Spirituality and Health

The Health Benefits of Religion

Spirituality and Religion in Nursing Theory

• As nursing sought to establish itself as a profession with a legitimate knowledge base, the concern with human spirituality was downplayed and even consciously ignored until the early 1980s

• To avoid falling into a mentality of treating patients merely as things, nursing theorists Betty Newman & Jean Watson began in the 80s to advocate that nurses cultivate an awareness of their client’s beliefs

Koenig and LarsonStudy 1988

• Harold Koenig and David Larson Studied 542 people aged over sixty, finding that over a year, those who attended church at least weekly were hospitalized 56 percent less (43 percent less after controlling for illness, age, and depression)

• Also, when hospitalized, those affiliated with any religion stayed less than half as long as those who claimed no religion

Results

• Research is on-going, with many outstanding concerns regarding methods

• However, there is growing evidence from 1000s of studies that considered aggregately show: higher degree of religious & spiritual practice is associated with lower mortality from all causes (i.e. it has a generally positive impact on health)

• Don’t just trust me!—research paper is opportunity to test this claim

Spirituality, Health and Care

• Koenig, Mcullough, and Larson (2001) reviewed more than 1200 studies on religion and health, 2/3 of which showed a significant statistical relationship between religious activity, better physical health, and lower use of medical services

• International Council of Nurses has declared that culturally congruent health care “is a basic human right, not a privilege” (ICN, Code for Nurses, 1973)

• International Council of Nurses (2005) defines health as “Mental, physical, social and spiritual wellbeing”

Holisitic Care

• An approach to medicine that sees wellness as a state of harmony between body, mind, emotions, and spirit in an ever-changing environment

• Care of the whole person, including the mind and spirit, is a professional nursing responsibility

• Since people’s spiritual beliefs can conflict, it is important for nurses to learn about the spiritual beliefs of others and think about their own beliefs so they can work an appropriate approach to responding to the spiritual needs of others

SPIRITUALITY, HEALTH AND NURSING PRACTICE: CNA Position Statement

2010• Therapeutic communication skills

identified by the CNA as competencies:– Openness to a range of spiritual

perspectives (or lack thereof ) is part of ethical nursing practice

– Nurses need not feel they must be knowledgeable in particular spiritual traditions, but they are required to be open to inviting or allowing reflection by the individual on the spiritual dimension of his or her experience of illness and suffering

– Nurses may deem self-reflection on their own spiritual beliefs to be beneficial to their practice

http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS111_Spirituality_2010_e.pdf

Possible Scientific Explanations

1. Strict moral standards can obviously can help promote healthy lifestyle

2. Typical group oriented character of religion supports our well-understood needs for group acceptance and interaction

3. Salvation beliefs can obviously effect our sense of security and well being

4. So-called supernatural effects might just be examples of the “placebo effect”

Happiness

• There is now extensive research suggesting that religious people are happier and less stressed (Rudin, Mike. 2006-04-30. "The science of happiness". BBC)

• Surveys by Gallup, the National Opinion Research Center and the Pew Organization conclude that “spiritually committed” people are twice as likely to report being "very happy" than the least religiously committed people

Financial Worry

• Survey of Canadian, 30% admit to worrying about their finances

• However, more of the “very religiously committed” (41%) than the “Non-Religious” (28%) say they do not worry, while more than twice as many of the non-religious (21%) than the very committed worry a great deal.

• This despite the fact that the average house-hold income of the “very committed” is a bit lower than that of the non-religious

Depression, Drug Abuse and Suicide

• An analysis of over 200 social studies contends that "high religiousness predicts a lower risk of depression and drug abuse and fewer suicide attempts, and more reports of satisfaction with sex life and a sense of well-being” (Smith, Timothy; Michael McCullough, and Justin Poll (2003). "Religiousness and Depression: Evidence for a Main Effect and Moderating Influence of Stressful Life Events". Psychological Bulletin 129 (4): 614–36.)

Self-Esteem, Hypertension

• A review of 498 studies published in peer-reviewed journals concluded that a large majority of them showed a positive correlation between religious commitment and higher levels of perceived well-being and self-esteem and lower levels of hypertension (David Myers The Science of Subjective Well-Being Guilford Press 2007 )

Forgiveness

• A wide range of studies indicate that forgiving those who hurt you can improve your mental and physical wellbeing– E.g. 2004 study showed that women

who were able to forgive their spouses and feel benevolent toward them resolved conflicts more effectively.

