Cancer affects individuals in all human dimensions. Cancer patients are more susceptible to spiritual distress. Several studies have addressed spiritual distress using quantitative designs; however, a qualitative approach to the experience of spiritual distress could provide a deeper understanding of the phenomenon. This study aims to synthesis the experience of spiritual distress as lived by cancer patients in qualitative primary studies. This is a literature review based on electronic databases search. A total of 4075 citations was identified and 23 studies were included. The most frequent qualitative research method was phenomenology (n = 15), and interviews were the main data collection method (n = 20). Two major themes have been identified related to the experience of spiritual distress: suffering and coping. Spiritual distress is an intimate, deep and suffering experience in life, which requires coping strategies and involves spiritual values and beliefs. Healthcare providers should be aware of this experience and recognize spiritual distress in cancer patients, as it is critical in providing holistic nursing care.

Purpose: To assess the spiritual well-being (SWB) of cancer patients undergoing chemotherapy in an outpatient setting. Method: Quantitative, cross-sectional, and descriptive study. A convenience sample of 150 participants was obtained. Data collection instrument was a self-reported questionnaire that included the SWB Questionnaire (SWBQ), whose scores range from 20 to 100. SPSS software, version 21, was used in data analysis. The study was approved by the institutional ethics committee. Results: Patients’ ages ranged between 35 and 83 years; most were female (64.7%), married (68.0%), Catholic (86.7%), and with breast cancer (35.3%) and colorectal cancer (25.3%). The average SWBQ total score was 65.91 ( SD = 12.177). The highest score of the SWBQ was obtained in females, widows and singles, Evangelic and Catholic, and with lower educational level and professional occupation. The Cronbach α was 0.89, and the subscales αs ranged between 0.78 and 0.94. Conclusion: The SWBQ scores were reasonable. These results can guide nurses’ clinical reasoning, as the assessment of SWB may precede the diagnosis of risk for spiritual distress, readiness for enhanced SWB, or spiritual distress. Thus, the use of this instrument may facilitate spirituality being effectively implemented in clinical practice, favoring holistic health care.

PURPOSE This article explores the current structure of NANDA‐I nursing diagnoses (ND) labels. METHODS Critical analysis of the ND labels, as categorized in the NANDA‐I terminology. FINDINGS Most of the 244 ND labels are composed of terms from the focus and judgment axes. CONCLUSIONS The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. IMPLICATIONS FOR NURSING PRACTICE Improvements in NANDA‐I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient‐centered care. OBJETIVO Este artigo explora os títulos dos diagnósticos de enfermagem da NANDA‐I. MÉTODOS Análise crítica dos títulos dos diagnósticos de enfermagem da NANDA‐I. RESULTADOS A maioria dos 244 diagnósticos de enfermagem classificados são compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSÕES A especificidade das respostas às transições de saúde e vida pode não estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICAÇÕES PARA A PRÁTICA Melhorias nos diagnósticos da NANDA‐I em relação ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acurácia do processo diagnóstico que é necessário à prática clínica. Complementar os títulos dos diagnósticos de enfermagem poderia refletir a acurácia do raciocínio clínico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

Spirituality has been widely considered important for patients' health and for healthcare practice and is related to connectedness, meaning in life, and transcendence. Research concerning spirituality is growing rapidly, and the implementation of spiritual care should be based on evidence. This literature review aims to describe the methods that have been used in nursing research focusing on spirituality. The electronic search on databases through EBSCOhost identified 2091 citations, and a total of 231 studies were included. The methods used in research on spirituality in nursing are mostly quantitative (52.4%), but some are qualitative (42.8%) and mixed (4.8%). Regarding the quantitative research, most studies are observational (90.9%), and these are mainly descriptive (82.7%) and correlational (17.3%). Most studies used a cross-sectional design (98.7%), and few used longitudinal design (1.3%). The qualitative research is descriptive (39.4%), phenomenological (26.3%), and grounded theory (14.1%). Research on spirituality in nursing is based on both main paradigms (quantitative and qualitative), but also on mixed methods. Studies have mainly been conducted using cross-sectional designs when compared to longitudinal designs. The latter seem to constitute a gap in nursing knowledge and evidence regarding the changes of spirituality over time, which is particularly important for nurses' delivery of spiritual care.

