ArticlePDF AvailableLiterature Review

The spiritual dimension: its importance to patients' health, well-being and quality of life and its implications for nursing practice

Authors:

Abstract

The spiritual dimension is described and is interpreted as the need for: meaning, purpose and fulfillment in life; hope/will to live; belief and faith. As the spiritual dimension is important for the attainment of an overall sense of health, well-being and quality of life (referred to as the health potential) and as illness and hospitalisation can precipitate spiritual distress, patients' spiritual needs should be addressed. The nurse's role in spiritual care is discussed with reference to the nursing literature.
Pergamon
hr. J. Nurs. Srud., Vol. 32, No. 5, pp. 457 468, 1995
Copyright Q 1995 Elsevier Science Ltd
Prmted m Great Britain. All rights reserved
002&7489/95 S9.50f0.00
0020-7489(95)000074
The spiritual dimension: its
importance to patients’ health,
well-being and quality of life and its
implications for nursing practice
L. ROSS (n&e WAUGH), B.A., R.G.N., Ph.D.
Research Fellobv, Department cf Management and Social Sciences, Queen Margaret College, Cierwood Terrace,
Edinburgh EHl2 8TS, U.K.
Abstract-The spiritual dimension is described and is interpreted as the need
for: meaning, purpose and fulfilment in life; hope/will to live; belief and faith.
As the spiritual dimension is important for the attainment of an overall sense
of health, well-being and quality of life (referred to as the health potential) and
as illness and hospitalisation can precipitate spiritual distress, patients’ spiritual
needs should be addressed. The nurse’s role in spiritual care is discussed with
reference to the nursing literature.
Introduction
The author’s interest in the subject of spiritual care was stimulated following an encounter
with a terminally ill patient. Having been asked if she would like a passage read to her from
the Bible lying on her locker, the change in this woman’s expression was remarkable.
Instead of lying sleeping, or staring blankly into space, her eyes widened, she strained to
raise her head, smiled and attempted to speak for the first time in several months. Later,
just before she died, she expressed how much this, together with prayer, had meant to her.
She had a spiritual need which she wanted to be met. This profound and moving experience
suggested to the author that the spiritual dimension could have a considerable influence on
a patient’s quality of life. It was with the desire to discover more about the relationship
451
458 L. ROSS
between the spiritual dimension and the individual’s health potential that the literature was
reviewed and a doctoral study conducted.
Description and definition of the spiritual dimension
The need for spiritual integrity is a basic human need (O’Brien, 1982). Chambers dic-
tionary defines the “spirit” as: the vital principle; the soul; a breath of wind; essence; chief
quality; that which gives real meaning (MacDonald, 1972). In the nursing literature, the
spiritual dimension is described in a multiplicity of ways:
l
it strives for meaning and purpose in existence (Dickinson, 1975; Henderson, 1973;
Piepgras, 1973; Travelbee, 1971);
l
it strives for transcendence beyond the here and now in search of some higher power or
God (however defined by the individual)/something greater than self (Fish and Shelly,
1978; Henderson and Nite, 1978; Martin and Carlson, 1988; O’Brien, 1982; Stallwood-
Hess, 1969);
l
it inspires, motivates and hopes, directing the individual toward the values of love, truth,
beauty, trust and creativity (Dickinson, 1975; O’Brien, 1982; Stall, 1979; Travelbee,
1971).
From the above definitions, the spiritual dimension would appear to be a complex phenom-
enon. It has been regarded as the central “artery” which permeates, energises and enlivens
all other dimensions of an individual and around which all values, thoughts, decisions,
behaviours, experiences and ultimate concerns are centred (Brewer, 1979). As such it has
been described as the mainstream of life (Dickinson, 1975; Stoll, 1979; Yura and Walsh,
1982) and it has been suggested that without spiritual well-being the other dimensions, i.e.
the biopsychosocial, can never function or be developed to their fullest capacity and hence
the highest quality of life is unattainable.
From the descriptions and definitions given it would appear that the spiritual dimension
is a dual concept consisting of both vertical and horizontal elements. The vertical element
could be considered to encompass the transcendental, i.e. the individual’s relationship with
a power beyond self (referred to hereafter as “God”) or the individual’s value system. The
horizontal element could be thought of as an outworking of the vertical in the individual’s
lifestyle and relationships with self, others and environment.
The definition which probably best captures and summarises the spiritual dimension is
that of Renetzky (1979) who defines it in terms of its three component parts namely:
(1) the “power within man” giving “meaning, purpose and fulfillment” to life, suffering
and death;
(2) the individual’s “will to live”;
(3) the individual’s belief and faith in self, others and God.
Evidence for the influence of the spiritual dimension on the health potential
Support for the influence of the spiritual dimension on the individual’s health potential
is presented by considering each component of the spiritual dimension in turn, as defined
above.
THE SPIRITUAL DIMENSION 459
Meaning and purpose
According to Yura and Walsh (1982, p. 90):
“the greatest task of human kind is to determine the meaning of life”
Other authors (Autton, 1980; Colliton, 1981; Frankl, 1959) regard search for meaning
as a universal trait which is essential to life itself. Jung and Peck (McClymont et al., 1986)
postulate, respectively, that meaning is necessary for the maintenance of ego integrity and
for the prevention of restlessness and deterioration in old age. According to Burnard (1989)
and Frank1 (1959), spiritual distress results when there is an inability to invest life with
meaning and is characterised by feelings of emptiness and despair. Research studies also
highlight the importance of meaning in life for health and well-being.
