Measuring spirituality as a universal human experience: a review of spirituality questionnaires

The Relationship Between Psychological Pain, Spiritual Well-Being, and Social Support in Turkish Women Undergoing Therapeutic or Elective Abortion

This study was conducted to determine the relationship between psychological pain, spiritual well-being, and social support among Turkish women undergoing therapeutic or elective abortion. The cross-sectional study was conducted with 342 women who were hospitalized in the gynecology and obstetrics service of a city hospital between March 2021 and December 2022 in Turkey. The mean psychological pain, spiritual well-being and perceived social support scores of women undergoing therapeutic/elective abortion were 26.96 ± 11.21, 110.72 ± 13.09 and 64.09 ± 15.62, respectively. There were a significant negative correlation between psychological pain with spiritual well-being and social support. According to linear regression analysis, spiritual well-being, social support, age, employment status, economic level, history of abortion, number of abortion, current abortion type, and gestational week were statistically significant predictive factors of psychological pain. Therefore, healthcare providers can provide individualized psychosocial-spiritual care and counseling services that decrease psychological pain in women after therapeutic or elective abortion.

Utilization of Art in Nursing Education to Enhance Student Spiritual Growth and Holistic Nursing Practice

Purpose: The purpose of this study was to investigate student nurses' perceptions of how creative art activities might support spiritual self-exploration, foster understanding of holistic care and promote spiritual growth in relation to Mercy and Jesuit values emphasized in their nursing program. Design: A qualitative design was used with data collected through surveys and students' reflections. Methods: Students enrolled in an introductory nursing course with a service-learning component participated in the study. Students were initially asked to create drawings depicting Mercy/Jesuit charisms, spirituality, and holistic nursing then complete written reflections. At the term's end, students created group art projects connecting service learning, holistic nursing care, and spiritual growth. Students responded to survey questions regarding spirituality, Mercy/Jesuit charisms, nursing practice, and their art experiences. Findings: Surveys were completed by 122 of the 137 students who participated in the art projects. After initial difficulty with artistic expression, most students reported the projects provided an opportunity for introspection related to personal spirituality, nursing, and the impact of service-learning experiences on future nursing practice. Conclusion: Arts-based learning can help students explore and express spirituality related to nursing and support their understanding and integration of values essential to the delivery of holistic nursing care.

Feet in Hell, Spirit in Heaven: Spiritual Transformation of Chinese Travelers on the Camino de Santiago

The study aims to understand the precursors, catalysts, and dimensions of the spiritual transformation of Chinese travelers on the Camino de Santiago, a pilgrimage-tourist route in Spain. This research has adopted the theoretical framework of spiritual transformation by Pargament and his colleagues in collecting the transformative experience of Chinese Camino travelers reported in 139 blogs and stories. Thematic analysis is employed in analyzing the data. The study results show that Chinese travelers underwent spiritually transformative experiences, as observed in the changes in their relationship to themselves, others, nature, and the transcendent. These four dimensions are interconnected and experienced as something integrated with Chinese cultural and spiritual traditions. This study also explores the transculturality of spiritual experience, the important role of embodied engagement, and the critical and essential qualities of liminality in the transformative process on the Camino de Santiago.

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.

The Relationship Between Spiritual Well-Being and Post-Traumatic Growth in Turkish Patients Undergoing Solid Organ Transplantation

This study was conducted to determine the relationship between spiritual well-being and post-traumatic growth in solid organ transplant patients. This cross-sectional study was conducted with 366 patients who presented to the organ transplantation polyclinic of a university hospital between September 2021 and February 2022 in Turkey. The mean Post-Traumatic Growth Inventory and Spiritual Well-Being Scale scores of solid organ transplant patients were 81.33 ± 20.28 and 37.18 ± 8.69, respectively. There was a significant positive correlation between post-traumatic growth and spiritual well-being. According to linear regression analysis, spiritual well-being, gender, marital status, transplanted organ, donor type, and previous mental disorders were statistically significant predictive factors that affected post-traumatic growth. Spiritual well-being was an important variable that affected post-traumatic growth in solid organ transplant patients. Therefore, healthcare providers can provide individualized psychosocial-spiritual care and counseling services that increase post-traumatic growth in patients after organ transplantation.

Validity and Reliability of the Turkish Version of the Spirituality Instrument-27 (SpI-27©)

Introduction: This methodological study aimed to adapt the Spirituality Instrument-27 (SpI-27©) to the Turkish language and culture. Design: The psychometric study was carried out with 267 individuals who were hospitalized in the cardiology clinic and who were diagnosed with a chronic disease. Data collection tools were the demographic questionnaire and the SpI-27©. The Statistical Package for Social Sciences was used for data analysis and confirmatory factor analysis. Results: The Kaiser-Meyer-Olkin index was 0.848 and Bartlett's test of sphericity was statistically significant (p = 0.000). The root mean square error of approximation was 0.05, the standardized root mean squared residual was 0.04, the adjusted goodness-of-fit index was 0.87, the goodness-of-fit index was 0.92, the nonformed fit index was 0.91, and the comparative fit index was 0.90. Connectedness with others accounted for 38.24 of the total variance, self-transcendence accounted for 11.71, self-cognizance accounted for 10.56, and conservationism and belief accounted for 9.82 of the total variance (total variance was 70.34%). The highest item factor loading of the scale was 0.812 and the lowest one was 0.398. Cronbach's alpha coefficient of the scale was 0.927. Conclusion: This measurement tool will enable researchers to plan and implement nursing interventions accurately and effectively by assessing the spiritual needs of individuals with nonmalignant chronic diseases. The use of this tool in different languages can help diagnose the spiritual needs of nurses working with multicultural and multilingual patients.

Systematic review of the relationship between burn-out and spiritual health in doctors

OBJECTIVE

To investigate the relationship between burn-out and spiritual health among medical doctors.

DESIGN

Systematic literature review and narrative synthesis of cross-sectional studies.

SETTING

Any setting, worldwide.

DATA SOURCES

Five databases were searched from inception to March 2022, including Medline, Embase, PsycINFO, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Any study design that involved medical doctors (and other healthcare staff if assessed alongside medical doctors), that measured (in any way) both burn-out (or similar) and spiritual health (or similar) medical doctors.

DATA EXTRACTION AND SYNTHESIS

All records were double screened. Data extraction was performed by one reviewer and a proportion (10%) checked by a second reviewer. Quality was assessed using the Appraisal of Cross-sectional Studies tool. Due to the heterogeneity of the included studies, a narrative review was undertaken without a meta-analysis.

RESULTS

Searches yielded 1049 studies. 40 studies met eligibility criteria and were included in this review. Low reported levels of spirituality were associated with high burn-out scores and vice versa. Religion was not significantly associated with lower levels of burn-out. Few studies reported statistically significant findings, few used validated spiritual scores and most were vulnerable to sampling bias.

