Richard Sawatzky

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

Attributes of Spiritual Care in Nursing Practice

Nurses are increasingly being called on to engage in spiritual care with their patients. A diverse body of theoretical and empirical literature addresses spirituality as it relates to nursing practice, yet there is little consensus about what spiritual nursing care entails. The purpose of this article is to conceptualize spiritual care in relation to nursing practice. A brief historical review indicates that our current understandings of spiritual nursing care have been shaped by three eras characterized by particular approaches: the religious approach, the scientific approach, and the existential approach. We draw elements from each of these approaches to propose attributes of spiritual care in the context of nursing practice. We propose that spiritual nursing care is an intuitive, interpersonal, altruistic, and integrative expression that is contingent on the nurse’s awareness of the transcendent dimension of life but that reflects the patient’s reality.

Physical activity as a mediator of the impact of chronic conditions on quality of life in older adults

BackgroundChronic conditions could negatively affect the quality of life of older adults. This may be partially due to a relative lack of physical activity. We examined whether physical activity mediates the relationship between different chronic conditions and several health outcomes that are important to the quality of life of older adults.MethodsThe data were taken from the Canadian Community Health Survey (cycle 1.1), a cross-section survey completed in 2001. Only respondents who were 65 years or older were included in our study (N = 22,432). The Health Utilities Index Mark 3 (HUI3) was used to measure overall quality of life, and to measure selected health outcomes (dexterity, mobility, pain, cognition, and emotional wellbeing) that are considered to be of importance to the quality of life of older adults. Leisure-time physical activity was assessed by determining weekly energy expenditure (Kcal per week) based on the metabolic equivalents of self-reported leisure activities. Linear and logistic regression models were used to determine the mediating effect of leisure-time physical activity while controlling for demographic variables (age and sex), substance use (tobacco use and alcohol consumption), and obesity.ResultsHaving a chronic condition was associated with a relative decrease in health utility scores and a relative increase in mobility limitations, dexterity problems, pain, emotional problems (i.e., decreased happiness), and cognitive limitations. These negative consequences could be partially attributed to a relative lack of physical activity in older adults with a chronic condition (14% mediation for the HUI3 score). The corresponding degree of mediation was 18% for mobility limitations, 5% for pain, and 13% for emotional wellbeing (statistically significant mediation was not observed for the other health attributes). These values varied with respect to the different chronic conditions examined in our study.ConclusionOlder adults with chronic conditions are less likely to engage in leisure-time physical activities of at least 1,000 Kcal per week, and this association partially accounts for some negative consequences of chronic conditions, including mobility limitations, pain, and emotional problems. These findings provide support for health promotion programs that facilitate or encourage increased leisure-time physical activity in older people with chronic conditions.

Conceptualising spirituality and religion for healthcare.

AIMS To discuss some of the challenges of conceptualising spirituality and religion for healthcare practice. BACKGROUND With the growing interest in spirituality in healthcare, has come the inevitable task of trying to conceptualise spirituality, a daunting task given the amorphous nature of spirituality, the changing understandings of spirituality among individuals and the diverse globalised society within which this task is taking place. Spiritualitys relationship to religion is a particularly challenging point of debate. DESIGN Critical review. CONCLUSIONS Three social and historical conditions - located in the context of Western thought - have contributed to current conceptualisations of spirituality and religion: the diminishment of the social authority of religion as a result of the Enlightenment focus on reason, the rise of a postmodern spirituality emphasising spiritual experience and current tensions over the ideological and political roles of religion in society. The trend to minimise the social influence of religion is a particular Western bias that seems to ignore the global megatrend of the resurgence of religion. Current conceptualisations are critiqued on the following grounds: that they tend to be ungrounded from a rich history of theological and philosophical thought, that a particular form of elitist spirituality is emerging and that the individualistic emphasis in recent conceptualisations of spirituality diminishes the potential for societal critique and transformation while opening the door for economic and political self interest. RELEVANCE TO CLINICAL PRACTICE Constructing adequate conceptualisations of spirituality and religion for clinical practice entails grounding them in the wealth of centuries of philosophical and theological thinking, ensuring that they represent the diverse society that nursing serves and anchoring them within a moral view of practice.

