Research Article

Published: 30 Apr, 2018

Journal of Psychiatry and Behavioral Health Forecast

The Effect of Spiritual Care Based on Sound Heart Model
on Quality of Life in Hemodialysis Patients
Mazandarani HK1, Asadzandi M2,3,4,5*, Saffari M6,7 and Khaghanizadeh M8
1
Critical Care Nursing, Student of Baqiyatallah University of Medical Sciences, Tehran, Iran
2
Assistant Professor, Department of Anesthesiology, Nursing Faculty, Baqiyatallah University of Medical Sciences,
Tehran, Iran
3
Faculty Member of Quran, Hadith and Medicine Research Center, Baqiyatallah University of Medical Sciences,
Tehran, Iran
4
Faculty Member of Spiritual Health of the Academy of Medical Sciences, Iran
5
Founding Member of Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
6
Associate Professor, Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
7
Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
8
Associate Professor of Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences,
Tehran, Iran

Abstract
Background and Objective: Depression, anxiety and its consequences: frustration, mitigation of
effort, as spiritual distress decreases quality of life in hemodialysis patients that requires spiritual
care. The aim of this study was to investigate the effect of spiritual care, "based on the Sound heart
model," on the quality of life in hemodialysis patients.
Methods: In a semi-experimental study, 32 outpatients under hemodialysis were selected. In
educational support system, spiritual counseling was done based on the model. Intervention with
emphasis on improving the four-person relationships with God, self, people and nature was done.
The purpose of spiritual counseling was: creating optimism, hope and courage to face the crisis of
disease, spiritual self-awareness, development of social communication with love and forgiveness,
OPEN ACCESS enjoyment of nature. Training spiritual skills in eight individual sessions was conducted by
presenting a booklet. The SF36 quality of life questionnaire was completed before the intervention,
after completing the consultation and three months later by the patients. The trend analysis was
*
Correspondence:
Minoo Asadzandi, Assistant Professor, done by repeated measures analysis of variance.
Department of Anesthesiology, Nursing
Results: The mean (SD) age of the participants was 57.75 (12.56) and 62.5% of the samples were
Faculty, Baqiyatallah University of
male. The quality of life score before intervention was 46.36 (14.98) and three months after the
Medical Sciences, Tehran, Iran.
intervention, increased to 61.36 (13.16), there was a significant difference between the repeated
E-mail: zandi498@yahoo.com
(001/0 p<) measures using ANOVA
Received Date: 29 Mar 2018
Accepted Date: 27 Apr 2018 Conclusion: Spiritual counseling was able to provide self-efficacy, self-control and daily self-
Published Date: 30 Apr 2018 calculation in patients. Sound heart model can be used to improve the quality of life in hemodialysis
patients.
Citation: Mazandarani HK, Asadzandi
M, Saffari M, Khaghanizadeh M. The Keywords: Quality of life; Kidney dialysis; Spiritual care
Effect of Spiritual Care Based on
Sound Heart Model on Quality of Life Knowledge Translation (KT)
in Hemodialysis Patients. J Psychiatry “What is already known in this topic?” Existing studies have not used a care model. Researchers
Behav Health Forecast. 2018; 1(1): only have used a few religious concepts or Richard Bergin's interventions based on the Christianity
1006. beliefs by trying to adapt to the culture of Iranian Muslim patients.
Copyright © 2018 Asadzandi M. This is "This article adds to the previously known knowledge" This study, while presenting a
an open access article distributed under systematic method of care based on the spiritual care model of Sound heart in Islamic paradigm
the Creative Commons Attribution and with harmony with the beliefs of Muslim patients, teaches community-based care using an
License, which permits unrestricted implementation algorithm.
use, distribution, and reproduction in
Introduction
any medium, provided the original work
is properly cited. Hemodialysis is one of the most successful and commonly used methods for kidney replacement

ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 1 2018 | Volume 1 | Edition 1 | Article 1006