CONCLUSIONS

Published research suggests that burn-out is linked to spiritual health in medical doctors but not to religion. Robust research is needed to confirm these findings and develop effective interventions.

PROSPERO REGISTRATION NUMBER

CRD42020200145.

A Reevaluation of the Factor Structure, Reliability, and Validity of the Spiritual Well-Being Questionnaire (SWBQ)

The 20-item Gomez and Fisher (Personal Individ Differ 35:1975-1991, 2003) Spiritual Well-Being Questionnaire (SWBQ) is a widely used measure of spiritual well-being. Its theoretical model is a higher-order model with primary factors for personal, communal, environmental, and transcendental well-being, and a secondary global spiritual well-being factor. The current study, conducted in Australia, reevaluated the factor structure of the SWBQ. Unlike previous studies, the current study also used exploratory structural equation modeling (ESEM) to examine the factor structure of the SWBQ and selected the preferred model using not only global model fit values, but also the clarity, reliabilities, and validities of the factors in the models. A total of 227 adults (males = 63; females = 164; M age = 26.1 years; SD = 5.2 years) completed the SWBQ. Based on the model selection criteria applied in the study, the ESEM model with four group factors was selected as the preferred model. However, there was also adequate support for the proposed theoretical higher-order model and the first-order oblique model with the four well-being factors. Concerning our preferred model, its factors showed reasonable clarity for factor loadings and (omega) reliabilities. However, only the communal domain scale was supported empirically for external validity. The implications of the findings for the theoretical model, the use of the SWBQ, and future studies are discussed. In this respect, there are three potential models (theorized higher-order model, 4-factor first-order oblique model, and the ESEM model proposed in this study) that warrant further detailed investigation with a larger, more representative population and additional validation 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.

Earbuds, smartphones, and music. Spiritual care and existential changes in COVID-19 times

Rooted in a Durkheimian functionalist reading of religion, in this article, we present and discuss the results of a scoping study of on-line sources on the delivery of spiritual care during the COVID-19 pandemic in England. Spiritual care highlights the bond between healthcare and religion/spirituality, particularly within the growing paradigm of holistic and humane care. Spiritual care is also an area where the importance of the physical presence of receivers and providers is exceptionally important, as a classic anthropological understanding of the religious ritual would maintain. Three themes were found, which speak to changes brought about by the pandemic. These revolve around disembodiment, solitude, and technology in spiritual care, of religious and non-religious nature. A fourth theme encapsulates the ambivalence in the experience of spiritual care delivery, whereby distant and virtual care could only partially compensate for the impossibility of physical presence. On the one hand, we draw from anthropology of the ritual and phenomenology to make the case for the inalienability of intercorporeality in being there for the other. On the other hand, relying on digital religious studies and post-human theories, we argue for an opening up to new ways of conceptualising the body, being there, and being human.

Religious and secular spirituality: Methodological implications of definitions for health research

The importance of spirituality as a research topic has been increasingly recognized, which has led to several studies on the topic. Areas including psychology, medicine, and nursing have produced studies on spirituality under a plurality of definitions and methods, which reveals the complexity of the theme. However, this has resulted in a range of potential problems, including: (1) the use of overlapping and contradictory terms between studies, or even within the same study, (2) research methodologies that do not fit the definitions (sometimes unreflectively) assumed by the authors, (3) difficulties, or even the impossibility, of comparing the results of studies, (4) controversies in respect of the inclusion/exclusion of secular groups in research on spirituality, and (5) ambiguous measurements, often being exclusively dependent on each participant's individual interpretation of what spirituality means. This article discusses these problems, recommends theoretical and methodological alternatives and presents taxonomy of definitions of spirituality.

Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies

CONTEXT

Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers.

OBJECTIVES

To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers.

METHODS

A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study.

RESULTS

36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored.

CONCLUSION

HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.

Mindfulness based stress reduction among substance abuse patients at de-addiction center

It is of interest to investigate the effectiveness of a mindfulness-based stress reduction program on stress and salivary cortisol among substance abuse patients. There were 60 drug addicts who were receiving treatment at the addiction centre. Samples are divided into 30 drug abuse patient experimental and 30 substance abuse patient control groups using the simple random sampling approach. Salivary cortisol, a pre-test stress biomarker, was measured and used to analyse the results. The MBSR programme was administered over thecourse of eight weeks, with two 1-hour sessions held each day, with a cap of 15 participants. The biomarker for stress (salivary cortisol) will be obtained once again at the end of the program to assess the post-test level of perceived stress and compare it to the results. Patients showed improvements in stress level (p < 0.05) following the 8-week MBSR program. The mean level of blood cortisol in the experimental group was 18.08 (3.62), which was dropped to 7.54 (1.29) before the intervention. The mean cortisol level in the experimental group differs by 10.54 (3.45) between pre and post intervention following the intervention (p value is < 0.005). Thus, there is a difference between the experimental conditions before and after the intervention. The mean serum cortisol level in the pre-test is 17.30 (2.34) and the mean serum cortisol level in the post test is 17.15 (2.31) in the control group (p value is > 0.005). Data shows that there is a significant difference between the groups. MBSR may be a beneficial intervention for reducing stress, in Patients taking treatment in de addiction centre.

Stairway to Heaven: A First-Person Account of Noesis

Mystical and spiritual experiences have been reported throughout human history. Causal explanations for these range from psychopathology of mental illness, drugs such as hallucinogens, neurological disorders including temporal lobe epilepsy, and genuine mystical or spiritual awakening. There is a common core of phenomena in such experiences, as described both in historical accounts and recent research, but also evidence of cultural specificity. This article is a personal account of such an experience, which occurred in a postanesthetic state. A striking feature of the experience was noesis: a sense of revelation and complete understanding. I argue that while there must be a neural basis to these phenomena, it is difficult to reduce the subjective meaning of the experience purely to a brain dysfunction. Reconciling mechanism and meaning of such experiences remains a challenge for both neuroscience and philosophy.

Relationship Between Spirituality, Religiosity, and General Life Satisfaction Among Canadians Living with Neurological Conditions in New Brunswick and Manitoba

This study assessed the association between religion and spirituality on general life satisfaction among a sample of community-dwelling Canadians with neurological conditions. The data represented responses from two provinces that participated in the national Canadian Community Health Survey-Annual Component (CCHS-2011). A weighted subsample (n = 4562) of respondents with neurological conditions from the provinces of New Brunswick and Manitoba was used. Multivariate logistic regression fitted the models using STATA version 14. Spiritual coping, self-perceived general, and mental health were found to be predictors of greater life satisfaction and quality of life. It may be beneficial to incorporate spiritual and religious needs in the circle of care for those living in the community with neurological conditions.

