Re-examining definitions of spirituality in nursing research

The Nursing Staff's Understandings of Spiritual Care in an Oncology Clinic in 2003 and 2023: A Mixed Method Longitudinal Study

AIM(S)

To explore the understandings of spiritual care among nursing staff at an Swedish oncology clinic, with a special focus on changes over time.

DESIGN

Qualitative, longitudinal, descriptive design.

METHODS

A questionnaire-based replication study conducted in 2003 (N = 68) and 2023 (N = 47), comparative and thematic analysis.

RESULTS

The thematic analysis generated four main themes in 2023: (i) Relate to the whole person-spiritual care as an approach, (ii) enable an atmosphere of humanity and security around the patient-spiritual care as a nursing intervention, (iii) enable the patient to live out their spirituality or practice their religion-spiritual care that focuses on practical aspects directly linked to practising a religion and (iv) awareness of the importance of one's own approach to spiritual care-spiritual care that focuses on the personal qualities of the caregiver. Compared with 2003, there are many similarities but also some differences: the importance of one's own approach is more emphasised in 2023, and there is an increased awareness that nursing interventions can be different depending on who the patient is and who the caregiver is; spiritual care is more clearly characterised by an effort to relate to the whole person and the understanding of what can/should be included in the framework of spiritual care is broader.

CONCLUSION

The concept of 'spiritual care' can change over time and can depend on societal changes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

When studying understandings of the concept of 'spiritual care' in a nursing context or evaluating studies on the topic, the stability of the concept of 'spiritual care' over time should be accounted for.

REPORTING METHOD

When applicable: SRQR.

PATIENT OR PUBLIC CONTRIBUTION

None.

Quantitative and Qualitative Research in the Field of 'Spirituality and Health': An Introductory How-to-Guide from a Brazilian Perspective

The present article aims to describe the different steps on how to design, develop and conduct quantitative and qualitative Spirituality and Health (S/H) studies from a Brazilian perspective, discussing definitions and instruments, and proposing a "how-to guide" for those interested in this field of research. A narrative review of the literature has been conducted by experts in the field of S/H aiming to develop a "how-to-guide". Spirituality is a very complex concept that has several challenges in the current scientific literature, including the lack of consensus in the definitions, the numerous dimensions assessed, the diverse instruments for measurement, the criticisms from other scholars, the great diversity of religious and cultural traditions and the growing number of "spiritual but not religious" individuals. This review supports that S/H studies may follow the high scientific standards, using consolidated research procedures and solid methods for both qualitative and quantitative research. Some peculiarities of the research methods for this field are discussed. S/H research is still under development, and there are several future directions for S/H studies, aiming to minimize previous criticisms and generating stronger evidence.

Self-Reported Religiosity and Spirituality of Registered Nurses in Virginia

ABSTRACT

The professional nurse cares for an increasingly diverse population, varying in ethnicity, culture, and faith beliefs that influence health and wellness. The moral obligation of the nurse to provide individualized, holistic care of clients includes spiritual care. Supported by the Agape Model of Nursing, nurses should understand their personal religiosity and its impact on the care they provide. The purpose of this study was to better understand the self-reported religiosity and spirituality of registered nurses licensed to practice in the Commonwealth of Virginia.

How nurses can apply spiritual care to improve the daily lives of people with learning disabilities and their families

BACKGROUND

Most UK nursing research into spirituality overlooks its daily application in certain specialties, notably learning disability nursing.

AIMS

Tz explore spirituality over the lifespans of people with learning disabilities and how spiritual care affects their quality of life. To provide practical examples for nurses on how to apply spiritual care in their daily practice.

METHODS

A literature review conducted between January 2002 and July 2022) following recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Thomas and Harden's (2008) approach to thematic synthesis was used to structure 10 full-text articles into three key themes.

FINDINGS

The three key themes were: the role of the nurse, the impacts on the individual, and family/carer perspectives.

CONCLUSION

The nursing role in using spiritual care encompasses care planning an individual's spiritual activities, facilitating time alone, nurturing values such as self-acceptance, building therapeutic relationships, and advocating for progression in existing social structures and legislation.

Spirituality moderates the relationship between cancer caregiver burden and depression

OBJECTIVES

Cancer has become a chronic disease that requires a considerable amount of informal caregiving, often quite burdensome to family caregivers. However, the influence of spirituality on the caregivers' burden and mental health outcomes has been understudied. This study was to examine how caregiver burden, spirituality, and depression change during cancer treatment and investigate the moderating role of spirituality in the relationship between caregiver burden and depression for a sample of caregivers of persons with cancer.

METHODS

This secondary analysis used a longitudinal design employing 3 waves of data collection (at baseline, 3 months, and 6 months). Family caregivers completed the Caregiver Reaction Assessment, Spiritual Perspective Scale, and the PROMIS® depression measure. Linear mixed model analyses were used, controlling for pertinent covariates.

RESULTS

Spirituality, total caregiver burden, and depression remained stable over 6 months. More than 30% of the caregivers had mild to severe depressive symptoms at 3 time points. There was evidence of overall burden influencing depression. Of note was a protective effect of caregivers' spirituality on the relationship between depression and caregiver burden over time (b = -1.35, p = .015). The lower the spirituality, the stronger the relationship between depression and burden, especially regarding subscales of schedule burden, financial burden, and lack of family support.

SIGNIFICANCE OF RESULTS

Spirituality was a significant resource for coping with caregiving challenges. This study suggests that comprehensive screening and spiritual care for cancer caregivers may improve their cancer caregiving experience and possibly influence the care recipients' health.

Perceived Risks and Therapeutic Benefits of Cannabis Among College Students Amidst the COVID-19 Pandemic

More than half of the United States has legalized medicinal and/or recreational cannabis. The purpose of the study is to understand cannabis use and perceptions among college students with cannabis experience - 21 years and older - in a legalized cannabis state. Participants included 170 college students, the majority identified as female (72.9%, n = 124) and Latinx/Hispanic (55.9%, n = 95). The online survey included demographic questions and questionnaires measuring cannabis consumption, cannabis use disorder, and quality of life. Participants answered open-ended questions about the negative, positive, and spiritual impact/s of cannabis on their life and health, and how the COVID-19 pandemic impacted their cannabis use. A paired-sample t-test indicated participants significantly found more relief using cannabis compared to non-cannabis treatments or medications. There was no significant correlation between quality of life and cannabis use disorder symptoms. Inductive content analysis of 112 written responses revealed perceived negative effects (e.g., anxiety/mental health issues) and positive effects (e.g., relaxation/stress reduction) from using cannabis. Most participants reported no spiritual benefits; however, some participants discussed cannabis use improving connection to self and self-awareness. Regarding the impact of the COVID-19 pandemic on use, most participants (27.8%) reported increased cannabis use, while some reported decreased cannabis use. These findings reflect the importance of understanding the wide-range of benefits and risks perceived by college students who consume cannabis and how these results can inform the development of university prevention and wellness strategies within states that have legalized recreational and medical cannabis.

