SPIRITUALITY IN HEART FAILURE PATIENTS 1

Background. Heart failure (HF) is a severe, progressive disease that afflicts large numbers of individuals around the world. One significant factor affecting quality of life in persons with HF is the extent to which spiritual needs are met. Developing an understanding of spirituality in the HF patient is essential in order for the healthcare professional to provide the highest quality care possible. This study focused on examining spirituality in HF patients by means of conducting in-depth interviews with individuals diagnosed with HF and completing a descriptive analysis of the responses. The goal of this study was to gain insight into how spirituality affects the healthcare professional-patient relationship in regards to HF. Methods. This project was a qualitative descriptive study in which six people with established diagnoses of HF were interviewed in-depth utilizing a reliable spiritual assessment tool, FICA (Faith, Importance, Community, Address in care), as a base accompanied by follow up questions. The data were transcribed and critically analyzed. Results. Five of six participants in this study verified important spiritual beliefs and described various ways these impact their day-to-day lives, relationships, and healthcare practices. One participant denied spirituality or religion to be significant in her life. SPIRITUALITY IN HEART FAILURE PATIENTS 2 Conclusion. The findings of this study support the premise that spirituality is unique to each individual. By inquiring into a patient’s spiritual beliefs, one can access a wealth of information regarding the individual’s background, personality, psychological state, ideals, and more. The possible positive impact addressing spirituality could have for both patients and providers will remain unknown until further research is conducted. LITERATURE REVIEW Heart failure (HF) afflicts numerous individuals including approximately 5.1 million people in the United States. Of those suffering from HF, about fifty percent die within five years of their diagnosis (Go et al., 2013). Ensuring that such individuals maintain the highest quality of life possible throughout their disease process is the ultimate goal of health professionals. One important aspect of quality of life is spirituality. Despite the fact that HF is known to cause spiritual distress, health care providers often do not address this distress leading to negative consequences for the patient (Molzahn et al., 2012). HF is a serious, chronic disease that develops when the heart is no longer able to pump blood sufficiently, causing circulatory needs of the body to go unmet (McCall, 1994). HF is highly prevalent and exceedingly expensive, as it is estimated to have cost the U.S. $39.2 billion in 2010 (CDC, 2010). When diagnosed with HF, individuals may experience symptoms including but not limited to shortness of breath, increased respirations, pulmonary crackles, activity intolerance, edema of the lower extremities, increased abdominal girth, and SPIRITUALITY IN HEART FAILURE PATIENTS 3 weight gain (Konick-McMahan, Bixby, & McKenna, 2003). In order to reduce the severity of such symptoms, improve functional status, and delay disease progression, many lifestyle alterations are required of such patients. These consist of following stringent medication regimens, adhering to a low-sodium diet, incorporating daily exercise, and avoiding excess tobacco, alcohol, and fluid (Black, Davis, Heathcotte, Mitchell, & Sanderson, 2006). Patients diagnosed with HF tend to experience a decreasing quality of life as their disease progresses towards the end stage and they are less and less able to perform activities of daily living (Rector et al., 2006). A study performed with 101 end stage HF patients found that those experiencing a religious struggle experienced greater depression, marginally decreased life satisfaction, and increased number of nights subsequently hospitalized (Park, Wortmann, & Edmondson, 2011). Health is generally taught to be multidimensional encompassing multiple, yet different realms including physical, social, intellectual, emotional, and spiritual health. If medical professionals aim to treat patients holistically, balance and depth between these distinctive areas of health must be attained (Cottrell, Girvan, & McKenzie, 2002). In focusing on the spiritual aspect of health, the term “spirituality” must be defined (Molzahn et al., 2012). In the past, spirituality was used interchangeably with religion. While religion is related to spirituality it is important to address the fact that the modern understanding of spirituality encompasses not only religion but also much more (Koenig, 2008, p. 349). Spirituality itself is seen by many to be multifaceted, including elements of the SPIRITUALITY IN HEART FAILURE PATIENTS 4 meaning and purpose in life, inner peace, hope and optimism, faith, wholeness and integration, experiences of awe and wonder, and