Nursing Perspectives on Spiritual Well-being of Patients Undergoing Hemodialysis: A Narrative Review

INTRODUCTION

Spiritual well-being is essential for the quality of life, especially for hemodialysis patients, as this type of treatment requires significant adaptations and often triggers physical and emotional hardships. (Asiri et al., 2023). These challenges emphasize the significance of attending to these patients' medical requirements and spiritual well-being. (Abd & Hattab, 2016; Pokpalagon et al., 2022). Spiritual well-being emerges as a critical coping mechanism, fostering resilience, hopefulness, and positive mental attitudes, thereby improving patients' overall health outcomes and well-being. (Hassani et al., 2022). For many individuals, spiritual well-being and religion are crucial aspects of their lives that contribute to their overall well-being. (Fradelos et al., 2022). Although spiritual well-being is a complex concept, its presence is solid and enduring in one’s life and serves to cope with challenges. (de Brito Sena et al., 2021). Religiosity and spiritual well-being motivate individuals to adopt healthy practices, avoid risky behaviors, and build strong support networks. (Koslander et al., 2021).

 Patients undergoing hemodialysis are susceptible to various negative impacts on their lives, including reduced physical function, compromised independence, and decreased overall quality of life. Due to the prolonged and intensive nature of hemodialysis treatment, these patients often experience emotional and psychological distress. (Hartiti et al., 2021). However, spiritual well-being has consistently been identified as a source of comfort, peace, and strength, assisting these patients in coping with their demanding treatment regimen. (Fradelos et al., 2015). A narrative review of the topic can shed light on the significant role of Spiritual Well-being in the health care of such patients. This can also generate discussions among healthcare professionals on integrating spiritual care into the overall healthcare plan for hemodialysis patients. (Pokpalagon et al., 2022).

The current study is the first to assess the impact of social support and spiritual well-being on quality of life in Iraqi society. The results show that social support and spiritual well-being are combined and have separate effects on the quality of life of patients with hemodialysis. In Iraq, there are no studies on social support and the impact on the quality of life of patients suffering from dialysis. Therefore, the study of the relationship between social support and amputee life expectancy shows that social support and amputee life expectancy are strong, Eloy et al., 2022. Eloy et al. point out that good family cohesion and social relationships, both in good times and in evil, sadness and joy, disease and disability characterize Iraqis. Thus, the same reason is expected to be reported in the present study, as there is a relationship between social support and the quality of life of hemodialysis patients.

This review seeks to narratively analyze the role of spiritual well-being in patients undergoing hemodialysis, highlighting the noteworthy experiences and perspectives of these patients. It outlines the correlation between spiritual well-being and quality of life and discusses how active engagement in spiritual activities can influence coping mechanisms. Ultimately, the findings form a foundation for developing and implementing holistic healthcare plans that incorporate spiritual needs into patient care procedures, moving beyond the physical aspects of treatment. This narrative review is designed to provide the healthcare community with valuable insights, emphasizing the importance of supporting spiritual well-being to foster positive health outcomes in hemodialysis patients. This paper presents a narrative review of various studies exploring spiritual well-being in hemodialysis patients. The primary purpose is to offer an apparent insight into the current literature on this subject, highlight key findings, and identify areas requiring further investigation.

RESEARCH METHODOLOGY

Employing a narrative review approach, this study delved into the spiritual well-being of hemodialysis patients. In 2024, a thorough search was conducted across prominent electronic databases, including Web of Science, Scopus, Science Direct, Bio-Med-Central, Cochrane, PubMed Central, Scientific Information Database (SID), and Google Scholar. These databases were chosen for their rich repository of scholarly resources.

Choose a Topic: The chosen topic of this study is the "spiritual well-being of hemodialysis patients." This topic focuses on understanding and exploring the spiritual well-being of individuals undergoing hemodialysis treatment. Hemodialysis, a life-sustaining medical procedure for patients with end-stage renal disease, is often a psychological challenge. Amidst these challenges, the spiritual dimension of well-being becomes increasingly relevant. Spiritual well-being encompasses various facets, including religious beliefs, existential concerns, meaning and purpose, connection with others, and feelings of inner peace and fulfillment. For hemodialysis patients, addressing their spiritual needs is crucial for holistic care and quality of life.

By investigating the spiritual dimensions of well-being among hemodialysis patients, researchers aim to identify interventions and support systems that can enhance their spiritual well-being, coping abilities, and overall quality of life. This research contributes to a holistic approach to patient care, recognizing the importance of addressing spiritual needs alongside medical and psychosocial aspects.

