Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework

Bridging the gap: Normalising spiritual care in undergraduate nursing education: A review of qualitative research

AIM

To summarise the qualitative evidence exploring the attitudes and experiences of undergraduate nursing students involving spiritual care.

BACKGROUND

Understanding patients' spiritual needs allows nurses to provide support and comfort during illness and recovery. However, no consensus exists on how to teach and deliver spiritual care in the undergraduate nursing curriculum.

DESIGN

A review of qualitative research METHODS: Systematic database searches included CINAHL Plus with full text, EMBASE, PubMed and Medline. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The reviewers independently conducted study selection, quality appraisal and data extraction. The included studies were appraised using the Critical Appraisal Skills Programme tool. Thematic analysis guided by Thomas and Harden was used.

RESULTS

Twelve papers were included in this review. Thematic analysis revealed three overarching themes: (1) a complex understanding of spirituality and spiritual care, (2) a lack of comprehensive education on spirituality and spiritual care and (3) a quest to normalise spirituality and spiritual care among nursing students.

CONCLUSIONS

This systematic review affirms the need to include the subject of spiritual care in the early stages of undergraduate nursing programs. More research is needed to examine how new nursing graduates incorporate spiritual care in their clinical practice and the barriers they face. Like other literature, there is a need for a clear definition of spirituality and spiritual care to allow student nurses to understand spirituality and spiritual care better and will enable them to integrate them into their future practice fully.

Exploring efficacy of spiritual-based interventions (SBIs) in addressing depressive symptoms among cardiac patients in MENA region: a scoping review

Background

Depression is a widespread psychological issue among patients with cardiac diseases, which affects treatment adherence, recovery, and overall quality of life. Spiritual-based interventions (SBIs) have gained attention for their potential to alleviate depressive symptoms. However, there is a dearth of research investigating the efficacy of these interventions in the Middle East and North Africa (MENA) region.

Objective

This scoping review aims to synthesize available evidence on the efficacy of spiritual-based interventions in reducing depressive symptoms among cardiac patients in the MENA region.

Methods

The present research used a systematic approach to searching electronic databases such as SCOPUS, Web of Science, and ESBECOhost Arab research world in the English language from 2015 to 2025, based on the Arksey and O'Malley framework. Papers were identified based on spiritual-based Intervention addressing depressive symptoms among cardiac patients in the MENA region. Studies were analyzed using the Population-Concept-Context (PCC) framework, as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR).

Results

The analysis pinpoints numerous Spiritual Interventions, such as prayer, mindfulness, and Faith-based counseling, as usual practices. The results showed that SBIs are related to a decrease in depression symptomology and enhancement of psychological wellbeing. Nevertheless, variability in the study models, small amounts of samples, and sparse long-term studies are also some of the current study's limitations.

Conclusion

This research indicates that the efficacy of spiritual-based interventions can reduce depressive signs in cardiac patients in the MENA region. However, additional research is required to ascertain long-term efficacy and cross-cultural effectiveness.

Undergraduate nursing students' perceptions and experiences of learning spiritual competencies: A qualitative meta-synthesis

BACKGROUND

Nursing focuses on improving individuals' overall well-being through a holistic approach that includes spiritual care, which is key for fostering compassionate relationships and addressing patients' spiritual needs. Despite its importance, challenges remain in integrating spiritual care into patient care, and little is known about how nursing students perceive and acquire spiritual care competencies during their education.

AIM

This meta-synthesis aims to interpret and synthesize qualitative evidence on the learning process of spiritual care competencies among nursing students.

REVIEW METHODS

Searches in six databases were conducted. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to guide this review. A total of 1248 studies were screened. Inclusion criteria were: qualitative studies published between 2013 and 2023 in Spanish and English languages, and undergraduate nursing students as participants. The quality of the (n=12) identified studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. A total of (n=11) studies were analysed using two-step metasynthesis procedures and following Sandelowski and Barroso's (2007) methodology.

RESULTS

A total of 686 undergraduate nursing students participated in the studies included in this meta-synthesis. The findings were synthesized into three categories: (1) Approach to Spirituality: back-and-forth actions between theory, care, and self-awareness, (2) From the Known (Intrapersonal-Interpersonal) to the Unknown (Transpersonal) and (3) Knowing how to be, knowing how to do, and knowing how to be present in spiritual care. One meta-theme emerged: 'Personal and Professional Transformation in the Provision of Spiritual Care: The Journey of Nursing Students Towards Holistic and Empathetic Practice'.

CONCLUSIONS

Nursing students' understanding of spiritual care is influenced by their personal, cultural, and religious backgrounds. However, there is a lack of formal spiritual care education. Acquiring spiritual care competencies is crucial for delivering holistic care, emphasizing the need for enhanced education in both undergraduate nursing programs and continuing professional development.

The Effect of Palliative Spiritual Care Education on Nursing Students' Perception of Spiritual Care and Attitudes towards Death in Turkey: A Quasi-Experimental Study

The aim of this study was to assess nursing students' perceptions of spiritual care, their attitudes toward death, and the impact of a palliative spiritual care course on these perceptions and attitudes. This study employed a quasi-experimental design with a pre-test/post-test structure and two groups. Data were collected through the Spirituality and Spiritual Care Rating Scale and Death Attitude Profile-Revised. The study group consisted of 106 students experimental (n = 53) and control group (n = 53), who took the public health nursing course in the 2021-2022 academic year. There was a significant difference between the mean scores on the Spirituality and Spiritual Care Rating Scale, as well as the Death Attitude Profile-Revised, between the control group students and the experimental group students. The importance of spirituality and spiritual care should be emphasized in course content and internships by integrating relevant topics into the nursing curriculum and creating more training opportunities to help nurses develop skills for caring for dying patients and their families in palliative care units.

A systematic Review of Spirituality Tools Based on Psychometric Qualities and Recommendations for Future Research

Spiritual lifestyles positively impact physical and mental health, which can be addressed by effective spiritual tools. This review systematically evaluates general spirituality instruments retrieved from various databases. Among the top four validated tools with strong psychometric properties, each exhibited a limitation-such as contamination, absence of subscales, or lack of confirmatory factor analysis-which impacts their broader applicability. Furthermore, these tools don't adequately address the widespread mental health issues in society. Therefore, spirituality scales incorporating domains such as meditation, surrender, and detached action with connection to transcendence awareness are proposed. Linking to neural imaging of brain functions, these tools can scientifically address mental health challenges across diverse cultural contexts.

Nursing Students' Perceptions of Spiritual Care in Türkiye: A Mixed Methods Study

Student nurses' sensitivity and personal perceptions about spirituality and spiritual care are important in providing spiritual care because student nurses need to explore their spirituality and their relationship to care. The study was carried out with a sequential explanatory mixed method design. Quantitative data for the research was collected using the descriptive characteristics form and the spirituality and spiritual care rating scale. As a result of the data obtained from the focus group interviews, the authors identified five contexts, fifteen themes and many sub-themes. As a result of this study, it was determined that the student's perceptions of spirituality and spiritual care were above average, and they saw spiritual care as a dimension of holistic care. However, they did not feel competent in providing spiritual care in clinical practice.

Religion, Faith, and Spirituality as Barriers and Facilitators to Antiretroviral Therapy Initiation Among People with HIV in Indonesia

Indonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals' decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiving and holding fatalistic beliefs was linked to postponed ART initiation. Conversely, perceiving religion as loving and forgiving, seeking forgiveness through religious practices, viewing ART intake as a "collaborative" effort with God, and engaging in righteous deeds facilitated ART initiation. These findings indicated that religion, faith, and spirituality can serve as both barriers and facilitators to ART initiation, depending on individuals' faith-based practices and perceptions of religion, whether punishing or forgiving. We recommend that people with HIV and health care providers better recognize the role of religion, faith, and spirituality in coping with shame, guilt, and stigma after an HIV diagnosis. This recognition can facilitate informed decisions regarding ART initiation, ultimately improving health outcomes for individuals with HIV in Indonesia.

