Measuring Spirituality: Conceptual and Methodological Considerations
Gray, Jennifer PhD, Rn, Journal of Theory Construction and Testing
Measuring spirituality is difficult because multiple, competing definitions exist. None of the definitions may be congruent with the spirituality of a specific population, such as racially and ethnically diverse persons. The lack of conceptual clarity becomes a threat to construct validity. Other methodological challenges include social desirability and dependence on self report. Despite these challenges, the need to measure spirituality is great. Two tools used frequently to measure spirituality are evaluated in the context of these challenges: the Spirituality WellBeing Scale (Paloutzian & Ellison, 1982) and the Spiritual Perspective Scale (Reed, 1987).
Key Words: spirituality, measurement tools, spiritual well-being, spiritual needs, holistic nursing
Spirituality was integral to early nursing practice. Religious orders prepared nurses to care for the ill and dying as a benevolent service (Narayanasamy, 1999b). As nursing developed into a scientific discipline, education and research related to spirituality was not deemed appropriate in academic institutions. Spirituality has reemerged since 1980 as an appropriate topic for education and research, because of its influence on health and importance in the lives of our patients (Smith, 2006). This reemergence has resulted in increased efforts to operationalize aspects of spirituality for research. This paper will address the importance of measuring spirituality, acknowledging the inherent conceptual and methodological challenges. These challenges will be explicated through the evaluation of two spirituality instruments commonly used in nursing research: Spiritual Weil-Being Scale (Paloutzian & Ellison, 1982) and the Spiritual Perspective Scale (Reed, 1987).
Importance of Measuring Spirituality
The measurement of spirituality is important, because many patients view spirituality as a resource that influences their health. Using spirituality as a resource is not limited to patients with religious affiliations. Approximately 11% of Americans are not affiliated with an organized religion. Of this group, about a third prays at least occasionally. Over 60% believe in God (Baylor Institute for the Study of Religion, 2006). Pain, suffering, terminal illness, life events, and aging can precipitate an existential crisis that science cannot resolve. Patients may turn to their spiritual beliefs to provide meaning and hope. As a result, spirituality has been recognized as a resource by older persons (Foley, 2000; Hungelmann, Kenkel-Rossi, Klassen, & Stollenwerk, 1985; Hungelmann et al., 1996), persons living with HIV/AIDS (Gray, 1997; Gray & Cason, 2002; Coleman, 2004; Tuck, McCain, & Elswick, 2001), persons with cancer and their family caregivers (McClain, Rosenfeld, & Breitbart, 2003; Taylor, 2006), and persons with spinal cord injury (Matheis, Tulsky, Matheis, 2006).
Spirituality affects healing and health. Florence Nightingale described spirituality, an inherent human quality, as the most powerful resource for healing (Macrea, 1995). Contemporary nurses describe spirituality as a psychological resource for healing (Daaleman & Frey, 2004; Johnson, 2003; Smith, 2006). Spirituality's effect on physical health has also been documented (Lee & Newberg, 2005). Among African Americans living with HIV/AIDS, Coleman (2003) found existential well being was negatively related to HIV symptoms and positively related to cognitive function and mental well-being. Conner and Eller (2004) found a significant positive relationship between spirituality and perceived health among African American Christians. Only one study was found that linked stronger spiritual beliefs to poorer clinical outcomes (King, Speck, & Thomas, 1999).
Spirituality is essential to providing holistic care. Providing holistic care means attending to the body, mind, and spirit (Hardin & Kaplow, 2005; Harrison & Burnard, 1993; Narayanasamy, 1999b; Smith, 2006). …