A Narrative Analysis of Spiritual Coping in Individuals with Terminal Heart Failure

Abstract

Approximately 6 million Americans have heart failure with treatment costs estimated at $30.7 billion annually. Those in late stages of the disease experience profound physical, emotional, and spiritual suffering. Spiritual wellbeing has been linked to quality of life as well as mental and physical health in patients with heart failure. While holistic nursing care promotes spiritual coping, barriers exist. Currently, nursing lacks theory to explain spiritual coping processes in patients with heart failure, which leaves nurses ill-equipped to promote spiritual wellbeing in providing care to patients. In this study, I employed open-ended interviewing and narrative analysis techniques to gain a better understanding of spiritual coping over time in patients with terminal heart failure. Participants were recruited from the inpatient cardiovascular wards of an academic, tertiary medical center in the Midwest of the United States. Eligible participants were in stage III or IV heart failure, able to speak English, and able to participate in an extended interview. Purposive sampling was used to create a sample with varied heart failure experiences and diversity in religious and/or spiritual orientation and sociocultural background. Participants were asked to tell me about their spiritual journey. Follow-up prompts focused on describing experiences and strategies that participants associated with spiritual wellbeing. Interviews were read for thematic and structural patterns. The findings were synthesized into a model of spiritual coping comprising three spiritual coping pathways: heart failure as spiritually integrative, transformative, or disintegrative experience. The specificity of the model of spiritual coping in terminal heart failure offers nurse researchers a structure to support the future development of interventions and aid nurses in promoting quality of life by addressing suffering in patients who have terminal heart failure.