Insights on spirituality and bereavement: A systematic review of qualitative studies.

AIM: To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies. DESIGN: A systematic review of qualitative studies. DATA SOURCE: A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review. METHODS: A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology. REPORTING METHOD: PRISMA checklist. RESULTS: The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome. CONCLUSION: In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement. IMPLICATIONS: The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement. NO PATIENT OR PUBLIC CONTRIBUTION: This is a systematic review.

"Spiritual distress (00066)" in patients under fertility treatment: Clinical validation study.

PURPOSE: This study aimed to clinically validate the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in people under assisted reproductive technologies, and to determine the sensitivity, specificity, and predictive value of the defining characteristics. METHODS: Cross-sectional study that was conducted between September 2019 and June 2020. Recruitment happened by invitation posted in fertility-related websites. Those who accepted to participate were asked to fill the consent form and the online questionnaire. Statistical analysis was based on Rasch's model. The study was approved by the Ethics Committee. FINDINGS: The sample comprised 104 Portuguese individuals undergoing assisted reproductive techniques. The "Spiritual distress (00066)" was validated and 22 defining characteristics were confirmed as representative. No item showed differential item functioning. "Perceived suffering" was the most sensitive defining characteristic and had the highest negative predictive value. "Insufficient courage" had the highest positive predictive value, and "Anger toward power greater than self" was the most specific. CONCLUSIONS: Results validated the presence of the NANDA-I nursing diagnosis of "Spiritual distress (00066)" in a sample going through assisted reproductive technologies, improving accuracy of this nursing diagnosis in such population. IMPLICATIONS FOR NURSING PRACTICE: This is a crucial step to raise the level of evidence of such nursing diagnosis and to increase the level of evidence on NANDA-I terminology. Furthermore, this study has contributed to raising the quality of nurse's critical judgement and clinical reasoning and allow an early spiritual and a more holistic and personalized patient-centered intervention in the reproductive field.

OBJETIVO: O presente estudo teve como objetivo analisar a validade clínica do diagnóstico de "angústia espiritual (00066)" em pessoas a realizar técnicas de reprodução assistida e determinar a sensibilidade, especificidade e valor preditivo das características definidoras. MÉTODOS: Este é um estudo transversal que decorreu entre Setembro de 2019 e Junho de 2020. O recrutamento ocorreu por meio de convite lançado em sítios afetos ao tema da fertilidade. As pessoas interessadas em participar preencheram um formulário de consentimento informado e um questionário online. A análise estatística primou pelo emprego do modelo Rasch. O estudo foi aprovado pela Comissão de Ética. RESULTADOS: A amostra final incluiu 104 portugueses submetidos a técnicas de reprodução medicamente assistida. O diagnóstico de "angústia espiritual (00066)" foi validado e 22 características definidoras foram confirmadas pelos dados. "Sofrimento percebido" foi a característica definidora mais sensível e com o maior valor negativo preditivo. "Coragem insuficiente" destacou-se no valor positivo preditivo, e "Raiva relativa a Poder Maior do que o próprio" foi a mais específica. CONCLUSÕES: Os resultados obtidos validaram a presença do diagnóstico de "angústia espiritual (00066)" em pessoas a realizar técnicas de reprodução assistida, contribuindo, desta forma para melhorar a acurácia deste diagnóstico de enfermagem nesta população. IMPLICAÇÕES PARA A PRÁTICA: Este é um passo crucial para elevar o nível de evidência deste diagnóstico de enfermagem e aumentar o corpo do conhecimento da terminologia NANDA-I. O seu contributo passa também por elevar a qualidade do julgamento crítico dos enfermeiros e o seu poder de decisão clínica permitindo uma intervenção precoce mais holística, centrada na espiritualidade e no paciente em contexto reprodutivo.

"Impaired Resilience (00210)" in patients under fertility treatment: Clinical validation study.

