"Mending Broken Hearts: The Role of Spirituality in Cardiac Illness" is a perfect example of a paper on care. Heart disease has been reported as bringing “ one’ s spiritual side into greater focus” (Walton, 1999). Spirituality, the dimension of human life that has been regarded as the central artery that permeates, energizes, and enlivens; all other dimensions may serve as a buffer for the stressful physical, emotional, and psychological events associated with illness (Raholm, 2002). Spirituality is the manner by which human beings make sense of life events and establish the meaning of their existence amid potentially life-threatening illnesses.
Spirituality is a universal phenomenon; however, no universal definition exists. Table 1 summarizes viewpoints and definitions of spirituality as used in the studies included in this research synthesis. Spirituality has been found to enhance health (Coyle, 2002). Research literature shows evidence that studies investigating the influence of spirituality on the recovery and coping of patients with diseases such as cardiac illness are rapidly emerging. Several studies have shown that people who score higher on spirituality or religious scales have lower mortality due to coronary heart disease (CHD) or cardiac surgery-related complications (Haskell, 2003).
In Ornish’ s Lifestyle Heart Trial, findings suggest that the degree of spiritual well-being may be an important factor in the progression or regression of CHD (Morris, 2001) and recent studies show evidence that negative psychosocial factors contribute significantly to its development (Razanski, Blumenthal, & Kaplan, 1999). The impact of CHD on American society is enormous. It is the number one killer for both men and women and is the leading cause of premature, permanent disability in the workforce accounting for 19% of disability allowances by the Social Security Administration (American Heart Association, 2004).
Technology-enhanced biophysical and pharmacologic interventions have been the mainstay of CHD management. The technological advancements of the past century have provided the healthcare industry with sophisticated machinery to save and sustain life, shifting the focus from a caring, service-oriented model to a technological, cure-oriented model (Puchalski, 2001). A paradigm shift is hoped to happen this XXI century with the current impetus on the mind-body connection. Increased recognition is currently being given to the bio-psycho-social-spiritual model of care. In this holistic model, every disease entity has a psychosomatic component, and biological, psychological, social, and spiritual factors always contribute to symptomatology (Dossey & Keegan, 2000). PURPOSE OF THIS RESEARCH SYNTHESIS The purpose of this research synthesis was to analyze research literature regarding the role of spirituality in the coping of patients with cardiac illness during the period of January 1991 to October 2004.
The goals were to identify research progress, knowledge gaps, and priorities for future research; and to propose a study that will advance the science of the domain of spirituality. METHODS The Research Domain The domain of spirituality in the context of cardiac illness and recovery specifically CHD, acute myocardial infarction (AMI), congestive heart failure (CHF), post-coronary artery bypass graft (CABG), heart transplantation, healthy-heart promotion, and effects on blood pressure was the focus of this research synthesis. Research on spirituality and cardiac illness branched out from the broader domain of spirituality and health.
To conduct an exhaustive search of the domain and gain insight as to how research on spirituality in cardiac illness emerged from the broader domain of spirituality and health, the keywords spirituality and health without delimiters were used initially in electronic database searches for the period from1980 to 2004.
Ancestral searching was also utilized. A PubMed search yielded zero results from 1980 to 1983; 42 results from 1984 to 1993; and 815 results from 1994 to 2004. When delimiters were added to the search terms (middle-aged + aged: 45+ years, publication date from 1980 to 2004, English) were used, PubMed yielded 261 and CINAHL, 346 articles. Dates were further delimited to 1991 to 2004. Inclusion and Exclusion Criteria Research articles were retrieved electronically via PubMed and CINAHL.
The main criterion for inclusion in this synthesis was that the research article pertained to spirituality in the context of cardiac illness and recovery and published in a refereed journal. Research studies that related spirituality and cardiac illness to variables such as the constructs of hope, optimism, self-efficacy, uncertainty, and health locus of control were also included. Only articles in English with subjects above 18 years old that were published between January 1991 to October 2004 were scrutinized for inclusion. Excluded in this synthesis were editorials, theoretical literature, quality improvement projects, abstracts, unpublished doctoral dissertations, and articles published in Public Health Reports. Keywords for spirituality included spirituality, spiritual health, spiritual well-being, spiritual dimension, spiritual care, spiritual distress, spiritual need, spiritual support, spirituality assessment, spirituality measurement, religion, religiosity, purpose in life, meaning in life, transcendence, and connectedness.
Keywords for cardiac illness included coronary heart disease CHD, coronary artery disease, CAD, heart disease, congestive heart failure, CHF, chronic heart failure, heart failure, acute myocardial infarction, AMI, myocardial infarction, coronary bypass graft surgery, CABG, open-heart surgery, cardiac surgery, and cardiovascular.
With CINAHL’ s yield of 346 articles was further delimited to spirituality and the cardiac disease subcategories of CHD, AMI, CABG, CHF, and heart transplantation. Thirteen (3.8%) emerged that closely met inclusion criteria. From PubMed’ s yield of 261 articles emerged 20 (7.7%) that closely met inclusion criteria. A combined CINAHL and PubMed yield gave an initial pool of 33 articles, 26 (78.8%) of which were selected to be included in this research synthesis. No article was obtained via ancestral search. The earliest article in this research synthesis was published in 1991 by Saudia, Kinney, Brown, and Young-Ward. Instrument Critical and systematic analysis of each study was done using Moody’ s Research Analysis Tool Version 2004 (MRAT-04), a 46-item comprehensive research analysis tool (Moody et al. , 1988).
It was available electronically and was formatted and coded into the Statistical Package for Social Sciences (SPSS) software to facilitate data analysis. Each article was treated as a single unit of data with multiple data points as determined by the applicable number of items in the MRAT-04. Study Sampling and Sample The final sample consisted of 26 research studies that met inclusion criteria for spirituality and cardiac illness distributed as follows: eight studies (30.8%) on CABG, six (23.1%) on CHF, four (15.4%) on a heart transplant, three (11.5%) on CHD, two (7.7%) on AMI, two (7.7%) on influence on BP, and one (3.8%) on healthy-heart promotion.
Four studies (15.4%) were conducted outside the USA. Most of the studies were conducted in single sites; three (11.5%) were conducted on two sites. Seven (27%) of the studies were part of a larger study. The major type of data analyzed in all the studies were primary data. Profile of Studies Research articles on spirituality and cardiac illness during the study period were published in 20 refereed journals. CONCLUSIONS The findings identified in the research synthesis in the domain of spirituality in cardiac illness provided a good base from where a conceptual model of spirituality can be framed from.
It is notable that themes that emerged can be organized within the seven constructs in the framework of the proposed conceptual model of spirituality. The challenge that is at hand is the identification of research instruments to measure the seven constructs of spirituality.
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Raholm, M. B. (2002). Weaving the fabric of spirituality as experienced by patients who have undergone coronary bypass surgery. J Holist Nurs.20 (1), 31-47.