1
Asadzandi M, et al., Journal of Psychiatry and Behavioral Health Forecast

in controlling chronic renal failure in the world and in Iran, which patient and his family with a family-centered approach [36]. The
is essential for the continuation of life with this life-threatening model provides the possibility of establishing meaningful relationship
illness [1]. Studies in 2014 showed that approximately 89% of the with God by faith. With creating self-awareness (understanding the
662.2 million world's dialysis patients and 94% of the 27,457 Iranian person's thoughts, intentions and emotional states), benefiting from
dialysis patients, were hemodialysis patients [2]. This treatment is nature and communicating effectively with family and friends [37]
still the most important treatment for chronic renal failure, which and creating a social-spiritual support network, for emotionally
results in more patients surviving, but is considered as a source of adaptation to illness [38]. So the aim of this study was to investigate”
stress [3]. Hemodialysis results in: a feeling of dependence on the the effect of spiritual care based on the Sound Heart model on the
device, a change in lifestyle, a reduction in the ability to play social quality of life of hemodialysis patients”.
roles, an increase in the cost of health services, and a decrease in the
quality of life of patients [4,5]. Hemodialysis also causes problems for
Materials and Methods
patients such as: digestive complications, reproductive problems, skin This study was conducted in a semi-experimental study, one
problems, lack of focus, Irritability, boredom, sleep disorders, restless group, before and after, at Baqiyatallah Hospital in Tehran in 1395.
leg syndrome [6-8] and psychiatric disorders such as: depression and The sample size was calculated 32, using standard deviation and
anxiety [9,10]. In the last decade, a 46% prevalence of depression has mean value obtained from Rahimi’s study [39], with a 20% drop, the
been reported in hemodialysis patients [11,12], which has led to: an probability of the first type error is 0.05 and the test power equal to
increase in fatigue, decreased physical activity and patients' quality of 80%. At first 38 patients were selected according to Inclusion criteria.
life [13-15]. (Adult patients, over 18 years, were able to complete questionnaires,
Persian language, having a history of six months of dialysis, at least
Quality of life is person's perception, from feeling of hope, life
twice a week for dialysis). During the study, 6 patients were excluded
satisfaction, physical, mental, social, and family health [16], which is
according to exclusion criteria (illness leads to hospitalization, loss of
directly affected by stress and mental health status [17]. The neglect
self-care capacity, death, and transfer to another center for dialysis
of quality of life leads to frustration, lack of motivation for efforts and
or kidney transplantation). Eventually, 32 patients formed the study
reduction of economic, cultural and health activities of an individual
volume. After receiving the Code of Ethics Committee and Clinical
[18]. Over time, with a significant change, hemodialysis patients
Practice Code, the researcher referred to the hemodialysis department
develop a decline in quality of life [19]. There is a positive relationship
of Baqiyatallah Hospital. According to patients' demographic data
between depression and pain with a decrease in quality of life [14,20]
and inclusion criteria, samples were selected as available. After
and a significant relationship between symptoms of insomnia and the
explaining the method of research and obtaining informed written
psychological dimension of quality of life [21]. Depression requires
consent, the questionnaires were completed before the intervention
care because it reduces adherence to treatment and increases clinical
by the patients.
mortality [22,23]. Spiritual care, is an essential component of nursing
practice, which determines how people respond to their illness, it is The demographic questionnaire (12 questions) included:
the most important contributor to achieving a balance in maintaining gender, age, marital status, occupation, education, history of kidney
health and coping with illness [24]. Using religion for communication transplantation, history of surgery and disease, vascular access,
with God [25] and spiritual interventions while helping patients to history of dialysis, number of dialysis, and duration of dialysis. The
cope with the biological challenges of disease [26]. It has a positive SF-36 quality of life questionnaire assesses the quality of life in eight
effect on patients' longevity [27] and improve hemodialysis patients' areas: Physical function (10 questions) and body pain (2 questions)
health [28,29]. Spiritual care by decreasing depression and anxiety of and general health (5 questions) physical activity limitations (4
patients improves their quality of life [30,31]. questions) psychological limitations (3 questions) social functions (2
questions) energy domains (4 questions) and having a good feeling
In educational and support system, one of the most important
(5 questions). These eight domains form two physical and mental
psychological interventions in hemodialysis patients is psychosocial
components. The physical component includes: physical activity
spiritual support and counseling [32]. Spiritual counseling is a
areas, functional limitations due to physical problems, body pain.
treatment and intervention based on the potential power of faith and
The mental component includes: having a good feeling, limiting
spirituality, in the direction of healing and recovery [33] which as a
emotional and social performance. Energy and public health are
complementary method, improves the quality of life of patients [34].
common in both areas. Questions are rated Likert (1 to 5). Each of
The "Spiritual Care Model of Sound Heart", based on the religious
these dimensions has 100 points. A high score reflects a better quality
spirituality of the Abrahamic religions, emphasizes self-care and
of life. The validity and reliability of SF36 quality of life questionnaire
home care in educational and support system. The goal of spiritual
have been confirmed in studies both inside and outside Iran. The
care in model is to achieve a healthy spirit or Sound heart (a calm
validity and reliability of the Persian translation of this questionnaire
and safe soul, full of trust, love, hope, joy, security, satisfaction of
were approved by Mont Azeri et al. In 2005 and Cronbach's alpha was
fate, pleasure, patience, happiness, optimism, without fear and future
reported 0.65 [40].
anxiety, as well as regret and sorrow) by development and correction
of the four dimensions of human communication (with God, others, The intervention included: nine spiritual counseling sessions, 15
Self and nature). The model uses the assistance and participation of to 45 minutes, individually, during dialysis once a week, with emphasis
the patient and his family in care [35]. Regarding the necessity of on improving the four-person relationships with God, self, people and
community-based care, it acts in harmony with the values and beliefs nature. The purpose of spiritual counseling was: creating optimism,
the followers of the Abrahamic religions, including Muslim patients. hope and courage to face the crisis of disease, spiritual self-awareness,
For outpatients, provides counseling and spiritual skills training in development of social communication with love and forgiveness,
an educational support system. It considers the values and interests enjoyment of nature. Training spiritual skills in individual sessions
of patients to choose the method of spiritual care and supports the was conducted by presenting a booklet. After completing the training

ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 2 2018 | Volume 1 | Edition 1 | Article 1006

Asadzandi M, et al., Journal of Psychiatry and Behavioral Health Forecast

Table 1: Comparison Quality of life (SF36) questionnaires in participants.

Level Posttest 2
Statistical test
Pre-test mean (SD) Posttest 1 mean (SD) (Three months later)
(RMANOVA)
Variable mean (SD)
F: 7.27
Physical functioning 51.87(27.52) 59.53(24.96) 62.96(23.48)
P:0.01
F:19.00
Role limitations – physical 31025(37.52) 38.28 (38.93) 78.12 (36.33)
P˂0.001
F:2.04
Pain 44.45(21.42) 45.46 (17.49) 40.07 (15.44)
P:0.16
F:0.26
General health 41.09 (18.21) 43.43 (14.55) 42.34 (13.43)
P:0.60
F:13.77
Emotional well-being 54.50 (26.27) 62.00 (19.30) 67.00 (19.27)
P˂0.001
F:18.36
Role limitations - emotional 48.95 (39.98) 61.45 (31.80) 87.50 (27.75)
P˂0.001
F:0.12
Social function 55.46 (21.98) 57.81 (16.11) 56.64 (13.46)
P:0.73
F:16.53
Energy/fatigue 43.28 (20.14) 51.87 (15.33) 56.09 (17.02)
P˂0.001
F:28.33
Quality of life (SF36) 46.36 (14.98) 52.48 (9.71) 61.34 (13.16)
P<0.001

