NURSES’ EXPERIENCES IN PROVIDING SPIRITUAL CARE OF PATIENTS WITH HEART FAILURE
Downloads
Introduction: Spirituality plays an important role in the physical health of patients with chronic diseases. This study aimed to explore the experiences of nurses in providing spiritual care to patients with heart failure (HF) in Indonesia. Method: This study employed a descriptive exploratory design with a qualitative approach. Thirteen nurses from the cardiology unit were selected using purposive sampling. Data were collected through semi-structured interviews and field notes. Thematic analysis was conducted to analyze the data. Results: Five major themes emerged, including perceptions regarding spiritual care, the importance of meeting the spiritual needs of patients, implementation of spiritual care, obstacles in providing spiritual care, and nurses’ hopes. Most participants associated spiritual care with religious practices. All participants believed that the spiritual needs of patients with HF must be met. However, spiritual care was still rarely implemented. Nurses commonly assisted patients in performing religious practices rather than addressing existential needs. The barriers to providing spiritual care originated from patients, nurses, and the availability of tools. The nurses hoped that specific personnel could provide spiritual care and that spiritual guidance activities in the hospital could be reactivated. Conclusions: Spiritual care remains a neglected aspect in the treatment of patients with HF. Facilitating religious practices is the primary intervention that fulfills the spiritual needs of patients with HF in Indonesia.
Abu, H. O., Ulbricht, C., Ding, E., Allison, J. J., Salmoirago-Blotcher, E., Goldberg, R. J., & Kiefe, C. I. (2018). Association of religiosity and spirituality with quality of life in patients with cardiovascular disease: a systematic review. Quality of Life Research, 27, 1–21. https://doi.org/10.1007/s11136-018-1906-4
Aburuz, M. E. (2018). Anxiety and depression predicted quality of life among patients with heart failure. Journal of Multidisciplinary Healthcare, 11, 367–373. https://doi.org/10.2147/JMDH.S170327
Ahmad, M., & Khan, S. (2016). A Model of Spirituality for Ageing Muslims. Journal of Religion and Health, 55(3), 830–843. https://doi.org/10.1007/s10943-015-0039-0
Alhurani, A. S., Dekker, R. L., Abed, M. A., Khalil, A., Al Zaghal, M. H., Lee, K. S., Mudd-Martin, G., Biddle, M. J., Lennie, T. A., & Moser, D. K. (2015). The Association of Co-morbid Symptoms of Depression and Anxiety With All-Cause Mortality and Cardiac Rehospitalization in Patients With Heart Failure. Psychosomatics, 56(4), 371–380. https://doi.org/10.1016/j.psym.2014.05.022
Alpert, C. M., Smith, M. A., Hummel, S. L., & Hummel, E. K. (2017). Symptom burden in heart failure: assessment, impact on outcomes, and management. Heart Failure Reviews, 22(1), 25–39. https://doi.org/10.1007/s10741-016-9581-4
Atarhim, M. A., Lee, S., & Copnell, B. (2018). An Exploratory Study of Spirituality and Spiritual Care Among Malaysian Nurses. In Journal of Religion and Health (pp. 1–15). Springer New York LLC. https://doi.org/10.1007/s10943-018-0624-0
Bakar, A., Adriani, M., Nur Qomariah, S., Hidayati, L., Nur Pratiwi, I., & Ni, L. (2017). Nurses’ Spirituality Improves Caring Behavior. International Journal of Evaluation and Research in Education (IJERE) Journal, 6(1), 2252–8822. https://doi.org/http://dx.doi.org/10.11591/ijere.v6i1.6343
Bekelman, D. B., Dy, S. M., Becker, D. M., Wittstein, I. S., Hendricks, D. E., Yamashita, T. E., & Gottlieb, S. H. (2007). Spiritual Well-Being and Depression in Patients with Heart Failure. J Gen Intern Med, 22, 470–477. https://doi.org/10.1007/s11606-006-0044-9
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Carpenter, K., Girvin, L., Kitner, W., & Ruth-Sahd, L. A. (2008). Spirituality: A dimension of holistic critical care nursing. Dimensions of Critical Care Nursing, 27(1), 16–20. https://doi.org/10.1097/01.DCC.0000304668.99121.b2
