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.

Diálogos entre C. G. Jung e William James: as pesquisas psíquicas / Diálogos entre C. G. Jung e William James: las investigaciones psíquicas / Dialogues between C. G. Jung e William James: the psychical researches

RESUMO. C. G. Jung e William James compartilhavam uma série de interesses de pesquisa. Por ocasião da Conferência realizada na Universidade de Clark, no ano de 1909, os dois autores tiveram a oportunidade de se encontrar e conversar. Os debates abordaram temas que não estavam na pauta da conferência, especialmente pesquisas psíquicas, também chamadas modernamente de experiências anomalísticas ou relacionadas à 'psi'. Desde seu período como estudante de medicina, Jung se interessou pelos fenômenos anômalos da consciência, tendo pesquisado os principais autores associados ao espiritualismo dos séculos XVIII e XIX. William James foi pesquisador reconhecido dos chamados fenômenos psíquicos, tendo participado de sociedades como a Society for Psychical Research e a American Society for Psychical Research. Através de seus estudos, James e Jung buscavam contribuir para a psicologia dinâmica, também chamada de psicologia profunda. O objetivo deste artigo foi ampliar os diálogos estabelecidos na universidade de Clark, resgatando informações importantes acerca da teoria dos dois autores.

RESUMEN. C. G. Jung y William James compartían una serie de intereses de investigación. En la conferencia celebrada en la Universidad de Clark, en 1909, los dos autores tuvieron la oportunidad de encontrarse y conversar. Los debates se centraron en temas que no estaban en la agenda de la conferencia, especialmente en la investigación psíquica, también llamada en la actualidad experiencia anomalística o relacionada con la psi. Jung de su tiempo como estudiante de medicina se interesó por fenómenos anómalos de conciencia, después de habiendo investigado los autores principales asociados con el espiritualismo de los siglos XVIII y XIX. William James era conocido investigador de los llamados fenómenos psíquicos, y participó en las sociedades como la Society for Psychical Research y la American Society for Psychical Research. James y Jung a través de sus estudios trataron de contribuir a la psicología dinámica, también llamada psicología profunda. El propósito de este artículo es ampliar el diálogo establecido en la Universidad de Clark, rescatando la información importante acerca de la teoría de los dos autores.

ABSTRACT. C.G. Jung and William James shared several research interests. At the conference held at Clark University in 1909, the two authors could meet and talk. The debates were especially on topics regarding psychical research, contemporarily also called anomalistic or psi-related experiences, which were not considered on the conference schedule. Since his period as a medical student, Jung has been interested in anomalous phenomena of consciousness, having researched the prominent authors associated with the spiritualism of the 18th and 19th centuries. William James was a recognized researcher of the so-called psychic phenomena, participating in societies such as Society for Psychical Research and the American Society for Psychical Research. Through their studies, James and Jung aspired to contribute to dynamic psychology, also called depth psychology. This article aimed to broaden the dialogues established at Clark University, rescuing important information about the theory of the two authors.

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.

Treatise on the influence of theism, transhumanism, and posthumanism on nursing and rehabilitation healthcare practice.

Reservations concerning the ontologies of theism, transhumanism and posthumanism compel an explicatory discourse on their influences on Nursing and rehabilitation healthcare. Key journals in Nursing and health sciences have recently devoted themed issues on intelligent machine technologies such as humanoid healthcare robots and other highly technological healthcare devices and practice initiatives. While the technological advance witnessed has been a cause for celebration, questions still remain that are focused on the epistemological concerns. The purpose of this article is to discuss theistic ontologies such as the Judeo-Christian, Shinto-Buddhist and Islamic religious belief systems on transhumanism and posthumanism in the assimilation of symbiotic technological beings in Nursing and rehabilitation healthcare practice. In view of the approaching technological singularity dominating arguments regarding the future of human beings, a treatise on Nursing and rehabilitation health care is positioned well within the realms of human care. Theism, transhumanism and posthumanism are directing discussions regarding human beings and healthcare processes. It is imperative that the beneficial effects of these discussions be acknowledged within the highly technological world of Nursing and rehabilitative healthcare.

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.

Depression and suicidal ideation: association of physical, mental, social, and spiritual health status.