Spirituality and health outcomes within the context of social determinants of health

ABSTRACT

Spirituality has a significant impact on patients' overall quality of life, however, it is often overlooked in the context of social determinants of health (SDOH). Nurses are well positioned to lead the expansion of SDOH models to include spirituality; however, routine nursing care does not emphasize spiritual assessment knowledge and skills. This article discusses spirituality and how it fits into the SDOH model, nursing education, and interdisciplinary healthcare. Spiritual care training may improve the confidence of nurses to integrate routine mental and spiritual assessments in clinical practice and serve as leaders in promoting spiritual care within interdisciplinary healthcare teams.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Building Spiritual Care Competency in Undergraduate Psychiatric Mental Health Nursing Students: A Quality Improvement Project

Purpose: The spiritual care of patients is often overlooked in health care as many nurses are unprepared to provide competent, holistic care that addresses patients' spiritual needs. Since undergraduate academic instruction prepares nurses for practice, innovative strategies that train pre-licensure nurses to care for the spiritual needs of patients are essential. Design: A course needs assessment identified spiritual care as the most deficient competency for undergraduate psychiatric students. A three-phase quality improvement project designed to increase student awareness and practice of spiritual care included (a) development of a quality improvement plan, (b) implementation, and (c) outcome evaluation. Methods: Spiritual care was introduced into the Spring 2020 semester through didactic content and experiential practice. Additionally, an evidence-based spiritual assessment tool (i.e., HOPE questions) was integrated into the course to train students for use in clinical and simulation. Surveys were used to compare the 2019 and 2020 cohorts. Findings: Results showed a statistically significant increase in students' perception of spiritual care competency after project completion. Conclusions: Future implications include the use of similar methods to improve spiritual care competency for pre-licensure nursing students. Keywords: Spiritual care, undergraduate nurse, spiritual assessment.

Factors affecting spiritual care competency of mental health nurses: a questionnaire-based cross-sectional study

BACKGROUND

Although providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses.

METHODS

This prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] "big-five Mini-Markers" questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses.

RESULTS

The mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of "Conscientiousness" (p < 0.001), "Agreeableness" (p < 0.001), "Extraversion" (p = 0.03), and "Openness/Intellect" (p < 0.001).

CONCLUSIONS

Both personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

Community Health Nurses' Spirituality Shapes Their Practice Working With Indigenous Communities in British Columbia, Canada

Common conceptions of spirituality in nursing often concentrate on nurses providing spiritual care, but there is insufficient research indicating how nurses' spirituality impacts their nursing practice. This study examines how Indigenous and non-Indigenous community health nurses' experiences of spirituality, regardless of any religious affiliation, shape their nursing practice with Indigenous communities. Results indicate that spirituality is a pervasive nursing ethic manifesting respect, connectedness, love, acceptance, caring, hope, endurance, and compassion toward clients. Participants' experiences of spirituality promote self-awareness, open-mindedness, and acceptance of others and encourage participants' reflexivity, which grounds their nursing practice. Nurses' spiritual awareness fosters an appreciation for Indigenous community healing, leading to more reciprocal interactions with community members. Significantly, these participants provide care spiritually; they do not provide spiritual care.

Impacts of extrinsic and intrinsic factors on psychiatric nurses' spiritual care attitudes

WHAT IS KNOWN ON THE SUBJECT?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses. Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated. Notwithstanding the known impact of certain intrinsic factors (e.g., personality-related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses. Certain intrinsic factors, including those personality-related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care. Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on-the-job training programmes that involves actual practice and collaboration in a multidisciplinary team. ABSTRACT: Introduction Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim To conduct a questionnaire-based survey on mental health nurses from eight hospitals. Method A total of 239 psychiatric nurses were assessed based on (1) "big-five Mini-Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on-the-job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care.

Relationships between Spirituality, Religious Fundamentalism and Environmentalism: The Mediating Role of Right-Wing Authoritarianism

According to past research, religious attitudes can strongly influence individuals' beliefs and behaviors. The purpose of this study was to assess the relationships between spirituality (the Scale of Spirituality; dimensions include religious spirituality, expanding consciousness, searching for meaning, sensitivity to art, doing good, and sensitivity to inner beauty), religious fundamentalism (the Religious Fundamentalism Scale), support for right-wing authoritarianism (the Right-Wing Authoritarianism Scale), climate concerns (the Environmental Concern Scale), and pro-environmental behavior (the Pro-Environmental Behavior Scale). The cross-sectional study involved 512 Poles aged 18-63 (M = 34.63, SD = 5.96; Mdn = 33), including 51% females. Multiple regression analysis revealed that two dimensions of spirituality (sensitivity to art and doing good) and religious fundamentalism are significant and opposite predictors of climate concern and pro-environmental behavior. Spirituality appeared to foster increased climate concern and caring behavior, while religious fundamentalism negatively predicted the same variables. Mediation analysis revealed that the relationship between religion and environmentalism could be explained in part by differences in support for right-wing authoritarianism (authoritarianism itself was negatively related to environmental outcomes). In addition, analysis of variance revealed that believers (70% of participants in the study were Catholic) showed significantly lower scores regarding climate concerns and pro-environmental behavior than non-believers, yet the inclusion of support for right-wing authoritarianism as a covariate in the equation reduced intergroup differences to statistical insignificance. The data obtained suggest that religious attitudes and socio-political views may play important roles in solving environmental problems.

