Journal of Education and Health Promotion

Abstract BACKGROUND: Since poor communication with the patient has a negative impact on the quality of 
nursing care, taking the necessary measures to strengthen the relationship with the patient seems 
necessary. This study was conducted to determine the effect of spiritual intelligence training on 
nurses’ skills for communicating with patients.
MATERIALS AND METHODS: This experimental study with the control group and the pretest‑posttest 
design was conducted on 70 nurses working in Imam Khomeini Hospital, Mahabad, in 2019. 
Randomized stratified sampling was used to recruit participants. Then, participants were randomly 
assigned to the two groups of control and intervention. The demographic information form and the 
patient‑nurse communication skill questionnaire were used to collect the data. For the intervention 
group, 7 spiritual intelligence training sessions were held as a workshop in 2 months. Two weeks 
and a month after the intervention, both groups completed the questionnaires. Data were analyzed 
with the SPSS software version 17.0.
RESULTS: The findings showed that the mean communication skill scores in the intervention group 
before training were 44.71 ± 7.62, which significantly increased to 66.22 ± 8.43 2 weeks after training. 
Bonferroni multiple comparisons showed the mean communication skill scores significantly increased 
before, 2 weeks later and in the follow‑up phase in the intervention group (P < 0.001).
CONCLUSION: Spiritual intelligence training is effective in improving the communication skills of 
nurses. It is recommended that the prepared content can be provided to in‑service training units; 
consequently, nurses can improve their communication skills by individual and group learning.

Abstract BACKGROUND: Competence in providing spiritual care to patients has become an increasingly
important aspect of nursing care delivery. However, studies on nurses’ competence in spiritual care
delivery and the factors affecting it are very limited. The present study was conducted to evaluate
Iranian nurses’ competence in providing spiritual care and its relationship with their Spiritual
Well‑Being.
MATERIALS AND METHODS: The present study is descriptive‑analytical research conducted in Bam
in the south of Iran between 2016 and 2017. All nurses working in the teaching hospitals affiliated
with Bam University of Medical Sciences were invited to participate in the study. For data collection,
the Spiritual Care Competence Scale (SCCS) and the Spiritual Well‑Being Scale (SWBS) were used.
Collected data were then analyzed using descriptive statistics (mean and standard deviation), Pearson
correlation coefficient, independent t‑test, and one‑way ANOVA with SPSS software.
RESULTS: In this study, 158 nurses were participated. The result showed that the mean score
SCCS and SWBS were 101 ± 12.6, 76.92 ± 13.4, respectively. Pearson correlation test showed a
significant and direct relationship between the mean score of SCCS and SWBS (P = 0.001, r = 0.264).
The results of this test also showed a significant relationship between all the dimensions of SCCS
and SWBS (P < 0.05).
CONCLUSIONS: In this study, the nurses had a relatively appropriate competence in providing
spiritual care to patients. There was also a significant relationship between the nurses’ spiritual
care competency and their spiritual well‑being. Given the lack of adequate studies in spiritual care
delivery competencies, it is recommended that similar studies are conducted among nurses in other
parts of the country and worldwide.

Abstract INTRODUCTION: Spiritual health is considered one of the important dimensions of health and has
been given serious attention by the scientific community, World Health Organization, health discourse,
and medical education. However, despite these considerations, there is a controversy in defining
the nature of this category and its dimensions and indicators. The purpose of this study is to identify
the indicators and dimensions of spiritual health for medical students.
MATERIALS AND METHODS: This qualitative study with exploratory approach utilized conventional
content analysis and individual in‑depth interviews with experts in the area of spiritual health and
spirituality in medical sciences selected through purposeful sampling. The study was conducted at
Aja University of Medical Sciences in Tehran in 2018. The semi‑structured interview was a tool used
to achieve data saturation, that interviewed with 19 experts. Member check, credibility, and reliability
were measured to increase the validity and reliability of the results. Inductive content analysis was
used for the analysis of data in three main phases: preparation, organization, and categories and
creating categories.
RESULTS: Based on the findings of the interviews, 52 indicators were identified.Then, the indicators
of spiritual health were identified in the following four categories) relationship with God, relationship
with himself, relationship with others, relation with the environment (and these categories were divided
inthree dimentions (cognitive, attitudes and emotions, behavioral)
CONCLUSION: The findings of the present study showed that in order to have spiritual health, it is
important to pay attention to one’s relationship with God and one’s relationship with oneself, one’s
relationship with others, and one’s relationship with the environment, and it is necessary to pay
attention to it in medical science curricula.