Selection Criteria: Inclusion criteria encompassed English-language articles published between January 2013 and January 2024, focusing on the spiritual well-being of adult hemodialysis patients. Studies involving adults aged ≥18 who underwent hemodialysis were considered, including cross-sectional, correlational, and descriptive analytics studies. Exclusion criteria included systematic reviews or randomized control trials with a comparison group. Irrelevant content provides conference presentations, case reports, letters to the editor, pre-prints, and articles without full-text access.

Search Strategies: The Medical Subject Headings (MeSH) search tool was utilized to identify relevant keywords about spiritual well-being in hemodialysis patients. Keywords were searched within abstracts, titles, and keywords of articles, employing various combinations with operators. Terms such as "Spiritual Well-being," "Hemodialysis Patients," "religious," "non-religious," "religious Well-being," "existential well-being," "affiliation," "alienation," "satisfaction," "end-stage renal disease," and "chronic kidney disease" were included to capture diverse literature from healthcare, nursing, and medicine. An explanation of the PRISMA diagram is as follows [Figure 1]

Studies Selection Process: Initial searches yielded 33 published articles, which underwent title and abstract screening to exclude duplicates and irrelevant articles, resulting in 12 articles for full-text review. Further refinement based on predefined criteria led to the inclusion of 12 articles, comprising nine original studies, two review studies, and one descriptive-analytic study. The final selection underwent meticulous analysis to synthesize pertinent evidence.

Synthesis: The synthesized literature was systematically organized following a thorough review of full-text articles, facilitating a comprehensive analysis of pertinent evidence. Through meticulous examination, key themes and patterns emerged, providing insights into the spiritual well-being of hemodialysis patients. The findings of this review discuss existing literature, highlighting implications for clinical practice, research, and future directions in understanding and addressing the spiritual needs of patients who are undoing hemodialysis.

Data Analysis: Researchers conducted rigorous article extraction and review processes, evaluating the relevance of selected publications by examining titles, keywords, and abstracts. Eligible articles were screened for inclusion, and relevant data were extracted using a pre-prepared checklist encompassing author(s), publication year, study design, sample size, setting, data collection tools, and results.

RESULT

A review of related articles highlighted the spiritual well-being of patients undergoing hemodialysis in six categories, as listed below.

Table 1: Studies in the field of Spiritual Well-being in Patients Undergoing Hemodialysis

DISCUSSION

The current study is the first to assess the impact of social support and spiritual well-being on the quality of life in Iraq. The results demonstrate that social support and spiritual well-being have combined and separate effects on the quality of life of hemodialysis patients. In Iraq, no previous studies have been conducted on the impact of social support on the quality of life of patients undergoing hemodialysis. Thus, studying the relationship between social support and the life expectancy of amputees reveals a strong correlation. Iraqis are known for their strong family cohesion and social relations during both good and bad times, including periods of sadness, joy, illness, and disability. Therefore, it is expected that similar findings will be reported in the current study, highlighting the relationship between social support and the quality of life of hemodialysis patients.

Hemodialysis can drastically impact a patient's life, including spiritual well-being. (George et al., 2022). Spiritual well-being, a crucial aspect of overall quality of life, is associated with the individual's relationship with a higher power, self, others, and the environment. (Afrashteh et al., 2023). Therefore, understanding the impact of spiritual well-being on patients undergoing hemodialysis is critical. Spiritual well-being might serve as a buffer, providing patients with meaning, purpose, and coherence despite their health complications. (Ebrahimi et al., 2014). It might become a crucial coping resource, offering hope and resilience, thereby diminishing the negative psychological impacts of the disease and fostering mental well-being. (Kömürcü & Kuzu, 2022).

 Studies have indicated that patients with severe chronic illnesses perceive spiritual well‐being as a multidimensional concept that combines physical and psychological health.(Pilger et al., 2017) (Pokpalagon et al., 2022)(Abdulwahid, 2017) Ghasemi et al., 2014; Fradelos, 2021; de Brito Sena et al., 2021).  The current results suggest an essential role for religious/ Spiritual Well-being in the QOL of patients undergoing hemodialysis (Hassani, Gholamzadeh Jofreh, et al.,2022; Pilger et al., 2017; Hassani, Zarea, Jofreh, et al., 2022; Fradelos, 2021; Saffari et al., 2013; Senmar et al., 2020; Hartiti et al., 2021; Asiri et al., 2023 Fradelos et al., 2022; Bulathwatta et al., 2023; Cheawchanwattana et al., 2015; Ebrahimi et al., 2014). Changes in factors such as religion and spiritual well-being should be considered to determine predictors of patients' quality of life and health status. To better understand how spiritual/religious beliefs and adaptation influence QOL in patients of different cultures and religions, it is necessary to conduct transcultural studies, longitudinal follow-up studies, and intervention studies to understand the representative samples of these patients further.  (Saffari et al., 2013).

