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Abstract

Objective: To evaluate the effect of prayer on anxiety in cancer patients undergoing chemotherapy. Method: Quasi-experimental study, with pre and post-intervention. Twenty patients admitted to treatment of continuous intravenous chemotherapy were recruited. The volunteers were evaluated through interviews using a questionnaire of sociodemographic, clinical and spiritual characteristics, the Index of Religiosity Duke University and the State-Trait Anxiety Inventory. Vital signs were measured and collected salivary cortisol. The intervention was applied prayer and data collection occurred in three phases: first collection (baseline), pre and post-intervention. Results: The data found between the pre and post-intervention samples showed different statistically significant for state anxiety (p= <0.00), blood pressure (systolic, p=0.00, diastolic, p=<0.00) and respiratory rate (p=0.04). Conclusion: Prayer, therefore, proved to be an effective strategy in reducing the anxiety of the patient undergoing chemotherapy.
684





Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG

Objevo: Evaluar el efecto de la plegaria
sobre la ansiedad de pacientes con cáncer
en tratamiento quimiotepico. Método:
Estudio casi experimental con pre y post in-
tervención. Fueron reclutados 20 pacientes
hospitalizados en tratamiento de quimiote-
rapia endovensa connua. Los voluntarios
fueron evaluados por medio de encuesta,
ulizándose un cuesonario de rasgos so-
ciodemográcos, clínicos y espirituales, el
Índice de Religiosidad de la Universidad de
Duke - DUREL y el Inventario de Ansiedad
Trazo-Estado. Fueron vericadas las señales
vitales y recogido el corsol de la saliva. La
intervención aplicada fue la plegaria, y la re-
colección de datos sucedió en tres momen-
tos: primera recolección (basal), pre y post
intervención. Resultados: Los datos encon-
trados entre las recolecciones pre y post
intervención revelaron diferencias estadís-
camente signicavas para el estado de
ansiedad (p=<0,00), la presión arterial (sis-
tólica, p=0,00; diastólica, p=<0,00) y la fre-
cuencia respiratoria (p=0,04). Conclusión:
La plegaria demost ser una estrategia
eciente en la reducción de la ansiedad del
paciente en tratamiento de quimioterapia.

Neoplasias
Quimioterapia
Espiritualidad
Religión
Ansiedad
Enfermería oncológica

Objevo: Avaliar o efeito da prece sobre
a ansiedade de pacientes com câncer em
tratamento quimioterápico. Método: Estu-
do quase experimental com pré e pós-in-
tervenção. Foram recrutados 20 pacientes
internados em tratamento de quimiotera-
pia endovenosa connua. Os voluntários
foram avaliados por meio de entrevista,
ulizando um quesonário de caracterís-
cas sociodemográcas, clínicas e espiritu-
ais, o Índice de Religiosidade da Universi-
dade de Duke DUREL e o Inventário de
Ansiedade Traço-Estado. Foram aferidos os
sinais vitais e coletado o corsol salivar. A
intervenção aplicada foi a prece e a coleta
de dados ocorreu em três momentos: pri-
meira coleta (basal), pré e pós-intervenção.
Resultados: Os dados encontrados entre
as coletas pré e pós-intervenção revelaram
diferenças estascamente signicavas
para o estado de ansiedade (p=<0,00), a
pressão arterial (sistólica, p=0,00; diastó-
lica, p=<0,00) e a frequência respiratória
(p=0,04). Conclusão: A prece demonstrou
ser uma estratégia eciente na redução da
ansiedade do paciente em tratamento de
quimioterapia.

Neoplasias
Quimioterapia
Espiritualidade
Religião
Ansiedade
Enfermagem oncológica

Objecve: To evaluate the eect of prayer
on anxiety in cancer paents undergoing
chemotherapy. Method: Quasi-experimen-
tal study, with pre and post-intervenon.
Twenty paents admied to treatment
of connuous intravenous chemotherapy
were recruited. The volunteers were evalu-
ated through interviews using a queson-
naire of sociodemographic, clinical and
spiritual characteriscs, the Index of Reli-
giosity Duke University and the State-Trait
Anxiety Inventory. Vital signs were mea-
sured and collected salivary corsol. The
intervenon was applied prayer and data
collecon occurred in three phases: rst
collecon (baseline), pre and post-inter-
venon. Results: The data found between
the pre and post-intervenon samples
showed dierent stascally signicant
for state anxiety (p= <0.00), blood pres-
sure (systolic, p=0.00, diastolic, p=<0.00)
and respiratory rate (p=0.04). Conclusion:
Prayer, therefore, proved to be an eecve
strategy in reducing the anxiety of the pa-
ent undergoing chemotherapy.

Neoplasms
Drug therapy
Spirituality
Religion
Anxiety
Oncology nursing
Effectiveness of prayer in reducing
anxiety in cancer patients
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Original article


