Critical care hospitalisation is emotionally overwhelming for the relatives of patients. Research has shown that religiosity is an effective coping resource for people with health related problems and has been correlated with better health outcomes. However the processes by which religiosity is utilized and its effects on relatives of critically ill patients have not been adequately explored. This article presents relatives' experiences and processes of religiosity; it is part of a wider grounded theory study on the experiences of critically ill patients' relatives in Greece. Twenty-fi ve relatives of patients in the intensive care units of three public general district hospitals in Athens, Greece, participated in 19 interviews. Religiosity was found to be the main source of hope, strength and courage for relatives and was expressed with church/monastery attendance, belief in God, praying, and performing religious rituals. Health care professionals should pay attention and understand these aspects of coping.
KEYWORDS: experiences; distress; families; coping; religiosity; intensive care unit
Intensive care unit (ICU) hospitalisation causes great emotional distress to relatives in Greece (Plakas, Cant, & Taket, 2009) and internationally (Agard & Harder, 2007; Hughes, Bryan, & Robbins, 2005; Kutash & Northrop, 2007). Two studies conceptualised this emotional state as anticipatory grief (Coulter, 1989; Plakas et al., 2009). Paparrigopoulos et al. (2006) found that relatives of ICU patients in Greece suffered depressive and posttraumatic stress throughout the hospitalisation. Research has identifi ed religiosity to be among relatives' coping resources (Casarini, Gorayeb, & Filho, 2009; Chan & Twinn, 2007; Johansson, Hildingh, & Fridlund, 2002; Koller, 1991; Patel-Chua, 1996). However, very little is known about the ways in which religion helps in coping. This paper addresses that gap by presenting and discussing relatives' experiences of religiosity as a coping mechanism.
BACKGROUND Defi nitions of religiosity and spirituality
Religiosity and spirituality are terms that have been used interchangeably in the literature. However, it has been argued that they were wrongly considered synonymous (Burkhart & Hogan, 2008; Lee & Newberg, 2005). Spirituality is a broad concept encompassing practices, beliefs and attitudes toward mystical forces, or a higher power (Krebs, 2001), personal meanings and explanations (McSherry & Jamieson, 2011) which help to construct a meaning and purpose in life (Burkhart & Hogan, 2008; Yick, 2008), and is not associated necessarily with faith in a 'God'. Religiosity is associated with human expression of the rites and rituals of a particular faith tradition and with a form of God (Burkhart & Hogan, 2008, p. 928) and is limited to those practices, beliefs and attitudes which are part of an organised religious activity (Bjarnason, 2007).
In Christian religion, for example, God is the cosmic life regulator and the centre around which all revolve. As Yick (2008) argues, religiosity can be affected by culture and ethnicity; this might have been the case in Greece, where the culture is interlinked with the Greek Orthodox Christian faith. Christianity fl ourished in Greece nearly 2000 years ago; earlier than many other countries in the world. Greeks carry on a rich Christian Orthodox cultural tradition; there is a close link between religion, national identity and the state. Rosenbaum (1991) studying the health meanings and practices of Greek-Canadian widows observed that religiosity was central in their lives. The signifi - cance of religion and faith to God in Greek life is also evident in the fi ndings of a 2005 survey in 65 countries; Greeks were the most religious people among western Europeans and the eight most devout in the world. Eighty six per cent of Greeks self-defi ned themselves as religious whereas the Western European average was 60% (Voice of the People, 2005). …