The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

Spirituality in Nursing and Health: A Historical Context, Challenges, and Way Forward.

This article aims to share the historical context of spirituality in nursing, meanings and expressions of spirituality, and different models of spirituality along with its significance in nursing education and practice. Several challenges and tools for the successful integration of spirituality in education and practice are also discussed.

Hospitalized Patients' Perspectives on Spiritual Assessment: A Mixed Methods Study.

BACKGROUND: Research shows that spirituality is important, but patients report that nurses rarely address spiritual issues, and research from the patient viewpoint is limited. AIM: The research objective was to gain knowledge about hospitalized patients' perspectives on spiritual assessment by nurses. METHOD: This is a mixed methods exploratory study reporting on quantitative/qualitative aspects of the patient perspective. Norwegian nurses in an acute care hospital distributed a 21-item spiritual assessment survey to patients they felt would not be burdened by completing it. Patients' demographic data were not identifiable, survey packets were returned anonymously via hospital mail by 157 hospitalized patients. Each survey item and several variables on the demographic sheet had space for comments. Quantitative analysis used SPSS 21, qualitative data were thematically analyzed. FINDINGS: Statistically significant correlations were found with all survey items. Hospitalized people reported high comfort with spiritual assessment by nurses. Qualitative findings revealed that patients had differing views on if, when, and how nurses should ask spiritual questions of them. CONCLUSIONS: It is important to identify patients' perspectives in order to provide patient-centered holistic care. Understanding patient views will enlighten nurses and may promote spiritual care and improve patient health outcomes.

Reconciling as a Primary Pastoral Act of Spiritual Care.

Hiltner's shepherding perspective offered a primary reference point for pastoral theologians. This paper examines how the reconciling function of that perspective guides the care proceeding from it for Black persons experiencing medical crises. I analyze connections in the work of Archie Smith with Black persons involved in the healthcare system to show how Black persons draw upon spiritual resources and other resources implicit to the Black community itself in order to reconcile lived experiences with sickness.

Spirituality and religiosity for the transcendence of the elderly being.

OBJECTIVE: to understand the life experiences that favor transcendence of the elderly being. METHOD: a qualitative phenomenological hermeneutic study, in two groups of elderly coexistence. The selection of participants was by intentional sampling: 11 elderly, achieving theoretical saturation. Data collection was carried out through a phenomenological interview with a detonating question. Ethical principles of the General Health Law in health research were fulfilled. Analysis with Heideggerian hermeneutic circle was performed. RESULTS: unity of meaning on the consciousness of a higher power for transcendence is highlighted, where spirituality and religiosity are resources of the elderly for strength, feel protected, overcome difficult situations and reach fullness; both favor the understanding of their historicity by manifesting enlightenment. FINAL CONSIDERATIONS: transcendence of the elderly being is favored with spirituality and the experiences of their daily life are imbued with a spiritual and religious relationship that give meaning to their existence.

Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.

OBJECTIVE: When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. METHOD: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.

Spirituality and religiosity for the transcendence of the elderly being / Espiritualidade e religiosidade para a transcendência do ser idoso / Espiritualidad y religiosidad para la trascendencia del ser anciano

ABSTRACT Objective: to understand the life experiences that favor transcendence of the elderly being. Method: a qualitative phenomenological hermeneutic study, in two groups of elderly coexistence. The selection of participants was by intentional sampling: 11 elderly, achieving theoretical saturation. Data collection was carried out through a phenomenological interview with a detonating question. Ethical principles of the General Health Law in health research were fulfilled. Analysis with Heideggerian hermeneutic circle was performed. Results: unity of meaning on the consciousness of a higher power for transcendence is highlighted, where spirituality and religiosity are resources of the elderly for strength, feel protected, overcome difficult situations and reach fullness; both favor the understanding of their historicity by manifesting enlightenment. Final considerations: transcendence of the elderly being is favored with spirituality and the experiences of their daily life are imbued with a spiritual and religious relationship that give meaning to their existence.