A Scoping Review on Biopsychosocial Predictors of Mental Health among Older Adults

This review aims to map the available evidence on biopsychosocial predictors of elderly mental health. The articles were independently screened in three selected databases, namely Pubmed, Proquest and Google Scholar. The stages consist of identifying the research questions, seeking and selecting relevant evidence, mapping data, and concluding and reporting results. The PRISMA flowchart was used to show the PEOS evidence search flow. A total of 23,722 articles were obtained from all databases during the initial search, where 458 titles fulfilled the eligibility criteria at the title screening stage. Furthermore, 383 articles passed through abstract screening, where 75 met the inclusion criteria and were included for full-text screening. Based on the full-text screening stage, 28 articles were excluded and the remaining 47 articles that matched the search process were included for data extraction. This review creates biopsychosocial variables related to the mental health of the elderly. The biological factors consist of age, biomarkers, female, health conditions, chronic diseases, and physical function. Variables related to psychological factors are affect, personality traits, and subjective well-being. Meanwhile, social factors include smoking, sleep quality, physical activity, daily living, social support, marital status, loneliness, religiosity, spirituality, and early life conditions.

Tool for the assessment spiritual care after the COVID-19 pandemic: a sequential exploratory study

Background

The present study aimed to develop a tool to assess spiritual care after the COVID-19 Pandemic.

Materials and methods

This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, through 14 in-depth semi-structured individual interviews with clerics, specialists in Islamic jurisprudence and principles, specialists in education and health promotion, and using the content analysis approach, tool items were designed. Purposeful sampling was performed with maximum diversity of experts and enthusiasts in the field of spiritual health.

Results

Content analysis of the data obtained from interviews led to explaining the concept of spiritual care after the COVID-19 Pandemic in four main themes: spiritual care needs, spiritual care characteristics, outcomes of spiritual care, and the challenge of providing spiritual care. The average content validity index of the tool was 0.94. Exploratory factor analysis showed 4 factors that explained more than 62.83% of the variance. The correlation of spiritual cares scale score for COVID-19 Pandemic with spiritual care tool was (0.86, p <0.001).

Conclusion

Spiritual care tool is a valid and reliable tool, with 38 items to assess the spiritual care after the COVID-19 Pandemic.

Abbreviated San Diego Wisdom Scale (SD-WISE-7) and Jeste-Thomas Wisdom Index (JTWI)

OBJECTIVES

Wisdom is a personality trait comprising seven components: self-reflection, pro-social behaviors, emotional regulation, acceptance of diverse perspectives, decisiveness, social advising, and spirituality. Wisdom, a potentially modifiable trait, is strongly associated with well-being. We have published a validated 28-item San Diego Wisdom Scale, the SD-WISE-28. Brief scales are necessary for use in large population-based studies and in clinical practice. The present study aimed to create an abbreviated 7-item version of the SD-WISE.

METHOD

Participants included 2093 people, aged 20-82 years, recruited and surveyed through the online crowdsourcing platform Amazon Mechanical Turk. The participants' mean age was 46 years, with 55% women. Participants completed the SD-WISE-28 as well as validation scales for various positive and negative constructs. Psychometric analyses (factor analysis and item response theory) were used to select one item from each of the seven SD-WISE-28 subscales.

RESULTS

We selected a combination of items that produced acceptable unidimensional model fit and good reliability (ω = 0.74). Item statistics suggested that all seven items were strong indicators of wisdom, although the association was weakest for spirituality. Analyses indicated that the 28-item and 7-item SD-WISE are both very highly correlated (r = 0.92) and produce a nearly identical pattern of correlations with demographic and validity variables.

CONCLUSION

The SD-WISE-7, and its derived Jeste-Thomas Wisdom Index (JTWI) score, balances reliability and brevity for research applications.

Spirituality During the COVID-19 Pandemic: An Online Creative Arts Intervention With Photocollages for Older Adults in Italy and Israel

The present study aimed to examine how expressions of spirituality were stimulated and reflected in an online creative arts intervention for older adults during COVID-19 lockdowns. The online process focused on the creation of digital photocollages together with narrative elements of dignity therapy. Twenty-four Israeli and Italian community-dwelling older adults aged 78–92 participated in a three-session online intervention involving the production of three photocollages. The visual and verbal data (participants’ chosen photos and photocollages, and transcripts of the sessions) were qualitatively analyzed within an abductive framework. Four themes were generated, representing the four domains of spirituality that were stimulated by and expressed in the process: (1) Connectedness with the self, (2) connectedness with others, (3) connectedness with the environment, and (4) connectedness with the transcendent. The findings show how photographs can serve as projective visual stimuli which elicit personal content through spontaneous thinking, and they reveal the multifaceted nature of spirituality, wherein each domain nourishes the others. Overall, the findings illustrate how creative arts intervention guided by the tenets of dignity therapy can contribute to the spiritual care of older adults during periods of social isolation, or to the spiritual support provided in palliative care.

Understanding interdisciplinary perspectives of plant intelligence: Is it a matter of science, language, or subjectivity?

BACKGROUND

Evidence suggests that plants can behave intelligently by exhibiting the ability to learn, make associations between environmental cues, engage in complex decisions about resource acquisition, memorize, and adapt in flexible ways. However, plant intelligence is a disputed concept in the scientific community. Reasons for lack of consensus can be traced back to the history of Western philosophy, interpretation of terminology, and due to plants lacking neurons and a central nervous system. Plant intelligence thus constitutes a novel paradigm in the plant sciences. Therefore, the perspectives of scientists in plant-related disciplines need to be investigated in order to gain insight into the current state and future development of this concept.

METHODS

This study analyzed opinions of plant intelligence held by scientists from different plant-related disciplines, including ethnobiology and other biological sciences, through an online questionnaire.

RESULTS

Our findings show that respondents' personal belief systems and the frequency of taking into account other types of knowledge, such as traditional knowledge, in their own field(s) of study, were associated with their opinions of plant intelligence. Meanwhile, respondents' professional expertise, background (discipline), or familiarity with evidence provided on plant intelligence did not affect their opinions.

CONCLUSIONS

This study emphasizes the influential role of scientists' own subjective beliefs. In response, two approaches could facilitate transdisciplinary understanding among scientists: (1) effective communication designed to foster change in agreement based on presented information; and (2) holding space for an interdisciplinary dialogue where scientists can express their own subjectivities and open new opportunities for collaboration.