Religiosidade/Espiritualidade na Prática em Enfermagem: Revisão Integrativa

Introdução: Embora a dimensão religiosa/espiritual seja um dos vértices do cuidado em saúde, tem despertado dúvidas quanto à sua operacionalização na prática profissional. Objetivo: Compreender de que modo a religiosidade/espiritualidade (R/E) está presente na atuação profissional em Enfermagem. Método: Revisão integrativa da literatura científica realizada em seis bases de dados/bibliotecas do campo da saúde, incluindo artigos publicados entre janeiro de 2008 e dezembro de 2021. Resultados e Discussões: O corpus foi composto por 21 estudos, em sua maioria qualitativos (85,72%), com primeiro autor brasileiro (57,15%). A R/E se faz presente na prática em Enfermagem, de maneira que algumas atitudes, disposições e comportamentos parecem indispensáveis para o cuidado religioso/espiritual e alguns contextos parecem mais propícios para tal integração. Conclusão: O lugar que a R/E ocupa dentro da Enfermagem ainda não está consolidado, existindo diversos questionamentos e dilemas éticos em aberto. Recomenda-se a realização de estudos que possam oferecer evidências para a prática em termos da incorporação dessa dimensão no cuidado em saúde.

Family Members' of Coronary, Cardiosurgery and General ICU Patients Resilience, Perceived Stress, Spirituality: a Cross Sectional Analysis

BACKGROUND

Family members' of coronary, cardiosurgery and general ICU patients are psychologically burdened, shaken, experiencing negative emotions such as fear, anxiety, sadness and despair due to the severity of the disease and possible death.

OBJECTIVE

To investigate family members' resilience in correlation with perceived stress and spirituality of coronary, cardiosurgery and general ICU Patients.

METHODS

A cross-sectional study was conducted on a random sample of 104 family members of patients (34 men and 70 women), admitted in the coronary, cardiosurgery and general ICU for greater than 48 hours. The PSS-14 was used to assess perceived stress. Resilience was investigated using CD-RISC-25 and spirituality using DSES. Also APACHE II was used to assesses the severity of the disease and the outcome of patients admitted to the ICU.

RESULTS

Resilience is significantly correlated with the scales of perceived stress (p <0.001) and daily spirituality (p = 0.019). On the contrary, the more their daily spirituality, the greater their resilience. In the present study no significant association was found between the DSES and the PSS-14.

CONCLUSION

The main findings of the present study is the significant association between resilience and spirituality and perceived stress. Therefore, it is necessary to design interventions aiming at enhancing resilience, limiting perceived stress and promoting spirituality.

The Relationship Between Nursing Students' Perceptions of Spirituality and Spiritual Care and their Personal Values

This study involved a descriptive and correlational study to determine how nursing students at one university in Turkey perceive spiritual care. The data were collected through a personal information form, the Spiritual Care-Giving Scale and the Portrait Values Questionnaire. The data were analyzed using Pearson's Correlation Analysis and hierarchical regression analysis. There was a correlation between perceptions of personal values and spiritual care. It was observed that the values that predicted perception of spiritual care were the values of hedonism and tradition. Therefore, it is recommended to plan value-based training, especially on subjective concepts such as spiritual care and plan simulation-based training where students can measure the results of their behaviors and reactions in given scenarios.

Spiritual and Emotional Experience With a Diagnosis of Breast Cancer: A Scoping Review

BACKGROUND

The breast cancer diagnosis causes a high level of suffering and distress in patients who experience difficulties in coping. There is a need to improve knowledge of emotional and spiritual coping in response to the stressful situation of women who must face this diagnosis.

OBJECTIVES

The aims of this study were to map women's spiritual and emotional coping experiences reported after a breast cancer diagnosis and examine the proposed interventions and suggestions for clinical practice.

METHODS

A scoping review was performed by searching the Scientific Electronic Library Online, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American & Caribbean Health Sciences Literature, Medical Literature Analyses and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, PSYCINFO, and Google Scholar databases using Medical Subject Headings terms. Additional pertinent studies were identified by reviewing the bibliographies of the included studies. Twenty articles were included according to the recommendations for scoping reviews.

RESULTS

Study findings regarding emotional and spiritual coping with the diagnosis and proposed interventions were synthesized. A thematic list of interventions and recommendations for clinical practice is also provided.

CONCLUSIONS

The studies demonstrated that women with breast cancer are challenged by their emotions and experiences. The review highlights the importance of spiritual coping for redefining women's meaning in life. In clinical practice, caring for women's inherent needs when they are coping with a diagnosis is important to establish integral care.

IMPLICATIONS FOR PRACTICE

Nurses can evaluate coping strategies, offer support for adaptation to the disease, provide qualified listening, help women in their search for significance while coping with cancer, and help them identify ways to overcome this stressful situation. Similarly, they can encourage patients to find spiritual comfort and emotional support.

The Influence of Religiosity and Spirituality on Health in Canada: A Systematic Literature Review

The association between religion and health has been the subject of growing interest in academia. However, limited reviews of such studies in Canada exist. The paper systematically reviews and synthesizes existing literature on the relationship between spirituality and health in Canada. Available general databases such as: Medline; Web of Science, PubMed, Sociological abstract, Social Service Abstracts, Google scholar, Humanities International Index, JSTOR, CPI.Q Canadian Periodicals, and American Theological Library Association were searched for the period between 2000 and April 2019 inclusive. Collected data were then systematically analysed for common themes about spirituality and health in Canada. In total, 151 articles were found, but only 128 had relevance with the study objectives. Overall, the analysis showed that religion and spirituality do influence health behaviours, and well-being. However, more gender-based studies need to be conducted to tease out the differences in religion/spirituality and health across different genders, and ethnic groups in Canada.

The assessment of spirituality between cancer and chronic inpatients: a cross-sectional study

PURPOSE

Spiritual well-being had a protective effect on quality of life in cancer, due to the cultural, regional, and custom differences; it was rarely been discussed between cancer and chronic diseases in Chongqing, China. We aimed at comparing the level of spirituality in two groups and discussing its factors of subjects with cancer at county regions.

METHODS

A cross-sectional questionnaire survey was distributed to 630 inpatients who received treatment between January and December 2020 in Chongqing University Three Gorges Hospital. In addition to basic demographic data, spirituality was measured using the Chinese version of Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12). The mean, standard deviation, independent t-tests, ANOVA, and multiple regression were used for statistical description and analysis.

RESULTS

Significant differences were found between cancer and chronic diseases in total scores of FACIT-Sp-12 and each domain (P < 0.05). The meaning, peace, faith, and total scores in cancer were 11.21 ± 3.38, 10.66 ± 4.46, 11.43 ± 3.54, and 33.3 ± 10.35, respectively, which were lower than chronic diseases (13.00 ± 3.21, 12.95 ± 4.76, 12.66 ± 3.64, 38.61 ± 10.88, respectively). The spiritual well-being had significant differences in gender, character, and emotional with spouse for cancer (P < 0.05). The male and extravert character were significantly associated with a greater spiritual well-being.

