ROSSINI GAYARES- JOVERO, RN, MN, CA-LT, ATPM, SFRIN

I. Purpose of Doing Research on Spirituality and Health

II. Nursing Theorists that Supported Spirituality and Its
Related Concepts
III. Instruments Used to Measure Spirituality and
Related Concepts in Research
IV. Directions for Future Research
 At the end of the discussion,
students will be able to:
1. Discuss the importance of research
in spirituality and health to the
discipline of nursing.

2. Identify nursing theories that include

the concept of spirituality

3. List instruments that nursing

researchers commonly use to
measure spirituality

4. Identify areas for future nursing

research regarding the relationship
between spirituality and health
 If nurses assume human beings to be biopsychosocial and
spiritual beings, then it follows that nursing research should
be involved in describing the relationship of the spiritual
dimension of human beings to health. Nurses would not
think twice about studying the physical effects of nursing
intervention, the psychological effects of an illness or the
social aspects of a community health education program.
 Because nursing is a science, it is imperative that spiritual
care in nursing practice be based on knowledge from evidence.
 At first glance, it may seem odd to talk about
research and spirituality. One might think it is
impertinent for human beings to think that
they can research spirituality or mix science
with something “sacred’.
1. The purpose of nursing research
to study spirituality and
health is NOT to study God
but to study human beings.
2. Through research, nurses aim to
describe, explain and predict
how beliefs in a higher power,
religious practices, religious
practices, or interactions with
members of faith communities
affect the health of individuals.
3. Nursing research can study
the effects of spirituality on
health or the meanings people
give spirituality during health
or illness.
4. Nursing research about
spirituality is relevant from a
theoretical perspective based
on the fact that many nursing
theorists discussed
spirituality- related concepts
in their theories.
5. Using knowledge about spirituality
generated from nursing research can
positively update nursing practice.
1. Florence Nightingale (1969)-
proposed that nursing was a
process that manifested the
presence of a Creator in the
world.
2. Jean Watson (1999)- viewed the
person as spirit, the soul as
sacred energy, and the body as
an instrument of the soul in her
Transpersonal Theory of
Caring.
3. Dorothea Orem (2001)- when
viewing human beings as
persons, she linked spiritual
experiences with a state of
well- being, the perceived
condition of personal
existence.
4. Betty Neuman (1995)-
suggested that spirituality as a
client variable, moves the
client system toward well-
being through spiritual
energy.
5. Roy and Andrews (1999)
described spirituality
within the self- concept
mode of a person as an
adaptive system.
6. Madeleine Leininger
(1991)- specified religion as
a factor that gives meaning
to a cultural group in her
sunrise model.
7. Malinski and Smith
(1994)- proposed
middle range theories
of spirituality based on
Rogers’ Theory.
8. Coward and Reed
(1996)- proposed
theories on self-
transcendence
9. Rosemarie Parse (1981, 1995)-
from her “Man-living-health”
theory, the Human Becoming
Theory is a combination of
biological, psychological,
sociological, and spiritual
factors, and states that a person
is a unitary being in continuous
interaction with his or her
environment. It is centered
around three themes: meaning,
rhythmicity, and transcendence.
10. Margaret Newman (1994)-
claims that every person in every
situation, regardless of how
disordered and hopeless it may
seem, is part of the universal
process of expanding
consciousness, which is a process
of becoming more of oneself,
finding greater meaning in life,
and of reaching new dimensions
of connectedness with other
people and the world.
• Uses numbers to measure variables with findings that are
usually reported using statistics.
• Various instruments are used to measure spirituality and related
concepts such as transcendence, religious beliefs, religiosity and
religious activities. Other concepts measurable by the spirituality
instrument include: spiritual needs, spiritual well- being,
spiritual coping, religious orientation, hope, meaning and
purpose in life, love and relatedness, forgiveness
 
