Health Dimensions and Spirituality

Afza.Malik GDA

Spirituality and Health Dimensions

Health Dimensions and Spirituality

Dimensions of Human Self,Spirituality as Di mention of Health,Importance of Spirituality,Factor Affecting Growth of Spirituality,Spirituality and Health Care,How to Study Spirituality,Nursing Care and Spirituality.

Dimensions of Human Self

    Spirituality represents the human propensity to reach beyond immediate boundaries of the self to experience a greater reality and meaning. 

    In nursing, spirituality is defined in terms of a variety of human experiences that provide a sense of transcendence or awareness of a connection to something greater than the self without devaluing the self, through intrapersonal, interpersonal, and transpersonal dimensions (Reed, PG, 1992 ).

    The intrapersonal dimension focuses on looking inward to find personal meaning; concepts within this dimension address purpose in life, inner strength, inner peace, courage, and serenity. 

    The interpersonal dimension focuses on relationships with other people and other living systems, as well as with the broader environment and nature; concepts within this dimension include trust, sense of connectedness, forgiveness, interconnectedness, and love. 

    The transpersonal dimension focuses on one's relationship to the unknown or unseen, mystery, God, a higher being or power, and other supernatural entities or expressions of a reality that exist beyond ordinary experiences. 

    Concepts within this dimension include faith, hope, self-transcendence, acceptance, mystical experiences, awareness of a divine presence, experienced grace, specific religious beliefs and practices, and nonreligious, nontheistic, or existential expressions of transcendence.

Spirituality as Di mention of Health

    Despite the often cited description of spirituality as ineffable, a unifying force, the essence of human beings, and other immeasurable terms, spirituality is regarded by nursing theorists and researchers as a multidimensional concept that can be studied through various empirical indicators and research methods , as suggested in Reed's (1992) paradigm for investigating spirituality.

Importance of Spirituality

    Spirituality is considered to be an important area for research and practice in nursing as a human experience or process relevant in everyday life and during health-related events, particularly in times of increased awareness of mortality. 

    Dimensions of spirituality have been addressed by eminent nursing theorists including Florence Nightingale, Martha Rogers, Jean Watson, Betty Neuman, Madeline Leininger, Callista Roy, and Rosemarie Parse, as well as by an increasing number of researchers who are developing middle-range theories. 

    Spirituality is regarded as integral to human wholeness, development, and well-being, and increasingly is considered a fundamental concern of nursing practice.

    The turn of the 21st century evidenced fairly active inquiry into spirituality. However, research on spirituality was not considered a legitimate area of nursing science until the mid-1980s when nurse researchers published the first reports of studies on spirituality. 

    Research activity was accompanied if not preceded by the expansion of clinical knowledge about spirituality. Noted examples are two books that addressed spiritual and religious dimensions of nursing practice: Fish & Shelly's 1978 book, Spiritual Care: The Nurse's Role and subsequent editions, and Verna Carson's 1989 Spiritual Dimensions of Nursing Practice.

Factor Affecting Growth of Spirituality

    Several factors converged to stimulate and nurture the growth of spirituality research in nursing: 

(a) publications in the social sciences that linked spirituality to various indicators of well-being and mental health, as found in sociologist Moberg's research on religion, therapies based on the transpersonal movement in psychology, and life span developmental theories about the spiritual dimensions of aging.

(b) development of instruments that measure spiritually related concepts such as Ellison's (1983) Spiritual Well-Being (SWB) Scale and Reed's (1987) Spiritual Perspective Scale.

(c) maturity of nursing as a discipline that defined itself a science with theories whose focus extended beyond the biomedical to include the breadth of human health experiences and patients' perspectives.

(d) scientists' increased attention to the voice of the clinicians (eg, Highfield & Cason, 1983), whose patients attested to the positive influences of spirituality in health care.

(e) efforts to establish a more holistic approach to nursing diagnosis and assessment that included the spiritual dimension, as found in Ruth Stoll's 1979 "Guidelines for Spiritual Assessment," published in the widely read American Journal of Nursing. 