CONCLUSION

The study shows a medium level of spiritual well-being in cancer, which stands the population with lower economic and education in county regions. It suggests that under the current nursing mode, we should provide specifically spiritual care to the female, introvert, and those with poor relationship with spouses and create a harmonious doctor-patient environment to improve the spiritual well-being.

What do doctors understand by spiritual health? A survey of UK general practitioners

BACKGROUND

In the UK, doctors' regulatory and professional bodies require general practitioners (GPs) to consider discussing spiritual health as part of the consultation. However, spiritual health is not defined in guidance, and it is unknown what individual doctors understand by the term.

RESEARCH QUESTION

What do GPs understand by the term 'spiritual health'?

AIM

To explore how GPs understand and define spiritual health.

DESIGN AND SETTING

Survey of GPs in England 9 April 2019-21 May 2019.

METHOD

A mixed-methods online survey asked practising GPs in England qualitative free text questions-'What does the term 'Spiritual Health' mean to you?' and 'Any comments?' after five vignettes about discussing spiritual health with patients. These were subject to thematic analysis using a priori themes from the literature on GP definitions of spiritual health, and on attitudes towards the topic.

PARTICIPANTS

177 practising GPs in England.

RESULTS

177 GPs responded to the survey. Understanding of spiritual health fitted into three themes: self-actualisation and meaning, transcendence and relationships beyond the self, and expressions of spirituality. A full range of views were expressed, from a minority who challenged their role in spiritual health, through to others enthusiastic about its place in healthcare.

CONCLUSION

Spirituality and religiosity are understood by English GPs to be distinct concepts. A consensus definition of spiritual health incorporating the themes identified by working doctors, may be helpful to support GPs to follow the recommended guidance in their practice.

Spiritual Well-Being in Older Adults: A Concept Analysis

This concept analysis of spiritual well-being (SWB) in the older adult seeks to improve nurses' integration of spiritual care. Using Walker and Avant's method, the author identified five defining attributes of SWB: personal faith, religious practices, spiritual contentment, productive engagement, and healthy interpersonal relationships. Antecedents to SWB include awareness of one's spiritual needs and seeking to live a meaningful and purposeful life. Model, borderline, and contrary cases are presented to illustrate the defining attributes of SWB. Nursing implications for practice are discussed.

Forgiveness and Health Outcomes in Cancer Survivorship: A Scoping Review

BACKGROUND

Religious and spiritual beliefs including forgiveness are an important aspect of cancer survivorship; however, the relationship between forgiveness and health is not well understood.

OBJECTIVE

The aim of this study was to conduct a scoping review that examines and maps the current research regarding relationships between forgiveness and health outcomes in individuals with cancer.

METHODS

We searched 5 electronic databases using key search terms related to forgiveness and cancer. Using a scoping review framework, we synthesized the existing literature regarding forgiveness and health among individuals with cancer and examined forgiveness as a process for coping with cancer.

RESULTS

We located 277 articles for review; 24 met inclusion criteria. Forgiveness in interpersonal relationships emerged more often as forgiveness coping than other types of forgiveness. Most studies reported a positive association between forgiveness and mental health. Fewer studies were available regarding relationships between forgiveness and physical health, and findings were mixed.

CONCLUSIONS

Forgiveness in interpersonal relationships is a spiritual concern for individuals with cancer. Addressing forgiveness needs may promote mental health in cancer survivors. More empirical evidence is needed to understand the role of forgiveness in physical health in individuals with cancer.

IMPLICATIONS FOR PRACTICE

Acknowledging forgiveness beliefs is a psychosocial-spiritual intervention that nurses can provide to support mental health in individuals with cancer. The potential role of forgiveness in physical health for individuals with cancer requires further study.

Exploring the Meaning of Spirituality and Spiritual Care with Help From Viktor Frankl

Problem: A difficult concept to understand, spirituality is not often addressed in healthcare. Purpose: This paper will explore the concept of spirituality and spiritual care using the theory of meaning by Viktor Frankl. Implications: Authors will provide ways for nurses to think about spiritual needs and spiritual care for patients and identify barriers to spiritual care implementation. Suggestions are made for spiritual inquiry, resources are provided for spiritual care education and training, and recommendations are made for nursing education curricula and health care policy change. Conclusions: With a greater understanding of spirituality, nurses practicing holistic care can increase their spiritual care competence and implement spiritual care into practice.

The Importance of Spirituality for Women Facing Breast Cancer Diagnosis: A Qualitative Study

Breast cancer remains significantly distressing and produces profound changes in women’s lives. Spirituality is an important resource at the time of diagnosis and treatment decisions. This qualitative study aimed to explore the spiritual experience of women diagnosed with breast cancer and the considerations of spirituality in health care using the existential phenomenology approach. The sampling procedure was intentional, based on the study’s exclusion and inclusion criteria. Forty women participated in individual interviews. The research was conducted in the outpatient clinic of a reference federal university hospital in South-Eastern Brazil. Throughout the research process, ethical principles were carefully followed. Five themes were identified: (1) meaning of spirituality–source of spiritual strength, (2) well-being in the relationship with God, (3) well-being in religious fellowship, (4) values and purpose of life–meaning in life, and (5) spirituality as a foundation to continue. Respect for patient’s spiritual values was recognised as a fundamental principle in health care. Spirituality was revealed as a source of support during the complex process of being diagnosed with breast cancer. Thus, health care professionals that value and encourage spirituality are needed, favouring better patient response to the diagnosis.

Associations between religious and spiritual variables and neuroimmune activity in survivors of breast cancer: a feasibility study

PURPOSE

Chronic stress is associated with neuroimmune inflammation and adverse outcomes in breast cancer survivors. Some breast cancer survivors rely on religious and spiritual (R/S) variables to manage stress after breast cancer treatment. A spiritually based psychoneuroimmunological (PNI) model of health suggests that R/S variables influence neuroimmune activity; however, these associations are not well-established. A pilot study was conducted to assess the feasibility of studying associations between R/S variables and neuroimmune biomarkers in breast cancer survivors.

