Lyren Chiu

An Integrative Review of the Concept of Spirituality in the Health Sciences

Spirituality is a universal human phenomenon, yet confusion and incomprehension of the concept is ever-present. The purpose of this study was to explore how research on the concept of spirituality has been reported in the health literature in the past decade and develop an ontological and theoretical understanding of spirituality. The examination was based on quantitative and qualitative integrative review approaches, which integrated empirical research on spirituality. The sample included 73 spirituality research articles, which were published in English between January 1990 and September 2000. An electronic data-collection tool was designed for use in this project and formatted using Excel software for transfer of codeddata into the NVivo software for the data analysis. The results identified essential elements of spirituality, current use of operational definitions and instruments, conceptual frameworks used in spirituality research, and cultural aspects of spirituality. Historical comparison among decades and barriers in researching spirituality are discussed.

A Meta-Analysis of the Relationship Between Spirituality and Quality of Life

The relationship between spirituality and various dimensions of health and quality of life has been extensively examined during the past decade. Though several literature reviews have been conducted in an attempt to synthesize research findings pertaining to the relationship between spirituality and health, a meta-analysis of studies examining spirituality in relation to quality of life has not been identified. The present study was designed to: (a) determine whether there is empirical support for a relationship between spirituality and quality of life, (b) provide an estimate of the strength of this relationship, and (c) examine potential moderating variables affecting this relationship. The research design followed accepted methods for quantitative meta-synthesis. Potential moderating effects of several methodological differences and sample characteristics were examined using meta-analytic approaches with multivariate linear regression and analysis of variance. An extensive multidisciplinary literature search resulted in 3,040 published reports that were manually screened according to pre-established selection criteria. Subsequent to the selection process, 62 primary effect sizes from 51 studies were included in the final analysis. A random effects model of the bivariate correlation between spirituality and quality of life resulted in a moderate effect size (r=0.34, 95% CI: 0.28–0.40), thereby providing support for the theoretical framework underlying the study wherein spirituality was depicted as a unique concept that stands in relationship to quality of life. Subsequent regression analyses indicated that differences among operational definitions of spirituality and quality of life were associated with the variability in estimates of the magnitude of the relationship (R 2 =0.27). Other potential moderators, such as age, gender, ethnicity, religious affiliation and sampling method were examined but the findings pertaining to these variables were inconclusive because of limitations associated with the sample of primary studies. The implications of this study are mostly theoretical in nature and raise questions about the commonly assumed multidimensional conceptualization of quality of life. Copyright Springer 2005

Lived Experience of Spirituality in Taiwanese Women with Breast Cancer

This study explored spirituality as a lived experience through in-depth, face-to-face interviews of 15 Taiwanese women with breast cancer. A Phenomenological research method was employed to guide the study. Four main themes and 12 subthemes, conceptualized under a meta-theme of hsin, emerged as characteristic of the current “lifeworlds” of the study participants. Interpretation of the findings revealed that spirituality is a journey and a unidirectional evolving process that the participants experienced at different levels of wholeness and integration. Spirituality in Taiwan not only must be seen as metaphysics but also should be approached in the cultural context of patients. Nurses should attend to each patient as a unique person, focus on “here-and-now” encounters, and help their patients transform and evolve to a higher plane of wholeness and integration. Nurses should, as well, nurture and support their own spirituality to be available healing resources for others.

Spirituality and treatment choices by South and East Asian women with serious mental illness.

The purpose of this qualitative study is to investigate how South and East Asian immigrant women who have diagnoses of serious mental illness make treatment choices in relation to spirituality and to explore how gender, cultural beliefs, and spirituality intersect with the process of choice. The findings reveal that the process of spiritual choice includes three interrelated phases: (1) identifying contributing factors, (2) exploring spiritual resources and strategies, and (3) living with the choices. Variations among health beliefs and health care decisions are explained and services that women see as being helpful are identified.

The status of complementary therapy services in Canadian palliative care settings.

Goal of workLittle is known about complementary therapy services (CTs) available in Canadian palliative care settings.Materials and methodsAn online survey was e-mailed to multiple Canadian palliative care settings to determine the types and frequency of CTs provided and allowed, who are the CT providers, funding of CT services, and barriers to the provision of CTs.Main resultsThe response rate was 54% (74/136). Eleven percent of surveyed palliative care settings provided CTs, and 45% allowed CTs to be brought in or to be used by patients. The three most commonly used CTs were music (57%), massage therapy (57%), and therapeutic touch (48%). Less than 25% of patients received CTs in the settings that provided and/or allowed these therapies. CTs were mostly provided by volunteers, and at most settings, limited or no funding was available. Barriers to the delivery of CTs included lack of funding (67%), insufficient knowledge of CTs by staff (49%), and limited knowledge on how to successfully operate a CT service (44%). For settings that did not provide or allow CTs, 44% felt it was important or very important for their patients to have access to CTs. The most common reasons not to provide or allow CTs were insufficient staff knowledge of CTs (67%) and lack of CT personnel (44%).ConclusionsOverall, these findings were similar to those reported in a US-based hospice survey after which this survey was patterned. Possible reasons for these shared findings and important directions regarding the future of CT service provision in Canadian palliative care setting are discussed.

Commentary by Chiu

The author of this article developed an account of an empowerment process using a grounded theory research study of 12 Chinese cancer patients, emphasizing knowledge translation from a nursing perspective. The author provided readers with an opportunity to expand their horizons culturally, conceptually, and spiritually. Empowerment traditionally has been addressed within the context of a sociopolitical environment, emphasizing aspects of power, action, and control. The findings in this study suggest that the empowerment of cancer patients is more than giving them control or choice, or giving them resources, but is also a process of finding meaning in life, acquiring knowledge, skills, and transformation. The findings reveal a spiritual dimension of self-empowerment in patients. As Frankl (1963, 1969) suggested, meaning is essential for life; through creative actions and receptive attitudes, one can overcome adverse conditions. Frankl (1969) proposed that a person’s spirit is transformed and revealed in the person’s freedom to rise above or to transcend this bodily or psychic condition, choosing the way in which to respond to those conditions imposed on the person by heredity factors or the environment. Empowerment is dynamic in nature, involving others and self-empowerment. Nurses’ personal qualities and skills, as embedded in the nurse-patient relationship, constitute an important source of empowerment for patients. The author suggests that nurses should facilitate patients to find meaning in life, as well as in transforming their thoughts and attitudes. As elements of the empowerment process, this study included conscious awareness, acceptance of reality, transformation of thoughts, active participation, relationship, and enabling. These aspects of empowerment support Watson’s (1988) transpersonal caring. Watson’s vision for nursing is “to help persons gain a higher degree of harmony” through a transpersonal caring relationship (p. 49). She characterized this relationship as one of mutuality, in which the whole nurse engages with the whole client, with each bringing her or his own experience and meaning to an actual caring occasion. Watson (1999) rejects the connotations of power as conveyed with a judgment of other human beings. This requires that the nurse create an opportunity for active participation of the client in the caring process to the extent that the client is willing and able. In this process, in contrast to a consumeristic approach, nurses actively facilitate client’s authentic self-determination, including