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Background: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). Aim: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. Methods: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). Results: Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants’ spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants’ experience in ICU/ED, and being of the male gender are further predictors of MD burden. Conclusions: MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.

The FeverApp Registry is a model registry focusing on pediatric fever using a mobile app to collect data and present recommendations. The recorded interactions can clarify the relationship between user documentation and user information. This initial evaluation regarding features of participants and usage intensity of educational video, information library, and documentation of fever events covers the runtime of FeverApp for the first 14 months. Of the 1592 users, the educational opening video was viewed by 41.5%, the Info Library was viewed by 37.5%, and fever events were documented by 55.5%. In the current sample, the role of a mother (p &lt, 0.0090), having a higher level of education (p = 0.0013), or being registered at an earlier date appear to be cues to take note of the training video, Info Library, and to document. The FeverApp was used slightly less by people with a lower level of education or who had a migration background, but at the current stage of recruitment no conclusion can be made. The user analyses presented here are plausible and should be verified with further dissemination of the registry. Ecological momentary assessment is used more than the information option, in line with the task of a registry. Data collection via app seems feasible.

The Spiritual Needs Questionnaire (SpNQ) measures psychosocial, existential, and spiritual needs in clinical contexts. The objective was to confirm its factor structure in Brazil, comparing the results of its validation for Portuguese in Rio de Janeiro, under similar sampling conditions, in Jo&atilde, o Pessoa (Para&iacute, ba-Brazil), among 157 HIV(Human Immunodeficiency Virus)+ patients, most of them men (49%) (women = 35%, other = 16%), aged between 30 and 49 years (53.5%). From exploratory factor analysis and internal consistency analysis a structure of five factors (or components) was obtained: Religious Needs (&alpha, = 0.73), Inner Peace and Family Support Needs, gathered (&alpha, = 0.64), Existential Needs (&alpha, = 0.49) and two new factors instead of &ldquo, Giving/Generativity Needs&rdquo, being Social Recognition Needs (&alpha, = 0.54), referring explicitly to religious practices, with items formerly found in the Religious Needs factor, and Time Domain: Reflection and Clarification Needs (&alpha, = 0.57), which group only two items (item 4, &ldquo, reflection on the past&rdquo, (formerly in the Inner Peace component) and item 5, &ldquo, resolution of outstanding problems&rdquo, ). The institutional religiosity perceived in the composition of the Social Recognition Needs component shows that these patients differentiate &ldquo, religiosity&rdquo, from &ldquo, spirituality&rdquo, The Religious Needs component was formed with items from the &ldquo, construct definition. The most important component was Inner Peace and Family Support Needs, a relevant coping strategy in this disease. The results met proper validity criteria, and SpNQ proved to be sensitive and appropriate to situations of cultural and clinical diversity between samplings.

Background: Sometimes prayer life can be difficult even for very religious persons, who may experience phases of &ldquo, spiritual dryness&rdquo, which may have a negative effect on their well-being. Methods: To address this topic, we analyzed three contrasting groups of persons (religious brothers and sisters (RBS), n = 273, Catholic lay persons (CLP), n = 716, other lay persons (OLP), n = 351) with standardized measures and investigated how often indicators of spiritual dryness were perceived within these groups and how the perception that private prayers go unanswered could be a result of this. Results: Spiritual dryness was highest in RBS compared to RLP and OLP. For RBS, perception of being &ldquo, spiritually empty&rdquo, was the best predictor of prayers going unanswered, indicating emotional/spiritual exhaustion, while in OLP, the perception that God is &ldquo, distant&rdquo, was the best predictor, indicating that, particularly in this (younger) group, spiritual doubt is of particular relevance. For CLP, feeling that God is distant, feeling abandoned by God, and feeling &ldquo, were similarly relevant predictors of feelings that prayers go unanswered. Conclusions: This knowledge may help psychologists/psychotherapists, pastoral workers, and spiritual advisors to differentiate the underlying causes of spiritual dryness (in terms of &ldquo, discernment&rdquo, ) and thus support persons struggling with God, their faith, and life.

The item response theory (IRT), or latent trace theory, is based on a set of mathematical models to complement the qualitative analysis of the items in a given questionnaire. This study analyzes the items of the Spiritual Needs Questionnaire (SpNQ) in the Portuguese version, applied to HIV+ patients, with R Studio 3.4.1, mirt statistical package, to find out if the items of the SpNQ possess appropriate psychometric qualities to discriminate between respondents as to the probability of marking one answer and not another, in the same item, showing whether or not the questionnaire is biased towards a pattern of response desired by the researcher. The parameters of discrimination, difficulty, information, and the characteristic curve of the items are evaluated. The reliable items to measure the constructs of each of the five dimensions of the SpNQ of this HIV+ sample (Religious Needs, Inner Peace and Family Support Needs, Existential Needs, Social Recognition Needs, and Time Domain Needs) are presented, as well as the most likely response categories, depending on the latent trace level of the individuals. The questionnaire items showed satisfactory discrimination and variability of difficulty, confirming the good psychometric quality of SpNQ.