sessions and three months later, the quality of life questionnaire was of human communication (with God, others, self, and creation) by
completed by the patients. To investigate the normal distribution of applying the skills of faith therapy (prayer, remembrance of God,
quantitative variables, the Kolmogorov-Smirnov test was used. The healing touch with healing worship, trust, tolerance, and resort) to
data obtained from the questionnaires were analyzed using SPSS24 create the courage to face disease crisis, future optimism and hope.
software and repeated measures (RMANOVA) by using ANOVA The skill of daily checking and recording of emotional states (self-
test. The significance level in this study was less than 0.05. calculation) for creating self-spiritual awareness. Recommending
forgiveness, charity, goodness to develop relationships with people.
Findings And use of the blessings of the creation world (looking at the water
The demographic characteristics of the sample, were as follows: and trees, listening to the song of birds, using bright and joyous
62.5% male, 84.4%, married persons, 50% of retired, 1.3% of illiterate, colors, Kindness to animals, growing plants, Perfume use) to develop
81.2% did not have kidney transplants. After spiritual counseling and a relationship with nature [47].
also three months later, the statistical analysis showed a significant
The use of Richard Bergin's spiritual interventions, without any
difference (P<0.001). The mean (standard deviation) of the total
change, in the study of Ghahari et al. in Iran, had no significant effect
quality of life questionnaire before the intervention was 46.36 (14.98)
on the stress, anxiety and depression of women with cancer [48].
and 61.34 (13.16) three months later. Comparison of the domains
The sound heart model Emphasizes community-based care and is in
of the SF36 quality of life questionnaire was found: physical activity,
harmony with the religious culture of the Muslim people of the world
physical activity, feeling good, feeling and fatigue were significantly
and followers of the Abrahamic religions.
different. But in other areas, there was no significant statistical
difference (Table 1). Spiritual Care and Strengthening Family Relationships in Kim's
Study, increased Coping and Welfare among family caregivers of
Discussion Alzheimer's Patients [49]. The sound heart model also looks at the
The findings of this study showed that after spiritual counseling home as a place to create a sense of security and relaxation in the
based on Sound heart model, quality of life in hemodialysis patients patient. Emphasizes the strengthening of family relationships, the
was increased. Quality of life in hemodialysis patients was reported participation and support of family members in patient care and is
low in the study of Taheri et al. in Iran in 2010 [41] and Vigan et consistent with this study. Momeni performed spiritual care program
al. 2012-2013 at the Sylvanus Olympio University Hospital in Lomé, for three days based on the needs of the patient with the help of a
Togo [42] just like patients in this study. clergyman and a family member and reduced the anxiety of patients
with ischemic heart disease [50]. Sound heart model emphasizes
Bormann [43] Kim and Spillers [44] used the Richards & Bergin
on teamwork with the help of doctor, nurse, cleric, psychologist
spiritual interventions, include: praying for patients, encouraging
and family member for spiritual counseling. But in this study, the
patients to pray, discussing divine issues, using the Bible in the
investigator performed all stages of spiritual care alone.
treatment, using techniques of relaxation and imaging, persuading
the patient for forgiveness and sacrifice, helping the patient to be in The frequency of anxiety and depression in hemodialysis patients
harmony with spiritual values, self-disclosure of ideas, expression of in the study of El Filali et al. in the Northeast of Morocco Dialysis
spiritual experience, consultation with Priest. In Iran Mahdavi [45] Center in 2015 revealed the importance of psychiatric care [51].
Rehāni [46] used group spiritual care with the Richards & Bergin Aqajani used religious concepts such as: patience and amnesty to
spiritual education package, which was co-sponsored by religious conduct spiritual counseling and could reduce the anxiety and
experts and professors, with Iran's culture and Islam. They provided depression of hemodialysis patients [52]. Morasaie in counseling with
spiritual care with emphasizes on trust, resort, patience, charity, spiritual approach, succeeded in promoting hope in hemodialysis
mention, prayer. That is consistent with this research in the areas patients [53]. Bam dad had a significant effect on improving the
of: prayer and mention, pardon and forgiveness and speaking about spiritual health of patients by listening and instilling hope during
divine destiny and self-disclosure of ideas. Spiritual interventions in hospitalization [54]. In these studies, a model of spiritual care was
this study include: strengthening and correction of the four dimensions not used while this study was conducted based on a care model and

ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 3 2018 | Volume 1 | Edition 1 | Article 1006