Portuguese Version of the Spiritual Well-Being Questionnaire: Validation Study in People under Assisted Reproductive Techniques

Attention has been given to the experience of individuals undergoing assisted reproductive techniques. However, only recent literature has focused on the spiritual journey triggered by such an event and highlighted the nurses and midwives’ roles in the assessment of the spiritual needs of those living with infertility. This study aimed to perform a psychometric test of the factor structure of the Portuguese version of the Spiritual Well-being Questionnaire in a sample of people undergoing assisted reproductive techniques. This descriptive cross-sectional study was conducted between September 2019 and June 2020 on a sample of 104 Portuguese adults attending fertility treatment. An online questionnaire was released on fertility-related websites. A confirmatory factor analysis was conducted on six hypothesized models of the instrument. The findings provided evidence of an adequate internal consistency of the instrument, and the validity and reliability of the oblique four-factor model was confirmed. Spiritual well-being had a significant association with the nature of infertility and a higher score was achieved by participants that perceived religion as very important. This study provides a validated tool for nurses and midwives to assess spiritual well-being and promote an integrated reproductive healthcare approach. Further longitudinal research with bigger samples would provide more evidence of the spiritual needs of people living with this condition.

Natality and Relational Transcendence in Humanist Chaplaincy

Every life has a beginning and an end. Natality and mortality are both profound existential fundaments of life that may lead us to question meaning in life as well as to find meaning. In spiritual care, the focus is often on mortality as a source of existential suffering, and on ways to deal with such suffering according to worldview traditions. In humanist traditions, mortality is not only seen as an existential threat but also as an existential given that people need to embrace to find meaning in life. Natality has received much less attention, both in spiritual care and in humanist thought. In this article, we build on philosophical ideas of Arendt and Butler to explore the significance of natality for a humanist perspective on meaning in life and spiritual care. We argue that taking natality into account results in a relational understanding of humanist spiritual care in which the notion of “relational transcendence” is a central element. Natality also means that we can initiate, create, and act in the world, which highlights the political dimension of humanist spiritual care. We reflect on the implications of natality and relational transcendence for humanist spirituality and chaplaincy and formulate some concrete building blocks for working from this perspective.

Spirituality, Personality, and Emotional Distress During COVID-19 Pandemic in Croatia

This study examined the association between spiritual quality of life (QoL), spiritual coping, emotional distress, and personality during the COVID-19 pandemic lockdown in a convenience sample of Croatian adults (n = 2,860, 80.6% women). Participants completed an online questionnaire that collected information on sociodemographic characteristics, distress (the Depression, Anxiety, and Stress Scale 21), spiritual coping and spiritual QoL (the WHO Quality of Life-Spirituality, Religiousness, and Personal Beliefs), and personality (the International Personality Item Pool). The hierarchical regression analysis demonstrated that personality traits, especially emotional stability, were the most significant predictors of mental health outcomes. Spiritual coping styles were a predictor of worse, while spiritual QoL of better psychological outcomes. Results demonstrate the complex relations between different aspects of spirituality/religiosity with personality and emotional outcomes and suggest that distress motivates the engagement of spiritual coping in times of disaster.

Spirituality during COVID-19 in Northern Italy: The experience of participating in an online prayer group

Spirituality has ascendant value during times of adversity. Religious activities have beenfound to increase spirituality, and therefore might be considered a coping resource for the individual. The present research aims to explore participants' experience in an online Catholic prayer group in northern Italy that was held throughout the period of COVID-19 social restrictions. The group comprised 16 Catholic individuals aged 34 to 85, who were interviewed in writing following a protocol of four open-ended questions. The results reported four main thematic areas: (1) the benefits of the spiritual journey while coping with the pandemic; (2) the potential of the online setting; (3) the challenges of the online setting; and (4) the bond with God and how it evolved during the pandemic. The findings confirm the valuable contribution of the on-line group religious activity to the participants'    wellbeing, particularly during the time of social distancing.

Domains of spirituality and their importance to the health of 75 533 adolescents in 12 countries

Spirituality is an ancient concept with many contemporary applications to the field of health promotion. While recognized in the UN Convention on the Rights of the Child as a basic human right, definitional misunderstandings about what spirituality is, and is not, and the mechanisms by which it affects the health of young people, remain. In this cross-national analysis involving >75 000 adolescents from 12 countries, we examined the relative importance of each of four spiritual health domains (connections to self, others, nature and the transcendent) in the lives of young people, and how these connections relate to a standard indicator of positive mental health status. Descriptive and applied regression analyses confirmed two major findings: (i) boys and girls in all 12 countries ranked the importance of each of the four domains in the same order, with 'connections to self' identified as most important; and (ii) both direct and indirect pathways are evident that connect the remaining three domains to positive mental health status, but through strong connections to self. Based on our scale items, fostering a strong connection to self, which involves cultivating a sense of meaning, purpose and joy in the lives of adolescents, appears most fundamental to fostering optimal mental health. This may be achieved directly or, dependent upon context and culture, indirectly with emphasis on the connections afforded by the other three domains. Such findings provide important insights to guide the content of adolescent health promotion interventions.

Development of an Instrument to Assess Spirituality: Reliability and Validation of the Attitudes Related to Spirituality Scale (ARES)

Background: Several instruments that measure spirituality present overlaps with positive emotions, impacting the interpretation of their findings. In order to minimize these problems, we aimed to develop, assess the reliability and validate a new scale to evaluate spirituality. Methods: The instrument was designed using a theoretical framework minimizing tautological issues (i.e., Koenig's framework), a qualitative study investigating the definitions of spirituality, the development of the first version of instrument by experts' meetings and a qualitative cognitive debriefing. Then, the instrument was examined for its content validity by a multidisciplinary group of judges and was pilot-tested in two different groups - less religious (medical students - n = 85) and more religious (practicing religious members - n = 85). Finally, psychometric properties and validity were assessed. Results: The developed Attitudes Related to Spirituality Scale (ARES) is a self-report 11-item instrument using five-level Likert items. ARES presented appropriate psychometric properties revealing excellent internal consistency (alpha = 0.98) and temporal stability (ICC = 0.98). Likewise, ARES was strongly correlated with other validated R/S instruments (i.e., Duke Religion Index and Brief Multidimensional Measure of Religiousness/Spirituality) and was able to discriminate higher and lower religious groups. In the exploratory factor analysis, a unidimensional structure of the scale was described. Fit indices for the scale demonstrated good fit in the unidimensional model. Conclusion: The ARES is a reliable, valid and stable one-dimension instrument that is appropriate for use in the Portuguese-speaking population. Descriptors: Spirituality; Scale; Factorial Analysis; Instrument; Measure; Psychometrics.

Association between spirituality/religiousness and quality of life among healthy adults: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) is determined by multiple factors that include components such as spirituality and religiousness (S/R). Even though various systematic reviews have investigated the association between S/R and improved health outcomes in the most different groups, healthy young individuals are seldom addressed.

