Sílvia Caldeira

Clinical Validation of the Nursing Diagnosis Spiritual Distress in Cancer Patients Undergoing Chemotherapy

OBJECTIVE Validate the nursing diagnosis spiritual distress in cancer patients. METHODS Cross-sectional approach using Richard Fehrings Clinical Diagnostic Validity Model. FINDINGS The prevalence of diagnosis was 40.8% in a sample of 170 patients. A total of 16 defining characteristics were validated. Expresses suffering had the highest sensitivity value and lack of meaning in life had the highest specificity value. CONCLUSIONS The diagnosis was validated. Cancer patients in spiritual distress are in a state of suffering related to lack of meaning in life. IMPLICATIONS FOR PRACTICE Sensitive diagnosis tools and language are required for nurses to make accurate judgments in situations of spiritual distress. Validation in different contexts would increase the clinical evidence of this diagnosis.

Spiritual leadership and spiritual care in neonatology

AIM This article aims to explore spiritual care in the neonatal care environment in addition to highlighting the importance of spiritual leadership of a health team in that context. BACKGROUND Neonatal care is an ethically demanding and stressful area of practice. Babies and families require spiritual needs to be recognized in the context of holistic care. Literature around spiritual leadership is explored to nurture workplace spirituality. EVALUATION Analysis of a range of sources provides a theoretical reflection on spiritual leadership and spiritual care in neonatal care settings. KEY ISSUES The literature identifies that the carers should consider carefully on how care given may affect the infant and family. Themes relating to the babys and familys spiritual needs and those of the staff in this area are identified. Spiritual leadership by the manager will provide support to the staff and help spiritual need to be met in this area of practice. CONCLUSION Spiritual needs should be acknowledged within neonatal care whether these are of babies, families or the team itself. IMPLICATIONS FOR NURSING MANAGEMENT Managers have responsibility to ensure that spiritual care is carried out for babies and their families and to care for the team as spiritual leaders.

A esperança da pessoa com cancro - estudo em contexto de quimioterapia

Background: hope is a concept which helps people to deal more effectively with a crisis. The scientific evidence suggests its importance in the...

Between spiritual wellbeing and spiritual distress: possible related factors in elderly patients with cancer

OBJETIVOS: este articulo describe la evaluacion del bienestar espiritual de ancianos con cancer sometidos a quimioterapia y de posibles factores predictivos del diagnostico sufrimiento espiritual. METODO: se trata de un estudio metodologico, de validacion clinica de diagnosticos enfermeros, con entrevista para el relleno de formulario. RESULTADOS: participaron 45 ancianos, catolicos, mayoritariamente del sexo femenino, con cancer de mama, edad promedia de 70,3 anos. La prevalencia de sufrimiento espiritual correspondio al 42%; y 24,4% de los ancianos estaban medicados con antidepresivos. Se observo asociacion significativa entre la presencia de sufrimiento espiritual, medicacion antidepresiva y escolaridad; se verifico aumento (diferencia no significativa) en el inicio del tratamiento. CONCLUSION: estos resultados enfatizan la necesidad de clarificar este diagnostico y la responsabilidad de los enfermeros en la atencion espiritual a los pacientes. Las intervenciones deberan ser adecuadas siempre que identificado un diagnostico enfermero que constituye una respuesta compleja y que no se reduce al tratamiento farmacologico.Copyright

A espiritualidade nos cuidados de enfermagem: revisão da divulgação científica em Portugal

Context: research and publication, in the international scientific scene, about spirituality and health have been growing since the 90s, particularly in nurs...

Comfort, well-being and quality of life: Discussion of the differences and similarities among the concepts

HighlightsThe distinction among the concepts of comfort, well‐being and QoL is often unclear.This ambiguity can lead to redundancies, gaps, and knowledge dispersion.The concepts are not surrogate terms but related concepts sharing common attributes. Aim: To analyze the differences and similarities of the concepts of comfort, well‐being and quality of life (QoL). Methods: Review of concept analysis research on PubMed, Cinahl (full text) and Scielo, using the search terms “Comfort”, “Well‐being”, “Quality of Life” and “Concept Analysis”. Results: Eighteen studies were included. Comfort is a broader holistic concept while well‐being is mainly related to psycho‐spiritual dimensions. QoL reflects the individual perception of satisfaction with life. Conclusions: The concepts are not surrogate terms, but related concepts sharing common attributes. Caution should be taken in further research, particularly as regards the correct use and framing of the concepts.

Nursing Diagnosis of "Spiritual Distress" in Women With Breast Cancer: Prevalence and Major Defining Characteristics.

Background: Spirituality and spiritual needs of cancer patients are frequently mentioned in the nursing literature, but the most significant defining characteristics of spiritual distress in the context of clinical reasoning and nursing diagnosis are rarely explored. Understanding of these is important for effective spiritual intervention. Objective: The aim of this study was to identify the prevalence and the defining characteristics of the nursing diagnosis “spiritual distress,” as classified according to NANDA International, among women with breast cancer. Methods: This was a quantitative and cross-sectional study, comprising the third phase of a larger study investigating the clinical validation of spiritual distress in cancer patients undergoing chemotherapy. Fehring’s clinical diagnostic validation model was used to identify the prevalence and the major defining characteristics of the diagnosis. A convenience sample was used, and data were collected by structured interview. Results: A total of 70 women participated; most were married (62.9%) and had a mean age of 54 years, and 55.7% reported having at least 1 person depending on them. The average length of time since the cancer diagnosis was 30.9 months. Twenty-seven participants were experiencing spiritual distress (38.6%). Eleven defining characteristics were classified as major. Conclusions: The prevalence of spiritual distress and the major defining characteristics give clinical evidence about the nurse’s role in providing spiritual care. The results are useful for the improved use of the NANDA International diagnoses within this domain. Implications for Practice: The findings highlight the importance of assessing the defining characteristics of the diagnosis as an objective strategy to improve clinical reasoning related to spirituality and to facilitate more effective interventions.

