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.

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.

Frequency of nurse-provided spiritual care: An international comparison.

AIMS AND OBJECTIVES: To compare the frequency of nurse-provided spiritual care across diverse cultures. BACKGROUND: Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement. DESIGN: This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument. METHODS: Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed. RESULTS: Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics. CONCLUSIONS: In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care. RELEVANCE TO CLINICAL PRACTICE: Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Nurse-led care management models for patients with multimorbidity in hospital settings: A scoping review.

AIM: The aim of this scoping review is to map the nurse-led care management models for patients with multimorbidity in hospital settings. BACKGROUND: Patients with multimorbidity in hospital, due their complexity, benefit a nurse-led care management model. This care management model allows for better identification of patients' needs and a person-centred approach. EVALUATION: This review followed the JBI methodology for scoping reviews. The search included the international databases Web of Science, CINAHL, MEDLINE, Nursing & Allied Health Collection and grey literature. A total of 21 articles were included in the final content analysis. KEY ISSUES: Three categories of nurse-led care management models emerged from the data, namely, nurse-led programs, case management and nurse facilitator models. The interventions focused on training, discharge support, follow-up, health promotion and patient-centred care. CONCLUSION: The centrality of the patient is a common characteristic of nurse-led care models, namely, the acquisition of disease self-management skills, preparation for hospital discharge and continuity of care in the community. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse-led care management models can empower patients to manage their chronic conditions more effectively. Adapting these care management models in hospital settings will be a challenge for nurse managers. SCOPING REVIEW PROTOCOL: The full protocol used can be accessed at doi:10.11124/jbies-20-00222.

Instruments for Assessing Spiritual/Religious Coping in Multicultural Clinical Settings.

ABSTRACT: A review of literature was conducted to discover and compare various instruments that could be used in daily nursing practice to assess spiritual and religious coping in a variety of multicultural clinical settings. Fifteen spiritual and religious (S/R) instruments were identified, used in 31 studies in multiple countries. These S/R coping tools may be useful to nurses in assessment and for planning interventions.

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.

Spiritual Needs of Brazilian Children and Adolescents with Chronic Illnesses: A Thematic Analysis.

PURPOSE: To identify the spiritual needs of children and adolescents with chronic illnesses and how these needs are met by health professionals during hospitalization. DESIGN AND METHODS: A qualitative descriptive study was developed with 35 children and adolescents, between 7 and 18 years old, diagnosed with cancer, cystic fibrosis, and type 1 diabetes. Interviews with photo-elicitation were conducted during the hospitalization at a Brazilian public pediatric hospital. Findings were treated using thematic analysis, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed for quality reporting. This research was approved by a research committee. RESULTS: Two themes emerged. The first, entitled 'Spiritual needs', encompasses five types of needs: (1) need to integrate meaning and purpose in life; (2) need to sustain hope; (3) need for expression of faith and to follow religious practices; (4) need for comfort at the end of life; and (5) need to connect with family and friends. The second theme was the 'Definition of spiritual care'. CONCLUSIONS: Children and adolescents with chronic illnesses have spiritual needs while in hospital. Meeting these needs is essential for finding meaning, purpose and hope in the experience of living with chronic illnesses and at the end of life, based on their faith, beliefs and interpersonal relationships. But, these needs have not been fully addressed during hospitalization. PRACTICE IMPLICATIONS: These results emphasize the need to implement spiritual care when caring for hospitalized pediatric patients, which includes addressing spiritual needs.

Professional characteristics and the prevalence of advance directives among palliative care professionals: A cross-sectional study.

OBJECTIVE: This study aimed to investigate the association between professional characteristics and the prevalence of advance directives among palliative care professionals. METHODS: This is a descriptive cross-sectional study. A diverse sample of 327 healthcare professionals completed an online survey investigating demographic variables, length of time working in palliative care, post-graduate qualifications in palliative care, and development of their own advance directives. RESULTS: The prevalence of advance directives among professionals working in palliative care was associated with factors such as higher academic qualifications, holding a post-graduate qualification in palliative care, and working in palliative care for a longer time. Furthermore, psychologists were most likely to have registered their own advance directives, compared with other healthcare professionals. SIGNIFICANCE OF RESULTS: Post-graduate palliative care education and professional experience in this area appear to be important factors associated with palliative care professionals writing of their own advance directives. However, our study suggests that just being involved in or familiar with the context of palliative and end-of-life care does not guarantee that health professionals register their advance directives.

Dignity in nursing: A synthesis review of concept analysis studies.