    The number of nurses who currently include spiritually related questions and variables in their research has grown considerably since the mid-1980s.

Spirituality and Health Care

    Research findings, as well as a fund of practice knowledge in nursing, support the relevance of spirituality. Spiritually related variables such as hope, courage, and self-transcendence consistently have been found to be significant and at times critical factors in processes of healing and during health related events associated with particular life phases such as pregnancy, childhood, aging, and end of life.

    Dominant areas of research include: terminal illness and dying, chronic illness, cancer, life-threatening and acute illness, mental health in aging, alcoholism and substance abuse, critical losses and life events, and nurses' and other caregivers' health. 

    The majority of spiritually related research efforts have focused on enhancing well-being during terminal illness. Important examples include Beverly Hall's (1998) work with patients who have HIV/AIDS and research on women with breast cancer at diagnosis and end-stage (Coward, 1991, 1998; Mickley, Soeken, & Belcher, 1992). 

    Research findings from these and many other studies overall support the significance of spiritual factors in patient well-being.

    Another area of research is represented in the work of several British nurses (Draper, McSherry, Narayanasamy, Owens, Ross) as well as American nurses (such as Tuck andEmblen), who focused attention on the nurse's spirituality and approaches to spiritual care as important elements in practice. 

    Ethical questions about the congruence between patient and nurse perspectives, and between the nurse's values and actions relative to spirituality, are especially important to study as nurses assume a more active role in spiritual care.

    Researchers predominantly have used quantitative designs that incorporate one or more instruments to measure spirituality and its correlates. One caveat in quantitative study results is that statistically significant correlations between spiritual variables and well-being variables are not infrequently of small to moderate magnitude. 

    This is attributed to small sample size, measurement error, or the influence of other intervening factors that relate to health and well-being, and has not discouraged continued study of spirituality as a relevant human experience. 

    Increasingly, scientists are employing mixed methods and qualitative methods, notably phenomenology and grounded theory, to better understand spirituality as experienced during significant health experiences or life events.

How to Study Spirituality 

    Methods to study spirituality across time and cultures are expanding the terrain of knowledge. Researchers are just beginning to address questions about potential changes in spirituality over the trajectory of illness or across the life span. Their inquiry employs both qualitative and quantitative longitudinal designs that provide insights into spiritual experiences, practices, and strategies over time. 

    Another trend is the increasing number of researchers who are examining spirituality from a cultural perspective (eg, Pincharoen & Congdon, 2003).

    A final method to be recognized is conceptual or philosophical inquiry. The resulting publications of conceptual articles that integrate clinical knowledge, provide ethical analysis, and clarify the complex concept of spirituality have added substantially to the research literature on spirituality. 

    There are several pathways to knowledge about spirituality that nurses are likely to choose in the future. A major direction is the intervention-based study. 

    Several potential nursing interventions or patient strategies regarding spirituality have already been identified in the literature: spiritual autobiography, life review, therapeutic relationship, prayer in all its forms, meditation, spiritual counseling, guided imagery, existential therapy, personal writing and reflection, and engagement in altruistic activities. 

Nursing Care and Spirituality

    Nurse scientists also are likely to study spirituality as related to not only psycho-social indicators of well-being, but to bio behavioral indicators as well, including those derived from the psycho-neuro immunological perspective. 

    In contrast, a less likely direction for future nursing research is the study of a purely neuro-biological basis for spiritual religious beliefs, as is already occurring among some scientists outside of nursing.

    Nurses will continue to publish on the clinical as well as empirical significance of spirituality for patient care, as illustrated, for example, in the extensive writings by Margaret Burkhardt and her colleagues. 

    Understanding the role of spirituality in nursing practice will burgeon as more researchers and clinicians work together to build knowledge about spirituality to generate nursing theory-based strategies that facilitate well-being (eg, Coward, 1998; Relf, 1997).

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