Spiritual crisis: a concept analysis

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

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

Spiritual Interventions Delivered by Nurses to Address Patients' Needs in Hospitals or Long-Term Care Facilities: A Systematic Review

Introduction: Despite increasing evidence of the benefits of spiritual care and nurses' efforts to incorporate spiritual interventions into palliative care and clinical practice, the role of spirituality is not well understood and implemented. There are divergent meanings and practices within and across countries. Understanding the delivery of spiritual interventions may lead to improved patient outcomes. Aim: We conducted a systematic review to characterize spiritual interventions delivered by nurses and targeted outcomes for patients in hospitals or assisted long-term care facilities. Methodology: The systematic review was developed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a quality assessment was performed. Our protocol was registered on PROSPERO (Registration No. CRD42020197325). The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to June 2020. Results: We screened a total of 1005 abstracts and identified 16 experimental and quasi-experimental studies of spiritual interventions delivered by nurses to individuals receiving palliative care or targeted at chronic conditions, such as advanced cancer diseases. Ten studies examined existential interventions (e.g., spiritual history, spiritual pain assessment, touch, and psychospiritual interventions), two examined religious interventions (e.g., prayer), and four investigated mixed interventions (e.g., active listening, presence, and connectedness with the sacred, nature, and art). Patient outcomes associated with the delivery of spiritual interventions included spiritual well-being, anxiety, and depression. Conclusion: Spiritual interventions varied with the organizational culture of institutions, patients' beliefs, and target outcomes. Studies showed that spiritual interventions are associated with improved psychological and spiritual patient outcomes. The studies' different methodological approaches and the lack of detail made it challenging to compare, replicate, and validate the applicability and circumstances under which the interventions are effective. Further studies utilizing rigorous methods with operationalized definitions of spiritual nursing care are recommended.

Spiritual distress of patients living with cancer in Northern Vietnam

BACKGROUND

Literature on the spirituality of cancer patients has been mainly focused on the experiences of western patients. Few studies explore the experience of Asian cancer patients, while no spiritual study on cancer patients has been conducted in Vietnam.

PURPOSE

The purpose of this study was to survey the spiritual distress of cancer patients at two general hospitals in northern Vietnam.

METHODS

This was a quantitative survey with a cross-sectional design. This study used purposive sampling with a fitting the inclusion criteria, alongside the Spiritual Distress Scale-Vietnam version (SDS-V). The data was collected by an investigator in two general hospitals in northern Vietnam. The study received approval from two research councils.

RESULTS

The results demonstrated that the demographics of cancer patients in the study reflected the national data of Vietnam. Regarding the four exploratory dimensions, more than 50% of cancer patients expressed feeling hardship and sorrow, most did not feel loneliness, most patients reported a good relationship with others and God, while the majority of were afraid to discuss death.

CONCLUSIONS

Due to impact of aging and poverty on the sample patients, further studies into the interconnectivity between economics and the spiritual health status of patients is recommended. Additionally, since the 132 Vietnamese cancer patients reported a positive relationship with others and God, healthcare professionals should study effective strategies to apply the above strengths in easing hardships for future cancer patients.

From Supporting Moral Competence to Fostering Spiritual Growth: The Psycho-Didactic Potential of the Konstanz Method of Dilemma Discussion (KMDD®)

This paper aimed to introduce the Konstanz Method of Dilemma Discussion KMDD® as one of the most effective methods that are designed to foster moral competence and, therefore, to promote tolerance and equality, regardless of cultural background, religion, or views. It is mainly used within the educational context, but it can be also implemented in different environments and conditions. The Konstanz Method of Dilemma Discussion should also be considered as the representative of a psycho-didactic approach to education. There is a possibility of assessing KMDD®’s effectiveness with the Moral Competence Test (MCT®), as well as comparing its significance with other methods that are not only based on the discussions of moral and spiritual dilemmas. Therefore, dilemma discussions would seem to be the best framework for practicing not only social skills and a democratic attitude but also positive mental health and psychological stability by providing a background for personal moral and spiritual growth.

