Attitudes Toward Spirituality and Spiritual Care among Iranian Nurses and Nursing Students: A Cross-Sectional Study

Addressing spiritual needs is taken into account as an integral part of holistic health care and also an important component of nursing practice. The aim of present study is to evaluate attitudes toward spirituality and spiritual care among nurses and nursing students at Semnan University of Medical Sciences in Iran. In this cross-sectional study, all nurses (n = 180) working in the teaching hospitals affiliated to Semnan University of Medical Sciences as well as senior nursing students (n = 50) selected by the census method. Finally, 168 individuals meeting the inclusion criteria were evaluated as the study sample. The data collection instrument was the Spirituality and Spiritual Care Rating Scale. The mean and standard deviation scores of attitudes toward spirituality and spiritual care among nurses and nursing students were 59 ± 10.9, and the scores obtained by the majority of study population (64.3%) ranged between 32 and 62 which were at a moderate and relatively desirable level. Nurses and nursing students working in aforementioned hospitals reported positive attitudes to spirituality and spiritual care. Given the importance of spiritual care and also the moderate level of spirituality and spiritual care among nurses and nursing students in this study, institutionalization of the concept of spirituality, provision of an appropriate context to deliver such care, and also implementation of interventions in order to improve spiritual care along with other nursing skills were assumed of utmost importance.     

Spiritual Inquiry and Well-Being in Life-Limiting Illness

ABSTRACT

Introduction: End of life, as a developmental phase, is accompanied by inner resources as well as losses. Spirituality is a potential inner resource for integrating illness that often occurs during this time. Despite the increase in spirituality research, how spiritual perspectives are used in life-limiting illness remains under-investigated. Better knowledge about this process may be useful for health care providers, family caregivers and patients themselves to enhance well-being at end of life. This study describes the process of how patients and family care-givers use their spiritual resources to facilitate well-being at the end of life.

Method: A qualitative study was designed, based upon the grounded theory method, that entails theoretical sampling of concepts (not sampling of people as in quantitative designs), and the analytic technique of constant comparison of the data until conceptual categories are saturated with supporting data and a theory can be identified. The sample consisted of 12 respondents: 6 dyads of elderly patients with a life-limiting illness and family caregivers. Interviews occurred over a 2-year period.

Results: Data analysis generated a theory about a process called “transcending life-limiting illness,” which derived from two related themes: spiritual inquiry and end-of-life dimensions.

Conclusion: The results expand existing knowledge about how people, either as patients or as family caregivers of persons facing end of life, live with life-limiting illness. The process of transcending life-limiting illness goes beyond merely coping to tap resources for well-being. This resource is expressed through an ongoing dialectic process of spiritual inquiry about life and death as supported by six critical life dimensions.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

The relationship between the spiritual well-being of university students in Hong Kong and their academic performance#

The study aims to examine the relationship between the spiritual well-being of university students in Hong Kong and their academic performance measured by Cumulative Grade-Point Average, using both quantitative and qualitative methods. The quantitative part of the study consists of 1130 Year 2 and Year 3 students from three universities in Hong Kong. The questionnaire is adapted from the Spiritual Health and Life-Orientation Measure developed by John Fisher. Results indicate a moderately positive relationship between the spiritual well-being of the respondents and their academic performance. The qualitative part of the study is comprised of 11 focus group discussions. The findings of this support the quantitative findings and contribute to the exploration of how students’ spiritual well-being and their pursuits of academic success are correlated. The several spiritual attributes, namely, concentration, persistence, self-confidence, self-discipline and interpersonal relationships are found in the resulting positive relationship through the qualitative findings.     

The Challenge of Maintaining Spiritual Connectedness for Persons Institutionalized with Dementia

ABSTRACT

Persons with dementia who reside in long term care facilities continue to have spiritual needs, but providing for these needs presents many challenges. Encouraging, fostering and maintaining spiritual connectedness is crucial to providing for a high quality of life. Memory, grief and mourning, care planning, communication, and education of caregivers are discussed within the context of a working application of spiritual well-being. Practical ways to deal with some of the dilemmas for the individual person with dementia, his or her family, support network, and the religious community are addressed.     