Self-transcendent feelings such as gratitude, compassion, and awe are highly relevant for human societies. So far, empirical research has focused more on the relational aspects of these feelings (concrete persons), and less on the spiritual aspects referring to the Sacred in a person’s life. We intended to validate an extended version of the former three-item Gratitude/Awe scale. This extended scale was designed with a focus on the experiential aspects of being moved and touched by certain moments and places/nature, on related reactions of pausing with daily activities, and on the subsequent feelings of awe and gratitude. Enrolling 183 test persons (67% women; 59% with a Christian confession) in a cross-sectional study, we can confirm that the seven-item Gratitude/Awe scale (GrAw-7) has good psychometric properties (Cronbach’s alpha = 0.82) and moderate correlation (r = 0.42) with grateful disposition (GQ-6 questionnaire). Structured equation modeling (SEM) confirmed that both constructs, although moderately related, are different. While Gratitude/Awe was best predicted by the frequency of meditation practice, a grateful disposition was best predicted by the frequency of praying and by general life satisfaction. The GrAw-7 scale is not contaminated with specific religious topics or quality of life issues, and can be easily implemented in larger studies.

This paper gives a summary of findings from studies using the five-item Reliance on God’s Help (RGH) scale, which was developed a decade ago as an integral part of a comprehensive measure to differentiate between external and internal adaptive coping strategies. It has been used for both healthy and diseased persons. We will summarize data on internal reliability scores and the distribution of mean values for the respective items in the different study samples. Also, we will present a structural equation model (SEM) to confirm the scale’s validity. Our analysis shows that the RGH scale is a short, valid, and reliable measure of a person’s strong basic trust in God (faith), regardless of what life brings. The items do not address aspects such as well-being, inner peace, or specific moods. Thus, it is important to note that the RGH scale was not per se associated with indicators of well-being or health-related quality of life, indicating distinct dimensions.

To analyse how patients with chronic diseases would interpret their illness, and how these interpretations were related to spirituality/religiosity, life satisfaction, and escape from illness, we performed a cross-sectional survey among patients with chronic diseases from Poland (n = 275) using standardized questionnaires. Illness was interpreted mostly as an Adverse Interruption of life (61%), Threat/Enemy (50%), Challenge (42%), and rarely as a Punishment (8%). Regression analyses revealed that escape from illness was the best predictor of negative disease perceptions and also strategy associated disease perceptions, and a negative predictor of illness as something of Value, while Value was predicted best by specific spiritual issues. Patients’ religious Trust and partner status were among the significant contributors to their life satisfaction. Data show that specific dimensions of spirituality are important predictors for patients’ interpretation of illness. Particularly the fatalistic negative perceptions could be indicators that patients may require further psychological assistance to cope with their burden.

In order to measure a wide spectrum of organized and private religious, spiritual, existential and philosophical practices, the SpREUK-P (SpREUK is the German language acronym of “Spirituality/Religiosity and Coping with Illness”) questionnaire was developed as a generic instrument. To account for the fact that institutional religiosity declines, not only in Europe, and to explore the alternative use of various existing esoteric and spiritual resources, the instrument also addresses non-religious forms of spiritual practices. Previously, it was tested in a more secular context and was found to be of relevance for atheistic/agnostic individuals. Now we intended to apply the instrument to 275 Polish individuals with chronic diseases (100% Catholics, 74% women, mean age 56 ± 16 years). The factorial structure of the SpREUK-P’s Polish version was similar to the primary version, but lacked an exclusive “spiritual (mind-body) practices” subscale. Factor analysis revealed four main factors, which would explain 67% of the variance, i.e., religious practices (Cronbach’s alpha = 0.90), humanistic practices (alpha = 0.87), existentialistic practices (alpha = 0.80) and gratitude/awe (alpha = 0.80). The correlation pattern underlines construct validity. Interestingly, in Polish individuals, existentialistic practices did not significantly differ between religious and non-religious individuals (nor between men and women), while all other forms of spiritual practices did differ significantly.

