The efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health: A systematic review and meta-analysis.

BACKGROUND: Spiritual interventions have proved to alleviate suffering, help the patient to prepare for end of life issues, improve quality of life, and well-being. OBJECTIVE: This study aims to investigate the efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health as compared to control groups not receiving such care. METHODS: This is a systematic review and meta-analysis of clinical trials from SCOPUS, PUBMED, Web of Science and CINAHL databases. The searches were carried out between May and July 2020 without restrictions concerning the date of publication. Peer-reviewed articles published in English, Portuguese or Spanish, focusing on nurses were included. This study followed the PRISMA guidelines. In addition, the CONSORT and The Cochrane Collaborations tool for assessing risk of bias were followed. RESULTS: The search process identified 1308 publications, 18 randomized controlled trials were included for the systematic review and 9 for the meta-analysis. The meta-analyses revealed that spiritual interventions were associated with lower mental health symptoms (SMD = -6.91 [-9.83,-3.98], p < 0.001, I2 = 99 %), greater well-being (SMD = 1.26 [0.58, 1.93], p < 0.001, I2 = 94 %) and higher levels of spirituality (SMD = 0.48 [0.29, 0.67], p < 0.001, I2 = 31 %) as compared to individuals in the control group. CONCLUSIONS: Spiritual interventions seem to be effective to promote health, as seen for mental health, spirituality, well-being and physical outcomes. Nevertheless, more than half of the studies have a high risk of bias in any of the dimensions evaluated and there is an important heterogeneity among interventions and outcomes. This is particularly important to nurses and nurse managers who want to provide a holistic care to their patients.

The Effect of Spiritual Care on Anxiety and Depression Level in Patients Receiving Hemodialysis Treatment: a Randomized Controlled Trial.

The present study was conducted to determine the effect of spiritual care on the anxiety and depression levels of patients receiving hemodialysis treatment. The research was carried out between January and May 2019 in a training and research hospital hemodialysis unit in the Eastern Anatolian Region of Turkey. The research was completed with a total of 71 patients (33 experiments, 38 controls) who received hemodialysis treatment. Regarding in-group comparison, the difference between the mean scores of pre-test and post-test of the patients concerning the anxiety and depression in the experimental group was found to be statistically significant (p ˂ 0.05). It was determined that training for strengthening spirituality was effective in reducing the anxiety and depression levels of patients receiving hemodialysis treatment. It can be suggested that spiritual care should be used as a complementary method in health care practices to increase the effectiveness of the treatment.

Reflection: Spirituality during COVID-19.

In this article, the author describes how spirituality affect the lives of people during COVID-19 pandemic. The author reflects on the meaning of religiosity and spirituality (R/S) from a practical, theological and pastoral point of view. This article presents new insights on the ongoing search for meaning and purpose of life amidst the COVID-19 pandemic.

Connected to the spirit of the frog: An Internet-based survey on Kambô, the secretion of the Amazonian Giant Maki Frog (Phyllomedusa bicolor): Motivations for use, settings and subjective experiences.

BACKGROUND/AIM: Kambô is a name for the secretion of the Giant Maki Frog (Phyllomedusa bicolor), which has been used by indigenous cultures from the Amazonas basin and has recently become popular in alternative healing circles in Western countries, with a certain overlap with psychedelic self-exploration. METHODS: We carried out an online-based survey in English (54.92%) and German investigating motivations for using Kambô, settings in which rituals take place, and subjective experiences during and after the application. RESULTS: Participants (n = 386, mean age: 38.08 years, (standard deviation = 9.95)) were well-educated individuals with an increased lifetime prevalence of the use of ayahuasca (67.88%). A plethora of motivations for using Kambô was reported, including general healing, detoxification and spiritual growth. Acute effects included severe physical reactions and mild psychoactive effects, most surprisingly, the feeling of being connected to the frog's spirit (41.97%), whereas predominantly positive persisting psychological effects were reported. Few participants reported long-lasting physical (2.85%) or mental (1.81%) health problems which they attributed to Kambô. Of the participants, 87.31% reported an increase in personal well-being or life satisfaction, and 64.26% considered Kambô to have been at least of 'very much' spiritual significance for their lives. CONCLUSIONS: The majority of users claimed beneficial effects including more health-orientated behaviors, whereas only very few participants complained about new health problems which they ascribed to Kambô. In retrospect, Kambô was given a high personal and spiritual significance by many participants. Additional research is needed to determine in how far reported effects are modulated by setting and subjective expectations.

