A Need for Clarity in Funding Spiritual Interventions

Abstract

There is growing evidence that the use of spirituality and spiritual activities enhances quality of life and perceptions of well-being in individuals with serious illness (Carson & Green, 1992; Hall, 1998; Koenig et al., 1992). It has been suggested that many individuals use religion and religious practices as coping mechanisms in times of stress (Koenig, George, & Siegler, 1988). The theoretical foundation for the study of spirituality is based on the work of Reed (1987) and Frankl (1955, 1963). These authors conceptualized spirituality as consisting of two equally important but separate components: religion and transcendence. Religion is a created framework of beliefs, values, codes of conduct, and rituals. In contrast, transcendence is a level of awareness that exceeds ordinary physical boundaries and limitations (Reed, 1987). Spirituality is a broad, often abstract concept that includes the overlapping components of transcendence and religiosity, as well as the operationalization of these components in daily activities (i.e., religious or spiritual practices). In persons with HIV/AIDS, clinicians have long understood the importance of spiritual practices in maintaining a sense of well-being despite the presence of a life-threatening illness. Such use of spirituality has appropriately varied in its practice depending on the social and cultural groups implementing their beliefs. In the early years of the HIV/AIDS epidemic, when few medical treatments for HIV infection were available, gay men frequently turned to spiritual activities drawn from Eastern religious philosophy to transcend the symptoms of their illness and maintain a sense of wellness. As HIV/AIDS has moved into other populations, including people of color, the use of spiritual and religious activities to respond to illness has often been based more heavily on Judeo-Christian doctrine. My own research has demonstrated the relevance of spirituality and spiritual activities in HIV-infected women’s efforts to deal with their illness (Sowell et al., 2000). Depending on how spiritual activities were integrated into treatment care plans, they either served to support medically based treatment or acted as barriers to such treatment. In this issue of JANAC, McCormick, Holder, Wetsel, and Cawthon provide an excellent discussion of the use of spirituality as a resource in coping with HIV/AIDS. These authors argue for an integrated perspective of nursing practice that acknowledges the role of spirituality in creating a sense of empowerment in people with HIV/AIDS. However, to date, most research in the area of health and spirituality has been descriptive. At best, research has identified a relationship between spirituality and/or religious activities and positive health outcomes. What is needed is to move the knowledge we have gained in such exploratory work to the testing of spiritually based interventions. Although spirituality may continue to be viewed as too abstract or too poorly operationalized by many traditional researchers, we have enough knowledge to move our research to controlled intervention studies. The challenges to moving spiritually based research to the intervention study level are twofold. First, there is a need to advocate for spiritually based interventions to establish a funding base for such research. Second, there is a need for researchers to develop ethical interventions that respect the individual’s spiritual beliefs and practices. These interventions have to be tested using accepted scientific methods and demonstrated empirical Editorial