Understanding the Ageing Process: A Developmental Perspective of the Psychosocial and Spiritual Dimensions

SUMMARY

This chapter describes a perspective of psychosocial and spiritual development in the later years of life. It outlines a study of nurses conducted in six nursing homes using pre and post workshop tests to identify changes in nurses' assignment of a list of behaviours as psychosocial or spiritual. Use of SPSS found significant changes between the pre and post tests. Pre workshop tests only identified items as spiritual if they included the word God, or Bible. Results from this study highlight the potential role for nurses in aged care to provide spiritual care as part of holistic care. It also highlights the fact that many nurses feel ill prepared for this role.     

Spiritual Experiences of Muslim Critical Care Nurses

The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723–734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.     

Spiritual Health and Outcomes in Muslim ICU Patients: A Nationwide Cross-Sectional Study

The aim of the present study is to describe how religiosity and spirituality affect the psychiatric morbidity of Muslim intensive care unit (ICU) patients. We conducted a prospective nationwide cross-sectional study of ICU patients discharged from 45 medical centers spanning 31 proivinces in Iran. Adults (age ≥ 18 years) admitted to the ICU and treated with invasive mechanical ventilation were eligible. Nine validated survey tools were administered to detect direct and indirect associations between spiritual health (SH) and depression, anxiety, and post-traumatic disorder. The Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale—Revised (IES-R), Post-Traumatic Stress Syndrome 14 question (PTSS-14) quality-of-life (QoL), and quality of patient to physician or nurse communication (PP-QoC and PN-QoC) scales were modeled through two mediators by structural equation modeling (SEM). Sex, ICU type, LOS, and APACHE II score were added in the independent variable list. 338 eligible patients were discharged from the ICUs during the study period. 56 were excluded (clinical status), and 282 were administered the survey. 278 returned it, with 272 complete and 6 partial responses. SH displayed no direct or indirect association to QoL. SH was indirectly associated with decreased depression and anxiety (B = ? 0.081, p < 0.05) via PP-QoC mediator. Both direct and indirect positive associations were observed between SH and IES-R (B = 0.293, p < 0.05; via PP-QoC) and PTSS-14 scores (B = 0.267, p < 0.001; via PP-QoC). Medical ICU location was associated with decreased PTSS-14 scores via the same mediator. In this survey of Muslim ICU patients treated with invasive mechanical ventilation, SH correlated with decreased depression and anxiety, but paradoxically increased post-traumatic stress. The most influential mediator was patient–physician quality-of-communication.     

Anger, Spiritual Meaning and Support from the Religious Community in Dementia Caregiving

This study explores the relationships between spiritual meaning and social support from the religious community and problem behaviors, anger and depression in 128 dementia caregivers. The results suggest a mediating role of anger in the relationship between the appraisal of problem behaviors and depression. Support from the religious community is directly and negatively associated with anger, but the relationship between spiritual meaning and anger is mediated by caregivers’ appraisals of problem behaviors, suggesting that spiritual beliefs might help caregivers to find meaning in caregiving experiences and thus appraise care recipients’ behavioral problems as less stressful.     

The onset of dementia caregiving and its longitudinal implications

This study examined patterns of entry into the caregiving role and how onset influences outcomes pertinent to the caregiving process. Using 3-year longitudinal data, the present analysis classified dementia caregivers into 1 of 4 onset sequences: those whose entry into caregiving was defined by diagnosis, those who first recognized symptoms and then obtained a diagnosis, those caregivers who first recognized symptoms and then provided care, and those who provided care prior to diagnosis or recognition. Analyses revealed that respondents who experienced a less abrupt entry into caregiving were less likely to institutionalize their relatives and reported greater decreases in well-being. The findings point to the dynamic process that defines entry into caregiving and emphasize that how individuals assume caregiving roles have implications long after onset.     