OBJECTIVE

To assess the association between S/R and HRQoL among young, healthy individuals.

METHODS

Systematic review of papers published in the last ten years and indexed in four academic research databases (PubMed, Web of Science, Cochrane Library, and Scopus) and two gray literature databases. Inclusion criteria were studies assessing S/R and HRQoL using validated instruments and assessing healthy adults (i.e., non-clinical patients, not belonging to any specific group of chronic diseases), aged between 18 and 64 years old.

RESULTS

Ten out of 1,952 studies met the inclusion criteria: nine cross-sectional and one longitudinal cohort study, in which 89% of the participants were college students. Nine studies report a positive association between S/R and HRQoL, while one study did not report any significant association. The main HRQoL domains associated with S/R were the psychological, social relationships, and environment domains, while the S/R most influent facets/components were optimism, inner strength, peace, high control, hope, and happiness.

CONCLUSIONS

Higher S/R levels among healthy adult individuals were associated with higher HRQoL levels, suggesting the S/R can be an important strategy to deal with adverse environmental situations even among those without chronic diseases, enhancing the wellbeing of individuals. Registration of systematic review: PROSPERO-CRD42018104047.

Validation and Utilisation of the Spiritual Well-Being Questionnaire: SHALOM

The Spiritual Well-Being Questionnaire (SWBQ) was developed from a theoretical understanding that spiritual well-being (SWB) is expressed in the quality of relationships that each person has across one or more of four domains, namely with self, others, environment and/or with a transcendent other. Based on the SWBQ, the Spiritual Health And Life-Orientation Measure (SHALOM) is unique in that it compares each person's lived experience with their ideals on the 20 items reflecting the four domains of SWB. This paper builds on previous reviews of the SWBQ-SHALOM, by providing breadth and depth of data and their validity, from a wide range of sources, and expressing the instrument's usefulness in a variety of settings. It provides an overview with details from 60 studies that started with the SWBQ-SHALOM. Presented herein are ideas on what can be done with further investigations of this vital aspect of life.

The Qualitative Assessment of Two Translated Dutch Spirituality Scales for Children

PURPOSE

This article describes the translation and qualitative assessment and small scale validation of two spirituality scales designed for children from English to Dutch and includes the translation and validation process and the results of the two most commonly used and best validated measurement instruments for spirituality in children: the Feeling Good, Living Life scale (FGLL) by Fisher (2004, 2009) and the Spirituality Sensitivity Scale for Children by Stoyles et al. (2012).

DESIGN AND METHODS

The translation process was designed according to Beaton et al. (2000) and both the translation and the validation process followed the instructions of the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN, 2018). The qualitative validation was done by a three-step test-interview eliciting the face validity of both questionnaires.

RESULTS AND CONCLUSIONS

The results show that both instruments were reliably translated, are face valid with some minor alterations and structurally validated overall in the small-scale pilot.

PRACTICE IMPLICATIONS

More attention from healthcare professionals and educators should be directed at using spiritual measuring instrument to develop the spiritual vocabulary of children. A larger study is needed to also confirm the cultural validity of the translated scales.

Exploring the Roles of Daily Spiritual Experiences, Self-Efficacy, and Gender in Shopping Addiction: A Moderated Mediation Model

Although spirituality has been considered a protective factor against shopping addiction, the mechanisms involved in this relationship are still poorly recognized. The present study aims to test the association of daily spiritual experiences, self-efficacy, and gender with shopping addiction. The sample consisted of 430 young adults (275 women and 155 men), with a mean age of 20.44 (SD = 1.70). The Daily Spiritual Experiences Scale, the General Self-Efficacy Scale, and the Bergen Shopping Addiction Scale were used to measure the study variables. The results showed that: (1) Daily spiritual experiences had a direct negative effect on shopping addiction; (2) daily spiritual experiences were positively related to self-efficacy, thought the effect was moderated by gender; (3) self-efficacy negatively correlated with a shopping addiction; and (4) the indirect effect of daily spiritual experiences on shopping addiction through self-efficacy was significant for women but insignificant for men. The findings confirm that spirituality protects young adults against developing a shopping addiction. They also suggest that when introducing spiritual issues into shopping addiction prevention or treatment programs, the gender-specific effects of spirituality on shopping addiction via self-efficacy should be considered to adequately utilize young women’s and men’s spiritual resources.

Leadership, religiousness, state ownership of an enterprise and unethical pro-organizational behavior: The mediating role of organizational identification

This study proposes a model in which organizational identification mediates the correlations among state-owned enterprises (SOEs), authentic leadership, Christian religiousness, and unethical pro-organizational behavior (UPB). The proposed theoretical framework is based on moral identity theory, social identity theory, and social exchange theory. We tested the hypothesized model using data (N  =  389) from employees of various companies and industries in Poland. Of the respondents, 49.1% worked in SOEs. The reliability and validity of the measures were established. The correlation coefficients among the analyzed variables were obtained using the bootstrap confidence interval method. To thoroughly examine the causal relationships among the variables, covariance-based structural equation modeling (CB-SEM) was adopted. Path analysis was conducted and used to verify a model in which organizational identification mediated the correlations among state involvement in the ownership of an enterprise, authentic leadership, Christian religiousness, and UPB. State involvement in the ownership of an enterprise, authentic leadership, and Christian religiousness were linked to increased organizational identification, which in turn was linked to the intensification of UPB. With the level of organizational identification controlled, state ownership of an enterprise was linked to lower UPB intensity. Limitations, implications and future research directions are discussed.

Religiosity and Spirituality of patients with severe mental disorders

BACKGROUND

Religion and spirituality form an integral part of life, yet have been poorly studied in patients with mental illness.

AIM

This study evaluated the religious and spiritual practices, a sense of purpose/connection, religious/spiritual belief and sense of hope/control among clinically stable patients diagnosed with schizophrenia, bipolar disorder, and depression and compared the same with healthy controls. It also aimed to evaluate the association of residual psychopathology with various dimensions of religiosity and spirituality.

MATERIALS AND METHODS

Patients diagnosed with schizophrenia, bipolar disorder, and major depressive disorder, in a state of clinical remission were assessed on the Spiritual Attitude Inventory and compared with a healthy control group.

RESULTS

A total of 284 participants were recruited, which included patients with major depressive disorder (n = 72), bipolar disorder (n = 75), schizophrenia (n = 63), and healthy controls (n = 74). The groups were matched for age and gender. As compared to healthy controls, participants with any severe mental disorder had significantly lower participation in organized religious activities. In terms of existential well-being, all patient groups had significantly lower scores than the healthy control group. Patients with severe mental disorders significantly more frequently used negative religious coping than the healthy controls and also had lower scores on the sense of purpose. No significant difference was observed between the three patient groups on various dimensions of religiosity and spirituality as assessed in the present study. In patients with schizophrenia, higher use of negative religious coping was associated with greater residual psychopathology.