RESUMO Objetivo: compreender as experiências de vida que favorecem a transcendência do ser idoso. Método: estudo qualitativo, fenomenológico hermenêutico, em dois grupos de convivência de idosos. A seleção dos participantes foi por amostragem intencional: 11 idosos, atingindo saturação teórica. Coleta de dados através de uma entrevista fenomenológica com uma questão detonadora. Foram cumpridos ss princípios éticos da Lei Geral de Saúde em pesquisa em Saúde. Análise com círculo hermenêutico Heideggeriano. Resultados: destacou-se a unidade de significado sobre a consciência de um poder superior para a transcendência, onde a espiritualidade e a religiosidade são recursos dos idosos para a força, se sentir-se protegido, superação de situações difíceis e atingir a plenitude; ambas favorecem a compreensão de sua historicidade manifestando a iluminação. Considerações finais: a transcendência do ser idoso é favorecida pela espiritualidade, as experiências de sua vida cotidiana são imbuídas de um relacionamento espiritual e religioso que dá sentido à sua existência.

RESUMEN Objetivo: comprender las experiencias de vida que favorecen la trascendencia del ser anciano. Método: estudio cualitativo fenomenológico hermenéutico, en dos grupos de convivencia de ancianos. La selección de participantes fue por muestreo intencionado: 11 ancianos, logrando la saturación teórica. Recolección de datos a través de entrevista fenomenológica con una pregunta detonadora. Se cumplieron principios éticos de Ley General de Salud en Investigación para la Salud. Análisis con círculo hermenéutico heideggeriano. Resultados: destacó unidad de significado sobre la consciencia de un poder superior para la trascendencia, donde espiritualidad y religiosidad son recursos del anciano para fortaleza, sentirse protegido, superación de situaciones difíciles y alcanzar la plenitud; ambas favorecen la comprensión de su historicidad manifestando iluminación. Consideraciones finales: la trascendencia del ser anciano se favorece con la espiritualidad, las experiencias de su cotidiano están impregnadas de una relación espiritual y religiosa que dan sentido a su existencia.

Spiritual Perspective, Mindfulness, and Spiritual Care Practice of Hospice and Palliative Nurses.

Spiritual care is a key tenet of palliative care. A nurse's spiritual perspective has been recognized as an influencing factor in spiritual care, and results from several studies have shown an increase in spiritual perspective as a result of participation in programs designed to develop mindfulness as well as developing skills necessary for spiritual care. A descriptive correlational design was used with a convenience sample of nurses from the Hospice and Palliative Nurses Association. Data were collected online using the Spiritual Perspective Scale, Mindful Attention Awareness Scale, and the Nurse Spiritual Care Therapeutics Scale. Spiritual perspective was positively correlated with age (ρ = 0.2, P = .046), years of registered nurse experience (ρ = 0.208, P = .039) and higher in those with a religious affiliation (U = 392.5, P < .001, r = 0.54). A positive correlation was found between mindfulness and spiritual care (r = 0.212, P = .05), with mindfulness explaining 4.5% of the variance in spiritual care. No significant relationships were found between spiritual perspective and mindfulness or spiritual care. Identifying mindfulness as a factor that may influence spiritual care has implications for education, research, and practice.

The free spirit: spiritualism meanings by a Nursing team on psychiatry / El espíritu suelto: significados de espiritualidad por equipo de enfermería en psiquiatría / O espírito solto: significados de espiritualidade por equipe de enfermagem em psiquiatria

ABSTRACT Objective: To analyze the meanings attributed by nursing professionals in psychiatry to spirituality and its relationship with care. Method: Clinical-qualitative, with appreciation of symbolic meanings. We interviewed 18 individuals for a semi-structured script of open questions and the data were analyzed in the light of psychoanalytic hermeneutics. The discussion was undertaken with the overlap of understanding of the sacred symbol, psychological and the meaning of life. Results: Different spiritualities are interposed by personal restlessness and the experience of transience. Spirituality aids in social functions, personal balance and commitment to endure the anguish of transience. Among professionals, it has been shown as an ethical-combative attitude to evil forms, but there is a restriction in dealing with patients' spirituality. Final considerations: The meanings pointed to the limits of human reason, resembling caregivers and patients in subjective conditions by which they avoid spirituality in psychiatry. It is suggested that spiritual attention be given to professionals.

