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SPIRITUAL CARE NEEDS DETERMINATION SCALE ON PATIENTS ACCORDING TO THE OPINION OF DOCTORS, NURSES AND MIDWIVES: DEVELOPMENT, VALIDITY AND RELIABILITY

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IMUCO
INTERNATIONAL
MULTIDISCIPLINARY
CONFERENCE
IMUCO 2016
21-22 April 2016
ANTALYA TURKEY
www.imuco.org
PROCEEDINGS BOOK
IMUCO
INTERNATIONAL
MULTIDISCIPLINARY
CONFERENCE
INTERNATIONAL
MULTIDISCIPLINARY
CONFERENCE
Proceedings Book
C h a i r m a n o f C o n f e r e n c e
Prof. Dr. İlhan GÜNBAYI
R e g u l a t o r y A u t h o r i t y
Prof. Dr. Temel ÇALIK
Assoc. Prof. Dr. Aydın ÇETİN
Assoc. Prof. Dr. Sezai TOKAT
Asst. Prof. Dr. Nurhodja AKBULAEV
Dr. Nazim CAFEROV
Kadir KESKİN
ACKNOWLEDGEMENT
On 21-22 April, 2016 in International Multidisciplinary Conference (IMUCO 2016)
in Antalya many researchers and scholars from multidisciplinary fields came
together, led multidisciplinary studies be discussed in an established
background by submitting their knowledge and experience.
With this e-book consisting of articles submitted and selected in the
conference, it is aimed to reach to worldwide researches and scholars and
share knowledge.
Additionally, we would like to thank to all those public and private
organizations contributing to our conference, those scholars in charged for
regulatory authority, congress secretary and science board, invited speakers
and those colleagues participating from multidisciplinary fields with their
articles.
Sincerely,
Prof. Dr. İlhan GÜNBAYI
Chairman of the Conference
Chairman of Conference
Prof. Dr. İlhan GÜNBAYI
Regulatory Authority
Prof. Dr. Temel ÇALIK
Assoc. Prof. Dr. Aydın ÇETİN
Assoc. Prof. Dr. Sezai TOKAT
Asst. Prof. Dr. Nurhodja AKBULAEV
Dr. Nazım CEFAROV
Kadir KESKİN
Congress Secretary
Res. Asst. Irmak DALDIR
Res. Asst. Abdullah Emre ÇAĞLAR
Res. Asst. Yusuf Ali DANIŞ
Science Board
Prof. Dr. Abesadze NINIKA
Prof. Dr. Abdilbaet MAMASIDIKOV
Prof. Dr. Abdurrahman TANRIÖĞEN
Prof. Dr. Ali İlker GÜMÜŞELİ
Prof. Dr. Çetin BEKTAŞ
Prof. Dr. Gelaschwili SIMON
Prof. Dr. Hüseyin CERTEL
Prof. Dr. İlhan GÜNBAYI
Prof. Dr. Mariya KOCHKORBAEVA
Prof. Dr. Mehmet AKGÜN
Prof. Dr. Nasriddin Sadriddinov
TALBAKOVICH
Prof. Dr. Nino MIKIASHVILI
Prof. Dr. Olga NOSOVA
Prof. Dr. Osman GÖKALP
Prof. Dr. Ömer Faruk TEBER
Prof. Dr. Rajab Rajabov
KUCHAKOVICH
Prof. Dr. Satıbaldı OMURZAKOV
Prof. Dr. Temel ÇALIK
Prof. Dr. Yüksel KÖSEOĞLU
Assoc. Prof. Dr. Abdukarim
Kurbanov RAKHIMOVICH
Assoc. Prof. Dr. Ainur NOGAYEVA
Assoc. Prof. Dr. Alica LUPTAKOVA
Assoc. Prof. Dr. Aripov Abdugani
ABDUHAMIDOVICH
Assoc. Prof. Dr. Aydın ÇETİN
Assoc. Prof. Dr. Fariz AHMADOV
Assoc. Prof. Dr. Firdaus NOROV
Assoc. Prof. Dr. Filiz Angay KUTLUK
Assoc. Prof. Dr. Frumkin Boris
EFIMOVICH
Assoc. Prof. Dr. Gaini MUKHANOVA
Assoc. Prof. Dr. Geray MUSAYEV
Assoc. Prof. Dr. Hilale Caferova
ALIMARDANQIZI
Assoc. Prof. Dr. İlhan TOPUZ
Assoc. Prof. Dr. Mehmet AKINCI
Assoc. Prof. Dr. Mehmet MERT
Assoc. Prof. Dr. Mutahayira
MADZHNUNOVA
Assoc. Prof. Dr. Natiq QURBANOV
Assoc. Prof. Dr. Olgun KİTAPÇI
Assoc. Prof. Dr. Rahmatullo AMINOV
Assoc. Prof. Dr. Saadet GANDILOVA
Assoc. Prof. Dr. Sergej VUCTOVIČ
Assoc. Prof. Dr. Shavkat Rustamov
RAKHIMOVICH
Assoc. Prof. Dr. Tarık TUNCAY
Assoc. Prof. Dr. Qadir BAYRAMLI
Asst. Prof. Dr. Aydın AYDIN
Asst. Prof. Dr. Barış AŞÇI
Asst. Prof. Dr. Barış ÇİFTÇİ
Asst. Prof. Dr. Bayram AKAY
Asst. Prof. Dr. Bülent YILDIZ
Asst. Prof. Dr. Duygu Çelik ERTUĞRUL
Asst. Prof. Dr. Elşen MEMMEDLİ
Asst. Prof. Dr. Eman HAYAJNEH
Asst. Prof. Dr. Erkan KAVAS
Asst. Prof. Dr. Fahriye UYSAL
Assoc. Prof. Dr. Farzad KIANI
Asst. Prof. Dr. Fatih YILDIZ
Asst. Prof. Dr. Haneen Abudayeh
Asst. Prof. Dr. Hasan ERDOĞAN
Asst. Prof. Dr. Hasan YÜKSEL
Asst. Prof. Dr. İhsan SARI
Asst. Prof. Dr. Kıyalbek
AKMOLDOYEV
Asst. Prof. Dr. Mahmut GULLE
Asst. Prof. Dr. Mehmet Faruk
ÖZÇINAR
Asst. Prof. Dr. Mehmet Metin DAM
Asst. Prof. Dr. Mohammed Ahmed
SHAH
Asst. Prof. Dr. Murad Alpaslan
KASALAK
Asst. Prof. Dr. Murat BELKE
Asst. Prof. Dr. Mustafa Cevdet
ALTUNEL
Asst. Prof. Dr. Nilüfer Vatansever
TOYLAN
Asst. Prof. Dr. Nurhodja AKBULAEV
Asst. Prof. Dr. Özgür ARPACI
Asst. Prof. Dr. Raqif QASIMOV
Asst. Prof. Dr. Recep TEMEL
Asst. Prof. Dr. Seher Derya KULA
Asst. Prof. Dr. Sibel Su ERÖZ
Asst. Prof. Dr. Şahin EKBEROV
Asst.Prof. Dr. Hakan ÇETİN
Asst. Prof. Dr. Vassilya UZUN
Asst. Prof. Dr. Vedat ÖZYAZGAN
Asst. Prof. Dr. Hüseyin TOPUZ
Dr. Amanda CHUANG
Dr. Han Chun HUANG
Dr. Nazim CAFEROV
Dr. Oqtay QULIYEV
Dr. Ruhi İNAN
Dr. Südabe SALIHOVA
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SPIRITUAL CARE NEEDS DETERMINATION SCALE ON PATIENTS
ACCORDING TO THE OPINION OF DOCTORS, NURSES AND
MIDWIVES: DEVELOPMENT, VALIDITY AND RELIABILITY
Dr. Erkan Kavas
Süleyman Demirel Üniversity, F.E.A.S., Department of Social Work
drerkankavas@gmail.com
ABSTRACT
The purpose of the article; to make development work the validity and reliability analysis of the 'Spiritual
Care Needs Determination Scale' to determine the views of doctors, midwives and nurses about the spiritual care
needs of patients who are treated in inpatient institutions.
