Spirituality and chronic illness

Assessing Spirituality and Religiousness in Advanced Cancer Patients

The aim of this study was to translate the Spiritual Involvement and Beliefs Scale into the Greek language and validate its psychometric properties in a sample of advanced cancer patients treated in a palliative care unit. The scale was translated into Greek with the “forward-backward” procedure. It was administered twice, with a 3-day interval, to 82 patients with advanced cancer. Patients completed the Spiritual Involvement and Beliefs Scale and the Greek Hospital Anxiety and Depression Scale. The scale had an overall Cronbach α of 0.89. Overall test-retest reliability was satisfactory at P < .0005. Satisfactory construct validity was supported between the Spiritual Involvement and Beliefs Scale subscales and Hospital Anxiety and Depression subscales. Interscale and interitem correlations were found satisfactory at P < .0005. These results support that the Spiritual Involvement and Beliefs Scale is an instrument with satisfactory psychometric properties and is a valid research tool for spirituality in advanced cancer patients.

Spiritual well-being as a dimension of quality of life for patients with advanced cancer and AIDS and their family caregivers: Results of a longitudinal study

Based on a longitudinal, quality-of-life study, this article presents pilot data regarding the spiritual well-being of patients with advanced cancer or AIDS and their family caregivers. Data include similarities and differences between the patient and caregiver populations and patient/family caregiver dyads as well as trends with regard to changes in spiritual well-being during the illness and dying process. The reliability of the Spiritual Well-Being Scale 1 was examined for patient and caregiver groups, as was the relationship between selected demographic variables and spiritual well-being. Implications for practice are discussed.

Personal Spirituality of Persons with Early-Stage Dementia

During times of stress and uncertainty, research has documented that individuals may turn to religion and spirituality as coping resources. But what about those with dementia who have a decreased cognitive capacity? Do they also turn to religion and spirituality and are these coping resources related to overall quality of life? The objective of this study was to describe the spiritual experiences of persons with early-stage dementia and to explore the relationship between personal spirituality and perceived quality of life. Twenty-three participants were interviewed using: a semi-structured interview guide; the System of Belief Inventory (SBI); and the Quality of Life Index (QLI). Qualitative data analysis illuminated an overall theme of `faith in God' and six related categories: beliefs; support from God; sense of meaning/purpose in life; private practice; public practice; and changes due to dementing illness. There were significant relationships between the SBI scores and the QLI scores. Findings suggest that those with early-stage dementia often find personal spirituality and its internal meanings important in coping with their life situations, that is, spirituality is associated with their perceived quality of life.

Spirituality in Multicultural Caregivers of Persons with Dementia

This qualitative study examined spirituality in a multicultural group of caregivers of persons with dementia. The work was based upon earlier focus groups that centered on general outreach to African-American caregivers. While initial questions focused on caregiving experiences, service needs, and barriers to service use, caregivers spontaneously shared their experiences concerning spirituality and caregiving. In an effort to respond to these comments and embrace a more expanded outreach approach, successive focus groups specifically addressed questions about spirituality and caregiving. Using semi-structured questionnaires, three focus groups with existing community-based groups were conducted ( N = 43). Four major categories emerged from the data: teachers of the faith; the role of faith in one's life; benefits of spirituality; and the caregiver, the care-receiver and the caregiving experience. These major categories were integrated into a spiritual model for the caregiver and the caregiving experience. Findings suggest that community-based outreach approaches should embrace an appreciation for caregivers' faith development, expressions, and experiences of spirituality; that clinical interventions should be more proactive in responding to spiritual/religious issues; and that future research efforts should refine methods and approaches for a more integrated scientific basis that further examines relationships between spirituality and mental and physical health outcomes.

