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INTRODUCTION
This chapter aims to provide the readers of the research foundation and purpose.
The part includes the research background of the study, statement of the problem, the
scope and limitations of the study, the significance of the study, and the definition of
terms. The theoretical framework and conceptual framework are also presented in this
patients and it is due to various factors. Since this complication leaves undesirable
effects on physical and mental health and also on the patients’ quality of lives, one of
the main nursing cares is using various strategies to reduce the anxiety. Experience of
living with a disease shows spirituality creates purpose and meaning in life for patients.
Spiritual care, as part of nursing care for patients with other diseases or from
diverse populations, has not been widely studied. In addition, nursing education does
not routinely include the teaching of spiritual care. Nurses want to give spiritual care but
their preparation may be lacking; other barriers such as role confusion and increased
workload and lack of time may prevent them from giving spiritual care (Piles, 1990).
Health care researchers have suggested a correlation between better mental and
physical health and a person’s spirituality or religious practices (Koenig, 2002). Indeed,
using spiritual and religious resources gives patients and families strength to cope
during
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a crisis (Kloosterhouse & Ames, 2002). Given that little is known about nurses’
experiences with spiritual care, one wonders how spiritual care is given (Taylor, 2005),
what the experience means to nurses, and how the experience affects nurses and their
future actions like how a positive experience could encourage the nurse and others to
Patient studies confirm that spiritual care can be positive. Hermann (2001) and
Sellers (2001) conducted qualitative studies and found that patients desired the
inclusion of spirituality by nurses. Moreover, although many nurses would agree that
spiritual care is a nursing responsibility, a disparity exists between that belief and the
Early studies indicated that the lack of attention to the spiritual needs of patients
in most health care centers leads to increased anxiety, decreased hope, spiritual
isolation, and finally, an increase in the length of treatment (Kim et al. 2012). Therefore,
professional nursing should pay special attention to this dimension of health, as spiritual
care is the basis of a holistic nursing and is considered as a legal duty which should be
Accordingly, the present study aimed to investigate the impact of spiritual nursing
care in alleviating patient anxiety as perceived by nurses in the Tacloban City Hospital.
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Statement of the Problem
nursing care in alleviating patient anxiety as perceived by nurses in the Tacloban City
Hospital.
1.1. Age
1.2. Gender
To the Nursing Students. The results and findings of the study will serve as
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improving nursing care while integrating the significance of spiritual nursing care on
To the Nurses. Their opinions will be heard as a basis to provide innovative and
To the Future researchers. Result of the study will also serve as springboard to
all young researchers to conduct another studies related to impact of spiritual nursing
This research will be focusing on the impact of spiritual nursing care in alleviating
patients’ anxiety and its effectiveness, advantages and disadvantages. The study will be
The study is all about the impact of spiritual nursing care in alleviating patients’
anxiety and its effectiveness on the side of nurses. The study will be conducted to
determine the factors and opinions of the nurses in Tacloban City Hospital.
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Theoretical Framework
Nursing: Healthcare Ministry Within the Church (2018) that spirituality is useful in
orienting the practice of any nurse carrying out holistic care, which includes attention to
the needs of body, mind, and spirit, Such a theoretical orientation is important especially
for nurses caring for those experiencing long-term chronic illness, life-threatening and
terminal illness., as well as any illness or injury that affects an individual’s personal
The major theme in the theoretical framework of the Parish Nursing: Healthcare
Ministry Within the Church, 2003 is that spiritual care can help the nurses with patient
that has illness whether physical and mental to assess and evaluate its spiritual needs
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Conceptual Framework
Religious Practice
Support of Faith Community
Affirmation in Worship Social Support
Encouragement of Spiritual Companions
Consolation from Prayer Family
Communication with God Through Friends
Religious Practices Caregivers
The impact of these spiritual and religious attitudes and behaviors on one’s
finding spiritual meaning in illness may also be mediated by such potentially intervening
of family, friends, and/or caregivers; and current stressful life events: emotional,
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Definition of Terms
Important terminologies mentioned in this study that can pose confusion and
a. Spiritual Nursing Care. It defines for caring for the human spirit thorough the
development of caring relationships and interconnectedness between the nurse and the
b. Spiritual Nursing Care. It consists of nursing methods or activities that rely on the
beliefs to help them to achieve better physical mental, social and spiritual health,
a. Holistic Care. It means to provide support that looks at the whole person, not just
