Evolutionary Concept Analysis of Spirituality

Il Sun Ko; So Young Choi; Jin Sook Kim

doi:10.4040/jkan.2017.47.2.242

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This article has been corrected. See "Corrigendum: Evolutionary Concept Analysis of Spirituality" in Volume 47 on page 712.

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Ko, Choi, and Kim: Evolutionary Concept Analysis of Spirituality

Original Article

Journal of Korean Academy of Nursing 2017; 47(2): 242-256.

Published online: 28 April 2017

DOI: https://doi.org/10.4040/jkan.2017.47.2.242

Evolutionary Concept Analysis of Spirituality

Il Sun Ko¹, So Young Choi¹, Jin Sook Kim²

¹College of Nursing, Yonsei University, Seoul, Korea.

²Department of Nursing, the Graduate School, Yonsei University, Seoul, Korea.

Address reprint requests to: Kim, Jin Sook. Department of Nursing, the Graduate School, Yonsei Univerity, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3389, Fax: +82-2-392-5440, somach87@hanmail.net

Received 19 December 2016 Revised 3 March 2017 Accepted 4 March 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was done to clarify attributes, antecedents, and consequences of spirituality.

Methods

Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing.

Results

Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: ‘intimacy and connectedness with God’ and ‘holy life and belief’, 2) horizontal dimension: ‘self-transcendence’, ‘meaning and purpose in life’, ‘self-integration’, and ‘self-creativity’ in relationship with self, ‘connectedness’ and ‘trust’ in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included ‘life centered on God’ in vertical dimension, and among horizontal dimension ‘joy’, ‘hope’, ‘wellness’, ‘inner peace’, and ‘self-actualization’ in relationship with self, ‘doing in love’ and ‘extended life toward neighbors and the world’ in relationship with others·neighbors·nature. Being negative was defined as having ‘guilt’, ‘inner conflict’, ‘loneliness’, and ‘spiritual distress’. Facilitators of spirituality were stressful life events and experiences.

Conclusion

Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are ‘connectedness with God’, ‘self-transcendence’, ‘meaning of life’ and ‘connectedness with others·nature’. Unchangeable consequences of spirituality are ‘joy’ and ‘hope’. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

Keywords: Spirituality, Analysis

Figures and Tables

Figure 1

Flow diagram of study selection.

Figure 2

Conceptual model of Spirituality.