Approaches for Analyzing the Relationship Between Spirituality and Health Using Measures Contaminated with Indicators of Mental and Social Health

There has been concern raised in religion/spirituality (R/S) research about the use of measures of spirituality that are contaminated by indicators of mental and/or social health. Many of these scales are used widely in published studies examining associations with health, and yet many researchers and reviewers are not aware of contamination issues. We have previously cautioned researchers to be careful in their choice of religious/spirituality (R/S) measures (Koenig and Carey in J Relig Health, 63(5):3729-3743. https://doi.org/10.1007/s10943-024-02112-6 , 2024), and to avoid using measures contaminated with the health outcome being assessed, which will result in tautological findings (particularly between spirituality and mental health). However, not all is lost. There are approaches for analyzing collected data using contaminated measures that can still result in meaningful and interpretable results, which may contribute to our knowledge of the impact of R/S on health. In this brief article, we describe several approaches for analyzing such data including deleting contaminated items from the scale, analyzing subscales separately, and modeling psychosocial scales, subscales, or collections of variables as mediators in the causal pathway that leads from R/S to health. The use of path analysis or structural equation modeling to identify direct effects and indirect effects through mediating constructs may also be helpful in this regard.

How spirituality is understood in occupational therapy: A qualitative study

INTRODUCTION

Since the inception of occupational therapy, spirituality has been a unique component of practice. However, much of the professional discourse on how to define spirituality has originated internationally. This study aimed to explore how Australian occupational therapists interpret and understand spirituality in their practice.

METHODS

This study employed an interpretive phenomenological methodology and reflexive thematic analysis. Twenty-three individual interviews were conducted with Australian occupational therapists across various work and specialty contexts.

CONSUMER AND COMMUNITY INVOLVEMENT

Because the participants in this study were occupational therapists, the research design did not include input from consumers or the community.

FINDINGS

Three main themes emerged from this study: (i) definitions of spirituality were complex and often described a person's connection to meaning and purpose in life; (ii) human factors that supported addressing spirituality included therapist self-reflection and clinical experience, while therapist discomfort and specific client circumstances acted as barriers; and (iii) environmental factors that supported addressing spirituality included access to training and a supportive workplace, while barriers included cultural taboos, as well as time and funding limitations.

CONCLUSION

All occupational therapist participants acknowledged spirituality as the meaningful connection between one's inner self and the outer world, and for most participants, this included acknowledging the transcendent. Therapist skills that facilitated the integration of spirituality into practice included self-reflection and building rapport with clients, which therapists could control. However, factors like years of clinical experience were beyond their control. In terms of environmental factors, therapists could influence their access to spirituality training, but aspects like a supportive work environment were often outside their influence. Additionally, many therapists reported feeling uncomfortable discussing spirituality within what they considered to be a culturally closed local context. To help overcome these challenges, the occupational therapy profession could benefit from developing culturally sensitive spirituality resources, research, and training.

PLAIN LANGUAGE SUMMARY

Spirituality has always been a part of occupational therapy, but much of the talking about it comes from other countries. This study looked at how Australian occupational therapists see spirituality. We interviewed 23 occupational therapists from all different jobs. They all agreed that spirituality is about connecting a person's inner self with the world. While therapists could control things like self-reflection and building relationships with clients, their years of clinical experience was outside their control. Likewise, they may be able to look for further education, but a supportive work environment was often out of their hands. Many therapists also felt uncomfortable discussing spirituality in workplaces where it was not openly accepted. To face these challenges, the profession may need more resources, research, and training on spirituality in practice.

Cross-Cultural Adaptation and Cross-Validation of the Italian Version of the EPICC Spiritual Care Competency Self-Assessment Tool for Clinical Nurses

AIM

To cross-culturally adapt and psychometrically test the Italian version of the EPICC Spiritual Care Competency Self-Assessment Tool for clinical nurses (EPICC Tool-It).

DESIGN

Multicentre, cross-sectional validation study.

METHODS

The 28-item EPICC Tool was translated into Italian and culturally adapted following a rigorous methodology. A nationwide survey was conducted. Psychometric evaluation included content validity, structural validity (exploratory and confirmatory factor analyses), construct validity (known group analysis) and reliability using Cronbach's alpha, McDonald's omega and factor score determinacy.

RESULTS

The sample included 725 clinical nurses (76% female, 80% hospital-based), on average 38.7 years old (SD 11.33), with 14.6 years (SD 11.03) of experience. Confirmatory factor analysis supported a four-factor model (Knowledge of spirituality, Attitudes towards spirituality and spiritual care, Knowledge of spiritual care and Skills in spiritual care), with a second-order factor for the EPICC Tool-It. Construct validity was supported through known group analysis, showing score variation based on nurses' experience, education and religiosity. Internal consistency was excellent across all factors and the overall scale.

CONCLUSION

A valid, multidimensional instrument is provided to assess spiritual care competencies in Italian-speaking nurses. The EPICC Tool-It is suitable for research and practice, facilitating evaluation of self-perceived competencies and educational effectiveness.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The use of the EPICC Tool-It by nursing managers, educators and clinicians is recommended in both clinical and research settings to support education on spiritual care competencies.

IMPACT

The EPICC Tool-It sets reliable measurement standards for spiritual care competencies, enhancing holistic care and comprehensive understanding of competencies globally.

REPORTING

This study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Patients, service users, caregivers, or the public were not involved in the study. However, nurses as target users of the tool participated in the cultural adaptation and validation process.

Religious affiliation and perceptions of healthcare access during and after COVID-19 in Poland

Introduction

In response to the unprecedented impact of the COVID-19 pandemic on healthcare systems and social life worldwide, this study examines the role of religion in shaping perceptions of healthcare access in Poland during and after the pandemic.

Methods

The research is based on anonymous surveys conducted among adult Poles during the third wave of the pandemic and in the post-pandemic period, with participants divided by the timing of their responses. The research employed a cross-sectional survey design with a validated questionnaire. Data collection occurred during the third wave of the pandemic and the post-pandemic period. The questionnaire incorporated demographic questions and assessed the significance of religion in respondents' lives using a Visual Analogue Scale (VAS) for healthcare accessibility.

Results

Participants (n = 541) were recruited through online and paper-based surveys, meeting the inclusion criteria of being aged 18 or older and residing in Poland. Findings indicate that Roman Catholic respondents rated healthcare accessibility higher than non-religious individuals, potentially due to social and community support. However, statistical analysis revealed no significant differences in actual healthcare access among groups, suggesting systemic factors played a larger role.

Discussion

These results highlight religion as a source of emotional support rather than a determinant of healthcare access.

[Spirituality as an inductive dimension of health and well-being]

The scope of this study was to analyze interventions related to spirituality as a contribution to the health and well-being of women in a recyclable materials association. The method used was action research, complemented by phenomenological analysis, the intervention being conducted through spirituality workshops in a recyclable materials Association in southern Brazil, between July/2022 and June/2023, with the participation of working women from this context. Three thematic categories emerged from the reflexive analysis technique, which enabled the recording of senses, insights and the significance of the interventions, namely: The data organized and analyzed resulted in three thematic categories, namely: Recognizing oneself in another dimension; Connecting with oneself and with others; and Feeling empowered and committed. The conclusion drawn is that the analysis of interventions related to spirituality as a contribution to the health and well-being of women from an association of recyclable materials highlighted the need to diversify theoretical-practical and investigative approaches, in order to broaden the perception of health and understand the human being in its singular and multidimensional dimension.