PURPOSE: The aim of this study was to determine if multidimensional (physical, mental, social, spiritual) health status could predict the presence of depressive symptoms and suicidal ideation in the general population. METHODS: We administered a population-based, cross-sectional survey to 1200 participants from the general Korean population. The survey included the 5 Health Status Questionnaire (5HSQ) for self-rated health status, Patient Health Questionnaire-9 (PHQ-9) for depression, and a question from the PHQ-9 for suicidal ideation. Multiple logistic regression was performed to estimate the association of significant socio-demographic factors and self-rated health status with depression and suicidal ideation. RESULTS: Physical health status was associated with depression in both men and women (men: adjusted odds ratio [aOR], 4.69; 95% confidence interval [CI] 2.44-9.00; women: aOR, 2.05; 95% CI 1.13-3.72) while spiritual health status only affected men (aOR, 5.50; 95% CI 2.59-11.65) and mental health status only women (aOR, 3.92; 95% CI 2.03-7.54). Social health status was associated with suicidal ideation in men (aOR, 4.87; 95% CI 2.74-19.99) while mental health status was associated with suicidal ideation in women (aOR, 4.31; 95% CI 1.90-9.76). CONCLUSION: Physical, mental, social, and spiritual self-rated health statuses were all found to be associated with an individual's predisposition to depression and suicidal ideation with notable differences between men and women.

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.

Associations Among Exposure to Potentially Morally Injurious Experiences, Spiritual Injury, and Alcohol Use Among Combat Veterans.

Potentially morally injurious experiences (PMIEs) are events that may violate deeply held values or belief systems. Combat engagement places service members at a heightened risk for PMIE exposure. Exposure to PMIEs may elicit internal conflict between moral beliefs and experiences and, if unresolved, conflict may manifest as feelings of guilt, shame, and spiritual or existential crisis. Further, distress caused by these experiences may promote harmful behaviors (e.g., excessive alcohol use), which may serve as attempts to cope with PMIEs veterans have witnessed or participated in. The present study examined a sequential mediation model in which combat exposure was associated with alcohol use (i.e., alcohol consumption, dependence symptoms, and alcohol-related problems) via PMIE exposure and spiritual injury (e.g., alienation from and/or anger towards respective higher power) in a community sample of 380 recent-era combat veterans. Multiple-group sequential mediation was then used to examine whether the model fit similarly across men and women. Exposure to PMIEs and spiritual injury sequentially mediated the association between combat and alcohol; higher levels of PMIE exposure and spiritual injury were associated with increased alcohol use, R2 = .17, f2 = 0.07. The multiple-group model showed that these associations significantly varied between genders such that the mediation was only significant among men. The results indicated that PMIEs and spiritual injury were associated with increased alcohol use, but these associations differed as a function of gender. Future research is needed to refine our understanding of moral and spiritual injury and explore possible risk and protective factors.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Las Asociaciones entre la Exposición a Experiencias Potencialmente Dañinas Moralmente, Daño Espiritual, y el Uso de Alcohol Entre Combatientes Veteranos EXPOSICION, DAÑO ESPIRITUAL, Y USO DE ALCOHOL Las experiencias potencialmente dañinas moralmente (PMIEs en su sigla en inglés) son eventos que pueden transgredir los valores profundamente arraigados o los sistemas de creencias. La participación en combates posiciona a los miembros en servicio en un más alto riesgo de exposición a las PMIEs. La exposición a las PMIEs puede provocar conflictos internos entre las creencias morales y las experiencias y, si no son resueltos, el conflicto puede manifestarse como sentimientos de culpa, vergüenza, y crisis espirituales o existenciales. Además, el malestar causado por estas experiencias puede promover conductas dañinas (por ej., uso excesivo de alcohol), las cuales pueden servir como intentos para lidiar con las PMIEs que los veteranos han observado o en las que ellos han participado. En el presente estudio, en una muestra comunitaria de 380 combatientes veteranos de la era reciente, se examinó un modelo de mediación secuencial en el cual la exposición al combate fue asociada con el uso de alcohol (por ej., consumo de alcohol, síntomas de dependencia, y problemas asociados al alcohol) por medio de la exposición a las PMIEs y el daño espiritual (por ej., alienación y enojo contra una deidad). Una mediación secuencial de grupos múltiples fue luego usada para examinar si el modelo se ajustaba similarmente entre hombres y mujeres. La exposición a las PMIEs y el daño espiritual mediaron secuencialmente la asociación entre el combate y el alcohol; niveles más altos de exposición a las PMIEs y el daño espiritual se asociaron con mayor uso de alcohol, R2 = .17, f2 = 0.07. El modelo de grupos múltiples mostró que estas asociaciones variaron significativamente entre los géneros, de manera tal que la mediación fue solamente significativa entre los hombres. Los resultados indican que las PMIEs y el daño espiritual se encuentran asociados con un mayor uso de alcohol, pero estas asociaciones son diferentes dependiendo del género. Las futuras investigaciones son necesarias para mejorar nuestro entendimiento del daño moral y espiritual y explorar posibles factores de riesgo y protectores.

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.