A Systematic Literature Review Toward the Characterization of Comfort.

Comfort integrates the taxonomies and the classifications of nursing knowledge. Its meaning is not yet clear, although it is an important construct from which theories are developed. This article aims to analyze comfort in nursing scientific literature. The results highlight a particular interest in comfort at crisis situations such as illness, palliative care, or intensive care. Comforting seems to be a complex intervention. More studies are needed to achieve its operational assimilation and implementation in clinical practice, as well as the evaluation of its efficiency and effectiveness.

Editorial: Time as presence and opportunity: the key to spiritual care in contemporary nursing practice

Spirituality as an emerging area of academic study within health care has experienced rapid development over a 20year period with mounting evidence that spiritual support yields improvements in a variety of physical and psychological health outcomes (Koenig 2012). The scientific development in the field of health sciences and its ethical and moral foundations leave no space for doubt with regard to nurses’ duty to assess patients’ spiritual needs. A holistic provision of care based on a scientific clinical reasoning, which comprises the assessment of spiritual needs, the nursing diagnosis, the planning of effective interventions and the evaluation of positive health outcomes is increasingly expected of nurses (Caldeira et al. 2013). However, at the same time the notion of meaning making is gaining popularity as the central component of spirituality (Caldeira et al. 2013), gaining consensus on definitions of spirituality within the literature from a research perspective has proved challenging (Koenig 2012). Notwithstanding these debates, providing spiritual care in clinical practice attracts less dissension and is more straightforward (Koenig 2012). It is primarily based on practical care and application by directly addressing clients’ individual spiritual needs, by supporting meaning-making, connections and transcendence, alleviating suffering and providing a sense of wellbeing that may help clients deal with adversity (Weathers et al. 2015). Even so, despite a belief among most nurses that providing spiritual care to patients is important and part of their role (McSherry & Jamieson 2011), there are a great deal of barriers in the clinical environment that impede spiritual care delivery. It can be difficult to provide spiritual care due to a lack of training, lack of objectivity of the concept of ‘spiritual care’, uncertainty about the role and lack of time (McSherry & Jamieson 2011). While a lack of education and understanding are clearly practical barriers to enacting spiritual care practices, we find it curious that time presents itself as a barrier to the provision of this essential care. We suggest that re-examining the understandings of time and nurse behaviours within time spaces might legitimately contribute to more meaningful and effective care. Conversely, if time is used as a reason not to provide spiritual care then this is something that will likely be detrimental to both the profession and to the clients in our care. It is true that nursing interventions require time, and time is a critical factor in the management of clinical practice, taking particular relevance when it comes to prioritising tasks. However, what is of concern is that when nurses perceive not having time to provide the care they consider they should, the most frequent nursing care left undone are comfort and support of clients (Ausserhofer et al. 2014). As such, when nurses perceive they lack time they tend to become more concerned with routines and tasks. Curiously, while the amount of time required for the intervention of ‘spiritual support’ by nurses is recommended as 16–30 minutes, according to the Nursing Interventions Classification (NIC), and the intervention ‘facilitating spiritual growth’ takes longer, 31– 45 minutes (Bulechek et al. 2013), simply being in the moment with a client can also facilitate spiritual care delivery (RCN 2011). Spiritual care turns into reality in a space between two verbs or two conditions: do/doing and be/being. Although time is important for the management of care, this is a time counted in units, numerically, rhythmic and quantitatively. It is this clock watching and measuring of time that causes a lack of attention to how time can be used in a more meaningful way. On the one hand, time is a basic resource for quality of care and for the organisation of the nursing teamwork, and on the other hand, there is a challenge towards transforming the clock-time into a substance time or meaningful time. Counting time, chronologically, refers to the order of time, within specific time periods (Stevenson 2015). However, it is of interest to note that unlike English there are two ancient Greek words for time still in use today, Kr onos and Kair os. While Kr onos refers to chronological or sequential time, Kair os refers to time as having a more qualitative and significant element. Kair os ‘is variously described in relation to a temporality and to a way of acting: it is the opportune moment’ (Sloane 2006). It is a ‘propitious moment for decision or action’ an ‘opportunity’ (Stevenson 2015). Thus, it is useful for nurses to consider time as an opportunity where meaningful things can happen, rather than something to be counted. Time use can be made more efficient but also more dignified, by giving more thought and substance to available time. This is the key: caring in a different way. Spiritual care is not about interventions counted in time, but about how meaningful those interventions are for clients. Using time effectively means being able to see more than just look, and being able to listen more than just hear. These attributes require communicational, human and ethical skills without which nursing care is just a checklist of delivered tasks. Indeed in an RCN report on members’ views (n = 4054) on spirituality, 89 9% of respondents confirmed the most fre-

Spiritual Well-Being and Spiritual Distress in Cancer Patients Undergoing Chemotherapy: Utilizing the SWBQ as Component of Holistic Nursing Diagnosis

Abstract Holistic nursing care requires attention to the spiritual dimension. This is particularly important when caring for patients with cancer. This research presents the results of the assessment of spiritual well-being using the Spiritual Well-Being Questionnaire (SWBQ) to validate the nursing diagnosis of spiritual distress. Structured interviews were conducted with 169 patients in one hospital in Portugal. We concluded that the SWBQ is a useful and reliable instrument to assess spiritual distress, which highlights the importance of listening to patients and questioning them about spiritual needs as well as the importance of differential diagnosis aimed at effective interventions.