 Researchers have highlighted that patients undergoing hemodialysis can experience varied emotional distress, such as feelings of fear, depression, and uncertainty about their future. (Hoang et al., 2022). These feelings might affect the patients' spiritual well-being, creating a sense of hopelessness and existential crisis. (George et al., 2022). Conversely, many patients find strength and solace in their Spiritual Well-being, offering them fortitude and coping mechanisms. (Saffari et al., 2013). It is believed that robust spiritual well-being provides patients with psychological resilience, aiding them in effectively dealing with the physical and mental stress associated with hemodialysis. (Hatami et al., 2019).

 Spiritual Well-being plays a compelling role in coping with the challenges and hardships presented by hemodialysis, a procedure that can be mentally exhausting, emotionally draining, and physically debilitating. (Ababa, 2020). Amid these challenges, spiritual well-being contributes significantly to how patients navigate these experiences. Spiritual well-being can be viewed as a multidimensional construct encompassing both religious and existential well-being. (Fradelos et al., 2015). It is a concept that describes an individual's sense of peace, purpose, and connection to others, offering a sense of hope and meaning in life (Pasyar et al., 2020). This holistic perspective addresses the patient's physical, social, psychological, and spiritual health. (Pasyar et al., 2020). It accommodates patients to navigate their distress and maintain hope despite the daunting nature of their medical regime. (Hassani, et al., 2022). Also, patients who reported a high sense of spiritual well-being exhibited higher levels of adaptation to the disease and demonstrated superior coping mechanisms related to adequacy and acceptance of their treatment regimen. (Saffari et al., 2013).

 Moreover, Spiritual Well-being's beneficial effects on health outcomes extend beyond the emotional domain. Several studies propose a positive association between spiritual well-being and physical health.(Hassani, Gholamzadeh Jofreh, et al., 2022; Mayoral Sánchez et al., 2010; Gale & Therivel, 2022; Hassani, Gholamzadeh Jofreh, et al., 2022; KÖMÜRCÜ & KUZU, 2022). Patients with high spiritual well-being reported less physical discomfort, reduced symptoms, and lower fatigue associated with hemodialysis. (Theofilou, 2022). Spiritual Well-being also appears to be integral in mediating the psychological distress associated with chronic illness. (Hassani, Zarea, Gholamzadeh Jofreh, et al., 2022). It helps to mitigate the feelings of depression, stress, and anxiety that often accompany the strains of living with renal disease and undergoing regular hemodialysis.(Pilger et al., 2017) Furthermore, Spiritual Well-being serves as a buffer against the existential crisis that might emerge when confronted with the reality of a life-threatening illness. It allows patients to find meaning in their experiences and fosters a sense of coherence and continuity in their disrupted lives. Inculcating spiritual practice into patient care protocols can fundamentally enhance individual resilience and promote a positive trajectory in their illness experience. (Asiri et al., 2023).

 Patients grappling with end-stage renal disease often experience considerable physical and psychological distress, which can significantly deteriorate their quality of life.(Senmar et al., 2020). Hence, spiritual well-being, in this context, emerges not only as a coping mechanism but as an inherent part of holistic care.( Fradelos et al., 2015). An array of factors appears to influence spiritual well-being amongst patients on hemodialysis; predominantly, they range from psychosocial aspects to broader environmental and existential themes. (Kömürcü & Kuzu, 2022). For instance, patients' attitudes, beliefs, and perceptions about illness can positively or negatively impact spiritual well-being.(Malinakova et al., 2017). Mental health is another crucial factor; anxiety, depression, and feelings of loneliness or isolation often diminish spiritual well-being. Conversely, robust social support networks and quality interpersonal relationships can reinforce it, highlighting the social dimension of spiritual health. ( Fradelos, 2021; Abd & Hattab, 2016).