PURPOSE: The aim of this study was a clinical validation of the NANDA-I nursing diagnosis "Impaired Resilience (00210)" in people under fertility treatment and determination of the sensitivity, specificity, and predictive value of the defining characteristics. METHODS: A cross-sectional study was conducted between September 2019 and June 2020. A total of 104 patients were recruited through fertility-related websites, and they answered an online questionnaire after giving informed consent. The Rasch model was used for statistical analysis. The study was approved by the Ethics Committee. FINDINGS: The "Impaired Resilience (00210)" had a prevalence of 15.4% in the sample, and seven defining characteristics confirmed as representative are "decreased interest in vocational activities," "depression," "impaired health status," "ineffective coping strategies," "low self-esteem," "renewed elevation of distress," and "social isolation." No item showed differential item functioning. "Renewed elevation of distress" and "low self-esteem" were the most sensitive defining characteristics and had the highest negative predictive value. "Shame" was the most specific one. CONCLUSIONS: The nursing diagnosis "Impaired Resilience (00210)" was validated, and results may improve its accuracy in people going through fertility treatment. IMPLICATIONS FOR NURSING PRACTICE: This paper contributes by raising knowledge regarding NANDA-I nursing diagnosis and enhancing the quality of nurses' critical judgment and clinical reasoning. A more effective assessment will allow early recognition of patients struggling with adversity during fertility treatment and enhance a nursing resilience approach in the reproductive field.

OBJETIVO: Este estudo teve como objetivo a validação clínica do diagnóstico de enfermagem "Resiliência comprometida (00210)" em pessoas a realizar tratamento de fertilidade; e determinar a sensibilidade, especificidade e valor preditivo das características definidoras. MÉTODOS: Foi conduzido um estudo transversal entre Setembro de 2019 e Junho de 2020. 104 participantes foram recrutados através de sítios afetos ao tema da fertilidade, respondendo um questionário online após o seu consentimento informado. O modelo Rasch foi empregue na análise estatística. O estudo foi aprovado pela Comissão de Ética. RESULTADOS: A "Resiliência comprometida (00210)" teve uma prevalência de 15.4% na amostra, e 7 características definidoras foram confirmadas: "Interesse diminuído pelas atividades profissionais"; "Depressão"; "Estado de saúde comprometido"; "Estratégias de coping ineficazes"; "Isolamento social". Nenhum item apresentou funcionamento diferencial. O "Aumento renovado da angústia" e a "Baixa autoestima" foram as características mais sensíveis e com valores preditivos negativos mais altos. A "Vergonha" foi a característica mais específica. CONCLUSÕES: O diagnóstico de Enfermagem NANDA-I de "Resiliência comprometida (00210)" foi validado e os resultados possibilitaram melhorar a sua acurácia em pessoas a realizar tratamento de fertilidade. IMPLICAÇÕES PARA A PRÁTICA: Este artigo contribuiu para elevar o corpo do conhecimento da terminologia NANDA-I dos diagnósticos de enfermagem e contribuir para elevar a qualidade do julgamento crítico e poder de decisão clínica dos enfermeiros. Uma intervenção mais eficaz e preventiva permitirá apoiar as pessoas na sua habilidade para lidar com a adversidade durante o tratamento de fertilidade, sendo promotora de uma abordagem de Enfermagem baseada na resiliência em contexto reprodutivo.

The Resilience Scale in Portuguese Adults under Assisted Reproductive Techniques.

Assessing resilience response to an adverse event such as infertility requires measuring the same construct adequately and accurately by nurses. The objective of this study was to explore the validity and reliability of the Portuguese version of the Resilience Scale for adults. A cross-sectional and methodological design was used, and factor analyses were performed. The sample comprised 140 adult Portuguese individuals under fertility treatment recruited from health-related websites. The findings yielded a bad fit of the hypothesized Resilience Scale structure with the observed data. Instead, a 21-item tool with a four-factor structure revealed high internal consistency (0.94). The tool correlated positively and significantly to the Portuguese version of the Spiritual Well-Being Questionnaire and was negatively associated and lacked correlation with the Fertility Adjustment Scale. The 21-item Resilience Scale is a reliable tool suitable to measure resilience in Portuguese adults under assisted reproductive techniques. This tool offers the opportunity of early recognition by health professionals aiming to enhance patients' coping skills effectively and promote positive psychological and mental health outcomes.

Validation of the Portuguese Version of the Fertility Adjustment Scale.

