The Effect of Psychospiritual Intervention on the Level of Spiritual

Inpatients

Nur Aini*, Novi Kartika Dewi and Erma Wahyu Mashfufa

Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang,

Jalan Bendungan Sutami No. 188A, Malang, Indonesia

Keywords: Intervention psychospiritual, level of spiritual, inpatient, holistic.

Abstract: The problem faced by sick human are not only physical problems but also psychological and spiritual patients

will experience imbalances. The purpose of this study was to determine the effect of psychospiritual

interventions on the spiritual level of patients. This was a one-group pre-test post-test study conducted in May

2018 at the Aisyiyah Islamic Hospital in Malang. Samples of 15 inpatients were taken by purposive sampling

technique. A socio-demographic questionnaire, the DSES (Daily Spiritual Experiences Scale) was utilized for

data collection. This intervention was carried out 4 days (4 meetings) for 30-60 minutes each. The data were

analyzed using Wilcoxon test in SPSS. The majority of the spiritual level of patients at pre was 13 people

(86.7%) and low 2 (13.3%), after intervention 14 people (93.3%) had a high level and 1 (6.67 %) medium. p-

value (0.001) <α (0.05), which means there is a spiritual level difference before and after intervention. The

psychospiritual interventions is very effective in improving the spiritual quality of care patients. Thus, have a

positive impact on patient health. Therefore, it is recommended that nurses not only focus on physical aspects

but provide holistic care in all aspects, especially spiritual.

1 INTRODUCTION

The concept of holistic nursing, health is not only

limited to physical, mental and social health but

includes all elements of human beings, namely

biological, psychological, social, cultural and

spiritual aspects. But in some cases, the fulfillment of

spiritual aspects is often forgotten. Especially when

the patient has a worse condition of physical health

conditions. Hosseini et al (2013), current studies have

suggested that spiritual care has been a neglected

aspect of nursing and spiritual care is neglected in the

present Swedish health care system.

King and Gates (2006) in Mundakir et al (2016)

that nursing services focus more on medical planning

and only a little time to carry out aspects of holistic

nursing. Mundakir et al (2016) nurse services to

remind and teach patients to worship during a cure are

only done 15% of nurses. The survey of Health

Ministry results in hospitals in Indonesia It is

estimated that around 54-74% of nurses carry out

medical assignments, 26% of nurses do hospital

administration work, and 68% of basic care tasks

needed are carried out by family nurses (Puskom

DepKes, 2014). The results of observations

conducted by researchers at RSI Aisyiyah Malang in

2017-2018 show the results of meeting the spiritual

needs of patients are still lacking.

Psychospiritual therapy is an approach that

incorporates religion and spirituality into

psychotherapy or a technique involves psychological

and spiritual for the treatment of psychological

problems (Mishra and Kotnala, 2016; Abbas, 2017).

Islamic Psychospiritual Therapy have roots well

embedded in the spiritual foundation of the Qur’an

and the Sunnah of the Prophet Muhammad (S.A.W),

in which it is a healing technique where the individual

is transferred from the realm of ill health to the realm

of wellbeing in a manner that is Godly (Adeeb and

Bahari, 2017). Spirituality, religion, belief and

practice are important elements of health and well

being. The balance of services concerning bio, psycho

and spiritual needs in hospitals is exactly necessary

for patients during their hospital stay. Spirituality

refers to connectedness, a sense of being human,

transcendence, and meaning in life. Previous studies

have reported the following, spirituality is a strong

predictor and promoter of psychological health. It can

increase resistance against mental health crises

following the diagnosis and treatment of cancer in

Aini, N., Mashfufa, E. and Dewi, N.

The Effect of Psychospiritual Intervention on the Level of Spiritual Inpatients.

DOI: 10.5220/0009120700370040

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 37-40

ISBN: 978-989-758-462-6

patients (Guilherme et al., 2016; Xing et al., 2018).

Therefore, the aim of this study is an effectiveness of

psychospiritual interventions on the spiritual level of

inpatients.