Simsen (1985) found that medical and surgical patients demonstrated a need to find
meaning in their illness and hospitalisation. Kobasa (Martin and Carlson, 1988) reported
fewer negative stress symptoms in individuals who were committed to and found meaning
in their work, and Antonovsky (1979) and Frank1 (1959) reported survival, minimal
psychological damage and even strengthening of character in holocaust victims who had
managed to maintain a sense of meaning and purpose in their lives throughout their
ordeal. Furthermore, out of 1000 cases in his clinical experience (he does not detail the
selection of the sample), Renetzky (1979) found that as the degree of meaning, purpose
and fulfilment increased, so did the role of religion and the degree of healthy self love. A
decrease in the “void” (sense of emptiness) equated with an increase in spiritual well-being.
Will to lire
The will to live and hope are closely linked. Hope has been regarded as a major motivator
of behaviour, acting as a powerful life force, producing vitality and liveliness in life (Dubree
and Vogelpohl, 1980). There is considerable documented evidence that without hope, death
can result. For example, both animal and human studies show that prolonged and repeated
exposure to events which are not life threatening but are unavoidable, and over which the
individual has no control, produces helplessness/hopelessness. The end product of this is
frequently death. Such instances include voodoo death and concentration camp experiences
(Frankl, 1959; Seligman, 1974). It is because of its often drastic effects that helplessness/
hopelessness has been appropriately termed as “passive suicide” (Limandri and Boyle,
1978, p. 79).
The importance of hope to life can be seen, not only in death caused by its absence, but
also in healing produced by its presence. Evidence for the positive effects of hope has been
observed by clinicians. Both Renetzky (1979) and Swaim (1962) reported that the greater
the will to live, the greater the chance their clients had of overcoming illness.
A different type of evidence which reports non-verifiable events illustrates the positive
effects of hope. For example, Gardner (1983) and Tari (1978) document numerous instances
of miraculous events such as healing of the deaf and blind and raising of the dead, where
hope and also faith in God were central.
Beliqfund,faith in sev, others and God
Renetzky (1979) reported his observation over 30 years working as a sociologist that the
will to live and the degree of meaning, purpose and fulfilment were increased significantly
when belief in God existed. Renetzky (1979) concluded that the factor above all else which
460 L. ROSS
appeared to influence the individual’s spiritual well-being, and hence their state of health
and quality of life, was belief in God.
Other studies have indicated the influence of belief and faith on health. O’Brien (1982)
noted that patients who possessed a positive religious perspective on life adapted more
readily to the stress of haemodialysis. Martin and Carlson (1988) reported the findings of
two studies which indicated the therapeutic effect of faith in reducing pulmonary oedema,
need for antibiotic therapy and intubation. However, Martin and Carlson (1988) questioned
these findings given the biased samples used and absence of tests to determine statistical
significance. Although further research would be helpful to test these observations, it would
appear that the optimum health potential can be attained when meaning, purpose and
fulfilment in life, a will to live and belief and faith in self, others and God exist.
Illness and hospitalisation as spiritual encounters
Healthy people can initiate action to meet their own spiritual needs. Illness and/or
hospitalisation may, however, prevent individuals from having their spiritual needs met or
fully met and may, therefore, prevent them from obtaining their optimum health potential
(Fig. 1). It may be that the experience of illness/hospitalisation causes some people to face
loss of control for the first time in their life. As Granstrom (1985, p. 42) stated:
1. When a healthy individual feels in
control of his/her life, h&he may
not be forced to seek meaning
beyond self, therefore, in the event
of illness
forced to real& that he/she is not
in total control of his/her life
i
motivated to seek a centre of
control outside self (i.e. God).
Less likelihood of spiritual
needs being fulfilled.
3.
An individual who has a centre of
control outside self (i.e. God) may
be caused to question his/her
nlationship with God because of
the experience of physical illness.
4. Hospitalisation and the experience
of physical illness will mean that
the= are likely to be fewer
resources available to the
individual from which hir
spiritual needs can be satisfied,
e.g. s/he will be physically unable
to attend church etc.
1
May feel isolated from normal
support system and therefore
vulnerable
1
Less
likelihood of spiritual need
being fulfiied. I
I Spiritual need -
1
Increased chance of expetiencing spiritual distress
1
Adverse effects on overall state of health
(Fish and Shelly. 1978. McGilloway & Donaolly. 1977)
Fig. 1. Ways in which illness and/or hospitalisation can precipitate spiritual distress.
THE SPIRITUAL DIMENSION 461
“Many individuals do not seriously search for the meaning and purpose of life but live as if life will
go on for ever...Often it is not until the crisis, illness...or suffering occurs that the illusion (of security)
is shattered...Therefore, illness, suffering... and ultimately death, by their very nature become
spiritual encounters as well as physical and emotional experiences.”
For many patients, therefore, spiritual care will be a necessary part of their total care.
This raises the question of the nurse’s role in spiritual care.
The nurse’s role in spiritual care
Florence Nightingale, a pioneer in the emergence of nursing, considered that:
“the sick body is something more than a reservoir for storing medicines.” (Kramer, 1957, p.36)
In addition to caring for patients’ physical needs she described nursing as a “fine art”
dealing with:
“the living body--the temple of God’s spirit”. (Colliton, 1981, p. 492)
Nursing has its origins in religious orders where the body and spirit were cared for
together. About a century ago, however, the importance attributed to the spiritual dimen-
sion was to change, the philosophy of care moving away from a holistic to a dualistic
approach. Care of the individual’s spirit and body gradually separated, the latter increasing
in importance while the former declined (Penrose and Barret, 1982).
Despite evidence of attempts to rediscover holism, e.g. complementary therapies, nursing
remains dominated by the medical model which concentrates on the disease process with
medical and surgical treatments. In a climate where the medical model is prevalent, two
questions arise:
(1) Are patients’ spiritual needs given due attention?
(2) Should spiritual care be part of the nurse’s role?
In an attempt to answer question (I), some of the literature on spiritual care is explored.
