Characteristics of spirituality in the lives of women in a rural Appalachian community

"Turn It over to God": Faith Enhances Mental Health of Rural Appalachian Older Adults

In Appalachia, rates of depression and suicidality are higher than national averages. Additional disparities of age, geographic isolation, economic distress, and mental healthcare provider shortages contribute to mental health challenges among rural Appalachian older adults (RAOAs). Based on ethnonursing research in East Tennessee, this article expands on findings about how RAOA faith beliefs and practices enhance mental health. Faith was found to decrease worry, improve coping, facilitate a sense of peace, and deepen thankfulness and joy. Implications for nursing practice and education indicate the importance of providing spiritual care to promote mental health and well-being for this vulnerable population.

Influence of Spiritual Engagement on Appalachian Older Adults' Health: A Systematic Review

Appalachia leads the country in mortality related to chronic comorbidities, such as heart disease, cancer, depression, and suicide. Appalachian older adults experience disproportionate risks for poor health outcomes. Spirituality is integral to Appalachian culture, and many older adults use spiritual engagement (SE) to cope with health challenges. Despite these connections, there is limited evidence about SE and well-being in this population. Therefore, the current systematic review addresses the literature gap of how SE influences health of Appalachian older adults. Using thematic synthesis, we analyzed 11 qualitative and three mixed methods studies. Major findings indicate that SE positively impacts holistic health through adaptive coping, guided partnerships with God, decreased loneliness, and enhanced sense of purpose. Future studies could examine SE practices among diverse populations, SE virtual experiences, and SE nursing assessments. Understanding how SE influences health of Appalachian older adults could prepare nurses to reduce disparities and improve health outcomes for this vulnerable population. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 45-52.].

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.

An Integrative Review of the Concept of Spirituality in the Health Sciences

Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. The purpose of this study was to explore how research on the concept of spirituality has been reported in the health literature in the past decade and develop an ontological and theoretical understanding of spirituality. The examination was based on quantitative and qualitative integrative review approaches, which integrated empirical research on spirituality. The sample included 73 spirituality research articles, which were published in English between January 1990 and September 2000. An electronic data-collection tool was designed for use in this project and formatted using Excel software for transfer of codeddata into the NVivo software for the data analysis. The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality. Historical comparison among decades and barriers in researching spirituality are discussed.

Lived Experience of Spirituality in Taiwanese Women with Breast Cancer

This study explored spirituality as a lived experience through in-depth, face-to-face interviews of 15 Taiwanese women with breast cancer. A Phenomenological research method was employed to guide the study. Four main themes and 12 subthemes, conceptualized under a meta-theme of hsin, emerged as characteristic of the current “lifeworlds” of the study participants. Interpretation of the findings revealed that spirituality is a journey and a unidirectional evolving process that the participants experienced at different levels of wholeness and integration. Spirituality in Taiwan not only must be seen as metaphysics but also should be approached in the cultural context of patients. Nurses should attend to each patient as a unique person, focus on “here-and-now” encounters, and help their patients transform and evolve to a higher plane of wholeness and integration. Nurses should, as well, nurture and support their own spirituality to be available healing resources for others.

A Qualitative Descriptive Study of Spirituality Guided by the Neuman Systems Model

The purposes of this qualitative descriptive study were to explore the meaning of spirituality as described by aging adults in various states of health, to describe the relationship between spirituality and health, and to explain client expectations for healthcare providers related to spirituality. All identified meanings and themes were compared to the characteristics of spirituality proposed by Betty Neuman in the Neuman systems model to determine the credibility of the model for assessing and guiding holistic nursing practice. Three themes were formulated: a) Spirituality is an individual, conscious, committed connection to God, requiring a human response; b) positive spirituality contributes to personal wholeness and health; and c) spirituality sustains and comforts in times of stress.

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

Different concepts have been presented which denote driving forces and strengths that contribute to a person's ability to meet and handle adversities, and keep or regain health. The aim of this study, which is a part of The Umeå 85+ study, was to describe resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health in a sample of the oldest old. The study sample consisted of 125 participants 85 years of age or older, who ranked themselves on the Resilience Scale, Sense of Coherence Scale, Purpose in Life Scale and Self-Transcendence Scale and answered the SF-36 Health Survey questionnaire. The findings showed significant correlations between scores on the Resilience Scale, the Sense of Coherence Scale, the Purpose in Life Test, and the Self-Transcendence Scale. Significant correlations were also found between these scales and the SF-36 Mental Health Summary among women but not among men. There was no significant correlation between perceived physical and mental health. The mean values of the different scales showed that the oldest old have the same or higher scores than younger age groups. Regression analyses also revealed sex differences regarding mental health. The conclusions are that, the correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults. Another conclusion is that the dimensions that constitute mental health differ between women and men.