CONCLUSION

Considering the association of negative religious coping with residual psychopathology, there is a need to incorporate psychological interventions to address religious and spiritual issues for patients with various severe mental disorders.

The Chinese Spiritual Coping Scale: Development and Initial Psychometric Evaluation

The aim of the study was to develop and psychometrically evaluate the Chinese Spiritual Coping Scale. The items in the questionnaire were written according to the study's theoretical conception and literature research. A sample of 415 participants with or without religious beliefs was used for exploratory factor analyses to select the items. In addition, another sample of 207 participants was used to cross-validate the factor structure and examine the internal consistency. The results supported the four-factor structure of the Chinese Spiritual Coping Scale (17 items, four dimensions: Mystical Experience, Moral Practice, Meaning Exploration, and Transcendent Attitude). The analyses demonstrated adequate internal consistency and construct validity. The overall psychometric evaluation of the Spiritual Coping Scale suggested that this could be a promising measure of spiritual coping for Chinese individuals.

Psychometrics Properties of the Daily Spiritual Experience Scale in Slovak Elderly

The aim of this study was to evaluate psychometric properties of the daily spiritual experience scale (DSES) in Slovak elderly (n = 250). Cronbach's alpha coefficient was 0.98. Reliability tests confirmed excellent internal consistency. Principal component analysis produced one-factor model which explained 75.86% of the total variance of the Slovak DSES. A higher frequency of spiritual experiences was associated with higher level of spirituality, meaning in life, religion/spiritual affiliation, and lower level of depression which justified construct validity of the DSES. Women stated greater spiritual experiences than men. Findings confirmed that the Slovak DSES is valid and reliable.

Rhythmic Chanting and Mystical States across Traditions

Chanting is a form of rhythmic, repetitive vocalization practiced in a wide range of cultures. It is used in spiritual practice to strengthen community, heal illness, and overcome psychological and emotional difficulties. In many traditions, chanting is used to induce mystical states, an altered state of consciousness characterised by a profound sense of peace. Despite the global prevalence of chanting, its psychological effects are poorly understood. This investigation examined the psychological and contextual factors associated with mystical states during chanting. Data were analyzed from 464 participants across 33 countries who regularly engaged in chanting. Results showed that 60% of participants experienced mystical states during chanting. Absorption, altruism, and religiosity were higher among people who reported mystical states while chanting compared to those who did not report mystical states. There was no difference in mystical experience scores between vocal, silent, group or individual chanting and no difference in the prevalence of mystical states across chanting traditions. However, an analysis of subscales suggested that mystical experiences were especially characterised by positive mood and feelings of ineffability. The research sheds new light on factors that impact upon chanting experiences. A framework for understanding mystical states during chanting is proposed.

Is spirituality a component of wisdom? Study of 1,786 adults using expanded San Diego Wisdom Scale (Jeste-Thomas Wisdom Index)

OBJECTIVE

Wisdom has gained increasing interest among researchers as a personality trait relevant to well-being and mental health. We previously reported development of a new 24-item San Diego Wisdom Scale (SD-WISE), with good to excellent psychometric properties, comprised of six subscales: pro-social behaviors, emotional regulation, self-reflection (insight), tolerance for divergent values (acceptance of uncertainty), decisiveness, and social advising. There is controversy about whether spirituality is a marker of wisdom. The present cross-sectional study sought to address that question by developing a new SD-WISE subscale of spirituality and examining its associations with various relevant measures.

METHODS

Data were collected from a national-level sample of 1,786 community-dwelling adults age 20-82 years, as part of an Amazon M-Turk cohort. Participants completed the 24-item SD-WISE along with several subscales of a commonly used Brief Multidimensional Measure of Religiousness/Spirituality, along with validated scales for well-being, resilience, happiness, depression, anxiety, loneliness, and social network.

RESULTS

Using latent variable models, we developed a Spirituality subscale, which demonstrated acceptable psychometric properties including a unidimensional factor structure and good reliability. Spirituality correlated positively with age and was higher in women than in men. The expanded 28-item, 7-subscale SD-WISE total score (called the Jeste-Thomas Wisdom Index or JTWI) demonstrated acceptable psychometric properties. The Spirituality subscale was positively correlated with good mental health and well-being, and negatively correlated with poor mental health. However, compared to other components of wisdom, the Spirituality factor showed weaker (i.e., small-to-medium vs. medium-to-large) association with the SD-WISE higher-order Wisdom factor (JTWI).

CONCLUSION

Similar to other components as well as overall wisdom, spirituality is significantly associated with better mental health and well-being, and may add to the predictive utility of the total wisdom score. Spirituality is, however, a weaker contributor to overall wisdom than components like pro-social behaviors and emotional regulation. Longitudinal studies of larger and more diverse samples are needed to explore mediation effects of these constructs on well-being and health.

The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health

Therapeutic psychedelic administration and contact with nature have been associated with the same psychological mechanisms: decreased rumination and negative affect, enhanced psychological connectedness and mindfulness-related capacities, and heightened states of awe and transcendent experiences, all processes linked to improvements in mental health amongst clinical and healthy populations. Nature-based settings can have inherently psychologically soothing properties which may complement all stages of psychedelic therapy (mainly preparation and integration) whilst potentiating increases in nature relatedness, with associated psychological benefits. Maximising enhancement of nature relatedness through therapeutic psychedelic administration may constitute an independent and complementary pathway towards improvements in mental health that can be elicited by psychedelics.

Concordance among patients and physicians about their ideal of autonomy impacts the patient-doctor relationship: A cross-sectional study of Mexican patients with rheumatic diseases

INTRODUCTION

In patient-doctor interaction both parties play a role. Primary objective was to determine if the concordance among rheumatologists and their patients of their ideal of autonomy was associated with a better patient-doctor relationship. Secondary objective was to describe factors associated to a patient paternalistic ideal of autonomy (PPIA).

MATERIALS AND METHODS

This cross-sectional study had 3 steps. Step-1 consisted in translation/cultural local adaption of Ideal Patient Autonomy Scale (IPAS), a 14-items Dutch questionnaire. Step-2 consisted of IPAS validity and reliability in 201 outpatients. Step-3 consisted of the application of IPAS and the patient-doctor relationship questionnaire (PDRQ) to 601 outpatients with a medical encounter, and of IPAS to the 21 attending rheumatologists. Each patient-physician encounter was classified into with/without concordance in the ideal of autonomy and PRDQ scores were compared (Man Whitney U test). Regression analysis was used for associations.