Asadzandi M, et al., Journal of Psychiatry and Behavioral Health Forecast

the interventions were planned and implemented in the form of haemodialysis patients. Clinical rehabilitation. 2009; 23: 53-63.
executive steps and scheduling algorithm. 6. Dong R, Guo Z-Y, Ding J-R, Zhou Y-Y, Wu H. Gastrointestinal symptoms:
Application of the Sound Heart Model reduced anxiety in patients a comparison between patients undergoing peritoneal dialysis and
hemodialysis. World Journal of Gastroenterology: WJG. 2014; 20: 11370.
undergoing CABG, (36) and improved sleep quality in patients with
coronary disease [55]. In these studies, spiritual care was performed 7. Danquah FVN, Zimmerman L, Diamond PM, Meininger J, Bergstrom N.
by a nurse for hospitalized patients in the acute phase and in a semi- Frequency, severity, and distress of dialysis-related symptoms reported by
patients on hemodialysis. Nephrology Nursing Journal. 2010; 37: 627-639.
compensatory system. However, in this study, hemodialysis patients
were considered as outpatients with self-care ability and therefore, in 8. Zamanian H, Kharameh ZT. Translation and psychometric properties of
the educational system, spiritual counseling was conducted to give the persian version of the dialysis symptom index in hemodialysis patients.
chronic patients an effective way of self-care. Nephro-urology monthly. 2015; 7.
9. Rioux JP, Narayanan R, Chan CT. Caregiver burden among nocturnal
The limitations of this study were: Lack of time for the student to
home hemodialysis patients. Hemodialysis International. 2012; 16: 214-
measure the quality of life in six months to one year, the reluctance 219.
of patients family in counseling sessions, the lack of a place for
spiritual counseling, the unwillingness of patients to attend hours for 10. Mollahadi M, Tayyebi A, Ebadi A, Daneshmandi M. Comparison between
anxiety, depression and stress in hemodialysis and kidney transplantation
counseling other than dialysis time, and patients' unwillingness for
patients. Iranian Journal of Critical Care Nursing. 2010; 2: 153-156.
home visits and lack of control group in the study. Therefore, it is
suggested that spiritual counseling be performed, in a suitable place 11. Yucedal C, Olmez N, Gezen G, Celik F, Altindag A, Yilmaz M, et al.
(like the counseling room), with the presence of the patient and one Depression in dialysis patients. Journal of Renal Care. 2003; 29: 151-155.
of his family members, in a teamwork form. 12. Saglimbene V, Palmer S, Scardapane M, Craig JC, Ruospo M, Natale P,
et al. Depression and all-cause and cardiovascular mortality in patients
Conclusion on haemodialysis: a multinational cohort study. Nephrology Dialysis
Transplantation. 2016; 32: 377-384.
Using a community- based spiritual care model is an appropriate
method to meet the spiritual needs of patients and improve their 13. Bai YL, Lai LY, Lee BO, Chang YY, Chiou CP. The impact of depression
quality of life. Considering the importance of improving the quality on fatigue in patients with haemodialysis: a correlational study. Journal of
of life in patients and the findings of this study, it is recommended to clinical nursing. 2015; 24: 2014-2022.
use this model for chronic patients. 14. Belayev LY, Mor MK, Sevick MA, Shields AM, Rollman BL, Palevsky PM,
et al. Longitudinal associations of depressive symptoms and pain with
Acknowledgments quality of life in patients receiving chronic hemodialysis. Hemodialysis
We would like to sincerely thank and appreciates the dialysis International. 2015; 19: 216-224.
staff of Baqiyatallah hospital and all patients who collaborated in 15. Chan L, Tummalapalli SL, Ferrandino R, Poojary P, Saha A, Chauhan K, et
conducting this study. al. The Effect of Depression in Chronic Hemodialysis Patients on Inpatient
Hospitalization Outcomes. Blood purification. 2017; 43: 226-234.
Conflicting of Interest
16. Zeraati AA, Naghibi M, Ojahedi MJ, Ahmad ZS, Hasan ZB. Comparison
This article is extracted from a master thesis in nursing of Quality of Life between Hemodialysis and Peritoneal Dialysis Patients
IRCT2016120431233N1 and ethics committee code number: in Imam Reza and Ghaem Hospital Dialysis Centers in Mashhad. Medical
IR.BMSU.REC.1395.180 at Baqiyatallah University of Medical journal of mashhad university of medical sciences. 2010: 169-176.
Sciences, Tehran, Iran. 17. García-Llana H, Remor E, Del Peso G, Selgas R. The role of depression,
anxiety, stress and adherence to treatment in dialysis patients’ health-
Financial Disclosure related quality of life: a systematic review of the literature. Nefrologia.
Study was done with financial assistance of: spiritual health group, 2014; 34: 637-657.
Academy of Medical Sciences and Quran, Hadith and Medicine 18. Heidari M, Alhani F, Kazemnejad A, Moezzi F. The effect of empowerment
research center of Baqiyatallah University of Medical Sciences. model on quality of life of Diabetic adolescents. Iranian Journal of
Pediatrics. 2007; 17: 87-94.
References
19. Ferreira RC, Silva FilhoCRd. Quality of life of chronic renal patients on
1. Hinkle JL, Cheever KH. Brunner & Suddarth's textbook of medical- hemodialysis in Marília, SP, Brazil. Jornal Brasileiro de Nefrologia. 2011;
surgical nursing: Lippincott Williams & Wilkins. 2013. 33: 129-135.
2. Najafizadeh K. Date of kidney transplantation in Iran. Presented at the 20. Santos PR. Depression and quality of life of hemodialysis patients living in
First International Congress on Nephrology and Urology 2015. Iranian a poor region of Brazil. Revista Brasileira de Psiquiatria. 2011; 33: 332-337.
Society for the Protection of kidney patients. State's kidney transplant.
2015: 2-6. 21. Theofilou P. Association of insomnia symptoms with kidney disease
quality of life reported by patients on maintenance dialysis. Psychology,
3. Pron K AZF, Ghouja Zadeh M, Ahangar R. The stressors and adaptability health & medicine. 2013; 18: 70-78.
methods for patients undergoing peritoneal dialysis. Nursing & Midwifery
Journal of Tabriz. 2010; 5: 34-41. 22. Almeida AM, Meleiro A, Alexandrina M. Revisão: Depressão e
insuficiência renal crônica: umarevisão. Jornal Brasileiro de Nefrologia.
4. Ramirez SP, Macêdo DS, Sales PMG, Figueiredo SM, Daher EF, Araújo 2000; 22: 192-200.
SM, et al. The relationship between religious coping, psychological distress
and quality of life in hemodialysis patients. Journal of psychosomatic 23. Saeed Z, Ahmad AM, Shakoor A, Ghafoor F, Kanwal S. Depression in
research. 2012; 72: 129-135. patients on hemodialysis and their caregivers. Saudi Journal of Kidney
Diseases and Transplantation. 2012; 23: 946.
5. Ouzouni S, Kouidi E, Sioulis A, Grekas D, Deligiannis A. Effects of
intradialytic exercise training on health-related quality of life indices in 24. Potter PA, Perry AG, Patricia, Stockert PH. Fundamentals of nursing:

ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 4 2018 | Volume 1 | Edition 1 | Article 1006

Asadzandi M, et al., Journal of Psychiatry and Behavioral Health Forecast

Elsevier Health Sciences. 2016. single-center study on 64 hemodialysis patients at the Sylvanus Olympio
University Hospital in Lomé, Togo. Saudi Journal of Kidney Diseases and
25. Tanyi RA, Werner JS. Women's experience of spirituality within end-stage
Transplantation. 2017; 28: 609.
renal disease and hemodialysis. Clinical Nursing Research. 2008; 17: 32-49.
43. Bormann J, Warren KA, Regalbuto L, Glaser D, Kelly A, Schnack J, et al. A
26. Jofre R, López-Gómez JM, Valderrábano F. Quality of life for patient
spiritually based caregiver intervention with telephone delivery for family
groups. Kidney international. 2000; 57: 121-130.
caregivers of veterans with dementia. Alzheimer's Care Today. 2009; 10:
27. Aghighi M, Heidary Rouchi A, Zamyadi M, Mahdavi-Mazdeh M, Rajolani 212-220.
H, Ahrabi S, et al. Dialysis in iran. Iran J Kidney Dis. 2008; 2: 5-11.
44. Kim Y, Spillers RL. Quality of life of family caregivers at 2 years after a
28. Kimmel PL. Psychosocial factors in dialysis patients. Kidney international. relative's cancer diagnosis. Psycho‐Oncology. 2010; 19: 431-440.
2001; 59: 1599-1613.
45. Mahdavi B, Fallahi KM, Mohammadi F, Hosseini M. The effect of
29. Oreopoulos D, Ossareh S, Thodis E. Peritoneal dialysis: past, present, and group spiritual care on quality of life in family caregivers of elders with
future. Iranian journal of kidney diseases. 2008; 2: 171-182. Alzheimer's disease. 2015: 34-42.

30. Koszycki D, Raab K, Aldosary F, Bradwejn J. A multifaith spiritually based 46. Reihani T, Sekhavat Poor Z, Heidarzadeh M, Mosavi SM, Mazlom SR.
intervention for generalized anxiety disorder: A pilot randomized trial. The effect of spiritual self-care training on feeling of comfort in mothers
Journal of clinical psychology. 2010; 66: 430-441. of hospitalized preterm infants. Journal of midwifery and reproductive
health. 2014; 2: 112-119.
31. Saffari M, Pakpour AH, Naderi MK, Koenig HG, Baldacchino DR, Piper
CN. Spiritual coping, religiosity and quality of life: A study on Muslim 47. Asadzandi M. Sound Heart: Spiritual Nursing Care Model from Religious
patients undergoing haemodialysis. Nephrology. 2013; 18: 269-275. Viewpoint. Journal of Religion and Health. 2015: 54.

