Volume 9, Issue 3 (September 2022)
Health Spiritual Med Ethics 2022, 9(3): 113-132 |
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Ghanbari-Afra L, Yadollahi S, Taheri L, Fendereski M. Evaluation of Spiritual Health and Its Related Factors in Iranian Nurses and Nursing Students: A Narrative Review. Health Spiritual Med Ethics 2022; 9 (3) :113-132
URL: http://jhsme.muq.ac.ir/article-1-486-en.html
URL: http://jhsme.muq.ac.ir/article-1-486-en.html
1- rauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran., Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran , ghanbari.afra91@yahoo.com
2- Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran., Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
3- Department of Pediatric Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.
4- Department of Nursing, Forghani Hospital, Qom University of Medical Sciences, Qom, Iran., Qom University of Medical Sciences, Qom, Iran
2- Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran., Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
3- Department of Pediatric Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.
4- Department of Nursing, Forghani Hospital, Qom University of Medical Sciences, Qom, Iran., Qom University of Medical Sciences, Qom, Iran
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Introduction
According to the definition of the World Health Organization (WHO), spiritual health is one of the four dimensions of human health, next to the physical, mental, and social dimensions [1]. Spiritual health comprises dimensions of religious and existential health. Religious health reflects the relationship with God or infinite power, and existential health reflects our relationship with others, the environment, and ourselves, and it can be considered the ability to integrate different aspects of the individual’s existence with different choices [2]. People with good spiritual health have a holistic approach to life and can act with an open and dynamic mind when facing problems [3]. When spiritual health is seriously compromised, a person may suffer from mental disorders, such as feeling lonely, depressed, and losing meaning in life [4].
One of the most challenging work environments is hospitals, where most of the people working in these centers are nurses [5]. Nurses, due to the nature of their profession, including direct and constant contact with patients’ pain and suffering, shortage of personnel, inappropriate working conditions [6], multiple tasks, high volume of work, insufficient support [7], rotation of working shifts and sleep disorders, physical problems, the complexity of nursing services [8, 9], the conflict between work and family life and lifestyle disorder [9], are exposed to physical, psychological and social stressors more than other working people [10]; these factors make their health, especially their spiritual health, vulnerable [4].
Spiritual health can be useful as a source of comfort and hope for nurses who face many stressful factors every day and are responsible for caring for patients [11]. Also, it can have a vital role in adapting to stress, have a positive effect on the mental and physical health of people, and can be considered a common solution to deal with any problem and improves the quality of nursing services [3]. According to Stahl (1989), caregivers’ awareness of spiritual health can create a positive motivation in health caregivers, which ultimately helps them achieve satisfaction in their personal and professional life [12].
Different studies have reported the spiritual health of nurses differently. For example, in the study conducted by Shamsai (2020), the spiritual health of Emergency Department nurses was at an average level [3]. While Mousavi and Nehri (2017) reported the spiritual health of nurses at a high level in the Special Ward [13]. Different studies have reported factors, such as age, gender [14], moral distress [3], professional commitment and nursing care [15], and depression [16] affecting spiritual health. On the other hand, in Jalali’s study (2019), no relationship was reported between clinical competence and spiritual health [17]. In the study conducted by Tavan (2016), no relationship was observed between the age, marriage, and education degree of nurses with spiritual health [18]. Therefore, the question arises, what factors are related to the spiritual health of nurses?
In recent decades, spiritual health has gained weight similar to other dimensions of health (physical, mental and social) [19]. The results of the mentioned studies can have useful information regarding the spiritual health of nurses and nursing students, and its related factors. It also helps design and implement suitable solutions to improve the spiritual health of nurses and nursing students. However, due to the multitude of studies, readers may not be able to reach a consensus. Also, most studies conducted in this field are descriptive. Therefore, conducting a review study can help clarify and integrate the results of the studies [20]. Since no review study has been conducted in this field so far, in this review study, we will focus on the spiritual health of Iranian nurses and nursing students and its related factors to help the researchers, nurses, managers, and other interested people in the field of spiritual health to reach a quick summary of the results of the relevant studies. Maybe, a small step can be taken to improve this problem.