Abstract BACKGROUND: Death anxiety is one of the most common problems among women with cancer,
which can affect the useful treatment process. With regard to the superior role of spiritual well‑being
over other aspects of health, the present study is aimed to compare the relationship between spiritual
well‑being and death anxiety among women with breast and cervical cancers and women with gastric
and colorectal cancers.
METHODOLOGY: This was a descriptive–correlational study. Research statistical population included
Iranian women with cancer at major hospitals in Isfahan, Iran. 160 research samples were selected
through convenience sampling method based on inclusion criteria using a demographic questionnaire,
spiritual well‑being scale (Paloutzian et al.) and death anxiety scale (Templer). Research data were
analyzed through SPSS 22 using independent t‑test, Pearson’s correlation, and analysis of variance
at significance level 0.05.
RESULTS: The study findings indicated a significant inverse relationship between death anxiety
and spiritual well‑being (at 0.05) in both groups. As a result, people with higher spiritual well‑being
would experience less anxiety about death. In addition, the relationship between death anxiety and
spiritual well‑being in women with gastric and colorectal cancers was stronger than those with breast
and cervical cancers.
CONCLUSION: Spiritual well‑being is of effective factors of death anxiety among women suffering
from cancer. Spirituality and meeting spiritual needs are considered as nursing care priorities for
these women. Furthermore, paying attention to the spirituality by nurses may shield against individual
difficulties.

Abstract INTRODUCTION: Spiritual health is one of the four dimensions of health in humans, and the others
are physical, psychological, and social dimensions. This dimension is essential to increase the
adaptation to the disease. Therefore, this study was aimed to determine spiritual health in women
with multiple sclerosis (MS) and its association with self‑esteem.
METHODS: This is a descriptive cross‑sectional study, and 210 women with MS referring to Ayatollah
Kashani Hospital affiliated to Isfahan University of Medical Sciences were selected using convenience
sampling method. The data were collected by questionnaires of demographic characteristic
questionnaire (6 items), Rosenberg Self‑esteem Scale (10 items), and Ellison and Paloutzian Spiritual
Well‑being Questionnaire (20 items). Data were analyzed using descriptive statistics, Pearson’s
correlation coefficient, and multiple regression analysis at a significance level of 0.05.
RESULTS: The mean and standard deviation of spiritual health  (including religious health and
existential health) and self‑esteem in MS patients were 48.8 ± 6.80, 44.7 ± 6.70, and 3.21 ± 2.5,
respectively. The results showed that 95.2% of the research units had moderate‑to‑high
spiritual (religious and existential) health and 57.7% had high self‑esteem. Pearson’s correlation
coefficient also showed a significant positive correlation between religious health and existential
with self‑esteem (r = 0.22, P = 0.03 and r = 0.24, P = 0.01, respectively).
CONCLUSIONS: In this study, most of the women with MS had high levels of spiritual health and
self‑esteem. This can be used as a coping strategy and has a protective effect against stress‑induced
illness and even against complications of the treatment. In addition, in some cases, it is effective in
alleviating frustration in these patients.

Abstract BACKGROUND: The importance of spirituality and spiritual growth in humans has been increasingly
taken to attention by psychologists and mental health professionals. In this study, we aimed to
investigate the relationship between the tendency to aggression and individual resilience also
considering the role of mediator of spirituality in academic students by path analysis.
MATERIALS AND METHODS: A cross‑sectional study was conducted using structural equation
method (SEM). The target population consisted all of undergraduate academic students in Ilam, Iran
University of Applied Sciences, in 2018. Participants included 200 people whom were selected by
stratified random sampling. Data collection tools were demographic, Buss and Perry aggression,
spirituality assessment, and resiliency of Connor and Davidson questionnaire. In this study, bivariate
analysis was used to determine the directionality correlation between the study variables.
RESULTS: The results showed that there was a significant and positive correlation between
spirituality and resilience (r = 154% r = 83%). Furthermore, there was a negative and nonsignificant
relationship between aggression with resiliency (r = −122% P = 101). In addition, there was no
significant correlation between the aggression and spirituality (r = 0.05%, P = 0.942). The results of
SEM showed that spirituality and aggression can predict about 20% of the variations in the degree
of resilience in academic students. Accordingly, the results of SEM spirituality in an indirect path
reduce the aggression and thus increase the resilience (r = 0.102).
CONCLUSION: The results of this study showed the effect of spirituality on increasing the level of
resilience and also positive mediator role of spirituality between aggression and resiliency.

