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- Nursing diagnosis of ‘‘spiritual distress’’ in women with breast cancer prevalence and major defining characteristicsPublication . Caldeira, Sílvia; Timmins, Fiona; Carvalho, Emília de; Vieira, MargaridaBackground: Spirituality and spiritual needs of cancer patients are frequently mentioned in the nursing literature, but the most significant defining characteristics of spiritual distress in the context of clinical reasoning and nursing diagnosis are rarely explored. Understanding of these is important for effective spiritual intervention. Objective: The aim of this study was to identify the prevalence and the defining characteristics of the nursing diagnosis ‘‘spiritual distress,’’ as classified according to NANDA International, among women with breast cancer. Methods: This was a quantitative and cross-sectional study, comprising the third phase of a larger study investigating the clinical validation of spiritual distress in cancer patients undergoing chemotherapy. Fehring’s clinical diagnostic validation model was used to identify the prevalence and the major defining characteristics of the diagnosis. A convenience sample was used, and data were collected by structured interview. Results: A total of 70 women participated; most were married (62.9%) and had a mean age of 54 years, and 55.7% reported having at least 1 person depending on them. The average length of time since the cancer diagnosis was 30.9 months. Twenty-seven participants were experiencing spiritual distress (38.6%). Eleven defining characteristics were classified as major. Conclusions: The prevalence of spiritual distress and the major defining characteristics give clinical evidence about the nurse’s role in providing spiritual care. The results are useful for the improved use of the NANDA International diagnoses within this domain. Implications for Practice: The findings highlight the importance of assessing the defining characteristics of the diagnosis as an objective strategy to improve clinical reasoning related to spirituality and to facilitate more effective interventions.
- Spiritual care: the nurses’ experiences in the pediatric intensive care unitPublication . Nascimento, Lucila C.; Alvarenga, Wylliane A.; Caldeira, Sílvia; Mica, Tâmisa M.; Oliveira, Fabiane C. S.; Pan, Raquel; Santos, Tabatha F. M.; Carvalho, Emília C.; Vieira, MargaridaPhysical aspects of disease management are often more evident than those related to spirituality or spiritual care. Spirituality may appear more crucial in pediatric intensive care units (PICUs) when patients are experiencing serious illness or end-of-life situations. This paper describes the meaning of spirituality according to nurses who had worked in PICUs and how they provide spiritual care to children and their families. It is an exploratory research using a qualitative approach, including interviews with eleven PICU nurses. Data were analyzed using thematic analysis; two themes were identified: meanings of spirituality and religiosity according to nurses, and the provision of spiritual care to children in the PICU and their families. The interviewed nurses recognized the importance and value of spiritual care and are aware that spiritual needs are considered to be of significantly less importance than physical treatments. Spiritual care was mainly focused on the children’s families; the nurses justified the absence of spiritual care to children, based on lack of time and children’s age and level of consciousness. These results highlight a deficiency in spiritual care in PICUs and demonstrate the need for improved knowledge and demonstrate the need to not only raise awareness of the spiritual dimension of children, adolescents, and their families, but also to enhance discussion and improve general knowledge on the importance of spirituality in the treatment regimen to provide effective holistic care.
- Spiritual needs of Brazilian children and adolescents with chronic illnesses: a thematic analysisPublication . Alvarenga, Willyane de Andrade; Machado, Júlia Rezende; Leite, Ana Carolina Andrade Biaggi; Caldeira, Sílvia; Vieira, Margarida; Rocha, Silvana Santiago da; Nascimento, Lucila CastanheiraPurpose: To identify the spiritual needs of children and adolescents with chronic illnesses and how these needs are met by health professionals during hospitalization. Design and methods: A qualitative descriptive study was developed with 35 children and adolescents, between 7 and 18 years old, diagnosed with cancer, cystic fibrosis, and type 1 diabetes. Interviews with photo-elicitation were conducted during the hospitalization at a Brazilian public pediatric hospital. Findings were treated using thematic analysis, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) was followed for quality reporting. This research was approved by a research committee. Results: Two themes emerged. The first, entitled ‘Spiritual needs’, encompasses five types of needs: (1) need to integrate meaning and purpose in life; (2) need to sustain hope; (3) need for expression of faith and to follow religious practices; (4) need for comfort at the end of life; and (5) need to connect with family and friends. The second theme was the ‘Definition of spiritual care’. Conclusions: Children and adolescents with chronic illnesses have spiritual needs while in hospital. Meeting these needs is essential for finding meaning, purpose and hope in the experience of living with chronic illnesses and at the end of life, based on their faith, beliefs and interpersonal relationships. But, these needs have not been fully addressed during hospitalization. Practice implications: These results emphasize the need to implement spiritual care when caring for hospitalized pediatric patients, which includes addressing spiritual needs.
- From the struggle of defining to the understanding of dignity: a commentary on Barclay (2016) “In sickness and in dignity: a philosophical account of the meaning of dignity in health care”Publication . Caldeira, Sílvia; Vieira, Margarida; Timmins, Fiona; McSherry, Wilfred
- Spiritual distress: proposing a new definition and defining characteristicsPublication . Caldeira, Sílvia; Carvalho, Emília Campos; Vieira, MargaridaObjective To identify the definition and defining characteristics (DCs) of spiritual distress (00066). Method Integrative literature review. Results Thirty-seven articles and 35 DCs were identified. Spiritual distress as a response to health problems in the context of nursing care is different from an impaired ability to experience and integrate meaning in life. Conclusions The diagnosis misses some DCs that emerged from the literature review and lacks comprehensiveness. The domain and the class are reductionist toward its meaning. The taxonomy lacks a spiritual domain to include this and other diagnoses currently dispersed in other domains. Implications for Practice Further content and clinical validation is needed, as well as an assessment, to determine the diagnosis' class and domain.