Methods
This research was a systematic review that investigated spiritual health and its related factors among Iranian nurses and nursing students in January 2022. The last search was on February 2, 2022. To identify articles on Iranian nurses and nursing students in Persian and English journals, Web of Science, Science Direct, Scientific Information Database (SID), Magiran, Irandoc, IranMedex, Scopus, Google Scholar, and PubMed databases were searched. To search in Farsi language databases, we used the keywords of “spiritual health”, “spiritual well-being”, “nurse”, and “Iran”, and in English databases, its MeSH equivalents, including “spiritual well-being”, “spirituality”, “nurse”, “related factors”, “Iran”, and “spiritual health” in a combination and using the operators AND and OR without time limit. Search strategy in the English PubMed databases was based on this combination (spiritual health [Title/Abstract]) AND (nurse [Title/Abstract]) and in the Scopus database based on this combination (spiritual health AND nurse*) TITLE-ABS. Two independent researchers searched the phrases in databases.
To determine the compatibility of the articles with the research topic, the title and the abstract of the articles were first examined and after the approval of the article based on the inclusion criteria, the texts of the articles were studied by the researchers. Descriptive articles on Iranian nurses were reviewed. We used the critical appraisal skills programme (CASP) checklist to examine the quality of descriptive articles. This checklist is recommended by Cochrane. The cross-sectional checklist has 12 questions, the case-control 11 questions, and the cohort 12 questions [21]. Scoring was done based on the importance of each part according to the present study. No rating scale has been made specifically for this system. However, using the study of Rico Kano (2020), each evaluated item was given the following qualitative scores: “yes” (1 point), “can’t say” (0.5 points), or “no” (0 points). Accordingly, when we encountered “yes” in two-thirds of the CASP sections, this score was regarded as “High”. “Average” quality was considered when the score of at least half of the questionnaire was “yes”. And finally, if more than two-thirds of the answers were “no”, the article was recorded as “low” quality [22]. In this way, the range of scores in case-control studies is 0-11, and in cross-sectional and cohort studies, 0-22. The higher the score, the higher the quality of the studies based on the CASP scale. Table 1 lists the results of the evaluation of the quality of the articles.
The inclusion criteria for selecting articles included articles published in Persian or English, the subject of the studies conducted in the field of the spiritual health of nurses working in Iranian medical centers and nursing students and the factors affecting it, availability of its publication, the full text in research and academic journals, and the studies obtaining medium and high points after quality evaluation. The exclusion criteria included the low quality of the study, short report, and letter to the editor.
To extract the data, the data extraction form was used, which included sections, such as the authors’ specifications and the year of publication, the purpose of the study, the type of research, the sample size, and the method of collecting information and results. After completing this form, the obtained results from the review of the articles were analyzed, summarized, and reported. At first, 117527 articles related to the spiritual health of nurses and nursing students were found. By removing duplicates, irrelevant cases, articles without full text, qualitative studies, other provider health care, letters to the editor, and short reports, 48 articles were recognized as eligible (Figure 1).
Results
Among the present studies, 7 cases were in the English language, and the rest were in the Farsi language. Forty cases of the studies were published from 2015 to 2022 and the rest were published before 2015. All studies were descriptive. The number of samples varied from 50 to 550 people. A total of 21 cases of nurses were investigated in all clinical wards of the hospitals, 9 cases in special wards, one case in an emergency, and one case in the oncology ward. Students were examined at undergraduate and graduate levels.
Among the studies conducted, 12 studies were sampled by simple random method, 12 by census method, 9 by convenience method, 6 by stratified random method, 2 by cluster method, 1 by an easy method, 1 by the exclusive method, and 1 by the voluntary method. The sampling method was not mentioned for two studies.
