Literature Review

Interdisciplinary Spiritual Care for Seriously Ill and Dying Patients

Article· Literature ReviewinThe Cancer Journal 12(5):398-416 · September 2006with 737 Reads
Abstract
Spirituality is essential to healthcare. It is that part of human beings that seeks meaning and purpose in life. Spirituality in the clinical setting can be manifested as spiritual distress or as resources of strength. Patients' spiritual beliefs can impact diagnosis and treatment. Spiritual care involves an intrinsic aspect of care, which underlies compassionate and altruistic caregiving and is an important element of professionalism amongst the various healthcare professionals. It also involves an extrinsic element, which includes spiritual history, assessment of spiritual issues, as well as resources of strength and incorporation of patients' spiritual beliefs and practices into the treatment or care plan. Spiritual care is interdisciplinary care-each member of the interdisciplinary team has responsibilities to provide spiritual care. The chaplain is the trained spiritual care expert on the team. Optimally, all healthcare professionals, including the chaplain, on the team interact with each other to develop and implement the spiritual care plan for the patient in a fully collaborative model.
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  • Article
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    Background Compassion and collaborative practice are individually associated with high quality healthcare. When combined in a compassionate collaborative care (CCC) practice framework, they are reported to improve health, strengthen care provision, and control health costs. Little is known about how to integrate and measure CCC, yet it is fundamentally applied in palliative and end-of-life care settings. This study aimed to identify quality indicators of CCC by systematically reviewing and synthesizing the current state of the palliative and end-of-life care literature. Methods An integrative review of the palliative and end-of-life care literature was conducted using Whittemore and Knafl’s method. Donabedian’s healthcare quality framework was applied in the data analysis phase to organize and display the data. The analysis involved an iterative process that applied a constant comparative method. Results The final literature sample included 25 articles. Patient and family-centered care emerged as a primary structure for CCC, with overarching values including empathy, sharing, respect, and partnership. The analysis revealed communication, shared decision-making, and goal setting as overarching processes for achieving CCC at end-of-life. Patient and family satisfaction, enhanced teamwork, decreased staff burnout, and organizational satisfaction are exemplars of outcomes that suggest high quality CCC. Specific quality indicators at the individual, team and organizational levels are reported with supporting exemplar data. Conclusions CCC is inextricably linked to the inherent values, needs and expectations of patients, families and healthcare providers. Compassion and collaboration must be enacted and harmonized to fully operationalize and sustain patient and family-centered care in palliative and end-of-life practice settings. Towards that direction, the quality indicators that emerged from this integrative review provide a two-fold application in palliative and end-of-life care. First, to evaluate the existing structures, processes, and outcomes at the patient-family, provider, team, and organizational levels. Second, to guide the planning and implementation of team and organizational changes that improve the quality delivery of CCC.
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  • Article
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  • Article
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  • Article
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  • Article
    Spiritual care is associated with improved health outcomes and higher patient satisfaction. However, chaplains often cover many hospital units and thus may not be able to serve all patients. Involving student chaplains in patient spiritual care may allow for more patients to experience the support of spiritual care. In this study, we surveyed 93 patients hospitalized on general medical units at a tertiary care center who were visited by nine student chaplain summer interns. The results indicated that the majority of patients appreciated student chaplain visits and these encounters may have positively influenced their overall hospital experience. Thus, student chaplains could be a way to extend valuable spiritual care in settings where chaplaincy staff shortages preclude access.
  • Chapter
    All health professionals (HPs)—especially those providing end-of-life care—have a duty to ensure patients receive the spiritual care they want. Spiritual care is an integral part of complete health care. The more serious the illness, the more important is the spiritual care. Circumstances usually allow spiritual care specialists such as chaplains, social workers, and pastoral counselors to give that care, but medically trained clinicians may occasionally need to give it. They should be prepared to do so. But, even when specialists give the spiritual care, the medically trained clinicians attending the patient should follow it as part of their responsibilities for coordinating all care.
  • Article
    Background: Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. Aims: To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. Design: Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. Data sources: The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. Results: A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre-post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. Conclusion: This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.
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  • Article
    Full-text available
    Nas duas últimas décadas, os estudos sobre a relação entre espiritualidade e saúde tem crescido significativamente no cenário internacional. No Brasil, as pesquisas nesse campo ganharam maior visibilidade a partir de 2009, sobretudo nas Ciências da Saúde, onde começou a aparecer o termo “cuidado espiritual”. Na Teologia, estudos sobre cuidado espiritual dentro do contexto da saúde são escassos. Este artigo pretende contribuir com a ampliação desta reflexão. Primeiramente, o cuidado espiritual é abordado a partir da produção científica em língua portuguesa. Em seguida, o modelo interdisciplinar de cuidado espiritual é apresentado como uma abordagem holística de cuidado ao paciente e também são delineadas as consequências da aplicação de um modelo de cuidado espiritual. Discute-se ainda, o papel novo e recém definido dos capelães hospitalares, conselheiros pastorais e cuidadores espirituais. O texto conclui mencionando os principais desafios que acompanham o cuidado espiritual interdisciplinar, especialmente aqueles que dizem respeito ao treinamento dos profissionais do cuidado em saúde.