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b. Holistic Care. It refers to the provision of care to patients that are based on a mutual
CHAPTER 2
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This chapter provides collective related literatures and relevant studies aiming to
Related Literature
implications for an individual’s health and wellbeing. Whilst the provision of spiritual care
and assessment of spiritual needs is a vital part of the nurse’s role, literature suggests
that nurses do not always engage in spiritual care with their patients or assess their
spiritual needs. This review aims to ascertain wider reasons for this inconsistent spiritual
the key domains of: ‘Beliefs and values and attitudes around spiritual care,’ ‘Frequency
level of knowledge around spirituality and spiritual care,’ ‘Ability to respond to spiritual
pain,’ and ‘Multiple Domains: beliefs and attitudes around spirituality and spiritual care,
amount of preparation, training and knowledge, spiritual care practices, perceived ability
that spirituality is useful in orienting the practice of any nurse carrying out holistic care,
which includes attention to the needs of body, mind, and spirit, Such a theoretical
orientation is important especially for nurses caring for those experiencing long-term
chronic illness, life-threatening and terminal illness., as well as any illness or injury that
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According to Mohsen Adib Hajbaghery (2014) Spiritual care has positive effects
on individuals’ stress responses, spiritual well-being (ie, the balance between physical,
psychosocial, and spiritual aspects of self), sense of integrity and excellence, and
dimension of practice. There are many indications that spiritual care is considered to be
Related Studies
et al. (2019), Spiritual care is a unique aspect of nursing care, which cannot be replaced
by psychological, social, or religious care, and responds to basic human questions such
as meaning in life, pain, suffering, and death. The spiritual care facilitates the medical
communication, and the nurses can create the power and spiritual support among the
individuals and improve their interactions with other family members, environment,
nature and superior power by encouraging them to recall the past and emphasizing the
special events (Heidari et al. 2017). Early studies indicated that the lack of attention to
the spiritual needs of patients in most health care centers leads to increased anxiety,
decreased hope, spiritual isolation, and finally, an increase in the length of treatment
(Kim et al. 2012). Therefore, professional nursing should pay special attention to this
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dimension of health, as spiritual care is the basis of a holistic nursing and is considered
The study shows that a significant percentage of the elderlies (68.88%) in the
intervention group reported their perceived stress at a high level before the
implementation of the spiritual care and 60% of the elderlies in the control group
reported that at a high level. As the perceived stress level in both groups did not differ
before the implementation of spiritual care (X2 = 1.13 and P = 0.45). After implementing
the spiritual care, the majority of the elderlies (62.22%) in the intervention group had the
low perceived stress level and the majority of the subjects (64.44%) in control group had
high perceived stress level. Therefore, after performing spiritual care, there was a
significant difference at the perceived stress level of both groups (X2 = 3.22 and P =
0.001) (Table 2). Regarding the mental health level, results demonstrated that the mean
score obtained from the general health questionnaire was 10.95 ± 27.2. Additionally, the
comparison of the mental health in the intervention and control groups before and after
implementing the spiritual care illustrated that before implementing the spiritual care in
the intervention and control groups, 51.11% and 57.77% of the participants were
suspected to have general disorder, respectively. Based on the results, before the
spiritual care implementation, no significant difference was not observed between both
groups in terms of mental health (X2 = 11.23 and P = 0.72). After implementing the
spiritual care, there was a significant difference in mental health level of both groups, as
in the intervention and control groups, 31.11% and 53.33% of the participants were
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Based on the results, the spiritual care has been effective in reducing the
perceived stress and increasing the mental health of the elderlies living in the
programs tailored to the needs of the elderlies and incorporating spiritual care
interventions in the care program in the therapeutic and rehabilitation centers. Thus, all
institutions and organizations with important goals like healthy elderly should pay more
attention to the importance of the role of spiritual health in the care to maintain the
mental health. In the same vein, they can take an important step in achieving their
therapeutic and care objectives by knowing the spiritual needs and encouraging the use
Deal (2010), Using spiritual and religious resources gives patients and families strength
to cope during a crisis, but nurses often do not offer spiritual care (Kloosterhouse &
Ames, 2002). The purpose of this phenomenological study was to explore nurses" lived
method. Five themes were identified: spiritual care is patient-centered, spiritual care is
an important part of nursing, spiritual care can be simple to give, spiritual care is not
expected but is welcomed by patients, and spiritual care is given by diverse caregivers.
