By Rebecca Feil 2010

Terms: Spirituality: person’s search for, or expression of, his connection to a greater and meaningful context (Barnum, 2003, pg. 1). Spiritual Care: involves “promoting an individual’s personal integrity, interpersonal relationships, and search for meaning”(Young and Koopsen, 2010, pg. 146). Health Outcome: health as a result from treatment. Inner Strength: Strength within yourself which is defined by your spirituality. This inner strength is called upon in times of need, heartache, desperation and other emotional situations.

 I have chosen this topic because I feel spiritual care is essential in the heath and healing of individuals. Healing takes place not only with use of medications but also inner strength.  I have chosen three areas (acute illness, end of life and healthy adults) to explore the outcomes of use of spirituality.

 Purpose: Explore factors associated with inner strength in women following coronary stent placement.  Study Aim: To explore the strategies utilized by women to develop strengths for health promotion and recover after seeking care for symptoms of MI.

 Participants eligible:  *English speaking adult women who were recovering from a post-coronary stent placement following a confirmed diagnosis of MI.  *Participants were recruited from a major tertiary health care center in the North-E ast region of the United States in response to a flyer.  *Participation in the study was voluntary.  *Exclusion criteria included patients who had cognitive deficits. Results: *The basic psychosocial problem faced by the women was changing patterns of fear. They were faced with fear from the onset of symptoms throughout recovery. Identified were: fear from blaming themselves for the MI, fear of mortality, fear of loss of control and fear of an altered self.  *Resolving the conflict and fostering inner strength occurred in 5 stages:  Stage 1: “uncertainty in seeking help”  Stage 2: Rapid changing  Stage 3: Confronting mortality  Stage 4: Reminiscing the past  Women reflected upon memories of childhood experiences that ignited their inner strength at an early age.  Stage 5: Spiritual solace  Faith and fervent prayer were evident in the women’s experiences and in their personal stories. (Mendes, 2010)

 Conclusion of study 1:  *Spirituality was a pervasive theme throughout the present study.  *The participants in the study were strongly connected by an inner dialogue with the spirit within themselves to move beyond their disease.  *They gathered inner strength by turning toward God, meditation and finding quiet times to pray. (Mendes, 2010)

 Purpose: To determine whether inpatient palliative consultation services improve outcomes of care.  Participants: Veterans had received inpatient or out-patient care from a participating VA in the last month of life. One family member completed each survey. (Mendes,2010)

 Data Collection: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life. The survey was known as the Family Assessment of Treatment at End-of-Life (FATE)  *Patient’s well-being and dignity (4 items)  *Adequacy of communication (5 items)  *Respect for treatment preferences (2 items)  *Emotional and spiritual support (3 items)  *Management of symptoms (4 items)  *Access to the inpatient facility of choice (1 item)  *Care around the time of death (6 items)  *Access to home care services (4 items)  *Access to benefits and services after the patient’s death (3 items) (Casarett, 2008)

 Results:  *524 respondents (N=524)  *Multivariable linear regression model used  *Palliative care patients had higher overall scores  *Palliative care consultation services can improve the quality of end-of-life care.  Conclusion:  *Consultations may not improve all outcomes for all patients  *Earlier consultations were independently associated with better overall scores primarily to improvement in communication and emotional support/spiritual support. (Casarett,2008)

 Purpose: To provide evidence that religiosity and spirituality have a positive impact on the health and well-being of older adults.  Participants:  *425 adults  *Ages years old  *Recruited from 13 states (one third being from outside the southeast United States  *89.6% Caucasian  *67.8% married  *Education range: fourth grade to graduate school  *Denomination indicated (122 Baptist, 154 Protestant, 41 Catholic, 67 as none, 28 as other and 13 as Christian. (Lawler-Row, 2009)

 Procedure:  *Packets were given to students with instructions to request participation by adults 55 years of age and older. Packets returned through the mail directly to the first author.  Measures:  *Religious involvement  *Spiritual well-being  Results:  Women had higher scores on total psychological well-being (p<.01) and on personal relations with others (p<.0001).  Existential well-being seems to have a direct effect on health, separate from its connection to religion, social support, and healthy behaviors.  Those individuals with higher levels of existential well-being have lower physical symptoms and depression and higher psychological and subjective well being, even after the contributions of gender, age, education, healthy behaviors and social support have been accounted for. (Lawler-Row, 2009)

 All studies proved that spirituality played an important role in health outcome.  Spiritual care has an impact on individuals dealing with illness or everyday life situations.  Changing patterns of fear help with recovery.  Inner Strength promotes healing and well- being.

 Spirituality is an important aspect to each person in different ways. Some people will use prayer, meditation, nature or rituals.  Spirituality provides individuals with insight, meaning and healing (Young & Koopsen, 2011, p. 92).  Spirituality can bring an ill person three benefits: hope, strength, and emotional support (Young & Koopsen, 2011, pg. 93).  Spirituality is the human search for eternal wisdom, but to humanize spirituality, we must look not only outside ourselves, but inside our own personhood to both the masculine and feminine parts of our beings (Young & Koopsen, 2011, pg 28).

 It is important for nurses to include spirituality in their practice to facilitate healing and health.  Providing compassionate and understanding and use of holding a hand is sometime the only thing needed by patients.  Listen to your patients to see what their needs are. Encourage them to verbalize what they need.  Use the hospital chaplain or community referral to help with spiritual needs.

 Barnum, B. S. (2003). Spirituality in nursing: From traditional to new age. (2nd Ed). New York, NY: Springer Publishing Company  Mendes, B., Roux, G., & Ridosh, M. (2010). Phenomenon of inner strength in women post-myocardial infarction. Critical Care Nurse Quarterly, 33 (3),  Casarett, D., Pickard, A., Bailey, F., Ritchie, C., Furman, C., Rosenfeld, K., et al. (2008). Do palliative consultations improve patient outcomes?. Journal of the American Geriatrics Society, 56 (4), Retrieved from CINAHL database.  Lawler-Row, K., & Elliott, J. (2009). The role of religious activity and spirituality in the health and well-being of older adults. Journal of Health Psychology, 14 (1), Retrieved from CINAHL database.  Young, C. & Koopsen, C. (2011). Spirituality, health, and healing: An integrative approach. (2nd Ed). Sudbury, MA: Jones and Bartlett Publishers.