The Daily Spiritual Experiences Scale and Well-Being: Demographic Comparisons and Scale Validation with Older Jewish Adults and a Diverse Internet Sample

A substantive literature connects spirituality to positive physical, social, and mental health. In this study, the Daily Spiritual Experiences Scale (DSES) was administered to 410 subjects who participated in a community study and to 87 residents at the Hebrew Home for the Aged at Riverdale (HHAR), the latter sample consisting primarily of older Jewish respondents. Internal consistency of the DSES in both samples was high and exploratory factor analyses revealed one dominant factor and a second factor, which included 14 and 2 items, respectively, consistent with the scale’s original validation (Underwood and Teresi 2002). Demographic subgroup comparison among religious groups revealed significantly fewer daily spiritual experiences among Jews, and lowest scores among those respondents endorsing no religious affiliation. Women exhibited more frequent daily experience than men, and attainment of higher levels of education was associated with less frequent daily spiritual experience. All but one of the outcome measures of physical and psychologic well-being were found to be positively associated with the DSES so that more frequent daily spiritual experience correlated with less psychopathology, more close friendships, and better self-rated health. Directions for future research, study interpretation and limitations, and clinical implications for use of the DSES are discussed.     

Interfaith Spiritual Care: A Systematic Review

Journal of Religion and Health - Although knowledge on spiritual care provision in an interfaith context is essential for addressing the diversity of patients’ religious and spiritual needs,...     

Effects of Spiritual Well-Being on Subsequent Happiness,Psychological Well-Being,and Stress

Recently, Gomez and Fisher (Gomez R and Fisher JW (2003) Pers Individ Dif 35: 1975–1991) proposed that four facets of spiritual well-being exist, namely, personal, communal, environmental, and transcendental spiritual well-being. Based on data from three independent studies, the present research effort tested the validity of a German version of (Gomez R and Fisher JW (2003) Pers Individ Dif 35: 1975–1991) of the Spiritual Well-Being Questionnaire (SWBQ-G). It was found that the SWBQ-G was factorially valid and that each of the four SWBQ-G scales was discriminant to mental, physical, and emotional well-being. Also, it was found that the SWBQ-G predicted levels of subsequent happiness, psychological well-being (positive relationship), and stress (negative relationship). These results add to our knowledge about the validity of the construct of spiritual well-being.     

Spiritual well-being in older adults: Harmonious interconnectedness

The current study was designed to identify indicators of spiritual well-being in persons 65 years of age and over, using a grounded theory approach through the constant comparative method of data analysis. The basic social process of harmonious interconnectedness was discovered. This process was the unifying force between categories and within each identified category. The study has implications for health care personnel in that it provides a basis for assessing spiritual well-being in patients.This study was partially funded by a special project grant from Marquette University.     

The acute psychobiological impact of the intensive care experience on relatives

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.     

Transitions in caregivers' use of paid home help: associations with stress appraisals and well-being

This study examines the associations between transitions in paid home care and stress appraisals and psychological well-being of family caregivers of dementia relatives. The sample consisted of 264 caregivers who completed up to 3 interviews during 1 year. Longitudinal analyses (i.e., generalized estimating equations) showed that the onset of paid home care was associated with increases in feelings of worry and strain and a worsening in positive affect. Ending paid home care was strongly associated with a decrease in depressive symptoms, whereas sustained use of paid home care was related to reduced overload. Several possible mechanisms for the complex relationship of paid home care and family caregivers' stress appraisals and well-being are discussed.     

Hassles and uplifts of giving care to a family member with dementia

The role of daily caregiving stressors (hassles) and small caregiving satisfactions (uplifts) in the well-being of 60 family caregivers was investigated. Hassles and uplifts in 4 domains of caregiving were examined, and direct effects of hassles, uplifts on caregivers' social and psychological well-being, as well as the interactive and net effects of hassles and uplifts, were assessed. Hassles associated with care recipients' behavior demonstrated strongest associations with well-being. Women and caregivers to socially responsive yet behaviorally inappropriate care recipients reported more behavior and cognitive hassles. Uplifts associated with assistance in activities of daily living and with care recipients' behavior were related to well-being, with more uplifts related to greater, rather than less, depression. More intensely involved caregivers reported more of these uplifts. Net effects in the hypothesized direction were found, but no interactive effects emerged.     

Spiritual care as eHealth: a systematic review

A systematic review was undertaken of the literature on the use of the Internet and other information and communication technologies (ICT's) in the provision and support of religious and spiritual care in healthcare. Indexes such as Medline, PsychoINFO and Proquest Religion were searched. The review found little systematic study of the effectiveness of the Internet and other ICT's in religious and spiritual care. It is believed that the results of this review provide a basis for promise spiri care in the further explora of the potential and of ICT's for tual healthcare.