  • Article
    Full-text available
    The aim of this systematic literature review was to ascertain the patient perspective regarding the role of the doctor in the discussion of spirituality. We conducted a systematic search in ten databases from inception to January 2015. Eligible papers reported on original research including patient reports of discussion of spirituality in a medical consultation. Papers were separated into qualitative and quantitative for the purposes of analysis and quality appraisal with QualSyst. Papers were merged for the final synthesis. 54 studies comprising 12,327 patients were included. In the majority of studies over half the sample thought it was appropriate for the doctor to enquire about spiritual needs in at least some circumstances (range 2.1-100%, median 70.5%), but patient preferences were not straightforward. While a majority of patients express interest in discussion of religion and spirituality in medical consultations, there is a mismatch in perception between patients and doctors regarding what constitutes this discussion and therefore whether it has taken place. This review demonstrated that many patients have a strong interest in discussing spirituality in the medical consultation. Doctors should endeavor to identify which patients would welcome such conversations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
  • Article
    Religion and spirituality have been linked to medicine and to healing for centuries. However, in the early 1900's the Flexner report noted that there was no place for religion in medicine; that medicine was strictly a scientific field, not a theological or philosophical one. In the mid to the latter 1900's there were several lay movements that started emphasized the importance of religion, spirituality and medicine. Lay religious movements found spiritual practices and beliefs to be important in how people cope with suffering and find inner healing even in the midst of incurable illness. The rise of Complementary and Alternative Medicine as well as the Hospice movements also influenced attention on the spiritual aspect of medicine. The Hospice movement, founded by Dr. Cecily Saunders, described the concept of "total pain"--- i.e. the biopsychosocial and spiritual aspects of pain and suffering. Since the 1960's there has been increased research done in the area of religion and health and spirituality and health. Most of the studies are association studies which demonstrate and association of religious or spiritual beliefs and practices and some healthcare outcomes. More recently, studies on meditation have demonstrated significant improvement in health care outcomes and suggest meditation as a therapeutic modality. There are also numerous surveys that demonstrate patient need for having spirituality integrated into their care. Finally, a recent study demonstrated that patients with advanced illness who have spiritual care have better quality of life, increased utilization of hospice and less aggressive care at the end of life. In spite of all these studies, we still do not have a biological evidence base for mechanisms of beliefs and practices. There is considerable controversy over whether spirituality and religion can or even should be measured as criteria for integration into clinical care. Many believe that healthcare professionals have an ethical obligation to attend to all dimensions of a person's suffering, including the psychosocial as well as the spiritual and that ethical obligation is sufficient to require integration of spirituality into clinical care. Over the last twenty years, there has been an increase in the number of required courses in spirituality and medicine in US medical schools giving rise to a new field of medicine. In February of 2009, a national consensus conference developed spiritual care guidelines for interprofessional clinical spiritual care. These guidelines as well as the educational advances, research and ethical principles have supported the newly developing field of spirituality and health.
  • Article
    Full-text available
    Objective. To identify the meanings, uses, and contexts of applying the culture brokerage concept in nursing articles published from 1995 to 2011. Methodology. A total of 32 articles were identified from the following databases: Cuiden, SciElo, Ovid Nursing, Ovid, Medline and Pubmed. Results. It was found that 56.2% of the articles were about research, 37.5% on reflection, and 6.2% topic revision. Five categories emerged from the analysis: culture brokerage concepts, culture brokerage and cultural competence, culture brokerage and the performers, culture brokerage in the care of immigrants, and culture brokerage in the care of individuals with chronic diseases. Conclusion. Culture brokerage is a type of emerging care; it has various approaches and applications in both the community and hospital environments. Its conceptualization helps in the development of the nursing discipline.
  • Article
    Full-text available
    Objective: to collect empirical evidence about the identification and care of spiritual needs for patients in palliative care units. Method: an anonymous questionnaire was designed and 1200 copies were distributed through the Medicina Paliativa journal to palliative care professionals all over Spain. Questionnaires included items on the detection, assessment, and care of spiritual needs in end-of-life patients. We received 202 completed questionnaires from 72 physicians, 73 nurses, and 57 psychologists, social workers, priests, and volunteers. Data were analyzed using a qualitative systematic content analysis and standard statistical quantitative procedures. Results: the return ratio was 17%. Among all 202 questionnaires analyzed, 31% of participants reported many difficulties in identifying spiritual concerns from sentences collected from their patients. Twenty-eight percent stated that nearly all of their patients expressed spiritual concerns, and 56% affirmed that only a minority of their patients did. Forty percent of all professionals interviewed expressed that they had little or very few abilities to respond to situations where patients showed spiritual suffering. Only 23% of professionals agreed that the spiritual needs of patients in their unit were taken into account regularly in the multidisciplinary team sessions, whereas 63% reported that such issues were never dealt with in clinical team sessions. Thirty-nine percent of professionals shared that they always or nearly always talked about death with their patients, whereas 43% said that they never or very rarely did so. From the content analysis of 463 literal expressions from patients, as collected by their carers, a taxonomy of 12 different types of existential-spiritual needs is proposed. This empirical categorization offers interesting clues about the rationale on which a model of spiritual care at the end of life should be based. Conclusion: data collected suggest that existential-spiritual needs are not properly cared for in most palliative care units in our country. Health professionals show an insufficient level of awareness in identifying spiritual distress in their patients. Additionally, our survey detected an inability to deliver appropriate care, and difficulties to discuss such issues in clinical team sessions.