Exploring the meaning of spirituality with aging adults in Appalachia

This phenomenological study explored the meaning of spirituality in the lives of aging adults in Appalachia. Forty adult volunteers in varying states of health ranging in age from 59 to 94 years participated in focus groups. Through open-ended questions, respondents described their perceptions of spirituality, spirituality, and health, and the role of spirituality in helping them cope. Themes that emerged from the data were a conviction that God exists and acts in the lives of persons, calls them to action, and is a source of connection in times of loss. Spirituality positively affects attitude, particularly as health declines. Respondents expected respectful and empathic health care providers who would meet their physical needs and be concerned about their spiritual needs. Spirituality was of paramount importance in the lives of these elders; thus, health care providers must consciously include spirituality in assessments and interventions. Nursing curricula must prepare students to provide spiritual care.

Nursing the spirit: the Framework of Systemic Organization

AIMS

To elucidate the concept of spirituality as an essential and integrated dimension of the functioning of individuals and families through the Framework of Systemic Organization (Friedemann 1995) and to demonstrate with a case example, how a nurse can integrate spirituality in the care of a terminally ill patient.

BACKGROUND

Spirituality is the focus of discussion in nursing and other health professions in the United States of America, but whether or not it should be generally included in patient care is heavily debated. Also unanswered is the question about how spirituality should be addressed. The Framework of Systemic Organization (Friedemann 1995) is introduced here as an organizing structure to guide nurses in caring for the spiritual needs of patients. IMPLEMENTATION OF THE THEORETICAL FRAMEWORK: Spirituality is defined as connecting to systems such as God, nature or other people, and thus finding meaning through relationships. Key to spiritual care is the establishment of a balance between control and spirituality that is tailored to an individual patient's history, values and needs. A case example is used to show how a nurse intervenes with a patient who faces death.

FINDINGS

The example shows that control remains important in a patient's life process until death arrives. Nevertheless, a dying patient benefits from an increasing focus on spirituality to gain self-acceptance, reconciliation with the family and restoration of emotional health. Nurses are instrumental in finding the balance between control and spirituality that a patient desires.

CONCLUSION

Nurses who have explored and reconciled their own spiritual beliefs can learn to address their patients' unique needs within the broad context of family and environment. Nursing the spirit by using the Framework of Systemic Organization is a client-directed and intimate process that leads to growth of both patient and nurse.

The personal and professional impact of undertaking an educational module on human caring

AIM OF THE STUDY

To evaluate the personal and professional impact of undertaking a 15-week degree level module on nursing as human caring.

BACKGROUND

Little is known about how to teach and enhance caring practices. An innovative module was implemented on a 4-year, postregistration nursing degree course in Wales to develop students' capacity to be caring practitioners. An understanding of its impact was sought to facilitate better future preparation of students.

RESEARCH METHODS

A full cohort of 25 part-time students, divided into four groups, participated in audio-taped focus groups before and after undertaking the module.

FINDINGS

From a personal perspective, the students experienced increased spiritual awareness characterized by: (1) enhanced connecting relationships with self and others, (2) finding purpose and meaning in life, and (3) clarification of values. Professionally, the module resulted in: (1) an increased knowledge and understanding of caring theory and related concepts, (2) a more holistic approach to care, and (3) enhanced caring practice.

CONCLUSIONS

Education may enhance students' capacity to be caring practitioners. Spirituality, in particular, was illuminated for the students as an important means of developing both themselves and their caring practices. They experienced transformative learning, and the focus groups, employed as the research method, served as a useful vehicle in this process. Reflective groups will be used as a teaching method on future modules.

The spiritual care meanings of adults residing in the midwest

Only limited nursing knowledge exists as theoretical guidance for nurses in providing spiritual care. Using Leininger's theory of culture care diversity and universality, the purpose of this ethnonursing research study was to discover the embedded spiritual care meanings, expressions, lived experiences, and practices of adults residing in the Midwest and their perceptions of spiritual nursing care. Data were collected through interviews of 6 key and 12 general informants. Five universal spiritual themes were supported by the findings. Culture care modes were used to explicate spiritual knowledge that can be integrated into nursing practice.

Spiritual resources of Chinese immigrants with breast cancer in the USA

A synthesis of ethnographic and phenomenological research approaches was used to investigate spiritual resource as the lived experience of Chinese immigrants with breast cancer in the US. The assumptions for the phenomena in this study were based upon Tu's cultural China and Confucian spirituality, as well as van Manen's phenomenological perspectives and Kleinman's ethnographic works. Fifteen Chinese immigrants with breast cancer in the US were recruited. The results reveal six cultural themes including family closeness, traditional Chinese values, religion, alternative therapy, art, prose and literature and Chinese support groups.