Nursing research using concept analysis plays a critical role for knowledge development, particularly when concerning to broad and foundational concepts for nursing practice, such as dignity. This study aimed to synthesize research concerning concept analysis of dignity in nursing care. Based on a literature review, electronic databases were searched (MEDLINE, CINAHL, COCHRANE, SCOPUS, EBSCOhost, and PubMed) using the terms "dignity," "human dignity," "concept analysis," and nurs*. Papers in Portuguese or English were included. The research synthesis was conducted independently by two reviewers. A total of 35 citations were identified and seven papers were included. Six studies were elected using Walker and Avant concept analysis methodology while one applied the Beth Rodgers evolutionary model. The concept of dignity has been studied by nurses, and its attributes, antecedents, consequences, and similar concepts were synthesized into a definition. Dignity emerged as a fundamental concept in nursing ethics and the main attributes synthesized were personhood (intrinsic), sociability (relational/behavioral), respect, and autonomy. The antecedents identified were: facilitators-patient focus care, recognition (of the attributes of dignity), education, and ethical competence; threats-vulnerability and organizational environment. The consequences were positive coping, empowerment, and dignity preservation. The synthesis of these seven studies using concept analysis provided a clear definition of dignity. These findings challenge future research and education, particularly for the study of undergraduate and postgraduate nursing education programs to enhance skills for preserving patient dignity in clinical practice.

Supporting diversity in person-centred care: The role of healthcare chaplains.

AIM: To explore healthcare chaplains' experience of providing spiritual support to individuals and families from minority religious and non-religious faiths and to identify key elements of the role. BACKGROUND: Currently, there is limited research uncovering the essential elements of healthcare chaplaincy, specifically with reference to religious and/or spiritual diversity, and as interprofessional collaborators with nurses and midwives in healthcare. RESEARCH DESIGN AND PARTICIPANTS: Using phenomenology, we interviewed eight healthcare chaplains from a variety of healthcare settings in the Republic of Ireland. Data were analysed using a seven-step framework comprising Moustakas' (1994) modification of the Van Kaam method of data analysis. ETHICAL CONSIDERATIONS: Ethical approval was granted by the university and the principles of informed consent applied. FINDINGS: Three main themes emerged: what the chaplain brings; components of ritual, minority faith or no faith; and practising chaplaincy. Subthemes included 'offering', 'awareness and insight', 'acceptance and empathy', 'skilled companionship', 'presence', 'a confidant and holder of hope' and 'a vital resource'. DISCUSSION AND CONCLUSIONS: The healthcare chaplain is a key collaborator in facilitating holistic person-centred care and in supporting healthcare professionals. Chaplaincy services are an essential but largely unrecognised and potentially cost-effective component of interprofessional team working. RELEVANCE TO CLINICAL PRACTICE: This study has illuminated key aspects of the healthcare chaplain's role as interprofessional collaborator in person-centred care, in navigating diversity and ensuring respect and dignity for the person irrespective of religious or spiritual care needs.

A commentary on spiritual leadership and workplace spirituality in nursing management.

AIM: Bring to discussion spiritual leadership and workplace spirituality on a health care system that faces constant challenges and seeks constant adaptations, as a way to guarantee nurses' well-being and quality of care. BACKGROUND: The work environment has shown to have impact on staff well-being. Workplace spirituality relates to sense of belonging, motivation and commitment. A spiritual leadership is fundamental to develop workplace spirituality. EVALUATION: Starting from literature, a reflection on the theme was carried out based on the results of the development of spiritual leadership and workplace spirituality in health care institutions, in professionals and in patients. KEY ISSUES: Nurses have spiritual needs which need to be also addressed in order to promote the sense of identification with the institutions' vision and goals. A relation between spiritual leadership, workplace spirituality and subjective well-being is often found in literature, and this is critical evidence towards new management and leadership dynamics and models in health care institutions that should integrate workplace spirituality. CONCLUSION: Nursing leaders are responsible for workplace spirituality facilitation. Nursing leadership and workplace spirituality seem both an answer and way to the change of health institutions management paradigm, but more studies are needed to inform this change in practice. IMPLICATIONS FOR NURSING MANAGEMENT: Workplace spirituality must be promoted in all health care institutions, aiming the humanization of care and teams. Nursing leaders must have spiritual competences and must include the promotion of workplace spirituality in daily agenda as a foundational area in management. The health care institutions' managers should consider the best leaders who should facilitate workplace spirituality.

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.

Intercessory Prayer on Spiritual Distress, Spiritual Coping, Anxiety, Depression and Salivary Amylase in Breast Cancer Patients During Radiotherapy: Randomized Clinical Trial.

The goal of this study was to assess the effect of intercessory prayer in the psychological, spiritual and biological scores of breast cancer patients who are undergoing radiotherapy. Double-blind RCT comprising a sample of 31 participants (15 in the Control Group and 16 in the Intervention Group). Data collection was performed in three time points (T0, T1 and T2). Significant changes have been identified in the intra-group analysis, concerning the decrease in spiritual distress score; negative religious/spiritual coping prevailed, while the total religious/spiritual coping increased between the posttest T2 to T0. Intercessory prayer was effective in religious and spiritual scores.

The use of the Medical Research Council framework in the study of complex interventions in nursing: a literature review.