There is an urgent need to provide healthcare professionals and midwives with validated tools as to improve fertility adjustment and promote well-being of couples with infertility. The purpose of this study was to test validity of the Fertility Adjustment Scale among people undergoing assisted reproductive techniques. A cross-sectional and methodological study was conducted, and a total of 104 Portuguese adults undergoing fertility treatment were recruited through fertility-related websites. The Fertility Adjustment Scale was administered along with the Spiritual Well-Being Questionnaire and the Resilience Scale for adults as a measure of concurrent validity. Scores revealed the sample's lack of adjustment to fertility. A significant correlation with measures of resilience provided evidence of convergent validity. There was a significant association of fertility adjustment with time of consultation and the cause of infertility. A Fertility Adjustment Scale with six items is a reliable tool that offers early recognition of patients' difficulties in adaptation to fertility problems during assisted reproductive techniques, which could be beneficial in not only an early recognition of healthcare intervention but of a more individualized approach to such patients.

The therapeutic dimension of research about spirituality: Particularities of cancer, mental health and infertility.

Healthcare is moving from a biomedical paradigm into a holistic paradigm, which includes all dimensions and needs of patients and families. Health conditions may trigger a spiritual journey for believers or non-believers bringing to light the nature of the human being and its vulnerable condition. Healthcare professionals are full participants in this life and health scenario and have an unquestionable duty related to the provision of spiritual care, on the basis of legislation, ethical codes, and on research evidence. Researchers are seizing better and broader knowledge about spirituality in healthcare, and research about this phenomenon is growing internationally. But, spirituality is considered complex, an area of intimacy and deep subjective meaning. These factors may raise some ethical concerns when submitting research projects to the ethics committees. In this paper, the authors share their experience in research about spirituality in the beginning of life issues/infertility and with adults with severe health conditions, and describe participants' perspectives on research engagement.

"Call for the Use of Axial Terms": Toward Completeness of NANDA-I Nursing Diagnoses Labels.

PURPOSE: This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. METHODS: Critical analysis of the ND labels, as categorized in the NANDA-I terminology. FINDINGS: Most of the 244 ND labels are composed of terms from the focus and judgment axes. CONCLUSIONS: The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. IMPLICATIONS FOR NURSING PRACTICE: Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. OBJETIVO: Este artigo explora os títulos dos diagnósticos de enfermagem da NANDA-I. MÉTODOS: Análise crítica dos títulos dos diagnósticos de enfermagem da NANDA-I. RESULTADOS: A maioria dos 244 diagnósticos de enfermagem classificados são compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSÕES: A especificidade das respostas às transições de saúde e vida pode não estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICAÇÕES PARA A PRÁTICA: Melhorias nos diagnósticos da NANDA-I em relação ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acurácia do processo diagnóstico que é necessário à prática clínica. Complementar os títulos dos diagnósticos de enfermagem poderia refletir a acurácia do raciocínio clínico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

The Human Responses and Nursing Diagnoses of Those Living With Infertility: A Qualitative Systematic Review.

OBJECTIVE: To systematically retrieve, critique, and synthesize patients' human responses about living with infertility and identify possible related nursing diagnoses according to NANDA-I. METHODS: Systematic review of qualitative nursing studies. FINDINGS: A total of 39 papers were included, 49 human responses, and 77 potential infertility-related nursing diagnoses were identified across three themes. Main foci matching nursing diagnosis were related to spiritual well-being, spiritual distress, and resilience. CONCLUSIONS: Patients respond to infertility in a variety of ways and this raises the need for a more effective, holistic, and accurate nursing diagnosis. IMPLICATIONS FOR PRACTICE: The accuracy of the nursing diagnosis is critical in raising the quality of the nursing process and in meeting infertile patients' circumstances and care expectations.

Spiritual aspects of living with infertility: A synthesis of qualitative studies.