METHOD

Salivary alpha-amylase (sAA) and interleukin-6 (IL-6) were sampled among women previously treated for breast cancer. The primary aim was to assess feasibility and acceptability of the sampling protocol. A secondary aim explored associations between sAA, IL-6, R/S variables, and health outcomes.

RESULT

Forty-one women completed the study. Biomarker sampling yielded 246 acceptable specimens used for analysis. SAA was detectable in 96% of specimens and IL-6 was detectable in 44% of specimens. The R/S variables with the strongest associations to sAA were spiritual self-rank (rs = .39; p < .05) and forgiveness (rs = .40; p < .05). The R/S variable with the strongest association to salivary IL-6 was positive congregational support (rs = .42; p < .05).

CONCLUSION

Feasibility and acceptability of the sampling protocol were confirmed. Reference ranges for sAA and IL-6 for female breast cancer survivors are presented. Results suggest that spiritual beliefs and religious practices are associated with neuroimmune activity, adding credence to a spiritually based PNI model of health. Findings lay the foundations for future R/S-based interventions to promote health and well-being in breast cancer survivors.

Factors that predict the perception of spirituality and spiritual care of nurses working in high-risk units and the effect of death anxiety

PURPOSE

Spirituality contributes to the health and well-being of individuals. This study investigates the factors that predict the spirituality perceptions and the effect of death anxiety of nurses.

DESIGN AND METHODS

This was a cross-sectional study, 382 nurses working in four public hospitals intensive care and emergency departments setting in two different cities in Turkey.

FINDINGS

Variables predicting the total and subscale scores of the Spirituality and Spiritual Care Rating Scale of nurses were determined by linear multiple regression analysis. Except for the religiousness subscale, the satisfaction level of nurses was found to be a significant predictor in total of Spirituality and Spiritual Care Scale.

PRACTICE IMPLICATIONS

Nurses working in high-risk units are unclear about their perception of spirituality and spiritual care.

Cultural Adaptation and Validation of the Moroccan Arabic Version of the Muslim Belief into Action (BIAC) Scale

Various approaches have been developed to comprehensively assess multiple dimensions of religiosity. The Belief into Action (BIAC) Scale was developed for this purpose and to evaluate the degree of translation of personal beliefs into real-life actions. The goal of the present study was to assess the validity and reliability of the Moroccan Arabic version of the Muslim BIAC, designed to assess the religiosity of Muslims. This study was conducted in two stages. First, the original version of Muslim BIAC was translated from English to Arabic using a standard forward-backward translation procedure. Second, the Moroccan Arabic version of the Muslim BIAC was administered to a sample of 132 students at Ibn Zohr University, Agadir, Morocco (mean age 22.2 years). The average score on the BIAC was 46.1 (SD = 17.2). The Cronbach's alpha for internal reliability was 0.81, with alphas for removed items ranging from 0.77 to 0.82. Test-retest reliability by intraclass correlation coefficient (ICC) was 0.87 (95% CI = 0.83-0.91). Discriminant validity indicated relatively weak correlations with depressive symptoms (r = - 0.06) and perceived stress (r = 0.08). The Moroccan Arabic version of the Muslim BIAC is a reliable and valid measure of religious involvement that can be used to assess the relationship between religiosity and health in Moroccan Arabic populations.

Evaluation of the reliability and validity of Functional Assessment Of Chronic Illness Therapy-Spiritual Well-Being-Expanded in elderly patients with chronic orthopaedic diseases

BACKGROUND

The Functional Assessment Of Chronic Illness Therapy-Spiritual Well-Being-Expanded (FACIT-Sp-Ex) scale can simultaneously evaluate the quality of life and spiritual health level of patients with chronic orthopaedic diseases. We performed the FACIT-Sp-Ex scale in Chinese, and tested its reliability and validity in patients with chronic orthopaedic diseases.

METHODS

There were 249 patients with chronic orthopaedic diseases who were selected for the questionnaire survey. AMOS 23.0 and SPSS 25.0 were used for statistical analysis to calculate the reliability and validity of the Chinese version of the scale.

RESULTS

The Chinese version of FACIT-Sp-Ex scale showed that root mean square error of approximation (RMSEA) was 0.06. Cronbach's alpha coefficient was 0.83, the subscale was 0.72 ~ 0.82. The meaning, peace, relational subscales and total scale of the FACIT-Sp-Ex were negatively correlated with hospital anxiety and depression scale (HADS) and positively correlated with health-related quality of life (HRQOL). All four subdomains were inversely associated with HADS anxiety symptoms, the peace and relational subscales were inversely associated with HADS depressive symptoms. Elderly female patients score higher than male patients in faith subscale. The highest-scoring disease in FACIT-Sp-Ex faith scale was osteoarthritis, which in FACIT-Sp-Ex total scale are piriformis syndrome and osteoarthritis.

CONCLUSION

The Chinese version of FACIT-Sp-Ex scale has good reliability and validity, which can be used as an evaluation tool for the spiritual status and quality of life of Chinese elderly chronic orthopaedic patients.

Spirituality and Healthcare—Common Grounds for the Secular and Religious Worlds and Its Clinical Implications

The spiritual dimension of patients has progressively gained more relevance in healthcare in the last decades. However, the term “spiritual” is an open, fluid concept and, for health purposes, no definition of spirituality is universally accepted. Health professionals and researchers have the challenge to cover the entire spectrum of the spiritual level in their practice. This is particularly difficult because most healthcare courses do not prepare their graduates in this field. They also need to face acts of prejudice by their peers or their managers. Here, the authors aim to clarify some common grounds between secular and religious worlds in the realm of spirituality and healthcare. This is a conceptual manuscript based on the available scientific literature and on the authors’ experience. The text explores the secular and religious intersection involving spirituality and healthcare, together with the common ground shared by the two fields, and consequent clinical implications. Summarisations presented here can be a didactic beginning for practitioners or scholars involved in health or behavioural sciences. The authors think this construct can favour accepting the patient’s spiritual dimension importance by healthcare professionals, treatment institutes, and government policies.

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BACKGROUND

Although nurses typically view spiritual care as important, it is provided infrequently.

OBJECTIVES

This research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.

METHODS

This cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.

RESULTS

The most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.

CONCLUSIONS

Nurses need education about providing spiritual care to those with psychiatric mental health needs.