2 METHODS

2.1 Study Design and Ethical Approval

The pre-test and post-test design groups used in this

study. The study was conducted on inpatients at

Aisyiyah Islamic Hospital Malang in May - June

2018. Data collected before and after the intervention.

Significant differences in the value of the pre-test and

post-test are indicators that psychospiritual

intervention could improve patient spirituality. The

local ethics committee approved the study protocol.

Before the enrollment in the study, each participant

had been explained the main objective of the study in

details and was asked to sign the written informed

consent for his or her participation in this study.

2.2 Participants

The purposive sampling used in this study. Inclusion

criteria: a minimum of 3 days hospitalization, Islam,

which is mature, conscious and can read Indonesian.

Fifteen participants joined in this study.

2.3 Instrument

The Daily Spiritual Experiences Scale (DSES)

instrument is a questionnaire written by Lynn G.

Underwood and used in this study. DSES has 16

items of questions consisting of 15 questions about

spiritual experience and 1 item question about the

closeness of the relationship with God. The

questionnaire was conducted twice, before and after

completing the intervention. Giving scores on DSES

1-15 questionnaire items using a Likert scale where:

1 (never), 2 (one at a time), 3 (several days), 4 (almost

every day), 5 (every day), 6 (several times a day). For

item no. 16 also uses a Likert scale with provisions;

value 1 (not close at all), 2 (somewhat close), 3 (very

close), 4 (very close). So that the total value obtained

on all items is categorized as a spiritual level

(Underwood, 2011): value 15-40 as low spiritual

level, value 41-65 as moderate spiritual level, and

value 66-90 as high spiritual level.

Validity and reliability tests were carried out, with

the values in this questionnaire being 0.47-0.88> r

table 0.444. The tool purchased is a module titled

"The Beauty of Pain." The contents of this module are

the beauty of pain, the wisdom of sickness, maybe

pain, and how when the patient is sick (Aini,

Fatmaningrum and Yusuf, 2011; Nihayati, 2015).

2.4 Study Protocol

Psychospiritual intervention gives 4 x, which is done

for 30-60 minutes, intervention steps such as 1). on

the first day: introduce yourself and foster trust, tell

the story of the Prophet Job (Ayub’s Prophet), and

collect data; 2). second day: filing complaints, giving

interventions regarding pain and beauty of pain, 3).

on the third days: an important intervention was given

about the obligations of a Muslim when he or she was

sick such as: praying and reciting dzikir to

remembered Allah, 4). the last day repeated all the

intervention on 1 - III day.

2.5 Statistical Analysis

Data analyzed by the Statistical Package for Social

Sciences (SPSS) version 21. Descriptive statistics

conducted sociodemographic characteristics (mean,

standard deviation, frequency, and percentage).

Wilcoxon test was utilized to compare the pre and

post-intervention by scores of the DSES.

3 RESULTS AND DISCUSSION

Total of participants was 15 person. Arrange of age

23 to 78 years (M = 49.8; SD: 11.2). 6 person of male

(40%) and female 9 (60%). The patient's spiritual

level as measured by the DSES questionnaire before

and after the intervention seen in table 1.

Table 1: Level of spiritual.

No Level of spiritual Pre Post p value

n % n %

1 High 13 86,7 14 93,3 0,001

2 Medium 0 0 1 6,67

3 Low 2 13,3 0 0

Total 15 100 15 100

HSIC 2019 - The Health Science International Conference

Table 1 showed that differences of the level

spiritual of the participants before and after the

ntervention. The value of p (0,001) < α (0,05), a data

analyzed by Wilcoxon, that means the intervention

psychospiritual improved spiritual of participants.

The study’s findings obtain a change in spiritual level

after given psychospiritual interventions. Although

some of the participants have high spiritual level

before the provided intervention, the post-test

results showed a significant increase. The spiritual

approach is an individual experience, a person's belief

in the meaning of life experienced and represent a

power that exists in the individual himself.

The provision of psychospiritual interventions

remain one form of intervention that refers to

the use of spiritual experiences of worship,

especially those related to God, which can be applied

by always being thankful for everything that has been

received to assist the individual adjust to the

emotional problems faced, how to overcome a change

in life, promote effective changes to spur somewone

in developing personality, and create therapeutic

interactions (Nihayati, 2015).