AIMS AND OBJECTIVES: To identify the spiritual aspects of patients experiencing infertility and seek a deeper and broader meaning of the involuntary childlessness experience. BACKGROUND: Infertility can be the cause for a spiritual crisis among some couples. Those who endure this involuntary childlessness condition frequently experience contradictory feelings and needs. In this context, core aspects of spirituality such as meaning and purpose in life are often questioned. DESIGN: A review and synthesis of qualitative empirical research was undertaken to seek a deeper understanding of the spiritual aspects of patients' experiences of infertility. METHODS: An aggregative synthesis was conducted according to Saini and Shlonsky (Systematic synthesis of qualitative research, 2012, Oxford University Press, Oxford), using thematic analysis. RESULTS: A total of 26 studies included female, male and couples. Settings revealed interviewees in different infertility phases such as diagnosis, assisted reproductive technologies and following fertility treatments. Two main themes emerged: spiritual needs and spirituality as a coping resource for infertility. CONCLUSION: Infertility affects the holistic existence of the couples. This adversity awakens spiritual needs along with unmet needs of parenthood. Coping strategies incorporating spirituality can enhance the ability of couples to overcome childlessness and suffering. RELEVANCE TO CLINICAL PRACTICE: Infertile couples' experiences of infertility may offer an opportunity for spiritual care particularly related to the assessment of spiritual needs and the promotion of spiritual coping strategies. Effective holistic care should support couples in overcoming and finding meaning in this life and health condition.

Estratégias de ensino em enfermagem para colaborar e trabalhar em equipe: revisão integrativa da literatura / Estrategias de enseñanza en enfermería para colaborar y trabajar en equipo: una revisión integrativa de la literatura / Nursing teaching strategies used to promote collaboration and teamwork: an integrative literature review

RESUMO Objetivo Identificar na literatura de Enfermagem, publicada entre 2010-2014, as estratégias de ensino aplicadas pelos docentes na promoção da capacidade de colaboração e de trabalho em equipe no estudante de Enfermagem. Métodos A revisão integrativa da literatura permitiu a seleção dos estudos empíricos publicados em Enfermagem, entre janeiro de 2010 e dezembro de 2014. A pesquisa decorreu em abril de 2015, recorrendo à plataforma EBSCOhost para pesquisa nas bases de dados CINAHL® Plus with Full text, Nursing & Allied Health Collection, Cochrane Collection, MedicLatina e MEDLINE with Full text, Academic Search Complete, Education Research Complete. Resultados Obtiveram-se 18 estudos empíricos. Abordagens acadêmicas baseadas em simulações de alta e baixa fidelidade, "role play", trabalhos de grupo, debates reflexivos e estágios clínicos foram estratégias empregadas. Conclusões Salienta-se a necessidade de instrumentos que possam ser usados na avaliação da competência de colaborar e trabalhar em equipe nos estudantes do primeiro ciclo de Enfermagem.

RESUMEN Objetivo Identificar en la literatura de Enfermería, publicada entre 2010-2014, las estrategias de enseñanza aplicadas por los docentes en la promoción de la capacidad de colaboración y de trabajo en equipo en el estudiante de Enfermería. Métodos La revisión integrativa de la literatura permitió la selección de estudios empíricos publicados en Enfermería entre enero de 2010 y diciembre de 2014. La investigación se llevó a cabo en abril de 2015, con el uso de la plataforma de EBSCOhost para la investigación en las bases de datos CINAHL Plus with Full Text, Nursing & Allied Health Collection, Cochrane Collection, MedicLatina y MEDLINE with Full text, Academic Search Complete, Educational Research Complete. Resultados Se obtuvieron 18 estudios empíricos. Simulaciones de alta y de baja fidelidad, "juego de roles", trabajo en grupo, discusiones reflexivas y prácticas clínicas se emplearon. Conclusiones Se destaca la necesidad de desarrollar herramientas que puedan ser utilizadas para evaluar la competencia de colaborar y trabajar en equipo en los alumnos del primer ciclo de Enfermería.

ABSTRACT Objective To identify in nursing literature published between 2010-2014 the teaching strategies capable of promoting collaboration and teamwork. Methods This integrative literature review allowed the selection of empirical studies in nursing literature published between January 2010 and December 2014. The review was taken in April 2015, using the EBSCOhost platform to search in databases such as CINAHL® Plus with Full Text, Nursing & Allied Health Collection, Cochrane Collection, MedicLatina and MEDLINE with Full Text, Academic Search, and Education Research Complete. Results Findings revealed 18 empirical studies. Academic approaches based on high and low-fidelity simulations, "role play", work group, reflective discussions and clinical stages were the strategies employed. Conclusions The present study emphasizes the need to develop instruments that can be used in the evaluation of the competence to collaborate and work as a team in students in the first years of nursing studies.