Brazilian nurses' concept of religion, religiosity, and spirituality: A qualitative descriptive study

Evidence points toward the impact of nurses' personal views and knowledge about religion, religiosity, and spirituality on health care. This qualitative research investigates nurses' concepts of religion, religiosity, and spirituality and how they use these concepts in practice. Thirty-four nurses were interviewed at a hospital in the state of São Paulo, Brazil. Content analysis was used to organize and code the results. Three main themes generated from the interviews were (i) religiosity/spirituality as an important dimension in life; (ii) notions of religiosity and spirituality; (iii) formal knowledge of the concept of religion, religiosity, and spirituality. The results indicate that religion, religiosity and spirituality should be incorporated into nurse training to improve the comprehension and competence of nurses in these areas of practice. It is recommended that to ensure holistic and person-centered care, there must be constant reflection on these concepts.

Nurses' spiritual attitudes and involvement-Validation of the Polish version of the Spiritual Attitude and Involvement List

Background

Spirituality is vital in the holistic approach to nursing care. The personal spirituality of nurses has been documented to have an impact on the spiritual nursing care they provide.

Aim

To validate the Polish version of the Spiritual Attitude and Involvement List (SAIL) among nurses and to describe spiritual attitudes and involvement of nurses as measured with the tool.

Design

A cross-sectional, validation study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology guidelines.

Methods

Study involving 163 nurses, with the use of four tools: (a) the SAIL; (b) the Self-Description Questionnaire; (c) the Scale of Spiritual Transcendence; and (d) the Brief Religious Coping questionnaire.

Results

The Explanatory Factor Analysis identified six factors and 25 items were retained explaining a total variance of 67.96%. In the Confirmative Factor Analysis, acceptable index fit values were obtained. Correlations were found between SAIL and the Brief Religious Coping questionnaire, the Self-Description Questionnaire, and the Spiritual Transcendence Scale. Nurses reported the highest scores on ‘Meaningfulness’ (= 4.95 out of 6.0, Standard Deviation [SD] 0.56) and the lowest on the ‘Transcendent Experiences’ factor (= 3.21 out of 6.0, SD 0.93). A strong correlation was found between ‘Spiritual Activities’ and the religious involvement of nurses (r = 0.506), and between ‘Connectedness with nature’ and the nurses’ age and work experience (r = 0.315 and r = 0.321, respectively).

Conclusion

The Polish version of SAIL shows acceptable psychometric properties and construct validity. With the validation of SAIL, future studies can be undertaken with the aim of measuring the personal spirituality of nurses in various settings (hospital vs. community), cultures, and countries, thus increasing the opportunity to compare findings. Moreover, more studies should be performed in order to assess whether there is any connection between personal spirituality and the spiritual nursing care provided to patients.

Content Analysis of the Meaning of Spiritual Care as Perceived by Nursing Students

Purpose

This study aimed to describe the meaning of spiritual care as perceived by nursing students.

Methods

This study used a descriptive research design, and the participants were 126 fourth-year nursing students from three nursing colleges. Data were collected from August to September 2019, and were analyzed using the content analysis method.

Results

Four themes of spiritual care with 15 sub-themes were extracted from the content analysis 1) "promoting spiritual well-being" (sub-themes "providing religious help", "caring for the patient as a spiritual being", and "presupposing human dignity regardless of religion"); 2) "taking place in actual nursing practice" (representative sub-themes "considering the perspective of the patient", "reducing suffering"); 3) "caring for the multifaceted needs of human beings" (representative sub-themes "providing physical, mental, and spiritual care", "caring for both the mental and physical health of the patient"), and 4) "growing together" (sub-themes "positively affecting patient well-being", "beginning with the nurse's self-transcendence").

Conclusion

These results suggest that nursing students consider spiritual care to be a highly positive and practical form of nursing care. However, because few students have been exposed to religion and spirituality, more systematic training should be provided.

End-of-Life Issues in the Era of the COVID-19 Pandemic

Purpose

The coronavirus disease 2019 (COVID-19) pandemic has brought the world to a standstill and has exposed the lack of preparedness of most nations' health care systems. Even in usual times, palliative care has not received its fair share of recognition as an important component of patient care; instead, the emphasis is often placed on aggressive patient management. Now, with the entire medical community and decision-making committees focussed on intensive patient care, end-of-life care has taken a backseat.

Methods

This article is a brief communication.

Results

COVID 19 infection has been shown to lead to greater mortality and morbidity in patients with pre-existing illnesses such as hypertension, diabetes, renal failure, and cancer. Patients typically in need of end-of-life care, such as those with late-stage cancer or heart failure, are therefore at a higher risk of both contracting COVID-19 and suffering a more severe disease course. The strict nationwide lockdowns being imposed in most countries have deterred patients from seeking medical attention or hospice care. Every day new research is coming to light regarding COVID 19. This has helped significantly in creating awareness and limiting the spread of disease. However, misinformation is also rampant, leading to discrimination and mistreatment of infected patients.

Conclusion

This pandemic has been a terrifying ordeal for all and has exposed our entire population physically, psychologically, emotionally, and financially to unimaginable stresses. In the present scenario, EOL care is as much a necessity as intensive care and should be given at least a fraction of its importance.

Spirituality among family caregivers of cancer patients: The Spiritual Perspective Scale

Spirituality is a critical resource for family caregivers of patients with cancer. However, studies on spirituality are hampered because measures of spirituality lack consistency and have not been validated in cancer caregivers. This study examined the validity of the Spiritual Perspective Scale (SPS) among cancer caregivers and explored whether measurement bias may influence differences in spirituality across caregiver and patient characteristics. In this secondary analysis, 124 caregivers of cancer patients were used to evaluate the validity of the 10-item SPS. A multiple indicators multiple causes model was applied to explore differences in the association between a latent spirituality factor and characteristics of caregivers and patients. Overall reliability of the SPS was adequate (Cronbach's α = .95). The SPS scores were predictive of higher meaning and purpose (r = .32, p = .004) and lower depression (r = -.22, p = .046) at 3-month follow-up. Construct validity of the SPS with a single-factor structure was supported in cancer caregivers. Adjusting for a direct effect of race did not alter the pattern of results, and caregivers who were older, female, ethnic minorities, less-educated, affiliated with a religion, and who provided care to another individual in addition to the patient had greater levels of spirituality. This study provides evidence for psychometric validation of the SPS in cancer caregivers. Understanding differences in caregivers' spirituality by using the SPS with psychometrically acceptable properties and minimal measurement bias deserves more attention to optimize spirituality assessment and support in cancer caregiving.