Transforming narratives of physician identity formation and healing: a longitudinal qualitative study of physicians' stories about spirituality and medicine, from residency to practice

BACKGROUND

Concern about burnout has prompted increased attention on fostering physician resilience throughout the educational continuum. Studies indicate that lack of meaning-making and connection (domains of spiritual wellbeing) place physicians at risk for burnout. While evidence support including spiritual care in comprehensive patient care to help patients/families heal from impactful experiences, few studies explore physicians' spiritual wellbeing as they routinely confront suffering and death in their daily work. Storytelling taps into spiritual aspects of human experience. This study, unique in the literature, examined the stories physicians chose to tell about spirituality and medicine over 20-years, from trainee to practicing physician, to explore how these experiences impact professional development and wellbeing.

METHODS

Design: Qualitative individual interview study - secondary analysis of a rich dataset of physician interviews, gathered over 20-years beginning in first-year residency, regarding attitudes and approach to spiritual care. For this new study, researchers extracted and analyzed the previously unexplored stories participants spontaneously told during interviews.

SETTING

Participants completed the same USA residency program and now practice throughout USA and Canada.

PARTICIPANTS

In study-year 1, all residents (PGY1,2,3) participated; response rate (RR) 97%, reflected a diversity of personal beliefs (atheist to religious). Researchers followed the PGY1 class for 20-years (2001-2020), interviewing them in study-years 1, 3, 11 and 20 (RR 100%, 100%, 97%, 54%).

DATA COLLECTION

Researchers extracted stories from interview transcripts.

ANALYSIS

4 researchers analyzed 204 stories from 66 interviews with 34 physicians, using grounded theory.

RESULTS

Irrespective of personal spiritual beliefs, trainees and practicing physicians told numerous spirituality-related stories. Longitudinal story themes-(1) Dissonance to Integration, (2) Formation and Transformation, and (3) Accidental to Purposeful Healing - reflected physicians' ongoing spiritual journeys as they grappled with meaning, values, purpose, and connection in their daily work. Spiritually impactful moments, whether distressing or uplifting, occurred throughout physicians' careers influencing professional/personal development, resilience and clinical approach. Spiritual practices (religious/secular) and reflection fostered healing for patients/families and physicians.

CONCLUSION

Physicians' longitudinal spiritual-care stories provide new insights into their professional/personal development. Reflection on spiritually impactful moments, both distressing and uplifting, may trigger transformative learning towards meaning-making, resilience, burnout prevention and positive physician identity formation.

Knowledge, attitudes, and practices of clerkship supervisors regarding the biopsychosocial approach at the University of Botswana's Faculty of Medicine

BACKGROUND

The biopsychosocial and spiritual model (BPSM), commonly referred to as body-mind unity, complements the biological model by expanding health professionals' understanding through the integration of psychological and eco-social elements as influential factors in health and disease. Clerkships are a phase of medical education where students transition from theoretical learning to practical application under the supervision of experienced health practitioners. This study investigates the knowledge, attitudes, and practices (KAP) of clerkship supervisors at the University of Botswana's Faculty of Medicine (UB-FOM) regarding the BPSM.

METHODS

We conducted a quantitative cross-sectional survey, distributing online (via Microsoft 365 Forms) and self-administered paper-based questionnaires to clerkship supervisors. KAP information was gathered using a five-point Likert scale and an open-ended question section that asked respondents to elaborate on factors they perceived as limitations to applying the BPSM.

RESULTS

Only 34.3% of approximately 140 clerkship supervisors invited to participate in the study responded. Forty-eight supervisors completed the questionnaire. Most participants (n = 38, 79.2%) reported receiving training on the BPSM during their undergraduate or postgraduate education. Most UB-FOM clerkship supervisors appreciated the importance of considering all four dimensions of health in healthcare activities (mean score = 4.14 > weighted mean score of 4.04). They felt less comfortable instructing medical students on the model during clinical rotations (mean score = 3.98 < weighted mean score of 4.04), and they expressed less agreement about the ability of psychosocial processes and treatments to alter medical illnesses. Additionally, they less recognised the importance of incorporating spiritual evaluation into medical practice (mean score = 3.82 < weighted mean score of 4.04). Obstacles to implementing the BPSM included time constraints during consultations, a negative attitude towards the BPSM, a lack of updated training, and an absence of defined guidelines for the BPSM.

CONCLUSION

While most UB-FOM clerkship supervisors who participated to the study acknowledged the importance of considering all four dimensions of health in healthcare activities, they felt less comfortable instructing medical students on the BPSM during clinical rotations and expressed less agreement about the efficacy of psychosocial processes in medical treatment. We recommend implementing research that specifically targets the beliefs and attitudes of clerkship supervisors.

Muslim Patients' Religious & Spiritual Resource Needs in US Hospitals: Findings from a National Survey

BACKGROUND

Healthcare provided without attending to patients' religious/spiritual needs contributes to inequities.

OBJECTIVE

Assess Muslim American views on the importance and accessibility of religious/spiritual resources in hospitals.

DESIGN/PARTICIPANTS/MAIN MEASURES

A survey was distributed at community events and online to self-reported Muslim adults. It contained measures of religiosity, importance and availability of specific religious/spiritual resources, and conventional sociodemographic descriptors. Analyses utilized chi-squared tests and regression models to test associations between participant characteristics and views on the importance and availability of religious/spiritual resources in hospitals.

KEY RESULTS

Of the 1281 respondents, many (68%; n = 875) were women, and South Asian (39%; n = 492) or Arab (37%; n = 469). Almost all (95%; n = 1203) noted it was important to have their religious/spiritual needs met in the hospital. The most important resources were halal food (93%; n = 1188), a neutral prayer space (93%; n = 1188), and medications without pork or alcohol (92%; n = 1177), yet a minority found such resources available; halal food (17%; n = 111), prayer space (26%; n = 169), and medication without pork or alcohol (9.3%; n = 59). Almost all (92%, N = 1180) felt comfortable identifying as Muslim in the hospital, yet few (27%, N = 173) were asked. Participants with higher positive religious coping placed greater importance on religious/spiritual needs being met (OR 1.15, p < .05). Those regularly attending congregational prayer services (β 0.2, p < 0.001), with more positive religious coping (β 0.11, p < 0.001), for whom Islam informed their whole approach to life (β 0.34, p < 0.001), and those with greater perceived discrimination in medical settings (β 0.03, p < 0.022) placed greater importance on the availability of Islamic resources in hospital. Those asked about religious affiliation (OR 2.23, p < 0.01) had higher odds of believing their religious/spiritual needs were met.

CONCLUSIONS

Muslim Americans have substantial unmet religious/spiritual resource needs in hospital settings. Patient-centered, equitable care may be enhanced by clinicians inquiring about, and mobilizing resources to attend to these.

The health and well-being of children with medical complexity and their parents' when admitted to inpatient care units: A scoping review

Children with medical complexity (CMC) are regularly admitted to inpatient care units to receive medical care. While admissions for CMC and their parents can negatively impact their health and well-being, mapping of evidence in this area appears underreported. A scoping review using the Joanna Briggs Institute methodology was conducted to map evidence on CMC and parents' experiences of care. The purpose of this paper is to report the findings from the scoping review specific to CMC and parents' experiences of care on their health and well-being. A total of 24 articles were synthesized, and themes included: psychological impacts for parents, impacts on functions of daily living, parents' coping strategies for psychological well-being, impacts of hospitalization on CMC, CMC coping strategies, spirituality, and interventional studies. Findings from this review demonstrate that CMC and their parents struggled with their psychological and emotional well-being and that both CMC and parents coped with the stress of hospitalization in a variety of ways. Healthcare professionals need to be educated on how to support CMC and their parents during hospitalization. Future development and implementation of innovative care models and interventions that offer CMC and their parents with enhanced psychosocial support are recommended.