RESUMEN Objetivo: Analizar los significados atribuidos por profesionales de enfermería en psiquiatría a la espiritualidad y su relación con el cuidado. Método: Clínico-cualitativo, con estimación de los significados simbólicos. Fueron entrevistados 18 sujetos por un itinerario semiestructurado de preguntas abiertas y los datos analizados a la luz de la hermenéutica psicoanalítica. La discusión se emprendió con la superposición del entendimiento del símbolo sagrado, psicológico y del sentido de la vida. Resultados: Distintas espiritualidades se interponen por la inquietud personal y la experiencia con la transitoriedad. La espiritualidad ayuda en las funciones sociales, en el equilibrio personal y en el empeño en soportar las angustias de la transitoriedad. Entre los profesionales se mostró como una actitud ético-combativa a las formas maléficas, pero hay restricción en trabajar con la espiritualidad de los pacientes. Consideraciones finales: Los significados señalaron los límites de la razón humana, asemejando cuidadores y pacientes en condiciones subjetivas por las que evitan la espiritualidad en la psiquiatría. Se sugiere atención espiritual para los profesionales.

RESUMO Objetivo: Analisar os significados atribuídos por profissionais de enfermagem em psiquiatria à espiritualidade e sua relação com o cuidado. Método: Clínico-qualitativo, com apreciação dos significados simbólicos. Entrevistou-se 18 sujeitos por um roteiro semiestruturado de questões abertas e os dados foram analisados à luz da hermenêutica psicanalítica. A discussão se empreendeu com a sobreposição do entendimento do símbolo sagrado, psicológico e do sentido da vida. Resultados: Distintas espiritualidades se interpõem pela inquietação pessoal e a experiência com a transitoriedade. A espiritualidade ajuda nas funções sociais, no equilíbrio pessoal e no empenho em suportar as angústias da transitoriedade. Entre os profissionais, se mostrou como uma atitude ético-combativa às formas maléficas, mas há restrição em lidar com a espiritualidade dos pacientes. Considerações finais: Os significados apontaram para os limites da razão humana, assemelhando cuidadores e pacientes em condições subjetivas pelas quais evitam a espiritualidade em psiquiatria. Sugere-se atenção espiritual para os profissionais.

Multidimensional needs of patients living and dying with heart failure in Kenya: a serial interview study.

BACKGROUND: Heart failure is an emerging challenge for Sub Saharan Africa. However, research on patients' needs and experiences of care is scarce with little evidence available to support and develop services. We aimed to explore the experiences of patients living and dying with heart failure in Kenya. METHODS: We purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in depth interviews with patients at 0, 3 and 6 months after recruitment, and conducted bereavement interviews with carers. Interviews were recorded, transcribed into English and analyzed using a thematic approach, assisted by Nvivo software package. RESULTS: Forty-four interviews were conducted. Patients experienced physical, psychosocial, spiritual and financial distress. They also had unmet needs for information about their illness, how it would affect them and how they could get better. Patients experience of and their interpretation of symptoms influenced health care seeking. Patients with acute symptoms sought care earlier than those with more gradual symptoms which tended to be normalised as part of daily life or assumed to be linked to common treatable conditions. Nearly all patients expected to be cured and were frustrated by a progressive illness poorly responsive to treatment. Accumulating costs was a barrier to continuity of care and caused tensions in social relationships. Patients valued information on the nature of their illness, prognosis, self-care, lifestyle changes and prevention strategies, but this was rarely available. CONCLUSIONS: This is the first in-depth study to explore the experiences of people living with advanced heart failure in Kenya. This study suggests that patients would benefit from holistic care, such as a palliative approach that is aimed at providing multidimensional symptom management. A palliative approach to services should be provided alongside chronic disease management aimed at primary prevention of risk factors, and early identification and initiation of disease modifying therapy. Further research is needed to determine best practice for integrating palliative care for people living and dying with heart failure.

Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: combining an evidence based treatment with cultural, traditional, and spiritual beliefs.

