Ameliorating the tension: use of forgiveness for healing.

PURPOSE/OBJECTIVES: To generate a grounded substantive theory of the process of forgiveness in patients with cancer. DESIGN: Qualitative approach, grounded theory. SETTINGS: Inpatient hospice, cancer support groups, homecare patients. SAMPLE: 25 adult patients with cancer between the ages of 35 and 88 (X = 62.4 years): 13 men and 12 women receiving active, palliative, or terminal treatment. METHODS: Using grounded theory methodology, open-ended interviews were transcribed verbatim and analyzed using constant comparative analysis and expert and participant validation. MAIN RESEARCH VARIABLE: Forgiveness as reflected in participants' past and current experiences. FINDINGS: Participants described hurtful events that initially caused severe negative emotional responses. Participants also described attempts to focus on living out priority values prompted by their cancer diagnosis. An escalating tension ensued between maintaining negative emotions and acting on personal values. Forgiveness was used to relieve this tension. Using several methods to gain perspective allowed resolving these negative emotions and living out priority values to various degrees. CONCLUSIONS: A cancer diagnosis promotes the rethinking of life priorities regardless of the stage of disease. For these participants, forgiveness was used to help clarify personal values and to help eliminate negative emotions from an inflicted hurt. IMPLICATIONS FOR NURSING PRACTICE: Nurses can facilitate the healing process by helping patients to identify and clarify priority values, recognizing appropriate definitions of forgiveness, using active listening or referral to help patients analyze their situations, encouraging active approaches to forgiving, and encouraging perseverance in the process.

Attempting to fathom the unfathomable: descriptive views of spirituality.

OBJECTIVES: To examine the various views of "spirituality and its uses in the disciplines of philosophy, theology, psychology, and nursing. DATA SOURCES: Definitions and descriptions of spirituality and related terms from the disciplines of philosophy, theology, psychology, and nursing. CONCLUSION: Although it is widely accepted that holistic nursing care incorporates care of the spirit, nursing's view of spirituality is influenced by varying paradigms. Nursing researchers are exploring spirituality. Spiritual care that is ethical and sensitive is an invaluable part of total patient care. IMPLICATIONS FOR NURSING PRACTICE: Appreciating various views of spirituality and recognizing the possible discrepancy between a nurse's and a patient's view of spirituality allows the reader to use such terms carefully and appropriately in providing sensitive patient care.

The concept of spirituality in nursing theories: differing world-views and extent of focus.

Although nursing has recognized spirituality as an important aspect of holistic patient care, exactly what spirituality means has remained rather amorphous. The purpose of this article is to present aspects of spirituality found in modern nurse theorists' ideas. These aspects are presented both in relation to reciprocal interaction or simultaneous action world-views and in relation to the extent of focus on the concept within the model or theory. This discussion will provide the researcher and practitioner with additional theoretical understanding on which to ground investigations and base practice.

Religion and adult mental health: state of the science in nursing.

As a part of human spirituality, religion has been theorized to influence the health of the individual, both positively and negatively. Although the nursing literature has focused recently on broad aspects of spirituality, the specifics of religious influences on health have been examined cursorily or have been ignored. This article reviews the major empirical data on religion and mental health that are pertinent to nursing. Three areas covered are mental health impact, coping, and aging. Suggestions for future research on the subject are presented.

Spiritual well-being, religiousness and hope among women with breast cancer.

The purpose of this study was to clarify spiritual health by examining the role of spiritual well-being (SWB), religiousness and hope in spiritual health. This was accomplished by obtaining questionnaire information from a convenience sample of 175 women diagnosed with breast cancer. Patients classified as intrinsically religious were found to have significantly higher scores on SWB than did those classified as extrinsically religious. There was no difference in hope scores between intrinsically religious and extrinsically religious patients, although hope was positively correlated with SWB. Existential well-being, a component of SWB, was the primary contributor of hope. The two major prognostic variables, stage of disease at diagnosis and number of positive lymph nodes, did not predict any of the scores.

God and the search for meaning among hospice caregivers.

The purposes of this study were (1) to describe both religious and nonreligious appraisals of caregiving for a terminally ill patient and (2) to explore the relationship between these appraisals with situational outcomes, mental health outcomes, and spiritual health outcomes in the caregivers. Ninety-two caregivers completed a questionnaire consisting of religious and nonreligious appraisals, general and religious outcomes, depression, anxiety, and purpose in life. Caregivers who appraised their situation as part of God's plan or as a means of gaining strength or understanding from God reported positive outcomes while caregivers who viewed their situation as unjust, as unfair punishment from God, or as desertion from God had low scores on mental and spiritual health outcomes. Religious appraisals made a significant and unique contribution to the prediction of situational outcomes and mental and spiritual health outcomes above and beyond the effects of nonreligious appraisals.