spiritual connection and strength (WHOQOLSRPB Group, 2006). Dr. Christina Puchalski, designer of the FICA spiritual assessment tool, described spirituality simply as the values and beliefs that allow a person to experience transcendent meaning and purpose in life (Puchalski & Romer, 2000). Another approach explored by Roberts and Yamane (2011) that will be utilized for the purposes of this study clarifies religion as a social or group phenomenon as opposed to spirituality being more of an individual experience. While there continues to be discussion surrounding the definition of spirituality in the healthcare world, there is no debate that it is an influential element in the healing process and important to many patients suffering from chronic illnesses such as HF (Koenig 2002; Murray et al. 2004). The process of coping with severe illnesses, including HF, frequently produces a significant amount of stress among those diagnosed (Molzahn et al., 2012). Spirituality is an important tool by which patients may cope with this stress (Murray et al., 2004). Individuals with chronic diseases are living longer and it is late in life that many demonstrate heightened concern for spiritual issues (Mackenzie et al., 2000). Those afflicted often reflect upon life’s meaning and the major existential and spiritual questions that accompany this process (Frank, 1995; Charon, 2006; Remen, 2006). The presence of a spiritual struggle or strained meaning system as reported by cardiac patients is significantly connected to adverse effects in regards to individuals’ mental and physical wellbeing (Ano & Vasconcelles, 2005; Zwingmann et al., 2006). SPIRITUALITY IN HEART FAILURE PATIENTS 5 At the same time, increasing amounts of literature have been published supporting the connection between spirituality and psychological and bodily health (Koenig et al., 2004; Koenig 2009). A study by Sloan, Bagiella, and Powell (1999) found 79% of Americans believe that healing can be facilitated by spirituality. Since the start of the 21 century the idea that mind and body work together to impact health and illness has continued to increased in acceptance (Black et al., 2006). Some recognize that chronic diseases, such as HF, may even develop into a spiritual encounter for several patients (Narayanasamy, 2002). Properly caring for patients with diseases like HF can prove to be challenging and may cause the healthcare worker to feel helpless at times (Molzahn et al., 2012). Some healthcare educators believe inquiring about patients’ spirituality can be mutually beneficial to the healthcare provider-patient relationship. A study by Ehman et al. (1999) found that two-thirds of the pulmonary outpatient study participants would appreciate questions about spirituality in a medical history but only 15% of participants reported having been asked about spirituality. Many individuals in today’s society find it uncomfortable to openly discuss spirituality, and the health professional is no exception. Information provided in healthcare textbooks in regard to the subject is limited and often only briefly discussed (Puchalski & Romer, 2000). The personal beliefs and spiritual needs of patients are seldom integrated into healthcare plans and are regularly overlooked by healthcare workers (Black at al., 2006). This lack of expertise concerning the spiritual aspect of health may have a negative impact on the holistic care of the HF patient. SPIRITUALITY IN HEART FAILURE PATIENTS 6 Fostering a professional understanding of the complexities of spirituality as a whole could allow healthcare professionals to better understand their patients’ individual spiritualties and provide for higher quality patient-centered care. Addressing the realms of holistic health and stepping beyond scientific technicalities permits the healthcare worker to reconnect with the compassion that originally lead them into the healthcare profession and is beneficial to the patient (Puchalski, 2001). Much remains to be explored in regards to the advantage of incorporating the spiritual realm of health into patients’ plans of care. Therefore, the purpose of this study was to examine spirituality in patients with HF. METHODS Design. This project was a qualitative descriptive study utilizing semistructured open-ended interviews to examine spirituality in patients with established diagnoses of HF. Subjects. Participants were recruited through the Washington Regional Medical Center Heart Failure Clinic. Six individuals were selected based upon the following criteria: resides within Northwest Arkansas, currently well compensated with a history of stage II or III HF, speaks and understands English, upper level cognitive functioning and hearing are intact, and displays interest in participating in the study. Ethics. This study was conducted following approval from the Institutional Review Boards at the University of Arkansas and Washington Regional Medical Center. SPIRITUALITY IN HEART