Religion and Spiritual Health in Patients With and Without Depression Receiving Hemodialysis: A Cross-Sectional Correlational Study.

BACKGROUND: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients. PURPOSE: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms. METHODS: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression. RESULTS: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio ( OR ) of depression for participants with a duration of hemodialysis of 1-5 years ( OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression ( OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early.

Mediating role of spirituality on the relationships between posttraumatic stress and posttraumatic growth among patients with cancer: A cross-sectional study.

Objective: This study explores the impact of posttraumatic stress (PTS) on posttraumatic growth (PTG) and verifies the mediating effect of spirituality among patients with cancer. Methods: This study used a cross-sectional correlational design. This study surveyed 141 hospitalized patients over 20 years of age diagnosed with cancer. Participants were recruited by convenience sampling from a regional hospital in Taiwan. Data were collected from January to April 2021. Measurements included sociodemographic and disease-related information and data from the following self-report questionnaires: Posttraumatic Stress Reaction Index-Short Form, Posttraumatic Growth Inventory, and Spiritual Health Scale-Short Form. Structural equation modeling and bootstrapping were used to analyze the mediating effect of spiritual health on PTS and PTG. Results: PTS and spirituality were negatively correlated, spirituality, and PTG were positively correlated, and PTS had no correlation with PTG. Spirituality fully presented a mediating role between PTS and PTG. Conclusions: Patients' spirituality should be regarded as an important variable that can impact stress appraisal and improve the patient's PTG when a diagnosis of cancer is received. Assessing spiritual health at regular intervals and integrating spiritual care with clinical care could decrease PTS and improve PTG for patients with cancer.

The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses.

AIM: To determine if levels of spiritual health, health-promoting behaviors, depressive symptoms and resilience change over time and determine if any variables have an impact on resilience among new nurses. BACKGROUND: Nurses provide patients with medical care and emotional support in high-stress environments. Resilience is a characteristic that allows one to adjust to these adverse situations. Resilience can help new nurses withstand the emotional stress of the workplace and improve nurse retention. METHOD: The study was conducted from 2017 to 2019 with a convenience sample of nursing students (N = 195). Data were collected at four timepoints with self-report questionnaires on spiritual health, health-promoting behaviors, resilience and the Beck Depression Inventory-II from 2017 to 2019. Three timepoints were collected during the fourth year of the student stage: fall semester (T1), spring semester (T2) and just prior to graduation (T3); the fourth timepoint was the novice stage (T4), after at least 3 months as a registered nurse. General estimating equations determined predictors of resilience. RESULTS: A total of 124 new nurses completed all questionnaires (63% response rate). Although mean scores fluctuated slightly during the student stage, the scores at T4 were significantly worse for spiritual health (Wald χ2 = 30.23, p < .001), health-promoting behaviors (Wald χ2 = 34.89, p < .001), depressive symptoms (Wald χ2 = 46.75, p < .001) and resilience (Wald χ2 = 21.54, p < .001). Spiritual health, health-promoting behaviors were positively correlated with resilience (p < .001); depressive symptoms were negatively correlated (p < .001). Controlling for the effect of time, resilience of novice nurses was positively associated with nursing school practicum grade, spiritual health and health-promoting behaviors (ß = 10.30, p < .001; ß = 12.14, p < .001; and ß = 14.62, p < .001, respectively) and negatively associated with depressive symptoms (ß = - 0.53, p < .001). CONCLUSIONS: Scores for all variables were similar over the three timepoints of the student stage. However, the significant changes at T4 compared with the student stage suggest the novice stage of nursing was challenging. Increasing resilience could reduce the challenges of transitioning to a hospital environment. Nursing educators and administrators could increase nursing students' resilience by restructuring the educational curricula. This could include helping nurses increase their spirituality and health-related behaviors and providing psychological support to reduce depressive symptoms. Increasing levels of resilience could reduce nurses' emotional stress and improve retention of new nurses.

A spiritual education course to enhance nursing students' spiritual competencies.

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students' spiritual competencies, individual spiritual growth, and the ability to care for patients.

Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses.

BACKGROUND: Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored. PURPOSES: The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses. METHODS: This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care. RESULTS: Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.

[The Impact of Demoralization on Spiritual Well-Being in Terminally Ill Patients].

