J Relig Health DOI 10.1007/s10943-015-0038-1 ORIGINAL PAPER
Sound Heart: Spiritual Nursing Care Model from Religious Viewpoint Minoo Asadzandi1
Springer Science+Business Media New York 2015
Abstract Different methods of epistemology create different philosophical views. None of the nursing theories have employed the revelational epistemology and the philosophical views of Abrahamic religions. According to Abrahamic religions, the universe and human being have been created based on God’s affection. Human being should deserve the position of God’s representative on earth after achieving all ethical merits. Humans have willpower to shape their destiny by choosing manner of their relationship with God, people, themselves and the whole universe. They can adopt the right behavior by giving a divine color to their thoughts and intentions and thus attain peace and serenity in their heart. Health means having a sound heart (calm spirit with a sense of hope and love, security and happiness) that is achievable through faith and piety. Moral vices lead to diseases. Human beings are able to purge their inside (heart) through establishing a relationship with God and then take actions to reform the outside world. The worlds are run by God’s will based on prudence and mercy. All events happen with God’s authorization, and human beings have to respond to them. Nurses should try to recognize the patient’s spiritual response to illness that can appear as symptoms of an unsound heart (fear, sadness, disappointment, anger, jealousy, cruelty, grudge, suspicion, etc.) due to the pains caused by illness and then alleviate the patient’s suffering by appropriate approaches. Nurses help the patient to achieve the sound heart by hope in divine mercy and love, and they help the patient see good in any evil and relieve their fear and sadness by viewing their illness positively and then attain the status of calm, satisfaction, peace and serenity in their heart and being content with the divine fate. By invitation to religious morality, the model leads the patients to spiritual health. Keywords
Nursing care model Sound heart Spirituality Religious viewpoint
& Minoo Asadzandi [email protected] 1
Department of Anesthesiology, Faculty of Nursing, Medicine and Religion Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Introduction The Necessity of Designing an Islamic Model of Health care The effect of philosophy on science and scientific theories, and the relationship between the abstract concepts of philosophy and those in the real world have caused the healthcare models shape the way in which health care is provided based on the views of the theorist (Burns and Grove 1993). Different epistemology doctrines have ushered in different philosophical approaches (Motahari 1984a, b). Experimental methods, reasoning and illumination have created different philosophical viewpoints (Motahari 1975). Cognition based on divine revelation and religious philosophy as well as the theorist’s presuppositions plays a role in the production of knowledge and even in the induction of phenomena and the scientific hypothesizing (Asadzandi 2005a, b, c, d, e, f). Such a knowledge gives philosophical color to science (Pirouzmand 1997a, b). Islam confirms other Abrahamic religions and introduces itself, Quran and the Sunnah of Prophet (Muhammad) as firm sources of recognition for humans while verifying the usefulness of sense, logic and illumination (Motahari 1984a, b). Referring to Islam produces philosophy and culture (a special lifestyle) and creates such presuppositions as belief in the unseen, existence of soul in human beings, existence of rankings of the soul in the world and the praise of God by all creatures (Asadzandi 2005a, b, c, d, e, f). Islam considers theology as something different from other branches of non-religious philosophy-based knowledge. Hence, it regards designing an Islamic model of health care as a must (Pirouzmand 1997a, b).
Necessity of Using Islamic Model of Health care Humans are social creatures (WHO), and each society determines the way of life of a group of people who have common beliefs, values and traditions (Mohseni 1995) which affect the social needs of people in each society (Asadzandi 2005a, b, c, d, e, f). Cultural differences affect the concept of health and illness, choice of treatment and healthcare method, etiology of the disease and the patient’s response to a disease (Asadzandi 2004a, b, c, d, e, f, g). It has given a social meaning to health and illness (Cockerham 1992) and has also pushed nursing toward community-oriented and holistic care (Griffith 1982). In order to offer communityoriented care, one should know the beliefs of a society and consider its culture and people’s needs and also use a model that is compatible with the cultural beliefs of that society (Asadzandi 2005a, b, c, d, e, f). This is because each healthcare model has three components: values and beliefs of the theorist; knowledge and skills of the model; and the aim of the function (Tomey and Alligood 2006). We should choose a model in which theorist’s beliefs are compatible with patient’s beliefs. Furthermore, the patient should accept its knowledge and operational objectives (George 1990). This highlights the necessity of using the Islamic model of health care for the followers of monotheistic faiths in the world.