  • Article
    Sally quickly fired off her questions, all of which came unsolicited: "How can a loving God do such a thing? What purpose does life have anyway? Why am I here? Who am I? My life doesn't matter! Why shouldn't I just end it all?" Dr. Jones, the attending resident, continued his assessment, asking Sally about pain in her abdomen. It was easy to see that she was annoyed as she stared back at Dr. Jones, silent at first, and then replied, "You're not listening, are you? You are all fakes, you and all of my Bible-thumping friends." She gathered her purse and walked out of the exam room. Across town, David, a provisionally licensed clinician was meeting Bruce, a patient who had just told his biomedical healthcare provider that he was feeling hopeless. David began to assess the situation and quickly learned that Bruce's wife of 57 years had died six weeks earlier. According to Bruce's self-report, he and his wife had spent all of their time together. Now alone, the widower was struggling with his grief. In spite of his emotional pain, Bruce assured David, "I know that God has a plan. I just miss my Sarah. © Springer International Publishing Switzerland 2014. All rights are reserved.
  • Article
    Discussion of religion and/or spirituality in the medical consultation is desired by patients and known to be beneficial. However, it is infrequent. We aimed to identify why this is so. We set out to answer the following research questions: Do doctors report that they ask their patients about religion and/or spirituality and how do they do it? According to doctors, how often do patients raise the issue of religion and/or spirituality in consultation and how do doctors respond when they do? What are the known facilitators and barriers to doctors asking their patients about religion and/or spirituality? A mixed qualitative/quantitative review was conducted to identify studies exploring the physician's perspective on discussion of religion and/or spirituality in the medical consultation. We searched nine databases from inception to January 2015 for original research papers reporting doctors' views on discussion of religion and/or spirituality in medical consultations. Papers were assessed for quality using QualSyst and results were reported using a measurement tool to assess systematic review guidelines. Overall, 61 eligible papers were identified, comprising over 20,044 physician reports. Religion and spirituality are discussed infrequently by physicians although frequency increases with terminal illness. Many physicians prefer chaplain referral to discussing religion and/or spirituality with patients themselves. Such discussions are facilitated by prior training and increased physician religiosity and spirituality. Insufficient time and training were the most frequently reported barriers. This review found that physician enquiry into the religion and/or spirituality of patients is inconsistent in frequency and nature and that in order to meet patient needs, barriers to discussion need to be overcome. © The Author(s) 2015.
  • Chapter
    In the lifetime of every person, critical life events can make the greatest demands on the person’s coping ability. Cancer is such an event. The progress of medicine does not necessarily contribute to reduce the stress. By contrast, spirituality plays an important role in fighting the alienation of a life-threatening illness and the alleviation of fear of impending death. Cancer patients often raise their spiritual concerns with their cancer care providers, and the expectation for oncology teams to provide spiritual support within the clinical context is increasing. Defining spirituality is difficult because it encompasses different intangible dimensions and level of expressions. “Spirit” is the life force that vitalizes human life, through which human beings derive meaning and purpose in their lives. The core of spirituality is universal and it connects with transcendent aspects of human lives, such as the Divine, the Universe, Nature, and Others. Expressions of spirituality vary in individuals and groups, as they interrelate with religion and culture, without superimposing. Each individual’s spirituality and religiosity should be respected when the spiritual care is offered. Whether and how can the oncology team offer spiritual care to cancer patients is still an open question. The role of chaplains, with specific education as experts spiritual advisors in multicultural and multireligious contexts, is increasing. While trained chaplains are in the best position to assume the primary role of spiritual caregiver, every team member, who has the opportunity to communicate with patients, should acquire the basic skills of spiritual assessment and care. The ideal goal is to offer integrative spiritual care as part of supportive care in cancer, consulting among oncology professionals, chaplains, and community members, in order to meet the needs of patients and their families also in low resource contexts.
  • Article
    A group of physicians of different ages and background gathered together to express their hope for a person-based medicine. The inescapable conclusion of their encounter is that care begets more care, whereas lack of care is contrary to one’s sense of mission and self-worth and generates the need for escapes from oneself. The translation of this concept into clinical practice lies in our ability to communicate our experience in our most common seat of encounter: when we are with another human being in need.
Literature Review
  • Article
    Practitioners of holistic nursing seek to be part of an environment that is healing, recognizing that healing occurs on many levels. Suffering and pain are viewed as part of larger life experience and may be sources of growth and transformation. Understanding that spirituality has to do with all of life and is expressed in a variety of ways, the practitioner of holistic nursing is open to the spirituality of self and others, as manifested in the ordinary as well as the dramatic, and in gentle ways encourages its experience and expression.
  • Exploring the relationships among spiritual well-being
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    Cotton SP, Levine EG, Fitzpatrick CM et al. Exploring the relationships among spiritual well-being. Psychooncology 1999; 8:429-438.
  • Ethical guidelines for spiritual care
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    Puchalski C, Anderson BM, Lo B et al. Ethical guidelines for spiritual care. Washington, DC: Association of American Medical Colleges, 2006.
  • Association of American Medical Colleges Contemporary Issues in Medicine: Communication in Medicine
    Association of American Medical Colleges Contemporary Issues in Medicine: Communication in Medicine. Report I, 1999; p 27.
  • Principles of Medical Ethics Accessed http://www.ama-assn.org/ama/pub/ category/2512.html 28 Implementation section of the 1996 standards for hospitals by JCAHO
    American Medical Association. Principles of Medical Ethics. Accessed August 2006. http://www.ama-assn.org/ama/pub/ category/2512.html 28. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Implementation section of the 1996 standards for hospitals by JCAHO. Oakbrook Terrace, IL, 1996.
  • Love and Healing: Bodymind Communication and the Path to Self-Healing, An Exploration
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    Siegel BS. Peace, Love and Healing: Bodymind Communication and the Path to Self-Healing, An Exploration. New York: Harper and Row 1990.