To cover a wider variety of specific aspects of spirituality, which are of relevance also in secular societies, the ASP (“Aspects of Spirituality”) questionnaire was developed. While it was used so far with healthy adults and with adolescents living in a secular society, it was meanwhile used also with Polish students who were predominantly Catholic. Here we compare the factorial structure of the ASP questionnaire in a sample of 871 German (73% non-religious) and 1,017 Polish adolescents/young adults (50% non-religious despite their Catholic denomination). The factorial structure of the ASP questionnaire with its four scales Religious Orientation: Prayer/Trust in God, Search for Insight/Wisdom, Conscious interactions/Compassion, Transcendence Conviction, were similar in the sample of German students and in the Polish students. By means of confirmatory factor analysis (CFA) we were able to use the number of items of the ASP in its student version (ASP-Students). Overall, the instrument is suited to measure a wide variety of vital aspects of spirituality, both religious and secular forms of spirituality. As the instrument avoids exclusive language and operationalizes also non-formal aspects of spirituality in terms of relational consciousness, it is suited, not only for individuals with a skeptical or a-religious attitude, but also for religious individuals.

The interest in the topic of spirituality as a more or less independent dimension of quality of life is continuously growing [...]

Objective: Although there are several reports which support a (negative) association between depression and spirituality/religiosity, the specific nature of the relationships remains unclear. To address whether patients with depressive and/or addictive disorders use this resource at all, we focused on a circumscribed variable of intrinsic religiosity, and analyzed putative associations between intrinsic religiosity, depression, life satisfaction and internal adaptive coping strategies. Methods: We referred to data of 111 patients with either depressive and/or addictive disorders treated in three German clinics. For this anonym cross sectional study, standardized instruments were used, i.e., the 5-item scale Reliance on God’s Help (RGH), Beck’s Depression Inventory (BDI), the 3-item scale Escape from Illness, the Brief Multidimensional Life Satisfaction Scale (BMLSS), and internal adaptive coping strategies as measured with the AKU questionnaire. Results: Patients with addictive disorders had significantly higher RGH than patients with depressive disorders (F = 3.6, p = 0.03). Correlation analyses revealed that RGH was not significantly associated with the BDI scores, instead depressive symptoms were significantly associated with life satisfaction and internal adaptive coping strategies (i.e., Reappraisal: Illness as Chance and Conscious Living). Patients with either low or high RGH did not significantly differ with respect to their BDI scores. None of the underlying dimensions of RGH were associated with depression scores, but with life satisfaction and (negatively) with Escape from illness. Nevertheless, patients with high RGH had significantly higher adaptive coping strategies. Regression analyses revealed that Reappraisal as a cognitive coping strategy to re-define the value of illness and to use it as a chance of development (i.e., change attitudes and behavior), was the best predictor of patients’ RGH (Beta = 0.36, p = 0.001), while neither depression as underlying disease (as compared to addictive disorders) nor patients’ life satisfaction had a significant influence on their RGH. Conclusions: Although RGH was significantly higher in patients with addictive disorders than in patients with depressive disorders, depressive symptoms are not significantly associated with patients’ intrinsic religiosity. Particularly those patients with high intrinsic religiosity seem to have stronger access to positive (internal) strategies to cope, and higher life satisfaction. Whether spirituality/religiosity is used by the patients as a reliable resource may depend on their individual experience during live, their expectations, and specific world-view.

There is need for a brief measure of religiosity that can be included in epidemiological surveys to examine relationships between religion and health outcomes. The Duke University Religion Index (DUREL) is a five-item measure of religious involvement, and was developed for use in large cross-sectional and longitudinal observational studies. The instrument assesses the three major dimensions of religiosity that were identified during a consensus meeting sponsored by the National Institute on Aging. Those three dimensions are organizational religious activity, non-organizational religious activity, and intrinsic religiosity (or subjective religiosity). The DUREL measures each of these dimensions by a separate “subscale”, and correlations with health outcomes should be analyzed by subscale in separate models. The overall scale has high test-retest reliability (intra-class correlation = 0.91), high internal consistence (Cronbach’s alpha’s = 0.78–0.91), high convergent validity with other measures of religiosity (r’s = 0.71–0.86), and the factor structure of the DUREL has now been demonstrated and confirmed in separate samples by other independent investigative teams. The DUREL has been used in over 100 published studies conducted throughout the world and is available in 10 languages.

The SpREUK questionnaire (SpREUK is an acronym of the German translation of "Spiritual and Religious Attitudes in Dealing with Illness") was developed to investigate how patients with chronic diseases living in secular societies view the impact of spirituality in their dealing with illness (in terms of reactive coping). The aim was to operationalize and quantify patients’ search for a transcendent source of support; their reliance on such a source of help; and whether they regard their illness as a chance for reflection and subsequent change of life and behavior. The contextual 15-item SpREUK has very good internal consistency estimates (ranging from 0.86 to 0.91), and differentiates three factors, i.e., Search (for Support/Access), Trust (in Higher Guidance/Source), and Reflection (Positive Interpretation of Disease). It avoids exclusive religious terminology and appears to be a good choice for assessing patients’ interest in spiritual/religious concerns, which is not biased for or against a particular religious commitment. This reliable and valid instrument is suited for patients in secular and also in religious societies.

