Spirituality and Spiritual Self-Care: Expanding Self-Care Deficit Nursing Theory

White, Mary L.


Heart failure (HF) is a chronic disease affecting an estimated 5.3 million men and women in the United States, with hospital discharges from for HF increasing by 171% since 1979. HF is the leading cause of hospitalizations admissions for the Medicare population. HF disease is 3 to 7 times higher in African Americans than White Americans. Spirituality among AAs is powerful and can provide coping skills for everyday life and have effects on health beliefs and practices that may affect health outcomes. Engaging in self-care and spiritual self-care activities can have a positive effect on quality of life. African Americans’ ability to cope with HF may be related to their perceived spirituality, levels of depression, and ability to engage in self-care and spiritual self-care. The purpose of this study is to extend the concept of spirituality and spiritual self-care within a self-care perspective that contributes to the quality of life of African American men and women diagnosed with HF. A substruction of Orem’s theory to incorporate spirituality and spiritual self-care into the Self-care Deficit Nursing Theory (SCDNT) needs to be tested to examine the influence of spirituality on self-care and quality of life. Six hypotheses will be tested in this study to determine the relationships among spirituality, spiritual self-care, physical and mental health, and quality of life. A purposive sample of 114 African American men and women diagnosed with HF will be asked to participate in the study. Participants will complete eight instruments: (a) Spiritual Involvement and Belief’s Scale – Revised; (b) Heart Failure Self-Care Behavior Scale; (c) Zung Self-Rating Depression Scale; (d) Patient Health Questionnaire; (e) Short Form (SF-12) Health Survey; (f) World Health Organization Quality of Life-BREF; (g) Spiritual Self-Care Practice Scale; (h) Researcher-developed demographic survey. HF clinical sites will be used to collect data from African American patients diagnosed with HF. African American patients previously diagnosed with HF who meet the inclusion criteria will be identified by their healthcare provider. They will be asked to read an information sheet that details the study and their rights as participants. Patients who agree to participate will complete instruments in the survey packet while waiting to see their health care provider. The instruments can be completed in 30 to 45 minutes. Patients who qualify for the study will receive a stipend of $20.00 for their participation. Data from the surveys analyzed using SPSS Windows, ver. 17.0. The data analyses will include descriptive statistics, multiple linear regression analysis, and mediation analysis. All decisions on the statistical significance of the findings will be made using an alpha level of .05. Findings of this study will be useful in developing nursing practices that incorporate spiritual self-care for patients with chronic illness, specifically HF. The health care professions need to recognize the role of spirituality in helping patients cope with their chronic illness. According to Orem, self-care is an important component of chronic illness treatment. While the present study focuses on HF, the findings will be applicable to other chronic illnesses.