Efectos del cuidado espiritual en la ansiedad situacional de pacientes quirúrgicos / Effects of Spiritual Care on Situational Anxiety of Surgical Patients

Introducción: Las personas con tratamiento quirúrgico presentan ansiedad, lo cual impide llegar al periodo operatorio en óptimas condiciones. El cuidado espiritual puede resultar efectivo en momentos como este. Objetivo: Evaluar el efecto del cuidado espiritual en el nivel de ansiedad situacional en pacientes quirúrgicos. Métodos: Investigación cuantitativa, preexperimental con pretest postest, en el Hospital Regional de Ayacucho, Perú, durante marzo a mayo de 2016. Población constituida por 123 pacientes quirúrgicos, entre los que se seleccionaron 30 entre 24 y 57 años, con ansiedad y dispuestos a participar en la investigación. La ansiedad se midió con el Test de Zung, las necesidades espirituales con un cuestionario validado por expertos y pilotaje con alfa de Cronbach > 0,75. Para los ejes temáticos y metodológicos de la intervención (cuidados espirituales) se revisó bibliografía sobre el tema, tuvieron en cuenta las necesidades de cuidados y niveles de ansiedad identificada. Se procesó la información con frecuencias absolutas, porcentajes, media, desviación típica, valor mínimo y máximo. Para contrastar hipótesis se utilizó la Prueba no paramétrica de rangos con signo de Wilcoxon. Para la relación entre necesidad de cuidado espiritual y evolución del nivel de ansiedad se utilizó Chi-cuadrada de Pearson (X2), con probabilidad de error del 5 por ciento. Resultados: El nivel de ansiedad situacional previo a la aplicación del cuidado espiritual fue de marcada a severa en 86,66 por ciento, aplicado el cuidado espiritual estuvo ausente en el 96,66 por ciento. Conclusión: La intervención con cuidados espirituales aplicada resultó efectiva en la disminución del nivel de ansiedad situacional en pacientes quirúrgicos estudiados(AU)

Introduction: People who should undergo surgical treatment present anxiety, which keeps them from reaching the operative period in optimal conditions. Spiritual care can be effective at times like this. Objective: To assess the effect of spiritual care on the level of situational anxiety in surgical patients. Methods: Quantitative pre-experimental research with pre- and post-test carried out in the Regional Hospital of Ayacucho, Peru, during March to May 2016. The population was made up of 123 surgical patients, of which 30 aged 24-57, with anxiety and willing to participate in the study were chosen. Anxiety was measured with the Zung test; spiritual needs, with a questionnaire validated by experts; and piloting, with Cronbach's alpha > 0.75. For the thematic and methodological axes of the intervention (spiritual care), a bibliography on the subject was reviewed, taking into account the care needs and levels of anxiety identified. The information was processed with absolute frequencies, percentages, mean, standard deviation, minimum and maximum values. The Wilcoxon signed rank test was used to test hypotheses. Pearson's chi-square (X2) was used for the relationship between need for spiritual care and evolution of anxiety level, with a probability of error of 5 percent. Results: The level of situational anxiety prior to the application of spiritual care was remarkable to severe in 86.66%; applied spiritual care was absent in 96.66 percent.. Conclusion: The intervention with spiritual care applied was effective in reducing the level of situational anxiety in the surgical patients studied.(AU)

What is the practice of spiritual care? A critical discourse analysis of registered nurses' understanding of spirituality.

Spirituality has been a part of nursing for many centuries and represents an essential value for people, including nurses and patients. Cumulative evidence points to the positive contribution of spiritually on health and wellbeing. However, there is little clarity about what spirituality means. The literature reveals that nurses have ascribed a diversity of interpretations to spirituality. However, no studies have investigated how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Therefore, the aim of this study was to uncover how registered nurses construct their understanding of spirituality using a critical discourse analysis approach. Twenty registered nurses from a non-denominational public hospital and a faith-based private hospital were interviewed about their understanding of spirituality and practice of spiritual care. A critical discourse analysis approach was used in the examination of the interview texts to uncover underlying social and power features. Links were made between the linguistic features the registered nurses used in their interviews and the broader social context of the study. Three discourses emerged from the interview texts. These include constructing spirituality through personal religious beliefs discourse, holistic discourse and empathetic care discourse. The findings of this study have implications for nurse education and policy makers.

Effects of the laying on of hands on anxiety, stress and autonomic response of employees in a hospital: A double-blind randomized controlled trial.