BACKGROUND: Nursing care addresses several complex interventions and international research into complex interventions is growing. The Medical Research Council framework (MRC-f) is the most cited framework describing the development and evaluation of interventions, but little is known about its use in nursing sciences. AIM: To review the literature for uses of MRC-f in developing complex interventions. DISCUSSION: Of 287 studies initially identified; the final sample comprised 13 papers. Most studies referred to the development or feasibility phase and were performed in the community. They were mainly focused on the physical dimension and few had a holistic approach. The lack of time and financial support, the subjective nature of these interventions, and difficulties in the recruitment of participants were reported as barriers. CONCLUSION: The use of MRC-f in the study of complex interventions is recent in nursing research, but it enhances the design of more feasible and effective nursing interventions. The lack of time, difficulties in the recruitment of adequate sample sizes and lack of financial support were identified as important barriers in the development of complex nursing interventions. IMPLICATIONS FOR PRACTICE: Nurse researchers need to develop skills in planning and conducting research into complex interventions. Academic courses may also be helpful in improving such skills.

Spiritual aspects of living with infertility: A synthesis of qualitative studies.

AIMS AND OBJECTIVES: To identify the spiritual aspects of patients experiencing infertility and seek a deeper and broader meaning of the involuntary childlessness experience. BACKGROUND: Infertility can be the cause for a spiritual crisis among some couples. Those who endure this involuntary childlessness condition frequently experience contradictory feelings and needs. In this context, core aspects of spirituality such as meaning and purpose in life are often questioned. DESIGN: A review and synthesis of qualitative empirical research was undertaken to seek a deeper understanding of the spiritual aspects of patients' experiences of infertility. METHODS: An aggregative synthesis was conducted according to Saini and Shlonsky (Systematic synthesis of qualitative research, 2012, Oxford University Press, Oxford), using thematic analysis. RESULTS: A total of 26 studies included female, male and couples. Settings revealed interviewees in different infertility phases such as diagnosis, assisted reproductive technologies and following fertility treatments. Two main themes emerged: spiritual needs and spirituality as a coping resource for infertility. CONCLUSION: Infertility affects the holistic existence of the couples. This adversity awakens spiritual needs along with unmet needs of parenthood. Coping strategies incorporating spirituality can enhance the ability of couples to overcome childlessness and suffering. RELEVANCE TO CLINICAL PRACTICE: Infertile couples' experiences of infertility may offer an opportunity for spiritual care particularly related to the assessment of spiritual needs and the promotion of spiritual coping strategies. Effective holistic care should support couples in overcoming and finding meaning in this life and health condition.

Functional Independence of Children With Myelomeningocele: Is It Associated With the Informal Caregivers' Burden?

PURPOSE: This study aims to evaluate the association between the functional independence of children after postnatal spinal dysraphism correction and informal caregivers' burden. DESIGN AND METHODS: This is a cross-sectional study conducted in a child neurosurgery clinic at a University hospital. We included informal caregivers of children between six months and seven-and-a-half years old who were operated on for spinal dysraphism correction due to myelomeningocele. Functional independence was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Caregivers' burden was assessed through the Caregiver Burden Scale (CBS). RESULTS: Twenty-six caregivers were assessed, all mothers, aged 18-42years. Five provided child care and engaged in paid work. Regarding functional independence, 23.1% of the children were classified as needing supervision, 23.1% moderate assistance, 42.3% maximal assistance, and 11.5% total assistance. Median value for the overall CBS was 27.0 (22.0-53.0). The mean global CBS score was 1.42 and the mean PEDI score was 1.95. Correlations between PEDI and CBS scores were very close to zero. CONCLUSIONS: We found no association between the functional independence of children with myelomeningocele from 0 to 7years old and the burden of informal caregivers. PRACTICE IMPLICATIONS: The effect of functional independence of children with myelomeningocele may be balanced by the caregivers' resilience so that caregivers' burden is not dependent upon the child's independence.

e-Health in palliative care: review of literature, Google Play and App Store.

AIM: To analyse the use of e-Health technologies and mobile apps in palliative care (PC). METHODS: Search on PubMed, using 'telemedicine', 'ehealth', 'mobile health', 'telecare', 'health information systems' and 'palliative care'. Original Portuguese, Spanish, French and English papers were included. Google Play and App Store (iOS) were searched for mobile apps using 'palliative care', 'medical apps' and 'symptom management'. RESULTS: Twenty-five papers and forty mobile apps were analysed. Teleconsultation is the principal e-Health technology. Mobile apps focus on communication, drugs, tools/clinical guidelines, hospice, symptom management and PC information. CONCLUSIONS: e-Health is an emergent topic in PC. Teleconsultation enhances communication among patients, families and PC teams, reinforces partnership and decreases the burden on families and use of the emergency services. IMPLICATIONS FOR PRACTICE: e-Health technologies are a good strategy in PC but further research based on different methodological approaches is needed to promote evidence-based practice.