The Spirituality of Children with Chronic Conditions: A Qualitative Meta-synthesis

Uncovering the Life Experiences Being Fathers of Children With Cerebral Palsy

PURPOSE

This research aims to uncover the life experiences of fathers of children with Cerebral Palsy (CP) in Indonesia.

DESIGN AND METHODS

This study utilized a descriptive phenomenological approach. Nine fathers of young children and adolescents with CP were purposively recruited and were interviewed in-depth between June and August 2023. Data were analysed by using Giorgi's descriptive phenomenological approach.

RESULTS

Our study identified three main themes: uncovering the meaning of being a father, expectations and hope for children's growing up, and the challenges of being a father. These themes were further divided into 10 sub-themes. Our research suggests that fathers consider having a disabled child as a gift and a test from God, and they hold specific meanings about being a father that gives them strength. Fathers are responsible for taking care of their children and not neglecting them. They have expectations and hopes for their children to become independent and successful, with the skills needed to make a living. Fathers face many challenges, such as dividing their time between work and family and figuring out how to stimulate their children's motor skills.

PRACTICE IMPLICATIONS

The research indicates that involving fathers in caring for children, particularly those with CP, has significant implications for program planning and service delivery. Therefore, professionals should integrate fathers' role in planning and delivering services for childcare.

Health-related quality of life of children and adolescents with sickle cell disease: An evolutionary concept analysis

The concept of Health-Related Quality of life (HRQOL) of children and adolescents with Sickle cell disease (SCD) is not clearly understood due to the lack of available studies. This review aimed to elucidate various attributes and related concepts of HRQOL in children and adolescents with SCD using Rodgers' et al. (2018) concept analysis framework. A systematic search was performed to identify studies reporting the attributes, antecedents, consequences, surrogate terms, and related concepts of HRQOL in children and adolescents with SCD. The review included 75 articles, including 70 quantitative, two mixed-methods, and three qualitative studies. These were categorized into attributes, antecedents, consequences, surrogate terms, related concepts, and an exemplar of HRQOL in children and adolescents with SCD. The review identified nine important attributes. It includes multidimensional and dynamic concepts, acknowledging the illness, maintaining emotional balance and self-control, coping with the disease, pain management, stigma and discrimination, treatment burden, palliative care and personal resilience. The antecedents were knowledge and attitude toward the disease, self-efficacy, social support, spirituality and spiritual well-being, disease severity, access to healthcare, environmental factors, and financial considerations. The consequences were independence in personal life, improved physical health outcomes, psychological well-being, family and caregiver well-being, improved family, social and peer relationships and social interactions, improved school performance, and improved overall HRQOL and long-term outcomes. This analysis provides an overview of HRQOL concepts related to children and adolescents with SCD, guiding further research into nursing care and clinical practice.

Psychometric evaluation of the spiritual perspective scale for adolescents and young adults with cancer

Objective

To evaluate the reliability and validity of the spiritual perspective scale (SPS) for adolescents and young adults with cancer.

Methods

The study was conducted with 277 adolescents and young adults with cancer aged 10-24 years who were recruited from Taiwan and Korea. The reliability of the SPS was assessed using Cronbach's α. Its factor structure was determined by exploratory factor analysis. Known-group validity was tested by comparing resilience scores between two groups and between countries using t test.

Results

Cronbach's α values for the SPS was 0.94, and item-total correlation values ranged from 0.53 to 0.84. Factor analysis generated two factors (spiritual behaviors and spiritual beliefs) that explained 78.02% of the total variance, with factor loadings ranging from 0.51 to 0.94. Participants with lower resilience had significantly lower spirituality scores compared to those with higher resilience (t = 3.13, P = 0.002). The SPS scores were not significantly different between participants in Taiwan and Korea (t = 1.09, P = 0.276). However, the spiritual beliefs subscale scores did show a significant difference between these groups (t = 2.74, P = 0.007).

Conclusions

The spiritual perspective scale is a valid and reliable tool for measuring the spirituality of adolescents and young adults with cancer in Taiwan and Korea. The SPS showed sensitivity in detecting variations in spiritual beliefs between adolescents and young adults with cancer in Taiwan and Korea.