The Spiritual Needs Questionnaire (SpNQ), originally written in the German language, was translated and validated into 11 languages, but not Latin languages, such as Brazilian Portuguese. This study aimed to determine the psychometric properties of the SpNQ after translation and transcultural adaptation to the Portuguese language, identifying unmet spiritual needs in a sample of patients living with HIV in Brazil. This pioneering study conformed a four-factor structure of 20 items, differentiating Religious Needs (α = 0.887), Giving/Generativity Needs (α = 0.848), Inner Peace (α = 0.813) and a new item: Family Support Needs (α = 0.778). The Brazilian version of the SpNQ (SpNQ-BR) had good internal validity criteria and can be used for research of the spiritual needs for Brazilian patients. The cross-cultural adaptation and comparison with previous studies showed that the SpNQ is sensitive to the cultural characteristics of different countries.

Today there are several approaches for bringing mindfulness, which conceptually refers to the Buddhist Vipassana tradition, into organizations. Programs referring to value-based attitudes and behaviors derived from specific Christian contexts are rarely evaluated. A prerequisite are reliable instruments for measuring the respective outcomes. We therefore performed a cross-sectional study among 418 participants to validate an instrument measuring specific aspects of Franciscan-inspired spirituality (FraSpir), particularly the core dimensions and transformative outcomes. Exploratory factor analysis of this FraSpir questionnaire with 26 items pointed to four main factors (i.e., “Live from Faith/Search for God”; “Peaceful attitude/Respectful Treatment”; “Commitment to Disadvantaged and Creation”; “Attitude of Poverty”). Their internal consistency (Cronbach’s alpha) ranged from 0.79 to 0.97. With respect to convergent validity, there were sound correlations with engagement in religious practices, gratitude and awe, and prosocial-humanistic practices. The 26-item instrument was found to be a reliable and valid instrument for use in training and education programs. Interestingly, nuns and monks scored significantly higher on the Faith and Poverty subscales than others, but similarly on the two subscales addressing considerate action in the world. These attitudes and behaviors are not exclusively valued by those of religious faith, but by all.

Collaboration within the recently established Network for Research on Spirituality and Health (NERSH) has made it possible to pool data from 14 different surveys from six continents. All surveys are largely based on the questionnaire by Curlin “Religion and Spirituality in Medicine, Perspectives of Physicians” (RSMPP). This article is a methodological description of the process of building the International NERSH Data Pool. The larger contours of the data are described using frequency statistics. Five subscales in the data pool (including the already established DUREL scale) were tested using Cronbach’s alpha and Principal Component Analysis (PCA) in an Exploratory Factor Analysis (EFA). 5724 individuals were included, of which 57% were female and the mean age was 41.5 years with a 95% confidence interval (CI) ranging from 41.2 to 41.8. Most respondents were physicians (n = 3883), nurses (n = 1189), and midwives (n = 286); but also psychologists (n = 50), therapists (n = 44), chaplains (n = 5), and students (n = 10) were included. The DUREL scale was assessed with Cronbach’s alpha (α = 0.92) and PCA confirmed its reliability and unidimensionality. The new scales covering the dimensions of “Religiosity of Health Professionals (HPs)” (α = 0.89), “Willingness of Physicians to Interact with Patients Regarding R/S Issues” (α = 0.79), “Religious Objections to Controversial Issues in Medicine” (α = 0.78), and “R/S as a Calling” (α = 0.82), also proved unidimensional in the PCAs. We argue that the proposed scales are relevant and reliable measures of religious dimensions within the data pool. Finally, we outline future studies already planned based on the data pool, and invite interested researchers to join the NERSH collaboration.

Why do we need some more questionnaires to measure aspects of spirituality/religiosity when we already have so many well-tried instruments in use?[...]

Background: We wondered whether “spiritual dryness” as a specific phase of “spiritual crisis” or insecurity is mostly a matter only of Catholic priests or can also be found in other pastoral professionals. Methods: In a cross-sectional survey, we measured the prevalence of spiritual dryness in non-ordained Catholic pastoral workers, and identified relevant predictors. Results: In a sample of 3.277 pastoral workers, 50% would occasionally experience phases of spiritual dryness, while 13% experience it often or even regularly. There were no significant differences between women and men, professions, or age groups. The best predictors of spiritual dryness were low transcendence perception and a low sense of coherence (both are resources), as well as depressive symptoms and stress perception (both are demands or stressors), which would explain 41% of the variance. Self-efficacy expectation and social support were not among the significant predictors. Conclusion: Both the proportions and the main predictors are similar compared to Catholic priests. It is thus not the underlying profession or vocation and the related life situation or differences in social support, but predominantly specific perceptions, feelings, and attitudes that are related to the phenomenon of spiritual dryness—and these can be found in all pastoral professionals who seriously live their spirituality.