This pilot study examined pre to post-change of patients in a substance use residential treatment center that incorporated Dialectical Behavior Therapy with specific cultural, traditional and spiritual practices for American Indian/Alaska Native adolescents. Specifically, the incorporation of cultural, spiritual and traditional practices was done while still maintaining fidelity to the evidence based treatment (DBT). 229 adolescents participated in the study and were given the Youth Outcome Questionnaire-Self-Report version at pre-treatment and post-treatment and the total scores were compared. The results of the research study showed that 96% of adolescents were either "recovered" or "improved" using clinical significant change criteria. Additionally, differences between the group's pre-test scores and post-test scores were statistically significant using a matched standard T-test comparison. Finally, the effect size that was calculated using Cohen's criteria was found to be large. The results are discussed in terms of the implication for integrating western and traditional based methods of care in addressing substance use disorders and other mental health disorders with American Indian/Alaska Native adolescents.

Dissociation: adjustment or distress? Dissociative phenomena, absorption and quality of life among Israeli women who practice channeling compared to women with similar traumatic history.

This study aimed to explore the relationship between traumatic history, dissociative phenomena, absorption and quality of life among a population of channelers, in comparison with a population of non-channelers with similar traumatic history. The study sample included 150 women. The measures included Traumatic Experiences Scale, Dissociative Experience Scale, Absorption Scale, Brief Symptom Inventory and Quality of Life (QOL) Assessment. Channelers presented significantly higher levels of dissociation, absorption and psychological health compared to the other group. Dissociation and absorption were trauma-related only among the comparison group. Hence, dissociation has different qualities among different people, and spiritual practice contributes to QOL.

Person-centred reflective practice.

Person-centred health and person-centred care have gained prominence across the UK following the publication of reports on public inquiries exploring failings in care. Self-awareness and participation in reflective practice are recognised as vital to supporting the person-centred agenda. This article presents an education framework for reflective practice, developed and used in one NHS board in Scotland, and based on the tenets of the clinical pastoral education movement. Providing an insight into the usefulness of a spiritual component in the reflective process, the framework provides an opportunity for nurses and other healthcare professionals to examine the spiritual dimensions of patient encounters, their own values and beliefs, and the effect these may have on their practice.

A phenomenological study of spontaneous spiritual and paranormal experiences in a 21st-century sample of normal people.

Summary.-This paper presents a phenomenological study using the methodology of Woodard's phenomenological and perceptual research. This method examines individuals' internal meanings during spontaneous spiritual and paranormal experiences, as described from their point of view. A group of 40 adults was phenomenologically interviewed after they responded to a newspaper announcement in New Hampshire asking for volunteers who had had spiritual and paranormal experiences. Using the method, Six Individual Situated Structures and a General Structure were identified and examined. Nine major themes were explicated during the participants' spontaneous experiencing: unexpectedness, contrariness to belief, certainty, contradictory experiencing, language as a barrier to expression, external influences, internal dialogue, evil as separateness, and some social psychological influences. Several themes observed in hypnotic experiencing, such as the characteristics of the Adequate Personality in Perceptual Psychology, are interpreted and discussed. This research illustrates how subjective experience can be adequately researched in a qualitative manner outside the confines of the laboratory setting. Limitations of the study and suggestions for further research are given.

[Mind-body connection, parapsychological phenomena and spiritual healing. A review]. / Conexión mente-cuerpo, fenómenos parapsicológicos y curación espiritual. Revisión.

Evidence regarding the influence of the mind on the body is abundant. Several mind-body healing procedures are currently being used, among them hypnosis, biofeedback, meditation, visualizations, management of emotions and prayer. Since the Big Bang, we are entangled with everything. This interaction would let individuals to communicate with the minds and bodies of others. The field of parapsychological research has provided a lot of information about significant events, including apparitions, communications with the dead, near-death experiences and out of the body experiences. It looks apparently evident, that consciousness can persist in the absence of brain function. According to the model that assumes that it is consciousness and not matter, the base of everything that exists, what survives after death is the "quantum monad" or spirit. It is said that spiritual cures are practiced by discarnate physicians who diagnose and prescribe conventional treatments, but very often they use unknown procedures based on the management of energy fields that are currently being studied by many physicists. Representative examples of the practice of spiritual medicine were the mediums Ze Arigo, George Chapman, Barbara Guerrero (Pachita) and presently the Brazilian medium John of God. Case reports of paranormal phenomena observed and studied by honest and serious scientists are very important for the advancement of parapsychology, because it has not been clearly established which approach, the qualitative or the quantitative, is more useful for the development of this field.