Future directions of spiritual care where spiritual care providers do not exist: a qualitative study

INTRODUCTION

Spiritual care is a fundamental aspect of palliative care, addressing the emotional, existential, and spiritual needs of patients facing life-threatening illnesses. However, in Thailand, the integration of spiritual care into the healthcare system remains underdeveloped due to the absence of professional spiritual care providers. This study aims to explore potential models and future directions for spiritual care within the palliative care context, focusing on how such care can be provided in the absence of professional spiritual care providers.

METHOD

This study is a part of the mixed-method project Shoulders to Cry on: Care for spirituality when spiritual care providers do not exist, aimed at exploring spiritual care in settings without professional providers in Thailand. Qualitative in-depth interviews were conducted with 20 experts from palliative care, religious studies, and social work fields. The participants were recruited through purposeful sampling, and the data were analysed using inductive thematic analysis. Transcribed interviews were managed using NVivo software to identify key patterns and insights for future spiritual care models.

RESULT

The analysis resulted in the development of the S.P.I.R.I.T. model, which outlines six essential themes for the future of spiritual care: (1) Spirituality Training Programs, (2) Providers for Spiritual Care, (3) Integrating Spiritual Care into Healthcare, (4) Research and Evidence-based Practices, (5) Interdisciplinary Collaboration, and (6) Transforming Care Systems. The findings suggest establishing structured training programs and interdisciplinary collaboration are crucial for effective spiritual care delivery.

CONCLUSION

The study emphasises the need for integrating spiritual care into Thailand's healthcare system, focusing on education, research, and collaboration between healthcare providers and religious or community figures. The S.P.I.R.I.T. model offers a framework for addressing current gaps, which could facilitate Thailand's palliative care system in better meeting the spiritual needs of patients. Future studies should focus on establishing spiritual care education in palliative care, especially in resource-limited countries, and addressing local contextual obstacles.

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.

The Confluence Between Spiritual and Mental Health: A Phenomenological Approach to the Study of Healthcare Professionals' Experiences

Background: Given the global concern about mental health in the world, different approaches are being explored in its approach and treatment. In this line, the care of the spiritual dimension has been shown in many studies to have a significantly positive relationship. In mental health units, the comprehensive approach that involves comprehensive care considers the spiritual dimension as an aspect of care that contributes to coping with mental health problems. Methods: This is qualitative research with a descriptive design and an ethnographic approach, using interviews with forty-five professionals from Spanish and Portuguese mental health units. Results: The professionals do not define the term spiritual health in the same way; however, all interviewees believe that S/R positively influences the mental health of their patients, although few address it. They believe that their own S/R can influence their attention to spiritual needs. Among the limitations are the lack of training and time due to the prevailing biomedical model. Lack of time and specific training in spiritual care are the main aspects to which they attribute the shortage in meeting spiritual needs. Most of them expressed feeling challenged to care for the spiritual dimension after this research. Conclusions: More studies are needed on the spiritual care provided by mental health professionals to specify specific training and the associated challenges in this field.

Spiritual Care Interventions for Adult Patients in Intensive Care Units: A Scoping Review Protocol

Caring for patients in intensive care units (ICUs) requires healthcare workers to recognize the importance of a spiritual care approach in these settings. Moving toward a holistic and patient-centered care model that incorporates spiritual care is essential for enhancing patients' healing process. The disease-centered approach of ICU and the perceived deficit of spiritual care highlight the need to add knowledge on integrating spiritual care interventions into daily ICU practices. The aim of this scoping review will be to develop a comprehensive overview of the characteristics of spiritual care interventions for adult patients in ICU according to JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. The inclusion criteria will be informed by the types of participants, concept and context, and types of evidence sources. Quantitative, qualitative and mixed methods studies, editorials, opinion papers and gray literature will be included. Databases such as PubMed (National Library of Medicine), CINAHL, Academic Search Complete, Psychology and Behavioral Sciences Collection, APA PsycINFO, Cochrane Central Register of Controlled Trials (via EBSCOhost), Scopus and Web of Science Core Collection will be searched. No date limit will be set. Titles and abstracts that meet the inclusion criteria, full texts of eligible studies and reference lists of all selected sources will be screened by 2 independent reviewers. Data will be extracted using customized tools, presented in diagrammatic or tabular format and summarized in a final narrative synthesis report. This research represents the first effort to develop a comprehensive overview of the characteristics of spiritual care interventions exclusively targeting adult patients in ICU settings. The findings will offer a thorough review of these interventions, including their main attributes, providers, resources, associated outcomes and assessment tools. Consequently, this knowledge can enhance the spiritual dimension of patient-centered care in the ICU, thereby promoting a shift from the traditional biomedical model to a more holistic perspective and establishing a new standard in critical care.

Approaching Suffering in Young University Students, New Challenge for a Compassionate University: A Qualitative Study of Undergraduate Nursing Students

BACKGROUND/OBJECTIVES

Student distress is diverse and manifests itself in a variety of ways. Driven by the constant pressure to meet academic and personal expectations, many students experience a deep sense of insufficiency and hopelessness. Anxiety and depression are widespread and are often accompanied by self-critical thoughts and feelings of worthlessness. Seeking temporary relief that often exacerbates their long-term struggles, some students resort to self-harm as a way to manage their emotional pain.

METHODS

This study employs an exploratory qualitative design with a phenomenological approach to deeply examine students' experiences of suffering. Using semi-structured interviews, the study captures detailed narratives from 17 purposely selected students, providing a rich understanding of their lived experiences. Adhering to COREQ guidelines (Consolidated Criteria for Reporting Qualitative Studies).

RESULTS

The analysis identified four main themes: the concept of suffering, its causes, students' responses, and coping strategies. Eleven sub-themes were identified, highlighting the significant challenges students face, including low self-esteem, anxiety, depression, and self-harm. These problems are increased by academic stress and social pressure derived from the intensive use of social networks. The constant social comparison and the search for external validation on social networks generate feelings of inadequacy and emotional exhaustion. Students often lack effective strategies to manage these pressures. In addition, bullying and the absence of meaningful relationships in the academic environment increase their suffering.

CONCLUSIONS

This study provides a novel contribution by focusing on the lived experiences of nursing students and emphasizing the importance of the compassionate university model as a framework for addressing student suffering. It highlights the urgent need to implement strategies for support and compassion in educational institutions centred on emotional management, presence, listening, and specific mindfulness and stress management programmes. Additionally, fostering healthier and more mindful use of social media is crucial to help students manage their expectations, reduce their suffering, and cultivate self-compassion.

Advancement of life and death education research: recommending implementation of the Life + Death Education Framework for teaching and research purposes

Life and death education is a distinct field of study that has potential practicality and life relevance for us to consider. For example, one notable inquiry pertaining to life education teaching entails appreciation and theoretical understanding of quality life functioning (e.g., a person's desire to attain spiritual wisdom vs. a person's desire to attain immense financial wealth). Our research undertakings recently involved the development of a blueprint or framework, which we termed as the 'Life + Death Education Framework'. This framework is intended to provide relevant information that may serve to assist educators, stakeholders, caregivers, etc. with their teaching practices of life and death education. We premise that to date, there is no clear consensus or agreement among educators as to what one is expected (e.g., specific learning outcome) to teach to students who wish to study and learn about life and death education (e.g., do we introduce to students the metaphysical lens about death?). Moreover, from our point of view, the Life + Death Education Framework may yield insightful guidelines and life-related benefits, such as the heightening of a person's well-being and/or his or her daily life functioning. As such, then, the focus of the present theoretical-conceptual article is for us to provide an in-depth narrative of the Life + Death Education Framework and how this framework, or potential universal blueprint, could help introduce and clarify our proposition of a life functioning-related concept known as 'self well-being'. Self well-being, for us, is an alternative nomenclature that may be used in place of subjective well-being.