1. Spiritual Well Being Scale (SWBS)- designed
to measure both horizontal and vertical
dimensions of SWB like the Likert- type scale
using statements describing the sense of
spiritual well- being
2. Spiritual Health Inventory (SHI)- is a 31-item
inventory rated on a 5 point Likert-type scale that has
demonstrated a higher level of validity and
reliability. The purpose of the inventory is to measure
patients' self-reported spirituality in the four aspects
of spiritual health (satisfactorily meeting spiritual
needs for self acceptance; a trusting relationship with
self based on a sense of life meaning and purpose;
having relationships characterized by unconditional
love, trust, and forgiveness with others and a
supreme being; and hope).
3. Spiritual Perspective Scale (SPS)- is a 10-item tool
designed to measure the extent to which individuals
hold certain spiritual beliefs and engage in spiritually
related behaviors. The SPS yields a single score and
does not contain subscales. The items are categorized
according to spiritual behaviors and beliefs.
4. Spiritual Involvement and Belief Scale (SIBS)-
a recently- developed tool designed to be widely
applicable across religious traditions, to assess
actions as well as beliefs, to address key
components not assessed in other available
measures, and to be easily administered and
scored.
5. God Locus of Health Control Scale (GLHCS)-
developed to assess the extent of an individual's belief
that God has ultimate control over one’s health status.
The GLHCS has a six- item response and was designed
as an adjunct to the widely used Multidimensional
Health Locus of Control (MHLC) scales. Responses are
totaled with high scores indicating a strong belief in
God as locus of control.
6. Self Transcendence Scale (STS)- consists of 15 items
relating to the specific behaviors or perspectives
involving the expansion of self-boundaries in various
ways, including Inwardly through introspective
activities, outwardly through involvement with others,
and temporally by living in the present or holding
perspectives of past and future that enhance the
present. Possible scores range from 15 to 60 (or 1.0 to
4.0 if the total score is divided by the total number of
items) where the higher scores indicate greater self-
transcendence. The final score reflects overall level of
self-transcendence and takes into account
intraindividual differences in self-transcendence
experiences. The STS has been translated into various
languages.
 refers to the capacity to expand personal boundaries
and be oriented toward perspectives, activities, and
purposes beyond the self without negating the value
of the self and the present context.
 defined as the expansion of self-boundaries in multi-
dimensional ways: for example: (a) inwardly in
introspective activities; (b) outwardly through
concerns about others' welfare; (c) temporally
whereby the perceptions of one's past and future
enhance the present; and (d) transpersonally
through connections with a higher or greater
dimension.
7. The Spiritual Care Practice (SCP)
Questionnaire- assesses and measures
spiritual care practices of nurses and perceived
barriers to spiritual care.  Part I of the SCP
focuses on the nursing process by measuring
the frequency of the assessment and
intervention. Respondents rate 9 items on a 1- 5
Likert Type Scale. Part II of the SCP assesses
barriers to providing spiritual care, asking
nurses to agree or disagree that the item is a
barrier to providing spiritual care.
 Many nursing studies about spirituality uses
qualitative research methods.
 Because qualitative studies use words, rather than
numbers, data collection is done through:
1) Semistructured interview guides containing open-
ended questions
2) Observation
 Transcripts from recorded interviews are reviewed
to find patterns and report finds as themes or
categories, which researchers use to formulate a
theory about the phenomenon of interest.
 commonly associated with Leininger’s theory
of culture; aims to describe the lifeways and
patterns phenomenon within the context of
culture.
 uses constant comparison to create a
theoretical construct about a process.
 through accounts of the lived experiences of
people, allows the researchers to describe the
essence or meaning of a phenomenon.  
 Much more research could be done to articulate the
influence of spirituality on health and well- being.
 The inclusion of adolescents and children in studies
would contribute significantly to an understanding
of spirituality and health across the lifespan
 Expanding the focus of research to include patients
with chronic illness other than cancer and HIV/
AIDS is indicated.
 Work can continue on refining
measurement of complex concepts
such as spirituality and
transcendence.
 Using nursing theories to guide
studies is imperative for building
nursing knowledge related to
spirituality and health.
 Building on the foundations of
previous studies, continued research
with people of different culture or
faith communities can serve not only
to describe belief patterns, but also
cultivate tolerance in health care
providers overwhelmed by the
population they serve.
 Although it is clear that people use spiritual
practices to promote health or healing from illness,
intervention studies to test the effects of such
practices should be considered as the next step in the
future.
 Interdisciplinary research should also be considered
because the provision of spiritual care involves
collaboration among various disciplines.
 The Code of Ethics for Nurses asserts that nurses have a
duty to respect the uniqueness of each patient. Therefore
nurses are obligated to continue professional growth and
advance the profession through knowledge development,
dissemination and application to practice. It is reasonable
for nurses to explore spirituality and health through
research in an effort to maintain an ethical and holistic
perspective when practicing nursing.
 Conducting future research to increase understanding of
the complexity of spirituality and its relationship with
health and using those findings are important ways to
improve spiritual care nursing.
1. How does your faith and belief in God influence
your health behavior.
2. What nursing research findings could you integrate
when caring for your client next time?
3. Are the barriers to providing spiritual care that
you encounter a symptom of your discomfort with
providing spiritual care? What can you do to
become more comfortable in providing spiritual
care?
4. If you were going to do research, what areas of
spirituality and health would you like to study
learn more about?