Iranian Journal of Critical Care Nursing Winter 2010, Volume 2, Issue 4; 149-152

* Correspondence; Email: h_hojjati1362@yahoo.com Received 2010/01/06; Accepted 2010/02/03

Relationship between different dimensions of prayer and spiritual health

in hemodialysis patients

Hojjati H.

*

MSc, Motlagh M.1 MSc, Nuri F.

1 BSc, Sharifnia S. H.2 MSc,

Mohammadnejad E.3 MSc, Heydari B.

4 MD

*

Young Researchers Club, Aliabad Katool Branch, Islamic Azad University, Aliabad Katool, Iran; 1Hemodialysis Department, Imam Reza(AS) Hospital, Mazandaran University of Medical Sciences, Amol, Iran;

2Zeynab Faculty of Nursing & Midwifery, Babol University of Medical Sciences, Amol, Iran;

3Nursing office, Imam Khomeini Clinical & Emergency Complex, Tehran University of Medical Sciences, Tehran, Iran;

4Faculty of Pharmacology, Kerman University of Medical Sciences, kerman, Iran

Abstract

Aims: Spiritual, physical and mental health is disturbed in some hemodialysis patients. Religious behaviours specially

prayer can increase spiritual energy and positive attitude in patients. The aim of this study was to analyze the relationship of

prayer with the spiritual health of hemodialysis patients.

Methods: This descriptive correlation study was performed on hemodialysis patients referred to Imam Reza Hospital of

Amol in 2009. 85 patients who had the study conditions were selected by purposive sampling method. Information was

collected through Meraviglia prayer frequency and Palutzian & Ellison spiritual health questionnaires. SPSS 16 statistical

software and descriptive and inferential statistics tests (Pearson correlation, ANOVA and Tukey's post hoc test) were used

to analyze data.

Results: Frequency of prayer was high in 96% of samples. 96% of samples prayed in high level. 85% had the experience of

prayer and 87% had a positive view on it. Spiritual health was high in 75% of samples. There was no significant relation

between the frequency of prayer and spiritual health (p=0.3). Significant relation was seen between frequency of prayer and

marriage (p=0.05) and also between spiritual health and age (p<0.01).

Conclusion: Frequency of prayer has no effect on spiritual health of hemodialytic patients. According to the dominancy of

religious culture and beliefs of Iranian people, it is expected from health care staff to pay more attention to religious and

spiritual dimensions in patients care.

Keywords: Frequency of Prayer‚ Spiritual Health, Hemodialysis Patients, Amol

Introduction

Chronic renal failure is one of the common human

physical diseases, so that today, 2 to 3 % of people are

suffering from this disease. This issue can disturb the

wellbeing and mental health of individuals [1],

because hemodialysis patients are often worried about

the unpredictable future of their disease. They often

lose their job and face with financial problems and are

always depressed and have the fear of death because

of chronic disease [2]. Recent studies have shown that

the spirituality and religious beliefs have a notable

effect and role on physical and mental health of people

and are considered as a common strategy to deal with

problems [3]. Dialysis patients are subjected to stress

like all chronic patients or sometimes more severe

than them and use confronting and adaptation

strategies which are protective processes to continue

their life [1]. Prayer is one of the religious behaviors

related to mental health and well-being [4] which is

used more than other rituals [5]. For James, prayer and

worship and connection with the spirit of world

creator have many functions and cause amazing

effects and results. Prayer strengthens the human’s

spirit and gives a special value and meaning to life

affairs; because the connection to the eternal power of

God is the single source of energy and renewal of the

lost spiritual forces [6]. Carl, the famous physiologist,

says that for human, communication with God is vital

like water and oxygen; because prayer is the highest

and the strongest trouble-shooter and by using the

power of prayer, the spiritual energy can be released

[7, 8]. Recently, many researchers have assessed the

effectiveness of prayer, in addition to common

treatment for the states such as depression, drug

dependences, marital problems and heart diseases, and

have benefited from it [4]. Koeing believes that

religion can cause a positive attitude towards the

world in individuals and help them cope with the

unfortunate events such as loss or disease and by

creating motivation and energy in person, give him the

hope that the life will get better. This causes the

increase of tolerance and acceptance of intolerable

conditions and in many of emergency cases which

Relationship between different dimensions of prayer and spiritual health of patients treated with hemodialysis ___________________