Abstract A spiritual well‑being‑based nursing intervention may boost older adults’ resilience‑based recovery. Its
potential contribution may have positive knock‑on effects: controlling skyrocketing healthcare costs;
reducing the productive population’s social burden of supporting the older adults; and alleviating a
generational conflict. However, healthcare policy‑makers are still skeptical about investing in those
healthcare resources which would develop and implement a spiritual well‑being‑based nursing
intervention for older adults. It is time for nurse scientists, as front‑line gatekeepers for patients’
omnidirectional well‑being, to escape from thinking within the box by actively addressing first the
feasibility, then the direct and indirect effectiveness on actual patient outcomes, and finally the cost
efficiency of a spiritual well‑being‑based nursing intervention for the added benefit of easing the
decision‑making of healthcare policy‑makers.

Abstract INTRODUCTION: For Muslim patients confronted with chronic diseases, spirituality is an important
resource for coping. These patients expect the health team to take care of the spiritual aspects. This
study aimed to explore the spiritual aspects of care for chronic Muslim patients.
MATERIALS AND METHODS: This qualitative‑descriptive exploratory study was conducted in
Isfahan, Iran, on a purposive sample of 25 participants, including patients, caregivers, nurses,
physicians, psychologists, social workers, and religious counselors. Data were collected through
semi‑structured interviews and analyzed through conventional content analysis.
RESULTS: The spiritual aspects of care for chronic Muslim patients fell into four main themes.
The first theme was religious aspect with the three subthemes of doing religious rituals, attention
to religious values, and providing the possibility of performing religious practices. The second
theme, i.e., pastoral aspect, consisted of three subthemes, namely giving consultation for finding
the meaning of life/death, helping to achieve intellectual transcendence, and improve the patient’s
communication with herself/himself and others. The third theme was psychological aspect, the four
subthemes of which included instilling calm to the patient, helping the patient to adapt, instilling hope,
and empathy. Finally, the fourth theme was a supportive aspect and included the four subthemes of
maintaining patient’s basic needs, continuity of care at home, creating awareness, and acceptance
and observance of patient’s respect.
CONCLUSION: Providing care based on the spiritual needs of chronic patients requires knowledge
and skills that the health‑care team need to provide through inter professional collaboration.

Abstract Context: Successful aging is a pattern of aging that has gained much attention during recent
years. One factor that has a negative impact on successful aging variables is hypertension. The
phenomenon of aging when accompanied with hypertension promotes spiritual needs. The aim
of this study was to examine the effect of the Islamic spiritual program on successful aging in
elderly patients with hypertension who were referred to health centers of Isfahan, Iran, in 2014.
Settings and Design: This study was a randomized clinical trial. Materials and Methods: The
participants (52 elderly patients with hypertension) were randomly divided into experimental
and control groups. While the control group received training related to health promotion, the
Islamic spiritual program was implemented in the experimental group for eight sessions in two
health centers of Isfahan. The data collection tools consisted of the 12‑item General Health
Questionnaire developed by Goldberg and the satisfaction with life scale developed by Diener.
The questionnaires were completed in three steps; pretest, posttest, and follow‑up (1‑month).
Statistical Analysis Used: Data were analyzed using SPSS statistical software version 20
and Chi‑square, independent t‑test, and repeated measures ANOVA. Results: Statistical tests
showed that the mean score of general health and life satisfaction of the experiment group had
a meaningful difference from that of the control group in the posttest stage (P < 0.001). This
difference was also meaningful in the follow‑up stage (P < 0.001). Conclusion: The results of the
study indicated the effectiveness of an Islamic spiritual program on successful aging variables.