The scale consisting of 19 substances was applied to 404 Doctors, Nurses and Midwives working in hospitals
which are functioning under Denizli Association of Public Hospitals. The Cronbach's Alpha value was found to
be 0.970, for the 19 items of Spiritual Care Need Determination scale on Patients. The scale was found to be highly
reliable. According to Spearman-Brown approach, the reliability level of the test is 0.922; according to Guttman
split-half approach, the reliability level of the test was found to be 0.920. These findings support the rate of
Cronbach's Alpha. The explanatory factor analysis was applied to demonstrate the scale of structure validity. As a
result of Bartlett test (p=0.000<0.05), it is determined that there is a relationship between the variables in the factor
analysis. Another hypothesis to be tested Factor analysis is the Kaiser-Meyer Olkin (KMO) test. It is determined
that there is a relationship between the variables in the factor analysis in Bartlett test (p = 0.000 <0.05). Another
hypothesis to be tested factor analysis is Kaiser-Meyer Olkin (KMO) test. In the test result (KMO = 0.968> 0.60),
it is determined that the sample size is sufficient for applying factor analysis. By selecting the varimax in factor
analysis application method, it is provided that the structure of the relationship between factors remains the same.
Variable in factor analysis was collected under a single factor which has %65.06 of the total variance. According
to the alpha and explained variance value in relation to the reliability, Spiritual Care Needs Determination Scale
on Patients was found to be a valid and reliable instrument. The findings related to validity study of Spiritual Care
Needs Determination Scale on Patients, the model of single-factor structure consisting of 19 items was tested by
Confirmatory Factor Analysis (CFA). The positive factor load was provided on CFA carried out in all 19 items.
Modification indices which has Ki-Square value for DFA, over 100 and creates change, were used. t test results
are significant for all items (t>1,96; p>0,05). According to the results of CFA, it was observed that item factor
loads are vary between 0.70 and 0.86. According to the results of CFA, values of R-squared (R2) were observed
to vary between 0.50 and 0.73.
According to those results, It may be expressed that Spiritual Care Needs Determination Scale in Patients is
a valid and reliable data collection tool to determine the opinions of the doctors, midwives and nurses working in
hospitals about Spiritual Care Needs of the patients treated in the inpatient institutions.
Keywords: Spiritual Care, Spiritual Support, Patient, Spirituality.
INTRODUCTION
At the time of illness, patients feel that their life is at risk. Accordingly, patients can become stressed. The
patient faces some questions such as , "Am I going to complete the works I have been doing? How will my family
survive after me? Why me? Will I be forgotten? Is God punishing me? What's going to happen to me after my
death ” (Büssing et al.,2005). In such cases, the patients who have spiritual value, can receive support from their
faith in coping with their diseases, pain, stress of life and in the healing process. Thus, while continuing the medical
treatment, at the same time patients try to resist this life-threatening condition taking strength from their faith and
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morale (Aştı et al., 2005). The patient, on the one hand, tries to cope with the disease, on the other hand, may feel
more combative and powerful taking advantage of positive, negative spiritual coping strategies. In the studies
conducted on this issue, it was determined that socio-economically disadvantaged patients, female patients and
elderly patients use spiritual coping ways more frequently (Boscaglia et al., 2005).
When an individuals encounter a sudden, unexpected situation which they do not like; they should be able to
learn sometings from these events, find solutions to the problems which have arisen, accept these living conditions
and be at peace with themselves. At this point, the individuals must ask the fundamental question" what does this
event want to teach me? " (Sharma, 2006). When this awareness is realized, the individuals will understand the
value of feelings, thoughts in their life. The acceptance process which helps in coping with the negative effects of
an event is possible to realize and face what we have lived through (Lama and Cutler, 2000). The necessary attitude
towards the events they live; to learn the lessons and focus what should be learned must be expressed to the people.
Thus, we have provided spiritual support. Conversely, focusing on the event and its impacts damage people. The
Events faced by people, the living conditions in their lives aim to enrich their lives, to add value, to enhance their
experience and to provide their progress morally developing their human characteristics. For this to happen,
"learning feature" is a feature that continues until the end of human life (Milan, 1996).
The main cause of the increasing stress coefficient of the person after the experiencing the event is to give
attention to the unfavorable situations and accordingly focusing on the negative thoughts. The religious beliefs
that People believe are quite effective in turning to positive thoughts. The reason is that, religious beliefs help to
resist stress factors that emerged after the events of the tense environment and give the power to endure with such
situations. People with strong religious beliefs relax and review the experience that they met more calm and mature
manner (Topuz, 2003). Indeed, the positive effects of religious beliefs were observed on the people experienced
the 1999 earthquake. The following statements reveales the impact of faith in determining the attitude of a person
who experienced the earthquake: “We live in God's property. Therefore, we don’t have difficulty in finding
consolation. God gives patience” (Köse and Küçükcan, 2000). To pray for help to the creator of man and to believe
that this request will be accepted is more effective to relax and in turning positive thoughts (Peale, 1997).
According to Ross (1994), Radetzky represents the spiritual dimension as 3 types need:
1. Life is the requirement of finding the meaning of suffering and death concepts, and their purpose and
power.