Spiritual Perspectives of Nurses in the United States Relevant for Education and Practice

The purpose of the current study was to describe nurses’ spiritual perspectives as they relate to education and practice. A multiple triangulation research design encompassing a questionnaire and a descriptive qualitative content analysis were used with the purpose of capturing a more complete, holistic, and contextual description of nurses’ spiritual perspectives. Multiple triangulation included two data sources, two methodological approaches, and nine investigators. Using survey methods, Reed’s Spiritual Perspective Scale (SPS) was sent to 1,000 members of Sigma Theta Tau International Nursing Honor Society (STTI). Results support Reed’s premise that spirituality permeates one’s life. Regardless of gender, participants with a religious affiliation had significantly higher SPS scores than those without one. Nurses having a spiritual base use it in practice. Six themes emerged from the qualitative analysis: Nurses perceive spirituality as strength, guidance, connectedness, a belief system, as promoting health, and supporting practice. The integration of spirituality in nursing curriculums can facilitate spiritual care.

The strength to cope: spirituality and faith in chronic disease

The lifelong management of a chronic condition requires considerable mental fortitude and commitment in social adjustment and adherence to medical advice. In examining strategies of adaptation, we draw on ethnographic research, including interviews with 69 people with type 2 diabetes and/or cardiovascular disease. We explore how they incorporate spirituality into their self-management routines, with positive impact on their health and wellbeing, and highlight the role of spiritual practices in supporting people with chronic conditions mentally, physically and socially, so encouraging personal responsibility for one's health and wellbeing.

Religious views on suicide among the Baganda, Uganda: a qualitative study

Relatively little research has been conducted on religion and suicide in Africa, yet religion has a lot of influence on people's way of life in Africa. To study religious views on suicide among the Baganda, Uganda, we used grounded theory and discourse analysis on a total of 28 focus groups and 30 key informant interviews. Suicide is largely seen as a breach of God's doctrine life is sacred, God's commandment thou shall not kill, and God's rule of agape. The study also focuses on the consequences of breaching God's divine providence: punishment from God and the Church. Religion still has a lot of influence on people's views on suicide in Uganda despite the challenges highlighted in the study. A recommendation from these results is that suicide prevention should cater to divergent views on religion and suicide. More qualitative research should be conducted in this area to facilitate theoretical comparison with this study.

Spirituality as a coping resource for African American parents of chronically ill children

PURPOSE

To examine spirituality as a coping resource for a sample of African American parents who have a child with a chronic condition.

STUDY DESIGN AND METHODS

Descriptive correlation design with a sample of 168 African American parents. Parents completed a demographic questionnaire, the Coping Health Inventory for Parents (CHIP), the Family Crisis Oriented Personal Evaluation Scale (F-COPES), and the spirituality subscale of the Functional Assessment of Chronic Illness Therapy Measurement System (FACIT-Sp-12). Data were analyzed with frequency distributions and Pearson product moment correlations.

RESULTS

Most frequently reported positive coping patterns included "believing in God," "doing things with my children," "believing that my child is getting the best medical care," and "having faith in God." Most frequent coping resources included "having faith in God," "seeking information from the family doctor," and "showing that we are strong." Results revealed a significant positive correlation between positive parental coping patterns and spirituality.

CLINICAL IMPLICATIONS

It is important for nurses to recognize ethnic and cultural aspects of coping and spirituality, and design and implement care measures that support spirituality among families with a child with special healthcare needs.

Exploring the Relation of Health-Promoting Behaviors to Role Participation and Health-Related Quality of Life in Women With Multiple Sclerosis: A Pilot Study

OBJECTIVE. We examined the relation of health-promoting behaviors to participation in life roles and health-related quality of life (HR–QOL) in women with multiple sclerosis.

METHOD. We used a correlational design. Frequency of health-promoting behaviors was obtained from the Health-Promoting Lifestyle Profile–II. Role participation was measured by the SF–36 Role-Physical, Role-Emotional, and Social Functioning scales, and HR–QOL was measured with the Physical and Mental Component scales.

RESULTS. Eleven significant positive correlations were found among specific health-promoting behaviors (e.g., nutrition, stress management, physical activity, positive interpersonal relations, spiritual growth), role participation, and HR–QOL.