Spiritual care is an integral part of nursing and nurses can support patients with spiritual
interventions.
about nurses giving spiritual care (Carroll, 2001; Stranahan, 2001; Taylor, Highfield, &
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Amenta, 1994). According to the participants, spiritual aspects of care should be
journey through spiritual care was documented by Kociszewski (2003). Spiritual care
appears to be beneficial to the patients when a shared belief is noted. The nurse can
support the patient with spiritual interventions such as time spent with them, listening,
and if they request, praying with them. Spiritual care is an integral part of nursing.
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CHAPTER 3
RESEARCH METHODOLOGY
This chapter presents the research design, locale, participants and sampling
considerations and reflexivity statement, and analysis of data. The purpose of this
chapter is to give clear plan map on how will the researchers systematically aim to meet
Research Design
type of research method. The data will be gathered through the use of survey-gathering
The data will include survey questionnaire and other things than can record
As instruments, the researchers will use of the quantitative approach, since the
study is more than just knowing the impact of spiritual nursing care in alleviating patient
anxiety but the effectiveness that takes to their advantages in coping with anxiety using
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Research Locale
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Respondents of the Study
This study will need the active participation of selected Nurses from Tacloban
City Hospital. The participants will be selected according to the following criteria:
3. Willing to participate
Research Instrument
In order to gather more relevant data about the study, the researcher will use
survey questionnaires to gather the data and the respondent’s opinion about the topic.
Under which, the researchers will conduct online survey amidst the COVID-19
pandemic to collect data from the respondents regarding the study. The online sruvery
will be conducted because that will be the only way allowed to gather data through
online in order to prevent the harm of the virus. The online survey will obtain the
necessary data coming from the respondents they will be related and have a valid and
Data Collection
The researchers will choose some of the Nurses from Tacloban City Hospital
that will be considered in the study which is the impact of spiritual nursing care in
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In order to determine the samples for this study, the researcher will choose and
ask permission to the head of Tacloban City Hospital and to the Nurses. The researcher
will also be considering the referrals of other people who are more appropriate to
provide opinions about the study as well as volunteering nurses of Tacloban City
Hospital.
To be able for the researchers to generate a result, statistical tools must be used
to evaluate the gathered data. Conducting a statistical analysis helps the researchers to
conduct a meaningful result which will give to all the gathered data. The researchers
used the statistical tools is the z-test which is used to analyze two different population
´ x−µo
z=
σ /√ n
µo = mean of population
n= no. of observation
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Chapter 4
This chapter presents the results, the analysis and interpretation of data gathered
from the answers to the questionnaires distributed to the field. The said data were
presented in tabular form in accordance with the specific questions posited on the
50-60 3 6% 4
40-49 9 18% 3
30-39 28 56% 1
20-29 10 20% 2
Total 50 100%
Results in the table above shows that 6% of the respondent has the age of 50-60
answered the questionnaire, 18% from the age of 40-49, 56% from the age of 30-39
and 20% from the age of 20-29. Therefore, most of our respondents came from 30-39 of
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Table 2. Gender of the Respondents
Male 8 16% 2
Female 42 84% 1
Total 50 100%
According to the table above, 84% of the respondents were female that
answered the questionnaire while 16% from the Male. Therefore, most of our
Employment
Regular 31 62% 1
Probationary 0 0% 3
Contractual 19 38% 2
Total 50 100%
Results in the table above shows that 62% of the respondent are regular
employee in Tacloban City Hospital while 19% of them are contractual. No one from the
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Table 4. Wards where assigned among the Respondents
assigned
ER 11 22% 2
Total 50 100%
Results in the table above shows that 78% of the respondent are assigned in
medical ward at Tacloban City Hospital while the remaining 22% came from the ER.
Therefore, most of our respondents are from medical ward that answered our
questionnaire.
14%
4 - Frequently
39%
3- Occasionally
47% 2- Rarely
1- Never
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Results above shows the percentage of respondents experienced its efforts to
maintain the religious principles and integrate spiritual nursing care to meet the spiritual
care needs of hospitalized patients as one of the challenges they usually encountered.
47% of the respondents occasionally encounter the said situation while utilizing spiritual
nursing care. 39% of them frequently encountered, and 14% were rarely experienced.
Hence, most of the nurses in Tacloban City Hospital are occasionally having a
hard time to maintain the religious principles and integrate spiritual nursing care to meet
the spiritual care needs of hospitalized patients due to the possible factors such as
nurses' lack of time to provide and to promote the spiritual care as regards to patients’
duty.