  • Recognizing spiritual needs in people who are dying
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    Stanworth, R. Recognizing spiritual needs in people who are dying. London: Oxford University Press, 2004.
  • Approaching Death: Improving Care at the End of Life Committee on Care at the End of Life, Division of Health Care Services, Institute of Medicine
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    Field MJ, Cassel CK. Approaching Death: Improving Care at the End of Life. Committee on Care at the End of Life, Division of Health Care Services, Institute of Medicine. Washington: National Academy Press, 1997.
  • Principles and Practice of Palliative Care and Supportive Oncology
    • Cm Puchalski
    • Spirituality
    Puchalski CM. Spirituality. In Berger A, Von Roenn J, Shuster J (eds.), Principles and Practice of Palliative Care and Supportive Oncology. Philadelphia: Lippincott, Williams & Wilkins, 2006.
  • Article
    Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (eg, chaplains) are available to clinicians to address the spiritual needs of patients.
  • Article
    This study attempted to identify positive and negative patterns of religious coping methods, develop a brief measure of these religious coping patterns, and examine their implications for health and adjustment. Through exploratory and confirmatory factor analyses, positive and negative religious coping patterns were identified in samples of people coping with the Oklahoma City bombing, college students coping with major life stressors, and elderly hospitalized patients coping with serious medical illnesses. A 14-item measure of positive and negative patterns of religious coping methods (Brief RCOPE) was constructed. The positive pattern consisted of religious forgiveness, seeking spiritual support, collaborative religious coping, spiritual connection, religious purification, and benevolent religious reappraisal. The negative pattern was defined by spiritual discontent, punishing God reappraisals, interpersonal religious discontent, demonic reappraisal, and reappraisal of God's powers. As predicted, people made more use of the positive than the negative religious coping methods. Furthermore, the two patterns had different implications for health and adjustment. The Brief RCOPE offers an efficient, theoretically meaningful way to integrate religious dimensions into models and studies of stress, coping, and health.
  • Article
    Talking about death and dying touches people in very profound ways. It has the potential to open the door to deep personal and intimate interactions. Questions about self worth, meaning, and purpose in one's life, as well as the reason for suffering and loss, can be triggered as a result of talking about dying. One can experience a profound awareness of loneliness and isolation. Feelings of anticipatory grief, death anxiety, and sadness can come up. Ultimately, there is a sense of how little we can control and how much uncertainty there is in life. A desire to run from intimate connections with others, from the often unanswerable questions, from the feelings, and from the uncertainty can prevent us from talking with our patients and loved ones about dying. Therefore, in order to be with a dying person and to talk about dying, we need to confront our own awareness that we too will die. This process is inherently spiritual, as we ask the very existential questions of who we are, why we are here on earth, and why we die. The task of dying, therefore, is not just spiritual for the patient or loved one who is dying, but also for all of us who have connections to others who die and ultimately for ourselves as we die. There is a natural tendency for us to separate people into the "ill and dying" or the "healthy and living." The differences lie in the type of illness someone has, the details of his or her life, his or her treatment, and how she or he approaches living and dying. But at the very core of who we all are, we are not that different. We all struggle with issues of loss, meaning and purpose, suffering, and eventual dying. In that struggle there is communion between all of us on earth. In that communion, the relationships and connections we form are the basis for partnership, help, and healing. One of the most important lessons I have learned from my patients is that I am not so different from them. We have a lot in common, for we are all in the process of living with dying. The time of death and the circumstances of death may differ, but not the journey. Subjects covered in this chapter include science and technology, living with dying, hospice and palliative care, research in spirituality and health, the importance of spirituality in patients' lives, spiritual beliefs and illness, spirituality and caregiving, mechanism of action, spiritual coping, suffering, medical education, and spiritual considerations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Objective: To investigate the protective and consolation models of the relationship between religion and health outcomes in medical rehabilitation patients. Design: Longitudinal study, data collected at admission, discharge, and 4 months postadmission. Measures: Religion measures were public and private religiosity, acceptance, positive and negative religious coping, and spiritual injury. Outcomes were self-report of activities of daily living (ADL), mobility, general health, depression, and life satisfaction. Participants: 96 medical rehabilitation inpatients; diagnoses included joint replacement, amputation, stroke, and other conditions. Results: The protective model of the relationship between religion and health was not supported; only limited support was found for the consolation model. In regression analyses, negative religious coping accounted for significant variance in follow-up ADL (5%) over and above that accounted for by admission ADL, depression, social support, and demographic variables. Subsequent item analysis indicated that anger with God explained more variance (9%) than the full negative religious coping scale. Conclusions: Religion did not promote better recovery or adjustment… (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Mr. Smith, a sixty-three-year-old man, was admitted to the medical unit to rule out a left-sided CVA. He was a tall, muscular man and clearly a strong figure in his household. His wife and adult son and daughter followed the stretcher, distraught. Mr. Smith was awake but could not speak. He desperately tried to communicate with his family, particularly his son. He seemed to know it was his time to die. I checked the admission board; he was assigned to me. It was clear that I was not only caring for Mr. Smith, but also for his family. Like every nurse, I knew what I needed to do–have been doing for years: transfer him to the bed, perform the physical assessment, check and carry out the doctor's orders and document the physical care.