Question (2) can only be answered by recourse to definitions of nursing, codes of conduct,
models of nursing and guidelines for nurse education.
Are patients’ spiritual needs given due attention?
Nursing texts devoted to or incorporating spiritual care of the patient tend to agree that
nurses should be giving spiritual care; however, in many of the texts, operational definitions
of “spiritual” and “spiritual need” are lacking as are guidelines for the practice of spiritual
care (Beland and Passos, 1975; Carson, 1989; Fish and Shelly, 1978; Henderson and Nite,
1978; McGilloway and Myco, 1985; Murray and Zentner, 1975; Narayanasamy, 1991;
Shelly and John, 1983).
Nursing research on spiritual care is very much in its infancy. The ability to generalise
findings to Britain is limited by the fact that the majority of studies are American in origin.
Only two British studies were identified (Chomicz, 1984; Simsen, 1985). In addition to the
fact that many of these studies are now rather outdated, most researchers used small
samples of convenience and tools which had not been tested for reliability or validity.
Moreover, comparison between studies is made difficult by the fact that operational defi-
nitions of terms are frequently lacking or are not cited in summarised versions of the
original studies. There is no guarantee, therefore, that the terminology used is consistent
across studies.
462 L. ROSS
Bearing these limitations in mind, an overview is presented below of this small, but
growing, body of research by looking first at studies which address the patient’s perspective
of spiritual need and spiritual care, followed by those concerning nurses’ opinions and
nurse education.
Research relating to the patient’s perspective on spiritual need and spiritual care
Five studies were identified which looked at the patient’s perspective on spiritual need
and spiritual care (Chomicz, 1984; Kealey, 1974; Martin et al., 1976; Simsen, 1985;
Stallwood-Hess, 1969). With the exception of one study (Kealey, 1974), it was found that
for many patients illness and hospitalisation can become spiritual encounters. During
these experiences a considerable proportion of patients reported spiritual needs such as for:
meaning; belief in God, often expressed through formal religious practices; relief from fear,
doubt, loneliness; relatedness to others/God (Chomicz, 1984; Martin et al., 1976; Stallwood-
Hess, 1969), and furthermore considered these needs of importance to them (Simsen, 1985).
Some patients would have liked nurses to help them with their spiritual needs by listening,
“being there” and referring to the clergy where appropriate (Chomicz, 1984; Kealey, 1974;
Martin et al., 1976; Stallwood-Hess, 1969). However, many felt that the nurse was too busy
to help in these ways.
Although patients tended to express satisfaction with the assistance they had received,
Stallwood-Hess (1969) found that the majority felt their needs had not been met to the full.
Furthermore, chaplains reported that, despite being given excellent physical care, patients
were often struggling to grasp the meaning of their suffering (Bowlby, 1980; Patey, 1977).
Given that hospitalised patients considered their spiritual needs of importance it would
seem appropriate that nurses should endeavour to help patients meet these needs. How
nurses perceive their role in spiritual care is addressed by looking at the appropriate
research.
Research relating to the nurses’s perspectizje on spiritual need and spiritual care
Six American studies, dating from as early as 1957, sought to obtain nurses’ opinions of
spiritual care and their role in this. As no British studies were identified which sought to
ascertain British nurses’ perceptions and giving of spiritual care, this formed the basis of
the author’s doctoral study (Ross, 1994a; Ross, 1994b; Waugh, 1992) the results of which
are briefly reported.
In general, the studies reviewed indicate that nurses within the samples were aware
patients had spiritual needs, the majority regarding it their duty to make provision for at
least some of these needs. According to Waugh (1992) and Piles (1986) 94.4% and 87.6%
of nurses, respectively, disagreed that spiritual care was the remit of the clergy only. Despite
this, however, it would appear that nurses had a limited ability to attend to the spiritual
needs of patients.
Chance (1967) found that the majority of student nurses identified spiritual needs,
although these results may be somewhat biased given that the nurses were enrolled at a
Seventh Day Adventist College. Although the majority of nurses (76.8%) in Waugh’s (1992)
study said they had identified patients’ spiritual needs, they were only asked if they had
done so at some point in their practice, therefore, there is no indication of the frequency
with which they identified these needs. In addition, the basis on which over half the nurses
THE SPIRITUAL DIMENSION 463
in Chadwick’s (1973) study concluded that patients’ spiritual needs had been adequately
met was unclear.
It is the general consensus of other studies, however, that despite the fact that nurses
usually displayed some knowledge of and ability to identify the more obvious, direct
religious needs e.g. for communion (Chadwick, 1973) they were less aware of spiritual
needs than those pertaining to the psychosocial dimension (Highfield and Cason, 1983).
Moreover. they demonstrated limited knowledge of spiritual needs and limited ability to
help patients meet these needs (Highfield and Cason, 1983; Kramer, 1957; Waugh, 1992).
Kramer (1957) Kealey (1974) and Piles (1986) found that whilst 93.6, 91 and 87.6%,
respectively, of nurses agreed that spiritual care was a nursing responsibility, only 56.4, 50
and 34.1%, respectively, felt able to provide for this adequately. Waugh (1992) and Chad-
wick (1973) similarly found that, despite the fact that 93.7 and 75% of nurses, respectively,
felt spiritual care was part of their role, only 47.8 and 50%, respectively, said that they
personally responded to patients’ spiritual needs. In Kealey’s study, patients with spiritual
needs received no help from nurses.
The inadequacy felt by nurses in providing spiritual care was further borne out by the
fact that, with the exception of Highfield and Cason’s (1983) study, many expressed the
need for further education in the meeting of such needs (Chadwick, 1973; Piles, 1986).
It would appear from the research reviewed that practising nurses expressed the desire
to be involved in giving spiritual care but felt inadequate in providing this. Patients’ spiritual
needs may, therefore, not be as fully met as they could be, the implications of which could
be serious as shown in Fig. 2.
