Insights on spirituality and bereavement: A systematic review of qualitative studies

AIM

To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies.

DESIGN

A systematic review of qualitative studies.

DATA SOURCE

A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review.

METHODS

A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology.

REPORTING METHOD

PRISMA checklist.

RESULTS

The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome.

CONCLUSION

In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement.

IMPLICATIONS

The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement.

NO PATIENT OR PUBLIC CONTRIBUTION

This is a systematic review.

"Impaired Resilience (00210)" in patients under fertility treatment: Clinical validation study

PURPOSE

The aim of this study was a clinical validation of the NANDA-I nursing diagnosis "Impaired Resilience (00210)" in people under fertility treatment and determination of the sensitivity, specificity, and predictive value of the defining characteristics.

METHODS

A cross-sectional study was conducted between September 2019 and June 2020. A total of 104 patients were recruited through fertility-related websites, and they answered an online questionnaire after giving informed consent. The Rasch model was used for statistical analysis. The study was approved by the Ethics Committee.

FINDINGS

The "Impaired Resilience (00210)" had a prevalence of 15.4% in the sample, and seven defining characteristics confirmed as representative are "decreased interest in vocational activities," "depression," "impaired health status," "ineffective coping strategies," "low self-esteem," "renewed elevation of distress," and "social isolation." No item showed differential item functioning. "Renewed elevation of distress" and "low self-esteem" were the most sensitive defining characteristics and had the highest negative predictive value. "Shame" was the most specific one.

CONCLUSIONS

The nursing diagnosis "Impaired Resilience (00210)" was validated, and results may improve its accuracy in people going through fertility treatment.

IMPLICATIONS FOR NURSING PRACTICE

This paper contributes by raising knowledge regarding NANDA-I nursing diagnosis and enhancing the quality of nurses' critical judgment and clinical reasoning. A more effective assessment will allow early recognition of patients struggling with adversity during fertility treatment and enhance a nursing resilience approach in the reproductive field.

“Spiritual distress (00060)” in patients under fertility treatment: Clinical validation study

PURPOSE

This study aimed to clinically validate the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in people under assisted reproductive technologies, and to determine the sensitivity, specificity, and predictive value of the defining characteristics.

METHODS

Cross-sectional study that was conducted between September 2019 and June 2020. Recruitment happened by invitation posted in fertility-related websites. Those who accepted to participate were asked to fill the consent form and the online questionnaire. Statistical analysis was based on Rasch's model. The study was approved by the Ethics Committee.

FINDINGS

The sample comprised 104 Portuguese individuals undergoing assisted reproductive techniques. The "Spiritual distress (00066)" was validated and 22 defining characteristics were confirmed as representative. No item showed differential item functioning. "Perceived suffering" was the most sensitive defining characteristic and had the highest negative predictive value. "Insufficient courage" had the highest positive predictive value, and "Anger toward power greater than self" was the most specific.

CONCLUSIONS

Results validated the presence of the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in a sample going through assisted reproductive technologies, improving accuracy of this nursing diagnosis in such population.

IMPLICATIONS FOR NURSING PRACTICE

This is a crucial step to raise the level of evidence of such nursing diagnosis and to increase the level of evidence on NANDA-I terminology. Furthermore, this study has contributed to raising the quality of nurse's critical judgement and clinical reasoning and allow an early spiritual and a more holistic and personalized patient-centered intervention in the reproductive field.

The Resilience Scale in Portuguese Adults under Assisted Reproductive Techniques

Assessing resilience response to an adverse event such as infertility requires measuring the same construct adequately and accurately by nurses. The objective of this study was to explore the validity and reliability of the Portuguese version of the Resilience Scale for adults. A cross-sectional and methodological design was used, and factor analyses were performed. The sample comprised 140 adult Portuguese individuals under fertility treatment recruited from health-related websites. The findings yielded a bad fit of the hypothesized Resilience Scale structure with the observed data. Instead, a 21-item tool with a four-factor structure revealed high internal consistency (0.94). The tool correlated positively and significantly to the Portuguese version of the Spiritual Well-Being Questionnaire and was negatively associated and lacked correlation with the Fertility Adjustment Scale. The 21-item Resilience Scale is a reliable tool suitable to measure resilience in Portuguese adults under assisted reproductive techniques. This tool offers the opportunity of early recognition by health professionals aiming to enhance patients’ coping skills effectively and promote positive psychological and mental health outcomes.