Exploring Spiritual Care Competency in Palliative Medicine: A Narrative Inquiry of Physician Care Notes on Spiritual Distress

Background: Spiritual care is a critical component of hospice and palliative medicine; however, physicians frequently lack the necessary competencies to adequately address patients' spiritual needs. This study aims to examine the spiritual care competencies of physicians as reflected in their care notes, thereby providing insights into their approaches for managing spiritual distress. Methods: A narrative inquiry approach was employed to qualitatively analyze interaction notes from 30 palliative care patients experiencing spiritual distress. Data were collected from a medical university professor's care notes between April 2019 and February 2024. Results: The most common form of spiritual distress observed was reluctance to leave life, followed by loss of dignity. Physicians demonstrated expertise in holistic care, addressing physical, psychological, and spiritual needs with a comprehensive approach. Their demeanor reflects acceptance of mortality and acknowledgment of the limitations of medical care, helping foster gratitude and contentment in patients. Effective communication was pivotal, involving the conveyance of information, empathetic engagement, and active listening. Compassionate interactions emphasized the importance of spiritual care in patient-centered care delivery. Conclusions: Spiritual care competencies are essential for improving patient outcomes and advancing comprehensive palliative care. Future efforts should integrate these competencies into communication training within medical education to more effectively enhance health care providers' competencies.

Commemoration of body donors in a religiously diverse society: A tale of two Korean medical schools

Although a diversity of religions exists in South Korea, with Buddhism and Christianity (Protestantism and Catholicism) being the two main faiths, Korean beliefs are deeply rooted in Confucianism. Despite the notion that the Confucian norm of filial piety discourages body donation to medical science, there has been a mindset shift in favor of body donation, driven by a heightened awareness of the body bequest programs and the care and dignity accorded to the altruistic body donors, together with the institution of commemorative services to honor them. As spirituality and religion are known to be factors that influence body donation, how religious- and non-religious-based memorial services are held to honor the donors as exemplified by two Korean medical schools-from a public university with no religious affiliation and from a Protestant-based university-are described here. The key concept of expressing gratitude and respect for the donors and their family members has positively impacted body bequest programs in this multi-religious society. Commemorative services held to pay tribute to the altruistic body donors may play an important role in inspiring a humanistic spirit in students, regardless of religious or non-religious beliefs, as exemplified by the two Korean medical schools. The takeaway here is that the elevation of spirituality in memorial services effectively resonates with society, thereby demonstrating the impact of spiritual principles independent of religious influence.

The Life + Death Education Framework: Proposition of a 'Universal' Framework for Implementation

Life and death education is a distinct field of study that has potential life relevance for consideration (e.g., self-awareness and subsequent improvement of one's own health well-being). Existing research development, situating in different learning-sociocultural contexts, has provided consistent evidence that showcases the differing viewpoints of life functioning (e.g., what is the true meaning of life?) and the intricate nature of death and dying (e.g., a death ritual that closely associates with a particular cultural group). Some of the research studies undertaken indicate the effective use of 'philosophization' or the discourse of philosophical analysis, enabling individuals to philosophize, contemplate, and seek transpersonal understanding of the subject matters of life and death (e.g., can a state of 'spiritual transcendence' help to alleviate a person's fear of death?). Such discourse, interestingly, has offered some informative yields for enriching and meaningful life purposes - for example, the seeking to attain transpersonal understanding of life (e.g., what does a state of self-transcendence actually mean?) and/or transpersonal life experience may assist a senior citizen to cope with his mental health during a temporary health crisis. Our teaching and research interest of life and death education over the past decade has led us to consider one important line of inquiry for development: namely, the proposition of a 'universal' blueprint or framework of life and death education for curriculum development, teaching, and research purposes. We are cognizant of the fact that, to date, there is no clear consensus or agreement as to what one is expected (e.g., specific learning outcome) to teach students who wish to study and learn about life and death education. On this basis, the present theoretical article introduces a theoretical framework, termed as 'The Life + Death Education Framework' (e.g., for universities), to assist educators for their quality teaching and/or research inquiries of life and death education. We firmly believe that the Life + Death Education Framework can be universal and, in this case, apply to different learning-sociocultural contexts.

Spanish-speaking Patients' Experiences with Hearing Health Care

Background/introduction: Health care providers working with Spanish-speaking patients must provide culturally and linguistically appropriate care to meet the communication needs of this population. Disparities related to hearing health care access remain understudied, leaving gaps in clinical practice and guidance for audiologists. The purpose of this study was to explore the experiences of Spanish-speaking patients with hearing loss when accessing hearing health care services through a limited income hearing aid program. Methods: Six Spanish-speaking patients (three monolingual Spanish, three bilingual Spanish/English) with hearing loss from the Oklahoma City metropolitan area completed in-depth, semi-structured interviews. Results/findings: Three main themes emerged: (1) perceived barriers to service delivery (cost, language, and transportation); (2) success with hearing health care (use of interpreters and reduced cost of services and amplification); and (3) cultural factors (family, religion, and use of home remedies). Discussion/conclusion: The themes identified can provide a foundation for service delivery of patient-centered services that are culturally and linguistically appropriate to help improve access to and quality of hearing health care, particularly for this population of patients. This study identified factors that may contribute to hearing health care disparities for Spanish-speaking adults, which may not be observed in other disciplines that are less communication-focused. Suggestions for improving services for audiologists serving Spanish-speaking patients are discussed.

Religion, Spirituality and Health Research: Warning of Contaminated Scales

The relationship between religiosity, spirituality and health has received increasing attention in the academic literature. Studies involving quantitative measurement of religiosity and/or spirituality (R/S) and health have reported many positive associations between these constructs. The quality of various measures, however, is very important in this field, given concerns that some measures of R/S have been contaminated with indicators of mental health. When this occurs, that is when R/S is defined and measured a priori, this subsequently guarantees a positive association between R/S and health (especially mental health). Such associations are called tautological, which involves correlating a construct with itself, thus producing associations that are uninterpretable and misleading. In this article, concerns about the measurement of R/S are discussed, examples of contaminated and potentially probelmatic measures of R/S are noted, and recommendations are made regarding uncontaminated measures of R/S that should be used in future studies of R/S and health.

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.

Investigation of Hope and Spiritual Well-Being Levels among Relatives of Intensive Care Patients in Turkey

This study was conducted to determine the levels of hope and spiritual well-being among relatives of intensive care patients. The data were collected using the Patient Descriptive Information Form, Trait Hope Scale, and Spiritual Well-Being Scale. The mean total scores on the Trait Hope Scale and the Spiritual Well-Being Scale were 48.24 ± 8.37 and 104.99 ± 8.06, respectively. The mean scores on the Trait Hope Scale differed significantly according to the employment status, income status, and the reaction of the patient's relatives during the visit (p < 0.05). A significant difference was found between the mean scores of patient relatives on the Spiritual Well-Being Scale according to the level of education, income, and the intensive care unit where the patient was hospitalized (p < 0.05). A significant positive correlation was found between the Trait Hope Scale and the Spiritual Well-Being Scale (p < 0.05). This study found that patient relatives had good hope and spiritual well-being levels, and spiritual well-being increased the level of hope among patient relatives.