- Spirituality in the undergraduate curricula of nursing schools in Portugal and São Paulo-BrazilPublication . Caldeira, Sílvia; Figueiredo, Amélia; Conceição, Ana Paula; Ermel, Célia; Mendes, João; Chaves, Erika; Carvalho, Emília; Vieira, MargaridaSpirituality is considered a dimension of nursing care, which is often recognized as being neglected, mainly due to a lack of education. Several studies have addressed nursing students’ perceptions and skills for providing spiritual care, but there is little evidence on how spirituality is addressed in undergraduate nursing curricula. This study comprised Portuguese and Brazilian nursing schools (from São Paulo) and describes how spirituality is addressed in undergraduate nursing curricula. It is descriptive and the survey research was performed in 2014–2015. The questionnaire was composed of closed and open-ended questions and was sent by e-mail. A total of 129 answers were obtained, mostly from Portugal. Results indicated that several curricular units include spirituality, although having different contents. The learning outcomes are consistent with improving nursing students’ integral education, developing the clinical reasoning regarding spirituality, and improving the assessment of the patient across the life span. Nevertheless, it seems that spirituality is poorly addressed in clinical practice. Few nursing schools have courses or curricular units specifically dealing with spirituality, but they do provide some form of teaching on the subject. No standard curriculum exists, but teachers believe that it is a very important subject that should be included in the courses taught.
- Clinical validation of the nursing diagnosis spiritual distress in cancer patients undergoing chemotherapyPublication . Caldeira, Sílvia; Timmins, Fiona; Carvalho, Emília Campos de; Vieira, MargaridaObjective: Validate the nursing diagnosis spiritual distress in cancer patients. Methods: Cross-sectional approach using Richard Fehring's Clinical Diagnostic Validity Model. Findings: The prevalence of diagnosis was 40.8% in a sample of 170 patients. A total of 16 defining characteristics were validated. Expresses suffering had the highest sensitivity value and lack of meaning in life had the highest specificity value. Conclusions: The diagnosis was validated. Cancer patients in spiritual distress are in a state of suffering related to lack of meaning in life. Implications for Practice: Sensitive diagnosis tools and language are required for nurses to make accurate judgments in situations of spiritual distress. Validation in different contexts would increase the clinical evidence of this diagnosis.
- The adequacy of the Q methodology for clinical validation of nursing diagnoses related to subjective FociPublication . Miguel, Susana; Caldeira, Sílvia; Vieira, MargaridaOBJECTIVE: This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. METHODS: Discussion paper about the characteristics of the Q methodology. FINDINGS: This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. CONCLUSIONS: The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses. IMPLICATIONS FOR PRACTICE: The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions.
- A commentary on spiritual leadership and workplace spirituality in nursing managementPublication . Ribeiro, Mónica; Caldeira, Sílvia; Nunes, Elisabete; Vieira, MargaridaAim: Bring to discussion how spiritual leadership and workplace spirituality, on a health care system that faces constant challenges and seeks constant adaptations, as a way to guarantee nurses’ well-being and quality of care Background: The work environment has shown to have impact on staff well-being. Workplace spirituality relates to sense of belonging, motivation and commitment. A spiritual leadership is fundamental to develop workplace spirituality. Evaluation: Starting from literature, a reflection on the theme was carried out based on the results of the development of spiritual leadership and workplace spirituality in health care institutions, in professionals and in patients. Key issues: Nurses have spiritual needs which need to be also addressed in order to promote the sense of identification with the institutions vision and goals. A relation between spiritual leadership, workplace spirituality and subjective well-being is often found in literature, and this is critical evidence towards new management and leadership dynamics and models in health care institutions, that should integrate workplace spirituality. Conclusion: Nursing leaders are responsible for workplace spirituality facilitation. Nursing leadership and workplace spirituality seem both an answer and way to the change of health institutions management paradigm, but more studies are needed to inform this change in practice.
- Validation of the Duke University Religion Index (DUREL) in Portuguese Cancer Patients Undergoing ChemotherapyPublication . Martins, Helga; Caldeira, Sílvia; Dias Domingues, Tiago; Vieira, Margarida; Koenig, Harold G.Religion is one of the strategies used to cope with life stressful events, particularly in cancer patients. This study aimed to translate, adapt and validate the 5-item Duke University Religion Index (DUREL) into European Portuguese. This is a crosssectional study in a sample of cancer patients receiving chemotherapy. Data were collected in July–October 2018, and the study was approved by the ethics committee of the institution. A sample of 150 participants was included (64.7% female and 35.3% male), aged 35–83 years, and mainly Catholic (86.7%). Participants who were females, older, had lower education and from evangelical religious traditions scored higher on the total score. The Cronbach’s alpha was 0.89. Factor analysis revealed a one-factor solution. Convergent validity was achieved between DUREL and BIAC (r=0.78; p<0.01). The DUREL European Portuguese version is a valid and reliable tool for measuring religious commitment in cancer patients undergoing chemotherapy