Chen-Scarabelli, C., Saravolatz, L., Hirsh, B., Agrawal, P., & Scarabelli, T. M. (2015). Dilemmas in end-stage heart failure. Journal of Geriatric Cardiology, 12, 57–65. https://dx.doi.org/10.11909/j.issn.1671-5411.2015.01.007
Chew, B. W., Tiew, L. H., & Creedy, D. K. (2016). Acute care nurses’ perceptions of spirituality and spiritual care: an exploratory study in Singapore. Journal of Clinical Nursing, 25(17–18), 2520–2527. https://doi.org/10.1111/jocn.13290
Clark, C. C., & Hunter, J. (2018). Spirituality, Spiritual Well-Being, and Spiritual Coping in Advanced Heart Failure: Review of the Literature. In Journal of Holistic Nursing, 37(1), 1–18. https://doi.org/10.1177/0898010118761401
Cooper, K. L., Chang, E., Luck, L., & Dixon, K. (2020). How Nurses Understand Spirituality and Spiritual Care: A Critical Synthesis. Journal of Holistic Nursing, 38(1), 114–121. https://doi.org/10.1177/0898010119882153
Donesky, D., Sprague, E., & Joseph, D. (2020). A new perspective on spiritual care: Collaborative chaplaincy and nursing practice. Advances in Nursing Science, 43(2), 147–158. https://doi.org/10.1097/ANS.0000000000000298
Egan, R., Macleod, R., Tiatia, R., Wood, S., Mountier, J., & Walker, R. (2014). Spiritual care and kidney disease in NZ: a qualitative study with New Zealand renal specialists. Nephrology (Carlton, Vic.), 19(11), 708–713. https://doi.org/10.1111/nep.12323
Gheorghiade, M., & Pang, P. S. (2009). Acute Heart Failure Syndromes. In Journal of the American College of Cardiology, 53(7), 557–573. https://doi.org/10.1016/j.jacc.2008.10.041
Gillilan, R., Qawi, S., Weymiller, A. J., & Puchalski, C. (2017). Spiritual distress and spiritual care in advanced heart failure. Heart Failure Reviews, 22(5), 581–591. https://doi.org/10.1007/s10741-017-9635-2
Gonçalves, J. P. D. B., Lucchetti, G., Menezes, P. R., & Vallada, H. (2017). Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials. In PLoS ONE, 12(10). https://doi.org/10.1371/journal.pone.0186539
Gross, L. M. (2016). A Muslim Archipelago: Islam and Politics in Southeast Asia. National Defense Intelligence College.
Herlianita, R., Yen, M., Chen, C. H., Fetzer, S. J., & Lin, E. C. L. (2018). Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia. Journal of Religion and Health, 57(2), 762–773. https://doi.org/10.1007/s10943-017-0437-6
Hosseini, M., Davidson, P. M., Khoshknab, M. F., & Nasrabadi, A. N. (2015). Experience of Spiritual Care in Cardiac Rehabilitation: An Interpretative Phenomenological Analysis. The Journal of Pastoral Care & Counseling : JPCC, 69(2), 68–76. https://doi.org/10.1177/1542305015586347
Jackson, D., Doyle, C., Capon, H., & Pringle, E. (2016). Spirituality, spiritual need, and spiritual care in aged care: What the literature says. Journal of Religion, Spirituality and Aging, 28(4), 281–295. https://doi.org/10.1080/15528030.2016.1193097
Janzen, K. C., Reimer-Kirkham, S., & Astle, B. (2019). Nurses’ Perspectives on Spiritual Caregiving: Tending to the Sacred. Journal of Christian Nursing : A Quarterly Publication of Nurses Christian Fellowship, 36(4), 251–257. https://doi.org/10.1097/CNJ.0000000000000575
Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A Concept Analysis of Holistic Care by Hybrid Model. Indian Journal of Palliative Care, 23(1), 71–80. https://doi.org/10.4103/0973-1075.197960
Johnson, K. S., Tulsky, J. A., Hays, J. C., Arnold, R. M., Olsen, M. K., Lindquist, J. H., & Steinhauser, K. E. (2011). Which domains of spirituality are associated with anxiety and depression in patients with advanced illness? Journal of General Internal Medicine, 26(7), 751–758. https://doi.org/10.1007/s11606-011-1656-2
Kimani, K. N., Murray, S. A., & Grant, L. (2016). Spiritual issues of people living and dying with advanced heart failure in Kenya: A qualitative serial interview study. BMJ Global Health, 1(3), 1–8. https://doi.org/10.1136/bmjgh-2016-000077
Kurniawati, N. D., Nursalam, & Suharto. (2017). Mind-Body-Spiritual Nursing Care in Intensive Care Unit. Advances in Health Sciences Research, 3(Inc), 223–228.
