Mental health disorders are comprised of a combination of symptoms that cause a disruption in daily functioning across the lifespan. Such symptoms include abnormal thoughts, feelings or emotions which in turn, can negatively affect behavior and disrupt relationships (American Psychiatric Association, 2018). As the prevalence of mental health disorders continues to rise globally (World Health Organization, 2018), it is essential that the nursing workforce understand psychospiritual factors that can provide comfort while caring for these individuals. Kolcaba (1994) notes that the psychospiritual context of comforting someone includes mental, emotional, and spiritual components of the self. Unfortunately, the evolution of mental health practice has suppressed the exploration of the psychospiritual nature of humans. Experts in the psychiatric field have a theory that thought has the ability to interrupt ones natural state of peace, wisdom and, love (Pransky & Kelley, 2014). Psychospiritual practices allow for the natural state of the mind to transcend, allowing negative thoughts to subside and symptoms to be self-managed. Using spirituality as a means of treatment and holistic comfort allows for the mind-body connection to have a positive effect on mental health. It has the potential to calm fears, to decrease anxiety and to reduce depression and trauma symptoms (Courtois, 2017; Pransky & Kahofer, 2012; Pargament, 2013 & Smothers & Koenig, 2018).
Background
Among the mental health disorders that are plaguing our world today, depression is the leading cause of disability worldwide affecting close to 300 million people (WHO, 2018). With traumatic events and loss reported as being commonplace worldwide, the World Health Organization reports the following among global statistics: 10% witness violence, 18.8% experience interpersonal violence, 17.7% are involved in traumatic accidents, 16.2% are exposed to war and 12.5% are exposed to vicarious trauma; all of which cause anxiety symptoms (2018). Research has shown that the post-911 world holds more fear, anxiety, worries and uncertainties than any other era (Crupi & Brondolo, 2017). The global health system is not able to respond to the demanding mental health needs of the population due to the mere fact that the ratio of practitioners to mental health patients is astronomically disproportionate. Psychospiritual practices can be a common and inherent coping strategy, allowing those affected by mental illness to be actively involved in their own plan of care in partnership with providers. According to Koenig, a pioneer in spirituality and health, “spirituality is transcendent, which is the intimate connection between our inner selves and the outer world. Part of spirituality is the journey toward embracing the mystical elements of our beliefs even without proof” (2017, pg. 109). Nursing researchers suggest spirituality is a positive coping mechanism decreasing the negative impact of traumatic stress on mental health (Reinert & Koenig, 2013). People who recognize themselves as being more spiritual overcome mental health disparities far greater than those who are not; this finding includes youth in the foster care system (Weber & Pargament, 2014).
The World Health Organization launched the Mental Health Gap Action Programme (mhGAP) in 2008 to reprioritize tactics to overcome the myriad of mental health issues globally. A primary focus to the MhGAP was to develop capacity building within communities (WHO, 2018). Nurses must engage communities in utilizing engrained values like psychospiritual factors to allow for the promotion and sustainability of mental wellness individually and communally. Existential well-being proves to have a positive impact on those who utilize psychospiritual practices such as meditation, prayer and yoga; practices that allow for mental health symptoms to improve in time (Florez et al., 2018).
Purpose
The purpose of this session is to critically appraise, synthesize, and present recent evidence based holistic psychospiritual practices that enhance comfort and allow for transcendence to a mentally well state of being.
Method and Evaluation Strategies
In order to accurately present psychospiritual evidence based practices that are essential to the care of those affected by mental illness, the Johns Hopkins Evidence Based Practice Model of evaluation was used. Kolcaba’s (1992; 1994) theory of holistic comfort allows for the seamless integration of theory to practice providing a framework for future practitioners to continue to evolve their skillset. A combination of both quantitative and qualitative research across the globe as well as seminal studies were included. The following databases from the last 5 years were searched: CINAHL, PubMed, and PsycINFO.
Appraisal Findings
Empirical evidence shows that clients hold many spiritual or religious beliefs that they wish to use as part of their psychotherapy and overall mental health care, especially for those with trauma histories. Excluding spiritual beliefs or practices into patient care is unethical and negligent of providers (Courtois, 2017 & Koenig, 2017). Lee, Connor, and Davidson (2018) state, “both spirituality and religion occupy an important place in the understanding and management of many who survive major psychological trauma” (p.68). It is essential that all health care professionals, especially nurses, understand the need to address a clients’ psychospiritual history as part of the assessment process. This allows for a holistic approach to care to be focused on the client in order to have a better chance of mental wellness and wholeness. Several systematic reviews and meta-analysis’ over the last 5 years conclude that religious and spiritual interventions result in significant decreases in anxiety, alcoholism, depression, post-traumatic stress symptoms and addictive disorders (Bonelli and Koenig, 2013; Goncalves, Menezes & Vallada, 2015; Smith et al., 2017 & Wang et al., 2014). To leave spirituality out of patient care offers the same disservice as if one was to impose their view on a client. In many countries outside of the United States it is commonplace for the healthcare team to address the clients’ spirituality as well as collaboration with religious and spiritual professionals as part of the general intake process (Dura et al., 2011).
Implications and Conclusion
The benefits from utilizing psychospiritual approaches to mental health care far outweigh any risks that are noted by researches and in fact are more detrimental when ignored (Koenig, 2015). Depression, anxiety, trauma and addictive symptoms have been reported to improve with the presence of spirituality (Goncalves, Menezes & Vallada, 2015). This has implications for the health care environment, mental health nurse practitioners, patient outcomes, and for health care providers across all disciplines. Discussing spiritual well-being should be a routine and integrated component of mental health practices with regular assessment and treatment. High quality research studies are needed to provide more evidence to show that the utilization of spiritual practices among patient populations are beneficial. Health care professionals can only increase their clients’ tool box allowing them to personally manage and alleviate problematic mental health symptoms. Taking a psychospiritual approach can indeed relieve, ease, and allow for transcendence to take place promoting inner peace and a grounded state of being.