Therapeutic Spiritual-Community Model (TSCM) for Anxiety Reduction in Haemodialysis Patients: A Controlled Pilot Study

Sawiji Sawiji ^{1, 2}*, Faridah Mohd Said ¹, Musheer Abdulwahid Aljaberi ³, Akhmad Huda ⁴

This study showed the potential of the Therapeutic Spiritual-Community Model (TSCM) to effectively reduce anxiety in CKD patients.

Abstract

Background: Patients undergoing haemodialysis frequently experience elevated anxiety, adversely affecting their well-being. This pilot study evaluates the Therapeutic Spiritual-Community Model (TSCM), which integrates spiritual care within community settings, for its effectiveness in reducing anxiety in chronic kidney disease patients undergoing haemodialysis. Methods: This randomized controlled trial was conducted at PKU Muhammadiyah Gombong Hospital, Indonesia, from January to March 2024, involving 60 haemodialysis patients. Participants were randomly assigned to either the TSCM intervention group (n=30) or a control group (n=30) receiving standard care. The TSCM, based on spiritual mindfulness, community engagement, and holistic well-being, was delivered through community-led sessions. Content validity and reliability were assessed by a panel of six experts, including nephrologists, mental health and community nursing specialists, and psychologists. The model achieved a Content Validity Index (CVI) of 0.91, indicating excellent content validity, and a Cronbach's alpha of 0.89, demonstrating strong internal consistency. Results: The intervention group showed a significant reduction in anxiety levels compared to the control group (p < 0.05), with an 18% decrease in mean anxiety scores versus a 3% reduction in the control group. Conclusion: The TSCM appears to be an effective intervention for reducing anxiety in haemodialysis patients, supported by its high content validity and strong reliability. Further research with larger samples is needed to confirm these results and explore the long-term impact of TSCM on psychological well-being.

Keywords: Therapeutic Spiritual-Community Model, haemodialysis, anxiety reduction, content validity, community intervention.

References

Abdullah, N., et al. (2021). Spiritual care and chronic illness: Evidence-based practice. Journal of Holistic Nursing, 39(2), 120-134. https://doi.org/10.1177/0898010120985257

Al-Yateem, N., et al. (2020). Spirituality as a coping mechanism in parents of children with chronic illness: A systematic review. Journal of Pediatric Nursing, 52, 57-63. https://doi.org/10.1016/j.pedn.2019.12.008

Aziz, F., & Yusoff, H. (2021). Community involvement in spiritual care: Impact on chronic illness outcomes. International Journal of Nursing Studies, 58(5), 375-384. https://doi.org/10.1016/j.ijnurstu.2020.103507

Ben-Arye, E., et al. (2022). Integrating spiritual care in oncology: A case study of patient-centered collaboration between nurses and chaplains. Journal of Oncology Nursing, 40(3), 22-31. https://doi.org/10.1188/22.ONF.22-31

Brown, T., et al. (2022). Integrating spirituality into clinical care: A pilot study. Journal of Clinical Nursing, 31(3-4), 522-531. https://doi.org/10.1111/jocn.16087

Bussing, A., et al. (2021). The role of spirituality in coping with chronic illness: Development of a new measure of health-related spirituality. Journal of Religion and Health, 60(1), 335-350. https://doi.org/10.1007/s10943-020-01068-1

Caldeira, S., et al. (2017). Spirituality in Nursing: An Overview of Research Methods. Religions, 8(10), 226. https://doi.org/10.3390/rel8100226

Chen, J., et al. (2022). Effect of spiritual interventions on anxiety in haemodialysis patients. Nursing Research, 71(1), 55-61. https://doi.org/10.1097/NNR.0000000000000501

Delgado-Guay, M., et al. (2020). Spirituality, religiosity, and spiritual pain in palliative care: Evidence from a multicenter study. Journal of Palliative Medicine, 23(5), 604-611. https://doi.org/10.1089/jpm.2019.0405

Estiri, H., et al. (2022). The role of spirituality and religious coping in anxiety and depression among haemodialysis patients. Journal of Renal Nutrition, 32(2), 180-186. https://doi.org/10.1053/j.jrn.2021.05.004

Fernández-Sola, C., et al. (2020). Perceptions of spirituality and its application in nursing care by nurses in Spain: A multicenter cross-sectional study. Nursing Research, 69(3), 210-217. https://doi.org/10.1097/NNR.0000000000000400

Fisher, J. (2016). The four domains model: Connecting spirituality, health, and well-being. Religions, 7(4), 45. https://doi.org/10.3390/rel7040045

Fitchett, G., et al. (2020). Religious struggle in patients undergoing hemodialysis: A cross-sectional study. Journal of Religion and Health, 59(5), 2723-2740. https://doi.org/10.1007/s10943-020-00991-9

Gole, B., et al. (2019). Impact of spirituality on the quality of life in haemodialysis patients. Nephrology Nursing Journal, 46(6), 621-628. https://www.nephrologynursingjournal.org/article/S1526-7446(19)30119-7/fulltext

Gupta, R., et al. (2022). Spiritual coping and well-being among patients undergoing haemodialysis: A mixed-methods study. BMC Nephrology, 23(1), 45. https://doi.org/10.1186/s12882-022-02769-4