The Power of a Belief System: A Systematic Qualitative Synthesis of Spiritual Care for Patients with Brain Tumors

Background: Diagnosis with a brain tumor is a critical event in the lives of patients and their families due to poor medical prognoses and complex clinical care. Spiritual care interventions have been known to have meaningful effects in morbid diagnoses and palliative medicine, but their role in the neuro-oncologic patient's experience is poorly understood. This systematic review explores the role of spirituality and its relevance to patient care in the diverse setting of brain tumors. Methods: A comprehensive systematic review was conducted following PRISMA-SR guidelines. PUBMED was queried for studies on spirituality and neuro-oncology. Identified studies included RCTs, interviews, surveys, and case reports that examined spirituality in neuro-oncological clinical care, quality of life, and patient experience. Of 214 articles identified, 21 studies met the inclusion criteria, and the results were narratively synthesized. Results: Spirituality may play a significant role in mental well-being by reconciling existential questions faced by both patients and caregivers, and can serve as a valuable resource to improve mental well-being and reduce rates of palliative caregiver burnout. However, the paucity of studies examining the education and integration of spiritual awareness within the clinical literature warrants further study. Conclusions: While spiritual care interventions may improve the quality of life and mental wellness of patients and their caregivers, it is unclear how spiritual awareness and education should best be implemented. Further research is needed to better understand how key components of spiritual awareness can be integrated into medical education to deepen the patient-physician relationship and improve clinical experiences.

Spiritual Support Staff Influence Stress Among Hospital-Based Health Care Personnel: A Cross-Sectional Study

BACKGROUND

Stress negatively affects well-being, relating to poor physical, emotional, and occupational outcomes for health care personnel. Health care professionals faced extreme stressors in the context of the COVID-19 pandemic, making occupational stress relief a top priority for hospital administrators. Many health systems employ specially trained spiritual support staff as one strategy to alleviate work-related stressors. It is unclear whether health care personnels' perceptions of the availability of spiritual care staff influence self-reported stress.

OBJECTIVE

The purpose of this study was to explore relationships between perceived stress and perceptions of availability of spiritual support among acute care health care personnel.

METHODS

This study analyzed cross-sectional, survey-based data collected between February and April 2022 from 1352 interdisciplinary health care staff working in a large, nonprofit Catholic health system in the Western United States. Bivariate tests and multivariate linear regression models were conducted to test for factors influencing perceived stress.

RESULTS

Results support that high stress was prevalent in the sample. Perceived availability of spiritual support staff in the hospital and seeking coworker and professional support for work-related stress all independently influence stress in this population when controlling for confounders.

CONCLUSIONS

Stress of health care personnel may be influenced by the perceived availability of specially trained spiritual support staff. Hospital administrators should advocate for spiritual support staff availability in all health care settings as one strategy to mitigate occupational stress that health care professionals may experience through providing high-stakes patient care. Further research is warranted to uncover targeted spirituality-related strategies to reduce stress and preserve well-being of health care personnel.

Is there an association among spirituality, resilience and empathy in medical students?

BACKGROUND

Spirituality has religious and nonreligious dimensions and is often linked to well-being, positive emotions, connection and meaning in life. Both empathy and resilience are important in medical training and future professional practice since they are considered core skills related to professionalism and patient care. Our study aimed to understand the relationships among spirituality, resilience, and empathy in medical students. We also aimed to determine whether there are differences by gender and between medical students in different years of a medical program.

METHODS

Medical students (n = 1370) of the first to fourth years of a six-year medical program, from six medical schools, completed questionnaires to assess empathy (Jefferson Empathy Scale and Davis Multidimensional Interpersonal Reactivity Scale) and resilience (Wagnild & Young Scale) and to rate their spirituality.

RESULTS

Medical students with high spirituality showed higher scores for both resilience and empathy (p < 0.001). In addition, we observed higher levels of both spirituality and empathy, but not resilience, in female medical students than in male medical students. In contrast, we did not detect significant differences in spirituality, empathy, or resilience between students in different years of medical school.

CONCLUSION

Medical students with high levels of spirituality have also higher scores for both empathy and resilience. Spirituality, empathy and resilience have similar values for students in different years of a medical program.

Exploring the Connections between Medical Rehabilitation, Faith and Spirituality

(1) Background: Patients who undergo a medical rehabilitation treatment are often facing a physical, emotional and spiritual crisis, mostly due to pain, loss of limb functionality, the memory of the pre-disease days or questions about their role and value in life. Most of the time, the physician does not have the ability to deal with these issues or to provide the expected responses. The aim of this study was to analyze the patient's perception on spirituality and faith while going through a medical rehabilitation program. (2) Methods: The current study included 173 patients treated in the Rehabilitation Department of the Clinical Rehabilitation Hospital in Cluj-Napoca, Romania. Of them, 91 comprised the study group and were assessed in 2023, while 82 comprised the control group and were assessed in 2007. All patients answered a 34-item questionnaire designed by the authors regarding the role of religion, spirituality and prayer in their post-disease life. (3) Results: The results show that 99% of the patients assessed believe in God, 80% pray every day, 50% have less pain after praying and 44% trust their priest the same as they trust their doctor. When comparing groups, results from 2023 show that more patients pray every day, while fewer are afraid of dying, think their disease is serious or wish for the medical team to pray with them, compared to 2007. (4) Conclusions: The physician should not neglect the faith of the patient and should use it to achieve a better rehabilitation outcome.

Components of spirituality in older adults: A phenomenological study through interviews based on dignity therapy

AIM

A key perspective in examining dignity, which is important for older adults, is spirituality. Therefore, this study aimed to identify the components of spirituality in older adults through interviews based on dignity therapy (DT).

METHODOLOGICAL DESIGN AND JUSTIFICATION

Colaizzi's descriptive phenomenology was applied to understand experiences rooted in the life world of older adults from their own perspective.

ETHICAL ISSUES AND APPROVAL

This study was approved by the ethical review committee of the author's university. All participants provided consent to participate.

RESEARCH METHODS

Semi-structured interviews based on DT were conducted with 11 community-dwelling adults aged 65 years or older who were using some form of medical or social services. The interviews were transcribed, and the text was analysed based on Colaizzi's phenomenological method.

RESULTS

Four themes were identified as components of spirituality in older adults: trauma, being silent about hard experiences, forming connections and taking on challenges and discovering one's own spirit. The participants felt a sense of helplessness and frustration as they dealt with traumatic events. Feelings of shame, guilt and/or resignation prevented them from talking about the distress they were experiencing, but they were able to move forward after receiving emotional support and having opportunities to share with others. These processes led to the discovery of a new self.

STUDY LIMITATIONS

This study assessed the experiences of older adults in Japan and may therefore have been influenced by the social background and culture of Japan. Future research should target older adults from a variety of social backgrounds as well as those with specific health conditions.

CONCLUSION

The findings suggest the importance of creating opportunities for healthcare professionals as well as family, friends and community members to help older adults reflect on their lives and talk about their accomplishments and unresolved issues. Doing so should help older adults maintain their dignity while remaining aware of their mortality.

Spirituality and Influencing Factors in Parkinson's Disease: A Scoping Review

Although the effect of spirituality in chronic disease has been discussed in recent years, little is known about spirituality and spiritual beliefs in Parkinson's disease. In this scoping review, the databases PubMed, Scopus and Web of Science were searched and initially identified 914 studies. A total of nine studies satisfied the inclusion criteria. It was found age, gender, education level, emotional changes, region of onset of Parkinson's disease, severity of symptoms, quality of life, religion affiliation and acceptance of Parkinson's disease influence spirituality in people with Parkinson's disease. In this context, future studies should focus on the relationship between Parkinson's disease and spirituality.