2. Live in hope requirement
3. The need of faith and trust towards superior power and other people.
When these requirements are examined individually in the frame of spiritual dimensions; to survive, to accept
the life and to live is foremost effective factor of the spirituality. Ross expressed the meaning of life with Walsh
and Yura’s identification in an article which was published in 1994. “The Mankind's greatest task is to describe
the meaning of life.” Ross’s same article gives place to Stoll’s expression and he emphasized the meaning of life
with the following expression “If the person does not need a justification about life, he already began to die”. On
the other hand Dickinson (1975), like many other writers, stated that life is a universal feature and the requirements
of its meaning should be accepted as the basic life (Uğurlu, 2014). Spiritual care assistant is the person that patients
will consult/ talk about their religious and spiritual issues. This person listens to the patient and helps the patient
in the meaning process of his/her disease (Topuz, 2014). Eventually, we can say "spirituality is an indispensable
element in nursing care" (Uğurlu, 2014).
In this study, Kavas and Kavas’s definition which adresses the spiritual care with a multidisciplinary approach
as a separate area of expertise is based. Kavas and Kavas (2014) defines the Spiritual Care as “The spiritual
support services presented for the inpatients who demand. It inculcats them spiritually, supports them spiritually
and morally, provides guidance to fulfill their worship as much as possible and supports the vital resistance on
the condition of avoiding the intervention the medical treatment in any way in hospitals.”
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Even though coming into question of the spiritual care works in hospitals is new for our country (Topuz,
2014). The developmental process of the spiritual care concept is still ongoing. The identification and classification
process is not yet completed in the health field. Therefore, to evaluate this concept objectively in health education
and practices, it is essential to determine the opinion of the doctors, nurses and midwives on spiritual care, there
is a need to develope measuring means for this purpose (Ergül and Temel, 2007; Kavas and Kavas, 2014).
“Spiritual Care Needs Determination Scale on Patients According to the opinion of Doctors, Nurses and
Midwives” was developed to meet this need.
1. Method
This study was conducted with a screening method.
1.1. Statistical Analysis of Data
SPSS 21.0 and LISREL software package was used for statistical analys assessing the results obtained in this
study.
Article pool was created by screening the relevant literature. The item 17 of the Scale (Spiritual Support is
an important part of Psychosocial Rehabilitation Services of the patients) and the item 19 (I believe that the
spiritual Support would eliminate the spiritual deviation/superstition in the patient) were taken from the study
“Spiritual Support Perception Scale; Validity, Reliability” developed by Kavas and Kavas (2014). Five-point
Likert-type frequency rating scale was used in the scale. The scale consists of following options; Strongly Disagree
(0), Disagree (1), Undecided (2), Agree (3), Strongly Agree (4). After the language validity, in order to determine
the content (coverage) validity of the scale Expert Opinion used previously on the validity of the language studies
was used from the Presentation form. Kendall's W statistic was calculated for the content validity rate on Experts
opinion and content validity index and the compatibility of between experts.
It is stated that the sample size in scale development study, the sample size is not less than 100 people, should
be at least 5 times larger of the number of the items to be subjected to factor analysis (Tavşancıl, 2002). The scale
consisting of 19 items was applied to totally 404 subjects selected randomly ( 49 doctors, 80 midwives and 275
nurses). As the sample calculation is 19 x 5 = 95 < 404, the adequate sample number for verification analysis has
been reached.
Factor Analysis was used to reveal the structure validity of spiritual Care Needs Determination Scale on
Patients. Confirmatory factor analysis was used to examine the dimensions of the original scale.
Cronbach's Alpha was used for the general reliability and lower dimensions reliability. The most common
method to examine the reliability is Cronbach's Alpha coefficient. Besides, the analysis was supported by the
approaches of Spearman-Brown and Guttman split-half. The assessment criteria used in the evaluation of
Cronbach's Alpha Coefficient (Özdamar, 2004);
If it is 0,00 ≤ α <0,40 the scale is not reliable.
If it is 0,40 ≤ α <0,60 the scale is low reliability.
If it is 0,60 ≤ α <0,80 the scale is very reliable.
If it is 0,80 ≤ α <1,00 the scale is a highly reliable.
To examine the reliability of scale item by time, test-retest applications were analyzed by pairedsamples t-
test. It was evaluated that, Results are in the %95 confidence interval and the meaningfulness is two-way on the
level of p <0.05.
2. Validity and Reliability Analysis
2.1. Coverage Validation Analysis and Expert Opinions about Spiritual Care Needs Determination Scale on
Patients.
2.1.1. Content Validity and Analysis of Expert Opinions
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Content validity ratio was developed by Lawsh (1975). Minumum 5 maximum 40 expert opinions are needed
in the technique of Lawsh. Each item is evaluated as; "Item measures the target structure " , “Item does not measure
the target structure ", “Item measures the target structure but it is unnecessary”. As well as the content validity,
expert opinions on similar understanding of the item, suitability to the target group, etc. can be rated.
According to this, content validity ratios are obtained by adding expert opinions about any item (Table 1).
Content validity ratios are obtained by one missing of the ratio of the number of experts who indicats "necessary"
to the ratio of total number of experts who opine about the item.
Equation 1 Content Validity Rate.
1
2/ N
N
CVR G
NG refers to the number of experts who says "necessary," about the item. N refers the total number of experts
stating views on the item. According to Equation 1; CVR=0 when about half of the experts opine about the item
as"necessary" , CVR >0 when more then half of the experts opine about the item as"necessary" , CVR <0 when
more then half of the experts do not opine about the item as"necessary". If CVR value is negative or 0, such items
are eliminated in the first place. Statistical criteria and significance are tested for the items which have positive
CVR values. To test the statistically significance of the obtained CVR, for content validity scales, cumulative
normal distribution were used in the relavant literature previously. In terms of easy calculation, the minimum value
of Content Validity Criteria at the significance level of p = 0.05 was converted to the table by Veneziano and
Hooper (1997). According to this, the minimum values for the number of specialists also give the statistical
significance of the item.
Table 10: α=0,05 The Minimum Values for Content Validation Criteria on the Level of Significance*
Minimum Value
Number of
Experts
Minumum Value
0.99
13
0.54
0.99
14
0.51
0.99
15
0.49
0.78
20
0.42
0.75
25
0.37
0.62
30
0.33
0.59
35
0.31
0.56
40+
0.29
* Source: Veneziano L. ve Hooper J. , “A methodforquantifyingcontentvalidity of health-
relatedquestionnaires”. 1997: AmericanJournal of HealthBehavior, 21(1):67-70.
Even though Lawsh technique is the most common techniques used in the content of validity, other
techniques have been developed. Davis technic (1992) is rating the expert opinions in-four as (a) "eligible" (b)
"the item should be revised slightly," (c) "the item should be revised seriously" and (d) "not eligible". In this
technique, "The content validity index" is obtained by the number of experts who tick (a) and (b) divided by the
total number of experts and this 0.80 value is considered as a measure of value instead of comparing to a statistical
measure (Gözüm and Aksayan, 2003).
