Health Dimensions and Spirituality Dimensions of Human Self
Spirituality is a fundamental human tendency that involves reaching beyond the immediate boundaries of the self to connect with a greater reality and find meaning. In nursing, spirituality is understood as a variety of human experiences that provide a sense of transcendence or awareness of a connection to something greater than oneself without diminishing the self. This understanding includes three key dimensions: intrapersonal, interpersonal, and transpersonal (Reed, 1992).
- Intrapersonal Dimension: Focuses on looking inward to find personal meaning. It involves concepts such as purpose in life, inner strength, peace, courage, and serenity. This dimension reflects an individual’s internal reflection and personal growth.
- Interpersonal Dimension: Relates to relationships with other people, living systems, the broader environment, and nature. It encompasses trust, a sense of connectedness, forgiveness, interconnectedness, and love. This dimension emphasizes the importance of human connections and community.
- Transpersonal Dimension: Concerns one’s relationship with the unknown or unseen, such as mystery, God, a higher power, or other supernatural entities. Concepts within this dimension include faith, hope, self-transcendence, acceptance, mystical experiences, awareness of a divine presence, experienced grace, specific religious beliefs and practices, and nonreligious or existential expressions of transcendence. This dimension explores spirituality beyond ordinary experiences and emphasizes connection to a higher reality or purpose.
Spirituality as a Dimension of Health
Although spirituality is often described in abstract terms, such as a unifying force or the essence of human beings, it is recognized by nursing theorists and researchers as a multidimensional concept that can be empirically studied through various indicators and research methods (Reed, 1992). Spirituality is considered a vital aspect of human health and well-being, influencing how individuals experience and cope with health challenges, particularly during times of increased awareness of mortality.
Importance of Spirituality
Spirituality is a significant area of research and practice in nursing because it is a fundamental human experience relevant to everyday life and health-related events. The dimensions of spirituality have been explored by eminent nursing theorists, including Florence Nightingale, Martha Rogers, Jean Watson, Betty Neuman, Madeline Leininger, Callista Roy, and Rosemarie Parse. These theorists have contributed to developing middle-range theories that incorporate spirituality as a core aspect of nursing care.
Spirituality is viewed as integral to human wholeness, development, and well-being. As such, it is increasingly considered a fundamental concern of nursing practice. While interest in spirituality became more pronounced at the turn of the 21st century, research on spirituality in nursing was not widely recognized until the mid-1980s, when nurse researchers published initial studies on the topic. This growing research activity coincided with an expansion of clinical knowledge about spirituality, exemplified by books like “Spiritual Care: The Nurse’s Role” by Fish & Shelly (1978) and “Spiritual Dimensions of Nursing Practice” by Verna Carson (1989).
Factors Affecting the Growth of Spirituality
Several factors have contributed to the increased interest and research on spirituality in nursing:
- Publications in Social Sciences: These linked spirituality to various indicators of well-being and mental health. Sociologist Moberg’s research on religion, therapies based on the transpersonal movement in psychology, and lifespan developmental theories on spiritual dimensions of aging all contributed to a broader understanding of spirituality.
- Development of Measurement Instruments: Tools such as Ellison’s (1983) Spiritual Well-Being (SWB) Scale and Reed’s (1987) Spiritual Perspective Scale enabled the empirical study of spirituality and related concepts, fostering further research.
- Maturity of Nursing as a Discipline: Nursing evolved into a discipline that defined itself as a science with theories extending beyond the biomedical model to include human health experiences and patient perspectives, emphasizing holistic care.
- Increased Attention to Clinician Voices: Scientists began to focus more on the voices of clinicians, such as those whose patients attested to the positive influences of spirituality in healthcare (Highfield & Cason, 1983).
- Holistic Approaches to Nursing Assessment: Efforts to establish a more holistic approach to nursing diagnosis and assessment, including the spiritual dimension, further promoted research and practice in this area. An example is Ruth Stoll’s “Guidelines for Spiritual Assessment,” published in the American Journal of Nursing in 1979.