Content Mission of Model In Islamic philosophy, epistemology, ontology, values, ethics and logic are all based on divine revelation (Hosseini al-Hashemi 1996). These concepts are such that in the
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epistemology of nature which is the world of time, place and movement, they are considered as signs to know the realm of heavens and earth so that we will infer the existence of the creator from the creature. Wisdom and thinking are emphasized, but observationbased emotional cognition is considered as personal, limited and superficial cognition that is bound within the present time and a special location. However, reason-based logical cognition is regarded as deep and capable of infiltrating the depth of phenomena and understanding the nature of intangible relations. It can infer the cause from the effect, is capable of deduction and can perceive the whole. Such manner of cognition can help people be aware of the past and predict the future. Islam also confirms the illuminationbased cognition, which is awareness of some supernatural inspirations (Motahari 1984a, b). Islam also introduces history as a good source of cognition that can help human beings perceive the role of their willpower in shaping their destiny (Pirouzmand 1997a, b). However, it believes that none of the cognitions are as comprehensive as divine revelation and says the unseen world and human soul can only be understood by resorting to divine revelation. Under such circumstances, the criterion of cognition’s veracity is not compatibility with reality or with the views of other present scholars or its usefulness for human beings and effectiveness in performance. The criterion for the veracity of any cognition is its compatibility with divine revelation (Hosseini al-Hashemi 1996; Asadzandi 2004a, b, c, d, e, f, g). Based on revelation epistemology, the world is moving unilaterally from God and to God. The epistemology believes that the world is not just this material world, but is made up of the sensible, malakut and limbo worlds which are moving toward spiritual growth and in which all creatures praise God according to their hierarchy of spirit (Asadzandi 2009). In short, it considers God as the source of mercy and prudence and as the creator and manager of the whole universe (Hosseini al-Hashemi 1996). Humans began to exist in the ‘‘Zar world’’ in which the covenant of monotheism was received from them (Raji 2011). Human life begins after Holy Spirit is breathed into their body, and their death occurs when the spirit leaves the body completely. However, death is movement from this world to another world and is a window to the eternal life (Asadzandi 2005a, b, c, d, e, f). In this view, no creature in this world has been created without a cause and no event is outside the will of God (Asadzandi 2013a, b, c; Shaabani 2012).
Design of Research Methods in the Model First Stage: Critique of Global Healthcare Models I was trying to find the answers to these two questions: What is the reason for the suffering of our ailing loved ones? How can I help alleviate their suffering? Thus, I began to study the nursing models (Asadzandi 2013a, b, c; Pirouzmand 1997a, b). Based on total survey and Islamic philosophical perspective in seven international healthcare models, the following stages were performed: 1.
Analysis of elements and relations of model
• Advance familiarity with the subject—Studying the subject—Analysis of the textual data • Encoding the analyzed statements—Taking notes from codes—Titling notes—Providing a main list (list of titles)—Categorizing the titles—Extracting the main themes of the model
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2.
Analysis of organizational principles of the model (review of ordering in materials)
• Discovering links between themes of the model reorganizing of the model themes
3.
Evaluating the model materials
• Extracting reasoning examples of model (analogical reasoning model)—Counterexamples (and applications of the model)—Finding general arguments and counterarguments • Principle counterarguments (presuppositions of the model) (Asadzandi 2001), which are comparable to perceptive analysis and communicative analysis methods (Walker and Avant 2005; Hajbagheri et al. 2007). It became evident that nursing met paradigm concepts are far from those based on Islamic philosophy and have ignored the most important aspect of human existence, that is, his soul and the unseen world. Perhaps, this is the main reason why the models have failed to alleviate patients’ pains (or suffering) (Asadzandi 2007a, b, c, d, e; Zomorrodian 1965; Zukav and Francis 2008a, b; Sharqawi 1965).
Second Stage of Research (Extraction of Themes) The meaning of soul and the unseen had to be defined because the first stage in the theorization process is conceptualization. Forming and naming the themes shapes our viewpoint. As a result, it organizes our observations which result in understanding the life situations and events (Ibrahim 2007). Meanwhile, the met paradigms of the academic course are not effective without creating a cohesive conceptual framework. Different processes exist for the purpose of conceptualization (Wakker 2005; Hajbagheri et al. 2007). To choose an appropriate process for conceptualization in any paradigm, we need to first respond to the type of concept and factors that are effective in defining that concept. The most important factors are: How many texts are available about the concept in point? Have the relevant sources been already tried? Have they been applied for the purpose of making a conceptual framework in the profession? (Walker and Avant 2005). While designing a macro-theory in nursing without any presuppositions, one would face a serious challenge regarding its met paradigms: we need to create new concepts and methods for explaining and defining those concepts (Walker and Avant 2005). While reviewing main and meta-paradigm concepts, one may come across some concepts whose nature is such that a special method cannot be helpful alone. Under such circumstances, we need to use simultaneous or combined methods to get an accurate definition of the concepts. The method we recommend for the definition of concepts is only a guideline, not an unchangeable procedure. Therefore, the researcher can change his method whenever he wants to (Meleis 1991). Naust The more abstract the concepts are, the more important the role of the researcher’s creativity becomes in defining them. The principle of creativity itself is an obstacle to methodology (Fawcett 1984, 2006). Rogers When we want to choose a suitable method for defining concepts, we need to consider the concept development philosophy. Any element in that philosophy which would lead the researcher to the concept development is acceptable. The reason is that
