Spiritual coping of Maltese patients with first acute myocardial infarction: a longitudinal study

Research provides evidence about the high levels of anxiety and depression in myocardial infarction (MI). This is because patients with MI face both an acute life-threatening illness and the potential for living with a major illness (Roebuck et al. 2001, Thornton 2001, Kim et al. 2000). Consequently, the patients' whole sense of meaning and purpose in life is at stake (Walton 1999, Burnard 1987, Simsen 1985). Research on spiritual coping and spiritual well being (SWB) in MI is still in its infancy. Therefore the aim of the study was to identify possible relationships between spiritual coping strategies (SCS) and anxiety, depression, SWB and personal characteristics of Maltese patients with MI, during hospitalisation and the first three months after discharge.The longitudinal descriptive correlational study recruited a homogenous systematic sample of seventy male (n=46) and female (n=24) patients with first MI, mean age of 61.9 years. The variables under investigation were assessed by the translated versions of the Hospital Anxiety and Depression (HAD) scale (Zigmond and Snaith 1983), JAREL------ SWB scale (Hungelmann et al.1985) and Helpfulness of Spiritual Coping Strategies (HSCS) scale designed for the study. The rationale for the perceived helpfulness of SCS was explored by the semi-structured face to face interview.The theoretical framework which guided the study incorporated the Cognitive Theory of Stress and Coping (Lazarus and Folkman 1984) and the Idea of the Holy (Otto 1950). Analysis of the qualitative data was guided by Burnard (1991) analysis model. Additionally, analysis of the quantitative data utilized both parametric and nonparametric statistical tests in order to identify differences between means of subgroups of the personal characteristics and correlations between SCS and anxiety, depression and SWB across time.The findings revealed a constant decline of anxiety and depression across time which is inconsistent with published research. However, the return of anxiety and depression to normal limits by the third month is congruent with research. In contrast, scores of SWB and SCS increased on discharge and remained stable across time.The qualitative data revealed that SCS, SWB and the Maltese culture, which promotes family support in illness, may have contributed towards the relief of anxiety and depression. The quantitative data exhibited a negative, significant relationship between SCS and anxiety and depression on the sixth week after discharge. Additionally, positive significant relationships were identified between SCS and SWB across time.The findings suggest that SWB may be a precursor to the relief of anxiety and depression. The minimal significant differences in SCS between the subgroups of personal characteristics propose the possible impact of the event of MI on spiritual coping and negative mood states. However these speculations may only be confirmed by further research as recommended in the study. Hopefully, the new knowledge produced by the study will be applied to the clinical practice and nursing education to promote patient care

Spiritual care education of health care professionals

Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE); work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.peer-reviewe

A demanda por competências em cuidado espiritual na educação em enfermagem e obstetrícia : revisão de literatura

Spirituality is embedded in nursing and midwifery practice and within the role of nurses and midwives. As a result, spirituality is an important element in nursing and midwifery education and practice, an area which has largely been ignored, in spite of the constant call of Professional Bodies for spiritual care competence in the provision of holistic care. This review aimed to analyze the existing literature and research to define competency and identify the key issues around the demand for competencies and education in spiritual care in nursing and midwifery. A search for articles in English was carried out using various search engines, using keywords: ‘competence, competency, definition, nursing, midwifery practice’. The findings showed that consensus on the definition of competency is still inconsistent. The majority of literature acknowledges the dimensions of knowledge, skills and attitudes which support the three components in Bloom’s Taxonomy namely, the cognitive, affective and psychomotor domains. Competence in spiritual care is guided by Benner’s theory: From novice to expert. Key issues were identified explaining the demand for competence in spiritual care such as, the complexity of spirituality and spiritual care which requires formal integration of spiritual care within the curricula by incorporating both the ‘taught’ and ‘caught’ perspectives of teaching and learning. Assessment of competence in nursing/midwifery education demands the formulation of generic and specific competencies oriented towards knowledge, skills and attitudes towards spiritual care. Thus, further research is suggested to develop a framework of competencies to be achieved by undergraduate and postgraduate students.peer-reviewe

The religious perspective of suffering in heart attack : from 'mystery' to the 'Mystery'

The perceived suffering of individuals may be different during the acute and chronic phases of a heart attack. Existing research on clients with a heart attack has been mainly conducted across the immediate acute phase and the first three to twelve months of recovery. This research has generated inconsistent findings on clients’ experiences of suffering, which might have been due to methodological factors such as the use of cross-sectional research design, and the sole collection of quantitative data which carries limitations in exploring the subjective variables of the religious and/or spiritual dimensions of suffering in illness. These research gaps were addressed by this longitudinal descriptive exploratory study which has collected in-depth data across the first five years of recovery from the onset of the heart attack. Therefore, in order to identify possible fluctuations across time, and provide in-depth data about the perceived religious perspective of suffering, this longitudinal study aims to explore the religious perspective of the mystery of suffering in clients with a first heart attack, both in the immediate acute phase and across the first five years of recovery.peer-reviewe

Nurses' and midwives' acquisition of competency in spiritual care : a focus on education