CONCLUSION. The findings suggest that involvement in health-promoting behaviors is associated with greater participation in life roles and HR–QOL for women with multiple sclerosis. This study provides preliminary evidence for the use and development of health promotion in occupational therapy treatment.

Spirituality, depression, living alone, and perceived health among Korean older adults in the community

Both theoretical and empirical studies have documented the protective effect of religiosity and spirituality on general health in older adults in community and hospital settings; however, no study has documented the relationship between spirituality and depression among older adults living alone in communities in Korea. We tested two hypotheses: Hypothesis 1: Korean older adults living alone would be more depressed and less healthy than older adults living with family, and Hypothesis 2: Individuals who are more religious and spiritual would report a lower level of depression and a higher level of general health even when other demographic and living status variables are controlled. A descriptive, comparative, and correlational design with a convenience sampling method was conducted among community-dwelling Korean older adults in Chounbook Providence, South Korea. This study included 152 men and women older than 65 years old. Hypothesis 1 was supported as Korean older adults living alone were significantly more depressed than were older adults living with family (P<.01). However, for Hypotheses 2, only spirituality activities and Spirituality Index of Well-Being scores were significantly associated with general health and/or depression (P<.01), but there were no relationships between the variables of attendance and importance of religion with general health and depression.

Demographic and clinical predictors of spirituality in advanced cancer patients: a randomized control study

AIM

To study the influence of cancer patients' sociodemographic and clinical characteristics in their spiritual beliefs and attitudes.

BACKGROUND

Patients' sociodemographic and clinical characteristics may have an important role in their spirituality. Failure to control these factors can lead to a false estimation on patients' spiritual beliefs. Previous studies have found that age, gender and health status associate with spiritual attitudes and beliefs.Design. Survey.

METHODS

The Spiritual Involvement and Beliefs Scale was administered to 82 cancer patients. Demographic characteristics, disease status and treatment regimen were recorded.

RESULTS

Among the most significant correlations were those between gender and all the subscales, cancer diagnosis, existential/meditative subscale, radiotherapy treatment and external/ritual, internal/fluid and existential meditative. In the prediction of spirituality, the contribution of gender, age, years of education, performance status and radiotherapy is high.

CONCLUSION

Acknowledging the specific patients' demographic and medical characteristics, such as female gender, old age, years of education, performance status and radiotherapy treatment, contributes to the prediction of patients' spiritual beliefs and attitudes.

RELEVANCE TO CLINICAL PRACTICE

Addressing spiritual needs in palliative care among the dying needs to be a priority and could be a crucial aspect of psychological functioning, especially when considering certain demographic and clinical characteristics.

Spirituality and well being among elders: differences between elders with heart failure and those without heart failure

Heart failure is a chronic debilitating disease that affects all aspects of a person’s life, including physical, mental and spiritual dimensions. The associations among these dimensions, and the relationship to overall health status, have not been clearly identified. The purpose of this quantitative, descriptive study was to explore differences between spirituality, depressive symptoms, and quality of life among elders with and without heart failure. A total of 44 elders with heart failure and 40 non-heart failure elders completed several questionnaires including: The Daily Spiritual Experiences Scale (DSES), Spirituality Index of Well-Being (SIWB), Center for Epidemiologic Studies Depression Scale (CES-D), and SF-12^™ Health Survey. There were significant differences in the groups on gender and ethnicity; thus these variables were controlled in the analyses related to the dependent variables. After controlling for gender and ethnicity, there were significant differences in the physical component of quality of life and spiritual well-being. The heart failure patients had significantly lower physical quality of life but more spiritual well-being than the non-heart failure patients. There were no significant differences in daily spiritual experiences, mental component of quality of life, and depressive symptoms between the two groups.