[A real fear of voodoo spirits]. / Een reële angst voor voodoogeesten.

Nigerian victims of human trafficking often fear revenge of voodoo spirits after escaping from their offenders. Human traffickers usually tell them that voodoo spirits will disturb their sleep and their peace of mind and eventually drive them crazy in case the victim would break the contract. In the Nigerian context, this fear is real and threatening. Western health care professionals should not consider this fear of voodoo as an anxiety disorder, especially because treatment would improperly challenge the validity of deeply rooted religious beliefs. We describe the case of a 35-year-old Nigerian male victim of human trafficking, who was sent to our Dutch treatment facility because of a disabling fear of voodoo. We refused treatment, but instead had an open dialogue about explanations for his symptoms. This made him aware of the way in which human traffickers abuse Nigerian religion and it relieved him from most of his anxiety.

The Spiritual Needs of Community-Dwelling Older People Living With Early-Stage Dementia-A Qualitative Study.

PURPOSE: To explore the spiritual needs of community-dwelling older people living with early-stage dementia. DESIGN: A descriptive qualitative research design with purposive sampling was used. METHODS: Ten older people who were receiving home care services from a mental hospital in central Taiwan were recruited. In-depth semistructured interviews were conducted and content analysis was performed. FINDINGS: Four themes emerged that described the spiritual wishes and needs of older people with early-stage dementia: the wish to turn back time, the need to instill meaning into past experiences, the need to rely on faith-based strength, and the wish to have one's remaining life under control. The spiritual needs centered on a strong yearning to engage in a tug-of-war with time to reverse the impaired memory and independence. CONCLUSIONS: This study provides insights into the spiritual needs of older people with early-stage dementia. They struggled to maintain a balance between independence and dependence, build a sense of self and value, seek guidance and support from religious faith, and retain control over their lives. CLINICAL RELEVANCE: The findings can be expected to help caregivers improve care of older people with dementia by empowering older people to hold onto control in their lives and providing opportunities for them to connect with others for fulfilling their spiritual needs.

Differential Diagnosis between Anomalous Experiences and Dissociation Disorder Using the Dissociative Disorders Interview Schedule (DDIS).

BACKGROUND: It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. OBJECTIVE: To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). METHODS: This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. RESULTS: Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. CONCLUSION: In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.

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.

Espíritos compositores e instrumentistas: a música na umbanda / Espíritus compositores e instrumentistas: la música en la umbanda / Composer and instrumentalist spirits: the music in umbanda

RESUMO A umbanda é uma religião de possessão em que espíritos são venerados, incorporados e desincorporados em meio a música, geralmente composta pelo som do atabaque (instrumento de percussão) e pelo canto. Conhecidas como pontos-cantados, as canções rituais estão presentes no culto e na vida cotidiana dos médiuns, contudo pouco se sabe sobre a compreensão nativa a seu respeito. Mediante um estudo de caso etnográfico, investigou-se a concepção de música umbandista, numa perspectiva etnopsicológica. Os participantes foram dez médiuns e seis espíritos, uma vez que são considerados pelo campo sujeitos interlocutores com personalidade própria. As informações foram coletadas e analisadas com base num procedimento etnopsicanalítico que combina entrevistas semiestruturadas e observação participante com uma escuta atenta aos implícitos e às repetições discursivas e discutidos com base numa revisão da literatura. Encontrou-se que os pontos-cantados ajudam o médium a concentrar-se no mundo simbólico umbandista, podendo ser disparadores de sentimentos, sensações e pensamentos, associados aos espíritos que eles descrevem. Os médiuns percussionistas disseram que tocam sob a influência dos espíritos que os instruem a fazer movimentos corporais organizados. Conclui-se que o sujeito da musicalidade umbandista não é entendido como a pessoa que aparentemente a compõe e a executa. O termo música apenas pode ser usado mediante a subordinação do entendimento nativo do emprego ritual da sonoridade a uma concepção etnomusicológica que a inclui. O sentido geral do uso da música na umbanda é propiciar concentração mental e, portanto, entender seu papel é crucial para o desenvolvimento do conhecimento etnopsicológico a respeito do culto.