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Content Validity criteria (100 % > 99 %) for all items was achieved. Content Validity Index for all items
(100% > 80%) was achieved (Table 2).
Table 11: Expert Opinions
Ite
m
No
Item
Inappropri
ate
A bit
Appropriat
e (Required
Item
Revision)
Quite
appropri
ate
(appropri
ate but
necessary
minor
changes)
Extremel
y
appropri
ate
Total
Numbe
r of
Experts
The
numb
er of
expert
s who
says
"neces
sary,"
Cont
ent
Vali
dity
crite
ria
Cont
ent
Vali
dity
Inde
x
1
I believe that Spiritual beliefs
helps to relax the patient in
stressful situations.
6
6
6
100
%
100
%
2
I believe that patients, in the
treatment process, receive
morale support from spiritual
faith.
6
6
6
100
%
100
%
3
I believe that Spiritual
support, allows patients to be
at peace with the current
situation.
1
5
6
6
100
%
100
%
4
Patients turn to prayer and
worship for spiritual support.
2
4
6
6
100
%
100
%
5
I believe that Spiritual
practices help to relax the
patient in stressful situations.
6
6
6
100
%
100
%
6
I believe that spiritual support
reduce medical fears in
patients.
1
5
6
6
100
%
100
%
7
I think that spiritual beliefs
will help in coping with the
challenges of the disease.
6
6
6
100
%
100
%
8
I think that the patients live
according their religious
beliefs for spiritual support.
6
6
6
100
%
100
%
9
I believe that spiritual support
ensures patients staying
positive towards life.
6
6
6
100
%
100
%
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10
I believe that Patients need to
know, the convenience
provided by the religion in
worship.
6
6
6
100
%
100
%
11
To pray for them increases the
patient's recovery hope and
supports the treatment
process.
6
6
6
100
%
100
%
12
I believe that spiritual support
give power to the patients in
patience the pain associated
with the disease.
6
6
6
100
%
100
%
13
I believe that spiritual support
will gain a sense that belief is
next to the patient.
6
6
6
100
%
100
%
14
I believe that morale support
will help spiritual healing in
patients.
6
6
6
100
%
100
%
15
I believe that to pray for them
makes patients relieve
spiritually.
6
6
6
100
%
100
%
16
I believe that patient need
spiritual morale support
during treatment.
6
6
6
100
%
100
%
17
Spiritual support is an
important part of psychosocial
rehabilitation services for
patients.
6
6
6
100
%
100
%
18
I believe that Spiritual support
will ensure to be peace with
their iner (spiritual) world.
6
6
6
100
%
100
%
19
I believe that Spiritual support
will eliminate spiritual
deviation (superstitions) in
patients.
6
6
6
100
%
100
%
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Table 12: The Compliance of Expert Opinions
N
Average
S.s
Min.
Max.
Kendall's
W
p
Expert 1
19
3,95
0,23
3
4
0,058
0,352
Expert 2
19
3,95
0,23
3
4
Expert 3
19
4
0
4
4
Expert 4
19
4
0
4
4
Expert 5
19
4
0
4
4
Expert 6
19
3,90
0,32
3
4
Kendall's W statistic was calculated to examine the conformity between the experts. It was found that there is a
conformity among the experts ( Kendall’s W = 0,058; p=0,352>0,05).
2.2. The test related to Spiritual Care Needs determination Scale on Patients Test-Retest Analysis
Table 13: Spiritual Care Needs Determination Scale on Patients Test-Retest Analysis(n=30)
Test
Retest
t
p
Ort
Ss
Ort
Ss
1. I believe that Spiritual beliefs helps to relax the patient in
stressful situations.
3,330
0,661
3,070
1,311
0,955
0,348
2. I believe that patients, in the treatment process, receive
morale support from spiritual faith.
3,300
0,651
2,900
1,269
1,461
0,155
3. I believe that Spiritual support, allows patients to be at
peace with the current situation.
3,200
0,714
2,970
1,098
0,893
0,379
4. Patients turn to prayer and worship for spiritual support.
3,100
0,712
2,770
1,104
1,262
0,217
5. I believe that Spiritual practices help to relax the patient
in stressful situations.
3,170
0,699
2,970
1,033
0,783
0,440
6. I believe that spiritual support reduce medical fears in
patients.
2,970
0,669
2,700
1,149
0,955
0,348
7. I think that spiritual beliefs will help in coping with the
challenges of the disease.
3,230
0,568
2,970
1,066
1,034
0,310
8. I think that the patients live according their religious
beliefs for spiritual support.
3,130
0,681
2,730
1,081
1,508
0,142
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9. I believe that spiritual support ensures patients staying
positive towards life.
3,270
0,521
2,930
1,015
1,439
0,161
10. I believe that Patients need to know, the convenience
provided by the religion in worship.
3,230
0,568
2,800
1,064
1,750
0,091
11. To pray for them increases the patient's recovery hope
and supports the treatment process.
3,170
0,648
2,800
1,157
1,363
0,183
12. I believe that spiritual support give power to the patients
in patience the pain associated with the disease.
3,270
0,640
2,830
1,020
1,898
0,068
13. I believe that spiritual support will gain a sense that
belief is next to the patient.
3,200
0,551
2,830
1,020
1,578
0,125
14. I believe that morale support will help spiritual healing
in patients.
3,170
0,531
2,900
0,960
1,161
0,255
15. I believe that to pray for them makes patients relieve
spiritually.
3,130
0,571
2,870
1,042
1,137
0,265
16. I believe that patient need spiritual morale support
during treatment.
3,170
0,592
3,030
1,033
0,538
0,595
17. Spiritual support is an important part of psychosocial
rehabilitation services for patients.
3,130
0,629
3,030
0,999
0,423
0,676
18. I believe that Spiritual support will ensure to be peace
with their iner (spiritual) world.
3,200
0,484
2,900
1,062
1,273
0,213
19. I believe that Spiritual support will eliminate spiritual
deviation (superstitions) in patients.
2,970
0,718
2,800
1,031
0,656
0,517
For all items, test - retest reliability was maintained on the t test implemented for 19 items of spiritual care needs
in patients (p>0,05).
2.3 Reliability Analysis Related to the Spiritual Care Needs Determination Scale on Patients
Table 14: Cronbach’s Alpha
Cronbach's Alpha
The Number of Item
0,970
19
Cronbach's alpha value was found to be 0.970 for 19 items of spiritual care needs on patients. The scale was
highly reliable.
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Table 6: Item Analysis
The Scale
Average when
the İtem is
Deleted
The Scale
Variance When
the İtem is
Deleted
Corrected İtem
Full Correlation
Cronbach Alfa
When the İtem is
Deleted
1. I believe that Spiritual beliefs helps to
relax the patient in stressful situations.