Perceptions of Children and Caregivers Regarding Asthma and Its Pharmacotherapy: A Qualitative Study

Asthma, when untreated, may lead to serious implications, especially in the pediatric population. Understanding the perceptions and needs of children and their caregivers may optimize asthma management. This study was aimed to analyze the perceptions of children and their caregivers regarding asthma and its pharmacotherapy. This is a qualitative study using 2 focus groups. We use the Bardin's content analysis. Three researchers made data cross-validation. As for results, the first focus group comprised 7 children who had uncontrolled asthma. The second group comprised 7 caregivers who were the children's mothers. Four categories emerged: living with asthma, impact of asthma, medications, and health care. Asthma and its pharmacotherapy significantly affect the daily activities of children and mothers. Thus, understand feelings and experiences of patients and caregivers, in addition to educational and welcoming interventions for families in asthma management may be carried out by health care professionals to minimize the damage caused by this disease.

Experiences of paediatric terminal oncology patients and their parents in palliative care: A qualitative systematic review

PROBLEM

The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues.

ELIGIBILITY CRITERIA

This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded.

SAMPLE

A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes.

RESULTS

Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death.

CONCLUSIONS

This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner.

IMPLICATIONS

Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures.

"God gives me hope!": Hospitalized children's perception of the influence of religion in coping with chronic illness

PURPOSE

The mechanism of the impact of religion on health is still unclear, especially in children and adolescents with chronic illness who live in religious contexts. This study aimed to understand the influence of religion on coping with chronic diseases from the perspective of hospitalized children and adolescents diagnosed with cancer, type 1 diabetes mellitus and cystic fibrosis.

DESIGN AND METHODS

Qualitative descriptive research used photo-elicitation interviews with 35 Brazilian children and adolescents with cancer, type 1 diabetes mellitus and cystic fibrosis, aged between 7 and 17 years old. A thematic analysis approach was used to analyze qualitative data.

RESULTS

Participants were diagnosed with cystic fibrosis (14.3%), cancer (57.1%), and type 1 diabetes mellitus (28.6%) and 82.9% had a religious affiliation. Three themes were constructed: finding strength and support in the relationship with the divine, religion as an important source of meaning, and religious practice as a promoter of well-being. These themes demonstrate that children and adolescents themselves perceived their illness as a journey through which their faith grew.

CONCLUSIONS

This research shows the influence of religion on the positive coping of chronic illness, being a source of strength and support from the relationship with the divine, as well as offering a source of meaning, purpose and well-being based on religious practices.

PRACTICE IMPLICATIONS

This study supports clinical practice, based on the recognition of the patient as a religious and spiritualized person who has spiritual beliefs and needs that are capable of influencing treatment.

Psychometric Properties of the Spiritual Care Needs Scale for the 9-18 Age Group in Turkey

This methodological study aimed to establish the validity and reliability of the Spiritual Care Needs Scale in the 9-18 age group within the Turkish context. Expert opinions were considered in the analysis of the study, which was completed with the participation of 840 children. The content validity index and Cronbach's alpha coefficients were examined, along with the results of the Shapiro-Wilk normality test and the explanatory and confirmatory factor analyses. The scale had 21 items under two subdimensions: "meaning and hope" and "caring and respect." According to the EFA, the scale explained 57.5% of the total variance. The meaning and hope subdimension explained 53.3% of the total variance, whereas the care and respect subdimension explained 4.16%. The total Cronbach's alpha value of the scale was 0.96, and the fit indexes were as follows: X2 = 513.807, df = 184, X2/df = 2.792, RMSEA = 0.065, GFI = 0.89, IFI = 0.94, NFI = 0.91, TLI = 0.93, CFI = 0.94, AGFI = 0.87, and GFI = 0.89. Therefore, the Spiritual Care Needs Scale is a valid and reliable measurement tool for the 9-18 age group in the Turkish population.

An integrated model of workplace spirituality: The past, present and future - A systematic literature review

BACKGROUND

Because of the continually changing nature of work, workplace spirituality (WPS) has drawn more attention in recent years from studies, organizations, and both public and private sectors. Organizations strive to enhance employee well-being and general job satisfaction while developing a feeling of community inside the workplace through fostering WPS.

OBJECTIVE

The study aims to assess the literature on WPS in an attempt to provide a broader perspective on the impact of spirituality in the workplace to strengthen and comprehend how an individual or collective spirituality is integrated and manifested in the workplace.