Mental and behavioral disorders result in increased absenteeism and abandonment of work. The objective of this study was to evaluate the anxiety, stress, depression, negative and positive affects, and hematological and autonomic responses of employees in a public hospital exposed to laying on of hands with (LHS) or without Spiritual connection (control-LHW). METHODOLOGY: Eighty-four employees with anxiety/stress were enrolled and randomly allocated into two groups of intervention LHS by Spiritist "passe" and control-LHW by volunteers with healing intent. Anxiety, stress and depression were evaluated by Depression Anxiety and Stress Scale (DASS21). Negative and positive affects by Subjective Well-being Scale (SWS), cardiac autonomic modulation by heart rate variability and cytokines and blood count were assessed by blood sample. RESULTS: Our study showed a significant improvement in the neutrophils (p = 0.041; d = 0.70) and cardiac parasympathetic activity, and reduction in VLF (p < 0.005) in the LHS. There was reduction in erythrocyte parameters and interleukin 10 (p < 0.005) in the control-LHW. In both groups there was a significant reduction in anxiety, stress, depression and negative affects after one session (p < 0.005). CONCLUSION: Laying on of hands with Spiritual connection by Spiritist "passe" appears to be effective in increasing cardiac vagal activity and regulation of immune responses of employees in a public hospital with stress/anxiety.

Loss and Resilience in the Time of COVID-19: Meaning Making, Hope, and Transcendence.

This article addresses the many complex and traumatic losses wrought by the COVID-19 pandemic. In contrast to individually based, symptom-focused grief work, a resilience-oriented, systemic approach with complex losses contextualizes the distress and mobilizes relational resources to support positive adaptation. Applying a family resilience framework to pandemic-related losses, discussion focuses on the importance of shared belief systems in (1) meaning-making processes; (2) a positive, hopeful outlook and active agency; and (3) transcendent values and spiritual moorings for inspiration, transformation, and positive growth. Practice guidelines are offered to facilitate adaptation and resilience.

En este artículo se abordan las numerosas pérdidas complejas y traumáticas ocasionadas por la pandemia de la COVID-19. A diferencia de un trabajo de duelo individual centrado en los síntomas, un método sistémico orientado a la resiliencia con pérdidas complejas contextualiza el distrés y moviliza los recursos relacionales para fomentar la adaptación positiva. Mediante la aplicación de un marco de resiliencia familiar a las pérdidas relacionadas con la pandemia, el debate se centra en la importancia de los sistemas de creencias compartidas en (1) los procesos de creación de significado; (2) una actitud positiva y optimista y una intervención activa; y (3) los valores trascendentes y la estabilidad espiritual para la inspiración, la transformación y el crecimiento positivo. Se ofrecen pautas prácticas para facilitar la adaptación y la resiliencia.

Perceptions and practices of spiritual care among hospice physicians and nurses in a Taiwanese tertiary hospital: a qualitative study.

BACKGROUND: Spiritual care is frequently cited as a key component of hospice care in Taiwanese healthcare and beyond. The aim of this research is to gauge physicians and nurses' self-reported perspectives and clinical practices on the roles of their professions in addressing spiritual care in an inpatient palliative care unit in a tertiary hospital with Buddhist origins. METHODS: We performed semi-structured interviews with physicians and nurses working in hospice care over a year on their self-reported experiences in inpatient spiritual care. We utilized a directed approach to qualitative content analysis to identify themes emerging from interviews. RESULTS: Most participants identified as neither spiritual nor religious. Themes in defining spiritual care, spiritual distress, and spiritual care challenges included understanding patient values and beliefs, fear of the afterlife and repercussions of poor family relationships, difficulties in communication, the patient's medical state, and a perceived lack of preparedness and time to deliver spiritual care. CONCLUSIONS: Our study suggests that Taiwanese physicians and nurses overall find spiritual care difficult to define in practice and base perceptions and practices of spiritual care largely on patient's emotional and physical needs. Spiritual care is also burdened logistically by difficulties in navigating family and cultural dynamics, such as speaking openly about death. More research on spiritual care in Taiwan is needed to define the appropriate training, practice, and associated challenges in provision of spiritual care.

Validity and reliability of the Turkish version of the Nurse Spiritual Care Therapeutics Scale.