685


Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG




Cancer is a sgmazed illness, for it brings suering and
changes to a person’s life
(1)
, as well as possibly causing de-
pression and anxiety
(2)
. People aected by cancer experi-
ence hospitalizaon, which includes hospital roune, wait-
ing for informaon, and a restricted number of visitors, all
of which can cause various reacons to the situaon
(3)
.
In light of the above and the sgma surrounding the
illness, feelings of fear and insecurity can arise, potenally
inuencing cancer treatment. Thus, reducing paents’
anxiety is necessary
(3)
.
The term anxiety comes from the
Greek word anshein, which means to oppress, to suf-
focate, and it can cause changes in the body, such as in-
creased heart and respiratory rate
(4)
. In addion to physi-
cal alteraons, social, psychological and spiritual aspects
are also aected.
Nurses are the professionals who accompany paents
and their families during the illness process, from diagnosis
to rehabilitaon. Comprehensive care must include physi-
cal, social, psychological and spiritual aspects. Nurses can
treat anxiety using acvies proposed by the Nursing Inter-
venons Classicaon (NIC)
(5)
,
which provides suggesons
such as trying to understand the paent’s point of view
regarding the feared situaon, listening closely, administer-
ing anxiety medicaon, and encouraging the family to stay
with the paent, as well as others. Such intervenons also
include taking a calm, reassuring approach and providing
paents with orientaon on relaxaon techniques.
In this sense, it is important for nurses to develop
strategies for reducing or eliminang anxiety and calming
paents. Studies have observed that spiritual experiences
can reduce anxiety levels
(6-7)
.
Spirituality can be pracced through prayer, classied
into two types: Peons, when those who pray ask God
for something for themselves; or intercession, when those
who pray ask God for something on someone else’s be-
half
(8)
. The act of prayer is a frequent spiritual acvity that
promotes well-being, facilitates the health-illness process
and oers health benets
(9)
.
Prayer is one of the acvies proposed for nursing in-
tervenons that provide spiritual support and facilitate
spiritual growth
(5)
. It is a strategy used to meet the spiri-
tual needs of paents and a calming technique. So why
not use it for reducing anxiety?
An invesgaon of studies aimed at understanding
prayer in a clinical context favors its use in nursing care, in
order to provide paents with well-being. Furthermore,
such invesgaons contribute to nursing knowledge and
strengthen care strategies involving non-convenonal thera-
pies. It is important to conduct studies on this topic in order
to evaluate the scienc eect of prayer and thus validate
its use by health professionals when caring for paents
(10)
.
The objecve of this study was to evaluate the eect
of prayer on the anxiety of cancer paents submied to
chemotherapy.

This was a quasi-experimental pre-post intervenon
study, conducted in the inpaent sector of a philanthropic
hospital in the South of the state of Minas Gerais, Brazil.
It took place between February and December 2012 with
paents submied to connuous intravenous anneo-
plasc chemotherapy.
We chose a convenience sample consisng of 45 pa-
ents receiving treatment in the oncology sector. Inclu-
sion criteria were having a cancer diagnosis, being over
18 years of age, receiving chemotherapy, being willing to
receive prayer and being clinically stable. Criteria for ex-
clusion were presenng hearing or speech impairments,
not being available for collecon of baseline corsol data
at eight in the morning and having received fewer than
three applicaons of chemotherapy during the data col-
lecon period.
Twenty-four paents were selected according to the
inclusion criteria and four individuals le the study be-
cause their chemotherapy treatment was interrupted
and/or they began to present hearing impairments.
Therefore, the nal sample comprised 20 paents.
Data collecon consisted of evaluang signs of anxiety
with the State-Trait Anxiety Inventory, measuring blood
pressure, respiratory rate and heart rate and applying the
prayer intervenon. First, we interviewed parcipants us-
ing a quesonnaire about sociodemographic and clinical
characteriscs created by the researcher based on the ob-
jecves and theme of the study, which was submied to a
pre-test renement process.
Parcipants were given the Duke University Religion
Index (DUREL)
(11)
, an instrument whose Brazilian Portu-
guese version has been properly validated
(12)
. It consists
of a ve-item scale measuring three dimensions of religi-
osity: organizaonal religious acvity (ORA); non-organi-
zaonal religious acvity (NORA) and intrinsic religiosity
(IR). The scores for each of the three dimensions must be
considered separately and there is no need to calculate
a total score
(11)
.
For ORA and NORA, a score lower than
three characterizes high levels of religious acvity; greater
than three, low levels of religious acvity. For the RI item,
a score below 7.5 characterizes high religiosity, and higher
than 7.5, low religiosity.
Subsequently, we applied the State-Trait Anxiety Inven-
tory (STAI)
(13)
, validated in Brazil by Biaggio et al.
(14)
It is an
instrument containing 40 statements describing a person’s
feelings, distributed in two parts, trait (STAI-T) and state
(STAI-S), each part consisng of 20 statements. Answers
are given on a four-point Likert scale (1 – absolutely not to
686





Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG
4 – very much). Scores for each subscale range from 20 to
80 points and indicate mild (0-30), moderate (31-49) and
severe levels of anxiety (greater than or equal to 50)
(13)
.
The rst sample of 1.0 ml of saliva for salivary cor-
sol analysis, called basal corsol, was gathered at 8 am
with Salivee® tubes
(15)
.
These were stored in a thermal
bag with ice and immediately sent to the laboratory for
analysis, conducted with the electrochemiluminescence
method. It is worth nong that whenever samples were
not immediately taken to the laboratory, they were main-
tained at a temperature between 2
o
C and 8
o
C for a maxi-
mum of 48 hours.
Heart rate, respiratory rate and blood pressure were
always measured in this sequence, 30 minutes aer rest
and with the paent sing up against the head of the
bed
(16)
.
Furthermore, as recommended by the adopted
literature, heart and respiratory rates were measured
through palpaon, using a chronometer for a one-minute
period. We used indirect measurement of blood pressure,
through the auscultatory method, using a stethoscope
and an aneroid sphygmomanometer in accordance with
Brazilian Society of Cardiology guidelines
(17)
.
For pre-intervenon data collecon, parcipants were
given the STAI-S once more, but not the STAI-T, which was
applied only once in the beginning. Saliva samples and vi-
tal sign measurements were also gathered by the same
examiner and with the same procedures as those adopted
for basal data collecon.
Soon aer, the prayer intervenon was carried out, cre-
ated and conducted by the researcher. It was a Chrisan
prayer, with no invocaon of saints, cing Psalm 138 of the
Bible, which speaks of divine omniscience: God knows all
and sees all. The prayer was in the form of an audio record-
ing 11 minutes long of a musicians voice with good dicon.
Parcipants listened to the recording using earphones with
a protecve plasc covering and were instructed to sit or
lie comfortably with their eyes closed to promote concen-
traon. Furthermore, they held hands with the researcher,
who conducted a silent intercession prayer.
There is no gold standard available in the literature for
prayer applicaon determining its format, beginning, du-
raon or the person who will apply the technique
(18)
.
To
guarantee the rigorousness and repeatability of the inves-
gaon, we sought to standardize the me and locaon of
the prayer, as well as always using the same type of prayer
and the same intercessor.
Thirty minutes aer prayer, paents were given the
STAI-S once more. Subsequently, saliva samples were
gathered and vital signs measured in the standardized se-
quence and by the same trained examiner (post-interven-
on data collecon).
For each of the pre-and post-intervenon observa-
ons on the STAI-S, saliva samples, and vital signs, three
repeons of data collecon were done in order to mea-
sure the repeatability of the observaons. This was needed
in order to increase the credibility of the data obtained
(19)
.
The control group received the same protocol, with no
prayer intervenon. The examiner remained beside them
during the same length of me as the prayer, conducng
a moment of personal interacon, which consisted of ob-
serving, listening to and giving aenon to the paent.
Results were charted and analyzed with the BioEstat 5.0
program. We used the two-sample t-test or the Wilcoxon
signed-rank test to compare state anxiety levels, salivary
corsol, blood pressure, and heart and respiratory rates
pre- and post-intervenon. For comparison between con-
trol and intervenon groups, we used the Mann-Whitney
U test or t-test specic for two independent samples. A
5% signicance level was adopted.
The study was approved by the research ethics com-
miee of the Federal University of Alfenas (Protocol no.
063/2011) and data were gathered only aer a Free and
Informed Consent form was signed.

Of the 20 subjects who parcipated in the study, 15
(75%) were male and ve (25%), female. Table 1 displays
other invesgated sociodemographic characteriscs.
Table 1 Sample sociodemographic characteristics - Alfenas,
Minas Gerais, Brazil, 2012
Sociodemographic characteristics f* %
Age
<40 years 2 10
40 to 50 years 4 20
51 to 60 years 11 55
61 to 70 years 3 15
Education Level
No formal schooling 1 5
Completed Elementary School 15 75
Completed High School 2 10
Completed Higher Education 2 10
Marital Status
Single 2 10
Married/Cohabitation 15 75
Divorced 3 15
Family income
Less than a monthly minimum wage
(MMW)
1 5
One to three MMW 16 80
Four to six MMW 2 10
Does not know 1 05
Religion
Catholic 13 65
Evangelical 6 30
No religion, but spiritualized 1 5
Jehovah’s witness 0 0

687


Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG



With respect to religious characteriscs (Table 2), the
sample revealed a high level of religiosity for the three
DUREL dimensions: organizaonal, non-organizaonal
and intrinsic religiosity. All paents reported prayer prac-
ce, as well as belief in its power. High religiosity was es-
pecially related to intrinsic religiosity and experiencing re-
ligiosity fully: Feeling God’s presence and striving to live in
accordance with one’s religious belief.
and one (5%), prostate. Considering me of illness discov-
ery, 12 (60%) reported having discovered the disease one to
six months before beginning treatment; four (20%), six to 10
months; and the others (20%), more than 10 months before.
The anxiety prole of the sample, as measured by the
complete STAI the rst me, before conducng the inter-
venon, displayed moderate levels of anxiety (Table 3).
Table 2 Description of subject’s religiosity according to the
Duke University Religion Index (DUREL) – Alfenas, Minas
Gerais, Brazil, 2012
ORGANIZATIONAL RELIGIOUS ACTIVITY
A) How often do you attend church or other religious meetings?
n=20 %
1. More than once a week
4 20
2. Once a week 5 25
3. Two or three times a month 2 10
4. A few times a year 7 35
5. Once a year or less 1 5
6. Never
1 5
NON-ORGANIZATIONAL RELIGIOUS ACTIVITY
B) How often do you spend time in private religious
activities, such as prayer, meditation or studying the Bible or
other religious texts?
1. More than once a day
4 20
2. Once a week 13 65
3. Two or three times a month 0 0
4. A few times a year 0 0
5. Once a year or less 02 10
6. Never
01 05
INTRINSIC RELIGIOSITY
C) In my life, I experience the presence of the Divine (i.e., God).
1. Denitely true of me
19 95
2. Tends to be true 1 5
3. Unsure 0 0
4. Tends not to be true 0 0
5. Denitely not true
0 0
D) My religious beliefs are what really lie behind my whole
approach to life.
1. Denitely true of me
18 90
2. Tends to be true 0 0
3. Unsure 1 5
4. Tends not to be true 1 5
5. Denitely not true
0 0
E) I try hard to carry my religion over into all other dealings in life.
1. Denitely true of me
16 80
2. Tends to be true 1 5
3. Unsure 2 10
4. Tends not to be true 1 5
5. Denitely not true
0 0
Table 3 Baseline anxiety prole - Alfenas, Minas Gerais,
Brazil, 2012
Variables
Group
( x
¯
± s )
Trait anxiety
36.2 ± 9.9
State anxiety 35.2 ± 7.1
Salivary cortisol (nmol/L) 9.7 ± 6.5
Systolic BP (mmHg) 118.5 ± 16.9
Diastolic BP (mmHg) 78.2 ± 14.1
Respiration (breaths per minute) 18.7 ± 3.1
Heart rate (bpm)
71.1 ± 9.4
Table 4 Comparison between pre-and post-intervention means
- Alfenas, Minas Gerais, Brazil, 2012
Variables
Pre-
intervention
Post-
intervention
p-value*
x
¯
s x
¯
s
State anxiety
33.52 4.92 28.42 5.57 < 0
Salivary cortisol
(nmol/L)
10.31 6.66 10.61 6.61 0.57
Systolic BP (mmHg) 122.08 12.98 115.33 11.58 0
Diastolic BP (mmHg) 80.83 10.37 76.5 9.6 < 0
Respiration (breaths per
minute)
20.43 4.58 18.2 3.33 0.04
Heart rate (bpm)
70.58 10.24 68.8 6.31 0.07