Abstract Background: Although 25‑33% of patients with non‑hematological malignancies suffer from
depression disorder, some studies have reported the rate among patients with leukemia as
high as 50%. Furthermore, based on studies chronic disease such as leukemia increases the
patients’ spiritual needs and may accelerate the patient problems. Therefore, spirituality has
a significant role in adapting to leukemia and coping with its consequent mental disorders
such as depression. Owing to the spirituality aspect importance and contradictory results of
previous research, this study was hence performed to determine the effects of a spiritual care
program on depression of patients with leukemia. Materials and Methods: This randomized
clinical trial was conducted in specialized cancer treatment center affiliated to Isfahan
University of Medical Sciences (Isfahan, Iran). A total of 64 adult patients with leukemia were
randomly divided into experiment and control groups. The spiritual care program including
supportive presence and support for religious rituals was implemented for 3 days. Depression
sub‑scale of 42‑item depression, anxiety and stress scale‑42 was completed before and after
the intervention for both groups. Data was analyzed using ANCOVA, Mann‑Whitney U‑test,
Chi‑square, in SPSS statistical software (version 18, SPSS Inc., Chicago, IL). Results: After
the intervention, mean score of depression was significantly lower in the experiment group
than in the control group (P < 0.01). Comparison the mean score of depression in two groups,
revealed the decrees in mean score of depression 11.09 (8.47) after spiritual care program
that it was significant (P < 0.001). Conclusion: Our spiritual care program could successfully
decrease depression level in patients with leukemia and nurses have to apply a holistic care
approach with emphasis on spiritual care to decrease depression, so paid attention to spiritual
aspect of patients accompanying with physical aspects in therapy process is recommended.

Abstract Introduction: Due to the impacts of spirituality and its dimensions on psychological structures in the
workplace and their ability to influence organizational performances have received a great attention
in recent years. Thus, this study investigated the relationship between dimensions of spirituality
with mental health and hope for future. Materials and Methods: This is a correlational study with
a statistical population, including public Hospital’s personnel of Shiraz done in autumn 1389. To
collect the research data, three different types of questionnaires were used: (1) Hope for the future
(4 items), (2) mental health (12 items), and (3) components of religiosity/spirituality at (31 items and
based on 5 components). Data were analyzed using Pearson’s correlation and Hierarchical regression
analysis. Findings: Research findings show that there are significant correlations between existential
well-being and hope for the future, motivation, devotion and coping and hope for the future, and
mental health and hope for the future. Furthermore, all components of religiosity/spirituality have
had significant correlations with mental health. Hierarchical regression analysis showed that in the
first step motivation, devotion and coping with a variance of 5%, in the second step motivation,
devotion and coping with mental health with a variance of 6.4%, in the third step motivation, devotion
and coping with mental health and existential well-being with a variance of 9.1% and in the fourth
step, the combining of motivation, devotion and coping and existential well-being with a variance
of 8.9% with hope for the future have meaningful multiple relationships. Conclusion: Findings
indicated that motivation, devotion and coping with existential well-being, respectively, were the
most important dimensions of religiosity-spirituality that together with mental health affect hope for
future. It is necessary that the dimension of motivation, devotion and coping, existential well-being
and personnel mental health should be strengthened to increase the staff’s hope for future.

Abstract Background: Spiritual well‑being is well‑recognized as a factor that affects cancer patients’
quality of life, quality of care, and satisfaction. There is evidence that supports the fact that
patients’ spiritual needs are associated with better quality of care, higher hospice utilization,
and less aggressive care at the end of life. However, few studies have examined the Spiritual
well‑being (SWB) in cancer patients. Less is known about spirituality; furthermore, no published
research about SWB and its relationship with demographic parameters in breast cancer
patients exists; this made us carry out this project. Materials and Methods: This cross‑sectional
study was a descriptive – analytical one, conducted on 297 breast cancer patients, with
a simple sampling methodology. The data collection instrument included a questionnaire
containing two parts (demographic information and standard SWB Scale questionnaire). The
data were analyzed with 95% confidence by SPSS18, using descriptive and analytic statistics.
Results: According to the results of the present study, SWB of most of the study subjects (52.52%)
was at a moderate level. Results showed that the average score for religious aspect of spiritual
well‑being (RWB) was 51.38 ± 8.17 for 60, average score for the existential aspect of spiritual
well‑being (EWB) was 42.47 ± 10.21 for 60, and the total score of SWB was 93.69 ± 10.04 for 120.
Based on the study findings, there was a statistically significant correlation between the SWB and
age (P = 0.03, r = 0.59), educational level (P = 0.04, r = −0.58), and marital status (P = 0.001), of
breast cancer patients. Conclusion: According to the results of the present study, the SWB of
most study subjects was at a moderate level. Furthermore, according to the results there was a
correlation between some important demographic parameters in women with breast cancer and
SWB. Hence, it is necessary for the treatment team to assess and improve the SWB of patients;
meanwhile the role of nurses is highlighted. In fact, the nurse is the first person who can recognize
the spiritual needs of a patient and even his/her family, and can be effective in meeting the spiritual
needs and improving their SWB. Therefore, it is strongly recommended that in patients with cancer,
a holistic care plan, based on spiritual care, development, and education of patients be applied, as
it is considered to improve their SWB.