Research relating to nurse education and spiritual cure
From the guidelines for nurse education, it appears that the teaching of spiritual care is
a necessary pre-requisite to its practice by nurses. No research, however. could be identified
which tested this assumption.
Few research studies, and certainly no British ones, were identified which looked at
whether or not spiritual care was taught to nurses. From responses received from persons
in charge of basic nurse education establishments in Scotland, it appeared that spiritual
care does not form substantial identifiable component in any education programme, e.g. it
may take the form of a one hour session from the hospital chaplain and be touched upon
in religious practices in care of the dying (Waugh, 1992).
In the U.S.A., however, moves have been made in the area of curriculum development.
As early as 1957, Lewis (Lewis, 1957) set about developing a resource unit for the inclusion
of spiritual care in the basic nursing curriculum at the University of Washington School of
Nursing. Hitchens (1988) found that students tended to project themes from their own
faith, values and life experiences into patient care situations. Life experience/crisis was a
major factor in determining the level of the student’s faith development which in turn
appeared to influence the way in which students planned spiritual care. These personal
attributes of the nurse were similarly noted by Waugh (1992) as factors apparently influ-
encing whether or not and how nurses in her sample gave spiritual care.
Although moves have been made in the U.S.A. to incorporate the teaching of spiritual
care into basic nurse education programmes, this seems not to have happened in Scotland.
Further British research is, however, required to clarify the current position.
Tmted with 8V8ihbk
knowledge within the
psychosocial framework.
I
t t
M8y bC tatally May be in8duluate
inappropriatein in sufficiently meeting
approech theneed
t
(IQtdWd md Cnoa 1983)
May 8ffcct the
ability to cope
withthestn%sofillness
t
Generally heighted stress level.
+
H8rmtill effects on functioning of foUowing aspects.
& of which arc inter-r&ted:-
s*2-,uI
hi al Fhysiokagic8l
tBlyIk 1975; cox. 1978)
I- + _I
Failure of nursing to
prevent uness, promote
he&b and wclMcing
According to Madow (1970. p. 407)
“DepriYationof8ncedpnxluccssome
formofiUnc&.
Btxaune gmwth needs ere less obvious
than deficit d, e.g. for food,
~Y~YtPvob&dedfarlongerand
the consquences of not satisfying
them may be less obvious.
t
Failure to satisfy needs.
+
“M~logy” which blow
(1970. p. 407) &kc5 88:
“illnes.s rcalthlg from frueation
or depliv8tion of higher necd.T.
t
This may display itself in
8 number
of
ways
e.g. lack of meaning,
alienation, lack of direction
t
The final sod ultimate consequence of
such need deprivation
1 actualisation” hasbeendisruptcd 1
3. Spiritual need identified. E
Approprkte action taken
t
Spiritual need met
4 I t
Resolution Selfactualisation
of spiritual facilitated
:iti Rernr of +ss effej Iyc2,0ticd
Social Physiological
t
Removal
of barrier ta recovery
Fig. 2. The implications of meeting and failing to meet patients’ spiritual needs
THE SPIRITUAL DIMENSION 465
Should spiritual care be part of the nurse’s role?
Definitions
qf
nursing. Definitions of nursing state that it is the responsibility of the nurse
to:
“..promote health, to prevent illness, to restore health and to alleviate suffering” (ICN, 1973).
“..assist the individual, sick or well, in the performance of those activities contributing to health or
its recovery (or to a peaceful death) that he would perform unaided if he had the necessary strength,
will or knowledge” (Henderson, 1977, p. 4).
Central to these definitions is the nurse’s role in assisting patients to achieve their
maximum health potential (Rogers, 1970). If, as discussed above, the level of health achieved
by an individual will depend in part on the extent to which their spiritual needs are met,
then in order for nurses to fulfill their function of promoting health, spiritual care is clearly
part of their role.
Codes of conduct. Both British and international codes of conduct support spiritual care
as a nursing responsibility.
The United Kingdom Central Council for Nursing, Midwifery and Health Visiting
(UKCC) states that it is the duty of the nurse to:
“Take account of the customs, values and spiritual beliefs of patients/clients” (UKCC, 1984a, p. 2).
Furthermore, it considers this to be:
“...a statement to the profession of the primacy of the interests of the patient or client” (UKCC,
1984b. p. 4).
The International Council of Nurses (ICN) (1973) considers its Code for Nurses to be:
“a guide for action based on values and needs of society...” and states that “The nurse, in providing
care, promotes an environment in which the values, customs and spiritual beliefs of the individual
are respected.”
Thus the spiritual beliefs of the individual are recognised and valued by the UKCC and
the ICN, so much so that this is reflected in their guidelines for nursing practice. However,
it is unclear what is actually meant by “taking account off’ and “respecting” patients’
“spiritual beliefs” or “promoting an environment” in which this can be achieved. It is not
clear if the nurse is expected to be actively or passively involved in helping patients meet
their spiritual needs. Also the definition of “spiritual beliefs” is open to interpretation; it
could be viewed in terms of religious needs only or in a broader context. The fact that the
ICN (1977, p. 14) considers the nurse:
“...best able to assess the operating... beliefs and incorporate her knowledge of them in directing
the nursing care...”
which suggests an active rather than a passive role for the nurse in respecting patients’
spiritual beliefs.
Although some issues require clarification, codes of conduct acknowledge spiritual care
as a necessary and valued part of the nurse’s role.
Models of nursing. Models of nursing include consideration of the spiritual dimension
either in religious terms (Henderson, 1977) or by concentrating on the needs for: meaning
(Fitzpatrick, 1989; Watson, 1989); transcendence (Fitzpatrick, 1989); wholeness, of which
the spiritual is part (Cerilli and Burd, 1989; Raleigh, 1989). Most authors contend that if
466 L. ROSS
spiritual needs are essential to the healthy individual’s sense of well-being, they will be all
the more necessary during illness.
