Nursing

Maxine Adegbola, RNy MSN

Abstract: Chronic illness presents challenges and opportunities to the person affected. Persons with

chronic illness have identified spirituality as a resource that promotes quality of life. Few authors and

researchers have considered spirituality as a factor in quality of life. This paper presents theoretical and

research tools to support the inclusion of spirituality and quality of life assessments as inseparable,

essential elements in the care of persons with chronic illness. The philosophical underpinnings of nursing

are caring and holism. Because of these underpinnings, nursing is well positioned to implement spiritual

interventions in practice, propel the development of theory, and build a body of evidence to promote

quality of life for persons with chronic illnesses.

Key words: spirituality, quality of life, FACT-Sp, FACT-G, chronic, holistic health

Spirituality and Quality of Life in Chronic Illness

The focus of healthcare has shifted from acute, infectious

diseases to chronic states (Lorig & Holman, 2003; Lorig,

1993; Schlenk et al., 1998). Chronicity is an irreversible

state of disease for which there is no cure (Connelly, 1987). The

prudent individual with chronic disease must employ strategies to

reduce the impact of the illness. By reducing the impact of the

illness and enhancing health, the individual strives for balanced

bio-psycho-social-spiritual health and well-being.

The individual's subjective psychological outlook in the

presence or absence of physiological and functional burden

determines the individual's perceived quality of life (Burckhart &

Anderson, 2003; Murdaugh, 1997). Quality of life (QOL) then

in the context of chronicity is a multidimensional, multifaceted,

dynamic, subjective view of varying degrees of health-related

satisfaction. This health-related satisfaction is connected to

spiritual well being. Spirituality is an important part of weilness

and indispensable in holistic, multidisciplinary care (Young &

Koopsen, 2005; Hill & Pargament, 2003; O'Connell &

Skevington, 2005).

Some have confusingly represented spirituality as religiosity,

but the two, although contiguous, are not synonymous. Spirituality

is a broader, overarching domain that may include religiosity,

but religiosity is not a necessary element of spirituality (Cooper-

Effa, Blount, Kaslow, Rothenberg, & Eckman, 2001; Estanek,

2006). Spirituality is best described by the apt quote that is

attributed to Pierre Teilhard de Chardin,

"We are not human beings having a spiritual

journey, but spiritual beings having a human

experience" -(Teilhardde Chardin, n.d.).

In recent years, numerous documents and research articles

have been published on religiosity and health, but few have

focused on spirituality and health (Peterman, Fitchett, Brady,

Hernandez, & Cella, 2002). Even fewer have considered spirituality

as a factor in maintaining quality of life. The purpose of this

paper is to provide theoretical and research tools to support the

inclusion of spirituality and quality of life assessments as inseparable,

essential elements in the care of persons with chronic

illness. Care that prevents the broken spirit and enhances spiritual

balance has the potential for improving QOL. The implications

of the constructs for practice, theory development, and research

will be described.

Quality of Life

With today's healthcare delivery system and impact of

managed care, it becomes imperative to justify interventions that

promote quality of life , show cost effectiveness of treatment

options (Thomas, 2000), and can holistically include spiritual

needs (Krupski, 2006). The subjectivity and multidimensionality

of individual's spiritual needs result in a phenomenon that is not

clearly understood by others, as the individual adapts to disease

and illness burden. The adaptation of the individual to a gap

existing between expected and actual functional states may have

health policy implications. Individuals with chronic illness, who

unexpectedly tolerate more aggressive therapy, and demonstrate

resilience, perplex healthcare providers, stakeholders, and expert

planners (Bonomi, 1996; Cella et al., 1992). In chronic and

palliative care QOL reports serve as a predictor providing

prognostic input regarding survival and well-being (Dharma-

Warden, Au, Hanson, Dupere, Hewitt, Feeny, 2004).

Definition