Hearing and Heeding the Voices of those With Advanced Illnesses

OBJECTIVES

To describe the feasibility of a chaplain-led spiritually focused life review interview and the development of a spiritual legacy document (SLD) for patients with advanced diseases and to describe changes in spiritual well-being (SWB), spiritual coping strategies (SC), and quality of life (QOL) after receiving the SLD.

PATIENTS AND METHODS

In all, 130 patients and support person (SP) pairs were recruited from July 2012 to January 2019. Following enrollment, demographic information was gathered and baseline questionnaires were administered. Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) and a linear analog scale assessment (LASA) measured SWB. LASAs also measured QOL and emotional well-being (EWB). Positive Religious Coping Scale (RCOPE) measured SC. After completion of baseline forms, participants were interviewed (individually) by a chaplain. Interviews were digitally recorded, transcribed, and verified. Transcripts were edited and participants were given the opportunity to make adaptations. The participant-approved draft was then developed into a professionally printed SLD. Follow-up questionnaires were administered to assess change.

RESULTS

Significant improvements from baseline to post-SLD follow-up were found for patients on the LASAs: SWB (average 7.7-8.3, P = .01), QOL (average 6.7-7.3, P = .03), EWB (average 6.9-7.5, P = .01), and on the positive RCOPE (average 1.8-2.0, P = .007). Effect sizes were approximately 0.25. Considering any improvement, 61.0% improved their positive RCOPE score, 46.6% improved EWB, and 39.7% improved SWB. No significant changes were found on the FACIT-Sp-12. No significant changes were found for SPs.

CONCLUSION

The results suggest that the primary participants who completed the study benefited by significantly increasing their QOL, SWB, EWB, and SC.

Spirituality in nursing: A concept analysis

BACKGROUND

Spirituality has always been present in the history of nursing and continues to be a topic of nursing interest. Spirituality has ancient roots. The term 'spirituality' is interpreted as spirit and is translated as breath and soul, whereas spirituality (immateriality) is spiritual nature. Historically, the term spirituality is associated with the term religiosity, a definition that persists today, and often the two terms are used interchangeably. In the healthcare context, the construct is still.

OBJECTIVE

To clarify the concept of spirituality in nursing.

RESEARCH DESIGN

In this article spirituality was explored using Rodgers' evolutionary and inductive method of concept analysis.

PARTICIPANTS AND RESEARCH CONTEXT

For this analysis, a sample of 71 articles published in English, from 2008 to 2018 from PubMed/Medline, CINAHL Plus with full text, PsycINFO, SciELO databases were retrieved. It was also accomplished an empirical search of dictionaries and e-books.

ETHICAL CONSIDERATIONS

This study was conducted according to good scientific practice.

FINDINGS

It emerged that "spirituality" is a dynamic process and has a range of attributes. The cultural dimensions, the religious and spiritual traditions, the ethnic diversity and the influence of the historical and social contexts represent the societal and historical conditions ingrained in the Western thought that influence the emergence of spirituality as a concept. Antecedents, attributes and onsequences appeared to inform and strengthen one another over time. Spirituality is a significant concept for the discipline of nursing with profound consequences for caring patients and for work organizations.

Reflections on the Spiritual Lives of Caregivers of Spouses with Dementia: Receiving Grace

Observations from research on the spiritual lives of persons caring for their spouses with dementia provide insight into the spirituality of caregivers. The author relates her personal journey of spirituality with findings from narratives of caregivers and the results of grace, joy, and trust. The lived experiences of caregivers who express faith in Jesus enable them to rest and love amid their caregiving. These insights can be useful when applied to nursing care and nursing education.

Spirituality as a sociocultural determinant of health in the context of medical curriculum: A call for action

Background: This study aimed to investigate the state of spirituality in the general medicine curricula in Iran. Methods: Reference books for general medicine were reviewed and data were analyzed according to the qualitative content analysis method. Results: After reviewing references, it was found that only 35 paragraphs of the educational reference pages dealt with this subject. Related topics to spirituality had 2 major themes: (a) spirituality and care (assessment, treatment, palliative care, and bereavement); (b) spirituality and professionalism (considering culture and medical ethics). Conclusion: This study showed that despite the importance of the subject and much evidence on spirituality and medicine, medical references have limitations. The authors suggested some strategies to develop a specific course and integrate all educational references with the objectives of the general medical education course in Iran.

Effect of an Educational Intervention Delivered to Senior Nursing Students to Strengthen Spiritual Care for People with Chronic Illness

This is an experimental, quantitative, parallel design study (control and experimental groups) with pre- and post-intervention assessment without blinding, which aimed to determine the effect of an educational intervention delivered to ninety Colombian senior nursing students to strengthen perceptions of spirituality and spiritual care for people with chronic illness. The Spirituality and Spiritual Care Rating Scale (SSCRS) was used as the instrument of measurement. The Wilcoxon test was used for comparisons between two groups, and the Kruskal-Wallis test for the comparison of global scale scores between the intervention group and the control group. To determine the effect of the intervention, Cohen's d statistic was used. The intervention modified the perceptions of spirituality and spiritual care in the experimental group (median = 80.2, SD = 10.2) compared with their initial perceptions (median = 70, SD = 11.2), p ≤ 0.001. The effect size (ES) of the intervention was 0.63, with a power of 0.80, indicating a moderate and acceptable effect size.

The Effectiveness of Spiritual Therapy on Spiritual Well-Being, Self-Esteem and Self-Efficacy in Patients on Hemodialysis

Spirituality is an important part of practice of the healthcare providers. Spiritual therapy is important for patients with chronic and end-stage diseases such as end-stage renal disease due to changes in physical, mental, social and spiritual needs. Promotion of spiritual well-being, self-esteem and self-efficacy is very important for these patients. The aim of this study was to determine the effectiveness of spiritual therapy on spiritual well-being, self-esteem and self-efficacy in patients on hemodialysis. The quasi-experimental research design was pre-posttest with the control group. The statistical population was the patients on hemodialysis in Governmental Hospital of Shahid Mostafa in Ilam, Iran, in 2015. Twenty-four patients were entered to the study by convenience sampling. They were divided into experimental and control groups randomly. Twelve 60-min sessions of spiritual therapy were held for the experimental group twice a week. The tools included spiritual well-being scale of Paloutzian and Ellison, Self Esteem Inventory of Cooper Smith and Self-Efficacy Scale of Sherer. Data were analyzed by SPSS software through descriptive and inferential statistics (analysis of covariance). p Values < 0.05 were considered significant. Results indicated that the scores in the experimental group changed in spiritual health from 39.32 ± 3.38 to 43.40 ± 2.82, in self-esteem from 42.65 ± 2.61 to 45.90 ± 3.88 and in self-efficacy from 40.99 ± 2.19 to 44.65 ± 2.58 which was significant compared with the control group (p = 0.01). Spiritual therapy can be used as an effective intervention to improve spiritual well-being, self-esteem and self-efficacy in patients on hemodialysis. This intervention is directed to holistic care. It can be done by interdisciplinary participation in caring and psychological teams.