The inclusion criteria of nurses included satisfaction and willingness to participate in the study, having a minimum degree in nursing, and work experience in a hospital. The exclusion criteria included unwillingness to cooperate, not signing the consent form to participate in the research, taking psychiatric drugs, unwillingness to cooperate, and delivering incomplete or invalid questionnaires.
The inclusion criteria of nursing students included willingness and consent to participate in the study, studying in the mentioned university, and not suffering from mental disorders based on self-report. The exclusion criteria included unwillingness to participate in the research despite initial consent, incomplete filling of the questionnaire, withdrawing from the university and not returning the questionnaire, and having a stressful event, such as the death of a loved one in the past year, a guest student, or illness.
The tool for gathering information in 39 studies was Paloutzian and Ellison’s spiritual health questionnaire, Amiri’s spiritual health questionnaire [23], spiritual health from the perspective of Islam [18], spiritual health in Iranian society [24], Fisher’s spiritual health [25], Delman and Frey’s spiritual health [26], Oncology spiritual health [27], Golparvar’s spiritual health [13, 28] and the questionnaire of statements of evaluating nurses’ attitude towards spiritual health [1].
In most studies, the spiritual health of nurses (21 cases) and nursing students (14 cases) was at an average level (in the range of 20-120). Spiritual health in the religious dimension was more than the existential dimension.
The spiritual health of nurses had a significant negative relationship with age [1, 27, 29-31], gender [18, 32], work experience [1, 18, 30], marriage, education, type of ward, type of shift and responsibility [33], financial status [27], caring behaviors [2], cooperation, assertiveness, self-control, hope, spiritual intelligence [34], clinical competence, professional ethics, interpersonal relationships [33], psychological capital and spiritual connection [13, 28], religious practices [26], provision of spiritual care [26, 30, 35, 36], attitude to spiritual care [27], religious adherence [37], job satisfaction [4, 14, 31 , 38, 39], job compatibility [25], quality of life [40, 41], vision, attitude and behavior [23], marital satisfaction [32, 37, 42], Islamic lifestyle [38], meaning in life [43], social level, mental state [27], coping methods [39], psychological health [44] significant positive relationship with obstacles related to nurses [29], job stress [45, 46], moral distress [3], coronavirus anxiety, tension and emotional turmoil [23], depression, anxiety [23, 43], and social dysfunction [43] (Table 2).
The spiritual health of nursing students had a significant positive relationship with age [47], marital status, type of university [48, 49], academic year [24], psychological ability [50], moral sensitivity [51], happiness [48], hope [49], internal religious orientation, source of internal control and problem-oriented leaders [52], spiritual intelligence [53], exam anxiety [54], and general health [55]. Also, it had a significant negative relationship with students’ anxiety at the time of entering the internship [56], and external control sources [52] (Table 3).
Discussion
The findings of most studies show that the spiritual health of nurses and nursing students was at an average level. Hsiao (2011) reported the spiritual health of nursing students at an average level which is consistent with the present study [16]. While in Pesut’s study, students had a high level of spiritual health [63]. In Wagner’s study (1998), more than 50% of nurses had high spiritual health [64]. Nursing is inherently a spiritual profession, and nowadays the emphasis on the importance of spirituality and spiritual care in nursing is evident. The average level of spiritual health in this group may be because the nursing education system in Iran has not yet included spiritual care as part of its curriculum [65]. Also, the differences between the studies can be attributed to the place of employment and geographical and cultural differences.
Spiritual health in the religious dimension was more than the existential dimension. But in the study of Hsiao (2011), the dimension of communication with others had a higher score than the religious dimension [16]. The religious dimension shows the relationship with God and the existential dimension shows our relationship with others, the environment, and ourselves. Therefore, more spiritual health in the religious dimension is not far from expected for the Iranian society, which is inclined toward religious and spiritual values.