Changing conceptions of mental distress among Somalis in Finland.

This article examines how the conceptions, expressions and treatment of mental distress are changing among Somalis living in Finland. The data derive from two focus group interviews with Somali seniors and two individual interviews with Islamic healers. Conditions conceptualized by the Finnish biomedical system as mental disorders, are seen by most Somalis as spiritual and/or social problems. Somali migrants face new sources of suffering and new ways of interpreting them. Consequently, traditional conceptions of mental distress both persist and change. Islamic understandings of healing, including notions of jinn spirits and treatment, continue to be important in exile.

Spirituality and job satisfaction among female Jewish Israeli hospital nurses.

AIM: This paper is a report of a study conducted to examine the relationship between spirituality and hospital nurses' work satisfaction and to determine the unique contributions of various specific aspects of spirituality to their work satisfaction. BACKGROUND: Spirituality has been indicated as a possible contributor to nurses' job satisfaction. However, few researchers have examined the relationship between spirituality and nurses' job satisfaction. METHOD: During 2007, 120 female Jewish Israeli hospital nurses responded to a questionnaire including a multidimensional measure of spirituality and a measure of overall job satisfaction. RESULTS: Correlation analysis indicated a positive relationship between life coherency aspects of spirituality and spiritual values with job satisfaction. Hierarchical regression analysis indicated the particular importance of an idealistic spiritual orientation (positive contribution) and a transcendent spiritual orientation (negative contribution) to the prediction of nurses' job satisfaction. CONCLUSION: The relationship between spirituality and nurses' job satisfaction is complex. Hospital managers may be able to enhance job satisfaction by providing opportunities for nurses to satisfy their spiritual needs (in particular, altruistic and ideological orientations) on the job. In addition, nurses with a strong transcendent orientation may be identified and given special attention to increase the likelihood of job satisfaction.

Recognition and treatment of psychotic symptoms: spiritists compared to mental health professionals in Puerto Rico and Brazil.

This article expands psychosocial and cultural perspectives on the experience and expression of psychotic symptoms and the treatment of schizophrenia by exploring how Spiritism, a popular religion in Latin America, provides healing to persons with severe mental illness. Beliefs and treatment by Spiritist healers of persons with psychotic symptoms, some diagnosed with schizophrenia, are described. Reactions by mental health professionals (psychologists, mental health technicians and psychiatrists) to this alternative treatment are described. Qualitative data have been collected through in-depth interviews with 49 Spiritist mediums in Puerto Rico, and case histories of 22 patients and their family members, all of whom gave informed consent. In Brazil, interviews were conducted with a sample of 115 Spiritist mediums, with their informed consent. These mediums responded to semi-structured interviews and standard measures of social adjustment and mental health. As expected, beliefs and practices of Spiritist healers regarding psychotic symptoms, whether manifested by themselves or by clients diagnosed with schizophrenia or other disorders, differ substantively from conventional psychiatric constructs and treatment approaches. According to patients' self reports and researchers' observations, spirit healers often achieve positive results with persons manifesting psychotic symptoms or diagnosed with schizophrenia in that symptoms become less frequent and/or social adjustment improves. We suggest psychosocial mechanisms to explain these findings and raise questions for future research.

Spirit-body healing II: a nursing intervention model for spiritual/creative healing.

This article describes an advanced intervention for spiritual healing that evolved from spirit-body healing, a hermeneutic phenomenological research study. The research study examined the lived experience of art and healing with cancer patients in the Arts in Medicine program at Shands Hospital, University of Florida. Max Van Manen's method of researching the lived experience was used in 63 patients over a 4-year period. Healing themes that emerged from the research were (1) go into darkness, (2) go elsewhere, (3) art becomes the turning point, (4) slip through the veil, (5) know the truth and trust the process, (6) embody your spirit, (7) feel the healing energy of love and compassion, and (8) experience transcendence. The intervention we offer allows nurses to apply creativity and guided imagery as advanced therapeutics and to continue to provide the leadership needed for integrating spiritual healing into patient care. It is one that personifies the nursing mission formalized by many hospitals: a commitment to treat the bodies, minds, and spirits of patients to the best of our ability as part of our routine care.