The Invisibility of Spiritual Nursing Care in Clinical Practice

Background and Purpose: Spirituality has been identified as the essence of being human and is recognized, by many health care professionals, as a central component in health and healing. Scholars have identified spiritual nursing care as essential to nursing practice and include caring for the human spirit through the development of relationships and interconnectedness between the nurse and the patient. However, despite the recognition of spiritual practices as important to health, little attention has been given to spirituality in nursing practice and education in the literature. The purpose of this article is to explore factors contributing to the invisibility of spiritual nursing care practices (SNCP), recognition and offer strategies to enhance the visibility of SNCP. Two major factors that reduce visibility of SNCP are conceptual confusion differentiating between spirituality and religion and limited education in the area of spirituality including nursing curricula and organizations. Strategies to enhance visibility of SNCP include educational approaches in nursing curricula and health care organizations. to influence nurses’ perceptions about spirituality and creation of a culture of spiritual care. Conclusion: Holistic nursing includes assessing and responding to the spiritual needs of patients. Changes in nursing education and health care systems are needed to increase the visibility of SNCP.

Opinions, Knowledge and Attitudes Concerning "Spirituality, Religiosity and Health" Among Health Graduates in a Spanish University

This study aims to investigate the opinions, knowledge and attitudes concerning spirituality, religiosity and health among 75 health MSc graduates from a Spanish university. The questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" was used. Most students had low levels of religious activities, agreeing that S/R could have a high influence on the health professional-patient relationship (62.6%). Nevertheless, they felt little prepared to address these issues (90.6%) and believed that universities were not providing enough information on this topic (91.9%). The most common barriers for addressing R/S were insufficient time (34.7%) and fear of offending the patients (31.9%). Nurse students tended to believe more on the influence of R/S on patients' health and on the appropriateness of addressing R/S issues. However, religious beliefs were not associated with students' R/S opinions. The incorporation of such topic could potentially promote the spiritual sensitivity of health professionals, improving the holistic care.

The therapeutic dimension of research about spirituality: Particularities of cancer, mental health and infertility

Healthcare is moving from a biomedical paradigm into a holistic paradigm, which includes all dimensions and needs of patients and families. Health conditions may trigger a spiritual journey for believers or non-believers bringing to light the nature of the human being and its vulnerable condition. Healthcare professionals are full participants in this life and health scenario and have an unquestionable duty related to the provision of spiritual care, on the basis of legislation, ethical codes, and on research evidence. Researchers are seizing better and broader knowledge about spirituality in healthcare, and research about this phenomenon is growing internationally. But, spirituality is considered complex, an area of intimacy and deep subjective meaning. These factors may raise some ethical concerns when submitting research projects to the ethics committees. In this paper, the authors share their experience in research about spirituality in the beginning of life issues/infertility and with adults with severe health conditions, and describe participants' perspectives on research engagement.

Factors promoting Iranian older adults' spirituality: a qualitative content analysis

Background

Spirituality plays an important role during old age, but reveals itself as a confounding mental health concept, which needs to be defined when providing spiritual care. The purpose of this study was to explore factors promoting Iranian older adults’ spirituality.

Method

In a qualitative content analysis approach, we searched for the factors promoting spirituality among a selection of Iranian older adults. Totally, 22 people aged above 60 years old were interviewed using open-ended questions. The recorded interviews were then transcribed, and a coding process was applied based on a qualitative, conventional content analysis.

Results

Three key factors were found to promote the spirituality among the older adults: 1) insight in personal belief, 2) spiritual socialization, and 3) peace of mind. Traditional dimensions, the cultural surroundings, and participants’ religious beliefs were apparent in each of the categories.

Conclusion

Society’s role in making the seniors spiritual role models was very important; moreover the hereafter life on religious grounds seemed to be another important factor in reaching for high levels of spiritual and mystical perfection. Educational interventions based on the elders’ needs for spiritual empowering by health care professionals especially with regards to their spiritual based social interactions and reaching peace of mind, will comprise a major part of wellness approaches.

Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship: A Pilot Study

BACKGROUND

Psychoneuroimmunological theory suggests a physiological relationship exists between stress, psychosocial-behavioral factors, and neuroendocrine-immune outcomes; however, evidence has been limited.

OBJECTIVE

The primary aim of this pilot study was to determine feasibility and acceptability of a salivary cortisol self-collection protocol with a mail-back option for breast cancer survivors. A secondary aim was to examine relationships between religiousness/spirituality (R/S), perceptions of health, and diurnal salivary cortisol (DSC) as a proxy measure for neuroendocrine activity.

METHODS

This was an observational, cross-sectional study. Participants completed measures of R/S, perceptions of health, demographics, and DSC.

RESULTS

The sample was composed of female breast cancer survivors (n = 41). Self-collection of DSC using a mail-back option was feasible; validity of mailed salivary cortisol biospecimens was established. Positive spiritual beliefs were the only R/S variable associated with the peak cortisol awakening response (rs = 0.34, P = .03). Poorer physical health was inversely associated with positive spiritual experiences and private religious practices. Poorer mental health was inversely associated with spiritual coping and negative spiritual experiences.

CONCLUSIONS

Feasibility, validity, and acceptability of self-collected SDC biospecimens with an optional mail-back protocol (at moderate temperatures) were demonstrated. Positive spiritual beliefs were associated with neuroendocrine-mediated peak cortisol awakening response activity; however, additional research is recommended.

IMPLICATIONS FOR PRACTICE

Objective measures of DSC sampling that include enough collection time points to assess DSC parameters would increase the rigor of future DSC measurement. Breast cancer survivors may benefit from nursing care that includes spiritual assessment and therapeutic conversations that support positive spiritual beliefs.