  • Article
    Characteristics of loneliness and spiritual well-being were studied in 64 chronically ill adults with rheumatoid arthritis and 64 randomly selected healthy adults to determine if a relationship existed between the variables as well as to determine if there was a significant difference in loneliness and spiritual well-being between the ill and healthy groups. The Abbreviated Loneliness Scale (ABLS) and the Spiritual Well-Being Scale (SWB), with the subscales of Existential Well-Being (EWB) and Religious Well-Being (RWB), were used. The predicted negative relationship between loneliness and spiritual well-being was supported in both the ill and the healthy group, with r=−.267 for the ill group and r=−.387 for the healthy group. There was no significant difference in loneliness between the two groups. There was a difference in SWB in that the III subjects had higher SWB (P<.01) and higher RWB (P<.001) than the healthy subjects. No differences in EWB were found. A canonical analysis of data from the III subjects indicated that persons with low loneliness tended to be young and have very low RWB and high EWB. Older females had high RWB. Current and ongoing pain state scores were then included to determine their relationship to the multiple variables; however, pain scores did not meet the. 40 level for interpretation.
  • Article
    The delivery of spiritual and religious care has received a high profile in national reports, guidelines and standards since the start of the millennium, yet there is, to date, no recognized definition of spirituality or spiritual care nor a validated assessment tool. This article suggests an alternative to the search for a definition and assessment tool, and seeks to set spiritual care in a practical context by offering a model for spiritual assessment and care based on the individual competence of all healthcare professionals to deliver spiritual and religious care. Through the evaluation of a pilot study to familiarize staff with the Spiritual and Religious Care Competencies for Specialist Palliative Care developed by Marie Curie Cancer Care, the authors conclude that competencies are a viable and crucial first step in 'earthing' spiritual care in practice, and evidencing this illusive area of care.
  • Article
    This study examined the relationship between spiritual well-being and hardiness in a group of 100 subjects who either tested positive for the human immunodeficiency virus (HIV+) or who had diagnoses of acquired immunodeficiency syndrome (AIDS)-related complex (ARC) or AIDS. Each subject completed the Spiritual Well-Being Scale, the Personal Views Survey (to measure hardiness), and a Demographic Data Survey. Analysis of data included Pearson Product-Moment Correlation Coefficients and multiple regression techniques. The results demonstrated that there was a significant relationship between spiritual well-being and hardiness (multiple R = .4165; P less than .001) as well as between the existential component of spiritual well-being and hardiness (multiple R = .5047; P less than .001). The conclusions of the study are that in this sample those individuals who were spiritually well and who were able to find meaning and purpose in their lives were also hardier. This finding has significance for the care that is provided to persons who are HIV+ or who have diagnoses of ARC or AIDS.
  • Article
    Caring is the medium through which nursing knowledge, skill, and touch are operationalized. Caring is a profound act of hope (White T. 1986. Unpublished data) that contributes to the spiritual well-being of others. In order to assure quality care, the impact of identifying and meeting patient spiritual needs must be taken into account.
  • Article
    pirituality and health is gradually becoming a recog- nized discipline within medicine. Increasingly more medical schools are teaching courses on spirituality and health. Furthermore, there are increased numbers of funded research projects looking at spirituality and how spir- itual beliefs may play an important role in coping with, re- covery from, and prevention of illness and disease. There has been major media coverage of these courses and projects, de- bates as to the relevance of spirituality to clinical care, and public outcry for more compassionate systems of care that are sensitive to patients' spiritual needs.
  • Article
    Exploring the theory that anxiety is lower in highly spiritual persons confronting life-threatening illness, this correlational study was conducted with 114 adults who had been diagnosed with cancer. Relationships were measured between spiritual well-being and state-trait anxiety, using the Spiritual Well-Being Scale, which distinguishes between the religious and existential dimensions of spirituality, and the State-Trait Anxiety Inventory, which differentiates between transitory and characteristic anxiety. Efforts were made to identify demographic features of the sample which could influence spirituality and anxiety and their interactions. A consistent inverse relationship (p less than .001) was found between spiritual well-being and state-trait anxiety, regardless of influences of gender, age, marital status, diagnosis, group participation, and length of time since diagnosis. This supports the theory that persons with high levels of spiritual well-being have lower levels of anxiety. Controlled studies now are indicated, with attention to diversity and specificity of ethnic, socioeconomic, and religious backgrounds, as well as cancer type, stage, symptoms, and prognosis. The hospice community is challenged to undertake studies of the spiritual dimension and its healing potential.
  • Gallup International Institute. Spiritual beliefs and the dying process: a report on a national survey Conducted for the Nathan Cummings Foundation and the Fetzer Institute
    • The George
    The George H. Gallup International Institute. Spiritual beliefs and the dying process: a report on a national survey. Conducted for the Nathan Cummings Foundation and the Fetzer Institute. 1997. http://www.ncf.org/reports/program/reports_ health.html. Accessed July 2006.
  • Article
    It is probably fortunate that systems of education are constantly under the fire of general criticism, for if education were left solely in the hands of teachers the chances are good that it would soon deteriorate. Medical education, however, is less likely to suffer from such stagnation, for whenever the lay public stops criticizing the type of modern doctor, the medical profession itself may be counted on to stir up the stagnant pool and cleanse it of its sedimentary deposit. The most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine—or, to put it more bluntly, they are too "scientific" and do not know how to take care of patients.One is, of course, somewhat tempted to question how completely fitted for his life work the practitioner of
  • Article
    Data on religious belief, activity, and connections, and ratings of happiness, life satisfaction, and pain level were obtained periodically from 71 patients with advanced cancer. Religious belief showed substantial positive correlation with life satisfaction, and religious activity and connections were significantly correlated with both happiness and life satisfaction. Religious patients also reported significantly lower levels of pain, even though they were no less likely to report the presence of pain. Data from the 36 patients who have since died show no correlation between the religion variables and duration of survival. In general, the patients showed little change in religious belief over time. Religion seems to be an important source of support for many patients.