Marzband, R., Hosseini, S. H., & Hamzehgardeshi, Z. (2016). A concept analysis of spiritual care based on Islamic sources. Religions, 7(6), 1–11. https://doi.org/10.3390/rel7060061
McIlvennan, C. K., & Allen, L. A. (2016). Palliative care in patients with heart failure. BMJ (Online), 353. https://doi.org/10.1136/bmj.i1010
Mills, P. J., Wilson, K., Iqbal, N., Iqbal, F., Alvarez, M., Pung, M. A., Wachmann, K., Rutledge, T., Maglione, J., Zisook, S., Dimsdale, J. E., Lunde, O., Greenberg, B. H., Maisel, A., Raisinghani, A., Natarajan, L., Jain, S., Hufford, D. J., & Redwine, L. (2015). Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients. Journal of Behavioral Medicine, 38(3), 407–415. https://doi.org/10.1007/s10865-014-9615-0
Moosavi, S., Rohani, C., Borhani, F., & Akbari, M. (2019). Consequences of Spiritual Care for Cancer Patients and Oncology Nurses: A Qualitative Study. Asia-Pacific Journal of Oncology Nursing, 6(2), 137–144. https://doi.org/10.4103/apjon.apjon_37_18
Murray, S. A., Kendall, M., Boyd, K., Worth, A., & Benton, T. F. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: a prospective qualitative interview study of patients and their carers. Palliative Medicine, 18(1), 39–45. https://doi.org/http://dx.doi.org/10.1191/0269216304pm837oa
Murray, S. A., Kendall, M., Grant, E., Boyd, K., Barclay, S., & Sheikh, A. (2007). Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34(4), 393–402. https://doi.org/10.1016/j.jpainsymman.2006.12.009
Musa, A. S. (2017). Spiritual Care Intervention and Spiritual Well-Being: Jordanian Muslim Nurses’ Perspectives. Journal of Holistic Nursing, 35(1), 53–61. https://doi.org/10.1177/0898010116644388
Naghi, J. J., Philip, K. J., Phan, A., Cleenewerck, L., & Schwarz, E. R. (2012). The Effects of Spirituality and Religion on Outcomes in Patients with Chronic Heart Failure. Journal of Religion and Health, 51(4), 1124–1136. https://doi.org/http://dx.doi.org/10.1007/s10943-010-9419-7
Nascimento, L. C., de Freitas Moreira Santos, T., de Oliveira, F. C. S., Pan, R., Flória-Santos, M., & Rocha, S. M. M. (2013). Spirituality and religiosity in the perspectives of nurses. Texto e Contexto Enfermagem, 22(1), 52–60. https://doi.org/10.1590/S0104-07072013000100007
O’Brien, M. E. (2014). Spirituality in Nursing (5th ed.). Jones & Bartlett Learning.
Papathanasiou, I., Sklavou, M., & Kourkouta, L. (2013). Holistic Nursing Care: Theories and Perspectives. American Journal of Nursing Science, 2(1), 1. https://doi.org/10.11648/j.ajns.20130201.11
Park, C. L., & Sacco, S. J. (2017). Heart failure patients’ desires for spiritual care, perceived constraints, and unmet spiritual needs: relations with well-being and health-related quality of life. Psychology, Health and Medicine, 22(9), 1011–1020. https://doi.org/10.1080/13548506.2016.1257813
Park, C L, Aldwin, C. M., Choun, S., George, L., Suresh, D. P., & Bliss, D. (2016). Spiritual peace predicts 5-year mortality in congestive heart failure patients. Health Psychology, 35(3), 203–210. https://doi.org/10.1037/hea0000271
Park, Crystal L., Lim, H., Newlon, M., Suresh, D. P., & Bliss, D. E. (2014). Dimensions of Religiousness and Spirituality as Predictors of Well-Being in Advanced Chronic Heart Failure Patients. Journal of Religion and Health, 53(2), 579–590. https://doi.org/10.1007/s10943-013-9714-1
Pearce, M. J., Coan, A. D., Herndon, J. E., Koenig, H. G., & Abernethy, A. P. (2012). Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients. Supportive Care in Cancer, 20(10), 2269–2276. https://doi.org/http://dx.doi.org/10.1007/s00520-011-1335-1
Ponikowski, P., Anker, S. D., AlHabib, K. F., Cowie, M. R., Force, T. L., Hu, S., Jaarsma, T., Krum, H., Rastogi, V., Rohde, L. E., Samal, U. C., Shimokawa, H., Budi Siswanto, B., Sliwa, K., & Filippatos, G. (2014). Heart failure: preventing disease and death worldwide. ESC Heart Failure, 1(1), 4–25. https://doi.org/10.1002/ehf2.12005
Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014). Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus. Journal of Palliative Medicine, 17(6), 642–656. https://doi.org/10.1089/jpm.2014.9427
Pusat Data Kementrian Agama RI [Data Center of Ministry of Religion of Republic of Indonesia]. (2018). Data Umat Berdasar Jumlah Pemeluk Agama Menurut Agama [Data on People Based on The Number of Religious Adherents by Religion]. https://data.kemenag.go.id/agamadashboard/statistik/umat
Ramezani, M., Ahmadi, F., Mohammadi, E., & Kazemnejad, A. (2014). Spiritual care in nursing: A concept analysis. International Nursing Review, 61(2), 211–219. https://doi.org/10.1111/inr.12099
Reed, P. G. (1996). Transcendence: Formulating Nursing Perspectives. Nursing S, 9(1), 2–4. https://doi.org/10.1177/089431849600900102
Reig-Ferrer, A., De La Cuesta-Benjumea, C., Fernández-Pascual, M. D., & Santos-Ruiz, A. (2019). A view of spirituality and spiritual care in a sample of spanish nurses. Religions, 10(2). https://doi.org/10.3390/rel10020129
Ross, L., & Austin, J. (2015). Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: implications for nurse managers. Journal of Nursing Management, 23(1), 87–95. https://doi.org/10.1111/jonm.12087
Shahih International. (2021). Translation of the Meanings of the Noble Qur’an - English Explanation. https://quranenc.com/en/browse/english_saheeh
Shahrbabaki, P. M., Nouhi, E., Kazemi, M., & Ahmadi, F. (2017). Spirituality: A Panacea for Patients Coping with Heart Failure. International Journal of Community Based Nursing & Midwifery, 5(1), 38–48. http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=120897867&site=ehost-live
Siler, S., Mamier, I., Winslow, B. W., & Ferrell, B. R. (2019). Interprofessional Perspectives on Providing Spiritual Care for Patients With Lung Cancer in Outpatient Settings. Oncology Nursing Forum, 46(1), 49–58. https://doi.org/10.1188/19.ONF.49-58
Silverman, D. (2000). Doing Qualitative Research. Sage Publications.