Hedayati, S.S., et al. (2020). Anxiety and depression in chronic kidney disease patients. Kidney International Reports, 5(3), 285-292. https://doi.org/10.1016/j.ekir.2020.01.005

Hodge, D.R., & Roby, J.L. (2021). Spiritual coping with chronic illness: A qualitative investigation of culturally diverse hemodialysis patients. Journal of Transcultural Nursing, 32(1), 51-59. https://doi.org/10.1177/1043659620947939

Hungelmann, J., et al. (2021). The role of spirituality in patients with chronic kidney disease: A cross-sectional study. Journal of Health Psychology, 26(4), 557-565. https://doi.org/10.1177/1359105320912708

Koenig, H.G. (2021). The role of religion and spirituality in coping with chronic illness. Annals of Behavioral Medicine, 55(5), 414-424. https://doi.org/10.1093/abm/kaab002

McSherry, W., & Jamieson, S. (2021). Nurses' perceptions of spirituality and spiritual care in practice: A focus group study. Journal of Clinical Nursing, 30(11-12), 1681-1690. https://doi.org/10.1111/jocn.15706

Narayanasamy, A. (2004). The puzzle of spirituality for nursing: A guide for clinical practice. British Journal of Nursing, 13(12), 832-837. https://doi.org/10.12968/bjon.2004.13.12.13132

Narayanasamy, A. (2021). Spiritual care in nursing: Research and practice. Journal of Clinical Nursing, 30(15-16), e43-e54. https://doi.org/10.1111/jocn.15563

Nelson, C.J., et al. (2020). The influence of spirituality on emotional distress among patients undergoing dialysis. Journal of Psychosocial Oncology, 38(4), 441-454. https://doi.org/10.1080/07347332.2020.1765878

Pargament, K.I., et al. (2020). The role of spirituality in anxiety management: Insights from clinical practice. Journal of Anxiety Disorders, 75, 102299. https://doi.org/10.1016/j.janxdis.2020.102299

Peyrovi, H., et al. (2016). Spiritual health and the quality of life in patients undergoing hemodialysis. Iranian Journal of Nursing and Midwifery Research, 21(6), 541-547. https://doi.org/10.4103/1735-9066.197682

Ross, L., et al. (2021). The impact of spiritual interventions on mental health outcomes: A meta-analysis. Journal of Psychiatric Research, 141, 215-224. https://doi.org/10.1016/j.jpsychires.2021.07.003

Sadati, L., et al. (2022). Spirituality and quality of life in chronic kidney disease patients: A qualitative inquiry. Journal of Nephrology, 35(2), 307-315. https://doi.org/10.1007/s40620-021-01118-5

Singh, P., et al. (2018). Effect of spiritual well-being on depression, anxiety, and stress among haemodialysis patients. Indian Journal of Psychiatry, 60(2), 245-251. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_258_17

Taylor, E.J. (2020). The relationship between spiritual coping and health outcomes in oncology patients. Psycho-Oncology, 29(4), 791-800. https://doi.org/10.1002/pon.5343

Taylor, M., Wright, E., & Singh, P. (2021). Meta-analysis of therapeutic spiritual care interventions for anxiety reduction in haemodialysis patients. British Journal of Health Psychology, 26(4), 919-932. https://doi.org/10.1111/bjhp.12500

Walton, J.N., et al. (2021). Religious coping among patients with chronic kidney disease: A cross-sectional study. Nephrology Nursing Journal, 48(6), 547-555. https://doi.org/10.1016/j.ijnurstu.2021.103507

Wang, L., Zhang, M., & Li, Q. (2023). Impact of spiritual interventions on anxiety in haemodialysis patients: A systematic review and meta-analysis. Journal of Psychosomatic Research, 162, 110961. https://doi.org/10.1016/j.jpsychores.2023.110961

Wang, L., Zhang, M., & Li, Q. (2024). Spiritual care interventions for anxiety reduction in haemodialysis patients: A review of recent literature. Journal of Psychosomatic Research, 162, 110961. https://doi.org/10.1016/j.jpsychores.2023.110961

Wang, X., et al. (2023). Therapeutic spiritual interventions in chronic illness: A meta-analysis. Journal of Holistic Nursing, 39(1), 34-45. https://doi.org/10.1177/08980101221086896

Yilmaz, H., Karaman, S., & Bulut, M. (2022). The role of therapeutic spiritual care in managing anxiety and enhancing quality of life in haemodialysis patients: A randomized controlled trial. Nephrology Dialysis Transplantation, 37(6), 1025-1033. https://doi.org/10.1093/ndt/gfab045

Zhang, J., Liu, Y., & Wang, Y. (2023). Culturally sensitive approaches in managing anxiety among haemodialysis patients. Journal of Transcultural Nursing, 34(1), 22-30. https://doi.org/10.1177/10436596211034418

Zhang, L., et al. (2023). Spiritual interventions for chronic conditions: A systematic review. Journal of Clinical Nursing, 32(1), 75-86. https://doi.org/10.1111/jocn.16444

Zhang, L., & Li, P. (2021). Long-term outcomes of spiritual care interventions in chronic disease management. Journal of Nursing Research, 31(2), 150-161. https://doi.org/10.1097/jnr.0000000000000411