Stress and depression in students: the mediating role of stress management self-efficacy.

Background:The prevalence of mental health issues appears to be increasing. Stress that leads to depression may be mediated if people believe that they have the wherewithal to manage it. Objective:The aim of this study was to examine the extent to which the relationship between adverse stress and depression is mediated by university students’ perceived ability to manage their stress. Method:Students were sampled randomly at a Canadian university in 2006 (n = 2,147) and 2008 (n = 2,292). Data about students’ stress (1 item), depression (4 items), stress management self-efficacy (4 items), and their demographics were obtained via the online National College Health Assessment survey and analyzed using confirmatory factor analysis and latent variable mediation modeling. Results:Greater stress management self-efficacy was associated with lower depression scores for students whose stress impeded their academic performance, irrespective oftheir gender and age (total R2depression = 41%). The relationship between stress and depression was mediated partially by stress management self-efficacy (37% to 55% mediation, depending on the severity of stress). Conclusions:Identifying students with limited stress management self-efficacy and providing them with appropriate supportive services may help them to manage stress and prevent depression.

Hospitable hospitals in a diverse society: from chaplains to spiritual care providers.

The chaplain’s role in health care services has changed profoundly within the contexts of managerial and fiscal constraints, and increasingly pluralistic and secularized societies. Drawing from a larger study that examined religious and spiritual plurality in health care, we present findings regarding the contributions of chaplains or spiritual care providers (SCPs) as they are referred to more recently, in Canadian institutional health care contexts. Qualitative analyses of interviews with 14 employed SCPs and 7 volunteers provided insights about legitimizing and crafting the role of SPCs, becoming part of the health care team, and brokering diversity. Implications are discussed in relation to role clarification and policy development for truly hospitable health care.

Particularizing the General: Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda

Proliferation of demands for accountability and health care quality places nurses under constant pressure to ensure professional practice is evidence-based. The corresponding emphasis on knowledge that pertains to general populations challenges nursings traditional focus on the uniqueness of each individual patient. Considering how nurses engage with professional systematic thinking processes, we reflect on ways competing agendas in the evidence-based practice environment compromise the professional vision aspired to by an earlier era of nursing model and framework builders. Exploring the scientific thinking underpinning practice evidence, we contemplate implications for applying general knowledge to particular practice, reconsidering options for conceptualizing nursing praxis.

Conceptual foundations of a palliative approach: a knowledge synthesis

BackgroundMuch of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity.MethodsWe conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach.ResultsThe following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care.ConclusionOur findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.

Guidelines for secondary analysis in search of response shift

ObjectiveResponse shift methods have developed substantially in the past decade, with a notable emphasis on model-based methods for response shift detection that are appropriate for the analysis of existing data sets. These secondary data analyses have yielded useful insights and motivated the continued growth of response shift methods. However, there are also challenges inherent to the successful use of secondary analysis for response shift detection. Based on our experience with a number of secondary analyses, we propose guidelines for the optimal implementation of secondary analysis for detecting response shift.MethodsWe review the definition of response shift and recent advances in response shift theory. We describe current statistical methods that have been developed for or applied to response shift detection. We then discuss lessons learned when using these methods to test specific hypotheses about response shift in existing data and of the features of a data set that could guide early decision-making about undertaking a secondary analysis.ResultsA checklist is provided that includes guidelines for secondary analyses focusing on: (1) selecting an appropriate data set to investigate response shift; (2) prerequisites of data sets and their preparation for analysis; (3) managing missing data; (4) confirming that the data fit the requirements and assumptions of the selected response shift detection technique; (5) model fit evaluation; (6) interpreting results/response shift effect sizes; and (7) comparing findings across methods.ConclusionsThe guidelines-checklist has the potential to stimulate rigorous and replicable research using existing data sets and to assist investigators in assessing the appropriateness and potential of a data set and model-based methods for response shift research.