Table 1

Concept Analysis of Spirituality in Studies

Study	Dimension	Attributes	Antecedents	Facilitators	Consequences
Medicine	N/A	Belief & Obedience, unique & personal experience (Verghese, 2008) A way of being in the world (Dein, 2005) Transpersonal reality (Bessinger & Kuhne, 2002) Search for realm of the sacred (Dein, 2005; Kim, 2013; King & Koenig, 2009) Meaning and purpose of life (Bessinger & Kuhne, 2002; Verghese, 2008), Connectedness with universe (King & Koenig, 2009; Verghese, 2008)	Cultural factors (Dein, 2005; Kim, 2013) Disease, critical care, oncology, end of life, bereavement (Bessinger & Kuhne, 2002)	N/A	Coping with disease (Puchalski, 2001) Healing, health, Recover (Bessinger & Kuhne, 2002, Dein, 2005; Puchalski, 2001) Facing death (Puchalski, 2001)
Counseling psychology	N/A	Cognitive, emotional, behavioral tendency (Cho & Kim, 2012) Self-transcendence: Self-renunciation, Selfdiscovery, Self-expansion, Maturity, Having healthy relationship, Unity with universe and others (Lee et al., 2003; Kim et al., 2009; Kim et al., 2009) Religious & Existential well-being (Kang, 2003)	Individual characteristics (Choi, 2001) Culture (Choi, 2001)	N/A	Self-actualization (Kim et al., 2009)
	Orient	Self-awareness, Mercy (Lee et al., 2003)
	West	Meaning and purpose in life (Choi, 2001)
Social welfare	Humanity, living	Relationship with God or Supernatural being (Oh, 2009) Self-development (Oh, 2009) Self-revolution (Oh, 2009) Searching for life's meaning (Oh, 2009; Oh & Jung, 2013)	Belief of world order including human organism, or God (Lee, 2003)	N/A	N/A Self-actualization (Lee, 2003) Inter-connectivity with existences including self, others and God (Lee, 2003)
Nursing	Vertical (religious wellbeing)	Connectedness with Higher power (Chiu et al., 2004; Cohen et al., 2012; Delgado, 2005; Gall et al., 2011; Gray, 2006; Kang et al., 2009; Kim et al., 2003; Kim et al., 2006; Kim et al., 2012; Lee, 2003; Lee et al., 2001; Lydon-Lam, 2012; McBrien, 2006; McEwan, 2004; McEwen, 2004; Tanyi, 2002; Wi & Yong, 2012) Participating in religious life (So & Min, 2006)	Sociodemographic characteristics Residence (Kang et al., 2009), Gender (Kang et al., 2009; Kim et al., 2012), Age (Kim, 2010; Kim et al., 2012; Sung, 2009), Income (So & Min, 2006), Sources for cost of living (Kim et al., 2012), Marital status (Sung, 2009), Parenting attitude (Lee et al., 2007), Educational level (Han, 2000) Religious characteristics Religion (Hadzic, 2011; So & Min, 2006), Institution (McSherry, 2006) Significance of religion (Kim, 2010), Participating in religious ceremony (Kim et al., 2012), Reading Bible and praying (Kim et al., 2012), Belief in God's existence (Sung, 2009), Spirit (Oh & Kang, 2000; Tanyi, 2002) Psychological characteristics Self-esteem (Kang et al., 2009), Life's meaning (Kang et al., 2009), Loneliness (Kim et al., 2012), Depression (Wi & Yong, 2012) Socialization (McSherry, 2006), Searching for meaning (McBrien, 2006)	Spiritual awareness, Awareness of God, Relatedness (Lee, 2003) Stressful events (Min, 2001) Inner introspection, Self-reflection (Min, 2001) Faith (Min, 2001)	Guilt (McBrien, 2006; Tanyi, 2002) Health (Delgado, 2005) Hope (McBrien, 2006; Tanyi, 2002) Inner conflict (Tanyi, 2002) Loneliness (Tanyi, 2002) Love, Joy (Tanyi, 2002) Peace (Delgado, 2005; Tanyi, 2002) Physical, Mental, Social, Spiritual Wellbeing (Oh & Kang, 2000) Positive attitude (So & Min, 2006) Spiritual distress (Tanyi, 2002) Spiritual pain (Tanyi, 2002) Spiritual reinforcement (Lydon-Lam, 2012) Spiritual wellbeing (Min, 2001) Wellness (Tanyi, 2002)
	Horizontal (existential wellbeing)	Harmonious inter-connectivity (Oh & Kang, 2000) Forgiveness (Choi et al., 2001) Love (Choi et al., 2001; Han, 2003; Kim et al., 2012; Wi & Yong, 2012) Connectedness (Choi et al., 2001; Han, 2003; Kim et al., 2012; Stephenson & Berry, 2015; Torskenaes et al., 2015; Wi & Yong, 2012) Peace (Kim et al., 2012; Lee et al., 2001; Wi & Yong, 2012) Trust, Belief (Delgado, 2005; Lee et al., 2001; Torskenaes et al., 2015) Value (Lydon-Lam, 2012; McBrien, 2006; Tanyi, 2002; Stephenson & Berry, 2015; Torskenaes et al., 2015) Transcendence (Delgado, 2005; Kim, 2010; Lee, 2003; Lydon-Lam, 2012; McEwan, 2004; McEwen, 2004; Oh & Kang, 2000; Oh et al., 2001; Stephenson & Berry, 2015) Searching for life's meaning and purpose (Cohen et al., 2012; Delgado, 2005; Gall et al., 2011; Kim, 2010; Kim et al., 2012; Lydon-Lam, 2012; McEwen, 2004; Oh & Kang, 2000; Oh et al., 2001; Torskenaes et al., 2015; Stephenson & Berry, 2015)
	Existential	Inner resources (Hadzic, 2011; Kim, 2010; McBrien, 2006; Oh & Kang, 2000; Oh et al., 2001; Tanyi, 2002) Self-awareness (Kim, 2010) Acceptance of death (Kim et al., 2012; Wi & Yong, 2012) Hope (Han, 2003; Han, 2000; Kim et al., 2012; Lee et al., 2001; Wi & Yong, 2012) Self-respect (Lee et al., 2001) Integration (Min, 2001) Self-acceptance (Lee et al., 2001) Orientation for the future (Lee, 2003) Core self (Self-essentials) (Gall et al., 2011) Becoming (Lydon-Lam, 2012) Presence (Tanyi, 2002)	Health related characteristics Post surgical period (So & Min, 2006), Event(illness) (Lydon-Lam, 2012; McBrien, 2006), Culture (McSherry, 2006) Life experience ©(McSherry, 2006)
	Intrinsic	Belief, Religious attitude, God, Love, Inter-connectivity, Devotion, Self-transcendence, Inner resources, Wisdom, Passion (Sessenna et al., 2007)	N/A	N/A
	Extrinsic	Religious activity (pray, worship, assembly), Religious or spiritual expression or experience, meaningful work, fruitful life, creative expression, cooperation with others (Sessenna et al., 2007)

Table 2

Integrated Results of Concept Analysis of Spirituality

Dimension		Attributes	Antecedents	Facilitators	Consequences
Dimension		Attributes	Antecedents	Facilitators	Positive	Negative
Vertical	Relationship with God	Intimacy/Connectedness with God Holy life and belief	Sociodemographic characteristics Race, residence, gender, age Marriage Economic status Educational level Parenting attitude Religious characteristics Kind of religion Acceptance of God's existence Participating in religious ceremony Significance of religion in life Reading Bible and pray, Repentance, Religious reflection Psychological characteristics Self-esteem Loneliness Depression Health related characteristics Disease Post surgical period	N/A	God-centered life	Guilty Inner conflict Loneliness
Horizontal	Relationship with self	Self-transcendence Meaning and purpose in life Self-integration Self-creativity		Stressful events and experiences	Joy Hope Wellness Inner peace Self-actualization	Spiritual distress
Horizontal	Relationship with others/neighbors/nature	Connectedness with others/neighbors/nature Trust		Stressful events and experiences	Doing in love Extended life toward neighbors and world	Spiritual distress

Bold face: terms newly identified.

Notes

This study was supported by the Research Grant of College of Nursing, Yonsei Univerity in 2012(No: 6-2012-0202).

^{CONFLICTS OF INTEREST} The authors declared no conflict of interest.

Appendix

Studies Included in Concept Analysis

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