– forgiving is a skill you can honehttp://www.health.harvard.edu/press_releases/power_of_forgiveness

– In 1997, a Stanford University study found that college students trained to forgive were significantly less angry, more hopeful, and better able to deal with emotions than students not trained to forgive.

http://www.umm.edu/altmed/articles/spirituality-000360.htm#ixzz27UdLIj3R

Gratitude• Robert Emmons at the UC Davis divided

participants into 3 groups keeping daily journals:1. Group 1: Wrote 5 things they were grateful for2. Group 2: Described 5 daily hassles 3. Control: Listed 5 events that had affected themGroup 1 reported higher levels of life-satisfaction,

optimism, and fewer health problems • Hundreds of studies have replicated these results

– E.g. people suffering from neuromuscular diseases reported getting more sleep, spending less time awake before falling asleep and feeling more refreshed after sleep

– University of Connecticut study found that gratitude can have a protective effect against heart attacks—people who saw benefits and gains from their experience, experienced a lower risk of having another heart attack

• “Can prayer increase gratitude?” Lambert, Fincham, Braithwaite, Graham & Beach, Psychology of Religion and Spirituality, 1(3), 2009, 139-149. doi: 10.1037/a0016731—Yes

Longevity in the United States

University Of Colorado At Boulder (1999, May 17). Research Shows Religion Plays A Major RoleIn Health, Longevity. ScienceDaily.

4 Types of Influence Studied

1. Health Behaviors that influence health risks (Eg. Smoking, drinking, religious activities such as fasting, etc)

2. Adjustment to Illness (Eg. Psychosocial and Psychodynamic effects)

3. Physiological functioning and disease progression (Eg. Healing effects of meditation, prayer, fasting, or manipulation of super-empirical forces, such as “Chi”)

4. Effects of “spiritual care” by health care professionals

1. Health Behaviors

• Lower rates of coronary disease, emphysema, cirrhosis & suicide (Comstock & Partriidge 1972)

• Lower blood pressure (Larson, Koenig & Kaplan, 1989)

• Lower rates of heart attack (Madalie, Kahn & Neufeld 1973)

2. Adjustment to Illness

• Improved functioning, compliance, self esteem & lower anxiety 1 year after heart transplant (R.C. Harris et. al. 1995)

• Reduced levels of pain in cancer patients (Yates, Chalmers, St James, et. al. 1981)

• Better perceived health and less medical service utilization (Frankel & Hewitt, 1994)

• Decreased disability among nursing home dwellers (Idler & Kasl, 1992, 1997)

3. Disease Progression - Meditation

• Alexander, Langer, Newman and Chandler (1989) compared impact on short-term mortality of 73 nursing home residents of Transcendental Meditation, Mindfulness Meditation, Relaxation Training and a control group. At 3 years TM group had a 100% survival rate, 87.5% for the MM group, 65% for the RT group and 62.5 for the control.

3. Disease Progression - Intercessory Prayer

• Byrd (1988), Sicher, Targ, Moore & Smith (1998), W.S. Harris (1999) conducted double blind studies on effects of prayer on mortality after heart attack. Patients prayed for– used 7% fewer antibiotics– 6% less need for intubation– 6% less pulmonary edema– 6% less congestive heart failure– 5% less heart attack

4. Effects of “Spiritual Care”

• A few studies have documented a positive relationship between care-giver attitudes towards spiritual care-giving and self-reported feelings of spiritual well-being (Millison & Dudley, 1990; Highfield, Taylor & Amenta, 2000)

• Still much controversy over whether “spiritual care” helps improve health outcomes (Sloan et. al 2000, VandeCreek, 1999 vs. Weaver et. all., 2002)

The Placebo Effect

• A placebo is a sham medical intervention

• In one common placebo procedure, a patient is given an inert sugar pill, told that it may improve his/her condition, but not told that it is in fact inert

• Such an intervention may cause the patient to believe the treatment will change his/her condition; and such belief sometimes seems to have a therapeutic effect, causing the patient's condition to improve

• This phenomenon is known as the placebo effect