The essential elements of spirituality among rural Thai elders

The purpose of the study reported here was to understand and describe the essential elements of spirituality among rural Thai elders. The research question that guided the study was: How do rural Thai elders experience and describe spirituality in their daily lives? This question was explored through in-depth, audio-taped, face-to-face interviews with 12 rural Thai elders living in the Nakhorn Prathom Province in the central part of Thailand during the period from January to March 1998. Prior to implementing the study, approval to conduct this study was granted from the Institutional Review Broad of the University of Alabama at Birmingham. Through the process of hermeneutic phenomenological data analysis, three categories and nine themes emerged. The findings of the study provide a knowledge base for Thai nurses to explore and explain spirituality to enhance nursing science and provide holistic nursing care. Further research should be conducted throughout the health and illness continuum with all age groups and with individuals of different cultures and belief systems.

The health care meanings, values, and practices of Anglo-American males in the rural midwest

Limited nursing knowledge exists to explain how culture influences men's health care decisions and practices. The purpose of this collaborative research was to explore the health care meanings, values, expressions, lived experiences, and practices of Anglo-American adult males residing in the rural Midwest. Using the ethnonursing research method, data were collected through interviews with 7 key and 12 general informants residing in Iowa. Four culture values and five themes were supported by the findings. Leininger's culture care modes were used to explicate culturally meaningful nursing care actions and decisions that are in harmony with the cultural values and practices of rural men.

Coping with breast cancer in later life: the role of religious faith

PURPOSE

To identify and examine religious and spiritual coping strategies among elderly women with newly diagnosed breast cancer.

METHODS

A convenience sample of 33 women age 65 years was recruited within 6 months of diagnosis. Respondents participated in a structured interview with open-ended questions. Transcripts of the interviews were analysed independently by three researchers and themes were discussed until consensus was reached.

RESULTS

Participants' religious background was varied: 17 Protestant, five Catholic, six Jews, and four Other. There was great variation in the frequency of religious service attendance. Religious and/or spiritual belief either increased or stayed the same during the time of health crisis. Analysis of transcripts revealed three themes. Religious and spiritual faith provided respondents with the emotional support necessary to deal with their breast cancer (91%), with social support (70%), and with the ability to make meaning in their everyday life, particularly during their cancer experience (64%).

CONCLUSIONS

Religious and spiritual faith provides elderly women newly diagnosed with breast cancer with important tools for coping with their illness and should be recognized by diagnosing physicians. It may be important to encourage these patients to seek religious support and/or to reconnect with their religious community.

Spirituality in the lives of older women

Little is known about the importance of spirituality in the older women. This study explores the role of spiritual in the lives of women 70 years of age and older. A convenience sample of 56 respondents responded to the JAREL Spiritual Well-Being Scale and a demographic data questionnaire. Using an analysis of variance, significance was found for those who did not attend school beyond high school and those who did. There were difference between Catholics and Protestants on the Faith Belief Dimension factor and the total spirituality score.

Spirituality and chronic illness

PURPOSE

To present a comprehensive overview of spirituality and identify strategies to support the spiritual dimensions of nursing care for people with chronic illness, focusing specifically on HIV-related illness and AIDS.

SIGNIFICANCE AND SCOPE

The AIDS crisis has brought new emphasis to the need to develop therapeutic interventions to support the coping resources of people living and dying with chronic illness. Conceptual, theoretical, and empirical knowledge related to spirituality was reviewed, integrated, and interpreted within the context of nursing care for this population, emphasizing the spiritual needs of people with HIV-related illness and AIDS.

CONCLUSIONS AND IMPLICATIONS

Spirituality has evolved beyond religious considerations to encompass multidimensional and existential perspectives that are integral to maintaining well-being for the chronically ill. A deeper understanding of spirituality enhances the potential for nurses to identify spiritual needs and incorporate spiritual caring into practice.

A review of prayer within the role of the holistic nurse

Prayer is an integral component of the spiritual life of mankind. It is a two-way dialogue with God. Clients in crisis may need prayer for encouragement, comfort, and support. Holistic nurses may use prayer with clients to positively influence how they cope with anxiety relative to illness. Addressing the spiritual needs of clients is an important element of care and the use of prayer is supported by both informal client responses and scientific research. Additionally, the active use of prayer may provide added value and enrichment to the holistic nurse-client interaction.

Reawakening spirit in clinical practice

This article describes processes for incorporating spirituality into clinical nursing practice. Spirituality is viewed as a unifying force manifested in the Self, which is expressed and experienced in the context of caring connections with oneself, others, nature, and God/life force. Spirituality relates to an inner knowing and source of strength reflected in one's being, one's knowing, and one's doing. The nurse's intentional, caring presence with clients makes possible the speaking and hearing of spiritual concerns. Such concerns are revealed in the context of one's life story. Nurturing the nurse's own spirit is essential for responding to the spirit in any interaction. Nurses frequently deal with issues of spirituality but may not label them as such. This article suggests processes through which nurses may more clearly identify spiritual issues. Spirit is understood to be both the source of and a manifestation of one's spirituality. By reawakening spirit in clinical practice, nurses will be more effective providers of holistic nursing care.