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researcher’s creativity in abstract concepts plays a key role. The more abstract the concept in point is and the bigger the researcher’s theory is, the more difficult the choice of a method for concept development. Subsequently, the researcher will need to choose more flexible methods and will be ready for change at any stage of conceptualization (Rodgers and Kanf 2000). Rogers and Neff One of the best methods used for conceptualizing in an academic course is defining main concepts of that course within the paradigm in question by using the definitions of other theories (Rodgers and Kanf 2000). Meliss believes that there is not just a single way to identify a phenomenon and that the next stage after conceptualization is the description of the phenomenon. While describing a phenomenon, we need to answer questions as to the nature, time of happening, limits, commonalities, internal changes, functions, habits, etc., related to phenomenon (Streubert 1990). Therefore, in the second stage of the research on the paradigm of Abrahamic religions and Islam, we referred to main sources in Islam like the Holy Quran and credible interpretations and hadiths for the purpose of knowing the nature of human soul and unseen world (Gheraati 2006a, b; Tabatabaee 1971; Pouryousef 2004; Abdulbaghi 1966; Koleini 1791). We then used the method employed by the seminary and extracted the meaning of soul (heart) (Beheshti 1978). In recognition of human, we identified heart status (sound heart, oft-retuning heart, unsound heart) (Dastgheib 1963), and the features of the perfect human being were defined according to Nahj al-Balaqah (Asadzandi 2004a, b, c, d, e, f, g, 2005a, b, c, d, e, f) and then attaining the sound heart (moral characteristics) was introduced as the main characteristic of the sound spirit. Then, the meaning of health, having the sound heart was recognized as the central concept of the model and the state (national) concept (Asadzandi 2003). Other meta-paradigm concepts of the model were defined within the paradigm of monotheistic religions (Asadzandi 2002, 2003, 2006a, b, c, d, e, f). In this way, we used credible books on ethics (Zukav and Francis 2008a, b). In the first stage of the research, we extensively studied the following: 1—Models and theories of nursing care. 2—Viennese psychotherapy methods (Freud, Yung, Adler, Frankel) (Asadzandi 2004a, b, c, d, e, f, g, 2006a, b, c, d, e, f). 3—Biological and physiological study, quantum theory and physics laws (Asadzandi 2006a, b, c, d, e, f). 4—Studying significant theories of psychology (Maslow’s human needs and perfect man, stress theory of Hans Selye) (Memarian 1997). Thus, we adopted the concepts from more inclusive sciences and redefined them in the field of nursing (which is comparable to Walker and Avant concept analysis).
Third Stage of Research: Designing a Model by Using the Concept Analysis Walker Avant Strategy After deriving the concept of sound heart (as the characteristic of the perfect human being), the existence aspects of human being and needs of each aspect were outlined and the three conditions of heart (sound, unsound and oft-returning) were specified (Dastgheib 1963). Ethical virtues as the basic characteristics cause people to live in the present time and not to regret the loss of health and not to be anxious about the future (Asadzandi 2007a, b, c, d, e). The ethical virtues also make people patient in calamities and thank God for His blessings and protect them against mental problems. Knowing such people’s characteristics made it possible to devise practical ways for providing health care for patients (Asadzandi 2007a, b, c, d, e). Sadness and fear in the face of disease were called the features of an unsound heart (Asadzandi 2007a, b, c, d, e). 5—The Prophet Muhammad (Peace be upon
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him) and the twelve Imams as well as other messengers of God like Abraham, Noah, Moses and Jesus were introduced as models of ethical excellence with all the characteristics of a sound heart (Gheraati 2006a, b; Motahari 1983a, b, c). 6—Providing models with definitional description (borderline models) and models related to the concept, the pious characteristics were introduced and compared to many aspects of the perfect human being in today’s science (Asadzandi 2004a, b, c, d, e, f, g). 7—As for the conditions needed for acquiring a sound heart, we spoke about the role of one’s will in deciding his destiny by choosing the four types of relations and also his lifestyle. We also discussed the effect of vices and virtues on the spirit and then on the body of people and the results of having a sound heart were identified (Motahari 1983a, b, c; Asadzandi 2006a, b, c, d, e, f, 2007a, b, c, d, e). 8—Assessing the concept in real world, outlining the experimental indices, categories of the concept (sound heart versus unsound heart were performed in the fourth stage of this research (Asadzandi 2013a, b, c). And in the fifth stage, spiritual nursing guidelines (based on the model) were conducted.
