Theory/Author Name and Background
The theory on spiritual well-being in illness is a concept that was explored by Sr. Mary Elizabeth O’Brien. Sr. Mary began her career as a nurse at the Mercy Hospital in Pennsylvania and she worked closely with people with chronic illnesses. Over the course of the history of nursing and specifically on the issues that touch on chronic illnesses and end-of-life care, the aspect of spirituality holds significant influence as to the development of the care plan (O'Brien, 2003). Even in the contemporary healthcare system, nurses are expected to observe the code of ethics within the specifics of holistic healing which seeks to actualize physical, emotional, physiological and spiritual healing. In fact, today, the concept has been accepted and determined as important not only in end-of-life care but even so within the outpatient and inpatient care units where illnesses may not be significantly complex (O'Brien, 2003).
However, chronically ill patients tend to be a group of patients who actually deserve and call for spiritual healing considering the emotional and psychological stress that comes with the knowledge that their condition may not necessary be cured rather it will be managed to prolong their life as they approach the painful outcome of death from an imaginary view. While working for her doctoral dissertation in Sociology at the catholic University of America, Sr. Mary got to interact with chronically ill patients at a more personal level aside from her professional experience of working with this group (O'Brien, 2003). Versed with her experience in sociology, Sr. Mary could relate the impact of spirituality to this group. At some time she noted that for the chronically ill patients, there is a perception that they are living on the mercies of a higher divine power and therefore, they are bound to be thankful and to expect a better life even amidst the strain to cope with their condition. Based on this knowledge, Sr. Mary went on to document her life stories and her exploration of spirituality in her book ‘Parish nursing: Health care ministry within the church’ in which she explored not only the role of spirituality for the individuals with chronic illness but also the role of the church in concepts of health promotion, health education, healing and wellness (O'Brien, 2003).
Sr. Mary based her beliefs on the concept of parish nursing introduced by Reverend Doctor Granger Westberg who formalized this concept within the healthcare and religious sector (O'Brien, 2003). However, Sr. Mary also explores the important tenets of voluntary church affiliated nursing roles that had been accomplished by various people in the past prior to the formalization of the Parish nursing and the later aspects of spirituality in healthcare delivery. Sr. Mary in fact depicts that the very first instance of spirituality is based on the story of the ‘Holy woman’ Veronica who is believed to have wiped the bleeding face of Jesus during the painful walk to Calvary (O'Brien, 2003). While this concept is not found in the Old and New Testaments Historians have significantly linked Veronica as the woman with a twelve year old hemorrhage who was healed by Jesus by touching the hem of the garment that Jesus was wearing. The story of wiping the bleeding face of Jesus at a painful moment of suffering indicates the spirit of a compassionate woman which then can give Christians enough reason to revere her memory as old as it may be today. The theory on spiritual well-being in illness has its specific interest on matters pertaining to the role of spirituality for those people in suffering and those in pain (Cordova, 2012).
The theory tries to bring into the fore the necessity of compassionate care and love and the need to manage the emotional and spiritual strength for those people who are in physical suffering. These patients when in a state of suffering and in life-altering conditions strive to make logic of the state in which they currently are and even in the case where cannot make the logic, there is an attempt to seek inner peace and acceptance with the self. This there has specific focus on patients who have experienced or are experiencing an illness or condition that technically puts an end or derails their life goals (O'Brien, 2003). In this state, the individual seeks to judge the consequences of the illness, their new state and their reason for continued living. This state subjects them to few options and at times affects their mental state but gradually they find an inner peace and they recognize that there is more to a life than their goals. At this point, the inner self has already identified the existence of a divine power that they actually associate with the inner peace that they are temporality finding within themselves(Visser, Garssen & Vingerhoets, 2010).
Theory Description
The theory on spiritual well-being in illness is based on four major concepts which include spiritual wellbeing, spirituality, religiosity and the intervening variables. On the concept of spiritual wellbeing, the theory assumes that for patients with chronic illnesses or those with disabilities, there is a state of acceptance that is necessary to help cope with the limitations that the illness poses on the individual. Those who ably achieve this state of spiritual wellbeing in illness tend to become more positive and satisfied with the other facets of their lives. Within this state, the theory assumes that these people gradually find more positivity and become more optimistic about their future. This state is facilitated by an inner experience in which the individual finds meaning of their illness from a spiritual perspective (Malinski, 2002).
This state is only possible or the individual attains this state in the condition that the other three concepts of spirituality, religiosity and the intervening variables do not contradict at any point. The communality between the key concepts proves a harmony with the inner self and technically an ability to accept the current state of health (Cordova, 2012). On the concept of spirituality, the theory holds that spirituality is the exploration of the personal relationship that one holds with God. It is more focused on personal faith as well as spiritual contentment. On the aspect of personal faith the theory presumes that an individual’s belief in God or lack of it thereof has critical meaning to the ability of the person to find meaning in the state of illness. The theory assumes that with faith in God still holding, one has to trust that the power, providence and love of God while also finding peace, strength and courage in the beliefs of God. These values must be demonstrated if at all the meaning being sought has to take cause.
Spiritual contentment on the other hand is an aspect that involves an individual’s perception of closeness to God and the ability to find security in the love of God. In that case therefore, the individual remains faithful to the beliefs that build that relationship with God and not for the fear of wrath or judgment rather as a personal allegiance to God. The third key concept of the theory is religiosity which is reflected by the individual’s methods of practicing their faith and that eliminates the element of being involved in any organized religious movement or tradition (Cordova, 2012). Actions such as prayers, spiritual readings, meditation as well as church attendance can be described as some of the common practices but not limited to the same. The individual derives motivation and encouragement from the people or groups that they interact with in the religious movement or during practice of their religiosity which can include pastors, spiritual companions and the faith community (O'Brien, 2003).