52,89
179,456
0,752
0,968
2. I believe that patients, in the treatment
process, receive morale support from
spiritual faith.
52,91
180,690
0,740
0,969
3. I believe that Spiritual support, allows
patients to be at peace with the current
situation.
53,00
178,596
0,800
0,968
4. Patients turn to prayer and worship for
spiritual support.
53,13
180,934
0,703
0,969
5. I believe that Spiritual practices help
to relax the patient in stressful situations.
53,02
179,245
0,795
0,968
6. I believe that spiritual support reduce
medical fears in patients.
53,31
177,947
0,750
0,969
7. I think that spiritual beliefs will help
in coping with the challenges of the
disease.
53,05
178,977
0,812
0,968
8. I think that the patients live according
their religious beliefs for spiritual
support.
53,14
179,479
0,762
0,968
9. I believe that spiritual support ensures
patients staying positive towards life.
53,04
179,257
0,804
0,968
10. I believe that Patients need to know,
the convenience provided by the religion
in worship.
53,00
181,035
0,760
0,968
11. To pray for them increases the
patient's recovery hope and supports the
treatment process.
53,10
177,287
0,815
0,968
12. I believe that spiritual support give
power to the patients in patience the pain
associated with the disease.
53,10
177,320
0,796
0,968
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13. I believe that spiritual support will
gain a sense that belief is next to the
patient.
53,15
177,761
0,813
0,968
14. I believe that morale support will
help spiritual healing in patients.
53,01
179,767
0,830
0,968
15. I believe that to pray for them makes
patients relieve spiritually.
53,08
179,450
0,778
0,968
16. I believe that patient need spiritual
morale support during treatment.
52,88
181,913
0,763
0,968
17. Spiritual support is an important part
of psychosocial rehabilitation services
for patients.
53,01
179,618
0,794
0,968
18. I believe that Spiritual support will
ensure to be peace with their iner
(spiritual) world.
53,03
179,679
0,818
0,968
19. I believe that Spiritual support will
eliminate spiritual deviation
(superstitions) in patients.
53,19
178,987
0,758
0,968
When total correlation of the item is examed, it was found to be over %70 for all compounds. when
Cronbach's alpha values of the spiritual care needs detection scale in patients are examed with deleted item; It was
found no exceeding the general Cronbach's alpha values for any item. There was no need to remove item on the
item analysis stage.
Table 15: Split Half Test
Cronbach's Alpha
Part 1
Value
,946
N of Items
10a
Part 2
Value
,953
N of Items
9b
Total N of Items
19
CorrelationBetween Forms
,855
Spearman-Brown Coefficient
EqualLength
,922
UnequalLength
,922
GuttmanSplit-HalfCoefficient
,920
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One of the reliability method is dividing the two halves of the test. According to Spearman-Brown approach,
the level of the test reliability is 0.922. According to GuttmanSplit-Half approach, the level of the test reliability
is 0,920. This finding supports the Cronbach's Alpha value.
2.4. Validity Analysis related to Spiritual Care Needs Determination Scale on Patients
2.4.1. Explanatory Factor Analysis related to Spiritual Care Needs Determination Scale on Patients
"Cronbach's alpha" which is the internal consistency coefficient is calculated to calculate the reliability of
the 19. item on Spiritual Care Needs Determination Scale on Patients. The general reliability of the scale was
found very high as alpha = 0.970. The explanatory (exploratory) factor analysis was applied to demonstrate the
structure validity of the scale. Factor analysis helps to be more easily understood the relationships between
concepts within the data set by the researchers, discovering the basic factors (the structure of the relationship) of
data set consisting of many variables (http://www.istatistikanaliz.com/faktor_analizi.asp, Accessed: 05/10/2015).
In order to test the factor analysis, it is expected to be a relationship between the variables included in the factor
analysis as a result of Bartlett test which is one of the presuppositions. When Bartlett case value is p <0.05, it is
considered to be a relationship between variables (Büyüköztürk, 2009). It is determined that there is a relationship
between the variables in the factor analysis in Bartlett test (p = 0.000 <0.05). Another hypothesis to be tested factor
analysis is Kaiser-Meyer Olkin(KMO) test. KMO value is a value indicating the size of example (observation) is
adequate, for measured variables. When KMO value is greater than 0.60, it is considered to be adequate number
of samples (Büyüköztürk, 2009). In the test result (KMO = 0.968> 0.60), it is determined that the sample size is
sufficient for applying factor analysis. By selecting the varimax in Factor analysis application method, it is
provided that the structure of the relationship between factors remains the same. Variable in factor analysis was
collected under a single factor which has %65.06 of the total variance. According to the alpha and explained
variance value in relation to the reliability, Spiritual Care Needs Determination Scale on Patients was found to be
a valid and reliable instrument. The factors Structure of the scale is shown below.
Tablo 8: The Factor Structure of the Spiritual Care Needs Determination Scale on Patients
Size
Item
Factor
Load
Explained
variance
Cronbach's
Alpha
Spiritual Care Needs
Determination on
Patients
(eigenvalues=12.361)
14. I believe that morale support will help
spiritual healing in patients.
0,854
65,060
0,970
18. I believe that Spiritual support will
ensure to be peace with their iner
(spiritual) world.
0,842
11. To pray for them increases the patient's
recovery hope and supports the treatment
process.
0,837
13. I believe that spiritual support will gain
a sense that belief is next to the patient.
0,837
7. I think that spiritual beliefs will help in
coping with the challenges of the disease.
0,833
9. I believe that spiritual support ensures
patients staying positive towards life.
0,826
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17. Spiritual support is an important part of
psychosocial rehabilitation services for
patients.
0,821
3. I believe that Spiritual support allows
patients to be at peace with the current
situation.
0,820
12. I believe that spiritual support give
power to the patients in patience the pain
associated with the disease.
0,820
5. I believe that Spiritual practices help to
relax the patient in stressful situations.
0,817
15. I believe that to pray for them makes
patients relieve spiritually.
0,807
16. I believe that patient need spiritual
morale support during treatment.
0,792
10. I believe that Patients need to know,
the convenience provided by the religion
in worship.
0,787
8. I think that the patients live according
their religious beliefs for spiritual support.
0,786
19. I believe that Spiritual support will
eliminate spiritual deviation
(superstitions) in patients.
0,786
1. I believe that Spiritual beliefs helps to
relax the patient in stressful situations.
0,777
6. I believe that spiritual support reduce
medical fears in patients.
0,776
2. I believe that patients, in the treatment
process, receive morale support from
spiritual faith.
0,765
4. Patients turn to prayer and worship for
spiritual support.