Fourth Stage of Research: Designing the Tool for Patient’s Psychological Response to the Disease Given the results of the third stage that was mainly built on the comparative method, we had to assess the concepts in an inductive stage in real condition and to bring out the phenomenon based on experiences of individuals so that we could make the conceptual model and apply it through comparison (Asadzandi 2013a, b, c). Diseases force human to react in all dimensions including spiritual dimension. This originates from the four types of individual relationships (Asadzandi 2013a, b, c; Farahzad 2011a, b). Therefore, in my interviews with the patients and their families, I always used clinical observation throughout my career as a nurse. During interviews with clinical nurses, professors of nursing and clinical psychologist and psychiatrists, the items were extracted and a tool for assessing the patient’s mental response to disease was designed (Asadzandi 2013a, b, c). The tool diagnoses patient’s spiritual problems and enables us to devise a healthcare program to achieve spiritual health (Asadzandi 2013a, b, c).
The Fifth Stage of Research: Design of Spiritual Healthcare Guidelines for Patient’s Base on Religion (Asadzandi 2013a, b, c) Accuracy and Reliability of the Qualitative Data Analysis The data and findings of qualitative research must be acceptable and reliable. The methods we have used for this purpose are as follows: 1.
2.
3.
Long-term study and consistent observation By allocating sufficient time to collect data (throughout my professional life, particularly the past 15 years) and by involvement with the patient for a long time, I have developed strong communication and I have been able to understand the language, culture and views of the participants. Incorporation in research By using numerous sources, I sought the opinion of experts and the families of the patients participating in the study. I also conducted this research over a period of 15 years and enjoyed the instructions from professors of related academic courses at 50 different congresses. Reviewing by supervisors Offering the model at academic circles as well as national and international congresses helped me enjoy the views of colleagues, and the publication of books also helped me in this way.
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4.
5. 6. 7.
Searching for opposing evidence The researcher has made efforts to use opposing views to modify the model in an objective way (Critique of the model at university classes). Acceptance of the researcher The researcher tried to convey what she learned to the patients sincerely. Evaluation The initial findings of the research were offered to the honorable professors of nursing, psychology, science academy etc., so that they would review it. Review of participants The model was given to a group of participants (patients, nurses, clinical) in order to express their modifying views (Streubert 1990).
Presuppositions Based on the verses of Quran (which confirm all other Abrahamic religions) and the hadiths (sayings) of the progeny of the Prophet Muhammad (Peace be upon him) (Gheraati 2006a, b; Tabatabaee 1971; Pouryousef 2004; Abdulbaghi 1966; Koleini 1791) 1—Faith in the only God, who has not given birth to anyone and has not been born and has no match and faith in His power and deity (None of His laws have tied his hands; He is always in the process of creating a new creature) (Hosseini al-Hashemi 1996). 2—Faith in His endless mercy; He has created the universe based on prudence and mercy and His mercy prevails his wrath (Farahzad 2011a, b; Asadzandi 2013a, b, c). 3—Faith in the unseen world. 4—Faith in the existence of soul which is the essence of human’s life and itself is alive eternally (Motahari 1982a, b, c, 1983a, b, c). 5—Faith in the prophet hood and the resurrection day, which exists in all divine religions and faith in the existence of angels who fulfill God’s orders (Motahari 1983a, b, c). 6—Admitting that all divine religions are unique religion of Islam (surrendering to God) and Prophet Abraham (Peace be upon Him) was the father of messengers of God (Hosseini al-Hashemi 1996). 7—Faith in the existence of a savior who will fill the world with justice (Akbari 2011; Shahmiri 2010). 8—Accepting that all creatures have degrees of soul and live in a cohesive system and they are always eulogizing God (Hosseini al-Hashemi 1996).
The Findings of Modern Sciences are Recognized 1—Holistic approach to nursing (Asadzandi 2006a, b, c, d, e, f). 2—Necessity of social view in health care (Asadzandi 2006a, b, c, d, e, f). 3—Necessity of helping patients and their families to be independent of the healthcare system (self-care approach) (Asadzandi 2013a, b, c). 4—Paying attention to the psycho-neuro-immunological findings of Ader and cohen (Asadzandi 2004a, b, c, d, e, f, g). 5—Paying attention to human needs and how it is influenced by the philosophy and culture of societies (social findings of medicine) (Mohseni 1995). 6—Emphasizing the necessity of meaning-therapy (existence of a logos that would give meaning to patient’s life) (Asadzandi 2006a, b, c, d, e, f). 7—Necessity of hope-therapy in treatment of patient and health care (Asadzandi 2007a, b, c, d, e). 8— Paying attention to the applications of supplementary nursing interventions (based on patient’s interest) particularly faith-therapy, Love-therapy, art-therapy, story-therapy and touch associated with healing prayers (Asadzandi 2006a, b, c, d, e, f). 9—Paying attention to the deep effect of beliefs on the psychological aspects of the patients (necessity of positively thinking and cognition-therapy) (Asadzandi 2007a, b, c, d, e). 10—Viewing human being as a multi-dimensional creature whose dimensions are inseparable from one another (Asadzandi 2013a, b, c). 11—Necessity of caring at home.