 Furthermore, accessibility and quality of healthcare services significantly impact patients' spiritual well-being. This includes providing appropriate health care and integrating spiritual care into treatment plans by healthcare providers.(Hartiti et al., 2021)Personalized, compassionate, human-centric care that acknowledges and attends to patients' spiritual needs can significantly enhance their spiritual well-being. (Reig-Ferrer et al., 2012). Alongside individual and situational factors, broader environmental variables also impact spiritual well-being. The societal and cultural context in which patients receive treatment shapes their spiritual perspectives and coping mechanisms.(Saffari et al., 2013). Cultural beliefs and values can provide spiritual solace or add to patients' stress, depending on how they align with their personal beliefs and lived experiences. (Pilger et al., 2017).

Moreover, religious or non-religious existential beliefs and philosophies influence how patients perceive illness, death, and their life purpose, thereby determining their spiritual well-being.(Yousefi Afrashteh et al., 2023). Spiritual practices, rituals, and pursuits—like prayer, meditation, and readings can equip patients with emotional resilience, hope, and inner peace. However, Spiritual Well-being is subjective and highly personal; thus, what may appear spiritually nourishing to one person may not hold for another.

Promoting spiritual well-being in hemodialysis patients can be crucial to their physical and mental health. Spiritual Well-being can be an effective coping mechanism when dealing with the stress and anxiety associated with hemodialysis.(Ebrahimi et al., 2014). Therefore, healthcare providers must integrate strategies that enhance spiritual well-being in their patient care protocols. This approach will improve patient satisfaction and positively influence their well-being and treatment outcomes. (Hassani, Gholamzadeh Jofreh, et al., 2022). One effective strategy for promoting spiritual well-being is empowering patients with disease education and self-care initiatives. Knowledge about their illness and ability to manage their condition often reduces the feeling of helplessness, ultimately empowering them as active participants in their care. It can foster a sense of hope and positivity, which feeds into their spiritual strength. (Hassani, Zarea, Jofreh, et al., 2022).

Furthermore, healthcare professionals can integrate holistic care approaches that focus beyond physical treatment. This includes acknowledging the patient's emotional, social, and spiritual needs, thus ensuring comprehensive care.(Faleh & AL-Fayyadh, 2022; Hassani, et al., 2022). Spiritual counseling, individually or in group therapy, can be helpful for these patients. It may offer them an outlet to voice their fears, frustrations, and hopes, fostering a sense of acceptance, peace, and spiritual growth.(Ali & Atiyah, 2017; Theofilou, 2022). In addition, healthcare providers should respect and accommodate patients' spiritual beliefs and practices, as they can be a significant source of comfort and resilience. This may involve providing a quiet space for prayer or meditation and facilitating access to spiritual leaders or counselors following the patient's preference. (Hartiti et al., 2021).

Another crucial element is promoting a conducive environment that fosters spiritual development. Creating a supportive, patient-centric healthcare environment where empathy, compassion, and respect are central values strengthens patient-provider relationships, supporting patients’ spiritual well-being (Senteio & Callahan, 2020). Ongoing staff education about patients’ spiritual needs and appropriate ways to address those can significantly impact the healthcare experience and outcomes for hemodialysis patients. Such educational initiatives must be based on comprehensive reviews of the most recent evidence to ensure they align with best practice guidelines. (Ebrahimi et al., 2014).

 Incorporating spiritual well-being into the care of hemodialysis patients can offer many benefits, such as improving their physical health and psychological and emotional well-being. While hemodialysis is a life-sustaining process, it can be challenging for patients as they navigate the constant routine of hospital visits and lifestyle changes.( Fradelos et al., 2022). Acknowledging the spiritual dimension of coping can alleviate some of the anxiety and distress associated with long-term dialysis. Research literature provides substantial evidence of the importance of spiritual well-being in dialysis patients.(Senmar et al., 2020). Spiritual Well-being, which encompasses an individual's search for meaning, purpose, and connection, can serve as a therapeutic tool in managing the physical discomfort and mental stress induced by the dialysis process.(Saffari et al., 2013)(Yousefi Afrashteh et al., 2023). By integrating Spiritual Well-being into healthcare practice, healthcare professionals can offer holistic care that addresses hemodialysis patients' physical symptoms and emotional and spiritual needs. (Asiri et al., 2023).