0,732
Total Variance %65.06
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2.4.2 Confirmatory Factor Analysis on Spiritual Care Needs Determination Scale on Patients
The findings relating to validity studies of Spiritual Care Needs Determination Scale on Patients with 19
items single-Factor structure have tested by CFA. The positive factor load was provided in Confirmatory Factor
Analysis carried out on 19 items (CFA). Thus, The Fit indexes obtained as a result of 19 items and the CFA for
testing of a latent variable is as follows; Goodness of Fit Index = GFI, Adjusted Goodness of Fit Index=AGFI,
Comparative Fit Index=CFI, Normed Fit Index=NFI, Non-normed Fit Index=NNFI, Root-Mean-SquareError of
Approximation=RMSEA, and Standardized Root Mean Square Residual=S-RMR were examed and and Ki-square
value (χ2 = 912.36, N = 404, sd= 151, χ2 / df = 6.04, p = 0.000) was found to be significant. The fit index value
was found as RMSEA=0,13, GFI=0,76, CFI=0,89, AGFI=0,70, NFI=0,88, NNFI=0,88, SRMR=0,049.
Table 16: The Goodness of Fit Criteria
Fit criteria
Good fit
Acceptable Limits
Results of Goodness of Fit
Result
Ki-square
0<Ki- square <2sd
2sd<Ki- square <3sd
Ki- square = 912,36 >
3sd=453
poor fit
p value
0.05<p< 1.00
0.01 < p <0.05
0,0000
-
Ki-square /sd
0<Ki- square /sd<2
2<Ki- square /sd<3
Ki- square /sd = 912,36/151
=6,04
poor fit
RMSEA
0<RMSEA<0.05
0.05<RMSEA<0.08
0,13 (%90 CI= 0,12 ; 0,14)
poor fit
p value
0.10<p<1.00
0.05<p<1.00
0,00
-
SRMR
0 <SRMR <0.05
0.05 <SRMR <0.10
0,049
Good fit
NFI
0.95 <NFI <1.00
0.90 <NFI <0.95
0,88
poor fit
NNFI
0.97 <NNFI <1.00
0.95< NNFI <0.97
0,88
poor fit
CFI
0.97 <CFI <1.00
0.95< CFI <0.97
0,89
poor fit
GFI
0.95 <GFI <1.00
0.90< GFI <0.95
0,76
poor fit
RFI
0.90 <AGFI <1.00
0.85< AGFI <0.90
0,86
poor fit
AGFI
0.95 <RFI <1.00
0.90< RFI <0.95
0,70
poor fit
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Figure 1: CFA Factor loadings of Spiritual Care Needs Determination Scale on Patients
Modification indices which has Ki-Square value for CFA, over 100 and creating change, were used. It is
found that the following items “1. I believe that Spiritual beliefs helps to relax the patient in stressful situations.”,
2. I believe that patients, in the treatment process, receive morale support from spiritual faith.” are very similar
questions and close to each other theoretically.
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Figure 2: CFA t tests of Spiritual Care Needs Determination Scale on Patients
t test results are significant for all items (t>1,96; p>0,05).
Table 17: Factor Loads obtained by CFA and described Variances of Spiritual Care Needs Determination
Scale on Patients
Item
Factor
Loads
R2
1. I believe that Spiritual beliefs helps to relax the patient in stressful situations.
0,74
0,54
2. I believe that patients, in the treatment process, receive morale support from spiritual faith.
0,72
0,52
3. I believe that Spiritual support allows patients to be at peace with the current situation.
0,79
0,62
4. Patients turn to prayer and worship for spiritual support.
0,70
0,50
5. I believe that Spiritual practices help to relax the patient in stressful situations.
0,80
0,63
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6. I believe that spiritual support reduce medical fears in patients.
0,76
0,57
7. I think that spiritual beliefs will help in coping with the challenges of the disease.
0,82
0,66
8. I think that the patients live according their religious beliefs for spiritual support.
0,77
0,59
9. I believe that spiritual support ensures patients staying positive towards life.
0,81
0,66
10. I believe that Patients need to know, the convenience provided by the religion in worship.
0,78
0,60
11. To pray for them increases the patient's recovery hope and supports the treatment process.
0,83
0,69
12. I believe that spiritual support give power to the patients in patience the pain associated
with the disease.
0,81
0,66
13. I believe that spiritual support will gain a sense that belief is next to the patient.
0,84
0,70
14. I believe that morale support will help spiritual healing in patients.
0,86
0,73
15. I believe that to pray for them makes patients relieve spiritually
0,81
0,66
16. I believe that patient need spiritual morale support during treatment.
0,79
0,62
17. Spiritual support is an important part of psychosocial rehabilitation services for patients.
0,82
0,67
18. I believe that Spiritual support will ensure to be peace with their iner (spiritual) world.
0,84
0,71
19. I believe that Spiritual support will eliminate spiritual deviation (superstitions) in
patients.
0,78
0,61
According to the results of DFA, item factor loads were observed to vary between 0.70 and 0.86. According
to the result of DFA, R Square (R2) values were observed to vary between 0.50 and 0.73.
CONCLUSION
Spiritual Care is defined as “The spiritual support services presented for the inpatients who demand. It
inculcats the patients spiritually, supports them spiritually and morally, provides guidance to fulfill their worship
as much as possible and supports the vital resistance on the condition of avoiding the intervention the medical
treatment in any way in hospitals.”
It was found that there are very few researches on spiritual care in our country. To meet the need of data
collection tool of Researchers who are interested in this field and to fill the gap in this field, “Spiritual Care Needs
Determination Scalewas developed to determine the views of the doctors, nurses and midwives working in the
inpatient institutions. When assessing the results obtained in this study, SPSS 21.0 and LISREL software package
were used for statistical analysis.
Firstly, Article pool was created by scanning the relevant literature in the study. After the language validity,
in order to determine the content (coverage) validity of the scale, “Expert Opinion Presentation form” which was
applied on the validity of the language studies previously was used. Kendall's W statistic was calculated for the
content validity rate on Experts opinion and content validity index and the compatibility between experts. The
scale consisting of 19 items was applied to 404 subjects (49 doctors, 80 midwives and 275 nurses) selected
randomly. Explanatory Factor Analysis was used to uncover the construct validity of Spiritual Care Needs
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Determination Scale on Patients. Confirmatory Factor Analysis was used to examine the size of the original scale.
Cronbach's Alpha was used for the general reliability and lower dimensions reliability. The most common method
to examine the reliability is Cronbach's Alpha coefficient. Besides, the analysis were supported by the approach
of Spearman-Brown and Guttman split-half. To examine the reliability of scale item by time, test-retest
applications were analyzed by pairedsamples t-test. Results which are in the confidence interval of 95% and the
meaningfulness which is p <0.05 level evaluated in two-way. Content Validity criteria (100% > 99%) for all items
was achieved. Content Validity Index for all items (100% > 80%) was achieved. Kendall's W statistic was
calculated to examine the conformity between the experts. It was found that there is a conformity among the
experts. ( Kendall’s W = 0,058; p=0,352>0,05).