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12—Veiwing the whole universe as a system (systemic view) (Hosseini al-Hashemi 1996).
Meta-Paradigm Concepts of the Model Concept of Human Being The master of creatures and God’s representative on earth has a soul which gives him existence. Perception, feeling, movement, consciousness and will of human being are capabilities that originate from his soul. Human beings have authority and power to choose. Human beings held accountable for choosing their relationships (with God, people, themselves and nature), and they decide their fate based on their choice (Motahari 1986; Dastgheib 1984a, b). Human begins are not at the mercy of fatalism or determinism, and they have full power of choosing. They only have no authority over the place and time of their birth as well as over death, their family, genetic code and the society of their birth place (Motahari 1982a, b, c). Their power to choose makes them responsible for their thoughts and actions (Dastgheib 1962). Human beings shape their different ethical (heart) conditions by making their choices (Dastgheib 1964).
Concept of Health The highest level of health is having a sound heart that originates from faith. Sound heart gives humans a sense of security, peace, trust, hope, love and energy and happiness. Sound heart helps one get rid of fears and anxiety about future and regret about the past and live in the present time. Those who have sound hearts have ethical virtues and are optimistic. The actions and thoughts and remarks of any individual are decided by his intentions (Asadzandi 2006a, b, c, d, e, f, 2007a, b, c, d, e). Humans have different heart conditions (Dastgheib 1963). Worshipping is an optional matter for human beings. If they manage to adapt themselves to the world, they will achieve health (Asadzandi 2013a, b, c).
Concept of Environment The relationship between an individual and God shapes his internal environment and eliminates such vices as jealousy, grudge, hunger for vengeance and pessimism. The external environment involving inanimate objects, plants, animals and other human beings (tangible world) and the unseen world (souls and angels) has surrounded human beings. Any stimulation from the outside world is from God and originates from His mercy and prudence and is a test for humans and those around him; a human’s reactions to such tests vary according to his spiritual growth (Asadzandi 2003).
Concept of Illness Feeling regretful about the past and living in anxiety about the future are symptoms of illness and are the result of one’s lifestyle and the four types of his relationships (Asadzandi 2007a, b, c, d, e). The thoughts and intentions of any human being impact his tempers, behaviors and manners. Therefore, optimism (thinking about the good side of everything) brings health and anything other than this will lead to disease (Farahzad 2011a, b). Wrath, grudge, hopelessness, jealousy, pessimism, belligerence, etc., are morbid traits
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and fills one’s life with insecurity, despair and depression and leads to illness (Asadzandi 2007a, b, c, d, e). Hence, we should consider these feelings as the root of many diseases.
Concept of Nursing Nursing is a valuable social and religious service and ranks among top religious values (Majlisi 1699a, b). The nurse solves problems based on nursing procedures (Alfaro 1995). The nurse initiates relationships with patients and gives them advice throughout the treatment as a counselor. The core of nursing care is the patient and his family. The nurse tries to make it possible for the health care to be provided mainly at home where the patient feels calm and safe. The nurse uses the logos of the patient to create love and hope in him throughout the treatment process. After establishing a relationship and winning the trust of the patient and his family, the nurse studies patient’s spiritual reaction to the disease and she pays attention to patient’s thoughts and feelings while trying to solve their physical problems caused by his illness. Feeling angry over one’s disease; feeling jealous of others who are healthy; and feeling like taking revenge on the agents of my illness and suspicious that other people planned to make me sick; all these feelings are abnormal, and they need to be assessed and resolved through appropriate ways. Nursing aims to change reactions caused by fear and sadness to feelings of love, trust, security, calm, peace, hope and energy. The patient should not think that he is a victim of fate and that he is involved in the surrounding environment. Instead, he should accept that his choices and lifestyle impact his illness and health (Asadzandi 2013a, b, c) Feeling optimistic that problems will be resolved and good things will happen after seeking refuge in God’s mercy will help dispel sadness and fear and are a basic principle of health care and they are accessible through faith-therapy (Dastgheib 1984a, b). Optimism should be created in the patient (Farahzad 2011a, b). During the treatment, besides secondary nursing interventions, religious techniques of alleviating patient’s pains and suffering such as narrating stories, Islamic dream-therapy (Sayyari et al. 2009), meditation, touching associated with healing worship (Asadzandi 2007a, b, c, d, e), prayertherapy (Taghizadeh et al. 2010, 2011) etc., are used as desired by the patient and his family.
The Objective of the Model The model based on holistic viewpoint identifies the spiritual reactions of the patient besides his physical, mental and social reactions according to content of assessment. Then, the model moves toward creating a feeling of hope, security, peace, love and energy for the patient. In this way, the patient develops a capability of taking care of himself, adapting himself to his new condition so as to go on his daily activities and performing his social role. In addition, he feels calm and satisfied and feels that he is immune to any harm (Asadzandi 2013a, b, c).