BACKGROUND: Terminally ill patients often experience demoralization, which negatively impacts their spiritual well-being. However, studies on the relationship between demoralization and levels of spiritual well-being in Taiwan are still at an early stage. Thus, more research is required to verify and support the correlation between demoralization and spirituality and to establish methods to care for and treat demoralization. PURPOSE: The purposes of this study were to investigate the demoralization and spiritual-well-being status of terminally ill patients and to determine the value of demographic data, disease characteristics, demoralization in predicting spiritual well-being. METHODS: A cross-sectional research design was used to evaluate terminally ill patients who were currently receiving hospice care at a teaching hospital in southern Taiwan. Data were collected using a structured questionnaire that included a demographic datasheet and the Chinese demoralization and spiritual well-being scale. Pearson product-moment correlation and hierarchical multiple regression were performed to analyze the relationship between the target variables and spiritual well-being. RESULTS: Of the 82 participants surveyed, 81.7% had high levels of demoralization. The average spiritual well-being score for the participants was 31.7 (moderate). A significant and negative correlation was found between degree of demoralization and level of spiritual well-being (r = -.600, p < .01). Regression analysis showed that, after controlling for demographic characteristics, disease characteristics, and other variables, demoralization scores were shown to predict the spiritual-well-being score, explaining 12.7% of total variance (ß = -.41, p < .001). In other words, higher demoralization was associated with lower spiritual well-being. CONCLUSIONS: Demoralization is a common problem in people with terminal illnesses and is an important factor affecting spiritual well-being in this patient population. In clinical practice, early assessment and identification of demoralization in patients as well as establishing relevant models of care for demoralization are necessary to help patients attain spiritual well-being at the end of life.

[The Spiritual Health Status and Spiritual Care Behaviors of Nurses in Intensive Care Units and Related Factors].

BACKGROUND: Patients suffer sudden and life-threatening conditions in intensive care units (ICU), which frequently result in traumatic changes in physical, mental, and spiritual health. Little research has been conducted on the spiritual health and spiritual care behaviors of nurses in ICU. PURPOSE: To explore the relationship among demographic characteristics, spiritual health, and spiritual care behaviors in ICU nurses. METHODS: A descriptive correlational research was used and 219 nurses from three teaching hospitals were enrolled as study participants. A structured questionnaire consisting of a demographic datasheet, a spiritual health scale, and a spiritual care behavior scale was used for data collection. SPSS for Windows version 22.0 was used for statistical analysis. RESULTS: The participants received few hours of spiritual-care education. The highest scored item for spiritual health was "connecting with people". The highest scored item for spiritual care behavior was "helping the patient out of adversity". Participants who were older in age and who had more years of clinical experience exhibited spiritual care behaviors such as "helping the patient out of adversity" and "retaining hope" more frequently with their ICU patients. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The older and more clinically experienced nurses in this study performed spiritual care behaviors at a higher frequency than their younger, less experienced counterparts. Therefore, it is recommended that hospitals retain more-experienced nursing staff to elevate the level of holistic health care. Concurrently, training in spiritual care skills should be provided to younger and less experienced nurses in order to facilitate more spiritual care behaviors. The results of this study provide a reference for providing spiritual care behaviors to patients.

The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring.

BACKGROUND: The personal spiritual health of nurses may play an important role in improving their attitudes toward spiritual care and their professional commitment and caring capabilities. PURPOSE: The purpose of this study was to explore the impact of nurses' personal spiritual health on their attitudes toward spiritual care, professional commitment, and caring. METHODS: A total of 619 clinical nurses were included in this cross-sectional survey. The measurements included the spiritual health scale-short form, the spiritual care attitude scale, the nurses' professional commitment scale, and the caring behaviors scale. Structural equation modeling was used to establish associations between the main research variables. RESULTS: The hypothetical model provided a good fit with the data. Nurses' spiritual health had a positive effect on nurses' professional commitment and caring. Nurses' attitudes toward spiritual care could therefore mediate their personal spiritual health, professional commitment, and caring. CONCLUSIONS: The findings indicated that nurses' personal spiritual health is an important value and belief system and can influence their attitudes toward spiritual care, professional commitment, and caring.

Psychometric testing of the properties of the spiritual health scale short form.

AIMS AND OBJECTIVES: To further examine the psychometric properties of the spiritual health scale short form, including its reliability and validity. BACKGROUND: Spirituality is one of the main factors associated with good health outcomes. A reliable and valid instrument to measure spirituality is essential to identify the spiritual needs of an individual and to evaluate the effect of spiritual care. DESIGN: A cross-sectional study design was used. METHODS: The study was conducted in six nursing schools in northern, central and southern Taiwan. The inclusion criterion for participants was nursing students with clinical practice experience. Initially, 1141 participants were recruited for the study, but 67 were absent and 48 did not complete the questionnaires. A total of 1026 participants were finally recruited, indicating a response rate of 89·9%. The psychometric testing of the spiritual health scale short form included construct validity with confirmatory factor analysis, known-group validity and internal consistency reliability. RESULTS: The results of the confirmatory factor analysis supported the five-factor model as an acceptable model fit. In the known-group validity, the results indicated that people who are in the category of primary religious affiliation have better spiritual health than people in the category of secondary religious affiliation and atheism. The result also indicated that the 24-item spiritual health scale short form achieved an acceptable internal consistency coefficient. CONCLUSIONS: The findings suggest that the spiritual health scale short form is a valid and reliable instrument for the appraisal of individual spiritual health. RELEVANCE TO CLINICAL PRACTICE: The spiritual health scale short form could provide useful information to guide clinical practice in assessing and managing people's spiritual health in Taiwan.