The fourth concept of the theory on spiritual well-being in illness is the intervening variables which include the severity of the condition as well as the functional impairment degree or intensity. On the other hand, the other three concepts can function optimally when there is sufficient social support from the family, friends, care team and the care givers. On the same wavelength other intervening factors such as the socioeconomic status, socio-cultural and emotional status of the individual will determine how well the individual can derive the spiritual positivity. It is important to recognize that these key concepts cannot function in isolation and they all should support and complement each other (Visser, Garssen & Vingerhoets, 2010).
Evaluation
These key concepts that describe this theory are technically derived from the major paradigms of person, health, environment and nursing. The theory presumes a person as a spiritual being with a physical and psychosocial aspect. The person is a rational and will put so much effort to find meaning in their illness or state of health with a purpose of seeking peace even in the midst of such suffering. The person has to take individual responsibility to embrace the illness or condition, modify their behaviors and attitudes accordingly as guided by the existing intervening factors (Malinski, 2002). The theory further asserts that a healthy individual is someone who shows optimism, remains hopeful and satisfied even amidst the presence of a chronic condition or a disability. The theory assumes that even in the in the midst of an illness, the individual is spiritually healthy and that the individual attaches a symbolic meaning to the illness or suffering by perception. The theory also supposes that there is a significant correlation between the spiritual wellbeing of an individual and the quality of life (Malinski, 2002).
In that case therefore, if the individual has higher faith, contentment, spirituality and has found more meaning for religious practice, then there is a consequence of greater optimism, satisfaction and hope in that state of illness. The third paradigm is the environment and the theory posits that the individual exists within an environment which includes their family, the caregivers and the faith community all have a direct impact on the life of the individual. All events that happen within this environment are seen as the source of the emotional, financial and socio-cultural; intervening factors in the search for spiritual well-being in wellness (Cordova, 2012). The fourth parading of the theory is that of nursing and the theory describes nursing as an activity whose primary goal is to assist a patient in illness or suffering to experience and develop hope as a coping mechanism. The role of the nurse is to aid an individual in identifying, supporting and strengthening the resources that support the individual spiritual in their state of illness (O'Brien, 2003). The theory holds that the nurse has an ability to modify the effects of the intervening variables so that they do not interfere with a person’s ability to achieve spiritual wellness. While the theory poses several assumptions across the paradigms, the very fact that they remain consistent across the key concepts and the inductive elements, implies that the theory poses significant logic and thus applicability (Malinski, 2002).
Application
In the contemporary nursing environment, nurses are being prepared to work in an environment in which they can provide holistic care to the patient. Holistic care is based on the concepts of spiritual wellness and wellbeing, promotion of perseverance using illness as well as physio-psychosocial wellness in the patient. In this view it is important to recognize that the spiritual concept is not only an important element for patients in pain of suffering but also a form of therapeutic healing that enables a patient to find inner peace and thus helping develop a viable coping mechanism (Visser, Garssen & Vingerhoets, 2010). Within the healthcare sector, nurses stand a good chance within which they can apply the concepts of the theory. On one hand, nurses are in direct contact with the patient as role models, care givers, and teachers and thus they understand the cognitive process and influence that spirituality poses to the patient.
For chronic patients, nurses recognize that beyond the illness and the management of the illness to afford the patient a viable quality of life, patients have an inner self that seeks to remain at peace and cope even within the physical suffering, Nurses thus stand at that central point where they can act as the actual modifiers of the intervening factors to ensure that all these intervening factors are in agreement with each other and do not compromise the patient’s inner self that continually seeks peace (Visser, Garssen & Vingerhoets, 2010). The theory by exploring the various elements and the historical perspective of nursing gives the nurse a framework on which they can have a better understanding of the spiritual needs of the patient that can influence that inner peace that is vital to coping and survival in amidst suffering. On the other hand, through the exploration of the paradigms and the key concepts, the nurse is afforded an opportunity to determine the various ways in which they can assess a patient and provide more attention to the spiritual needs of the patient (Visser, Garssen & Vingerhoets, 2010).
Upon this theory nurses have the ability to develop a working instrument or tool that can help determine or measure the spiritual wellbeing of the patient by combining their experience with patients and the theoretical value on which this theory is founded. Such a tool would be useful in addressing the needs of patients especially when they cannot adequately tell their story from a personal perspective or even so offer a standard tool along which each patient can be assessed to determine the spiritual wellness so that the care plan is designed within those needs (Cordova, 2012). Nurses have to create an atmosphere that allows patients to thrive in their spirituality and that involves sharing with them the stories and analogies that may lift their spirits as well as determining a need for faith communities to visit patients especially those in long term care and afford them a chance for empathy and support (Visser, Garssen & Vingerhoets, 2010).
For the nurse, the concept is to train the patient to live for something even in the situations of suffering and pain; that in itself is based on the ability of the nurse to connect with the spirituality of that individual and therefore offer them a therapeutic technique that solves their inner struggle to accept the self. Nurses can only connect with the spirituality of the patient when they have shared so much together and the nurse can derive the spiritual needs for the patient just as they would their own (Malinski, 2002).
References
Cordova, C. M. (2012). The lived experience of spirituality among type 2 diabetic mellitus patients with macrovascular and/or microvascular complications.
Malinski, V. M. (2002). Developing a nursing perspective on spirituality and healing. Nursing Science Quarterly, 15(4), 281-287.
O'Brien, M. E. (2003). Parish nursing: Healthcare ministry within the church. Jones & Bartlett Learning.
Visser, A., Garssen, B., & Vingerhoets, A. (2010). Spirituality and well‐being in cancer patients: a review. Psycho‐Oncology, 19(6), 565-572.