Tadwalkar, R., Udeoji, D. U., Weiner, R. J., Avestruz, F. L., LaChance, D., Phan, A., Nguyen, D., Bharadwaj, P., & Schwarz, E. R. (2014). The beneficial role of spiritual counseling in heart failure patients. Journal of Religion and Health, 53(5), 1575–1585. https://doi.org/10.1007/s10943-014-9853-z
Tiew, L. H., Kwee, J. H., Creedy, D. K., & Chan, M. F. (2013). Hospice nurses’ perspectives of spirituality. Journal of Clinical Nursing, 22(19–20), 2923–2933. https://doi.org/10.1111/jocn.12358
Veloza-Gómez, M., Muñoz de Rodríguez, L., Guevara-Armenta, C., & Mesa-Rodríguez, S. (2017). The Importance of Spiritual Care in Nursing Practice. Journal of Holistic Nursing, 35(2), 118–131. https://doi.org/10.1177/0898010115626777
Weathers, E. (2018). Spirituality and health: A middle eastern perspective. Religions, 9(2). https://doi.org/10.3390/rel9020033
Westlake, C., Dyo, M., Vollman, M., & JT, H. (2008). Spirituality and suffering of patients with heart failure. Progress in Palliative Care, 16(5/6), 257–265. http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105590311&site=ehost-live
Willemse, S, Smeets, W., van Leeuwen, E., Janssen, L., & Foudraine, N. (2018). Spiritual Care in the ICU: Perspectives of Dutch Intensivists, ICU Nurses, and Spiritual Caregivers. Journal of Religion and Health, 57(2), 583–595. https://doi.org/10.1007/s10943-017-0457-2
Wong, K. F., & Yau, S. Y. (2010). Nurses’ experiences in spirituality and spiritual care in Hong Kong. Applied Nursing Research, 23(4), 242–244. https://doi.org/10.1016/j.apnr.2008.10.002
Wu, J.-R., Lennie, T. A., Frazier, S. K., & Moser, D. K. (2016). Health-related quality of life, functional status, and cardiac event-free survival in patients with heart failure. Journal of Cardiovascular Nursing, 31(3), 236–244. https://doi.org/10.1097/JCN.0000000000000248
Xing, L., Guo, X., Bai, L., Qian, J., & Chen, J. (2018). Are spiritual interventions beneficial to patients with cancer?: A meta-analysis of randomized controlled trials following PRISMA. Medicine, 97(35), e11948. https://doi.org/10.1097/MD.0000000000011948
Yingting, Z., Pal, R. Y., Wilson, T. W. S., Lee, A., Ong, M., & Hwa, T. L. (2017). Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study. International Emergency Nursing, 37, 13–22. https://doi.org/10.1016/j.ienj.2017.07.001
Yu, D. S., Li, P. W., & Chong, S. O. (2017). Symptom cluster among patients with advanced heart failure : a review of its manifestations and impacts on health outcomes. https://doi.org/10.1097/SPC.0000000000000316
Zehtab, S., & Adib-Hajbaghery, M. (2014). The importance of spiritual care in nursing. Nursing and Midwifery Studies, 3(3), e22261.
Copyright (c) 2025 Fanni Okviasanti, Hafna Ilmy Muhalla, Susilo Harianto, Cucuk Rahmadi Purwanto, Ah Yusuf, Ninuk Dian Kurniawati, Mei-Feng Lin

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright Notice
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution (CC BY).