In this study, spiritual health had a significant positive relationship with age and work experience. In Borna’s (2020) study, age was also related to spiritual health [66]. Hsiao’s study results were contrary to the present study [16]. It seems that with the increase in work experience and received training, the professional and moral ability and therefore the spiritual health of nurses improves.
In this study, nurses’ spiritual health had a significant relationship with job satisfaction. In the study of Bakhtiari (2018), the spirituality of the work environment had a significant positive relationship with life satisfaction [67]. Altaf (2011) also pointed out the positive relationship between spirituality and job satisfaction [68]. It seems that spiritual health leads to the existence of integrity, continuity of work, understanding of the deep values of the work environment, a sense of being together, sociability, and solidarity among employees, and therefore improves their job satisfaction [67].
The findings of the present study showed that spiritual health has a positive relationship with the provision of spiritual care. Nissen (2021) considers the provision of spiritual care as one of the requirements of patient care and the development of a person’s spiritual health. Perhaps it can be said that spiritual care can be an inspiring conceptual framework for developing therapeutic programs and promoting spiritual health because it can help nurses to recognize the unmet spiritual needs of patients [69].
The findings of the present study showed that spiritual health has a positive relationship with professional ethics and interpersonal relationships. In Akrami Fard's study (2018), spirituality had a significant relationship with the moral sensitivity of nursing students. It seems that the strong influence, the growing ability, and the flourishing of the nature of professional ethics in different aspects of a person's existence lead to a relationship with spiritual health [70]. It seems that those nurses who consider themselves obliged to do the work correctly in the hospital and somehow observe ethical and professional considerations have high spirituality.
In this study, spiritual health had a positive relationship with clinical competence. A study that reported consistent results with the present study was not found. Therefore, according to the study of Ebrahimi (2017), it can be argued that a person with spiritual health can have skills used in the professional field or nursing process, including therapeutic relationships between nurses and patients, availability for patients, active listening, and expressing empathy, providing religious facilities for patients with specific religious beliefs, helping patients, etc. [70] and therefore have better clinical competence. On the other hand, it can be argued that spirituality and its aspects positively affect adaptation techniques and are effective in improving the quality of health care and nurses' performance.
In this study, spiritual health had a positive relationship with the general health of nursing students. This study's results are consistent with the study of Bozek (2020) [71] and Padehban's (2020) results [72]. Health has physical, mental, spiritual, and social dimensions. Therefore, a person with better spiritual health is expected to have higher general health. On the other hand, it can be concluded that students with a closer relationship with God, have a positive feeling towards their lives, hope for the future, pay more attention to the great God in solitude, and feel the presence of God in all areas of their lives. They realized that they are always supported by the creator of the universe. They can be useful and efficient people for society and have the necessary ability to fulfill their roles and duties and because of that, these students can pay attention to the necessary measures to deal with pressures and stresses and always try to create a healthy and lively environment.
According to the findings of this study, depression, anxiety, stress, and emotional turmoil weaken spiritual health. Hsiao's study finding is also consistent with the present study [16]. It can be said that a person in the mentioned conditions cannot use spiritual coping strategies and a positive attitude when dealing with stressful events, so spiritual health also decreases.
Regarding the limitations of this study, different questionnaires were used that examined different dimensions.
Conclusion
Based on the findings of this study, the spiritual health of nurses and nursing students was at an average level. An increase in factors such as demographic variables, job, education, job satisfaction, and spiritual care improves the level of spiritual health, and demoting factors, like stress, anxiety, and depression improve the level of the spiritual health of nurses. In addition, most studies conducted in the field of spiritual health and the factors affecting it in nurses and nursing students are descriptive. One of the strengths of this study is to determine the confirming factors for improving spiritual health in clinical departments, and one of its weaknesses is to examine spiritual health in only one culture (Iranian society), eliminate qualitative studies, and use more observational studies and methods of different evaluations. Therefore, the researchers are recommended to pay more attention to qualitative and experimental studies in their research. A specific tool should be designed to determine the spiritual health of nurses. Also, it is suggested that educational committees for the spiritual health of nurses be formed to promote and update this crucial matter in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The principle of protecting information and using the results of all studies was considered.
