Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis.

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.

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

AIM: To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies. DESIGN: A systematic review of qualitative studies. DATA SOURCE: A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review. METHODS: A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology. REPORTING METHOD: PRISMA checklist. RESULTS: The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome. CONCLUSION: In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement. IMPLICATIONS: The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement. NO PATIENT OR PUBLIC CONTRIBUTION: This is a systematic review.

Spiritual distress and religious involvement among cancer patients receiving chemotherapy: A longitudinal study.

PURPOSE: To determine the trajectories of spiritual distress and religious involvement among cancer patients during chemotherapy. METHODS: A prospective longitudinal study was conducted over 15 months with quarterly data collection, in a total of with five cut points. Data collection was applied a questionnaire that embraced sociodemographic characteristics, clinical profile, Spiritual Distress Scale, and Belief into Action Scale. Regarding, data analysis was performed univariate, bivariate, and multivariate statistics, and the study was approved by the Ethics Committee. FINDINGS: From the 322 cancer patients at the beginning, the attrition rate was 17.5% in the last time point. Most of participants were women (56.6%), with an average age of 60.3 years, and had a religious affiliation (93.7%). Statistically significant values were found of spiritual distress and religious involvement across the five cuts. At the end of 3 months after starting chemotherapy, the highest value of spiritual distress and the lowest value of religious involvement were reached. CONCLUSIONS: Cancer patients who are submitted to chemotherapy, after 3 months of treatment experience the peak of spiritual distress and the lowest value of religious involvement. This critical period for nurses' is required a massive approach regarding spiritual and religious needs. IMPLICATIONS FOR NURSING PRACTICE: Therefore, knowing the trajectories of spiritual distress and religious involvement during a certain period allows for the anticipating of planning of nursing therapeutic interventions in order to promote spiritual health and spiritual well-being outcomes in cancer patients.

Prevalence, defining characteristics, and predictors of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy: A longitudinal study.

INTRODUCTION: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected. PURPOSE: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy. DESIGNS: The study used a longitudinal questionnaire design with quarterly data collection points over a 12-month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal. FINDINGS: The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life. CONCLUSIONS: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress. CLINICAL RELEVANCE: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well-being in cancer patients.

Prophylactic negative pressure wound therapy in patients with closed surgical wound: An integrative review.

Surgical site infection is the leading healthcare-associated infection and a major contributor to rising healthcare costs. Implementation of measures to reduce this problem, particularly the prophylactic use of negative pressure wound therapy, may be an effective and promising method to reduce the risk of surgical site infection in patients with closed surgical wounds. The aim of the study was to identify the effectiveness of negative pressure wound therapy as a prophylactic measure in reducing the risk of surgical site infection in patients with a closed surgical wound. Whittemore and Knafl's five-step integrative review framework was carried out using three electronic databases. MEDLINE with Full-text, CINAHL with Full-text and Academic Search Complete were searched through the EBSCOhost Web platform. Articles search publication date was between 2018 and 2022. Nine studies were identified that addressed the effectiveness of prophylactic negative pressure wound therapy in reducing the risk of surgical site infection in the patient with a closed surgical wound. There was also evidence of effectiveness in reducing surgical wound dehiscence, drainage output and drainage time, as well as reducing the incidence of hospital readmissions and the need for wound debridement. Prophylactic negative pressure wound therapy can be an effective treatment option, among others, in reducing the risk of surgical site infection in patients with a closed surgical wound. This evidence promotes improved clinical practice regarding the management of the closed surgical wound, promoting health gains for patients.

Spiritual comfort, spiritual support, and spiritual care: A simultaneous concept analysis.

BACKGROUND: Spirituality is a dimension of life and the human being that should be included in holistic healthcare. One major barrier often described by nurses on implementing spirituality in practice relates to perceiving the concept of spirituality as subjective and sharing confounding similarities with other concepts. In this sense, the concepts of spiritual comfort, spiritual care, and spiritual support may require more distinct theoretical definitions aimed at clear and effective nursing interventions within spiritual care. AIM: To provide a definition of spiritual comfort, spiritual support, and spiritual care. METHODS: Simultaneous concept analysis (SCA) of three concepts according to Haase et al., which is grounded on Rodgers' evolutionary view. The method was based on a literature review with the search of electronic databases on May 2020. Search and analysis have been blinded conducted by two reviewers. RESULTS: One hundred thirty-six studies were included in the SCA. Findings suggest that spiritual comfort is an immediate state and an outcome. Spiritual support is related with an intimate and positive relationship with God. Spiritual care is defined as a complex and interactive process. Both spiritual support and spiritual care are grounded in a therapeutic context. CONCLUSION: This SCA allowed the attributes of each concept to be identified and provides definitions that may facilitate the understanding of these concepts and promote the implementation of spirituality in nursing practice, but which has also led to future research on this topic.

Validation of the Nurse Spiritual Care Therapeutics Scale in Portuguese palliative care settings: a methodological study.

BACKGROUND: Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care. AIM: To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings. METHODS: A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings. FINDINGS: A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23-60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution. CONCLUSION: The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

Spiritual Distress in Patients With Cancer Initiating Chemotherapy: A Cross-Sectional Study.