s 

Regarding clinical characteriscs, only two individuals
presented comorbidies such as diabetes and hyperten-
sion. With respect to the cancers locaon, 10 (50%) pre-
sented head and neck cancer; four (20%), intesnal; two
(10%), stomach; two (10%), bone marrow; one (5%), liver;
Anxiety state was inuenced by non-organizaonal
religious acvity, according to Spearman’s coecient
(p=0.01), and displayed a correlaon with age group
(p=0.01). No other sociodemographic characterisc inu-
enced anxiety in this study.
When comparing all pre- and post-intervenon means,
we idened modied values for state anxiety, blood pres-
sure and respiraon rate, conrming the eecveness of
prayer on these variables (Table 4).
According to the STAI-S, anxiety levels were reduced
aer prayer at each moment. Blood pressure was reduced
in the three measurements aer prayer, with values be-
low 120/80 mmHg, which is considered an adequate
value according to the Brazilian Society of Cardiology
(17)
.
Respiratory rate was also reduced signicantly, all values
registering above normal levels before intervenon but
showing a mean level of 18 rpm aer prayer, which is
within the standard range of 12 to 20 rpm
(16)
.
Values re-
lated to anxiety levels and vital signs were reduced aer
each intervenon and for all three repeons of pre- and
post-intervenon observaon (Table 5).
688





Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG

In oncology, paents’ lives are changed aer diagno-
sis and treatment; moreover, each paent responds dif-
ferently to situaons experienced during hospitalizaon,
which can generate anxiety
(2-3)
.
This was the case for the
subjects of this study, who required hospitalizaon in or-
der to receive connuous intravenous chemotherapy.
Among these paents, we observed a moderate level
of both trait (mean value 36.2) and state (mean value
35.2) anxiety, in response to the illness, treatment and
hospitalizaon process. Trait anxiety presented a corre-
laon with age group (p=0.01; r=0.52), for the older the
interviewee, the higher the anxiety level. Parcipants’
state anxiety presented a signicant relaon (p=0.01;
r=0.54) with non-organizaonal religious acvity, which
is related to individual religious acvity. Therefore, the
stronger the paents’ personal relaonship with God,
the less anxious they were.
Findings of a previous study
(20)
demonstrated that can-
cer paents submied to chemotherapy used religious/
spiritual coping methods for dealing with the disease and
would have liked to receive spiritual care from health pro-
fessionals. In this sense, the use of comprehensive prac-
ces or even pracces directed toward paents’ spiritual
dimension can be an important strategy to help cope with
cancer, its treatment and any consequent anxiety.
Furthermore, spirituality by means of prayer is ben-
ecial, for it leads to tension relief, increased hope and
reduced anxiety
(21)
.
Carrying out spiritual care is a chal-
lenge and requires that spirituality be included in profes-
sional training and that investments be made in research
in order to solidify knowledge of the phenomenon. Religi-
osity/spirituality can be considered a coping strategy for
paents diagnosed with cancer, whose treatment is per-
meated by stressful events, given the impact that the ill-
ness has on the person’s life
(7)
.
In the present study we used the spiritual pracce of
prayer. Its use as a supporng therapy for cancer treat-
ment must be strengthened, for we found that it caused a
posive eect on people’s lives
(22)
.
The intensity of parci-
pants’ anxiety was reduced, going from moderate to mild
(p< 0.00) aer prayer was applied.
When comparing the results of pre- and post-inter-
venon data collecon, we observed signicant altera-
ons in anxiety levels (p<0.00), respiratory rate (p=0.04)
and blood pressure (p= 0.00) of paents who received
prayer. Among other alteraons, anxiety causes increased
blood pressure, heart rate and respiratory rate
(4)
.
Thus, we
can infer that prayers can reduce the intensity of anxiety,
blood pressure and respiratory rate levels of paents.
Prayer can be a signicant pracce for stabilizing vital
signs, not only for people receiving chemotherapy, but
also for other paents or even people in good health.
This was the case in a study that used the Hail Mary
prayer in a sample of 23 healthy adults. The results dis-
played reduced respiratory rate and improved cardiac
funcon parameters
(23)
.
Praying the rosary, in addion
to being a religious pracce, was found to be a health
pracce; a result that also occurred in the present study
with paents receiving chemotherapy, but with a Chris-
an prayer that did not invoke saints and was conducted
in an ecumenical manner.
Prayer did not present a signicant correlaon (p=0.57)
with parcipants’ salivary corsol levels. In this sense, the
literature has demonstrated that the response of salivary
corsol to condions of stress and anxiety can vary, for
corsol can present elevated levels in response to acute
stress or be reduced with chronic stress
(15)
.
Prayer can be a care opon that contributes benecial-
ly to convenonal treatment. It also aends to the spiri-
tual dimension of paents hospitalized for chemotherapy.
The applicaon of prayer provides a new perspecve for
nursing care of these paents.