Guidelines,for nurse education
Both British and international guidelines for nurse education indicate that spiritual care
should be taught to nurses.
In preparation for Project 2000 it was recommended that nurse education should:
“provide opportunities to enable the student to... acquire the competencies required to: xiv)
identify... spiritual needs of the patient or client. devise a plan of care, contribute to its implemen-
tation and evaluation by demonstrating an appreciation and practice of principles of a problem
solving approach.” (UKCC. 1986, pp. 40-41).
This is further reflected in the National Board for Scotland’s (NBS) consideration of the
reforms for basic nurse education. Amongst its aims and objectives is that the nurse will be
enabled to:
“assess, plan, implement and evaluate care to meet the...spiritual...needs of the individual and
family/friends.” (NBS., 1990, p. 16)
In short, in the U.K., nursing students are to be taught how to give spiritual care using
the nursing process.
On the international scene the ICN (1973) which, as stated above, includes spiritual care
in its Code for Nurses, considers that:
“ln order to achieve its purpose the Code must be... put before and be continuously available to
students... throughout their study and work lives.”
Furthermore, the American Association of Colleges of Nursing (AACN) (1986) (p. 5)
recommends that the education of professional nurses should ensure their ability to:
“Comprehend the meaning of human spirituality in order to recognise the relationship of beliefs to
culture, behaviour, health and healing”
and to plan and implement this care.
Having looked at definitions of nursing, codes of conduct, models of nursing and guide-
lines for nurse education, it would seem that spiritual care is a nursing responsibility and
not an optional extra.
Conclusions
Spiritual well-being is important for the individual’s health potential and the experience
of illness/hospitalisation can threaten optimum achievement of this potential. There are
many indications that spiritual care is considered to be a nursing responsibility but there is
a lack of clarity. There is no agreed definition of what is meant by “spiritual.“, “spiritual
need” and “spiritual care” and there are few guidelines for nursing practice. There is a
distinct lack of research, particularly of British origin, on spiritual care. Bearing in mind
the limitations of available studies, it would appear that patients experience spiritual needs
but often these needs are not fully met, the implications of which could be serious. Patients
consider that the nurse could have a significant role in giving spiritual care and nurses
appear to be willing to do so but feel inadequate in this regard. It would seem that, despite
the fact that guidelines for nurse education advocate the teaching of spiritual care, this does
not happen to any great extent.
Although moves have been made to contribute to the knowledge base for spiritual care,
THE SPIRITUAL DIMENSION 461
this is very much in its infancy and nurses currently lack guidelines for practice. Clearly
there is need for further research to ascertain how patients feel they can best be helped to
meet their spiritual needs, to clarify the nurse’s role in spiritual care and to identify ways
in which spiritual care can best be taught.
ilc,kno~~k~dyrmenfs~The author wishes to acknowledge her director of studies, Dr L. Hockey, and her supervisors,
Miss E. Dove and Rev. Dr D. Lyall, for their advice and support throughout the study, and Queen Margaret
College for providing the research studentship. Special thanks also to Dr L. Hockey and Dr B. Alder for their
helpful comments on the manuscript.
References
American Association of Colleges of Nursing (1986). Essentials of College and University Education for
Professional Nursing. AACN, Washington.
Antonovsky. A. (1979). Health, Srrrss and Coping. Jossey-Bass, San Francisco.
Autton. N. (1980). The hospital chaplain. Nursing (Add-on Journal). 12(16), 697-699.
Beland. I.L and Passos, J.Y. (Eds) (1975). Clinical Nursing: Pathological and Psychosocial Approaches. MacMillan,
New York.
Blythe. P. (1975). Stress: The Modern Day Sickness. Pan Books, London.
Bowlby. R. (1980). Chaplains are different. Br. Med. J. 281(6256), 1689.
Brewer. D.C. (1979). Life stages and spiritual well-being. In Spiritual Well-being: Sociological Perspectiws (edited
by Moberg, D.O.). University Press of America, Washington.
Burnard. P. (1989). Counselling Skill.sJ‘or Health Prqfessionals. Chapman and Hall, London.
Carson. V.B. (1989). Spiritual Dimensions ofNursing Practice. W.B. Saunders, Philadelphia.
Cerilli, K. and Burd, S. (1989). An analysis of Martha Rogers’ nursing as a science of unitary human beings. In
Conceptual Models For Nursing Practice (Riehl-Sisca, J., Ed.), pp. 1899195. Appleton & Lange, Norwalk, CT.
Chadwick, R. (1973). Awareness and preparedness of nurses to meet spiritual needs. In Spiritual Care: the Nurse’s
Role (edited by Fish, S. and Shelly, J.A.), pp. 1677168. Inter Varsity Press, Illinois.
Chance, J.P.L. (1967). Nurses’ responses to patients’ spiritual needs. Unpublished Master’s thesis, Loma Linda
University, California.
Chomicz. L. (1984). What are patients’ spiritual needs? Unpublished B.Sc. dissertation, City University, London.
Colhton, M.A. (1981). The spiritual dimension of nursing. In Clinical Nursing: Pathoplz~~.siologicaland Py~chosocial
Approaches (edited by Beland, I.L. and Passos, J.Y.). 12th edition, pp. 492-501. Macmillan, New York.
Cox. T. (1978). Stress. Macmillan, London.
Dickinson, C. (1975). The search for spiritual meaning. Am. J. Nurs. 75(10). 1789-1793.
Dubree. M. and Vogelpohl. R. (1980). When hope dies-so might the patient. Am. J. Nurs. 80(1 I), 2046~2049
Fish. S. and Shelly, J.A. (1978). Spiritual Care: the Nurse’,r Role. Inter Varsity Press, Illinois.