OBJECTIVE: This study was conducted to evaluate the validity and reliability of the "Nurse Spiritual Care Therapeutics Scale" in Turkish nurses. METHOD: This study was a psychometric design. A convenience sample of 249 nurses working at the Malatya Training Research Hospital completed a structured questionnaire including demographic characteristics and the Nurse Spiritual Care Therapeutics Scale (NSCTS) between August and October 2018. Principal components analysis, internal consistency reliability, and Cronbach's α were used to measure the psychometric properties of the items of the scale. RESULTS: In the evaluation of construct validity, identified one factor with eigenvalues greater than 1 explained 50.83% of the total variance. The Cronbach's α value of the scale is 0.86. SIGNIFICANCE OF RESULTS: The present study provides evidence of NSCTS's validity, reliability, and acceptability. The scale can be used by Turkish nurses. This scale should be further evaluated with a larger sample in different regions in Turkey and various populations. The scale has potential applications for use both in research and as a screening tool in clinical settings.

Spirituality in cancer patients on phase 1 clinical trials.

OBJECTIVES: Patients with cancer who are at a transition to Phase I investigational treatments have been identified as an underserved population with regard to palliative care. This disease transition is often accompanied by spiritual and existential concerns. The study objective was to conduct a secondary analysis of data from a larger study testing a palliative care intervention. This paper reports the findings of this secondary focus on the spiritual needs of this population. METHODS: Patients (n = 479) were accrued to this study prior to initiating a Phase I clinical trial with data collected at baseline, and 4, 12, and 24 week follow-up. RESULTS: Qualitative data revealed that the transition to Phase 1 trial participation is a time of balancing hope for extended life with the reality of advancing disease. Quantitative results demonstrated increased spirituality over time in both religious- and non-religious-affiliated patients. CONCLUSIONS: Patients entering Phase I trials have important spiritual needs as they face treatment decisions, advancing disease, and often mortality. Spiritual care should be provided to seriously ill patients as a component of quality care.

The assessment of spiritual well-being in cancer patients with advanced disease: which are its meaningful dimensions?

BACKGROUND: Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review. METHODS: A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach's α was used to assess the reliability of the scale. RESULTS: This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith. CONCLUSIONS: The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.

A Spiritual Well-Being Model for the Healing Arts.

This article presents a theoretical model based on a synthesis of psychological (the word psyche means soul) theories regarding components of the human spirit, human spirituality, and the development of spiritual well-being, with a focus on the relationship between stress and human spirituality. These components include an insightful relationship with both oneself and others, a strong personal value system, and a meaningful purpose in one's life. Additional aspects include a model for spiritual growth (seasons of the soul) and various aspects of one's life experience that hinder or promote greater spiritual growth. Based on this model, holistic nurses may integrate these concepts into their world view of holistic healing and include the health of the human spirit as a greater part of the holistic wellness paradigm.

Remembrance and Renewal: Health Care Staff Spiritual Self-Care.

Relationship-based care (RBC), a holistic framework of caring, models partnerships in caring to permeate at levels of patient, provider-self, provider-teams, and community. Remembrance and Renewal (R&R) is a RBC practice addressing spiritual self-care. At a dedicated time and space, R&R is offered monthly, rotating through six different buildings at an academic, medical center. To date, close to 2,000 visits have occurred. Those engaging in the practice express appreciation for the space to grieve and space to renew their spirit. R&R is a RBC practice in alignment with the scope and standards of holistic nursing practice and addresses the Quadruple Aim of improving health care staff's work-life balance.

Testing the Pagan Prescription: Using a Randomized Controlled Trial to Investigate Pagan Spell-Casting as a Form of Noncontact Healing.

Objectives: This research investigates the healing practices of modern Paganism using a randomized controlled trial. Paganism is a burgeoning belief system in the United Kingdom, within which healing is a key aspect. However, Pagan spell-casting practices have received little attention from distance healing researchers. This study aims to address this gap in the literature. Design: This study utilized a randomized, double-blind, delayed intervention design. Settings/Location: Research took place at the University of Northampton. Subjects: Forty-four participants (30 females, 14 males) were recruited using snowball sampling (mean age = 24.30; range = 18-55). Procedure: Participants were randomly allocated to either Group A or B. Participants made written requests to the practitioner about changes they would like to see in their lives and provided a photograph and personal item to be used during the intervention. Participants attended meetings once a week during which they would take part in a guided body scan meditation before completing a quality-of-life measure. Healing practices were conducted for Group A between weeks 1 and 2 and for Group B between weeks 2 and 3. Outcome Measure: Well-being was measured using the 26-item WHOQOL-BREF. Results: Multivariate analysis of variance (MANOVA) showed a significant, positive change in general health from weeks 1 to 4 (F = 4.02, p = 0.025, η2 = 0.149). Separate analysis of variances of the four WHOQOL domains showed significant improvements across the study in the physical and psychologic domains only; there was no significant group difference on any of the outcomes. Conclusion: All participants showed an increase in health and well-being domains directly related to their spell requests. However, there are no group differences to suggest that the spell-casting intervention was responsible.