  • Article
    Spirituality can be defined as a belief system focusing on intangible elements that impart vitality and meaning to life's events. Often spirituality is expressed through formalized religions. Recently, the interplay of spirituality, religion, and health care has been explored in the medical literature. Spiritual belief systems impact on the incidences, experiences, and outcomes of several common medical problems. Unfortunately, there is little recent literature addressing the process of conducting a medically oriented spiritual history. One approach to assisting the physician in spiritual history taking, a mnemonic, SPIRIT, is presented as a guide to identifying important components of the spiritual history. This article addresses the issues of when and whom to interview, as well as specific professional and ethical issues related to this topic. Two case examples from my practice are presented to illustrate the utility of the SPIRITual history.
  • Article
    This study surveyed HIV-infected patients' attitudes toward physician-assisted suicide and examined the relationship between interest in physician-assisted suicide and physical and psychosocial variables. Three hundred seventy-eight ambulatory HIV-infected patients, 90% of whom met the criteria of the Centers for Disease Control for AIDS, were recruited from several sites in New York City. Self-report measures were used to assess pain, physical symptoms, psychological distress, depression, and social supports. Attitudes toward, and interest in, physician-assisted suicide were assessed through responses to a questionnaire. Sixty-three percent of the patients supported policies favoring physician-assisted suicide, and 55% acknowledged considering physician-assisted suicide as an option for themselves. The strongest predictors of interest in physician-assisted suicide were high scores on measures of psychological distress (depression, hopelessness, suicidal ideation, overall psychological distress) and experience with terminal illness in a family member or friend. Other strong predictors were Caucasian race, infrequent or no attendance at religious services, and perceived low level of social supports. Interest in physician-assisted suicide was not related to severity of pain, pain-related functional impairment, physical symptoms, or extent of HIV disease. HIV-infected patients supported policies favoring physician-assisted suicide at rates comparable to those in the general public. Patients' interest in physician-assisted suicide appeared to be more a function of psychological distress and social factors than physical factors. These findings highlight the importance of psychiatric and psychosocial assessment and intervention in the care of patients who express interest in or request physician-assisted suicide.
  • Article
    This study was undertaken to assess the life views, practices, values, and aspirations of women with various stages of gynecologic cancer. A self-administered questionnaire was completed by 108 women with various stages of cancer and 39 women with benign gynecologic disease. The questionnaire included items on demographics in addition to 16 multiple choice and 4 true-false items. The four questions related to criteria of good care, degree of involvement in decision making, psychosocial well-being, religious experience, and aspirations form the basis of this study. The data were analyzed with the Pearson chi 2 test (Systat, version 5.1) with significance set at p < 0.05. The women in this study placed greatest emphasis on receiving "straight talk" (96%) and compassion (64%) from their physicians. The newly diagnosed group put significantly less emphasis on compassion (33%, p = 0.037). Less than half expected their physicians to cure (43%, 56% for newly diagnosed) or contain (49%) the disease. For these women fear was the most dominant psychosocial consequence of having cancer, with difficulty communicating or feeling abandoned, isolated, or embarrassed less common. Those who specified their ears were afraid of pain (63% vs 39% for patients with benign disease, p = 0.019), dying (56%), losing control (48%), or becoming totally dependent (46%). Seventy-six percent indicated that religion had a serious place in their lives, with 49% becoming more religious since their cancer diagnosis, whereas no one became less religious. Ninety-three percent believed that the religious commitment helped sustain their hopes. These data suggest that (1) physicians should aim to educate their patients sufficiently for them to exercise control over their experience, to allay their fears, and to make personal decisions that further their aspirations, (2) patients in different stages of disease varied in their perceptions of themselves and their aspirations, (3) patients are dealing with fear as a primary problem, and (4) women with gynecologic cancer depend on their religious convictions and experiences as they cope with the disease.
  • Article
    To determine the relationships among spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer and if differences in hope, depression, and other mood states exist between those elderly with high and low intrinsic religiosity and spiritual well-being. Descriptive correlational and descriptive comparison. Acute care units of two hospitals located in the midwestern United States. 100 elderly people with diagnosis of cancer and a mean age of 73 years. Thirty-three of the subjects were male, and 67 were female. Sixty-two percent had either lung, breast, or colon cancer. Each subject was administered an intrinsic and extrinsic religiosity index, a spiritual well-being scale, a geriatric depression scale, the Miller hope scale, and the Profile of Mood States scale. Spiritual well-being, religiosity, hope, depression, and mood. A consistent positive correlation was found among intrinsic religiosity, spiritual well-being, hope, and other positive mood states. A consistent negative correlation among intrinsic religiosity, depression, and other negative mood states existed. Analysis of variance indicated that significantly higher levels of hope and positive moods existed in elderly patients with high levels of intrinsic religiosity and spiritual well-being. Intrinsic religiosity and spiritual well-being are associated with hope and positive mood states in elderly people coping with cancer. Nurses must assess and support intrinsic religiosity and promote spiritual well-being in elderly people coping with cancer.