METHODS

The literature was reviewed between 1994-2022 (including articles published online in 2023) and the deductive method was used.

RESULTS

As a new and significant contribution to knowledge in this study, maintaining a work environment of otherworldliness can help to advance work commitment (sympathy, mindfulness, significant work). Human resources practices should consider including care contemplation as an individual development program that results in increased empathy for others to support care and sympathy in the workplace. WPS centers around the humanistic idea of representatives in the work environment regarding how they experience a feeling of association, which means satisfaction and arrangement with the working environment. There are three ways to look at WPS: individual, authoritative, and intuitive.

CONCLUSION

This study has a significant contribution to knowledge enhancement and development. Such an approach to the development of a spirituality program within an organization can make a positive contribution to the improvement of business achievement and competitive gain. This model has some implications for organizational management where an internal spirituality program is desired. Future and additional research on model assessment under the same topic is strongly recommended.

Spiritual Well-Being and Related Factors in Children With Cancer

Introduction: There are specific gaps that call for empirical research in the experiences of spiritual well-being among children 12 years old and younger with cancer. Understanding these relationships can help to develop holistic and family centered care in pediatric oncology wards. This study assessed the spiritual well-being of children with cancer in association with their general well-being, happiness, quality of life, pain intensity, and personal characteristics. Method: The data were collected in Lithuania between June 2020 and November 2021. Children with cancer (N = 81) who were hospitalized at pediatric oncology-hematology centers participated in the study. Inclusion criteria were age (from 5 to 12 years old), diagnosis of oncologic disease for the first time, and absence of other chronic diseases. The instruments used were: Feeling Good, Living Life; Oxford Happiness Questionnaire, Short Form; Well-Being Index; PedsQL™3.0 Cancer Module, and a Wong-Baker FACES® Pain Rating Scale. Results: Communal and personal domains of spiritual well-being had the highest scores among pediatric oncology patients while both dimensions of the transcendental domain scored lowest. Age, level of education, and family composition revealed differences in children's spiritual health, happiness, and well-being, and church attendance was significant for overall spiritual well-being and its transcendental domain on lived experience dimension. Happiness had the strongest effect on all four domains of spiritual well-being. Discussion: Children emphasized the importance of spiritual aspects to feel better to a greater extent than they experienced in their lives. Despite their young age, children were familiar with family traditions, that is, religious practice and church attendance, and followed them in a particular sociocultural context.

Spiritual lives of children with cancer: A qualitative descriptive study in Lithuania

PURPOSE

To explore the experience and perception of spiritual lives of children with cancer.

DESIGN AND METHODS

A qualitative descriptive study included the collection of narratives on spiritual lives of children drawn from two university hospitals in Lithuania in the form of a semi-structured face-to-face interviews. Purposive sample of twenty-seven hospitalized children (5-12 y.) with non-terminal stage of cancer participated in the study.

RESULTS

The final four themes emerged from across all the questions as: being normal, community, comfort and connections with God.

CONCLUSIONS

Children with cancer needed to maintain as normal a life as posssible, despite being ill and undergoing treatment. Connections with family and friends were echoed in all the themes that emerged in the study. Children seemed to own their views about needing to pray or not; their needs revolved around asking for health and remission of their illness. Children diagnosed with cancer have a unique understanding of spirituality that is linked to their age, gender, and family composition. These ideas change as children develop and mature.

PRACTICAL IMPLICATIONS

The need to explore the spiritual lives of children with life threatening illnesses from an early age is evident. Health professionals need to recognize that a child is the product of their family, their community, their culture and their spirituality. Conversations with children about what God means to them and how prayer supports them, is essential. The opinion that spirituality topic might be hardly understood or too sensitive to children is rejected by the researchers.

How Do Religiosity and Spirituality Associate with Health-Related Outcomes of Adolescents with Chronic Illnesses? A Scoping Review

The aim of the current scoping review was to explore the associations between religious and spiritual factors and the health-related outcomes of adolescents with chronic illnesses, as well as to investigate possible mechanisms accounting for these relationships. In total, 20 studies meeting the eligibility criteria were reviewed after performing a search of the Scopus, Web of Science, and PubMed databases. The results suggested that religious and spiritual beliefs, thoughts, and practices (e.g., spiritual coping activities) might have both beneficial and deleterious effects on the way adolescents deal with their medical condition, on their psychosocial adjustment, on their mental and physical health, and on their adherence to treatments. Mediating and moderating mechanisms explaining these relations were also evidenced. Suggestions for future research and practical implications for healthcare professionals are provided in the concluding section of this work.

Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions

This study explored the evidence of validity of internal structure of the 12-item Functional Assessment of Chronic Illness Therapy—Spiritual Wellbeing Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. The study involved 301 Brazilian adolescents with cancer, type 1 diabetes mellitus, or cystic fibrosis. Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and Item Response Theory (IRT) were used to test the internal structure. Reliability was determined with Cronbach’s Alpha and McDonald’s Omega. The EFA suggested a one-dimensional scale structure in contrast to the original 2-factor model or the 3-factor model which were not reproduced in the current CFA. All quality indicators for the EFA one-factor exceeded the required criteria (FDI = 0.97, EAP = 0.97, SR = 3.96 and EPTD = 0.96, latent GH = 0.90. and the observed GH = 0.85). The FACIT-Sp-12 for adolescents yielded strong evidence for a 1-factor model and with good reliability.

Association between spiritual care competency and perceived professional benefit among nurses: A cross-sectional study

AIMS

This study aimed to investigate the status quo of nurses' spiritual care competency and their relationship with perceived professional benefit.

BACKGROUND

Spiritual care has always been considered a vitally important part of holistic nursing. Understanding the spiritual care competency of nurses during the COVID-19 pandemic can help nursing managers understand the weak links in spiritual care practice and improve the quality of nursing service. As a positive emotional experience and cognitive evaluation of the profession, perceived professional benefit can serve to adjust work pressure, relieve job burnout, and promote an individual's overall growth. However, the relationship between perceived professional benefit among nurses and spiritual care competency remains unclear.

METHODS

A total of 372 nurses were recruited from 15 separate Chinese hospitals. An online questionnaire was used to assess nurses' sociodemographic, spiritual care competency, and perceived professional benefit. Statistical analyses were performed using Pearson's correlation analysis, t-test, analysis of variance (ANOVA), and multiple stepwise linear regression analysis.

RESULTS

The total mean score of spiritual care competency (99.43 ± 21.10) among nurses was found to be moderate. Nurses' spiritual care competency was positively correlated with perceived professional benefit (P < .01). The multiple stepwise linear regression model (n = 372) had an explained variance (R² = 0.218) and showed that perceived professional benefit and the manner of receiving spiritual training were the main influencing factors of nurses' spiritual care competency (P < .001).

CONCLUSION

The study findings indicated that nurses need to improve their spiritual care competency by improving their perceived professional benefit.

IMPLICATION FOR NURSING MANAGERS

Our study evaluated the spiritual care competency of nurses and explored the correlation between perceived professional benefit and spiritual care competency among nurses. The results of this study can help nursing managers to carry out relevant interventions, thus improving nurses' spiritual care competency and optimizing the quality of nursing.

A Qualitative Study of the Spiritual Aspects of Parenting a Child with Down Syndrome

Parenting a child with Down syndrome can sometimes present certain difficulties and, thus, spirituality may function as a dimension related to finding meaning in life and as a coping resource. Spirituality is a critical dimension of nursing care, but scarce knowledge is available to specifically inform family nursing practice. The aim of this study was to explore the spiritual aspects of parenting a child with Down syndrome, as a qualitative secondary analysis. This is an observational qualitative study, based on in-depth interviews from 42 participants. Data analysis found seven categories that concern meaning and purpose in life: hope, family strength, spiritual practices, personal beliefs, and love, and trust in healthcare providers. Spirituality is a resource in parents’ lives who are living in this situation. Nurses should consider this dimension in supporting families and in improving management of this life and health condition.

Spiritual Needs of Brazilian Children and Adolescents with Chronic Illnesses: A Thematic Analysis

PURPOSE

To identify the spiritual needs of children and adolescents with chronic illnesses and how these needs are met by health professionals during hospitalization.

DESIGN AND METHODS

A qualitative descriptive study was developed with 35 children and adolescents, between 7 and 18 years old, diagnosed with cancer, cystic fibrosis, and type 1 diabetes. Interviews with photo-elicitation were conducted during the hospitalization at a Brazilian public pediatric hospital. Findings were treated using thematic analysis, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed for quality reporting. This research was approved by a research committee.