Australian Patient Preferences for Discussing Spiritual Issues in the Hospital Setting: An Exploratory Mixed Methods Study

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role.

Integrating spirituality into physical therapy: exploring its emerging role as a recognized determinant of health

This masterclass explores the increasing recognition of spirituality as a vital aspect of patient care, alongside other Social Determinants of Health (SDH) such as economic stability and education. The distinction between spirituality and religion is clarified, with spirituality described as a broader, more personal experience that can exist both within and outside of religious contexts. Research demonstrates that spirituality influences health in mostly positive ways, particularly in areas like mental health, resilience, and coping, making it a critical component of holistic, patient-centered care. In physical therapy, incorporating a patient's spirituality into their plan of care can enhance cultural competence and foster a more holistic care approach. However, many Physical Therapists (PTs) express uncertainty in addressing spiritual concerns, often due to limited training or unclear role expectations. The authors suggest that integrating tools like the Inclusive Spiritual Connection Scale (ISCS), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), Spiritual Well-Being Questionnaire (SWBQ), the Spiritual Health and Life-Orientation Measure (SHALOM), or the Spiritual Transcendence Scale (STS), along with enhanced education, could help therapists incorporate spirituality into practice more seamlessly. Integration of spirituality enables PTs to deliver more complete, personalized care that addresses the whole person. Ultimately, the authors advocate for recognizing spirituality as a key determinant of health and an important component of healthcare to ensure more inclusive treatment.

Spirituality in Adolescents and Young Adults With Cancer: An Evolutionary Concept Analysis

Background: Despite an increased focus on the importance of spirituality to human health, including adolescent health outcomes there remains an absence of evidence-based programs to address the spiritual needs of patients and families. A critical barrier is the absence of a clear conceptual understanding and operational definitions of spirituality for adolescents/young adults (AYAs) with cancer. The purposes of this concept analysis were to (a) clarify the concept of spirituality in the context of the AYAs' cancer experience and (b) generate a definition based on a review of the literature examining spiritual development and the role of spirituality in AYAs' health and cancer treatment. Method: We used Roger's evolutionary concept analysis method to identify antecedents, attributes, and consequences of spirituality in the context of AYAs' cancer using thematic analysis and included identification of case exemplars. Results: Of the 86 articles identified, 21 met our inclusion criteria. Analysis revealed four attributes of spirituality in AYAs with cancer: meaning and purpose, connectedness, life-long universal experience, and independent of or related to religion and faith traditions. Identified antecedents included the presence of spiritual resources, chronic illness, belief, or wonder about a higher power, and existential questions. Identified consequences included hope, meaning, feelings of peace, and enhanced well-being and illness acceptance. Based on the findings, we generated a definition of spirituality in AYAs with cancer. Discussion: Findings inform the development of measures and spiritual care interventions specific to AYAs with cancer. An important limitation to address in future research is the absence of AYAs' first-person accounts of their own spirituality.

Spiritual Dimension in Neurological and Neurodegenerative Diseases: A Systematic Mapping Review

Previous studies have shown the benefits of spirituality/religiosity with regard to health and quality of life for people. The high prevalence of neurological disorders, which are the main diseases that cause disability and dependency around the world, makes neurological disorders especially relevant. This systematic mapping review aimed to map the knowledge of spirituality experienced by people with neurological/neurodegenerative disorders and its influence on outcomes and the ability to cope with the disease. Following specified methodological criteria, a total of 13 articles were selected. The spiritual dimension should be considered a fundamental component of the quality of life and well-being of neurological patients as it can significantly influence their ability to cope with their disease.

Supporting elderly patients in strengthening their personal and spiritual health resources

Care for the sick, including spiritual support is sometimes called holistic medicine. The term bio-psycho-social-spiritual model is sometimes used to describe this type of therapeutic approach patient-oriented medicine. This report indicates the importance of taking into account the spiritual aspect of life due to its beneficial impact on the coping resources activated and the patient's well-being. Existential and spiritual issues are on the verge of new clinical and research interest in medicine, especially in gerontology, oncology, and palliative care. Clinicians focus not only on symptom control but also on spiritual and existential issues such as spirituality, hope, and meaning. This paper reviews the topic of spirituality in the context of illness and end-of-life care trying to define spirituality within the context of health resources of the subject. Spirituality is perceived in two of its main components: faith/religious beliefs and spiritual well-being. Especially this second construct is reviewed and described as a health resource.

Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial

OBJECTIVES

Stroke patients often experience poor sleep quality and spiritual health due to complications and limitations. In this situation, implementing spiritual care may reduce these problems. Therefore, this study aimed to examine the effect of a spiritual care program on sleep quality and spiritual health of Muslim stroke patients.

METHODS

This was a two-group randomized clinical trial conducted in Hamadan, Iran, in 2021, with 117 stroke patients. The samples were selected by convenience sampling and assigned to experimental (N = 59) and control (N = 58) groups based on random permutation blocks. The data were collected using the demographic information form, the Pittsburgh Sleep Quality Index, the Paloutzian and Ellison Spiritual Well-Being Scale, and the Modified Rankin Scale before and one month after the intervention. The experimental group received five daily sessions of spiritual care for 45-60 min based on standard and local methods, including patient orientation and identification of spiritual needs, religious care, supportive spiritual care, and beneficial evaluations. Data were analyzed by chi-square test, Fisher's exact test, independent t-test, and paired t-test at 0.05 significance level in SPSS 21.

RESULTS

The socio-demographic characteristics were similar between the groups (p > 0.05). At baseline, there was no significant difference in sleep quality and spiritual health between the experimental and control groups (p > 0.05). However, after the intervention, the sleep quality and spiritual health of patients in the experimental group improved significantly compared with the control group (p < 0.05).

CONCLUSION

The spiritual care program improved sleep quality and spiritual health of stroke patients; therefore, nurses should consider these aspects to provide holistic care.

Exploring Coping and Religiosity in an Indian Ashram for Older Adults

BACKGROUND AND OBJECTIVES

With the aging of Indians and the cultural context of family care, faith-based ashrams are a possible middle way for older adult care for strained families. Religiosity is multidimensional, but it is unclear how its different dimensions relate to coping. This exploratory study investigates the profile of residents living in a faith-based ashram of Haridwar, a pilgrimage town in Northern India. Additionally, it examines religiosity and coping in this population, and the correlates of positive coping response (PCR).

METHODOLOGY

Preliminary field survey helped zero in on a single consenting ashram. We included 95 older adult participants (≥ 60 years) residing for more than six months. Relevant dimensions were captured with a survey interview form to record sociodemographics, BriefCOPE, and Duke University Religion Index. The sample was representative of the institutionalized older-adult population considering the overlap of sociodemographics (age, gender, and marital status). We conducted linear regression to examine possible predictors of PCR.

RESULTS

Most older adults were Hindus, higher educated, married, and lived with their spouses. The participants were highly religious. Coping through religion was most common, followed by active coping. On linear regression, a significant model emerged [F (13, 63) = 3.411, p < .001), where age, education, and organizational religious activity were significant predictors of PCR. However, other sociodemographic (sex, marital status, economics, family contact) and dimensions of religiosity (non-organizational religious activity and intrinsic religiosity) variables failed to predict PCR.

CONCLUSION

Lesser age, higher education, and involvement in the public practice of religiosity are essential contributors to PCR in older adults. How different aspects of religiosity influence coping and lend meaning to dealing with stress, needs further exploration.

