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Spirituality and Well-Being: Focusing on What

Matters

Article  in  Western Journal of Nursing Research · October 2012

DOI: 10.1177/0193945912448315 · Source: PubMed

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Mary Jo Kreitzer
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Guest Editorial
Western Journal of Nursing Research

Spirituality and Well- 34(6) 707­–711

© The Author(s) 2012
Reprints and permission:
Being:  Focusing on sagepub.com/journalsPermissions.nav
DOI: 10.1177/0193945912448315
What Matters http://wjn.sagepub.com

Mary Jo Kreitzer

In a recent Wall Street Journal article titled “The Simple Idea That Is Trans-
forming Health Care” (Landro, 2012), well-being is touted as a strategy that
is fundamental to achieving improved health outcomes. A study published in
Population Health Management (Harrison, Pope, Coberley, & Rula, 2012)
was cited that found that higher self-reported well-being was associated with
fewer hospitalizations, ER visits, and medication use prompting the authors
to conclude that well-being improvement efforts represent a promising
approach to decrease future health care utilization and expenditures.
Well-being is not a particularly new concept, but perhaps an idea whose
time has come. In 1946, the World Health Organization defined health as a
state of complete physical, mental, and social well-being, and not merely the
absence of disease or infirmity. More than 30 years ago, Aaron Antonovsky
(1987), a professor of sociology, coined the term salutogenesis to describe an
approach to care that focuses on factors that support human health and well-
being, rather than on factors that cause disease.
Spirituality and well-being are closely intertwined, and for many, spiritu-
ality affects all aspects of well-being. Well-being is a state of being in balance
and alignment in body, mind, and spirit. It is a state in which people describe
themselves as feeling healthy, content, purposeful, peaceful, energized, in
harmony, happy, prosperous, and safe. The word spirit in Hebrew is ruah,
which translated means wind, breath or air, that which gives life. While
defined in many different ways, at the core, spirituality literally means life
giving or sustaining.
This special issue of the Western Journal of Nursing Research highlights
research and scholarship that focuses on spirituality and touches on many
dimensions of the Well-Being Model developed by the University of
Minnesota Center for Spirituality and Healing. As illustrated in Figure 1,
well-being is affected by health, purpose, relationships, community, security,
and the environment.
708 Western Journal of Nursing Research 34(6)

Figure 1. Well-Being Model

Each dimension of well-being is defined as follows:

Health: physical, emotional, mental, and spiritual health.

Purpose: an aim and direction, a direct expression of spirituality that
gives life and work meaning.
Relationships: social connections, networks, and the quality of
relationships.
Kreitzer 709

Community: resources and infrastructure and the extent to which peo-

ple are engaged and empowered.
Environment: access to nature as well as clean air, water, and toxin
free.
Security: basic human needs, stable employment, sufficient finances,
and personal safety.

In the opening article in this special series on spirituality and well-being,

Dr. Inez Tuck highlights several critical issues that have contributed to the lack
of development of spirituality as a core intervention within nursing. There is
limited agreement regarding the concept and definition of spirituality, and few
empirical studies of spiritual interventions have been published. She also
argues that nurses have demonstrated reluctance to provide spiritual care. A
major barrier cited is nurses’ lack of knowledge of appropriate spiritual inter-
ventions. Noting the paucity of well-developed and tested interventions, Tuck
describes her 14-year quest to develop a spiritual intervention—an 8 week
spiritual growth group.
Dr. Marlene Cohen and her colleagues tackled in their article, a historical
review of spirituality research and the particular and persistent challenges
posed by definitions of religion and spirituality. A critical review of existing
measures is provided as well as guidance on how to build on existing work
that has been conducted in the field while designing studies that will yield
clinically useful findings.
Three additional articles are illustrative of the early developmental stages
of spirituality research. In a study of 20 African American women, Sofia
Dalmida found that for many of the women in her study, the diagnosis of HIV
and living with HIV served as an impetus for them to discover meaning and
purpose in their lives while also stimulating a spiritual awakening. She also
affirmed the finding that spirituality and religion often play an important role
in managing stress and maintaining overall well-being.
Tuck and colleagues describe an innovative spiritual intervention designed
for family members of homicide victims. The intervention includes reflec-
tion, mindfulness, guided imagery, storytelling, and healing rituals. Eight
family members participated in the 2-day retreat and completed surveys at
5-time intervals over 2.5 years.
The final article by Baldacchino and colleagues examined spiritual
coping among three groups of individuals with life-threatening illnesses
in Malta: hospice clients with cancer, parents of children with cystic
fibrosis, and people recently diagnosed with their first myocardial infarction.
The descriptive analysis demonstrates the importance and uniqueness of
cultural context.
710 Western Journal of Nursing Research 34(6)

While there is room for continuing debate over definitions and clearly
more work that needs to be done on measurement and methodology, the
questions that intrigue and engage me are ones that focus on how spirituality
can improve well-being by strengthening capacity and expanding potential
in people, organizations, and communities. We need research and scholar-
ship that focuses not only on provider-based interventions but also on self-
care spiritual practices that help people discover purpose, meaning, and
connectedness.
The relationships between purpose, health, and spirituality have been well
documented. If well-being contributes to clinical and financial outcomes and
spirituality is interconnected with many of the other factors that affect well-
being, we also need research that explores the following:

•• Relationships and spirituality: What is the role of social connections,

social networks, and social support beyond organized religion?
•• Community and spirituality: What resources within communities
could strengthen spirituality of residents and are residents who expe-
rience spirituality in their lives more likely to contribute to commu-
nity engagement (participation and connections) and empowerment
(capacity for taking action)?
•• Environment and spirituality: How does the natural and built envi-
ronment contribute to spirituality? How can people and communi-
ties tap into healing power of nature in ways that nourish and sustain
them?
•• Security and spirituality: What is the relationship between vulner-
ability and spirituality?

Well-being has been studied by the Gallup Organization for more than 40
years. Their research, encompassing more than 150 countries, has revealed
common elements of well-being that transcend countries and cultures. According
to Gallup, well-being is affected by a love for what we do each day, the quality
of our relationships, the security of our finances, the vibrancy of physical health,
and the pride we take in what we contribute to our communities. And Gallup
notes, people take different paths to increasing their well-being, and for many,
spirituality drives them in all these areas (Rath & Harter, 2010).
Spirituality holds the potential for significantly affecting the health and
well-being of people, organizations, and communities. It is a strategic and criti-
cal time for nursing to provide leadership that advances research and scholar-
ship, education, and innovative care models.
Mary Jo Kreitzer, PhD, RN, FAAN
University of Minnesota
Kreitzer 711

References

Antonovsky, A. (1987). Unraveling the mystery of health—How people manage stress

and stay well. San Francisco, CA: Jossey-Bass.
Harrison, P. L., Pope, J. E., Coberley, C. R., & Rula, E. Y. (2012). Evaluation of the
relationship between individual well-being and future health care utilization and
cost. Population Health Management, 15, 1-6.
Landro, L. (2012, April 16). The simple idea that is changing health care. Wall Street
Journal. Available from http://online.wsj.com
Rath, T., & Harter, J. (2010). Wellbeing: The five essential elements. New York, NY:
Gallup.
World Health Organization. (1946). Preamble to the constitution of the World Health
Organization as adopted by the International Health Conference, New York, 19-22
June, 1946, signed on 22 July, 1946, by the representatives of 61 States (Official
Records of the World Health Organization, no. 2, p. 100) and entered into force
on 7 April, 1948.

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