The effects of a spiritual learning program on improving spiritual health and clinical practice stress among nursing students.

BACKGROUND: Numerous studies have indicated an association between spirituality and health outcomes. However, little information is available about interventions that have been shown to enhance spiritual health and decrease stress. PURPOSE: This study examined the effects of a spiritual learning program (SLP) on nursing student-perceived spiritual health and clinical practice stress. METHOD: A convenience sample of nursing students currently enrolled at a nursing school in northern Taiwan were recruited to participate in this quasiexperimental study as participants to experimental and control groups via simple random sampling. Results from a spiritual health scale and a perceived clinical practice stress scale, together with the score for clinical nursing practice, were compared between the groups. Baseline data were collected from all participants. The experimental group participated in 8 weeks of 50-minute per week SLP, which included lectures, discussion, reflection, and spiritual practices. A second data set was collected from all participants after the intervention. A third data set was collected after all participants had performed 4 weeks of nursing clinical practice. RESULTS: Participants were all women. Average age was 19.4 years (SD = 1.3 years). Generalized estimating equation analysis showed SLP to have a significant short-term effect on improving the total score for spiritual health (p < .01). Significantly greater improvement in clinical practice stress scores was also seen in the experimental group as compared with the control group (all p < .05). The experimental group obtained a higher score of the final clinical practice than the control group (t = 3.771, p < .001). CONCLUSION: The SLP may encourage participants to see stressors as meaningful events that are connected to individual life purposes. The program developed in this study may be used to improve spiritual health and reduce stress in nursing students' clinical practice. This SLP may be referenced when designing similar spirituality-related courses and applied to nursing student counseling.

The differences in spiritual health between non-depressed and depressed nurses.

AIMS AND OBJECTIVES: The aim of this study was to compare the differences in spiritual health between depressed and non-depressed nurses. BACKGROUND: Previous studies have revealed that spirituality can buffer emotional pressure and maintain health, even in cases of depression. Nurses may have a tendency to develop depression; however, the relationship between depression and spirituality in nurses has been investigated only rarely. DESIGN: A correlational study. METHODS: The study was conducted using a convenience sample of 283 nurses who worked at a local hospital in northern Taiwan. We used a structured, self-administered questionnaire to obtain the data. This questionnaire included a spiritual health scale, the Beck Depression Inventory and personal data. The quantitative data were analysed using the t-test, one-way analysis of variance and logistic regression. RESULTS: All the participants were women, and 22·6% of the participants were ascertained to have depression. The non-depressed group had a higher average score for the different domains of the spiritual health scale than the depressed group. When personal and job-related variables were controlled, spirituality was a significant explanatory variable for depression. CONCLUSIONS: The spiritual health of the non-depressed nurses was better than that of the depressed nurses. The result was consistent with the previous studies on other populations. RELEVANCE TO CLINICAL PRACTICE: The spiritual health and depression of nurses should be paid attention by nursing administrators. Spiritual promoting programme in preventing depression should be examined in future researches.

An exploration of the status of spiritual health among nursing students in Taiwan.

OBJECTIVE: Few studies have investigated the spiritual health of nursing students. The purpose of this study was to examine spiritual health in a group of senior nursing students in Taiwan, and to explore the factors that influenced the spiritual health of the group. METHOD: This was a cross-sectional study. A total of 1276 senior nursing students were selected using a probability-proportional-to-size (PPS) procedure, and were asked to complete a self-administrated questionnaire that included a spiritual health scale (SHS) and a demographic profile. RESULTS: All study participants were female with an average age of 20.1 years, and most reported a religious affiliation and participation in religious activities. Their spiritual health was moderate; and generally the study metric "connection to others" was the highest factor, and the metric "religion attachment" was the lowest. Certain demographic characteristics, including age, education level, aboriginal characteristic, level of religious devotion, and family atmosphere were predictors of spiritual health. CONCLUSION: Nursing educators should be aware of the impact of spiritual health on nursing students, and should consider developing spiritual and religious education programs to enhance students' spiritual health and to nurture their ability to supply spiritual nursing care for patients.