  • Article
    In recent years patients and some members of the medical community have expressed the concern that doctors have forgotten about compassion and too often ignore their patients' spiritual concerns. Patients can and should expect their physicians to respect their beliefs and be able to talk with them about spiritual concerns in a respectful and caring manner. Medical schools must teach their students how to meet these expectations, and health care systems need to provide practice environments that foster compassionate caregiving. Medical educators are recognizing the need to bring the art of compassionate caregiving back into the medical school curriculum. This paper focuses on one approach to achieving this goal, the study of spirituality and medicine. The authors discuss the relationship of spirituality and healing, and describe studies that have shown patients' desire to have spiritual issues addressed by their physicians and the potential health benefits of spiritual beliefs. Finally, they describe common elements of the spirituality courses offered by approximately 50 U.S. medical schools, including 19 schools that have been awarded grants from the National Institute for Healthcare Research for the development of curricula in spirituality and medicine.
  • Article
    Full-text available
    Recognizing that many Americans draw on religious or spiritual beliefs when confronted by serious illness, some medical educators have recommended that physicians routinely ask about spirituality or religion when conducting a medical history. The most appropriate wording for such an inquiry remains unknown. To examine patient acceptance of including the following question in the medical history of ambulatory outpatients: "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?" Self-administered questionnaires were completed by 177 ambulatory adult patients visiting a pulmonary faculty office practice at a university teaching hospital in 1997 (83% response rate). Fifty-one percent of the study patients described themselves as religious and 90% believe that prayer may sometimes influence recovery from an illness. Forty-five percent reported that religious beliefs would influence their medical decisions if they become gravely ill. Ninety-four percent of individuals with such beliefs agreed or strongly agreed that physicians should ask them whether they have such beliefs if they become gravely ill. Forty-five percent of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of the respondents indicated that they would welcome the study question in a medical history, whereas 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions. Many but not all patients surveyed in a pulmonary outpatient practice welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.
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    This study examined the relationships among spiritual well-being, quality of life, and psychological adjustment in 142 women diagnosed with breast cancer who were participating in a larger study designed to compare the efficacy of two psychosocial support programs. Participants were given a set of questionnaires that measured spiritual well-being, quality of life, and adjustment to cancer. Results revealed a positive correlation between spiritual well-being and quality of life, as well as significant correlations between spiritual well-being and specific adjustment styles (e.g. fighting spirit). There was also a negative correlation between quality of life and use of a helpless/hopeless adjustment style, and a positive correlation between quality of life and fatalism. In regression analyses, after controlling for demographic variables and adjustment styles, spiritual well-being contributed very little additional variance in quality of life. These findings suggest that while spiritual well-being is correlated with both quality of life and psychological adjustment, the relationships among these variables are more complex and perhaps indirect than previously considered.
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    This article describes the four quadrants of a whole person as a model of balanced health, then focuses on the natural emotions that volunteers and professionals encounter in hospice work. The significance of self-awareness in emotional and spiritual realms is emphasized to assist hospice workers in providing high-quality care and in nurturing themselves for the long term.
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    Clinical studies are beginning to clarify how spirituality and religion can contribute to the coping strategies of many patients with severe, chronic, and terminal conditions. The ethical aspects of physician attention to the spiritual and religious dimensions of patients' experiences of illness require review and discussion. Should the physician discuss spiritual issues with his or her patients? What are the boundaries between the physician and patient regarding these issues? What are the professional boundaries between the physician and the chaplain? This article examines the physician-patient relationship and medical ethics at a time when researchers are beginning to appreciate the spiritual aspects of coping with illness.
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    The relationship between spirituality and medicine has been the focus of considerable interest in recent years. Studies suggest that many patients believe spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to consider these factors in their medical care. A spiritual assessment as part of a medical encounter is a practical first step in incorporating consideration of a patient's spirituality into medical practice. The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions.
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    Throughout history, doctor-patient relationships have been acknowledged as having an important therapeutic effect, irrespective of any prescribed drug or treatment. We did a systematic review to determine whether there was any empirical evidence to support this theory. A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. The quality of eligible trials was objectively assessed by two reviewers, and the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients' expectations about the illness or the treatment, whereas emotional care refers to the style of the consultation (eg, warm, empathic), and aims to reduce negative feelings such as anxiety and fear. We identified 25 eligible randomised controlled trials. 19 examined the effects of influencing patients' expectations about treatment, half of which found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients' expectations through positive information about the treatment or the illness, while providing support or reassurance, significantly influenced health outcomes. There is much inconsistency regarding emotional and cognitive care, although one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.
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    Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (e.g., chaplains) are available to clinicians to address the spiritual needs of patients.
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    This article presents a model for research and practice that expands on the biopsychosocial model to include the spiritual concerns of patients. Literature review and philosophical inquiry were used. The healing professions should serve the needs of patients as whole persons. Persons can be considered beings-in-relationship, and illness can be considered a disruption in biological relationships that in turn affects all the other relational aspects of a person. Spirituality concerns a person's relationship with transcendence. Therefore, genuinely holistic health care must address the totality of the patient's relational existence-physical, psychological, social, and spiritual. The literature suggests that many patients would like health professionals to attend to their spiritual needs, but health professionals must be morally cautious and eschew proselytizing in any form. Four general domains for measuring various aspects of spirituality are distinguished: religiosity, religious coping and support, spiritual well-being, and spiritual need. A framework for understanding the interactions between these domains is presented. Available instruments are reviewed and critiqued. An agenda for research in the spiritual aspects of illness and care at the end of life is proposed. Spiritual concerns are important to many patients, particularly at the end of life. Much work remains to be done in understanding the spiritual aspects of patient care and how to address spirituality in research and practice.