For all items test - retest reliability was maintained on the t test implemented for 19 items of spiritual care
needs in patients (p>0,05). Cronbach's alpha value was found to be 0.970 for 19 items of spiritual care needs on
patients. It was determined that the scale was highly reliable.
When item total correlation of spiritual care needs on patients is examed, it was found to be over %70 for
all compounds. when Cronbach's alpha values of the spiritual care needs detecrmination scale on patients are
examed with deleted item; It was found no exceeding the general Cronbach's alpha values for any item, there was
no need to remove item on the item analysis stage.
One of the reliability method is dividing the two halves of the test. According to Spearman-Brown approach,
the level of the test reliability is 0.922. According to GuttmanSplit-Half approach, the level of the test reliability
is 0,920. This finding supports the Cronbach's Alpha value.
"Cronbach's alpha" which is the internal consistency coefficient is calculated to calculate the reliability of
the 19. item on Spiritual Care Needs Determination Scale on Patients. The general reliability of the scale was
found very high as alpha = 0.970. The explanatory (exploratory) factor analysis was applied to demonstrate the
structure validity of the scale. In order to test the factor analysis,it is expected to be a relationship between the
variables included in the factor analysis as a result of Bartlett test which is one of the presuppositions. It is
determined that there is relationship between the variables in the factor analysis in Bartlett test (p = 0.000 <0.05).
Another hypothesis to be tested factor analysis is Kaiser-Meyer Olkin (KMO) test. In the test result (KMO =
0.968> 0.60), it is determined that the sample size is sufficient for applying factor analysis. By selecting the
varimax in factor analysis application method, it is provided that the structure of the relationship between factors
remains the same. Variable in factor analysis was collected under a single factor which has %65.06 of the total
variance. According to the alpha and explained variance value in relation to the reliability, Spiritual Care Needs
Determination Scale on Patients was found to be a valid and reliable instrument.
The findings related to validity study of Spiritual Care Needs Determination Scale on Patients, the model of
single-factor structure consisting of 19 items was tested by Confirmatory Factor Analysis (CFA). The positive
factor load was provided on CFA carried out in all 19 items. Modification indices which have Ki-Square value for
CFA and creates changes over 100 were used. t test results are significant for all substances (t>1,96; p>0,05).
According to the results of CFA, it was observed that item factor loads are vary between 0.70 and 0.86. According
to the results of CFA, values of R-squared (R2) were observed to vary between 0.50 and 0.73.
It may be expressed that Spiritual Care Needs Determination Scale on Patients is a valid and reliable data
collection tool which determine the perceptions of the doctors, midwives and nurses working in hospitals.
According to findings obtained, the measurement tool developed for this study may eliminate a significant
deficiency in the relevant field and be a measurement tool that can be used in future studies.
4. RECOMMENDATIONS
1. Spiritual Care Needs Determination Scale on Patients which was developed under this work is an effective data
collection tool which determines Spiritual Care Needs of the patients according to the opinions of the doctors,
midwives and nurses
2. We recommend to test the validity and reliability of this developed scale with larger samples and repeated
measures.
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3. We recommend to test the validity and reliability of this scale in inpatient institutions of different religions and
cultures in different countries with repeated measurements.
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APPENDIX:1.
Spiritual Care Needs Determination Scale on Patients According to the opinion of Doctors, Nurses and
Midwives
Directive
The Spiritual Care is the spiritual support services presented for the inpatients who demand.
It inculcates the patients spiritually, supports them spiritually and morally, provides
guidance to fulfill their worship as much as possible and supports the vital resistance
on the condition of avoiding the intervention the medical treatment in any way in
hospitals.
This scale was prepared to determine the views of doctors, midwives and nurses about “the
Spiritual Care Need of Patients”. Please use the rating given in the next column, mark
X the option that best suits you.
Strongly Disagree
Disagree
Undecided
Agree
Strongly Agree
Answer the following items according to your observation on patients.
0
1
2
3
4
1
I believe that Spiritual beliefs helps to relax the patient in stressful situations.
2
I believe that patients, in the treatment process, receive morale support from spiritual
faith.
3
I believe that Spiritual support allows patients to be at peace with the current situation.
4
Patients turn to prayer and worship for spiritual support.
5
I believe that Spiritual practices help to relax the patient in stressful situations.
6
I believe that spiritual support reduce medical fears in patients.
7
I think that spiritual beliefs will help in coping with the challenges of the disease.
8
I think that the patients live according their religious beliefs for spiritual support .
9
I believe that spiritual support ensures patients staying positive towards life.
10
I believe that Patients need to know the convenience provided by the religion in
worship.
11
To pray for them increases the patient's recovery hope and supports the treatment
process.
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12
I believe that spiritual support give power to the patients in patience the pain associated
with the disease.
13
I believe that spiritual support will gain a sense that belief is next to the patient.
14
I believe that morale support will help spiritual healing in patients.
15
I believe that to pray for them makes patients relieve spiritually.
16
I believe that patient need spiritual morale support during treatment.
17
Spiritual support is an important part of psychosocial rehabilitation services for
patients.
18
I believe that Spiritual support will ensure to be peace with their iner (spiritual) world.
19
I believe that Spiritual support will eliminate spiritual deviation (superstitions) in
patients.
Article
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Objective (s): Patients suffering from different illnesses might need spiritual care especially those who are suffering from chronic diseases. The aim of this study was to perform a need assessment study of spiritual care. Methods: This was a qualitative study. First a questionnaire was designed based on literature review and experts opinions. Then this questionnaire was administered to a panel of experts using the Delphi method. The panel were experts in psychiatry, social medicine, epidemiology, quality of life, medical ethics, pediatric, nursing, occupational medicine and religion. Results: Experts indicated that patients with chronic diseases, patients with acute diseases at recovering period, incurable diseases, the patients at the end of life and also their families have priority for receiving spiritual care. Moreover they indicated that those with addiction, psychiatric diseases, sexual problems, HIV positive and infertility problems need spiritual care. Conclusion: Spiritual care could be integrated into the mainstream medical treatment. However, patients’ medical condition, culture, medical ethics and patient choice have important role in delivery of spiritual care.