Prayer was eecve in reducing the anxiety of paents
receiving chemotherapy. It is important to assess the anxi-
ety of these paents, especially those submied to con-
nuous intravenous treatment. Intervenons directed at
reducing anxiety can help paents with treatment adhe-
sion and provide them with a greater sense of well-being.
Table 5 Mean ( x¯ ) and sample standard deviation (s) of data
collected at three repetitions of pre- and post-intervention obser-
vation - Alfenas, Minas Gerais, Brazil, 2012
Variables
1
st
repetition
( x
¯
± s )
2
nd
repetition
( x
¯
± s )
3
rd
repetition
( x
¯
± s )
Pre-intervention
State anxiety 34.20 ± 5.99 33.35 ± 5.30 33.00 ± 6.29
Salivary cortisol
(nmol/L)
9.65 ± 7.71 10.55 ± 8.09 9.40 ± 6.75
Systolic BP
(mmHg)
119.75 ± 14.64 121.25 ±18.05 125.25 ± 18.46
Diastolic BP
(mmHg)
79.00 ± 12.52 80.50 ± 17.31 83.00 ± 13.42
Respiration
(breaths per
minute)
27.14 ± 23.55 23.00 ± 20.25 23.95 ± 20.06
Heart rate
(bpm)
68.28 ± 21.27 74.43 ± 14.19 74.67 ± 12.39
Post-intervention
State anxiety 31.48 ± 18.98 32.43 ± 18.72 33.00 ± 18.67
Salivary cortisol
(nmol/L)
9.75 ± 7.68 11.00 ± 7.67 9.70 ± 7.02
Systolic BP
(mmHg)
115.25 ± 13.32 115.25 ± 16.18 115.50 ± 15.38
Diastolic BP
(mmHg)
77.00 ± 8.64 76.00 ± 14.20 76.50 ± 14.24
Respiration
(breaths per
minute)
18.05 ± 3.84 18.50 ± 3.91 18.05 ± 3.47
Heart rate
(bpm)
68.80 ± 9.52 68.95 ± 8.96 68.65 ± 7.06
689


Carvalho CC, Chaves ECL, Iunes DH,
Simão TP, Grasselli CSM, Braga CG



The use of various means of invesgang anxiety facili-
tates and reinforces its idencaon. Among those used
in this study, measuring vital signs is eecve because
they are considered to be indicators of bodily vital func-
ons and are a roune part of nursing clinical pracce. It
is a simple technique that is cost-free and requires lile
me. The applicaon of a psychometric instrument is al-
so a simple, quick method of self-evaluaon; however, a
trained person is required to calculate the score. On the
other hand, salivary corsol analysis is more costly; even
though it is not an invasive procedure, it requires labora-
tory analysis and also requires a trained professional for
sample gathering and pernent recommendaons.
We concluded that nursing clinical pracce places pro-
fessionals in a posion to invesgate paent’s anxiety and
treat it through alternave therapies such as prayer. This
method aends to paents’ spiritual dimension and was
found to be eecve in reducing anxiety. Furthermore, its
use is simple and can be connuous, resulng in no nan-
cial costs and no change to the hospital service roune.
However, its use as a technique must sll be tested.
One of the limitaons of this study relates to the sam-
ple size, which prevents the generalizaon of the results.
This calls for replicaon of the invesgaon with a larger
sample size; especially with a clinical trial model so that
control and treatment group results can be compared.
Nonetheless, the results of the study have implicaons for
nursing clinical pracce, for it oers a standardized prayer
protocol that lasts a maximum of 10 minutes. The prayer
can be recorded and oered to paents to listen through
headphones during a chemotherapy session; it can also
be conducted by nurses themselves, in the form of inter-
cession, should the paent so desire.
Nursing sta can use prayer as a strategy for provid-
ing paents with spiritual support, in order to aend to
the needs related to their spirituality or even to help the
paent cope with the illness, its treatment and conse-
quent anxiety.