RESULTS

Step-1 followed ISPOR task force recommendations. Patients from Step-2 and Step-3 were representative outpatients with rheumatic diseases. IPAS structure underwent a modification; the 14 items were redistributed into four subscales, further combined into PPIA vs. patient-centered autonomy ideal. IPAS was valid and reliable. There were 497 patients with a preferred ideal of autonomy, primarily (84.9%) PPIA. There were 363 patient-doctor encounters with concordance in the autonomy ideal and their PDRQ-9 scores were higher. Religious beliefs and higher PDRQ-9 item 8 score ("I feel pleased with my doctor´s treatment") were associated to a PPIA.

CONCLUSIONS

Concordance of autonomy ideal among patients and their rheumatologists positively impacts on the patient-doctor relationship.

Structural validity of a brief scale adapted to measure adolescent spiritual health

Spiritual health is established as an important protective health asset in child populations. Measurement and assessment of this elusive concept are, however, challenging. Brief and age-appropriate instruments are required for surveys and related population health research. One longstanding model describing child spirituality suggests that scales and measures consider four standard domains describing connections to self, others, nature, and the transcendent. In this validation study, we tested the structural validity and internal consistency of a brief, literacy-level appropriate instrument for adolescents that was based on prior adaptations of this model. The 2018 cross-national study population included 47,180 children aged 11–15 years from 9 countries. Based upon theory, factor pattern matrices, and Scree plots, the exploratory factor analysis best supported the four-factor model, with items organized according to the original four domains. Internal consistency of the items was acceptable (alpha>.7) to good (alpha>.8) within domains, again within each of the 9 countries. The confirmatory factor analysis again supported the four-factor model (by country, SRMR: 0.020 to 0.042; and AGFI and NFI fit: >0.98). Model fit indices for the four-factor model were improved compared with its unidimensional version. Moving forward, our analysis establishes the structural validity and internal consistency of this adapted brief spiritual health instrument to be used in surveys of adolescents.

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

Background

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

Aim

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

Design

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

Methods

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

Results

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

Conclusion

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

Association of significant risk perception with the use of complementary and alternative medicine: A cross-sectional study in Hispanic patients with rheumatoid arthritis

BACKGROUND

Risk perception (RP) describes patient´s judgment of the likelihood of experiencing something unpleasant, and has been associated to the adoption of health behaviors. Current rheumatoid arthritis (RA) guidelines recommend early and intensive treatment, although patients also commonly use Complementary and Alternative Medicine (CAM). We aimed to investigate if significant RP was associated to CAM use in Hispanic RA outpatients and to describe additional associated factors.

METHODS

Between March and August 2019, 266 consecutive outpatients were invited to a face-to-face interview to collect socio-demographic and RA-related information, to assess comorbidity and the following patient-reported-outcomes: pain, overall-disease and treatment adherence with visual analogue scales, disease activity with RAPID-3, RP with a validated questionnaire, and CAM use with a translated and cross-culturally adapted for Argentina version of the International CAM questionnaire. Medical records were reviewed to corroborate the data provided by the patients. CAM use definition was restricted to "in the last 3 months". Significant RP was defined based on published cut-off. Multiple logistic regression analysis was used to investigate factors associated to CAM use. The study received IRB approval.

RESULTS

There were 246 patients included, primarily middle-aged women, with substantial disease duration, moderate disease activity and 70 patients (28.5%) had significant RP. Two hundreds patients (81.3%) were CAM users. Significant RP (OR: 2.388, 95%CI: 1.044-5.464, p = 0.039) and access to Federal health care system (OR: 2.916, 95%CI: 1.081-7.866, p = 0.035) were associated to CAM use.

CONCLUSIONS

Patient´s perception of RA-related negative consequences was associated to recent CAM use in Hispanic RA outpatients.

Development and validation of the Spirituality Instrument-27© (SpI-27©) in individuals with chronic illness

AIM

To develop and validate the Spirituality Instrument 27 (SpI-27©) in individuals with chronic illness (n = 249).

BACKGROUND

A need for a rigorously developed spirituality instrument that can be used with people who are religious and non-religious was identified.

METHODS

The initial 46-item instrument was developed from a concept analysis, a review of theoretical and empirical literature, and an appraisal of instruments measuring spirituality. Content validity was established with user focus groups and an expert panel review. A pilot study evaluated the online mode of administration and a descriptive correlational design assessed the reliability and validity of the instrument.

RESULTS

Results of exploratory factor analysis concluded a five-factor solution with 27 items: Connectedness with Others, Self-Transcendence, Self-Cognisance, Conservationism, and Connectedness with a Higher Power. Cronbach's alpha coefficients ranged from 0.823 to 0.911 for the five factors, and 0.904 for the overall scale. Paired t-tests, intra-class correlations, and weighted kappa values supported the temporal stability of the instrument. A significant and positive correlation was found between the SpI-27© and the Spirituality Index of Well-Being (p < 0.01), supporting convergent validity.

CONCLUSIONS

Findings support the validity and reliability of the SpI-27©, which was developed with patient input and is underpinned by theoretical and empirical literature. The SpI-27© should be validated for use with other samples. The conceptual framework that guided the study can be used to enhance healthcare professionals' understanding of spirituality and its core dimensions.

Differences in the association of spirituality, forgiveness, PTSD and stress among social workers and social work students treating trauma survivors

Providing professional assistance to trauma victims may cause significant emotional distress to those who provide the assistance. Dealing with such stress requires attention to significant personal resources. This study examined the relationship between tendency to forgive and spirituality with PTSD symptoms and stress among social workers and social work students (N = 157) who are at the front line dealing with trauma survivors. The study results demonstrated that social work students had higher levels of stress while no significant differences were found regarding spiritually, PTSD, and forgiveness. Examining the subscales revealed that social work students had higher negative PTSD alteration symptoms than trained social workers while trained social workers had higher levels of forgiveness to self. Additionally, structural equation models showed that among social workers, forgiveness to self and spirituality were associated simultaneously with lower PTSD symptoms and stress. However, among social work students, the tendency to forgive the self was associated with lower PTSD symptoms only. The findings illuminate spirituality and forgiveness as key factors that can help cope with the emotional toll of those who assist trauma survivors, while focusing on differences for trained professionals and training professionals. Theoretical and clinical implications are discussed.