Primary care parish nursing: academic, service, and parish partnership

Health care providers who want to make a difference in today's health care environment must support the idea of collaboration. To address the concerns of a university, a major medical center, and the community, a collaborative group shared their vision and developed creative strategies to serve the community. The critical components of this project included gaining the services of a nurse practitioner and nurse case manager, establishing physician liaison, assessing congregational health care needs, providing for both primary health and continuity of care needs, and maintaining the spiritual component of the faith community. Essential to the success of this program was the achievement of pastor and congregational support, enthusiasm, and involvement.

The Relationship Between Spirituality, Purpose in Life, and Well-Being in HIV-Positive Persons

Research has shown that spirituality has a positive effect on mental and physical health; however, few studies have explored the influence of spirituality on purpose in life and well-being in persons living with HIV. This descriptive cross-sectional study was designed to examine the relationship between spirituality, purpose in life, and well-being in a sample of 46 HIV-positive men and women. Spirituality was measured using the Spiritual Involvement and Beliefs Scale-Revised (SIBS-R), purpose in life was measured using the Purpose in Life (PIL) test, and well-being was measured using the General Well-Being (GWB) Schedule. Demographic data on gender, age, length of time living with diagnosis of HIV/AIDS, employment status, and religious affiliation were also collected. Spirituality was reported to be significantly correlated with purpose in life (r = .295, p = .049) but not with well-being (r = .261, p = .084). Additionally, the SIBS-R, PIL, and GWB had alpha coefficients greater than .83, suggesting they are reliable and valid measures for this population of HIV-positive persons. The result that spirituality and purpose in life were significantly correlated offers the potential for designing nursing interventions and care delivery approaches that support psychological adaptation to HIV. Further studies with larger and more diverse samples are needed to better understand the role of well-being in healing.

Spirituality, coping, and HIV risk and prevention in a sample of severely mentally ill Puerto Rican women

Hispanics have been disproportionately impacted by HIV/AIDS. Although HIV risk is significantly elevated among severely mentally ill persons (SMI), the risk of infection appears to be even greater among those SMI who are Hispanic, reflecting the increased risk of HIV among Hispanics. We report on findings from the first 41 participants in a qualitative study examining the context of HIV risk and risk reduction strategies among severely mentally ill Puerto Rican women residents in northeastern Ohio. Individuals participated in a baseline interview, two follow-up interviews, and up to 100 hours of shadowing. Interviews and shadowing activities were recorded and analyzed using a grounded theory. The majority of individuals reported using identification with a religious faith. A large proportion of the participants reported that their religious or spiritual beliefs were critical to their coping, had influenced them to reduce risk, and/or provided them with needed social support. Several participants also reported having experienced rejection from their faith communities. The emphasis on spirituality among Puerto Rican SMI is consistent with previous research demonstrating the importance of spirituality in the Hispanic culture and reliance on spiritual beliefs as a mean of coping among SMI. Our results support the incorporation of spiritual beliefs into secular HIV prevention efforts.

Religious beliefs, practices and treatment adherence among individuals with HIV in the southern United States

Nonadherence with medical treatment is a critical threat to the health of those living with HIV disease. Unfortunately the search for explanatory factors for nonadherence is still not fully developed, particularly in the area of religion and spirituality. Extant literature suggests that church attendance, religious practices and spiritual beliefs may improve health and generally benefit patients. However, religious beliefs may also play a negative role in treatment adherence due to the stigma attached to HIV disease, particularly in geographical areas and in population subgroups where religious practices are strong. In this exploratory study, HIV-positive individuals (n = 306) in a southern state were surveyed as to their attitudes and beliefs surrounding HIV disease and adherence with medical treatment for the disease. The results indicate that multiple factors influence adherence with treatment and that certain religious practices are positively associated with adherence, but certain religious beliefs are negatively related to adherence. The findings of this study reinforce the importance of remembering and addressing a patient's religious beliefs as a part of medical care.

