Developing a spiritual care model for patients and their relatives in illness

A qualitative study that uses Symbolic Interactionism as theoretical framework, and the Grounded Theory designed by Charmaz as methodological framework. Semi-structured interviews were performed with 10 participants, and the Model was validated by an expertise group, from march to may 2016, at a University Hospital in the South of Brazil. When analyzing the data, the following codifications were made: initial, focalized, axial and theoretical.

Results:

The categories that structured the Model were the following: Situating spirituality in their daily lives; Exercising spirituality in life; Perceiving the role of the nursing team in spiritual care; Identifying the manifestations of spiritual needs; Placing spirituality as a priority in care and Re- signifying the illness process.

Conclusion:

Developing the model has enabled us to achieve a conceptual understanding and interpretation of spiritual care in nursing and to draw up the connections among the nursing team, the patients and their relatives.

Keywords:
Nurse’s role; Spirituality; Nursing care; Nursing models; Nursing; Grounded Theory

Concepts	Definitions
Human groups	Constituted by human beings involved in actions, that is, activities that they perform in their lives with other individuals or in representing groups and organizations88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Objects	They were classified into three categories: physical, social and abstract objects. The nature of an object or of all objects consists of the meaning ascribed to it/them by its owner88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Human being	It indicates that the individual, as an acting organism, does not respond to others solely on a non-symbolic level, but emits signals to others and interprets signals from them88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Human action	The individual's ability to make indications for themselves and distinguishes their action88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Symbol	It represents the central concept of the SI and, in its omission, the interaction between human beings becomes unfeasible. Symbols are considered as social objects used by the actor for representation and communication88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Self	The self has two phases: The “I” and the “me”. In the first phase, the “I” refers to the individual as a subject, highlighting the characteristics, spontaneous dispositions, not socialized. In the second, the “me” comprises the individual as a social object, arising from the interaction88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Mind	The “mind” is an activity that points to the self. The mental process is considered as the symbolic interaction through which the individual handles the symbols and actively communicates with the self88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Assuming the other's role	It involves understanding the reasons and ways for which people act in a certain way88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Language	The use of the word in the dialogs and symbols, such as gestures, behaviors and actions, have social meanings, established in interactions and that become a symbol when they acquire meaning for those who use them88. Blumer H. Symbolic interactionism: perspective and method. Berkeley: University of California Press; 1969.
Social interaction	Mutual social action, involving symbolic communication and interpretation for the actions of others, considering in the organization of our actions the opinion of others1010. Charon JM. Symbolic interactionism: an introduction, an interpretation, an integration. 9th. ed. New Jersey: Pearson/Prentice Hall; 2007.
Family	Seen not only as a biological and natural unity, but as a social, therefore, interactional space where each event is lived from symbolically constructed meanings1111. Angelo M. Com a família em tempos difíceis: uma perspectiva de enfermagem [tese]. São Paulo (SP): Universidade de São Paulo; 1997.⁾

Central category Re-signifying the Illness Process (REFIP) - Spiritual Care Model
Categories	Subcategories
Assumptions	Recognizing spirituality as a necessity and a complement Walking in spirituality
Situating spirituality in your life
Exercising spirituality in life	Practicing spirituality in your own way Realizing spirituality as a life option Respecting beliefs
Actions	Identifying forms for coping with suffering Happening: the time to meet the needs
Identifying the manifestations of the spiritual needs
Realizing the role of the nursing staff	Advocating the patient’s rights and for the sake of the profession Talking about spirituality Caring for the process of death and dying Preparing the nursing staff Limiting care for personal, organizational, and religious beliefs
Results	Welcoming the patient and their families Using integrative practices Praying with the patient Comforting through spirituality Continuing to believe everyday
Prioritizing spirituality in care

Metaparadigms	Definitions
Human being	A multidimensional being (physical, emotional, social and spiritual) that is being cared and provides care, with beliefs and values influenced by their culture. The family makes up the universe of the being cared for.
Nursing	Profession in which the essence is the care for the human being in its entirety from conception to death, with technical, ethical and aesthetic knowledge applied by nurses and nursing technicians, in line with their beliefs and values, and is influenced by the care-related culture scenarios.
Environment	Place where the human beings live or stay during periods of their life that contemplates physical (urban and rural) and non-physical (social and historical context) aspects, being influenced by the cultural aspects of the human group where they are found. In the context of this study, it is the local hospital, with its own culture permeated with rules of how to be and behave for all who work and remain in this environment.
Health and disease	Process lived by human beings and influenced by biological, emotional, economic, social, cultural, spiritual and environmental dimensions.
Spiritual care	Care aimed at meeting the spiritual needs in their different manifestations, which can be identified and met by the nursing team sensitive to the moment lived by the person cared for and their family.

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Marta Georgina Oliveira de Góes mgogoes@gmail.com