Applications of the Model The model can be used for chronic or acute patients who are hospitalized at clinics, hospitals or other healthcare centers. It helps change the beliefs of the patient, causes him to believe that he will be cured and gives him hope. Thus, the model enables the patient to confront his disease and keep up his hopes with the help of his family. It also helps the patient achieve spiritual growth and content with divine will by stressing the need for selfcare at home (Asadzandi 2013a, b, c).
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Conclusion Therefore, each person adopts his own lifestyle based on his choice of manner of the four types of relationships and acquires special vices or virtues. Many diseases stem from wrong lifestyles and many of them come from bad ethical characteristics like fear, sadness, jealousy, grudge, suspicion, etc. Those who have sound hearts contract diseases because they are more loved by God and He wants to make them suffer so that they always remember God and acquire ego at peace. Of course, there is also a divine tradition to test the faith of humans so that it is known what hearts they have. However, to alleviate the pains of patients, because the Almighty is: 1—kinder than anyone else and we should make the patient take refuge to Him (supplication). 2—Is knowledgeable and is sympathetic and we should leave everything to Him and make Him our agent (recourse and trust). 3—Sees and hears everything and is a close prayer responder, we should ask Him for healing, as others are only means (prayer-therapy). 4—Is the kind reward-giver, the passions of the patient are sacred for Him (sanctity of patience and gratitude). 5—Does not turn down the needy, we should not be disappointed (hope-therapy). 6—Only ordains good for His servant, there is something good in the sufferings (positive thought). 7—Loves His servant very much, he deserves to be loved (love-therapy). 8—Has a place in the broken heart, the bed of a patient is a place for worshipping (faith-therapy). 9—I am partly to blame for the disease; hence, I have to be held accountable and I should take corrective actions (cognition-therapy). The nurse is a messenger with good tidings who gives hope to the patient and kindles the light of divine love in his heart; she strengthens patient’s will for healing and considers him God’s trust and holds the patient in high respect. She seeks help form close relatives of the patients and helps make the hospital’s environment safe like home through the patient’s love for his wife and children and she also encourages friends to visit him. God told Moses: ‘‘I fell ill, but you did not come to visit me?’’ Moses said: ‘‘You do not become ill.’’ God said: ‘‘My servant was ill; had you gone to visit him, you would have visited me.’’ During treatment, the nurse relates to the patient the story of Ayub’s passions, Moses’ supplication to God, Jesus Christ’s miracles, the cooling of the fire for Abraham, the love of Prophet Muhammad for God and the sufferings of Imam Hussein so that the patient does know that there were many people with higher degrees of faith before him who were tested and there will be many people after him. She amuses the patient and reads poetry for him. Lights, colors, twittering of birds, fragrance of plants, sports including swimming, modifying the patient’s diet, good sleeping habits, growing flowers, showing compassion for animals (to attract God’s compassion), the sound of flowing water and raining, beautiful natural scenes, the green color of grass, the beauty of his room and clothes, prayers, etc., are supplementary methods that could be used for speeding up the patient’s recovery and for providing him with health care. These are all aimed at strengthening love and hope in him. The nurse prays to God for him, and such a prayer will be fulfilled.
References Abdulbaghi, M. (1966). Al-Mua’jam al-Mufahras Le Alfadh al-Quran. Tehran: Islamic Publications. Akbari, M. (2011). Glorious age of return. Qom: Holy Mosque of Jamkaran Publications. Alfaro, R. (1995). Step-by-step guideline for application of nursing diagnosis and nursing process (Davachi and Baniasad, Trans.). Tehran: Shahrab Publications. Asadzandi, M. (2001). Critique of nursing models at the level of applied concepts and equations and model designing. Ph.D. thesis, Faculty of Health, Baghiatallah University of Medical Sciences, Tehran.
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J Relig Health Sayyari, S., Asadzandi, M., Ebadi, A., & Sanaei Nasab, M. (2009). A study of the effect of proceed model on sleep disorder of nurses while stressing the Islamic rituals of sleeping at Baghiatallah Hospital. Master’s Degree thesis, Baghiatallah Nursing College . Shaabani, M. (2012). Beauty of death as described by scholars. Qom: Wave of Science Publication. Shahmiri, H. (2010). Great return at the time of the emergence of Imam Mahdi. Tehran: Culture and Studies Research Center Publications. Sharqawi, H.(1965). A step beyond Islamic psychology or psychological health and ethics in Islam (Dr. Seyyed Mohammad Bagehr Hojjati, Trans.). Tehran: Islamic Culture Publications. Streubert, C. (1990). Qualitative research in nursing (advancing the humanistic imperative). Philadelphia: Lippincott com. Tabatabaee, M. (1971). Tfsyr Al-Mizan (Sayed Mohammad Mvsvyhmdany, Trans.). Qom: Office of Publications. Taghizadeh, K., Asadzandi, M., Tadrisi, S., & Ebadi, A. (2010). A study of prayer’s effect on mortality rate and critical condition of patients at intensive care units. Master’s Degree thesis, Baghiatallah Nursing College. Taghizadeh, K., Asadzandi, M., Tadrisi, D., & Ebadi, A. (2011). Effect of prayer on severity of patients illness in intensive care units. Iranian Journal of Critical Care Nursing, 4(1), 1–6. Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (2nd ed.). St. Louis, Mo: Mosby Elsevier. Walker, L., & Avant, K. (2005). Strategies for theory construction in nursing (4th ed.). New York: Pearson Prentice Hall. Zomorrodian, A. (1965). Truth of soul, brief knowledge of souls. Tehran: Islamic Culture Publications Center. Zukav, G., & Francis, L. (2008a). Place of soul (Amir Behnam, Trans.). Tehran: Pazineh Cultural Institute. Zukav, G., & Francis, L. (2008b). Heart of soul (Amir Behnam, Trans.). Tehran: Pazineh Cultural Institute.