Funding
The Deputy of Research and Technology of Qom University of Medical Sciences was the financial sponsor of this research.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
According to the definition of the World Health Organization (WHO), spiritual health is one of the four dimensions of human health, next to the physical, mental, and social dimensions [1]. Spiritual health comprises dimensions of religious and existential health. Religious health reflects the relationship with God or infinite power, and existential health reflects our relationship with others, the environment, and ourselves, and it can be considered the ability to integrate different aspects of the individual’s existence with different choices [2]. People with good spiritual health have a holistic approach to life and can act with an open and dynamic mind when facing problems [3]. When spiritual health is seriously compromised, a person may suffer from mental disorders, such as feeling lonely, depressed, and losing meaning in life [4].
One of the most challenging work environments is hospitals, where most of the people working in these centers are nurses [5]. Nurses, due to the nature of their profession, including direct and constant contact with patients’ pain and suffering, shortage of personnel, inappropriate working conditions [6], multiple tasks, high volume of work, insufficient support [7], rotation of working shifts and sleep disorders, physical problems, the complexity of nursing services [8, 9], the conflict between work and family life and lifestyle disorder [9], are exposed to physical, psychological and social stressors more than other working people [10]; these factors make their health, especially their spiritual health, vulnerable [4].
Spiritual health can be useful as a source of comfort and hope for nurses who face many stressful factors every day and are responsible for caring for patients [11]. Also, it can have a vital role in adapting to stress, have a positive effect on the mental and physical health of people, and can be considered a common solution to deal with any problem and improves the quality of nursing services [3]. According to Stahl (1989), caregivers’ awareness of spiritual health can create a positive motivation in health caregivers, which ultimately helps them achieve satisfaction in their personal and professional life [12].
Different studies have reported the spiritual health of nurses differently. For example, in the study conducted by Shamsai (2020), the spiritual health of Emergency Department nurses was at an average level [3]. While Mousavi and Nehri (2017) reported the spiritual health of nurses at a high level in the Special Ward [13]. Different studies have reported factors, such as age, gender [14], moral distress [3], professional commitment and nursing care [15], and depression [16] affecting spiritual health. On the other hand, in Jalali’s study (2019), no relationship was reported between clinical competence and spiritual health [17]. In the study conducted by Tavan (2016), no relationship was observed between the age, marriage, and education degree of nurses with spiritual health [18]. Therefore, the question arises, what factors are related to the spiritual health of nurses?
In recent decades, spiritual health has gained weight similar to other dimensions of health (physical, mental and social) [19]. The results of the mentioned studies can have useful information regarding the spiritual health of nurses and nursing students, and its related factors. It also helps design and implement suitable solutions to improve the spiritual health of nurses and nursing students. However, due to the multitude of studies, readers may not be able to reach a consensus. Also, most studies conducted in this field are descriptive. Therefore, conducting a review study can help clarify and integrate the results of the studies [20]. Since no review study has been conducted in this field so far, in this review study, we will focus on the spiritual health of Iranian nurses and nursing students and its related factors to help the researchers, nurses, managers, and other interested people in the field of spiritual health to reach a quick summary of the results of the relevant studies. Maybe, a small step can be taken to improve this problem.