32. Anandarajah G, Hight E. Spirituality and medical practice. American 48. Ghahari S, Fallah R, Bolhari J, Moosavi SM, Razaghi Z, Akbari ME.
family physician. 2001; 63: 81-88. Effectiveness of cognitive-behavioral and spiritual-religious interventions
on reducing anxiety and depression of women with breast cancer. Article
33. Moarefzadeh S, Sodani M, Shafi AA. The study of the effect of teaching of in Persian] Know Res Appl Psychol. 2012; 13: 33-40.
contrastive training skills originated of quran on reducing anxiety among
high school girl student in Ahvaz. 2010: 19-32. 49. Kim SS, Reed PG, Hayward RD, Kang Y, Koenig HG. Spirituality and
psychological well‐being: Testing a theory of family interdependence
34. Richards PS, Hardman RK, Berrett ME. Spiritual approaches in the among family caregivers and their elders. Research in nursing & health.
treatment of women with eating disorders: American Psychological 2011; 34: 103-115.
Association. 2007: 304.
50. Momeni T, Musarezaie A, Moeini M, NajiEsfahani H. The effect of spiritual
35. Breiddal SMF. Palliative care: A place for caregivers to thrive. Illness, Crisis care program on ischemic heart disease patients, anxiety, hospitalized in
& Loss. 2011; 19: 111-124. CCU: a clinical trial. Journal of Research in Behavioural Sciences. 2013:
36. Asadi M, Asadzandi M, Ebadi A. Effects of spiritual care based on Ghalb 554-564.
Salim nursing model in reducing anxiety of patients undergoing CABG 51. El Filali A, Bentata Y, Ada N, Oneib B. Depression and anxiety disorders
surgery. Iran J Crit Care Nurs. 2014; 7: 142-151. in chronic hemodialysis patients and their quality of life: A cross-sectional
37. Tanyi RA, Werner JS, Recine ACG, Sperstad RA. Perceptions of study about 106 cases in the northeast of morocco. Saudi Journal of Kidney
incorporating spirituality into their care: A phenomenological study of Diseases and Transplantation. 2017; 28: 341.
female patients on hemodialysis. Nephrology Nursing Journal. 2006; 33: 52. Aghajani M, Afaze MR, Morasai F. The effect of spirituality counseling on
532. anxiety and depression in hemodialysis patients. Evid Based Complement.
38. Walton J. Finding a balance a grounded theory study of spirituality in 2014; 3: 19–28.
Hemodialysis patients. Nephrol Nurs J. 2002; 29: 447-456. 53. Morasei F, Aghajani M. The effect of counseling with spirituality approach
39. Rahimi A, Ahmadi F, Gholyaf M. Effects of applying continuous care on hope in patients with chronic renal failure. Complement Med J Fac
model on quality of life in hemodialysis patients. Razi Journal of Medical Nurs Midwifery. 2014; 4: 778–786.
Sciences. 2006; 13: 123-134. 54. Bamdad M, Fallahi Khoshknab M, Dalvandi A, Ardakani K, Reza M.
40. Montazeri A, Gashtasbi A, Vahdaninya M. Translate and determine the Impact of spiritual care on spiritual health of hospitalized amphetamine
validity and reliability of such questionnaires Persian SF36. Payesh J. 2005; dependents. Iran J Psychiatr Nurs. 2013; 1: 10–18.
5: 49-56. 55. Taheri Z, S AM, Ebadi A. The effect of spiritual care based on Ghalbe Salim
41. Taheri N, Kamangar S, Cheraghian B, Mousavi SZO, Solaimanzadeh M. Model on the sleep quality of the patients with coronary artery disease.
Life quality of hemodialysis patients. 2013; 8: 119-124. Iran J Crit. Care Nurs. 2014; 7: 92-101.

42. Sabi KA, Noto-Kadou-Kaza B, Amekoudi EY, Vigan J, Ayamekpe K,

Amedegnato D. Quality of life of hemodialysis patients in Togo: A

ScienceForecast Publications LLC., | https://scienceforecastoa.com/ 5 2018 | Volume 1 | Edition 1 | Article 1006