Background: The debate that spirituality is ‘caught’ in practice rather than ‘taught’ implies that spiritual awareness comes about through clinical experience and exposure, requiring no formal education and integration within the curricula. This is challenged as it seems that providing students with a ‘taught’ component equips students with tools to identify and strengthen resources in ‘catching’ the concept. Aim: This study forms part of a modified Delphi study, which aims to identify the predictive effect of pre- and post-registration ‘taught’ study units in spiritual care competency of qualified nurses/midwives. Methods: A purposive sample of 111 nurses and 101 midwives were eligible to participate in the study. Quantitative data were collected by the Spiritual Care Competency Scale (SCCS) (Van Leeuwen et al., 2008) [response rate: nurses (89%; n = 99) and midwives (74%; n = 75)]. Results: Overall nurses/midwives who had undertaken the study units on spiritual care scored higher in the competency of spiritual care. Although insignificant, nurses scored higher in the overall competency in spiritual care than the midwives. Conclusion: ‘Taught’ study units on spiritual care at pre- or post-registration nursing/midwifery education may contribute towards the acquisition of competency in spiritual care.peer-reviewe

Spiritual coping of Maltese patients with first acute myocardial infarction: a longitudinal study

Research provides evidence about the high levels of anxiety and depression in myocardial infarction (MI). This is because patients with MI face both an acute life-threatening illness and the potential for living with a major illness (Roebuck et al. 2001, Thornton 2001, Kim et al. 2000). Consequently, the patients' whole sense of meaning and purpose in life is at stake (Walton 1999, Burnard 1987, Simsen 1985). Research on spiritual coping and spiritual well being (SWB) in MI is still in its infancy. Therefore the aim of the study was to identify possible relationships between spiritual coping strategies (SCS) and anxiety, depression, SWB and personal characteristics of Maltese patients with MI, during hospitalisation and the first three months after discharge.The longitudinal descriptive correlational study recruited a homogenous systematic sample of seventy male (n=46) and female (n=24) patients with first MI, mean age of 61.9 years. The variables under investigation were assessed by the translated versions of the Hospital Anxiety and Depression (HAD) scale (Zigmond and Snaith 1983), JAREL------ SWB scale (Hungelmann et al.1985) and Helpfulness of Spiritual Coping Strategies (HSCS) scale designed for the study. The rationale for the perceived helpfulness of SCS was explored by the semi-structured face to face interview.The theoretical framework which guided the study incorporated the Cognitive Theory of Stress and Coping (Lazarus and Folkman 1984) and the Idea of the Holy (Otto 1950). Analysis of the qualitative data was guided by Burnard (1991) analysis model. Additionally, analysis of the quantitative data utilized both parametric and nonparametric statistical tests in order to identify differences between means of subgroups of the personal characteristics and correlations between SCS and anxiety, depression and SWB across time.The findings revealed a constant decline of anxiety and depression across time which is inconsistent with published research. However, the return of anxiety and depression to normal limits by the third month is congruent with research. In contrast, scores of SWB and SCS increased on discharge and remained stable across time.The qualitative data revealed that SCS, SWB and the Maltese culture, which promotes family support in illness, may have contributed towards the relief of anxiety and depression. The quantitative data exhibited a negative, significant relationship between SCS and anxiety and depression on the sixth week after discharge. Additionally, positive significant relationships were identified between SCS and SWB across time.The findings suggest that SWB may be a precursor to the relief of anxiety and depression. The minimal significant differences in SCS between the subgroups of personal characteristics propose the possible impact of the event of MI on spiritual coping and negative mood states. However these speculations may only be confirmed by further research as recommended in the study. Hopefully, the new knowledge produced by the study will be applied to the clinical practice and nursing education to promote patient care

Spirituality in the Healthcare Workplace

Spirituality involves a sense of connectedness, meaning making and transcendence. There is abundant published research that focuses on the importance of spirituality to patients and their families during times of illness and distress. However over the last decade there has also been a growing awareness about the importance of considering the need to address peoples’ spiritual needs in the workplace. Engaging in ones own personal spirituality involves connecting with the inner self, becoming more self aware of ones humanity and limitations. Engaging with ones personal spirituality can also mean that people begin to greater find meaning and purpose in life and at work. This may be demonstrated in the workplace by collegial relationships and teamwork. Those who engage with their own spirituality also engage more easily with others through a connectedness with other staff and by aligning their values with the respective organization if they fit well with ones personal values. Workplace spirituality is oriented towards self-awareness of an inner life which gives meaning, purpose and nourishment to the employees’ dynamic relationships at the workplace and is eventually also nourished by meaningful work. Exercising ones personal spirituality contributes towards generating workplace spirituality. Essentially acting from ones own personal spirituality framework by being in doing can contribute towards a person becoming a healing and therapeutic presence for others, that is nourishing in many workplaces. Personal spirituality in healthcare can be enhanced by: reflection in and on action; role-modeling; taking initiative for active presence in care; committing oneself to the spiritual dimension of care; and, integrating spirituality in health caregivers’ education. As spirituality is recognized as becoming increasingly important for patients in healthcare, increasing educational opportunities are now becoming available for nurses internationally that could support personal and workplace spirituality