Methods
This research was a systematic review that investigated spiritual health and its related factors among Iranian nurses and nursing students in January 2022. The last search was on February 2, 2022. To identify articles on Iranian nurses and nursing students in Persian and English journals, Web of Science, Science Direct, Scientific Information Database (SID), Magiran, Irandoc, IranMedex, Scopus, Google Scholar, and PubMed databases were searched. To search in Farsi language databases, we used the keywords of “spiritual health”, “spiritual well-being”, “nurse”, and “Iran”, and in English databases, its MeSH equivalents, including “spiritual well-being”, “spirituality”, “nurse”, “related factors”, “Iran”, and “spiritual health” in a combination and using the operators AND and OR without time limit. Search strategy in the English PubMed databases was based on this combination (spiritual health [Title/Abstract]) AND (nurse [Title/Abstract]) and in the Scopus database based on this combination (spiritual health AND nurse*) TITLE-ABS. Two independent researchers searched the phrases in databases.
To determine the compatibility of the articles with the research topic, the title and the abstract of the articles were first examined and after the approval of the article based on the inclusion criteria, the texts of the articles were studied by the researchers. Descriptive articles on Iranian nurses were reviewed. We used the critical appraisal skills programme (CASP) checklist to examine the quality of descriptive articles. This checklist is recommended by Cochrane. The cross-sectional checklist has 12 questions, the case-control 11 questions, and the cohort 12 questions [21]. Scoring was done based on the importance of each part according to the present study. No rating scale has been made specifically for this system. However, using the study of Rico Kano (2020), each evaluated item was given the following qualitative scores: “yes” (1 point), “can’t say” (0.5 points), or “no” (0 points). Accordingly, when we encountered “yes” in two-thirds of the CASP sections, this score was regarded as “High”. “Average” quality was considered when the score of at least half of the questionnaire was “yes”. And finally, if more than two-thirds of the answers were “no”, the article was recorded as “low” quality [22]. In this way, the range of scores in case-control studies is 0-11, and in cross-sectional and cohort studies, 0-22. The higher the score, the higher the quality of the studies based on the CASP scale. Table 1 lists the results of the evaluation of the quality of the articles.
The inclusion criteria for selecting articles included articles published in Persian or English, the subject of the studies conducted in the field of the spiritual health of nurses working in Iranian medical centers and nursing students and the factors affecting it, availability of its publication, the full text in research and academic journals, and the studies obtaining medium and high points after quality evaluation. The exclusion criteria included the low quality of the study, short report, and letter to the editor.
To extract the data, the data extraction form was used, which included sections, such as the authors’ specifications and the year of publication, the purpose of the study, the type of research, the sample size, and the method of collecting information and results. After completing this form, the obtained results from the review of the articles were analyzed, summarized, and reported. At first, 117527 articles related to the spiritual health of nurses and nursing students were found. By removing duplicates, irrelevant cases, articles without full text, qualitative studies, other provider health care, letters to the editor, and short reports, 48 articles were recognized as eligible (Figure 1).
Results
Among the present studies, 7 cases were in the English language, and the rest were in the Farsi language. Forty cases of the studies were published from 2015 to 2022 and the rest were published before 2015. All studies were descriptive. The number of samples varied from 50 to 550 people. A total of 21 cases of nurses were investigated in all clinical wards of the hospitals, 9 cases in special wards, one case in an emergency, and one case in the oncology ward. Students were examined at undergraduate and graduate levels.
Among the studies conducted, 12 studies were sampled by simple random method, 12 by census method, 9 by convenience method, 6 by stratified random method, 2 by cluster method, 1 by an easy method, 1 by the exclusive method, and 1 by the voluntary method. The sampling method was not mentioned for two studies.
The inclusion criteria of nurses included satisfaction and willingness to participate in the study, having a minimum degree in nursing, and work experience in a hospital. The exclusion criteria included unwillingness to cooperate, not signing the consent form to participate in the research, taking psychiatric drugs, unwillingness to cooperate, and delivering incomplete or invalid questionnaires.
The inclusion criteria of nursing students included willingness and consent to participate in the study, studying in the mentioned university, and not suffering from mental disorders based on self-report. The exclusion criteria included unwillingness to participate in the research despite initial consent, incomplete filling of the questionnaire, withdrawing from the university and not returning the questionnaire, and having a stressful event, such as the death of a loved one in the past year, a guest student, or illness.
