doi.org/10.1177/0969733014547970

Piercy, G. (2013). Transformative learning theory and spirituality: a whole-person approach. Journal of Instructional Research, 2(1), 30-42. https://doi.org/10.9743/JIR.2013.2.14

Rattanamongkol, S. (2014). Transformative Learning čhāk prasopkān lǣkplīan rīanrū kap khrư̄akhāi kānrīanrū phư̄a kān plīanplǣng phư̄a phǣtthaya sāttra sưksā nai prathēt Thai [Transformative learning from learning experiences with learning community for transformation in Thailand]. Thammasat Medical Journal, 14(4), 489-491.

Sakunpong, N., Choochom, O., & Taephant, N. (2016). Development of a resilience scale for Thai substance-dependent woman: A mixed methods approach. Asian Journal of Psychiatry, 22(1), 177-181. https://doi.org/10.1016/j.ajp.2015.10.011

Sakunpong, N. (2018). Life narrative to substance use: voices from LGBT people. Journal of Health Research, 32(5), 387–394. https://doi.org/10.1108/JHR-08-2018-041

Sierra, C. E., Sabater, M. A., & Monux, L. Y. (2017). An instrument to measure nurses’ knowledge in palliative care: validation of the Spanish version of palliative care quiz for nurses. Plos One, 12(5), 1-15. https://doi.org/10.1371/journal.pone.0177000

Sukcharoen, P., Sakunpong, N., & Sripa, K. (2020). Spiritual dimension in palliative care from the perspective of Thai palliative caregivers. International Journal of Palliative Nursing, 26(2), 70-74. https://doi.org/10.12968/ijpn.2020.26.2.70

Tisdell, E. J. (2008). Spirituality and adult learning. New Directions for Adult and Continuing Education, 119(1), 27-36. https://doi.org/10.1002/ace.303

Tishelman, c., Bergenmar, M., Bernhardson, B. M., Blomberg, K., Borjeson, S., Foderus, H, Levealahti, E., Sahlberg, E., & Ternestedt, B. (2008). Using undergraduate nursing students as mediators in a knowledge transfer programme for care for patients with advanced cancer. European Journal of Cancer Care, 17(3), 253–260. https://doi.org/10.1111/j.1365-2354.2007.00840.x

Wallace, M., Grossman. S., Campbell, S., Robert, T., & Lange, J., (2009). Integration of end of life care content in undergraduate nursing curricula: Student knowledge and perceptions. Journal of Professional Nursing, 25(1), 50–56. https://doi.org/10.1016/j.profnurs.2008.08.003