science cannot help the person, this issue is very

important [9]. Spirituality, along with religious forces

such as prayer, has an important role in disease

acceptance [10]. For this purpose, nursing must have a

complete dominance on physical, mental, and spiritual

aspect of individual, but unfortunately in Iran, in many

cases nursing still helps identifying the patient’s

surface problems [11]. Accordingly, the aim of this

study was to investigate the relationship between

frequency of prayer and spiritual health of

hemodialysis patients.

Methods

This research is a descriptive correlational study. The

study population was all patients treated with

hemodialysis who had referred to the hemodialysis

centers of Imam Reza hospital in Amol in 2009. 85

people who all had the least literacy and were able to

communicate were selected by purposive sampling.

Those with chronic psychological or psychiatric

disease and with the history of narcotics and

psychedelic drugs were excluded from the study.

Paloutzian and Allison "spiritual well-being" standard

questionnaire contained 20 questions, and scoring was

based on Likert 6-option scale from "completely

disagree" to "completely agree". In negative questions,

scoring was done reversely. Finally, the spiritual

wellbeing score (20-120) was classified into three

levels: low (20-40), medium (41-99) and high (100-

120). Reliability of this instrument was confirmed in

2006 with alpha Chronbach's coefficient of 0.82, by

Rezaei in Tehran.

Prayer frequency questionnaire was developed by

Paloma and Pendleton in 1991 and was revised by

Meraviglia at the same year. This questionnaire had 32

questions. 17 questions were about the "prayer

rituals," which were classified in Likert seven-option

scale from "I’m not sure" (1 point) to "I do constantly”

(7 points). Range of scores was from 17 to 119. 9

questions were about the "previous experience of

prayer" with the scoring similar to praying rituals.

About the questions 4, 7 and 9 the scoring was done

reversely. Prayer previous experience’s scores range

was from 9 to 63. The final 6 questions assessed the

attitude of patients toward prayer. The answers of

these questions were classified according the 7-option

Likert scale from "completely disagree" (1 point) to

"completely agree" (7 score). About questions 2 and 4

the scoring was done reversely. The total score range

of attitude toward prayer was from 6 to 42. Total score

range of prayer was considered from 32 to 224. The

rate of prayer was classified into three levels of low

(0-81), medium (81-162) and high (163-224). The

reliability of three parts of prayer frequency

questionnaire namely prayer rituals, prayer previous

experiences and attitude toward prayer has been

determined by Meraviglia as 0.75, 0.78 and 0.72 and

was also confirmed in Iran, after the translation by

Rezaei by Chronbach's alpha coefficient of 0.79.

In order to collect data, after receiving permission

from university officials and researcher visit from

Amol Imam Reza hospital and selecting subjects and

introducing themselves and providing sufficient

explanation about the purpose of study and taking a

written consents, each participant completed the

questionnaire voluntarily. The questionnaires were

supposed to be filled within 20 to 30 minutes.

Concerning some patients who were very ill or

according their request, questionnaire was completed

by researcher through interview.

Apart from the researcher himself, two other

instructed individuals helped in presenting the

questionnaires to patients. Data was collected within

four weeks and analyzed by statistical SPSS 16

software. Data were analyzed using descriptive

statistics (tables, graphs, mean and standard deviation)

and inferential statistics (Pearson correlation

coefficient, ANOVA and Turkey’s post hoc test).

Results

The average age of subjects was 66.2±7.5 years that

47% were in age group of 60-70 years. 60% of

samples were women, 74% married, 43% illiterate,

55% rural and 48% were unemployed. On average,

patients had been treated with hemodialysis for four

years. 7% of subjects had the history of renal surgery

and 48% were kidney transplant candidates.