The tool for gathering information in 39 studies was Paloutzian and Ellison’s spiritual health questionnaire, Amiri’s spiritual health questionnaire [23], spiritual health from the perspective of Islam [18], spiritual health in Iranian society [24], Fisher’s spiritual health [25], Delman and Frey’s spiritual health [26], Oncology spiritual health [27], Golparvar’s spiritual health [13, 28] and the questionnaire of statements of evaluating nurses’ attitude towards spiritual health [1].
In most studies, the spiritual health of nurses (21 cases) and nursing students (14 cases) was at an average level (in the range of 20-120). Spiritual health in the religious dimension was more than the existential dimension.
The spiritual health of nurses had a significant negative relationship with age [1, 27, 29-31], gender [18, 32], work experience [1, 18, 30], marriage, education, type of ward, type of shift and responsibility [33], financial status [27], caring behaviors [2], cooperation, assertiveness, self-control, hope, spiritual intelligence [34], clinical competence, professional ethics, interpersonal relationships [33], psychological capital and spiritual connection [13, 28], religious practices [26], provision of spiritual care [26, 30, 35, 36], attitude to spiritual care [27], religious adherence [37], job satisfaction [4, 14, 31 , 38, 39], job compatibility [25], quality of life [40, 41], vision, attitude and behavior [23], marital satisfaction [32, 37, 42], Islamic lifestyle [38], meaning in life [43], social level, mental state [27], coping methods [39], psychological health [44] significant positive relationship with obstacles related to nurses [29], job stress [45, 46], moral distress [3], coronavirus anxiety, tension and emotional turmoil [23], depression, anxiety [23, 43], and social dysfunction [43] (Table 2).
The spiritual health of nursing students had a significant positive relationship with age [47], marital status, type of university [48, 49], academic year [24], psychological ability [50], moral sensitivity [51], happiness [48], hope [49], internal religious orientation, source of internal control and problem-oriented leaders [52], spiritual intelligence [53], exam anxiety [54], and general health [55]. Also, it had a significant negative relationship with students’ anxiety at the time of entering the internship [56], and external control sources [52] (Table 3).
Discussion
The findings of most studies show that the spiritual health of nurses and nursing students was at an average level. Hsiao (2011) reported the spiritual health of nursing students at an average level which is consistent with the present study [16]. While in Pesut’s study, students had a high level of spiritual health [63]. In Wagner’s study (1998), more than 50% of nurses had high spiritual health [64]. Nursing is inherently a spiritual profession, and nowadays the emphasis on the importance of spirituality and spiritual care in nursing is evident. The average level of spiritual health in this group may be because the nursing education system in Iran has not yet included spiritual care as part of its curriculum [65]. Also, the differences between the studies can be attributed to the place of employment and geographical and cultural differences.
Spiritual health in the religious dimension was more than the existential dimension. But in the study of Hsiao (2011), the dimension of communication with others had a higher score than the religious dimension [16]. The religious dimension shows the relationship with God and the existential dimension shows our relationship with others, the environment, and ourselves. Therefore, more spiritual health in the religious dimension is not far from expected for the Iranian society, which is inclined toward religious and spiritual values.
In this study, spiritual health had a significant positive relationship with age and work experience. In Borna’s (2020) study, age was also related to spiritual health [66]. Hsiao’s study results were contrary to the present study [16]. It seems that with the increase in work experience and received training, the professional and moral ability and therefore the spiritual health of nurses improves.
In this study, nurses’ spiritual health had a significant relationship with job satisfaction. In the study of Bakhtiari (2018), the spirituality of the work environment had a significant positive relationship with life satisfaction [67]. Altaf (2011) also pointed out the positive relationship between spirituality and job satisfaction [68]. It seems that spiritual health leads to the existence of integrity, continuity of work, understanding of the deep values of the work environment, a sense of being together, sociability, and solidarity among employees, and therefore improves their job satisfaction [67].
