NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay

NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay 
Grand theories provide a conceptual guidance that describes the practice of nursing as a whole.  These theories relate to every aspect of the metaparadigm of nursing, including health, person, nursing, and environment.  While grand theories are useful in our everyday practice, they are broad by design, and this can make it difficult to apply to specific situations with patients.  Middle range theories are more specific in nature, tending to guide nursing interventions, thus ultimately improving patient outcomes.  Focusing further is the concept of nursing, which can directly impact the front lines of the nursing field.  The concept of spirituality has broad characteristics like a grand theory, while it can conversely be honed into specific areas to implement in patient care setting (O’Brien, 2013).  This concept analysis paper will take a closer look at the concept of spirituality as it pertains to the practice of nursing.
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Purpose
The purpose of this concept analysis is to clarify spirituality using the Walker and Avant method.  Walker and Avant defined a specific method for concept analysis, which includes seven specific steps: selection of the concept, aims of the analysis, all uses of the concept, defining attributes, case model that displays the concept in practice, other alternative cases, the antecedents and consequences of the concept and empirical referents of the concepts (2010). NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay.
Definition and Attributes
             Spirituality is a broad concept involving one’s search for the meaning of life, and may or may not be associated with an organized religion.  In the field of nursing, spirituality is an intangible asset possessed by the patient, giving meaning and hope to one’s life, allowing one to transcend oneself (Reinert & Koenig, 2013).
The attributes of spirituality are many, including hope, trust, purpose, forgiveness, faith, values, love, and morality just to name a few.  A component of connectedness describes a connection with oneself, a higher power or supreme purpose (O’Brien, 2013). This connectedness can be the relationship one has with a higher power or deity, interpersonal relationships with peers or family, or the relationship between one and the environment one lives in (Reinert & Koenig, 2013). NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay.
Case Models
Case models are sample cases, which can further illustrate the concept, providing a deeper understanding to the true meaning of the concept.  Following are two case models showing how spirituality is a recognized factor in the health and well-being of patients and can have a profound impact on their quality of life. NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay.
Related Case Model
Ms. Smith is a 29-year-old female who has just been diagnosed with end stage renal disease (ESRD).   Ms. Smith seems to have a depressed affect about her new diagnosis, stating she is unsure how she is going to handle dialysis in her schedule.  She tells the nurse that she is a Christian, believing in God, and that she will pray about her situation.  She states she is connected with her church and knows they will help her get through this daunting diagnosis.  She asks the nurse to pray with her and the nurse complies. NR-501: Theoretical Basis for Advanced Nursing Practice – Concept Analysis: Spirituality Essay.
 The nurse holds Ms. Smith’s hands as she prays for strength and courage in the days ahead and asks God to show her hope.  When the prayer is over, she states that she feels better and that she knows God will support her.  The sees Ms. Smith at the dialysis unit at the hospital a few months later and asks her how she is doing.  She states she is doing well and has her faith to thank.  She has also started going to an ESRD support group and has gained support and strength from people in her situation.
            This case model shows how the patient’s spirituality helped her through a difficult diagnosis and helped to prepare her for the difficult days ahead.  It shows how believing in a higher power can give one inner strength and hope.  It also goes to show that the nurse is aware of the importance of spirituality in healing, offering to pray with the patient and show lateral support.  The patient connected with others in her situation, which offered her support on a horizontal level.
Contrary Case Model
Mr. Smith is a 20-year-old male who comes into the urgent care complaining of chest pain and shortness of breath.  Evaluation of the patient reveals nothing physically wrong, but while talking with him the nurse determines that he may have been having panic attacks.  Mr. Smith reveals to the nurse that he is in college and has been feeling very anxious prior to exams.  When discussing his support system, he says he was raised Catholic but no longer practices, and that he doesn’t really have any friends to speak of because he is always studying.
The nurse listens and provides emotional support, offering up a time when she had a panic attack prior to an exam in nursing school.  She also told him that he should join a study group to get in touch with people in his situation.  She also suggested that he fall back on his religious background for support.  The nurse recognized how important spirituality was in helping the patient to have a better outcome. 
            Mr. Smith returned to the urgent care a month later, after dropping out of college due to failing two different exams.  He was depressed and told the nurse that he had not joined a study group or tapped into his own faith.  He stated that he feels alone and feels like a failure, still having panic attacks and is now looking for help with his depression.
This case model shows how the patient’s lack of spirituality hindered the patient from healing and actually worsened the patient’s situation.  The nurse tried to show lateral support by empathizing with him, but ultimately the patient is responsible for his own spirituality.
Uses
One of the many uses for spirituality in nursing would be in the emergency room.  This diverse area sees patients from all walks of life who are in varying degrees of crisis.  Spirituality guidance from the nurse would allow the patient with a new diagnosis to cope and find hope for the future, or allow the dying patient to make peace with their life and family.  Showing kindness, support, and empathy are all critical factors of spirituality that could help so many.
Another use for spirituality would be in the cancer unit in a hospital setting.  Patients in this area have usually had time to adjust to their diagnosis, but may not have found their spirituality needed for active healing.  Assisting these patients in finding inner strength and hope is paramount to their recovery or acceptance of their disease.
Antecedents and Consequences
Antecedents are events that occur prior to the concept, or how the patient lived prior to an event (Bamonti, Lombardi, Duberstein, King & Van Order, 2015).  In the case of spirituality, this may be the patient’s quality of life prior to an event and their belief in something higher than oneself.  This can be shown through one’s philosophy on life and their belief system.
Consequences occur after the concept, and can have a negative or positive impact on one’s quality of life.  Positive impacts of spirituality would improve one’s sense of well-being, offering hope and peace.  Conversely, the negative aspects of spirituality can cause guilt and inner conflict, often worsening the situation (Bamonti, Lombardi, Duberstein, King & Van Order, 2015).
Empirical Referents
            Empirical referents are important tools used when measuring the existence of concepts in the nursing field.  One such tool is the Functional Assessment of Chronic Illness Therapy (FACIT), with a focus in spirituality (FACIT-Sp).  This tool was developed in the 1990s to measures spiritual well-being, without being limited to any one specific religion or tradition (Peterman, Fitchett, Brady, Hernandez, & Cella, 2012).
Bredle, Salsman, Debb, Arnold & Cella conducted a study investigating the role spirituality plays in the lives of patients undergoing cancer treatments (2011).  According to the FACIT-Sp results, those patients with increased spirituality had a higher quality of life compared to those who answered less spiritual. The FACIT-Sp has become an important tool in assessing the validity of spirituality in well-being and quality of life (Bredle, Salsman, Debb, Arnold & Cella, 2011).
Another measurement tool is the Spirituality Well-Being Scale (SWBS), published in 1982 and has proven itself useful in measuring quality of life (Monod, Brennan, E. Rochat, Martin, S. Rochat, & Büla, 2011).  A study conducted by Bamonti, Lombardi, Duberstein, King & Van Order used the SWBS to assess the relationship between depression and spirituality (2015).  The study showed an inverse relationship, as those who reported high levels of spirituality also reported lower levels of depression and higher quality of life.
Conclusion
The association between one’s physical health and their spirituality has proven to be significant in one’s overall quality of life and well-being.  For those patients undergoing trying illnesses, it can be an inner resource that patients can draw upon for strength and peace, promoting health and healing (Monod, Brennan, E. Rochat, Martin, S. Rochat, & Büla, 2011).  Spirituality is an important aspect in our nursing practice and should be taken into consideration when helping our patients achieve a better quality of life.  Through this concept analysis is has been shown that spirituality is an inner asset each patient has to varying degrees and the nurse has an opportunity to assist the patient in in that quest.
 