RESUMEN La umbanda es una religión de posesión en que los espíritus son venerados, incorporados y desincorporados en medio a la música, generalmente compuesta por sonido del atabal (instrumento de percusión) y por el canto. Conocidas como puntos-cantados, las canciones rituales están presentes en culto y en el cotidiano de los médiums, todavía poco se sabe sobre la comprensión nativa a su respecto. Mediante un estudio de caso etnográfico, se investigó la concepción de música umbandista, en perspectiva etnopsicológica. Los participantes fueran 10 médiums y 6 espíritus, considerados sujetos interlocutores con personalidad propia. Las informaciones fueron recolectadas y analizadas con base en un procedimiento etnopsicoalítico que combina entrevistas semiestructuradas y observación participante con una escucha atenta a los implícitos y las repeticiones discursivas y discutidos sobre la base de una revisión de la literatura. Los datos apuntan que los puntos-cantados ayudan al médium a concentrarse en el mundo simbólico umbandista, pudiendo ser disparadores de sentimientos, sensaciones y pensamientos, asociados a espíritus que ellos describen. Los médiums percusionistas dijeron que tocan bajo la influencia de los espíritus que los instruyen a hacer movimientos corporales organizados. Se concluye que el sujeto de la musicalidad umbandistano es entendido como la persona que aparentemente la compone y la ejecuta. El término música sólo puede ser usado mediante la subordinación del entendimiento nativo del empleo ritual de la sonoridad a una concepción etnomusicológica que la incluye. El sentido general del uso de la música en el umbanda es propiciar concentración mental y por lo tanto entender su papel es crucial para el desarrollo del conocimiento etnopsicológico acerca del culto.

ABSTRACT Umbanda is a religion of possession in which spirits are venerated, embodied and disembodied in the midst of music, usually composed of the sound of atabaque (percussion instrument) and singing. Known as sung points, ritual songs are present in cult and in mediums' daily lives, yet little is known about native understanding of them. Through an ethnographic case study, the umbandist conception of music was investigated in an ethnopsychological perspective. The participants were 10 mediums and 6 spirits, which are considered by the field as interlocutor subjects with their own personality. Information was collected and analyzed based on an ethno-psychoanalytic procedure that combines semi-structured interviews and participant observation with an attentive listening to the implicit ones and the discursive repetitions and discussed based on a review of the literature. The data points that sung points help the medium to focus on the umbandist symbolic world, and can be triggers to feelings, sensations and thoughts associated with the spirits they describe. The percussionist mediums said they play under the influence of the spirits who instruct into making organized body movements. It can be concluded that the subject of umbandist musicality is not understood as the person who apparently composes and executes it. The term music can only be used by subordination of the native understanding of ritual use of sonority to an ethnomusicological conception that includes it. The general sense of the use of music in umbanda is to provide mental concentration and therefore understanding its role is crucial for the development of ethnopsychological knowledge about worship.

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.

Imaging & neuropsychological changes in brain with spiritual practice: A pilot study.

BACKGROUND & OBJECTIVES: Some studies have systematically assessed the effects of spiritual practice (SP) on the brain using combined neuropsychological testing and functional imaging. The objective of the present study was to compare imaging and neuropsychological changes in healthy individuals after SP and those with only physical exercise. METHODS: Healthy adult male volunteers, aged 25-45 yr were randomized into two groups. Group 1 (SP group) underwent the SP and group 2 (controls) did brisk walk for 30 min daily. Detailed neuropsychological evaluation, resting-state functional magnetic resonance imaging (fMRI) and brain 99mTc ethyl cysteinate dimer single-photon emission computed tomography (SPECT) were carried out for both groups before and three months after intervention. RESULTS: Post-intervention, resting state fMRI showed increased connections of left precuneus (in the posterior cingulate cortex area of default mode network) in group 1 and increased left frontal connections in group 2. The neuropsychological tests showed significant improvement in 'Speed of Processing' (Digit Symbol Test) in group 1 and in Focused Attention (Trail Making A) in group 2. The SPECT data in group 1 showed significant improvement in perfusion of the frontal areas, with relatively lesser improvement in parietal areas. Group 2 showed significant improvement in perfusion predominantly in parietal areas, as compared to frontal areas. In addition, significantly improved mood was reported by group 1 and not by group 2. INTERPRETATION & CONCLUSIONS: This pilot study shows important functional imaging and neuropsychological changes in the brain with SP.

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.

Ethical Challenges When Caring for Orthodox Jewish Patients at the End of Life.

Dying is a deeply personal process. The personal values, goals, and experiences of a lifetime come to the forefront during the end of life and may be shaped to some degree by the religious and cultural identity of the patient and family. When patients are part of a faith-based, religious, or cultural minority group, it can be particularly challenging for the clinical care team to gain the understanding and insights needed to reconcile disparities between majority and minority values. This article uses a case study to illustrate and review ethical issues, which frequently occur and can be anticipated in the end-of-life care of patients who identify themselves as Orthodox Jews. Although the specifics are unique to this faith-based minority group, the process of identifying, educating, and developing a means to incorporate faith-based and cultural minority beliefs and values in the provision of care can be applied to other such minority groups that the clinical team may encounter in their work.

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.