Fitzpatrick, J.J. (1989). A life perspective rhythm model. In Conceptual Models of Nursitq: Analj,sis aad Application
(Fitzpatrick, J.J. and Whall, A.L., Eds), pp. 401-407. Robert. J. Brady, New Jersey.
Frank], V. E. (1959). Man’s Searc/t,for Meaning. Washington Square Press. Washington.
Gardner, R. (19X3). Miracles of healing in Anglo-Celtic Northumbria as recorded by the Venerable Bede and his
contemporaries: a reappraisal in the light of twentieth century experience. Br. Med. J. 287(6409). 192771933.
Granstrom, S.L. (1985). Spiritual nursing care for oncology patients. Top. C/in. Nuts. 7(l), 39-45.
Henderson, V. (1973). The nature of nursing. In The Challenge ofNursing: a Book of’licadings (compilers by Auld,
M.E. and Birum, L.H.). C.V. Mosby, Geneva.
Henderson, V. (1977). Basic Principles of’ Nursing Care. ICN, Geneva.
Henderson, V. and Nite. G. (Eds) (1978). Principkes and Practice af Nursing. 6th edition. MacMillan, New York.
Highfield, M. and Cason, C. (1983). Spiritual needs of patients: are they recognised? Cancer Nurs. 6(3), 187 192.
Hitchens. E.W. (1988). Stages of faith and values development and their implications for dealing with spiritual
care in the student nurse-patient relationship. Unpublished ED.D thesis, University of Seattle.
ICN (1973). Code for Nurses. Ethical Cowepprs Applied to Nursing. ICN, Geneva.
ICN (1977). T/w Nur.w’~r Dilemma. Ethical Con.tidera/ions in Nursing Practice. ICN. Geneva.
Kealey. C. (1974). The patient’s perspective on spiritual needs. Unpublished Master’s thesis. University of
Missouri, Columbia.
Kramer. P. (1957). A survey to determine the attitudes and knowledge of a selected group of professional nurses
concerning spiritual care of the patient. Unpublished Master’s thesis, University of Oregon.
Lewis, J.E. (1957). A resource unit on spiritual aspects of nursing for the basic nursing curriculum of a selected
school of nursing. Unpublished Master’s thesis. University of Washington. Seattle,
468 L. ROSS
Limandri, B.J. and Boyle, D.W. (1978). Instilling hope. Am. J. Nuts. 78, 79-80.
McClymont, M., Thomas, S. and Denham, M. (1986). Health Visiting and the Elderly. Churchill Livingstone,
Edinburgh.
MacDonald, A.M. (Ed.). (1972). Chambers 20th Century Dictionary. W.R. Chambers, Edinburgh.
McGilloway, F.A. and Donnelly, L. (1977). Religion and patient care: the functionalist approach. J. adv. Nurs.
2, 1, 3-13.
McGilloway, 0. and Myco, F. (Eds) (1985). Nursing and Spiritual Care. Harper and Row, London.
Martin, C., Burrows, C. and Pomillo, J. (1976). Spiritual needs of patients study. In Spiritual Care: the Nurse’s
Role (edited by Fish, S. and Shelly, J.A.), pp. 150-166. Inter Varsity Press, Illinois.
Martin, J.E. and Carlson, C.R. (1988). Spiritual dimensions of health psychology. In Behauiour Theory and
Religion (edited by Miller, W.R. and Martin, J.E.), pp. 57-l 10. Sage Publications, Beverley Hills.
Murray, R. and Zentner, J. (1975). Nursing Conceptsfor Health Promotion. Prentice Hall, New Jersey.
Narayanasamy, B. (1991). Spiritual Cure: a Resource Guide. BKT Information Services and Quay Publishing Ltd,
Nottingham.
NBS (1990). Nursing education, Preparation for practice 1992. July.
O’Brien, M.E. (1982). Religious faith and adjustment to long-term haemodialysis. 1. Religion Hlth 21,68.
Patey, E.H. (1977). The sacred and the secular. Nurs. Minor 145(19), 25-26.
Penrose, V. and Barret, S. (1982). Spiritual needs: in sickness I lack myself. Nurs. Mirror 154(10), 38-39.
Piepgras, R. (1973). The other dimension: spiritual health. In The Challenge of Nursing; a Book of Readings
(compiled by Auld, M.E. and Birum, L.H), Chapter 22. C.V. Mosby, St. Louis, MO.
Piles, CL. (1986). Spiritual care: role of nursing education and practice. A needs survey for curriculum
development. Unpublished PhD thesis, University of Saint Louis.
Raleigh, E.D. (1989). Wiedenbach’s model of nursing practice. In Conceptual Models of Nursing: Analysis and
Application (Fitzpatrick, J.J. and Whall, A.L., Eds), pp. 899107. Robert. J. Brady, New Jersey.
Renetzky, L. (1979). The fourth dimension: applications to the social services. In Spiritual Well-being: Sociological
Perspectives (edited by Moberg, D.), pp. 2155254. University Press of America, Washington.
Rogers, M. (1970). An Introduction to the Theoretical Basis ofNursing. F.A. Davis, Philadelphia.
Ross, L.A. (nee Waugh 1994a). Spiritual aspects of nursing. J. Adv. Nurs. 19,439-447.
Ross L (nee Waugh 1994b). Spiritual care: the nurse’s role. Nuts. Stand. 8 (29), 33-37.
Sehgman, M.E.P. (1974). Submissive death: giving up on life. Psychol. Today 7,80-85.
Shelly, J.A. and John, SD. (1983). Spiritual Dimensions of Mental Health. Inter Varsity Press, Illinois.
Simsen. B.J. (1985). Spiritual needs and resources in illness and hospitalisation. Unpublished M.Sc. thesis,
University of Manchester.