Spiritual well-being can be necessary resource for

patients and their families who struggle with serious

or chronic illness (Musarezaie et al., 2015). Studies

which supported these findings were (Hosseini,

Davidson and Green, 2013) that there were positive

correlations between spirituality and hope, happiness,

mental health, health and well-being, quality of life,

job satisfaction, coping and recovery in both patients

and caregivers. The prayer and religious

psychotherapy can improve happiness and physical

health and alleviate anxiety, and depression

(Mardiyono and Petpichetchian, 2011).

The spiritual level influenced by age. The average

age of respondents is 49,8 years and includes late

adulthood. Age related to maturity and the ability of

a person. Increasing age is increasingly able to show

mental maturity. It stated in a hadith Qudsi narrated

by HR. Tirmidzi, that the emergence of a person's

tendency to start self-improvement is at the age of 60

years. Normally that age, a person could be

compelled to return to improve his spiritual values

through efforts to adjust to the initial nature of his

creation. Making himself a servant of God who is

always obedient to Him (Jalaluddin, 2015). Beside

the age factor, changes in one's spiritual quality occur

due to other internal factors and external factors.

Internal factors relate to conditions that exist in a

person (internal). While external factors concern

conditions, situations and experiences in interacting

with their environment.

This includes experience through education,

socio-cultural conditions, and experiences in other

social interactions. The internal factors that are

considered to play an active role in the occurrence of

religious conversion are personality factors and

innate factors. While external factors that can have an

influence on the occurrence of religious conversion.

Among the factors mentioned are family factors,

living environment factors, changes in status, poverty

(Jalaluddin, 2015). The majority of respondents are

female.

Women are better at managing stress, this is

because it is influenced by emotional focused coping

(EFC). EFC allows individuals to recognise the good

idea (wisdom) of an event, expect sympathy and

understanding on others, or try to forget everything

related to things that have suppressed his emotions,

meaning that individuals learn to try and take lessons

or values from all efforts that have been done before

and used as a consideration exercise to solve the next

problem. This will further foster a person’s positive

emotions in interpreting something that happens

especially in spiritual matters.

The provision of psychospiritual

interventions is a stimulus that is carried out by

providing knowledge and experience on the

importance of fulfilling spiritual needs in this matter

relating to God, always grateful for what happened

and always believing God gives is the best so that

later can change perceptions someone in the face of

stress is faced especially in patients who are

undergoing a period of treatment at the hospital.

Spiritual care plays an important role in increasing

person’s spiritual well-being and has positive effects

on their stress responses, a sense of integrity and

excellence, and interpersonal relationships. Spiritual

enable a person to a purpose and purpose statement in

life and promotes access to inner strengths and

resources that will enhance the overall health

(Torabi, Sajjadi and Nourian, 2017; Younas, 2017).

Studies which supported these findings were

Abedi et al (2016), spiritual care of cancer patients

decreases the physical sign problems, anxiety, sleep

disorders, depression and disorders in their social

functions. There are a significant inluence of the

psycho-spiritual intervention on global QOL (quality

of life) and physical, role, emotional, cognitive, and

social isolation. The spirituality is seen as a unique

concept that stands in relationship to quality of life

(Jafari et al., 2013).

The limitation of this study is that research does

not involve several other factors that can affect the

patient's spiritual condition like the type of illness,

The Effect of Psychospiritual Intervention on the Level of Spiritual Inpatients

duration of illness. In addition, the number of

respondents in the study was lacking.

4 CONCLUSIONS

Performing psychospiritual interventions can

improve the patient's spirituality. A spiritual is

particularly important because it has a positive effect

and affects the health of patients. Therefore, in

providing nursing care to patients, nurses not only

need to be on the physical aspect but must provide

holistic care that includes and spiritual aspects

because it has proven to be truly a spiritual also

greatly improves patient health.

ACKNOWLEDGMENTS

The author gives thanks to the patients, hospital

management and staff nurses for their cooperation.

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