The mean of the total score of pray dimension (total

score of prayer rituals, previous experience of prayer

and attitude toward prayer) was calculated as 172± 10.

96% of the subjects prayed in high level. 85% of

subjects had the previous experience of prayer and

87% of them had a high attitude toward prayer

(Table1).

Table 1- Distribution of the absolute and relative frequency of

prayer dimensions in hemodialysis patients

Frequency→

Dimensions↓

Medium High M±SD

Freq. Perce. Freq. Perce.

Prayer rituals(17-119) 3 4 82 96 6±93.3

Previous experience

of prayer )63- 9( 11 15 72 85 5±47.5

Attitude toward

prayer )42- 6( 11 13 74 87 3±32

Total score of prayer

)224- 32( 3 4 82 96 10±172.2

__________________________________________________________________________________________________ Hojjati H. et al.

75% of subjects had high spiritual health and 25% had

an average spiritual health. 52% of the subjects were

"completely agree" that connection with God helped

them not to feel alone. Studies of the frequency of

prayer and spiritual health showed no significant

relation (p=0.31); i.e., the frequency of prayer has no

effect on the spiritual health of patients (Table 2).

Table 2- The relationship between the frequency of prayer and

spiritual health in hemodialysis patients

The frequency of

prayer→

Spiritual health ↓

Medium High Total P

valueFreq. Perce. Freq. Perce.Freq. Perce.

Medium 0 0 21 100 21 25

0.3 High 3 4 61 96 64 75

Total 3 4 82 96 85 100

Also, the ANOVA between the overall dimensions of

prayer and marriage (p=0.049) and Tukey's post hoc

test between spiritual health and the age in the group

of over 60 years presented a significant correlation

(p<0.01).

Discussion

Results showed that the amount of prayer and spiritual

health in hemodialysis patients are at high level.

Various studies show that patients with physical

injuries are impelled toward religious beliefs. Because

religion helps them tolerate the pain and torment of

the disease [12]. Among the religious references,

prayer has the most use for compatibility with such

circumstances [13].

Some studies show the relationship between religion

and faith is necessary for survival and resistance to

disease, because religion can reduce depression and

mental illness and increase the longevity and improve

the life and physical-psychological condition [14].

Prayer therapy is a way by which the spiritual

relationship between God and human beings in need

has been created, and this relationship leads to

renewing of the patient's morale and breaking of the

disappointment wall in his self; this affects the

acceptance and admittance of the disease [7]. Spiritual

support and religious resources and having a strong

relationship with the higher power can improve the

quality of life and interpersonal supports and reduce

the severity of symptoms that its results will be

beneficial for medical care and treatment [15].

Results of this study showed that married people prey

more. Rezaei in his study also has shown a significant

relationship between the frequencies of pray and

marital status in cancer patients under chemotherapy

treatment [16]. Yet Riliey et al. in their study showed

that married people have more spiritual health [17].

Also in this study there was significant correlation

between spiritual health and age of patients. Rezaei in

his study has shown that there is a direct relationship

between spiritual health and the age of cancer patients,

i.e. with increase in age, the spiritual health will

increase in cancer patients, which corresponds with

the results of this study [16]. Increase in spirituality at

the end of life is considered as the normal aging

process [4], because the person encounters the reality

of death and becomes compatible with it.

Conclusion

Finally, with regard to the importance of doing

spiritual and religious cares that today is considered as

one of the duties of nurses, nurses as a key member of

health team are responsible to not only consider the

physical and psychological aspects of patients but also

respect their opinions and values. Considering the

religious dimensions, nurses should better understand

the cultural, indigenous and religious status of

patients. Therefore, we hope that by implementation

of religious commandments which today are referred

as religious cares, lead to tranquility and accelerated

healing of patients.

Acknowledgement: At the end of this research it is

necessary to express gratitude for the efforts of

hemodialysis staff of Imam Reza hospital and the

sincere cooperation and tolerance of patients.

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