Stallwood-Hess, J. (1969). Spiritual needs survey. In Spiri/ual Cure: the Nurse’s Role (edited by Fish, S. and Shelly,
J. A.), pp. 147-149. Intervarsity Press, Illinois.
Stall, R.I. (1979). Guidelines for spiritual assessment. Am. J. Nurs. 79(19), 15741577.
Swaim, L. (1962). Arthritis, Medicine and Spiritual Laws. Chilton Book Company, Philadelphia.
Tari, M. (1978). Like a Might Wind. Kingsway, Eastbourne.
Travelbee, J. (1971). Interpersonal Aspects of Nursing. F.A. Dans, Philadelphia.
UKCC (1984a). Code of Professional Conduct ,for the Nurse, Midwife and Health Visitor, 2nd edition. UKCC,
London.
UKCC (1984b). Exercising Accountability. A Framework to Assist Nurses, Midwives andHealth Visitors to Consider
Ethical Aspects of Professional Practice. UKCC, London.
UKCC (1986). Project 2000. A new preparation for practice. UKCC, London.
Watson, J. (1989). Watson’s philosophy and theory of human caring. In Conceptual Models For Nursing Practice
(Riehl-Sisca, J., Ed.), pp. 219-236. Appleton & Lange, Norwalk, CT.
Waugh, L.A. (1992). Spiritual aspects of nursing: a descriptive study of nurses’ perceptions. Unpublished Ph.D.
thesis, Queen Margaret College, Edinburgh.
Yura, H. and Walsh, M. (Eds). (1982). Human needs 2 and the nursingprocess. Appleton Century Crofts, Norwalk.
(Received 28 February 1994; accepted in revisedform 9 January 1995)
... Studies have shown that well-being and quality of life are unlike in different patients who experienced the spirituality as a part of the treatment 8 . However, although many studies report religion and spirituality as a complementary therapy for patients with many diseases [9][10][11][12] , to our knowledge there is no available meta-analysis investigating the application of such practice as an intervention to improve well-being and quality of life of cancer patients, especially including western and eastern studies with no religion and spiritual distinction. Therefore, the aim of this study was to systematically review and analyze the literature about the effects of religion and spirituality on the well-being and quality of life of cancer patients. ...
... Secondarily, a hypothetical association model between religion and spirituality and the brain was elaborated to elucidate the relationship between neuroscience and faith. Studies investigating the relationship between religion/ spirituality and brain mechanisms involved in the sensation, faith and belief process were approached 11,12 . Religious and spiritual practices may involve prayers, mediation, standing, bending, sitting, and at the same time giving grace to the spirit of God. ...
Article
Full-text available
Objective: To systematically analyze quantitative data about the effects of religion/spirituality and the well-being/quality of life of cancer patients. The second aim was to hypothesize a neurophysiological model of the association between religion/spirituality and the brain. Methods: This study met the PRISMA Statement and was registered at PROSPERO database. Randomized and Controlled trials investigating religion/spirituality and well-being/quality of life of cancer patients were included. Based on neuroimaging and neurophysiology studies, a neuroanatomical model was developed to hypothesize the relationship between neuroscience and religion/spirituality. Results: A large effect size was found on the improvement of well-being/quality of life (SMD = 3.90 [2.43-5.38], p < 0.01). Heterogeneity was high among studies (I2 = 98%, p < 0.01). Specific regions of the brain, such as the temporal lobes, amygdalae and hippocampus, regions from the limbic system, were hypothesized to take part in the religion/spirituality phenomena and the well-being/quality of life improvement. Conclusion: Religion/spirituality intervention, mainly the Islamic, promotes an improvement on well-being/quality of life of cancer patients.
... Nonetheless, and as I have hinted above, in the last two decades or so, there have been growing calls to humanise the medical curriculum for more holistic, patient-centred (Branch et al. 2001;Johnson 2015;Bates 2017) and human-centred medical care (Ross 1995;Puchalski 2001;Büssing et al. 2013), which takes seriously the lived context of the patient. However, in spite of the remarkable reforms in the biomedical model and improvements in medical training in recent years, which have incorporated empathetic, mental and spiritual care (Mishra 2015), modern Western medicine is still obsessed with its materialistic outlook of the body, disease and the lack of humanistic care (Branch et al. 2001). ...
Article
In this article, I argue that every medical tradition is anchored in a certain anthropological understanding of the body, how that body can be afflicted by disease, and how best it can be treated. Also, each model of the body has implications for the nature of the patient-physician relationship and for quality of care. I compare two leading models of the body: the biomedical model, the predominant model in modern medicine; and the relational model, the leading model in indigenous sub-Saharan African medicine; and their implications on the conceptualisation of disease, the nature of the patient-physician relationship and quality of care. I show that because the biomedical model largely limits its clinical attention to the material body, it does not extend its gaze into the spiritual, social and ecological realms like the relational model, and in spite of the reforms it has undergone since the second half of the 20th century, this reductionist outlook has not faded. Also, because of the premium it places on rationality in the clinical encounter, the biomedical model emphasises individualistic values such as autonomy and emotional detachment of the physician from the patient. The relational model, on the other hand, though still uncharted, promotes inclusive values such as empathy, spirituality and harmony in health care. I argue that human nature is more complex than the biomedical and bio-psychosocial models construe; there are marginal models which may contribute to enhancing the biomedical model. Hence, there is a need to consider less-dominant medical approaches to the body.
... Maneviyat, Ross tarafından başlıca 3 boyutta tanımlanmıştır: Var oluştaki anlam ve amaç için çalışma, buradan daha öte/aşkın yüce bir güç veya Tanrı arayışı için gayret gösterme, bireyi sevgi, doğruluk, güzellik, güven ve yaratıcılık gibi değerlere yönlendirip, ilham ve umut vererek motive etme (Ross, 1995). ...