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... Research shows that prayer is correlated with decreased anxiety (Fox et al, 2016), depression (Lawler-Row & Elliot, 2016), and stress (Fox et al., 2016). Prayer is commonly used as a coping strategy for patients with various illnesses including cancer (Carvalho et al., 2014;Gansler et al., 2008) and those undergoing open heart surgery (Ai et al., 2008). In a quasi-experimental study of patients undergoing chemotherapy, a significant decrease in anxiety levels, respiratory rate, and blood pressure was reported in patients who prayed versus those who did not (Carvalho et al., 2014). ...
... Prayer is commonly used as a coping strategy for patients with various illnesses including cancer (Carvalho et al., 2014;Gansler et al., 2008) and those undergoing open heart surgery (Ai et al., 2008). In a quasi-experimental study of patients undergoing chemotherapy, a significant decrease in anxiety levels, respiratory rate, and blood pressure was reported in patients who prayed versus those who did not (Carvalho et al., 2014). ...
... While some mental health professionals may not fully appreciate the religious dimension in the context of client care due to their own personal biases or lack of training (McCullough, 1999;Pargament, 1997), the majority acknowledge the relevance of religious belief systems and practices in their work with clients (Rosmarin, Forester, & Shassian, 2015). The increased recognition of the relevance of religion in the provision of mental health care may stem, in part, from the growing empirical evidence of a generally salutary effect of religion and spirituality on psychological health, evidence that many individuals use religious coping during times of stress and adversity (Ai et al., 2006;Braun-Lewensohn, 2014;Hill, Hawkins, Raposo, & Carr, 1995;Carvalho et al., 2014;Pargament, 1997), and recognition that many clients, especially those with religious affiliation and those who place a high value on spiritual/religious involvement, have a preference for religious and spiritually integrated care (Rosmarin et al., 2015). ...
Thesis
Research tells us that there is a positive effect of prayer on well-being. However, little is known about the mechanisms that underlie this relationship. In addition, much of the available data concerning prayer and well-being is based on Christians living in the United States, and our knowledge of how prayer and well-being are functionally interconnected in other faith groups is sparse. The primary aim of this study was to understand how prayer impacts well-being in individuals of the Muslim faith. Specifically, four potential mediators of the relationship between prayer and well-being were examined: optimism, spirituality, mindfulness, and social support. Participants (N=155) were recruited online and completed measures of prayer habits and levels of trait mindfulness, spirituality, optimism, social support, and subjective well-being. The data were analysed using a parallel multiple mediator model to test for the indirect effect of the mediator variables on the relationship between prayer and well-being. Optimism and spirituality were both found to be mediators of frequency of prayer and subjective well-being. Mindfulness correlated with both frequency of prayer and well-being but did not mediate the relationship between the two. Social support correlated with frequency of prayer but not with well-being and was not a mediator in the relationship between prayer and well-being. Implications of findings for culturally informed mental health counselling are discussed.
... Ainda no contexto hospitalar, o reconhecimento dos benefícios da E/R é evidente, mas, paradoxalmente, o apoio institucional à dimensão espiritual parece ser incipiente, pois se observa que é pouco implementada como estratégia para a autoimersão no trabalho, interconectividade e autorrealização dos profissionais de enfermagem. Desse modo, compreender o fenômeno E/R no ambiente laboral e na prática assistencial da equipe de enfermagem, onde a jornada de trabalho muitas vezes é árdua e estressante, se justifica porque, de acordo com a literatura, a experiência espiritual do profissional, por meio da eufemia, fornece mecanismos, como a fé, no enfrentamento de situações adversas, em locais repletos de tensão (12) . ...
... No Brasil, estudo realizado em um hospital filantrópico com pacientes em tratamento quimioterápico revelou que a oração proporciona nova perspectiva para a assistência de enfermagem, por ser uma opção de cuidado que oferece benefícios ao tratamento convencional, além de atender a dimensão espiritual de pacientes internados (12) . Nesse mesmo estudo, os autores afirmam que a oração é uma ferramenta que auxilia a enfrentar a ansiedade e a doença e, por isso, pode ser considerada uma estratégia de cuidado pela Enfermagem (12) . ...
... No Brasil, estudo realizado em um hospital filantrópico com pacientes em tratamento quimioterápico revelou que a oração proporciona nova perspectiva para a assistência de enfermagem, por ser uma opção de cuidado que oferece benefícios ao tratamento convencional, além de atender a dimensão espiritual de pacientes internados (12) . Nesse mesmo estudo, os autores afirmam que a oração é uma ferramenta que auxilia a enfrentar a ansiedade e a doença e, por isso, pode ser considerada uma estratégia de cuidado pela Enfermagem (12) . ...
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Objectives: to understand the spirituality and the practice of euphemism experienced by nursing professionals in the hospital scenario. Methods: a descriptive, exploratory research with a qualitative approach, carried out with 18 nursing professionals from a hospital in southern Brazil. Data collection took place from September to October 2018, through recorded audio interviews. The reports were submitted to thematic content analysis and the discussion was based on the theory of transpersonal care. Results: four categories emerged from the speeches: Motivational reflection of spirituality in the work environment; Adherence to the practice of euphemism by nursing professionals; Satisfaction and frustration in the practice of euphemism by nursing professionals and; Spirituality as an increase in human faith. Final Considerations: professionals understand spirituality and the practice of euphemism as a tool that helps in motivating the team to face difficulties at work and increase the faith of hospitalized patients.
... Another important finding confirmed the link between lower levels of depression and anxiety and the practice of prayer. The finding is in agreement with numerous other studies (Carvalho et al., 2014;Miranda et al., 2020;Simão et al., 2016). Furthermore, prayer has been linked to happiness (Pérez et al., 2011). ...
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The purpose of the present study was to examine the association between religiosity, depression, and anxiety in Moroccan cancer patients. A convenience sample of 1055 participants was recruited to complete questionnaires. Socio-demographic, religious, and cancer characteristics were assessed. The Arabic version of the HADS scale was used to assess depression and anxiety. Bivariate chi-square and multivariate logistic regression were used to analyze data. The results revealed that engaging in religious practices significantly decreases the risk of suffering from depression and/or anxiety. However, some religious practices may have a counter effect. These findings suggest that religiosity is important for cancer patients in Morocco and is also associated with a better quality of life.
... Another important nding con rmed the association between lower levels of depression and anxiety with practicing prayer. This nding is in line with numerous studies [31,32,33,34]. In the same vein, prayer has been associated with well-being [35]. ...