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ZET Makalenin amacı; yataklı tedavi kurumlarında görev yapan Doktor, Ebe ve Hemşirelere yönelik 'Manevi Destek Algısı' ölçek geliştirme çalışması geçerlik ve güvenirlik analizlerini yapmaktır. Manevi Bakım kavramının gelişimsel süreci devam etmekle birlikte sağlık alanında tanımlanma ve sınıflandırma süreci henüz tamamlanmamıştır. Bu çalışmada 'Manevi Bakım; hastanelerde yatarak tedavi gören hastaların tıbbi tedavilerine hiç bir şekilde müdahalede bulunulmamak şartı ile talep eden hastalara manevi telkinde bulunmak, onları ruhsal (manevi) ve moral yönden desteklemek, ibadetlerini hastalıklarının verdiği imkânlar çerçevesinde yerine getirmelerine rehberlik etmek ve yaşama dirençlerini desteklemek amacıyla sunulan manevi destek hizmetleridir' şeklinde tanımlanmıştır. Öncelikle ilgili literatür bilgisi araştırılarak madde havuzu oluşturulmuştur. Oluşturulan madde havuzu kapsam geçerliliğinin sağlanması için uzman görüşüne sunulmuştur. Uzman görüşlerine göre düzenlenen ölçek pilot olarak 50 Doktor, Ebe ve Hemşireye uygulanarak güvenirlik katsayısı (Cronbach alpha) 0,963 olarak bulunmuştur. Sağlık çalışanları üzerinde tekrar test uygulanmış ve korelasyon katsayısı 0,947 olarak saptanmıştır. Ölçek bir sonraki adımda Denizli İli Kamu Hastaneler Birliği'ne bağlı yataklı tedavi kurumlarında (hastanelerde) görev yapan 244 Doktor, Ebe ve Hemşireye uygulanmıştır. Ölçek için yapılan güvenirlik analizi sonucunda güvenirlik katsayısı (Cronbach alpha) 0,940 olarak bulunmuş ve iç tutarlılığı etkileyen bir madde çıkartılmıştır. Ölçeğin yapı geçerliliğini ortaya koymak için yapılan açımlayıcı faktör analizi sonucunda ölçeğin % 58.4 varyans oranıyla tek faktör olduğu tespit edilmiştir. Manevi destek algısı konusunda ulaşabildiğimiz kadarıyla, Türkiye'de geliştirilmiş ilk ve tek ölçek olma özelliğinden dolayı paralel form çalışmasına yer verilememiştir. Bu sonuçlara göre ölçeğin geçerli ve güvenilir bir ölçme aracı olduğu söylenebilir.
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Spirituality has become a subject of interest in health care as it is was recognized to have the potential to prevent, heal or cope with illness. There is less doubt that values and goals are important contributors to life satisfaction, physical and psychological health, and that goals are what gives meaning and purpose to people's lives. However, there is as yet but limited understanding of how patients themselves view the impact of spirituality on their health and well-being, and whether they are convinced that their illness may have "meaning" to them. To raise these questions and to more precisely survey the basic attitudes of patients with severe diseases towards spirituality/religiosity (SpR) and their adjustment to their illness, we developed the SpREUK questionnaire. In order to re-validate our previously described SpREUK instrument, reliability and factor analysis of the new inventory (Version 1.1) were performed according to the standard procedures. The test sample contained 257 German subjects (53.3 +/- 13.4 years) with cancer (51%), multiple sclerosis (24%), other chronic diseases (16%) and patients with acute diseases (7%). As some items of the SpREUK construct require a positive attitude towards SpR, these items (item pool 2) were separated from the others (item pool 1). The reliability of the 15-item the construct derived from the item pool 1 respectively the 14-item construct which refers to the item pool 2 both had a good quality (Cronbach's alpha = 0.9065 resp. 0.9525). Factor analysis of item pool 1 resulted in a 3-factor solution (i.e. the 6-item sub-scale 1: "Search for meaningful support"; the 6-item sub-scale 2: "Positive interpretation of disease"; and the 3-item sub-scale 3: "Trust in external guidance") which explains 53.8% of variance. Factor analysis of item pool 2 pointed to a 2-factor solution (i.e. the 10-item sub-scale 4: "Support in relations with the External life through SpR" and the 4-item sub-scale 5: "Support of the Internality through SpR") which explains 58.8% of variance. Generally, women had significantly higher SpREUK scores than male patients. Univariate variance analyses revealed significant associations between the sub-scales and SpR attitude and the educational level. The current re-evaluation of the SpREUK 1.1 questionnaire indicates that it is a reliable, valid measure of distinct topics of SpR that may be especially useful of assessing the role of SpR in health related research. The instrument appears to be a good choice for assessing a patients interest in spiritual concerns which is not biased for or against a particular religious commitment. Moreover it addresses the topic of "positive reinterpretation of disease" which seems to be of outstanding importance for patients with life-changing diseases.
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In this paper the author relates how she initially became interested in spiritual care. A synopsis of a literature review is given in which the spiritual dimension is defined and evidence presented for its influence on health, well-being and quality of life. Spiritual care is also presented as part of the nurse's role. However, it is acknowledged that there is a lack of guidelines for the practice of spiritual care. A conceptual framework for the latter is, therefore, proposed by the author. As little is currently known about how nurses perceive the spiritual dimension and their role in spiritual care, the findings from a doctoral study, which examined these issues, are reported and discussed. The descriptive study was part of the author's PhD thesis (Waugh 1992).
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The objective of this study was to determine whether, after accounting for illness and demographic variables, spiritual involvement and beliefs and positive and negative spiritual coping could account for any of the variation in anxiety and depression among women within 1 year's diagnosis of gynecological cancer (GC). One hundred patients from outpatient GC clinics at two Melbourne-based hospitals completed a brief structured interview and self-report measures of anxiety, depression, spirituality, and spiritual coping. Using two sequential regression analyses, we found that younger women with more advanced disease, who used more negative spiritual coping, had a greater tendency towards depression and that the use of negative spiritual coping was associated with greater anxiety scores. Although not statistically significant, patients with lower levels of generalized spirituality also tended to be more depressed. The site of disease and phase of treatment were not predictive of either anxiety or depression. We conclude that spirituality and spiritual coping are important to women with GC and that health professionals in the area should consider these issues.
Cerrahi Hemşirelik Bakımının Manevi Boyutu (The Spiritual Dimension of Surgical Nursing Care
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Aştı, N., Pektekin, Ç., Adana, F. (2005). Cerrahi Hemşirelik Bakımının Manevi Boyutu (The Spiritual Dimension of Surgical Nursing Care), Hemşirelik Dergisi, 54: 27-34
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Ergül, Ş. ve Temel, A. B. (2007). Maneviyat ve Manevi Bakım Dereceleme Ölçeği'nin Türkçe Formunun Geçerlilik ve Güvenirliği (Reliability and Validity of Spirituality and Spiritual Care Rating Scale's Turkish Form), Ege Üniversitesi Hemşirelik Yüksek Okulu Dergisi, 23 (1), 75-87.
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