... Pode também ser definida como estando dependente de três componentes: a procura de um sentido, uma razão e um significado na vida; a necessidade de esperança, vontade para viver e a de ter fé em si próprio, nos outros e ou algo transcendente (Ross, 1995). ...
Thesis
Religion is a very important context for many individuals in society and spirituality is seen as a fundamental dimension for the human being (Aldwin, et al, 2014). The main goals of this thesis was to find the possible relation between the religious practice with spiritual well-being levels and psychological flourishing levels; and to verify the relationship between spiritual well-being´s dimensions and psychological flourishing's dimensions. The instruments used for this subject were Spiritual Health and Life Orientation Measure (SHALOM) and PERMA-Profiler (Seligman, 2011, Butler and Kern, 2013). The sample included for this study 837 participants aged between 18 and years 83 (M = 41,34; SD = 11,972), 69.9% female and 30.1% male. 63.7% refer to have a religious practice. The demonstration of the results showed the existence of a significant relationship between having a religious practice and spiritual well-being levels, as well as with psychological flourishing levels. It was found the higher frequency of the religious practice increase the spiritual well-being and psychological flourishing levels. However, the study showed as well exactly the opposite, as the lower frequency of religious practice, the higher the levels of Negative Emotions and Loneliness dimensions of psychological flourishing will come out. The relationship between spiritual well-being and psychological flourishing dimensions proved to be positive all thought weak. The conclusion was, having a religious practice has an important role in a person's well-being, however, may not be meaningful for all human beings.
Article
Full-text available
Background: The purpose of the research is to study the difference in the level of spiritual experiences and the levels of self consciousness among young adults and middle adults, and to assess the relationship between spiritual experiences and self consciousness on the quality of life. Method: A purposive sampling was used to recruit the participants. Data was collected from 120 individuals (60 young adults and 60 middle adults) using standardised questionnaires: Daily Spiritual Experience Scale (DSES), Self-Consciousness Scale (SCS-R) and WHO Quality of Life (WHOQOL-BREF). Result was analysed using SPSS v20 and MS Excel. Results: Significant correlation was found between Spiritual Experiences and few domains of both, Self Consciousness and Quality of Life at 0.01, 0.05 and 0.02 level. There exists a significant difference in the spiritual experiences and Self Consciousness among young adults and middle age adults. Conclusion: The spiritual experiences and self consciousness have a varying/significant effect on the quality of life in both young and middle adults. It is important for researchers to be aware of how their impact may differ in different conditions. piritual experiences, self consciousness and quality of life have been studied individually in the past decade extensively but the association between these three variables has not been explored in depth. It can be observed that spiritual involvement increases in the adult life cycle, moreover, it increases with age, as spiritual involvement helps predicting religious involvement, personality character, and subsequent negative life impacts. As for self consciousness, it decreases with age as conscious emotions such as shame, guilt, pride and embarrassment are highly prominent among younger adults.
Chapter
This chapter aims to provide a critical reflection on how individuals, families, tourists, in general, are looking for alternative forms of touristic and gastronomic experiences, very much rooted on the spiritual quest for peace, security, hope, self-awareness, and above all, emotional wellbeing. Hence, it discusses the rise of new forms of tourists, in the so called ‘new normal', who completely changed their mindset regarding holiday habits and eagerly seek to feed their body, mind, and soul, rethinking and replacing their previous touristic and gastronomic choices. Additionally, it argues that the pandemic is giving the tourism and hospitality industry an opportunity to reinvent their value propositions and design their offerings based on these new emerging features of post-COVID tourists by creating innovative touristic packages and crafting new marketing messages very much focused on the spiritual attributes of their offerings.
Article
Full-text available
Manevi danışmanlık ve rehberlik • Sosyal hizmet • Bağımlılık • Bağlanma • Din • Maneviyat Spiritual counseling and care • Social work • Addiction • Attachment • Religion • Spirituality
Article
This study examines religious faith as associated with adjustment to end-stage renal failure and its treatment regimen of maintenance hemodialysis. Both quantitative and qualitative data were collected initially and after a three-year interval in order to observe changes over time. The variable of the patient's perception of the import of religious faith was found to be positively related to interactional behavior and sick role behavior and to be inversely associated with alienation. Content analysis of qualitative responses for the item of perceived import of religious faith revealed a pattern of increasingly more positive patient attitudes occurring over time.
Article
present chapter has provided a relatively broad-based review of the spiritual aspects of the field of health psychology/behavioral medicine definition of spirituality / definition of health psychology spiritual-health connection: fact or fantasy stress, health, and spirituality capturing of spirituality: the measurement problem relaxation, meditation, prayer: a peace continuum health, disease, and spritual living / spirituality and disorders of lifestyle / coronary heart disease love, spirituality, and health: the immune system health spirituality in action: case studies (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Religion and patient care: the functionalist approach This paper offers an ideal type process which considers any patient, his intimates and hospital chaplain in the wider setting of personal care. It calls attention to an important aspect of patient care which offers a starting point from which to begin assessing the needs of any patient from a complementary perspective. The paper reveals two important consequences of the features of any patient situation for the structuring of whole patient care. The first is that the ill person can be susceptible to certain fundamental characteristics which bring him face-to-face with situations in which established practices display an insufficiency for providing mechanisms of adjustment. The second is that spiritual support can be a most important mechanism of adjustment to the aleatory and frustrating facts of these basic characteristics of the patient's existence. Also, it is not only that the ill person may have a need to be helped in this way, but that the appropriate general pattern of action in regard to the source of help is often related to evaluation by nursing and other health service personnel–who are inexpert in this field of care–of the general requirements of any patient situation. This evaluation may have important consequences regarding the completeness of patient care.