What Chaplains Wish Nurses Knew: Findings From an Online Survey.

This report presents qualitative data from a larger study that sought to examine chaplain perspectives on collaboration and nurse-provided spiritual care. This cross-sectional, descriptive study used online survey methods to distribute an investigator-designed questionnaire to a convenience sample of members of the Association of Professional Chaplains (N = 298). Findings were generated by written responses to 3 open questions that were thematically analyzed, as well as 1 quantitative item. Over half of these chaplains reported they did experience nurse "gatekeeping" at least occasionally. Themes from qualitative data revealed chaplains perceive nurses: lack understanding about the role and abilities of chaplains, sometimes overstep their role or impede the work of chaplains, and allow personal "baggage" to influence their collaboration with chaplains. Likewise, however, respondents respected nurses and were eager to collaborate. Naming these challenges to nurse-chaplain collaboration allows nurses and chaplains to begin to address them.

Research and Responsibility in Global Health: An Analysis of the Joining Forces Study in Ghana.

We explore conceptions of responsibility and integrity in global health research and practice as it is being carried out in the academic setting. Our specific motivation derives from the recent publication of a study by a clinical research team involving the delivery of mental health care services in a Ghanaian prayer camp. The study was controversial on account of the prayer camp's history of human rights abuses and therefore was met with several high-profile critiques. We offer a more charitable evaluation of the Joining Forces study. Our analysis has three primary goals. First, we respond to criticism suggesting that the Joining Forces research team needed to maintain some form of morally "clean hands" in relation to the human rights abuses at Mount Horeb prayer camp. We argue that, for academic global health practitioners working under severe resource constraints, what is reasonable and responsible to pursue is a complex proposition without a one-size-fits-all ethical answer. Second, we offer an explanation for why the Joining Forces study team designed the project as they did in spite of their obvious vulnerability to ethical concern. We argue that the Joining Forces study was a morally risky, but ethically earnest effort to reach a neglected patient population and promote behavior change in prayer camp staff. Third, we identify an open ethical question born of the researchers' commitment to pragmatism that, to our knowledge, has not been previously addressed in published discussion of the Joining Forces project. Namely, was the incomplete disclosure of information to prayer camp staff defensible? We close with a broader reflection on the notion of moral integrity in the pursuit of the salutary aims of global health.

Promoting Spiritual Healing by Stress Reduction Through Meditation for Employees at a Veterans Hospital: A CDC Framework-Based Program Evaluation.

Background: Employees in the Veterans Affairs (VA) hospital experience psychological stress from caring for vulnerable veteran populations. Evidence suggests that mindfulness meditation decreases stress in health care employees and military personnel. The purpose of this worksite program was to explore the acceptability of a mindfulness meditation program among VA workers. Methods: Chaplain residents developed the "Promoting Spiritual Healing by Stress Reduction Through Meditation" (Spiritual Meditation) program for employees in a VA hospital. To evaluate acceptability, a 13-multiple-choice-item survey with an open-ended question was administered after the intervention. Descriptive statistics and qualitative content analysis were performed. Findings: In 29 participants, 70% to 100% agreed with positive statements for the personal learning experience, program components, teacher quality, time to practice, and place to practice. Two categories emerged from qualitative responses: "positive practical experience of Spiritual Meditation" and "perceived values from Spiritual Meditation." Conclusion/Application to Practice: Occupational health nurses are uniquely positioned to lead and collaborate with chaplains to deliver Spiritual Meditation in their workplace setting.

Spiritually Sensitive Intervention to Mitigate Depressive Symptoms Among Hospitalized Children Affected With Congenital Heart Diseases: Insights for Holistic Pediatric Nursing.

This article reports on an experiment in 28 pediatric hospitals across 14 African and Asian cities. The aim was to examine the effect of a customized spiritually sensitive intervention (SSI) on mitigating depressive symptoms among hospitalized children with congenital heart diseases (CHD). Results showed that post-SSI, 1,139 treatment group children were less depressed vis-à-vis the control group. The SSI was more effective for children from African cities, boys, middle class, Christians and Buddhists, those undergoing medical care for ventricular septal defects, children who stayed in the hospital for 2 to 3 weeks and who regularly self-practiced the lessons after hospital discharge. The SSI could be effectively used for holistic pediatric nursing and health care across contexts with CHD affected children, with some culture-specific variations for greater impact.