RESULTS

Two themes emerged. The first, entitled 'Spiritual needs', encompasses five types of needs: (1) need to integrate meaning and purpose in life; (2) need to sustain hope; (3) need for expression of faith and to follow religious practices; (4) need for comfort at the end of life; and (5) need to connect with family and friends. The second theme was the 'Definition of spiritual care'.

CONCLUSIONS

Children and adolescents with chronic illnesses have spiritual needs while in hospital. Meeting these needs is essential for finding meaning, purpose and hope in the experience of living with chronic illnesses and at the end of life, based on their faith, beliefs and interpersonal relationships. But, these needs have not been fully addressed during hospitalization.

PRACTICE IMPLICATIONS

These results emphasize the need to implement spiritual care when caring for hospitalized pediatric patients, which includes addressing spiritual needs.

Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models

BACKGROUND

To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support.

AIMS

(1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework.

METHODS

A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0-24 years) with chronic conditions were included.

RESULTS

Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed.

CONCLUSIONS

By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.

Explanatory models of families of children with type 1 diabetes mellitus

OBJECTIVES

to analyze how children with type 1 diabetes mellitus and their families explain the pathology, based on their understanding of the factors related to the discovery of diabetes, the etiology, treatment, and prognosis of the disease.

METHODS

qualitative methodological approach, based on medical anthropology and the narrative method. In-depth interviews were conducted with 12 families of children with type 1 diabetes mellitus attending follow-up consultations at a specialized center. The statements were subjected to inductive thematic analysis.

RESULTS

the explanatory models identified describe the families search for the clarification of the signs and symptoms that the child had. Faced with the disease, families reorganized themselves to meet new health care needs of children, such as adequate nutrition, physical exercise, and blood glucose monitoring. Final Considerations: knowing the explanatory models allows the understanding of how families give meaning to the child's illness, favoring daily nursing care and an effective control of the disease.

Primary palliative care: Skills for all clinicians

The number of children with life-threatening and life-limiting conditions is increasing, requiring an individualized approach and additional supportive care. The American Academy of Pediatrics has called for pediatric palliative care to be available to all children who would benefit.^1,2 High quality pediatric palliative care is essential for these children. Collaborative team-based methods focused on improving quality of life have shown to improve outcomes in physical, emotional, and cognitive domains.³ Palliative care involvement at the time of diagnosis rather than just at the end of life has moved coordinated care upstream. All clinicians can and should deliver palliative care. The Joint Commission recommends having patient-centered palliative care services available for children, and the Centers for Medicare and Medicaid Services is reimbursing clinicians for this coordinated care. This article details how all pediatric clinicians can positively influence the care of seriously ill children by incorporating palliative care principles into their daily care, resulting in better outcomes for their patients and families.

Perceptions and experiences of living with type 1 diabetes among Latino adolescents and parents with limited English proficiency

We explored perceptions and experiences of living with type 1 diabetes mellitus (T1DM) among U.S. Latino adolescents (age 12-19 years) with T1DM and parents with limited English proficiency. We used a qualitative descriptive approach with semi-structured interviews of adolescents together with their parents. Interview data were reviewed, coded, and combined into themes about participant experiences with T1DM. Twenty-four adolescents (mean age: 15.4 years) and 23 parents participated. Analysis resulted in three themes: (a) Understanding and adapting to T1DM (i.e., initial fear and misunderstandings of T1DM; adolescents' reflections on living with a chronic health condition); (b) Coming to terms with social and environmental influences on T1DM self-management (i.e., T1DM as disruptive to school and social activities; dealing with stigma and judgments related to diabetes); and, (c) Integrating T1DM self-management expectations with components of Latino cultures (i.e., orientation toward family well-being; parent concerns about cultural preferences that influence food choices, positive influence of spirituality and religiousness; parental views of their current health care in comparison to that available in their place of birth). Adolescents and their parents reported experiences that are universal to adolescents with T1DM in addition to challenges that are unique to Latinos. Efforts aimed at improving T1DM self-management during adolescence with this population need to be tailored to meet the unique social and cultural contexts and delivered in a culturally and linguistically congruent manner.

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.