An Exploration of Spirituality in Rural Women With Chronic Illness

The purpose of this study was to explore expressions of spirituality in rural women with chronic illness. Six categories that emerged were prayer, faith, verse, finding meaning, transcendence, and family. Results of this study were consistent with findings in previous literature that spirituality can be an extremely helpful and powerful coping mechanism that can be used in managing the stressors of a chronic illness. Spirituality is an important illness management tool that needs to be acknowledged by healthcare professionals.

Spiritual Nursing Care

Until recently, little attention has been given to spiritual dimensions in the nursing literature. This article reviews spiritual nursing care in the nursing literature, including basic concepts and current thoughts on spirituality-related research. In addition, it describes mechanisms that may be used to promote spiritual care and outlines the need to enhance research efforts in this vital area.

Toward a middle-range theory of adaptation to chronic pain

Merton postulated that to significantly advance disciplinary knowledge, scholarship must include the development of middle-range theories that derive hypotheses, can be empirically investigated, and are linked to extant theories. The purpose of this paper is to present the strategies used to develop a middle-range nursing theory of adaptation to chronic pain based on Merton's description. Analysis and synthesis of the theoretical and research literature provided the foundational, theory-building strategies used to develop the adaptation to chronic pain model. Theoretical substruction was then used to deduce the adaptation to chronic pain model from Roy's adaptation model.

Testing a predictive model of the use of HIV/AIDS symptom self-care strategies

Several types of self-care strategies have been reported by patients with HIV/AIDS to manage their HIV/AIDS related symptoms. However, little research has examined the factors influencing the use of different HIV symptom self-care strategies. This paper presents the results of testing a predictive model of the use of eight types of symptom self-care strategies: medications, complementary treatments, self-comforting, daily thoughts/activities, changing diet, help-seeking, exercise, and spiritual care. Logistic regression tests were used to examine the likelihood of using the eight types of symptom self-care strategies that were summarized and categorized from the questionnaires reported by patients with HIV/AIDS (n = 359). Sociodemographic variables (age, gender, race, education, injection drug use, insurance status, income status) and disease-related variables (taking antiretroviral medications, symptom intensity, symptom bothersomeness, impact of symptom on daily life) were selected as predictive variables. Logistic regression analysis demonstrated that race (white vs. non-white) was a significant predictor for the use of medications (odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.33-0.92), self-comforting (OR = 2.17, 95% CI = 1.24-3.79), help seeking (OR = 5.71, 95% CI = 2.57-12.70), and spiritual care (OR = 5.09, 95% CI = 1.81-14.30). In addition, symptom intensity significantly predicted the use of medications (OR = 1.22, 95% CI = 1.05-1.40) and gender significantly predicted the use of spiritual care (OR = 3.76, 95% CI = 1.71-8.25). Racial difference is the predominant predictor for the use of symptom self-care strategies. The cultural differences in the use of symptom self-care strategies should be considered in symptom management.

Beyond the metaphysical: health-promoting existential mechanisms and their impact on the health status of clients

This paper aims to conceptualize the issues that surround the notion of existential health. It also seeks to establish the impact that existential issues have upon the health of the individual client and how these might explicitly be applied in clinical practice settings. The ability of clients to draw upon their own existential resources as a fundamental part of their health care experience often goes unrecognized in nursing. Whilst existential mechanisms may be theoretically recognized, as a valid aspect of an individual's unique and personal identity, they are not an established part of the health care activity of nurses. Entrenched biomedical frameworks of care delivery and the interchangeable use of metaphysical health states with existential health states in the established literature present particular dilemmas for the acknowledgement of existential health in clients. A review of the literature has been conducted. This account argues that the failure to recognize and assess a client's existential health status represents a major omission on the part of the clinical nurse. These nurses are, in effect, denying their clients the right to exercise and mobilize an important and valuable health resource.