PURPOSE: To assess spiritual distress in patients with cancer who were initiating chemotherapy. METHODS: This was a quantitative, observational, cross-sectional study. Data collection was conducted between February and June of 2019. The Spiritual Distress Scale (SDS) was administered to 332 patients with cancer. FINDINGS: Most participants (56.6%) were female, with the mean age at 60.3 years (SD = ±11.73). The mean SDS score was 56.6 (SD = ±13.39), with 30% of the participants reporting moderate and 9.6% reporting high levels of spiritual distress. Younger age (ß = -0.687, p = .008) and participants having no religious affiliation were predictors of SDS (ß = -8.322, p = .035) in patients with cancer initiating chemotherapy. CONCLUSIONS: Given the degree of spiritual distress reported, this study provides further evidence to support the need for nurses to assess spirituality in order to provide holistic care inclusive of spiritual domain. CLINICAL RELEVANCE: These results are relevant to clinical practice and indicate a need for nurses to use the clinical reasoning process to assess spiritual distress and to plan nursing interventions aimed at meeting the spiritual needs of patients with cancer who are initiating chemotherapy.

Disclosing and discussing the role of spirituality in the transition theory of Afaf Meleis.

Spirituality is as an individual, dynamic, and a complex concept. Meleis's theory includes spirituality in many aspects, and looking at this dimension within this specific theory may help in understanding spirituality as a critical dimension in transitions, as processes, but also as a dimension of self-transition as individual development and growing. Therefore, spirituality is an inherent and integral element of the several foundations of this theory, especially in nursing therapeutics, patterns of responses and transition conditions (facilitators and inhibitors).

Validation of the Duke University Religion Index (DUREL) in Portuguese Cancer Patients Undergoing Chemotherapy.

Religion is one of the strategies used to cope with life stressful events, particularly in cancer patients. This study aimed to translate, adapt and validate the 5-item Duke University Religion Index (DUREL) into European Portuguese. This is a cross-sectional study in a sample of cancer patients receiving chemotherapy. Data were collected in July-October 2018, and the study was approved by the ethics committee of the institution. A sample of 150 participants was included (64.7% female and 35.3% male), aged 35-83 years, and mainly Catholic (86.7%). Participants who were females, older, had lower education and from evangelical religious traditions scored higher on the total score. The Cronbach's alpha was 0.89. Factor analysis revealed a one-factor solution. Convergent validity was achieved between DUREL and BIAC (r = 0.78; p < 0.01). The DUREL European Portuguese version is a valid and reliable tool for measuring religious commitment in cancer patients undergoing chemotherapy.

Spiritual Well-Being in Cancer Patients Undergoing Chemotherapy in an Outpatient Setting: A Cross-Sectional Study.

Purpose: To assess the spiritual well-being (SWB) of cancer patients undergoing chemotherapy in an outpatient setting. Method: Quantitative, cross-sectional, and descriptive study. A convenience sample of 150 participants was obtained. Data collection instrument was a self-reported questionnaire that included the SWB Questionnaire (SWBQ), whose scores range from 20 to 100. SPSS software, version 21, was used in data analysis. The study was approved by the institutional ethics committee. Results: Patients' ages ranged between 35 and 83 years; most were female (64.7%), married (68.0%), Catholic (86.7%), and with breast cancer (35.3%) and colorectal cancer (25.3%). The average SWBQ total score was 65.91 (SD = 12.177). The highest score of the SWBQ was obtained in females, widows and singles, Evangelic and Catholic, and with lower educational level and professional occupation. The Cronbach α was 0.89, and the subscales αs ranged between 0.78 and 0.94. Conclusion: The SWBQ scores were reasonable. These results can guide nurses' clinical reasoning, as the assessment of SWB may precede the diagnosis of risk for spiritual distress, readiness for enhanced SWB, or spiritual distress. Thus, the use of this instrument may facilitate spirituality being effectively implemented in clinical practice, favoring holistic health care.

Validation of the Belief Into Action Scale (BIAC) in Portuguese Cancer Patients Receiving Chemotherapy.

Background: A large proportion of the world's population have religious beliefs, with 84.0% indicating an affiliation with a specific religious group. Few comprehensive measures to assess religious involvement currently exist in Portugal, particularly for the assessment of religiosity in cancer patients. Objective: To translate, adapt, and validate the 10-item Belief Into Action Scale (BIAC) in Portuguese cancer patients undergoing chemotherapy. Method: The methodological guidelines provided by Sousa and Rojjanasrirat were used to examine the psychometric properties of the BIAC. Results: The linguistic and conceptual equivalence of the scale was determined. The internal consistency was acceptable (Cronbach's α = .86). Varimax rotation with Kaiser normalization identified two factors made up of nine items. Conclusion: The European Portuguese version of the BIAC is a reliable and valid measure for assessing religiosity in cancer patients receiving chemotherapy to provide holistic care.

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

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

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

PURPOSE: This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. METHODS: Critical analysis of the ND labels, as categorized in the NANDA-I terminology. FINDINGS: Most of the 244 ND labels are composed of terms from the focus and judgment axes. CONCLUSIONS: The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. OBJETIVO: Este artigo explora os títulos dos diagnósticos de enfermagem da NANDA-I. MÉTODOS: Análise crítica dos títulos dos diagnósticos de enfermagem da NANDA-I. RESULTADOS: A maioria dos 244 diagnósticos de enfermagem classificados são compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSÕES: A especificidade das respostas às transições de saúde e vida pode não estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICAÇÕES PARA A PRÁTICA: Melhorias nos diagnósticos da NANDA-I em relação ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acurácia do processo diagnóstico que é necessário à prática clínica. Complementar os títulos dos diagnósticos de enfermagem poderia refletir a acurácia do raciocínio clínico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.