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    Using MEDLINE, (limited to the English language and the reference lists of the randomized controlled trials (RCTs), we assessed the impact of religion on health outcomes via systematic, critical review of the medical literature. All RCTs published from 1966 to 1999 and all non-RCTs published from 1996 to 1999 that assessed a relationship between religion and measurable health outcome were examined. We excluded studies dealing with non-religious spirituality, ethical issues, coping, well-being, or life satisfaction. We used the Canadian Medical Association Journal's guidelines for systematic review of the medical literature to evaluate each manuscript. Nine RCTs and 25 non-RCTs met these inclusion/exclusion criteria. Randomized controlled trials showed that intercessory prayer may improvehealth outcomes in patients admitted to a coronary care unit but showed no effect on alcohol abuse. Islamic-based psychotherapy speeds recovery from anxiety and depression in Muslims. Non-RCTs indicate that religious activities appear to benefit blood pressure, immune function, depression, and mortality.
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    The importance of spirituality in coping with a terminal illness is becoming increasingly recognised. We aimed to assess the relation between spiritual well-being, depression, and end-of-life despair in terminally-ill cancer patients. 160 patients in a palliative care hospital with a life expectancy of less than 3 months were interviewed with a series of standardised instruments, including the functional assessment of chronic illness therapy-spiritual well-being scale, the Hamilton depression rating scale, the Beck hopelessness scale, and the schedule of attitudes toward hastened death. Suicidal ideation was based on responses to the Hamilton depression rating scale. Significant correlations were seen between spiritual well-being and desire for hastened death (r=-0.51), hopelessness (r=-0.68), and suicidal ideation (r=-0.41). Results of multiple regression analyses showed that spiritual well-being was the strongest predictor of each outcome variable and provided a unique significant contribution beyond that of depression and relevant covariates. Additionally, depression was highly correlated with desire for hastened death in participants low in spiritual well-being (r=0.40, p<0.0001) but not in those high in spiritual well-being (r=0.20, p=0.06). Spiritual well-being offers some protection against end-of-life despair in those for whom death is imminent. Our findings have important implications for palliative care practice. Controlled research assessing the effect of spirituality-based interventions is needed to establish what methods can help engender a sense of peace and meaning.
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    This study was undertaken to determine when patients feel that physician inquiry about spirituality or religious beliefs is appropriate, reasons why they want their physicians to know about their spiritual beliefs, and what they want physicians to do with this information. Trained research assistants administered a questionnaire to a convenience sample of consenting patients and accompanying adults in the waiting rooms of 4 family practice residency training sites and 1 private group practice in northeastern Ohio. Demographic information, the SF-12 Health Survey, and participant ratings of appropriate situations, reasons, and expectations for physician discussions of spirituality or religious beliefs were obtained. Of 1,413 adults who were asked to respond, 921 completed questionnaires, and 492 refused (response rate = 65%). Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances. The most acceptable scenarios for spiritual discussion were life-threatening illnesses (77%), serious medical conditions (74%) and loss of loved ones (70%). Among those who wanted to discuss spirituality, the most important reason for discussion was desire for physician-patient understanding (87%). Patients believed that information concerning their spiritual beliefs would affect physicians' ability to encourage realistic hope (67%), give medical advice (66%), and change medical treatment (62%). This study helps clarify the nature of patient preferences for spiritual discussion with physicians.
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    Dr. Christina Puchalski is an internist and geriatrician who has recently designed a Spiritual Assessment consisting of four basic questions that physicians or others can integrate into patient interviews. The assessment is remembered by the acronym FICA, for the four domains it touches on: Faith, Importance, Community, and Address. In this interview with Innovations associate editor Anna L. Romer, Dr. Puchalski explores how she came to develop the spiritual history, how she sees it as distinct from a careful psychosocial history, and what she has learned as she has trained physicians across the United States to incorporate it into their medical interviews. This interview is excerpted from a thematic issue, 'Spirituality and End-of-Life Care,' Vol. 1, No. 6, 1999 of the online journal Innovations in End-of-Life Care. an archived version through the following link: https://web.archive.org/web/20121230024120/http://www2.edc.org:80/lastacts/issues.asphttp:/www.edc.org/lastacts/.
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    A series of systematic reviews has revealed relatively high levels of interest in religion and spirituality in different nursing specialties, but not in general nursing research journals. To identify the extent to which spirituality and religiousness were measured in all quantitative and qualitative research articles published in Research in Nursing and Health, Nursing Research, Advances in Nursing Science (ANS), and Image: The Journal of Nursing Scholarship from 1995 to 1999. A full-text search was conducted of ANS and Image using the Ovid search system. Nursing Research and Research in Nursing and Health were hand searched for spiritual/religious measures. Characteristics of selected studies, the measures taken, and their uses were coded for data analysis. A total of 564 research studies were identified, of which 67 (11.9%) included at least one measure of spirituality or religiousness. A significant difference was found between the percentage of qualitative and quantitative studies that contained measures of these concepts. Of the 119 qualitative studies, 23 (19.3%) contained a measure of religion or spirituality, compared to 44 of the 445 (9.9%) quantitative studies. Nominal indicators of religious affiliation were the most commonly used measures in the quantitative studies and measures of religion and spirituality were rarely used in the analyses. Although only a few quantitative or qualitative studies intended to focus on religion or spirituality, these themes often emerged spontaneously in the qualitative research. Research in Nursing and Health, Advances in Nursing Science, Nursing Research, and Image: The Journal of Nursing Scholarship all published research measuring spirituality and religiousness during the time-period studies. The rate at which spirituality and religion appeared in these nursing research articles is substantially higher than that found in most fields outside of nursing. Even more frequent inclusion of spiritual and religious variables and richer measures of spirituality and religiousness would help to increase the available scientific information on the role of spirituality and religion in nursing care.
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