Adjustment, spirituality, and health in women on hemodialysis

End stage renal disease (ESRD) is progressive, requiring adjustment. This descriptive correlational study examined levels of and relationships between adjustment, spiritual well-being, and self-perceived health in women with ESRD. The sample included 65 women aged 24 to 82 receiving hemodialysis at five outpatient centers in a large metropolitan area. Frequencies, central tendencies, and correlations were used for analyses. Overall, these women were fairly well adjusted as measured by the Psychosocial Adjustment to Illness Scale-Self-Report. They demonstrated fairly high levels of religious, existential, and overall spiritual well-being. Self-perceived health was good Spiritual well-being variables were all positively and significantly related to overall psychosocial adjustment and psychological distress adjustment. Self-perceived health variables were all positively and significantly related to overall psychosocial adjustment. Few significant relationships were found between spiritual well-being and other adjustment domains and between self-perceived health and other types of adjustment.

Spiritual pain: a comparison of findings from survivors and hospice patients

The article presents comparative research findings on the notion of "spiritual pain." The findings from interviews with hospice patients affirm the previously published, preliminary conceptualization of spiritual pain from interviews with survivors. However, while the survivor findings highlight the potential for spiritual pain associated with life after high-tech curative treatment, the hospice patient data emphasize the protectiveness of the hospice experience for deflecting the possibility of spiritual pain. It is anticipated the discussion of comparative findings will affirm the importance of researching this "ignored dimension" and, in so doing, will enrich our understanding of the spiritual dimension of healthcare. The work is part of a program presently developing a language of spirituality through research.

Spiritual issues and quality of life assessment in cancer care

Being diagnosed with cancer forces most human beings to face their own death. The comfortable sense of both invulnerability and immortality is shattered, making the patient thoroughly aware that life is finite and limited. Approaching death, cancer patients commonly embark on an inner journey involving a search for meaning as well as a reordering of priorities involving physical, psychological, social, and spiritual needs. Although interest in the role of spirituality, relating to both adjustment to cancer and the overall quality of life of cancer patients, has increased in recent years, most of the commonly used quality of life (QOL) instruments in oncology typically do not include spiritual issues. In this article, it is argued that assessing QOL effectively should involve all aspects of the personality, including mind, body, and spirit as well. This article also reviews recent studies, which have shown that spiritual well-being, although a many-sided and difficult construct to define, is closely related to the QOL of cancer patients. It is also suggested that further research is needed to understand how the new focus on spirituality can contribute to a more comprehensive assessment of patient's QOL in cancer care.

Spirituality and HIV disease: an integrated perspective

Spirituality is an important resource that individuals use to cope with a chronic illness such as HIV disease. Spirituality has both a religious and an existential component that share the concepts of meaning in life, hope, self-transcendence, and rituals. An integrated perspective utilizing these shared concepts is proposed to assist HIV-positive individuals in coping with the challenges of their disease. Nursing interventions include promoting hope, teaching, sharing information, and creating a sense of empowerment in people with HIV to address spiritual issues. The article concludes with a case study that emphasizes application of the integrated perspective of spirituality with an HIV-positive person.

Dyspnea self-management in African Americans with chronic lung disease

PURPOSE

To explore dyspnea self-management in African Americans with chronic obstructive pulmonary disease (COPD) or chronic restrictive pulmonary disease resulting from sarcoidosis.

DESIGN

Descriptive.

SAMPLE

Convenience sample of 29 African Americans, 15 with COPD (forced expiratory volume in 1 second/forced vital capacity = 53%), and 14 with sarcoidosis (forced expiratory volume in 1 second/forced vital capacity = 88%; total lung capacity 62.4% of predicted).

METHODS

Semistructured interviews.

FINDINGS

Content analysis revealed 4 dyspnea self-management themes: (1) traditional medical care, (2) self-care wisdom, (3) self-care action, and (4) self-care resources. Breathing strategies (a subtheme for self-care action) for patients with COPD focused on both inhalation and exhalation, whereas patients with sarcoidosis described inhalation breathing strategies only.

CONCLUSION

African Americans with chronic lung disease described use of different breathing strategies for COPD and sarcoidosis disorders. Both groups actively engaged in health-promoting activities for dyspnea management.