These factors have collectively contributed to the growth of spirituality research in nursing. Since the mid-1980s, the number of nurses including spiritually related questions and variables in their research has increased significantly.
Spirituality and Health Care
Research findings and practical knowledge in nursing support the relevance of spirituality to patient care. Spiritually related variables, such as hope, courage, and self-transcendence, are consistently found to be significant factors in healing processes and during health-related events associated with specific life phases, such as pregnancy, childhood, aging, and end of life.
Key areas of research include terminal illness and dying, chronic illness, cancer, life-threatening and acute illness, mental health in aging, alcoholism and substance abuse, critical losses and life events, and the health of nurses and other caregivers. The majority of spiritually related research efforts have focused on enhancing well-being during terminal illness. Notable examples include Beverly Hall’s work with patients with HIV/AIDS (1998) and research on women with breast cancer at diagnosis and end-stage (Coward, 1991, 1998; Mickley, Soeken, & Belcher, 1992). Findings from these and other studies generally support the significance of spiritual factors in patient well-being.
Another area of research is the nurse’s spirituality and approach to spiritual care as essential elements of practice. British nurses such as Draper, McSherry, Narayanasamy, Owens, and Ross, along with American nurses like Tuck and Emblen, have focused on these aspects. Ethical questions about the congruence between patient and nurse perspectives, and between the nurse’s values and actions regarding spirituality, are particularly important as nurses assume a more active role in spiritual care.
How to Study Spirituality
Studying spirituality presents unique challenges, but methods are evolving to expand the understanding of spirituality across time and cultures. Researchers are beginning to address potential changes in spirituality over the trajectory of illness or across the lifespan using both qualitative and quantitative longitudinal designs. These designs provide insights into spiritual experiences, practices, and strategies over time.
Other trends include increasing numbers of researchers examining spirituality from cultural perspectives (e.g., Pincharoen & Congdon, 2003). Conceptual or philosophical inquiry also plays a significant role in the study of spirituality. Publications that integrate clinical knowledge, provide ethical analysis, and clarify the complex concept of spirituality have significantly contributed to the research literature.
Several potential nursing interventions or patient strategies regarding spirituality have already been identified in the literature, such as spiritual autobiography, life review, therapeutic relationships, prayer, meditation, spiritual counseling, guided imagery, existential therapy, personal writing and reflection, and engagement in altruistic activities.
Nursing Care and Spirituality
Nursing care increasingly recognizes spirituality as a critical dimension of patient well-being. Nurse scientists are likely to continue studying spirituality concerning psychosocial indicators of well-being and biobehavioral indicators, including those from the psychoneuroimmunological perspective. However, it is less likely that future nursing research will focus solely on the neurobiological basis for spiritual or religious beliefs, a direction more commonly pursued by scientists outside nursing.
Nurses will continue to publish research on the clinical and empirical significance of spirituality in patient care, as exemplified by the extensive writings of Margaret Burkhardt and her colleagues. As more researchers and clinicians collaborate, the understanding of spirituality in nursing practice will expand, leading to the development of theory-based strategies that facilitate well-being (e.g., Coward, 1998; Relf, 1997).
Conclusion
Spirituality is a vital dimension of human health, encompassing a range of experiences and expressions that provide meaning, connection, and purpose. In nursing, spirituality is increasingly recognized as a critical aspect of holistic care, influencing how individuals cope with health challenges and navigate significant life events.
As the field of nursing continues to evolve, research on spirituality will likely grow, guided by a more nuanced understanding of its various dimensions and its impact on patient well-being. Future studies will explore spirituality using mixed methods, longitudinal designs, and cultural perspectives, expanding the knowledge base and enhancing the quality of care provided to patients. By integrating spirituality into nursing practice, healthcare providers can better support patients in achieving overall well-being and holistic health.