Nursing diagnoses: what about NANDA-I syndromes?

AIM

The aim of this paper is to propose a label structure for nursing diagnosis syndromes from NANDA-I.

BACKGROUND

Worldwide changes and human needs seem to get more complex, offering challenging opportunities for nursing care and to nursing knowledge. Nursing classifications represent nursing knowledge and are critical in guiding clinical practice and patient-centred care.

SOURCES OF EVIDENCE

This discussion paper is based on the analysis of NANDA-I Taxonomy II and related literature.

DISCUSSION/CONCLUSION

A total of 13 diagnoses comprise the term 'syndrome'; however, the labels are not consistent with the multiaxial system within the NANDA-I model of a nursing diagnosis. Syndromes require a more specific approach and definition when compared to other type of nursing diagnoses. A new format for describing the label is provided and would be useful in improving current syndromes and in reflecting a more individualized and patient-centred nursing care.

IMPLICATIONS FOR NURSING POLICY AND PRACTICE

The proposal provided in this paper could raise the quality of nurses' assessment, increase accuracy of NANDA-I nursing diagnoses, promote nurses' clinical reasoning and the adequacy of care. Ultimately, changes should be not only perceived in nurses´ practice but also in nursing education as curricula should promote a critical thinking. Nurse leaders and policymakers could additionally use this in the development of advanced programmes and protocols that could manage and monitorize implementation of advanced care.

The therapeutic dimension of research about spirituality: Particularities of cancer, mental health and infertility

Healthcare is moving from a biomedical paradigm into a holistic paradigm, which includes all dimensions and needs of patients and families. Health conditions may trigger a spiritual journey for believers or non-believers bringing to light the nature of the human being and its vulnerable condition. Healthcare professionals are full participants in this life and health scenario and have an unquestionable duty related to the provision of spiritual care, on the basis of legislation, ethical codes, and on research evidence. Researchers are seizing better and broader knowledge about spirituality in healthcare, and research about this phenomenon is growing internationally. But, spirituality is considered complex, an area of intimacy and deep subjective meaning. These factors may raise some ethical concerns when submitting research projects to the ethics committees. In this paper, the authors share their experience in research about spirituality in the beginning of life issues/infertility and with adults with severe health conditions, and describe participants' perspectives on research engagement.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review

OBJECTIVE

To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I.

METHODS

Systematic review of qualitative nursing studies.

FINDINGS

A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience.

CONCLUSIONS

Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis.

IMPLICATIONS FOR PRACTICE

The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

"Call for the Use of Axial Terms": Toward Completeness of NANDA-I Nursing Diagnoses Labels

PURPOSE

This article explores the current structure of NANDA-I nursing diagnoses (ND) labels.

METHODS

Critical analysis of the ND labels, as categorized in the NANDA-I terminology.

FINDINGS

Most of the 244 ND labels are composed of terms from the focus and judgment axes.

CONCLUSIONS

The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II.

IMPLICATIONS FOR NURSING PRACTICE

Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care.

OBJETIVO

Este artigo explora os títulos dos diagnósticos de enfermagem da NANDA-I. MÉTODOS: Análise crítica dos títulos dos diagnósticos de enfermagem da NANDA-I.

RESULTADOS

A maioria dos 244 diagnósticos de enfermagem classificados são compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSÕES: A especificidade das respostas às transições de saúde e vida pode não estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICAÇÕES PARA A PRÁTICA: Melhorias nos diagnósticos da NANDA-I em relação ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acurácia do processo diagnóstico que é necessário à prática clínica. Complementar os títulos dos diagnósticos de enfermagem poderia refletir a acurácia do raciocínio clínico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.