Wellness Check: Spirituality

Spirituality has mixed effects on outcomes in ALS patients and caregivers

1. In this scoping review, qualitative studies on amyotrophic lateral sclerosis (ALS) demonstrated a perceived benefit of spirituality on outcomes in both patients and their caregivers.

2. However, quantitative studies demonstrated mixed results with respect to the role of spirituality on patient and caregiver outcomes.

Evidence Rating Level: 1 (Excellent)

Amyotrophic lateral sclerosis (ALS) is a debilitating motor neuron disease (MND) that often presents itself with significant psychological distress. Spirituality is an approach often used in palliative care to help patients suffering from terminal diseases, like ALS. However, few studies have evaluated the role of spirituality in patients with ALS and their caregivers. As a result, the objective of the present study was to review the literature on the role of spirituality in individuals with ALS and their caregivers.

Of 1208 identified records, 18 (n=387 patients; 214 ALS, 164 caregivers) studies were included from various databases from January 2006 to April 2022. Studies were included if they addressed spirituality in patients with ALS/MND or their caregivers. Studies were excluded if they evaluated outcomes relating to healthcare professionals treating ALS, or if they only addressed religiosity. The review was performed using Joanna Briggs Institute and PRISMA guidelines. The primary outcome was the role of spirituality or spiritual interventions on individuals with ALS/MND and their caregivers.

The results demonstrated that within the qualitative literature, spirituality helped caregivers cope and supported them during their new reality. For patients, spirituality allowed them to embrace a new interpretation of life and their diagnosis with a greater focus on gratitude and appreciation. However, the quantitative studies demonstrated that spirituality had a mixed effect on outcomes. Despite these results, the study was limited by the exclusion of languages other than English, Spanish, Portuguese, and French, which may have limited the comprehensiveness of the search. Nonetheless, the present study provided an important tool to guide health care professionals to better understand the role of spirituality in the context of ALS/MND patients and their caregivers.

COVID-19 survivors experience several challenges spanning multiple health domains

1. In this umbrella systematic review, several challenges were identified to affect COVID-19 survivors which spanned multiple domains, including psychological, physical, and spiritual.

2. Although this study highlighted several biomedical sequelae, there was a lack of evidence regarding the long-term spiritual impacts of COVID-19 infection.

Evidence Rating Level: 1 (Excellent)

Thousands of individuals have suffered from COVID-19 and have experienced ongoing sequelae as a result. However, currently there is limited research into the impacts of COVID-19 past the acute phase infection, and therefore limited resources to aid survivors. As a result, the objective of the present study was to summarize the physical, psychological, social, and spiritual impacts of COVID-19 beyond 4 weeks of the illness.

Of 4024 identified records, 18 (n=493 articles, n= 295,455 patients) studies were included from database inception to October 2021. All studies that investigated COVID-19 survivors were included, in order to maintain a wide scope. Studies were excluded if they did not look at the impacts of COVID-19 beyond the acute phase, or if they were reviews that were not based on primary empirical studies. The review was performed using PRISMA guidelines and the Joanna Briggs Institute umbrella review method. The primary outcome was the overall impact of the COVID-19 illness in survivors beyond the acute phase.

According to the study results, physical, cognitive, and psychological symptoms were reported beyond the acute phase of COVID-19, including fatigue, dyspnea, depression, anxiety, brain fog, and difficulty concentrating. In addition, there was heterogeneity in the presentation of the aforementioned symptoms, and there were no clear demographic or physical predictors of who would experience symptoms beyond the acute phase infection. Although there were many biomedical sequelae highlighted, there was a lack of evidence regarding the long-term spiritual impacts of COVID-19. As such, the study was limited by an emphasis on physical outcomes which provides mostly a biomedical view of the disease’s effect on patients’ lives. Nonetheless, the present study provided important knowledge to guide future research into the long-term holistic health effects of COVID-19.

Critical care staff who are spiritual may suffer from increased moral distress

1. In this scoping review, critical care staff who were spiritual experienced greater moral distress due to a lack of resources and their perceived moral standards.

2. Furthermore, a lack of institutional support in accessing spirituality resources contributed in part to their moral distress.

Evidence Rating Level: 1 (Excellent)

Due to their work environment, critical care staff experience high levels of moral distress which negatively impacts their health. Though spirituality plays an important role in overall wellness, current studies have not explored the association between spirituality, moral distress, and resilience in this population. As a result, the objective of the present scoping review was to evaluate the influence of spirituality on moral distress and resilience in critical care staff.

Of 242 identified records, 13 (n=4057 individuals) studies were included from various databases from 2017 to 2021. Studies were included If their objective was to evaluate the impact of spirituality on moral distress in critical care staff. Studies such as editorials, points of view, and letters were excluded. The review was performed using PRISMA guidelines and used the five-step framework proposed by Arksey and O’Malley. Study quality was assessed using the Standard Quality Assessment Criteria. The primary outcome was moral distress and resilience in critical care staff.

The results demonstrated that critical care staff who were spiritual had increased risk of moral distress. Reasons for the increased risk of moral distress in spiritual critical care staff included a perception of higher moral standards, and issues with accessing spirituality resources. Furthermore, it was found that critical care staff desired more institutional support in order to access spiritual interventions. Despite these results, the study was limited by inclusion of only studies primarily from the United States which may limit generalizability to critical care staff from other countries. Nonetheless, the present study demonstrated the need to implement additional strategies to support the well-being of critical care staff.

Spirituality may improve coping in women diagnosed with breast cancer

1. In this scoping review, it was shown that spirituality allowed patients with breast cancer to better cope with their diagnosis and treatment.

2. Furthermore, some included studies showed that nurses may play an important role in discussing topics of coping and spirituality, and in creating a supportive environment for women diagnosed with breast cancer.

Evidence Rating Level: 1 (Excellent)

Breast cancer is the leading cancer diagnosis in women and presents itself with life-altering emotional and physical implications. Currently, there is a lack of understanding of the role that spiritual coping has in response to a diagnosis of breast cancer. As a result, the objective of the present scoping review was to understand women’s spiritual and emotional coping experiences following a breast cancer diagnosis and to propose suggestions for clinical practice.

Of 1851 identified records, 20 studies were included from various databases from 2011-2019. Studies were included if they reported spirituality and emotional coping in breast cancer patients. Studies were excluded if they included women who had survived breast cancer, caregivers and family members, or patients with other types of cancer. The review was performed using Joanna Briggs Institute methodology and following PRISMA guidelines. Various study characteristics were extracted by the authors and were narratively summarized based on themes. The primary outcome was the spiritual experience of patients diagnosed with breast cancer.

The results demonstrated that breast cancer patients identified spirituality as a positive coping strategy at the time of diagnosis and during treatment. Furthermore, spirituality was found to help women coping with breast cancer find meaning in their experience. It was also found that nurses can play an important role in supporting recently diagnosed patients by asking about the importance of spirituality and encouraging discussions about coping strategies. Despite these results, the review was limited by the lack of clinical trials or international studies investigating spirituality in breast cancer patients. Nonetheless, the present study emphasized the importance of spirituality as a coping strategy for patients recently diagnosed with breast cancer.

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