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Sound Heart: Spiritual Nursing Care Model from Religious Viewpoint Minoo Asadzandi1
Springer Science+Business Media New York 2015
Abstract Different methods of epistemology create different philosophical views. None of the nursing theories have employed the revelational epistemology and the philosophical views of Abrahamic religions. According to Abrahamic religions, the universe and human being have been created based on God’s affection. Human being should deserve the position of God’s representative on earth after achieving all ethical merits. Humans have willpower to shape their destiny by choosing manner of their relationship with God, people, themselves and the whole universe. They can adopt the right behavior by giving a divine color to their thoughts and intentions and thus attain peace and serenity in their heart. Health means having a sound heart (calm spirit with a sense of hope and love, security and happiness) that is achievable through faith and piety. Moral vices lead to diseases. Human beings are able to purge their inside (heart) through establishing a relationship with God and then take actions to reform the outside world. The worlds are run by God’s will based on prudence and mercy. All events happen with God’s authorization, and human beings have to respond to them. Nurses should try to recognize the patient’s spiritual response to illness that can appear as symptoms of an unsound heart (fear, sadness, disappointment, anger, jealousy, cruelty, grudge, suspicion, etc.) due to the pains caused by illness and then alleviate the patient’s suffering by appropriate approaches. Nurses help the patient to achieve the sound heart by hope in divine mercy and love, and they help the patient see good in any evil and relieve their fear and sadness by viewing their illness positively and then attain the status of calm, satisfaction, peace and serenity in their heart and being content with the divine fate. By invitation to religious morality, the model leads the patients to spiritual health. Keywords
Nursing care model Sound heart Spirituality Religious viewpoint
& Minoo Asadzandi [email protected] 1
Department of Anesthesiology, Faculty of Nursing, Medicine and Religion Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Introduction The Necessity of Designing an Islamic Model of Health care The effect of philosophy on science and scientific theories, and the relationship between the abstract concepts of philosophy and those in the real world have caused the healthcare models shape the way in which health care is provided based on the views of the theorist (Burns and Grove 1993). Different epistemology doctrines have ushered in different philosophical approaches (Motahari 1984a, b). Experimental methods, reasoning and illumination have created different philosophical viewpoints (Motahari 1975). Cognition based on divine revelation and religious philosophy as well as the theorist’s presuppositions plays a role in the production of knowledge and even in the induction of phenomena and the scientific hypothesizing (Asadzandi 2005a, b, c, d, e, f). Such a knowledge gives philosophical color to science (Pirouzmand 1997a, b). Islam confirms other Abrahamic religions and introduces itself, Quran and the Sunnah of Prophet (Muhammad) as firm sources of recognition for humans while verifying the usefulness of sense, logic and illumination (Motahari 1984a, b). Referring to Islam produces philosophy and culture (a special lifestyle) and creates such presuppositions as belief in the unseen, existence of soul in human beings, existence of rankings of the soul in the world and the praise of God by all creatures (Asadzandi 2005a, b, c, d, e, f). Islam considers theology as something different from other branches of non-religious philosophy-based knowledge. Hence, it regards designing an Islamic model of health care as a must (Pirouzmand 1997a, b).
Necessity of Using Islamic Model of Health care Humans are social creatures (WHO), and each society determines the way of life of a group of people who have common beliefs, values and traditions (Mohseni 1995) which affect the social needs of people in each society (Asadzandi 2005a, b, c, d, e, f). Cultural differences affect the concept of health and illness, choice of treatment and healthcare method, etiology of the disease and the patient’s response to a disease (Asadzandi 2004a, b, c, d, e, f, g). It has given a social meaning to health and illness (Cockerham 1992) and has also pushed nursing toward community-oriented and holistic care (Griffith 1982). In order to offer communityoriented care, one should know the beliefs of a society and consider its culture and people’s needs and also use a model that is compatible with the cultural beliefs of that society (Asadzandi 2005a, b, c, d, e, f). This is because each healthcare model has three components: values and beliefs of the theorist; knowledge and skills of the model; and the aim of the function (Tomey and Alligood 2006). We should choose a model in which theorist’s beliefs are compatible with patient’s beliefs. Furthermore, the patient should accept its knowledge and operational objectives (George 1990). This highlights the necessity of using the Islamic model of health care for the followers of monotheistic faiths in the world.
