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please formulate a response to this discussion with 5-6 points with explanation and references. This is a master’s level class for nursing. thank you. 

The concept that has been chosen for this concept analysis is spirituality. 
The aim or purpose of the concept analysis was to determine how nursing and the field of healthcare incorporate the concept of spirituality and the challenges of trying to include it in the care of patients. The analysis also allows us to gain a better understanding of the meaning of spirituality by analyzing the different defining attributes and characteristics that appear in the literature. The purpose is to help us build a foundation of what spirituality truly is based on the findings of the concept analysis (Sessanna et al., 2007). Understanding and defining spirituality can be challenging due to its subjective nature. People based on their own personal beliefs can have different ideas or feelings to what spirituality means to them. To some it can be attributed to their own religious beliefs and to others it can be a feeling they have. According to Sessanna et al. (2007), spirituality can be defined as spirituality as religious systems of beliefs, spirituality as meaning of life and purpose, as nonreligious beliefs, and finally as metaphysical or transcendental phenomena.
There were several uses of spirituality recognized within the articles. The attributes discovered by researchers include the following:
Meaning/Purpose: People have a purpose or “mission” that is specific to them and provides them with the ability to make sense of phenomena such as life and death (Vachon et al., 2009).
 Self-Transcendence: This attribute of spirituality comes about from a person’s ability to connect with their true inner-self in an effort to gain a sense of completeness and inner peace (Vachon et al., 2009). Nurses who attend to their own spirituality and self-awareness can promote comfort and treat patient’s diversity in a more effective manner (Smith, 2006 as cited in Gray, 2006).
Transcendence with a Higher Being/Adhering to a Religious Practice: People placing faith in a higher power or Divine Being, such as God, allows for them to transcend the physical world in which they dwell (Vachon et al., 2009). A person may be spiritual in the absence of any religious practices (Angeli, 2001, as cited in Sessanna et al., 2007).
Feeling of Communion/Mutuality: This spiritual attribute adheres to the feeling of not being alone, rather being connected with self, the environment, a Higher Being, and so on (Vachon et al., 2009).
 Faith/Beliefs: This attribute can be described as a person having faith in oneself or something greater than self. It can also tie into the attribute of having a purpose as someone can have a belief that an event had a particular purpose for unfolding (Vachon et al., 2009).
Hope: This attribute takes various forms as people use it throughout their spiritual practice. Hope carries people through hardships, end-of life expectations, and coming to terms with what life and death means for them personally (Vachon et al., 2009). Having hope is what allows someone to be treated as a whole due to its ability to influence a person’s understanding of life (Watson, 1979 as cited in Gray, 2006).
 Attitude Towards Death: A person takes on a spiritual approach towards death when they appreciate death as a transitional period, and therefore gives it meaning (Vachon et al., 2009)
Appreciation of Life: Having an appreciation for life, nature, beauty, and viewing each moment within life as a gift is part of the “spiritual attitude” seen in spirituality (Vachon et al., 2009).
Reflection of Personal Values: Part of being spiritual is personal reflection and finding out one’s personal values that hold the greatest importance (Vachon et al., 2009).
 Developmental Nature: Spirituality is developed over time, hence the term, “spiritual growth” (Vachon et al., 2009)
 Conscious Nature: In order to have a spiritual experience, a person needs to be aware of not only the action of doing, but the meaning of what they have done. They need to make a conscious effort to understand themselves through their beliefs, values, and their actions (Vachon et al., 2009).
 Health Promotion Through Healing/Holistic Care: A person can use their spirituality to help promote healing (Macrea, 1995, as cited in Gray, 2006). Spirituality allows a person to be cared for holistically through tending to the mind, body, and spirit (Hardin & Kaplow, 2005; Harrison & Burnard, 1993; Narayanasamy, 1999b; Smith, 2006, as cited in Gray, 2006). Having a strong spiritual awareness can decrease stress that the nurse feels which in turn decreases burnout (Marsh, Beard, & Adams, 1999 as cited in Gray, 2006).
Antecedents are causes that occur before the concept/effect (McEwen & Wills, 2023). Antecedents of spirituality can consist of feeling disconnected, a near death experience, mourning, end of life, feeling hopefulness for change, and suffering. Gray (2006) mentions acute or chronic illness, pain, suffering, terminal illness, aging, and life events as potential antecedents. Consequences are the outcomes of a concept/situation (McEwen & Wills, 2023). Consequences of spirituality consist of improved quality of life and/or clinical outcomes, decreased stress and anxiety, easier coping skills, improved trust, feeling connected, and appreciation of life. Gray (2006) mentions a newfound meaning or purpose and hope as consequences of spirituality. 
Empirical referents are ways or tools one can measure a concept (Leh, 2007). The Spiritual Well-Being Scale (SWBS) and the spiritual well-being subscale of the Functional Assessment for Chronic Illness Therapy (FACIT-SP) are both empirical referents used to measure spirituality (Vachon et al., 2009). There are two components that make up the SWBS; existential and religious. The existential component concentrates on the purpose of life while the religious component focuses on the relationship with God or a higher power (Vachon et al., 2009). The SWBS is a Likert scale that consists of 20 questions that are answered on a six-point scale ranging from strongly agree to strongly disagree (Gray, 2006).
Model Case: A 32-year-old female presents to the Emergency Department with her significant other who is in critical condition. The victim is a 34-year-old male and presents with multiple gunshot wounds. The patient is in and out of consciousness and needs medical attention. The patient’s injuries are life threatening and the patient is in need of emergent surgery. The victim’s significant other begs the nurse for a prayer as the victim is brought into the OR. The nurse contacts the chaplain to hold a prayer for the victim and the significant other. The nurse’s actions characterize spirituality by advocating for the patient’s needs. By holding this group prayer, this lets the victim’s significant other believe in faith and hope, transcending with a higher being, connecting with a higher power, and altering her attitude towards the outcome of this situation. From these measures, the victim’s significant other has decreased stress levels and is able to move forward to what lies in the future.
Contrary Case: A 27-year-old male presents to the Emergency Department as he admits to ingesting several pain killers and is concerned for his well-being. Patient is very anxious and is in tears while speaking with the medical staff. The patient came alone and is persistent that he does not want his family or friends to be notified of his hospitalization. When the patient asked why he took all the medication, he stated “it feels that I have no reason or purpose to live”. The emergency department was very busy at the time and the patient felt as if his care was being neglected which made him feel more distressed. Due to the ongoing stimulus of the emergency department, the patient’s anxiety is heightened. This caused the patient to leave the emergency department and decide to not seek care. 

References

Achille, M., Fillion, L., & Vachon, M. (2009). A conceptual analysis of spirituality at the end of

life. Journal of Palliative Medicine, 12(1), 53-57. https://doi.org/10.1089/jpm.2008.0189

Finnell, D., Jezewski, M. A., & Sessanna, L. (2007). Spirituality in nursing and health-related

            literature: A concept analysis. Journal of Holistic Nursing, 25(4), 252-262.

 https://doi.org/10.1177/0898010107303890

Gray, J. (2006). Measuring spirituality: Conceptual and methodological considerations. The

Journal of Theory Construction and Testing, 10(2), 58-64.

Leh, S. K. (2007). Preconceptions: A concept analysis for nursing. Nursing Forum, 42(3), 109     122. https://doi.org/10.1111/j.1744-6198.2007.00075.x

McEwen, M., & Wills, E. M. (2023). Theoretical basis for nursing (6th ed.). Wolters Kluwer.

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HEALTH SCIENCE
NURSING
NURS MISC