14% 20%
4 - Frequently
3- Occasionally
2- Rarely
67% 1- Never
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Results above shows the percentage of respondents believed that spiritual
nursing care is apart from nursing duty as one of the challenges they usually
encountered. 67% of the respondents occasionally encounter the said situation while
utilizing spiritual nursing care. 19% of them frequently encountered, and 14% were
rarely experienced. No one from the respondents had never experienced the problem.
Hence, most of the nurses in Tacloban City Hospital are occasionally believed
that spiritual nursing care is apart from nursing duty as one of the challenges they
usually encountered due to the possible factor such as the lack of clear guidelines for
the nurse's role in providing spiritual care; a lack of training and education on spirituality
for pre- and post-registration nurses and the lack of role clarity.
needs.
22% 4 - Frequently
3- Occasionally
2- Rarely
78% 1- Never
Results above shows the percentage of respondents that answered the lack of
awareness about the patient’s religion or spiritual care needs as one of the challenges
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they usually encountered. 47% of the respondents occasionally encounter the said
situation while utilizing spiritual nursing care. 14% of them frequently encountered, and
14% were rarely. No one from the respondents had never experienced the problem.
Hence, most of the nurses in Tacloban City Hospital stated that lack of
awareness about the patient’s religion or spiritual care needs as one of the challenges
they usually encountered due to the possible factor the lack of clear guidelines for the
nurse's role in providing spiritual care; a lack of training and education on spirituality for
pre- and post-registration nurses, and the lack of time to inquire the patients’ belief.
24% 4 - Frequently
28%
3- Occasionally
2- Rarely
1- Never
48%
Results above shows the percentage of respondents that answered the spiritual
care is perceived not vital on alleviating patient’s anxiety as one of the challenges they
usually encountered. 48% of the respondents occasionally encounter the said situation
while utilizing spiritual nursing care. 28% of them rarely encountered, and 24% of them
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were frequent experienced. No one from the respondents had never experienced the
problem.
Hence, most of the nurses in Tacloban City Hospital stated that spiritual care is
perceived not vital on alleviating patient’s anxiety as one of the challenges they usually
encountered due to the possible factor the difficulty in defining spirituality; the lack of
clear guidelines for the nurse's role in providing spiritual care; nurses' lack of time to
provide spiritual care; and a lack of training and education on spirituality for pre- and
post-registration nurses.
Figure 5. Belief that spirituality is personal and not included in dealing with
patients.
22% 4 - Frequently
3- Occasionally
2- Rarely
78% 1- Never
personal and not included in dealing with patients as one of the challenges they usually
encountered. 47% of the respondents occasionally encounter the said situation while
utilizing spiritual nursing care. 14% of them frequently encountered, and 14% were
rarely. No one from the respondents had never experienced the problem.
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Hence, most of the nurses in Tacloban City Hospital stated that spiritual care is
perceived not vital on alleviating patient’s anxiety as one of the challenges they usually
encountered due to the possible factor the difficulty in defining spirituality; the lack of
clear guidelines for the nurse's role in providing spiritual care; nurses' lack of time to
provide spiritual care; and a lack of training and education on spirituality for pre- and
post-registration nurses.
22% 4- Always
3- Often
2- Sometimes
78% 1- Never
Results above shows that 78% of the respondents always utilized this strategy to
cope up with the challenges they encountered while utilizing spiritual nursing care.
