Spirituality and Quality of Life in Chronic Illness
Adegbola, Maxine Rn, Msn, Journal of Theory Construction and Testing
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.
Keywords: spirituality, quality of life, FACT-Sp, FACT-G, chronic, holistic health
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 wellness 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 (CooperEffa, 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"-(Teilhard de 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. …