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Background: Many researchers have associated between religiosity with a lower level in depression and anxiety among patients with chronic diseases and especially in cancer patients. The aim of this study is to examine the association between spirituality and depression among Moroccan cancer patients. Another aim resides in to examining the association between spirituality and anxiety among Moroccan cancer patients. Methods: 1054 cases were included. Cancer profile, socio demographic and spiritual characteristics were considered. The data were firstly analyzed using the validated HADS scale arabic version. The statistical significance was tested using Chi-square test. The Odds ratios were also computed for the likelihood of being in depression and/or anxiety. Results: The results obtained revealed that the performance of religious practices such as reading Quran, doing Roquia , and the consideration of cancer as a divine test are factors that significantly decrease the risk of having depression and/or anxiety. However women wearing the “hijab” have three times higher chances of having anxiety compared to other women that do not wear the “hijab”. Patients considering cancer as a divine punishment have significantly higher odds of having anxiety and/or depression. Regarding charity, pilgrimage, visit of “marabouts”, use of medicinal plants and fasting are found to be insignificant predictors of depression and anxiety. Conclusions: The current evidence indicates that religiosity is important to patients facing cancer. Religiosity is not just protective in nature, but it can also be therapeutic. Praying, reading or listening to the Quran, as well as considering cancer as a divine test have been shown to reduce the level of depression and anxiety . In conclusion, the spiritual aspect plays an important role in the quality of life of cancer patients.
... anxiety, as well as increase self -satisfaction, hope and optimism about life which gives meaning and purpose topeople'slives. Prayer is a deep experience in which one connects to the supernatural force whichis imaginary, andit is felt in a deeper space. It has also been described as a process of intervention in spiritual care for those suffering (Carvalho et. al., 2014). Prayer is an impersonal communication with the supreme one. It is a universal pattern of rendering one's intentions from anoutpouring of those things that are sought within one's religion. Prayer thus is an outcome of one's belief in God which could be offered to reach God. Prayer creates a communion between one's soul with the divinit ...
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Religious beliefs involve the devotional practices and rituals related to supreme powers, spirituality and divine connection. These beliefs may also involve the mystery of life and death, ethics, morals and existence. Religion is a multifaceted unexplainable yet experiential phenomenon. Religion, spirituality and health care are issues of public health concerns that interfere with modern day medical ethics and practices. This study explored the socio-cultural factors influencing the health beliefs of twenty-five Nigerian women towards cervical cancer screening programmes in Poland. The health belief model was appliedto explore their perception and attitude towards the risk of cervical cancer and its preventative screening measures. The results from this research revealed that most Nigerian women living in Poland pray about their health and well-being as a means to prevent illness.
... A study of 160 terminal illness patients found that spiritual wellness protects against hopelessness at this stage of life 39 . Prayer appears to be an effective strategy that reduces anxiety in patients who undergo chemotherapy [40][41][42][43] . Thus, spiritual care has been incorporated into national care quality guidelines, including those of the National Consensus Project for Quality Palliative Care and the Joint Commission 38 . ...
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Religion, spirituality, health, and medicine have common roots in the conceptual framework of relationship among human beings, nature, and God. Old age is a stage of life associated with spirituality. During this time, religious, spiritual, and cultural beliefs may be particularly important. Objective: The aim of this article is to present a review and to contrast the scientific evidence on the role that religion and spirituality take on health and illness. Methods: A research was conducted using the PUBMED database with different search terms and covering articles from 2002 to 2018. Eligibility of each article was decided by at least two independent authors. Results and conclusion: Religious practices seem to help individuals to cope with various aging-related illnesses and losses, help them build up an important resource for resilience, and encourage social interaction and support. Health-care providers should consider asking patients about their spiritual practices and well-being.
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Introduction: Despite increasing evidence of the benefits of spiritual care and nurses' efforts to incorporate spiritual interventions into palliative care and clinical practice, the role of spirituality is not well understood and implemented. There are divergent meanings and practices within and across countries. Understanding the delivery of spiritual interventions may lead to improved patient outcomes. Aim: We conducted a systematic review to characterize spiritual interventions delivered by nurses and targeted outcomes for patients in hospitals or assisted long-term care facilities. Methodology: The systematic review was developed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a quality assessment was performed. Our protocol was registered on PROSPERO (Registration No. CRD42020197325). The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to June 2020. Results: We screened a total of 1005 abstracts and identified 16 experimental and quasi-experimental studies of spiritual interventions delivered by nurses to individuals receiving palliative care or targeted at chronic conditions, such as advanced cancer diseases. Ten studies examined existential interventions (e.g., spiritual history, spiritual pain assessment, touch, and psychospiritual interventions), two examined religious interventions (e.g., prayer), and four investigated mixed interventions (e.g., active listening, presence, and connectedness with the sacred, nature, and art). Patient outcomes associated with the delivery of spiritual interventions included spiritual well-being, anxiety, and depression. Conclusion: Spiritual interventions varied with the organizational culture of institutions, patients' beliefs, and target outcomes. Studies showed that spiritual interventions are associated with improved psychological and spiritual patient outcomes. The studies' different methodological approaches and the lack of detail made it challenging to compare, replicate, and validate the applicability and circumstances under which the interventions are effective. Further studies utilizing rigorous methods with operationalized definitions of spiritual nursing care are recommended.
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BACKGROUND: There is limited published evidence in KwaZulu-Natal on access to oral health care for patients undergoing cancer therapy in the head and neck region. OBJECTIVES: This study aimed to assess patients' oral health-related perceptions, practices and needs during cancer therapy. METHODS: This was a descriptive case study. A semi-structured face-to-face interview was conducted with volunteers (n=12) undergoing cancer therapy in head and neck region. Purposive sampling was used to select study participants who were recruited from a public tertiary central referral hospital in KwaZulu-Natal. A semi-structured interview was also conducted with the eThekwini district coordinator for oral health services to gain better insight into oral health service delivery for patients with special needs. RESULTS: The results indicated that oral health care in the sample population was not prioritised. Some of the emergent themes included: participants' knowledge and oral health self-care practices, support for participants to cope with head and neck cancer, barriers in accessing facility-based oral health care (poor access to dental services, failure of the local clinic to provide appropriate care), lack of referral by oncology care practitioners for patients to access dental care, and existing gaps in oral health service delivery The reported non-existence of a specific oral health policy to address cancer and the absence of a risk factor intervention program highlighted some of the shortcomings for quality oral health service delivery in this population group. CONCLUSION: The results indicated that oral health care is important for patients undergoing cancer therapy. There is an urgent need for oral health planning in the province to take into account the specific oral health needs of this vulnerable population