Meanings and Interpretations of Spirituality in Nursing and Health

Numerous spirituality models and tools have been developed in health education and research, but a gap still exists around the conceptual clarity and articulation of spirituality among nurses and healthcare providers. Nurses and healthcare providers still find it difficult to interpret and apply the concepts of spirituality in their practice settings. This paper provides a concept analysis of spirituality using the Walker and Avant method of conceptual analysis. Several databases including conceptual and empirical literature from various disciplines have been used. The defining attributes of spirituality included spirituality and religion as a separable or mutual construct, spirituality as a personal construct, wholeness and integration, meaning making and purpose, sense of connectedness and relationship, transcendence, inner source of power, energy, and strength. Major antecedents of spirituality found were faith, personal values, and belief systems, and life adversities. Consequences of spirituality included personal/spiritual growth and wellbeing, resilience, and religiousness. Spirituality is a unique and personal human experience, an individualised journey characterised by multiple experiential accounts such as meaning making, purpose, connectedness, wholeness and integration, energy, and transcendence. Spiritual experiences are often difficult to examine and measure using scientific tools and empirical language. Healthcare providers need to fully understand and apply spirituality and spiritual care aspects to provide holistic person-centred care.

Understanding the spirituality of parents following stillbirth: A qualitative meta-synthesis

This meta-synthesis aims to synthesize qualitative evidence from primary studies to better understand the experience of the spirituality of parents and its relationship to adapting following stillbirth. Five electronic databases were systematically searched and the quality of 21 eligible studies was critically appraised. A thematic synthesis revealed two analytical themes: (1) Spiritual suffering following stillbirth; (2) Moving through spirituality to adapt to the loss, each encompassing four descriptive themes. The findings can inform a more culturally and spiritually sensitive approach to care, taking into account the parents' beliefs, folk customs, religion, values, and spiritual needs.

The requirements of hospital-based spiritual care for cancer patients

PURPOSE

This paper aimed to discover the requirements of hospital-based spiritual care for cancer patients.

METHODS

This study was a descriptive qualitative-exploratory research, in which 25 participants were selected through purposive sampling and had semi-structured interviews.

RESULT

The data analysis revealed 3 themes and 8 sub-themes including fundamental requirements (changes in the attitudes and behaviors of the healthcare team), structural requirements (inter-professional collaborations, a reference system), and functional requirements (religious-spiritual, pastoral, psycho-spiritual, and supportive-spiritual care). In this study, the received topics have been related to the spiritual care which can help improve patient care.

CONCLUSION

The results were added to the repertoire of knowledge about the spiritual needs of cancer patients. The results indicated that it is essential to get acquainted with the spiritual care requirements in the hospital and enforce them through inter-professional collaboration. Accordingly, the spiritual care program should be designed, implemented, and evaluated.

Spiritual Needs of Families With Bereavement and Loss of an Infant in the Neonatal Intensive Care Unit: A Qualitative Study

CONTEXT

The hospital is a place full of distress and questions about the meaning of life. The death of a child can cause a spiritual struggle and crisis. Therefore, it is necessary for health care providers in the neonatal intensive care unit (NICU) to assess the spiritual needs of families that have lost a child.

OBJECTIVES

The purpose of this study was to explore the spiritual needs of families in Iran at the end of their baby's life and through bereavement in the NICU.

METHODS

This study was an exploratory qualitative study performed using purposeful sampling and semi-structured interviews with 24 participants. Inclusion criteria for families, nurses, and physicians included having experienced at least one newborn death in the last six months in the NICU. The research environment was the NICU in Isfahan, one of the largest cities in Iran.

RESULTS

Data analysis revealed three main themes: spiritual belief in a supernatural power, the need for comfort of the soul, and human dignity for the newborn.

CONCLUSION

The results of this study created a new vision in addressing spiritual needs of Iranian families who experience the death of a newborn.

Residents’ and caregivers’ views on spiritual care and their understanding of spiritual needs in persons with dementia: A meta-synthesis

Aims

To synthesize research that investigated how residents and caregivers view spiritual care, come to understand the spiritual needs of people with dementia, and how caregivers provide care congruent with peoples’ needs.

Methods and study design

Meta-synthesis using Noblit and Hare’s meta-ethnography. A synthesis of eight qualitative, empirical, primary studies that explored spiritual care in the context of dementia care was performed.

Findings

Spiritual care for persons with dementia was described in the forms of (i) performing religious rituals that provides a sense of comfort and(ii) coming to know the person, which provides opportunities to understand a person's meaning and purpose, and (iii) attending to basic needs provides an opportunity to appreciate others’ vulnerability and humanness.

Conclusions

Spiritual care intended to help persons with dementia to express their faith and religious beliefs, and help persons with dementia experience meaning in life, connectedness to self, God/deity and other persons.