 
References
Bamonti, P., Lombardi, S., Duberstein, P., King, D., & Van Orden, K. (2015). Spirituality            Attenuates the Association Between Depression Symptom Severity and Meaning   in Life. Aging & Mental Health, 1(6), 78-80.
Bredle, J., Salsman, J., Debb, S., Arnold, B., & Cella, D. (2011). Spiritual Well-Being as   a Component of Health-Related Quality of Life: The Functional Assessment of        Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Religions,           2(1), 77-94.
Monod, S., Brennan, M., Rochat, E., Martin, E., Rochat, S., & Büla, C.  (2011).    Instruments Measuring Spirituality in Clinical Research: A Systematic Review.        Journal of General Internal Medicine, 26(11), 1345–1357.
O’ Brien, M. (2013). A Middle Range Theory on Spiritual Well-being in Illness.     Spirituality in nursing: Standing on holy ground (4th ed., pp. 75-85). Sudbury,           MA: Jones and Bartlett.
Peterman, A., Fitchett, G., Brady, M., Hernandez, L., & Cella, D. (2012). Measuring         Spiritual Well-being In People With Cancer: The Functional Assessment Of             Chronic Illness Therapy – Spiritual Well-being Scale (FACIT-Sp). Annals of           Behavioral Medicine, 17(4), 49-58.
Reinert, K., & Koenig, H. (2013). Re-examining Definitions of Spirituality in Nursing       Research. Journal of Advanced Nursing, 69(12), 2622-2634.
Walker, L. O & Avant, K. C. (2010). Strategies for theory construction in nursing (5th         ed.). Upper Saddle River, NJ: Prentice Hall
 

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