The role of spirituality and religiosity on the suicidal ideation of medical students

BACKGROUND

There is solid evidence that spirituality and religiousness may reduce the suicidal ideation of individuals. However, studies are scarce on medical students.

AIMS

To investigate the relationship between spirituality, religiousness, and suicidal ideation among Brazilian medical students.

METHODS

This is a cross-sectional study including Brazilian medical students. Sociodemographic and health variables, suicidal ideation (item 9 of the Beck Depression Inventory - BDI), spiritual and religious Coping (Brief SRC), religiousness (Duke Religion Index), spiritual well-being - Meaning, Peace and Faith (FACIT SP-12), and depressive (PHQ-9) and anxiety (GAD-7) symptoms were assessed.

RESULTS

A total of 353 medical students were included, 62.0% presented significant depressive symptoms, 44.2% presented significant anxiety symptoms, and 14.2% presented suicidal ideation. In the adjusted Logistic Regression models, meaning (OR = 0.90, p = .035) and faith (OR = 0.91, p = .042) were associated with lower suicidal ideation, while negative spiritual and religious coping was associated with greater suicidal ideation (OR = 1.08; p = .006).

CONCLUSION

There was a high prevalence of suicidal ideation among Brazilian medical students. Spirituality and religiousness were associated with suicidal ideation in two different directions. These findings could help educators and health professionals to understand suicidal ideation among medical students, helping in the development of preventive strategies to mitigate such problem.

Spirituality in Australian Health Professional Practice: A Scoping Review and Qualitative Synthesis of Findings

This study explores how spirituality is integrated into practice across the different Australian health professions. Utilising the Joanna Briggs Institute's (JBI) protocol, six databases were searched, and sixty-seven articles were finally included. To present the findings, a qualitative synthesis was used. 'Meaning' and 'purpose in life' were found to be key to many spirituality definitions. The most frequently reported approach for Australian health professionals (HPs) in asking about client spirituality was using one or two questions within a comprehensive assessment. Major facilitators included a holistic care approach and prior training, whereas a key barrier was a lack of time.

Validation Study of the Revised Spirituality and Spiritual Care Rating Scale (SSCRS): A Cross-Sectional Survey in Poland

Introduction

The use of a validated scale, Spirituality and Spiritual Care Rating Scale (SSCRS) to measure nurses' perceptions of spirituality and spiritual care.

Aim

The purpose of this study was to analyse selected psychometric properties of the Polish version of the SSCRS, among them the applicability of the dimensions of spiritual care in nursing, ie, spirituality, spiritual care, religiosity and personalized care, to Polish conditions.

Methods

Poland-wide multicentre study with a cross-sectional validation design. The study was conducted between March and June 2019. Seven Polish Nursing Faculties accepted the invitation to participate in the study. A representative sample of 853 nurses enrolled in MSc (postgraduate) programs in nursing participated. After translation and cultural adaption of the SSCRS, the instrument underwent a full psychometric evaluation of its construct validity using (exploratory and confirmatory factor analysis), internal consistency (Cronbach's alpha and correlation analysis), reliability (test-retest analysis), known-group validity (Student's t-test) analysis.

Results

The exploratory and confirmatory factor analysis demonstrated that the Polish version of the SSCRS was a three-factor model with "Activity-centred spiritual care" (9 items), "Emotional support-centred spiritual care" (5 items) and "Religiosity" (3 items) domains. The Cronbach's alpha coefficient for the whole scale was 0.902, and the alpha values for the individual domains were 0.898, 0.873 and 0.563, respectively. The three domains mentioned above seemed to provide a comprehensive understanding of spiritual care perceived subjectively by Polish MSc in nursing students.

Conclusion

This study demonstrated a substantial degree of similarity in the selected psychometric characteristics of the Polish version of SSCRS and the original scale.

Palliative care and new technologies. The use of smart sensor technologies and its impact on the Total Care principle

BACKGROUND

Palliative care is an integral part of health care, which in term has become increasingly technologized in recent decades. Lately, innovative smart sensors combined with artificial intelligence promise better diagnosis and treatment. But to date, it is unclear: how are palliative care concepts and their underlying assumptions about humans challenged by smart sensor technologies (SST) and how can care benefit from SST?

AIMS

The paper aims to identify changes and challenges in palliative care due to the use of SST. In addition, normative guiding criteria for the use of SST are developed.

METHODS

The principle of Total Care used by the European Association for Palliative Care (EAPC) forms the basis for the ethical analysis. Drawing on this, its underlying conceptions of the human and its socio-ethical aspects are examined with a phenomenological focus. In the second step, the advantages, limitations, and socio-ethical challenges of using SST with respect to the Total Care principle are explored. Finally, ethical-normative requirements for the application of SST are derived.

RESULTS AND CONCLUSION

First, SST are limited in their measurement capabilities. Second, SST have an impact on human agency and autonomy. This concerns both the patient and the caregiver. Third, some aspects of the Total Care principle are likely to be marginalized due to the use of SST. The paper formulates normative requirements for using SST to serve human flourishing. It unfolds three criteria according to which SST must be aligned: (1) evidence and purposefulness, (2) autonomy, and (3) Total Care.

Yogic Spirituality and Positive Psychology vis-à-vis the Mental Health of Adolescents During COVID-19

COVID-19 ushered in a period of uncertainty and insecurity. It has affected the mental well-being of all, but certain groups are more vulnerable, including adolescents. Adolescence is a period of transition from childhood to adulthood in which the mental domain is still developing. The pandemic has had an adverse effect on the mental well-being of adolescents. Their normal routines are severely affected by the pandemic and related restrictions. There is a need for a coping mechanism or resources to empower this group of people. Spirituality has salubrious effect on all dimensions of health. The concept of spirituality is closely related to yoga and positive psychology. The article describes the similarities between yoga and positive psychology. It further posits that spirituality is closely related to yoga and positive psychology. The article also argues that both yoga and positive psychology could be useful in improving the mental dimension of health in adolescents in the COVID-19 era. A thorough study of the literature helped the authors to conclude that yoga and positive psychology definitely enhance mental well-being. The tenets of yoga and positive psychology can be incorporated into the daily regimen of children and adolescents to increase their resilience and mental strength. Further studies with robust study designs could ascertain the benefits of such measures.

Spirituality in the Context of Well-being. Evaluation of the Psychometric Properties and Added Value of the Spiritual Attitude and Involvement List Short Form (SAIL-SF)

There is growing evidence that spiritual well-being is positively associated with adaptive coping and health. The Spiritual Attitude and Involvement List (SAIL) was developed to measure a sense of connectedness to oneself, the environment and the transcendent as a universal experience. The aim of the current study was to develop a short form of the SAIL (SAIL-SF). A factor analytic approach was adopted to select the items for the SAIL-SF based on earlier studies among nurses (n = 458) and cancer patients (n = 445). The dimensionality, factor-loadings, internal consistency, construct validity and incremental validity of the final SAIL-SF were then evaluated in a new sample of adults (n = 225) participating in a trial assessing a positive psychology intervention. The first study yielded seven items, each representing one of the dimensions of the original SAIL: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. The seven items represented a single meaningful factor in both samples and the factor loadings of the items were adequately high. In the second study, a good fit across the various model indices was found and all items had adequately high factor loadings in a strict unidimensional confirmatory factor model and demonstrated good internal consistency. The SAIL-SF explained 7% of variance in ability to adapt above and beyond emotional, psychological, and social well-being. The current study shows that the SAIL-SF has good psychometric properties, and that spiritual well-being has a unique contribution to the ability to adapt in comparison with other types of well-being.