Development of a Short-Form of the RCOPE for Use with Bereaved College Students

Bereavement is being increasingly recognized as a key issue in college populations (Balk in Mortality 2:207-220, 1997; Balk et al. in Death Stud 34:459-468, 2010). However, there is currently a dearth of research on the impact that the loss of a loved one has on college students and the ways that college students cope during the grieving process. This lack of research, particularly among younger groups, is problematic as researchers have shown that emerging adults experience a surprisingly high number of losses and are an at-risk group for poor post-loss outcomes (Servaty-Seib and Taub 2010; Servaty-Seib and Hamilton 2006; Arnett in Am Psychol 55(5):469, 2000). Religion is a common way that individuals cope with bereavement (Frantz et al. in Pastor Psychol 44(3):151-163, 1996) and may also be commonly used by college students to manage everyday stress (Merrill et al. 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519-543, 2000; J Health Psychol 9:713-730, 2004) is a frequently used measure of religious coping that has recently been evaluated for use with a bereaved undergraduate population. Lord and Gramling (2014) examined the factor structure of the RCOPE and concluded that overlap between the positive and negative religious coping subscales when used with a bereaved undergraduate sample detracted from the predictive utility of the instrument. The researchers provided evidence for the use of a new 2-factor, 39-item version of the RCOPE with the bereaved college student population. The current study replicated Lord and Gramling (2014) with a large follow-up sample of bereaved undergraduates. Participants (N = 677) consisted of individuals who had lost a loved one within the past 2 years, had a mean age of 19.1, and were predominantly female (62%) underclassmen (84% freshman or sophomore status). A majority of participants (68%) were identified as Christian. Exploratory factor analyses closely mimicked the results of the previous study, and the number of items was further reduced in order to provide a briefer version of the scale for use in future research. Hierarchical regression models demonstrated discriminate, convergent, and predictive validity of the instrument.

Meaning and existential givens in the lives of cancer patients: A philosophical perspective on psycho-oncology

OBJECTIVE

Many cancer patients report changes in how they experience meaning in life and being confronted with life's limitations, understanding themselves as being vulnerable, finite, and free beings. Many would like to receive psychotherapeutic help for this. However, psychotherapy for these concerns often either focuses primarily on meaning in life (e.g., meaning-centered/logotherapy) or on existential givens (e.g., supportive-expressive therapy). The relationship between meaning in life and existential givens seems relatively unexplored, and it seems unclear how therapists can integrate them. The present article aims to explore the relationship between meaning and existential givens.

METHOD

Martin Heidegger was a founder of existentialism, inspiring both meaning therapies and supportive-expressive therapies. Therefore, we systematically apply his understanding of these phenomena, elucidated by four elements in his central metaphor of "the house."

RESULTS

(1) Walls: In everyday life, we construct ordinary meanings, like the walls of a house, to protect us from our surroundings, wind, and rain. (2) Surroundings ("existential givens"): Confronted with cancer, the meanings/walls of this house may collapse; people may start seeing their surroundings and understand that they could have built their house at a different location, that is, they understand the broad range of possibilities in life, their responsibility to choose, and the contingency of current meanings. (3) How to design, build, and dwell: People may design, build, and dwell in their house in different ways: they may lock themselves in their house of impermeable "ordinary meanings" and deny the existence of existential surroundings; they may feel overwhelmed by all possibilities and be unable to experience meaning; they may build the house as their true home, use life's possibilities, and listen to their true self by building permeable "existential meanings." (4). Navigator: People may experience inner guidance to navigate in designing, building, and dwelling in this house.

SIGNIFICANCE OF RESULTS

Meaning in life and existential givens are intertwined. Therefore, we suggest that it is necessary for psycho-oncologists to address both. Further clinical validation is required.