Spiritual distress may ascend from unmet spiritual needs. The use of instruments to measure spiritual distress seems to facilitate the approach to spirituality, such as the Spiritual Distress Scale (SDS) that has been used worldwide. No instrument to assess spiritual distress in cancer patients is currently available in Portugal. This study aims to conduct the translation, adaptation and validation of the SDS in Portuguese cancer patients undergoing chemotherapy. Methodological study based on Sousa and Rojjanasrirat (2011), a seven-step approach, started with the linguistic translation to the psychometric tests. The main participants (55.4%) were older than 60 years; about 64.7% were females, married (68.0%), and 86.7% were Catholic. Moderate spiritual distress was experienced by 49.3% of the participants. Linguistic and conceptual equivalences were obtained. The SDS European Portuguese version has an overall Cronbach’s alpha of 0.91, and the subscales were as follows: “relationship with self” (0.92), “relationship with others” (0.63), “relationship with God” (0.64) and “facing death” (0.85). Four factors emerged after Varimax rotation. Overall, these results indicate that the SDS European Portuguese version has good psychometric characteristics and can used in assessing spiritual distress in cancer patients.

Background: Spirituality is a critical dimension in palliative care, but difficulties have been described in literature concerning the effective implementation and measuring of spiritual care. Aim: To translate, adapt and validate the Nurse Spiritual Care Therapeutics Scale (NSCTS) in Portuguese palliative care settings. Methods: A methodological study was conducted. A final version of the questionnaire included the scale and was submitted to full psychometric testing using nurses working in Portuguese palliative care settings. Findings: A total of 88 nurses participated. The average age of the sample was 36.1 ± 8.93 years (range 23–60 years), and 92.0% were women. A Cronbach alpha value of 0.88; Kaiser-Meyer-Olkin measure of sampling adequacy 0.80; and Bartlett's Test of Sphericity were adequate. An exploratory factor analysis was conducted using principal axis factoring with an oblimin rotation that resulted in a three-factors solution. Conclusion: The European Portuguese NSCTS questionnaire is a valid and reliable tool to assess the frequency of nurses' activities concerning spirituality in palliative care.

Research about spirituality has grown widely in the past decades and the interest in health care is also evident in Portugal. This literature review aims to identify and to characterize Portuguese theses, dissertations, and papers about spirituality in health, and to provide a systematic overview of the knowledge concerning this subject. The search was conducted in February 2017 and updated in January 2018. Four independent reviewers screened and analyzed all citations, and a total of 76 results were included. Publications started in 2002 and include master degree dissertations (n = 37), scientific papers (n = 31), and PhD theses (n = 8). Papers were published in 24 national and international journals. Most papers were psychology- and nursing-related and had a quantitative design (n = 55). Samples were mostly composed of patients living with a chronic disease (n = 20) or elderly (n = 11). The Spiritual Well-Being Questionnaire (SWBQ) was the most used tool. A multidisciplinary approach is regarded as foundational in implementing spirituality in the provision of health care and the results underline the interest on this topic from other disciplines rather than nursing. Further studies must provide a deeper understanding of spirituality in children, adolescents or families’ perspective bringing new insights to advanced health practice.

Spirituality is broadly concerned with life's meaning, connection to a higher power, and the possibility of transcendence. Spirituality is included with religion, but these are related but different concepts. Religion has a community foundation and embraces beliefs, practices, and rituals related to the transcendent (Koenig, 2012). Spirituality is a different concept than religion, universal and related with individual meaning in life and connection (Koenig, 2012;Weathers, McCarthy, & Coffey, 2016). Spirituality and religion beliefs and practices play a critical role in serious health conditions, such as cancer, rising coping in dealing and overcoming this complex situation (Cipriano-Steffens et al., 2020). For many, spirituality contributes to the alleviation of suffering and a sense of well-being, peace, and inner strength, and allows for coping in the face of a severe illness (Weathers et al., 2016). Cancer is characterized as a traumatic life event in which patients may experience spiritual distress (Hui et al., 2011).Patients with cancer who experience spiritual distress often report feelings of struggle regarding existential issues, lack of meaning and purpose in life, disconnectedness, loneliness, isolation, and an uncertain future (Cobb & Chang, 2018). The start of receiving chemotherapy is a life-changing event for patients with cancer. This life event is considered a transition from the scope of health or illness (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). Personal factors, such as patients' spiritual beliefs, can play a major role as facilitators to overcome this process (Meleis et al., 2000). Recently, spirituality has been discussed as an inherent dimension of the transition theory of Meleis (Martins & Caldeira, 2021). In addition, nurses in clinical practice have a therapeutic intervention in helping patients to achieve a successful and healthy transition (Schumacher, Jones, & Meleis, 1999).Patients with poor spiritual well-being have been reported to be overwhelmed by spiritual distress