The findings of the present study showed that spiritual health has a positive relationship with the provision of spiritual care. Nissen (2021) considers the provision of spiritual care as one of the requirements of patient care and the development of a person’s spiritual health. Perhaps it can be said that spiritual care can be an inspiring conceptual framework for developing therapeutic programs and promoting spiritual health because it can help nurses to recognize the unmet spiritual needs of patients [69].
The findings of the present study showed that spiritual health has a positive relationship with professional ethics and interpersonal relationships. In Akrami Fard's study (2018), spirituality had a significant relationship with the moral sensitivity of nursing students. It seems that the strong influence, the growing ability, and the flourishing of the nature of professional ethics in different aspects of a person's existence lead to a relationship with spiritual health [70]. It seems that those nurses who consider themselves obliged to do the work correctly in the hospital and somehow observe ethical and professional considerations have high spirituality.
In this study, spiritual health had a positive relationship with clinical competence. A study that reported consistent results with the present study was not found. Therefore, according to the study of Ebrahimi (2017), it can be argued that a person with spiritual health can have skills used in the professional field or nursing process, including therapeutic relationships between nurses and patients, availability for patients, active listening, and expressing empathy, providing religious facilities for patients with specific religious beliefs, helping patients, etc. [70] and therefore have better clinical competence. On the other hand, it can be argued that spirituality and its aspects positively affect adaptation techniques and are effective in improving the quality of health care and nurses' performance.
In this study, spiritual health had a positive relationship with the general health of nursing students. This study's results are consistent with the study of Bozek (2020) [71] and Padehban's (2020) results [72]. Health has physical, mental, spiritual, and social dimensions. Therefore, a person with better spiritual health is expected to have higher general health. On the other hand, it can be concluded that students with a closer relationship with God, have a positive feeling towards their lives, hope for the future, pay more attention to the great God in solitude, and feel the presence of God in all areas of their lives. They realized that they are always supported by the creator of the universe. They can be useful and efficient people for society and have the necessary ability to fulfill their roles and duties and because of that, these students can pay attention to the necessary measures to deal with pressures and stresses and always try to create a healthy and lively environment.
According to the findings of this study, depression, anxiety, stress, and emotional turmoil weaken spiritual health. Hsiao's study finding is also consistent with the present study [16]. It can be said that a person in the mentioned conditions cannot use spiritual coping strategies and a positive attitude when dealing with stressful events, so spiritual health also decreases.
Regarding the limitations of this study, different questionnaires were used that examined different dimensions.
Conclusion
Based on the findings of this study, the spiritual health of nurses and nursing students was at an average level. An increase in factors such as demographic variables, job, education, job satisfaction, and spiritual care improves the level of spiritual health, and demoting factors, like stress, anxiety, and depression improve the level of the spiritual health of nurses. In addition, most studies conducted in the field of spiritual health and the factors affecting it in nurses and nursing students are descriptive. One of the strengths of this study is to determine the confirming factors for improving spiritual health in clinical departments, and one of its weaknesses is to examine spiritual health in only one culture (Iranian society), eliminate qualitative studies, and use more observational studies and methods of different evaluations. Therefore, the researchers are recommended to pay more attention to qualitative and experimental studies in their research. A specific tool should be designed to determine the spiritual health of nurses. Also, it is suggested that educational committees for the spiritual health of nurses be formed to promote and update this crucial matter in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The principle of protecting information and using the results of all studies was considered.
Funding
The Deputy of Research and Technology of Qom University of Medical Sciences was the financial sponsor of this research.
Authors' contributions
All authors equally contributed to preparing this article.
Conflict of interest
The authors declared no conflict of interest.
Type of Study: Review Article |
Subject:
Special
Received: 2022/05/29 | Accepted: 2022/12/13 | Published: 2022/12/31
Received: 2022/05/29 | Accepted: 2022/12/13 | Published: 2022/12/31
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