Meanwhile, 22% of them often used this strategy and no one from the respondents
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Hence, most of the nurses in Tacloban City Hospital always communicate with
their patient while considering and respecting their personal spiritual beliefs. It provides
14% 4- Always
3- Often
22%
64% 2- Sometimes
1- Never
Results above shows that 64% of the respondents always utilized this strategy to
cope up with the challenges they encountered while utilizing spiritual nursing care. 22%
of them often used this strategy while 14% of them sometimes used. No one from the
Hence, most of the nurses in Tacloban City Hospital always maintain a holistic
attentive to all suffering of their patients. Addressing the holistic needs of the patient
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Figure 8. I recognized that spiritual nursing care is important and helpful in
14% 4- Always
3- Often
2- Sometimes
86% 1- Never
Results above shows that 86% of the respondents always utilized this strategy to
cope up with the challenges they encountered while utilizing spiritual nursing care. 14%
of them often used this strategy and no one from the respondents answered sometimes
Hence, most of the nurses in Tacloban City Hospital always recognized that
spiritual nursing care is important and helpful in alleviating patient’s anxiety and in
dealing with them. Meeting the spiritual care needs of the patient can lead to physical
healing, reduction of pain, and personal growth. Nurses providing spiritual care
Figure 9. I recognized that spiritual belief is part of the patient and contributes to
10% 4- Always
3- Often
2- Sometimes
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90% 1- Never
Results above shows that 90% of the respondents always utilized this strategy to
cope up with the challenges they encountered while utilizing spiritual nursing care. 10%
of them often used this strategy and no one from the respondents had sometimes and
Hence, most of the nurses in Tacloban City Hospital always recognized that
spiritual belief is part of the patient and contributes to the patient’s healing, recovery,
all suffering of their patients and meeting the spiritual care needs of the patient can lead
Figure 10. I know that religious care is part of nursing duty and not apart on
14% 4- Always
3- Often
22%
64% 2- Sometimes
1- Never
Results above shows that 64% of the respondents always utilized this strategy to
cope up with the challenges they encountered while utilizing spiritual nursing care. 22%
28
of them often used this strategy while 14% of them sometimes used. No one from the
Hence, most of the nurses in Tacloban City Hospital always know that religious
care is part of nursing duty and not apart on rendering care to patients. They knew that
spirituality helps patients cope with stress, make crucial medical decisions, and
Chapter 5
This chapter presents the summary, the interpretations and conclusions based
on the results of the survey, and the researchers’ recommendations to help improve
future research surveys on the impact of spiritual nursing care in alleviating patient
anxiety.
Summary
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The study aimed to provide an in-depth understanding of the impact of spiritual
nursing care in alleviating patient anxiety as perceived by nurses in the Tacloban City
1.1. Age
1.2. Gender
spiritual nursing care in alleviating patient anxiety.e. Strategies utilized to cope with the
challenges encountered while using spiritual nursing care in alleviating patient anxiety.
patient anxiety as perceived by nurses in the Tacloban City Hospital. The researcher
identifies the challenges and strategies by the 50 respondents in terms of using spiritual
The research instrument used in the study was the survey questionnaires to
gather the data and the respondent’s opinion about the topic. Under which, the
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researchers conducted an online survey amidst the COVID-19 pandemic. The online
survey was able to obtain the necessary data coming from the respondents which is
related and have a valid and relevant data align with the topic.
classifying the data. This instrument helped the researchers to describe and interpret
the problem and analyzing relationship of variables, testing hypothesis and the
development of generalization. The errors were analyzed and tallied with the use of
The findings of the study in the online survey revealed that the most frequent
problem of the nurses of Tacloban City Hospital encountered are lack of awareness
about the patient’s religion or spiritual care needs and the belief that spirituality is
personal and not included in dealing with patients. Some problems they occasionally
encountered were maintaining the religious principles and integrate spiritual nursing
care to meet the spiritual care needs of hospitalized patients, the belief that spiritual
nursing care is apart from nursing duty, and the spiritual care is perceived not vital on
On the other hand, the strategy they always used to cope up with these problems
is to talk to or communicate with the patient while considering and respecting their
Conclusion
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After the statistical treatment and analysis of the collected data, the following
1.1 The most number of respondents are 30-39 years old with a frequency
of 28 (or 56%). Four (4), or 8%, of the respondents are the youngest at 16
years old.
1.2 The majority of the respondents are female with a frequency of 42 (or
Hospital while 19% of them are contractual. No one from the respondent is under
probationary.
frequency of 39 (or 78%). The remaining 11 respondents (or 22%) came from the
ER.
2. The respondents stated that the most frequent problem they encountered are
the lack of awareness about the patient’s religion or spiritual care needs and the belief
that spirituality is personal and not included in dealing with patients. Some of it are only
spiritual nursing care to meet the spiritual care needs of hospitalized patients, the belief
that spiritual nursing care is apart from nursing duty, and the spiritual care is perceived
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3. The respondents stated that the strategy they always used to cope up with
these problems is to talk to or communicate with the patient while considering and
Based on the result of this study, it can be concluded that there was a
nursing care.
Recommendations
In the light of the findings of the study, the following recommendations are
proposed:
1. This research study suggests that awareness regarding the patient’s religion or
principles and for the integration of spiritual approach in nursing practice in order
belief that spirituality is personal and not included in dealing with patients.
Therefore, this research study suggests that a part of dealing with the patient
holistically, is knowing and learning that spiritual beliefs of the patient is personal
yet, part of the patient in which may affect the patient’s perception of health or
illness.
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3. This research study also suggests that integration of Spiritual Nursing Care in
the field of nursing practice is necessary in alleviating patient’s anxiety and must
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