Genetic counseling graduate training to address religion and spirituality in clinical practice: A qualitative exploration of programs in North America

Patients receiving clinical genetics services often navigate emotionally difficult situations and may utilize their faith as a source of support, an aid in decision-making, or a core coping strategy. Although patients have expressed interest in discussing their religious or spiritual (R/S) beliefs with their genetic counselor (GC), GCs may avoid such conversations because they feel they do not have the necessary skills to discuss R/S beliefs (Reis, Baumiller, Scrivener, Yager, & Warren, 2007). This qualitative study explored how GC programs in North America currently prepare their students to discuss R/S matters with their patients. The aims of this study were to identify (1) the R/S topics genetic counseling programs currently cover in the curriculum, (2) how genetic counseling programs evaluate their students within the R/S topics and activities that are included in the curriculum, and (3) the value or importance placed on R/S training by genetic counseling program directors. Leaders of 12 (36%) of the 33 eligible GC programs at the time of the study participated in a semi-structured phone interview. Their responses were coded using open and axial coding techniques and analyzed using grounded theory. Results revealed that R/S issues are often covered during the psychosocial portions of the curriculum through writing assignments, in class exercises, and role plays. Almost all participating programs include information on pastoral care services, but have little to no training about specific R/S beliefs or the use of spiritual surveys. While participating program directors emphasized that it is critical for students to be prepared to hold conversations about patients' R/S beliefs, the strategies used to prepare students are inconsistent and often not evaluated. We provide suggestions for enriching the R/S training in genetic counseling graduate programs in order to prepare students to facilitate discussions around patients' religion and/or spirituality in genetic counseling sessions.

Developing the perceived social support scale for older adults: A mixed-method study

Social support has an important impact on the well-being of the elderly. Some studies have shown that perceived social support is more important than received social support. Perceived social support has different definitions across different age groups and cultures. So, this sequential exploratory mixed-method study was designed to develop and validate a perceived social support scale for community-dwelling elderly. In the qualitative phase, the perspectives of the elderly on perceived social support were defined through directed content analysis. Then, an extensive item pool was designed based on the elderly's perception and review of the literature. In the quantitative phase, the validity (content, face, and construct) and reliability (internal consistency, stability) of the newly developed scale was assessed using the sampling of five hundred elderly. The final scale consists of 34 items with domains of “emotional support”, “practical support”, “spiritual support”, “negative interactions” and “satisfaction with support received” that explained 58% of the total variance of the scale. The internal consistency varied from Cronbach's α = 0.70 to 0.87 for the subscales and as 0.92 for the whole scale. The study showed that the scale as a valid and reliable instrument can be used for the proper measurement of perceived social support among the elderly.

Measuring Spiritual Well-Being in Brazilian Adolescents with Chronic Illness Using the FACIT-Sp-12: Age Adaptation of the Self-Report Version, Development of the Parental-Report Version, and Validation

Spiritual well-being is a major issue in health care, but instruments for measuring this construct in adolescents are lacking. This study adapted the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp-12) for use with Brazilian adolescents with chronic diseases and developed a parental observer-rated version, using an expert panel, back-translation, and cognitive interviews with 72 participants. The psychometric properties of both versions were verified with two- and three-factor models by testing with 212 participants. The self- and parental-reported versions showed face validity, content validity, and acceptable levels of internal consistency for the overall scale and the two-factor model. The convergent validity was satisfactory for most items in both two- and three-factor models, but there was a lack of discrimination in the three-factor model using multitrait-multimethod analysis. This study presents the first instrument to assess the spiritual well-being of adolescents from their point of view and to allow their parents to serve as evaluators. However, we recommend further psychometric testing of the self- and parental-report scales to assess spiritual well-being in adolescents with chronic diseases in Brazil.

Spirituality and Religion-Relevance and Assessment in the Clinical Setting

Background:

There has been an increasing interest in the past several decades to study the relationship between spirituality and religion with physical and mental health as well as the various quality of life measures. This trend has led to the creation of an area of study called epidemiology of religion and spirituality. The policy shifts at various levels, in the mental health field, has occurred as well to educate healthcare providers, and address patients’ spiritual /religious needs in clinical settings. Despite these advances in research and policy shift, there is still some resistance in the health care community to assess and address the spiritual needs of patients in clinical settings.

Objective:

The objective is to review the published articles on spirituality/religion and its relationship with mental and physical wellbeing and discuss limitations of such research. The review articles on assessment and interventions to address spiritual or religious needs in clinical settings were also included.

Methods:

Author conducted a literature search using books@Ovid, Journals@Ovid Full Text, Your Journals@Ovid, Ovid MEDLINE® 1946 to January week 4 2019, Ovid Medline® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily without Revisions 2015-January 28, 2019; Ovid MD and Psychiatry Online.

Results:

A total of 1,040 articles were identified using keywords spirituality, religion, mental health, physical health, psychological well-being, healthy beliefs, psychopathological beliefs and quality of life. The search result included original research papers, review articles and commentaries.

Conclusion:

The review articles were narrowed to 100 articles based on relevance to the objectives outlined above. Seventy-five articles were referenced at the end.

A Concept Analysis of Spiritual Health

Spiritual health is an important dimension of health and forms part of a comprehensive care. This study was conducted to redefine and clarify the components of spiritual health based on different worldviews through Walker and Avant's concept analysis method. Being given a life and a soul and having beliefs are the antecedents of spiritual health. The attributes of this concept include a morality-oriented intellectual connectedness with the self, others, and the universe guided by a connection with the Transcendent and Superior being in order to create meaning in life and find its purpose in the context of culture and religion; transcendence is ultimately the consequence of spiritual heath. Using the attributes appeared in this conceptual analysis, nurses can evaluate the spiritual health of their clients and help them create positive outcome by providing appropriate interventions.

The Role of Spirituality and Religiosity in Subjective Well-Being of Individuals With Different Religious Status

Spirituality and religiosity have been found to be positive predictors of subjective well-being, even if results are not altogether consistent across studies. This mixed evidence is probably due to the inadequate operationalization of the constructs as well as the neglect of the moderation effect that the individuals' religious status can have on the relation between spirituality/religiosity and subjective well-being. The current study aimed to investigate the relationship of spirituality and religiosity with subjective well-being (operationalized as both life satisfaction and balance between positive and negative affect) and to test whether differences exist according to individuals' religious status (religious, non-religious, and uncertain). Data were collected from 267 Italian adults aged 18-77 (M = 36.68; SD = 15.13), mainly women (59.9%). In order to test the role of spirituality (operationalized as Purpose, Innerness, Interconnection, and Transcendence) and religiosity (operationalized as three dimensions of the religious identity: Commitment, In-depth Exploration, and Reconsideration of Commitment) in subjective well-being, two path analysis models were run, one for each predictor. To test the invariance of the two models across the individuals' religious status, two multi-group models were run. The models concerning spirituality were tested on the entire sample, finding that spirituality had a positive impact on subjective well-being (except for the dimension of Interconnection) and that this relation is unaffected by the individual's religious status. The models concerning religiosity were instead tested only on religious and uncertain, finding that the relationship between religiosity and subjective well-being changes across religious status. In particular, the main difference we found was that religious identity commitment positively predicted satisfaction with life among religious, but not among uncertain individuals. An interpretation of the results and their implications are discussed.