A narrative review of studies on spiritual well-being in patients undergoing hemodialysis suggests that heightened spiritual well-being is correlated with better health outcomes. (Koslander et al., 2021; Yousefi Afrashteh et al., 2023; Abraham et al., 2012; Pasyar et al., 2020). These include improved coping mechanisms, higher quality of life, better adherence to treatment, and lower levels of depression and anxiety. By allowing patients to express and explore their spiritual beliefs, healthcare providers can foster hope, acceptance, and a more positive outlook toward the challenging dialysis journey. (Hu et al., 2023). Spiritually oriented interventions, such as mindfulness, prayer, yoga, and meditation, can also equip patients to manage their stress levels and enhance their emotional stability. (Reig-Ferrer et al., 2012). Additionally, promoting the involvement of spiritual care professionals, like Islamic chaplains, in the healthcare team can provide patients with spiritual counseling and support – fostering a more profound sense of peace, purpose, and connection. (Hartiti et al., 2021).

A narrative review of various studies reveals some critical insights into the importance of spiritual well-being in patients undergoing hemodialysis. Spiritual well-being is often associated with better coping skills, less depression, improved quality of life, and more prolonged survival. (Hassani, Zarea, Jofreh, et al., 2022). Spiritual care can provide hope, purpose, and resilience amidst the uncertainty and strain imposed by the hemodialysis treatment regime. Therefore, healthcare providers can integrate spiritual care into the overall treatment scheme, offering patients a sense of compassion, empathy, and respect for their spiritual needs. (Pokpalagon et al., 2022). Healthcare providers can offer spiritual support through various channels. Facilitating access to spiritual resources like meditation spaces or chaplains, incorporating spiritual history taking and assessment into routine care, or simply acknowledging and respecting the patients' spiritual beliefs and practices are ways healthcare providers can encourage spiritual well-being. Additionally, healthcare providers can participate in interdisciplinary dialogues and collaborations to ensure a more holistic approach to patient care. (Ibrahim et al., 2022).

This narrative review emphasizes the two-fold relationship between hemodialysis and patients' spiritual well-being. It illustrates Spiritual Well-being's pivotal role in patients' lives, going beyond the physical realm of healing to address their psychological and emotional needs. Thus, Healthcare providers must recognize and address the spiritual needs of hemodialysis patients. Such an integrative approach to healthcare where the spiritual needs are assessed and supported can significantly influence patients' ability to cope, enhancing their overall well-being and quality of life. Further research is necessary to understand the most effective practices for promoting spiritual wellness in the dialysis population and creating a holistic treatment environment that fosters all dimensions of patient well-being.

 CONCLUSION

Spiritual well-being in patients undergoing hemodialysis confirms that supportive measures aimed at enhancing these patients' spiritual well-being can significantly help in disease management, alleviating emotional distress, pain, and suffering while also boosting overall health outcomes. Therefore, incorporating routine assessment of spiritual well-being should be considered a vital component in the therapeutic regimen for hemodialysis patients. Further studies are recommended to comprehensively understand the interplay between Spiritual Well-being and physical health and develop robust, context-specific interventions to promote spiritual well-being in these patients. These results indicate that religion/spirit plays a vital role in QOL in hemodialysis patients. Social and demographic variables, such as religion and spiritual well-being, should be paid more attention to identifying the predictors of these patients' quality of life and health status.

 Future directions for further research

Research on spiritual well-being in hemodialysis patients is still a developing field with considerable scope for expansion and innovation. Future studies should further explore the complex relationship between spiritual well-being and hemodialysis patients' psychological and physiological outcomes. Large-scale longitudinal investigations could be particularly insightful in highlighting causative associations and potential mediation effects. Additionally, patient-centered investigations exploring perceptions of spiritual well-being, influences on spiritual health, coping strategies, and interventions to boost spiritual well-being could provide valuable insights. Moreover, interventional research should explore the potential role of healthcare professionals in promoting spiritual well-being in these patients in the future. Increased education and training about the importance of spiritual care for healthcare providers caring for hemodialysis patients could further augment the therapeutic relationship and provide a supportive healing environment. Furthermore, an inclusive discussion on spiritual well-being within the medical community and its incorporation into guidelines for comprehensive renal care is a pertinent recommendation for future action.

Ethical considerations

The Ethics Committee of Baghdad University College of Nursing granted research ethics confirmation (ethical permission code: 6) for the current study. Throughout the reporting and publishing of the study results, the researchers in this review study remained committed to safeguarding intellectual property while strictly focusing on the scientific objectives of the information they collected.

ACKNOWLEDGEMENT

We thank our colleagues who provided insight and expertise that greatly assisted this review.

Financial support and sponsorship: There are no sources of funding to declare.

Conflicts of interest: The authors declare no conflict of interest to declare for publication. This article was derived from a Ph.D. dissertation.