Patterns of religious coping among bereaved college students

Contemporary research has suggested that bereavement is a paramount issue in college populations, a group which has historically been underrepresented in grief research (Balk. in Death studies 25:67-84, 2001; Balk et al. in Death Studies 34:459-468, 2010). Indeed, there has been a call to generate new research on grief with specific populations and age groups (Center for the Advancement of Health. in Death Studies 28:568-575, 2004). Religion is often described as a primary way that individuals cope with bereavement in particular (Frantz et al. in Pastor Psychol 44(3):151-163, 1996) and has been shown to effect college student reactions to stress in general (Merrill et al. in Mental Health, Religion & Culture 12(5):501-511, 2009). The RCOPE (Pargament et al. in J Clin Psychol 56(4):519-543, 2000, J Health Psychol 9:713-730, 2004) is a frequently used measure of religious coping, but has not been evaluated with a bereaved undergraduate population. Given that emerging adulthood is a critical developmental phase of religious identity (Fowler. in New Directions for Child Development 3(52):27-45, 1991), the current study examined the factor structure of the RCOPE within a sample of bereaved college students. An exploratory factor analysis was performed, which approximated the factor structure proposed by Pargament et al. (J Clin Psychol 56(4):519-543, 2000). However, a high correlation between the positive and negative religious coping subscales (r = 0.71) detracted from the predictive utility of Pargament et al.'s (2000) two overarching subscales. Therefore, an exploratory factor analysis with an orthogonal rotation was used to identify two uncorrelated subscales (adaptive religious coping and maladaptive religious coping). This new two-factor, 39-item version of the RCOPE was found to demonstrate good internal consistency (α > 0.8) as well as convergent and discriminant validity. The interaction between religious coping strategies and core beliefs about the predictability of the world is explored, and directions for future research and clinical practice are suggested.

Religious faith in coping with terminal cancer: what is the nursing experience?

This qualitative study describes nurses' reports on the role played by religious faith in the care of patients with terminal cancer. Using Gadamer's philosophical hermeneutics and C. Roy's adaptation model as a base, in-depth interviews were carried out with 23 nurses who had cared for patients with terminal cancer for at least 6 months. Three main themes emerged when a Gadamerian-based hermeneutic research method was applied: faith facilitates the coping process in cases of terminal cancer, faith hinders the coping process in cases of terminal cancer and terminal illness impacts faith. The lack of univocal results indicates that the role of faith in coping with death is essentially practical, individualised and changeable. The nurse-patient relationship can help to determine the spiritual needs of cancer patients at the end of life. This source of knowledge held by the nurse, together with the rest of the multidisciplinary team, can help to improve end-of-life care.

Spiritual care of the child with cancer at the end of life: a concept analysis

AIM

The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life.

BACKGROUND

Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop.

DESIGN

Rodgers' method of evolutionary concept analysis guided the review process.

DATA SOURCES

The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included.

METHODS

Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences.

RESULTS

The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care.

CONCLUSION

Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes.

Nurses' and caregivers' definition of spirituality from the Christian perspective: a comparative study between Malta and Norway

AIM

The aim of this cross-sectional comparative exploratory study was to explore the term spirituality as defined by four groups of nurses and two groups of caregivers from Malta and Norway.

BACKGROUND

Spirituality is a complex subjective concept which may or may not contain religiosity. Several factors may influence the individual's interpretation with implications to nursing care and nursing management.

METHODS

Data were collected from six purposive samples using focus group discussions in Malta and Norway. The Taxonomy of Spirituality guided the study.

RESULTS

Four themes defined the term 'spirituality'. Two differences were found between Malta and Norway. Connectedness with family and nature was emphasized more by the Maltese group while the Norwegian group identified both the positive and the negative energies of spirituality.

IMPLICATIONS TO NURSING CARE AND NURSING MANAGEMENT

A clinical environment conducive to holistic care is needed. Inclusion of spirituality in the continuous professional development programmes may enhance understanding of spirituality and foster spiritual growth.

CONCLUSIONS

Irrespective of differences in cultures between Malta and Norway, commonalities were found in the definition and essence of spirituality in nursing care. Trans-cultural longitudinal research is recommended to explore further the definition of spirituality.

Can nurses enhance spiritual care in end-of-life settings?

Professor Alan Gasperdiscusses the Department of Health's review into spiritual care at the end of life, which recommends training in spiritual care and identifies a range of qualities required of nurses working with this vulnerable patient group.

Integrating spirituality into critical care: an APN perspective using Roy's adaptation model

Integration of the spiritual domain into the nursing plan of care positively influences health and wellness. Applying nursing theory to practice reinforces the advanced practice nurse's (APN's) responsibility to integrate spiritual care into the critical care environment. Indeed, all nurses have an obligation to integrate spiritual care because the focus of nursing care is beneficence. Moreover, the focus of APN care is not curing, but healing. Healing can be assisted by entering into the patient's suffering to help reconstruct life plans and facilitate realizing meaning from the despair of illness even while facing extreme adversity and death. This article describes spiritual care of the critically ill adult patient and the role that the APN must, can, and should take to assimilate spiritual care into care of these patients and their families.