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BACKGROUND: There is a shortage of validated instruments for the study of religiousness in Brazilian samples. A recent study in a community sample pointed to an adequate validity for the Brazilian Portuguese version of the Duke Religiosity Index (P-DUREL). Nevertheless, no study to date has investigated the psychometric properties of the P-DUREL in psychiatric and/or university student samples. OBJECTIVE: To determine the internal consistency, the test-retest reliability and the convergent-discriminant validity of the P-DUREL in two distinct samples. METHODS: Sample 1: university students (n = 323). Sample 2: psychiatric patients (n = 102). The P-DUREL and the World Health Organization's Quality of Life Instrument—Spirituality, Religion and Personal Beliefs module (WHOQOL-SRPB); psychological distress symptoms were measured by means the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) in sample 1, and the Hospital Anxiety and Depression Scale (HADS) in sample 2. RESULTS: The P-DUREL had adequate internal consistency (Cronbach's α > 0.80) and test-retest reliability (Intraclass Correlation Coefficient > 0.90) in both samples. Moderate correlations (0.58 < r < 0.71) between the P-DUREL subscales were observed. Furthermore, significant correlations between the P-DUREL scores with the general WHOQOL-SRPB scores as well as with psychological distress symptoms measures were observed in both samples. DISCUSSION: The present study opens perspective for the use of P-DUREL for the investigation of religiousness dimensions in Brazilian samples with diverse socio-demographic backgrounds.
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The study investigated the religious coping in 10 cancer patients of a specialized institution, aged between 25 and 55 years old. The data were collected through interviews. The results were analyzed considering the content of the patients' verbal report, described as: (1) categories of verbal report's content (emotional support, healing, searching of meaning, contributions for treatment, and control); and (2) characteristics of religiousness/spirituality. All participants presented verbal reports with contents of religiousness/spirituality, which suggests that due to the relation between the disease and the possibility of death, religious coping became a strategy of stress reduction and quality of life improvement for those patients.
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to investigate the use of religious/spiritual coping among people with cancer undergoing chemotherapy. a quantitative, descriptive and cross-sectional study of 101 patients undergoing intravenous chemotherapy in an oncology outpatients center in a public hospital in Minas Gerais, made in the first semester of 2011. For data collection, an interview was held, using a questionnaire for characterizing the sample and the Brief Spiritual/Religious Coping Scale. all subjects made use of religious/spiritual coping (mean=3.67; sd=0.37); the younger individuals, those with no religion and those who consider spiritual support unimportant tend to use coping negatively; individuals who would like to receive spiritual support and who participate in support groups for cancer patients, on the other hand, use coping positively. the study reinforces that religious/spiritual coping is an important strategy for coping with cancer, and contributes to an understanding of the same as a useful tool for spiritual care.
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Background: The implications of spirituality in one's health have been studied and registered in hundreds of articles, demonstrating its relationship with several aspects of physical and mental health,probably positive and possibly causal. Objective: To present the recent evidences of the role of spirituality and religiosity in daily clinical practice. Methods: The articles were selected based on Medline database, through the keywords: "religiosity", "religion", "spiritual" and "spirituality". The articles were evaluated by analysis of method and determination of limitations of studies'design. Results: The major findings originated from the association of spirituality, religiosity and immunological activity, mental health, neoplasias, cardiovascular diseases and mortality, besides aspects regarding the intervention of the intercessory prayer, were presented in a descriptive and concise way. Conclusions: The relationship between the religiosity/spirituality and the physical health has been confirmed but the evidences are not sufficiently conclusive. So, this has become a very promising field of study.
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This study aimed to identify how religious and spiritual practices are experienced at different ages during the aging process. The study was cross-sectional and observational and conducted in the city of Chapecó, SC, from July 2008 to January 2009. The sample included 2,160 individuals with 720 individuals interviewed in each age group. The analysis was univariate and obtained the absolute and relative frequency of each variable. The final data obtained were statistically analyzed with SPSS 13.0 software. It was observed that 77.6% of the respondents were Catholic and that the older individuals were more religious. A total of 50.6% of the respondents prayed once a day, 38.3% of them to offer thanks and 30.4% in the supine position. We conclude that religiosity is a valuable resource in coping with the crises of everyday life and positively affects physical and mental health, particularly in the elderly.
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This analytical, cross-sectional study applied a quantitative approach to verify the presence of depression and the adherence to a chemotherapy treatment in patients with cancer at the central chemotherapy pharmacy of a university hospital. The sample consisted of 102 patients, and data were collected from October 2010 to May 2011. A structured interview was used to obtain sociodemographic, clinical and therapeutic data; the Morisky Test and Beck Depression Inventory were also applied. The results revealed that 10.8% and 1.9% of participants had moderate and severe depression, respectively. The presence of depression was significantly associated with variables such as income per capita, the number of surgeries, and disease duration. A lack of treatment adherence was identified in 48% of participants. These results indicate the need for health staff training to detect depressive disorders and chemotherapy treatment attrition among patients with cancer.
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Generalized anxiety disorder (GAD) is common in older adults and, although cognitive behavioral therapy (CBT) is an efficacious treatment for late-life GAD, effect sizes are only moderate and attrition rates are high. One way to increase treatment acceptability and enhance current cognitive behavioral treatments for GAD in older adults might be to incorporate religion/spirituality (R/S). The cases presented here illustrate the use of a 12-week modular CBT intervention for late-life anxiety, designed to allow incorporation of R/S elements in accordance with patient preferences. The three women treated using this protocol chose different levels and methods of R/S integration into therapy. All three women showed substantial improvement in worry symptoms, as well as a variety of secondary outcomes following treatment; these gains were maintained at 6-month follow-up. These preliminary results suggest that the incorporation of R/S into CBT might be beneficial for older adults with GAD. Strengths, limitations, and future directions are discussed.
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Objective: To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity. Design: Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation. Setting: Florence and Pavia, Italy. Participants: 23 healthy adults. Main outcome measures: Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations. Results: Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05. Conclusion: Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects. What is already known on this topic What is already known on this topic Reduced heart rate variability and baroreflex sensitivity are powerful and independent predictors of poor prognosis in heart disease Slow breathing enhances heart rate variability and baroreflex sensitivity by synchronising inherent cardiovascular rhythms