Content Mission of Model In Islamic philosophy, epistemology, ontology, values, ethics and logic are all based on divine revelation (Hosseini al-Hashemi 1996). These concepts are such that in the
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epistemology of nature which is the world of time, place and movement, they are considered as signs to know the realm of heavens and earth so that we will infer the existence of the creator from the creature. Wisdom and thinking are emphasized, but observationbased emotional cognition is considered as personal, limited and superficial cognition that is bound within the present time and a special location. However, reason-based logical cognition is regarded as deep and capable of infiltrating the depth of phenomena and understanding the nature of intangible relations. It can infer the cause from the effect, is capable of deduction and can perceive the whole. Such manner of cognition can help people be aware of the past and predict the future. Islam also confirms the illuminationbased cognition, which is awareness of some supernatural inspirations (Motahari 1984a, b). Islam also introduces history as a good source of cognition that can help human beings perceive the role of their willpower in shaping their destiny (Pirouzmand 1997a, b). However, it believes that none of the cognitions are as comprehensive as divine revelation and says the unseen world and human soul can only be understood by resorting to divine revelation. Under such circumstances, the criterion of cognition’s veracity is not compatibility with reality or with the views of other present scholars or its usefulness for human beings and effectiveness in performance. The criterion for the veracity of any cognition is its compatibility with divine revelation (Hosseini al-Hashemi 1996; Asadzandi 2004a, b, c, d, e, f, g). Based on revelation epistemology, the world is moving unilaterally from God and to God. The epistemology believes that the world is not just this material world, but is made up of the sensible, malakut and limbo worlds which are moving toward spiritual growth and in which all creatures praise God according to their hierarchy of spirit (Asadzandi 2009). In short, it considers God as the source of mercy and prudence and as the creator and manager of the whole universe (Hosseini al-Hashemi 1996). Humans began to exist in the ‘‘Zar world’’ in which the covenant of monotheism was received from them (Raji 2011). Human life begins after Holy Spirit is breathed into their body, and their death occurs when the spirit leaves the body completely. However, death is movement from this world to another world and is a window to the eternal life (Asadzandi 2005a, b, c, d, e, f). In this view, no creature in this world has been created without a cause and no event is outside the will of God (Asadzandi 2013a, b, c; Shaabani 2012).
Design of Research Methods in the Model First Stage: Critique of Global Healthcare Models I was trying to find the answers to these two questions: What is the reason for the suffering of our ailing loved ones? How can I help alleviate their suffering? Thus, I began to study the nursing models (Asadzandi 2013a, b, c; Pirouzmand 1997a, b). Based on total survey and Islamic philosophical perspective in seven international healthcare models, the following stages were performed: 1.
Analysis of elements and relations of model
• Advance familiarity with the subject—Studying the subject—Analysis of the textual data • Encoding the analyzed statements—Taking notes from codes—Titling notes—Providing a main list (list of titles)—Categorizing the titles—Extracting the main themes of the model
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2.
Analysis of organizational principles of the model (review of ordering in materials)
• Discovering links between themes of the model reorganizing of the model themes
3.
Evaluating the model materials
• Extracting reasoning examples of model (analogical reasoning model)—Counterexamples (and applications of the model)—Finding general arguments and counterarguments • Principle counterarguments (presuppositions of the model) (Asadzandi 2001), which are comparable to perceptive analysis and communicative analysis methods (Walker and Avant 2005; Hajbagheri et al. 2007). It became evident that nursing met paradigm concepts are far from those based on Islamic philosophy and have ignored the most important aspect of human existence, that is, his soul and the unseen world. Perhaps, this is the main reason why the models have failed to alleviate patients’ pains (or suffering) (Asadzandi 2007a, b, c, d, e; Zomorrodian 1965; Zukav and Francis 2008a, b; Sharqawi 1965).
Second Stage of Research (Extraction of Themes) The meaning of soul and the unseen had to be defined because the first stage in the theorization process is conceptualization. Forming and naming the themes shapes our viewpoint. As a result, it organizes our observations which result in understanding the life situations and events (Ibrahim 2007). Meanwhile, the met paradigms of the academic course are not effective without creating a cohesive conceptual framework. Different processes exist for the purpose of conceptualization (Wakker 2005; Hajbagheri et al. 2007). To choose an appropriate process for conceptualization in any paradigm, we need to first respond to the type of concept and factors that are effective in defining that concept. The most important factors are: How many texts are available about the concept in point? Have the relevant sources been already tried? Have they been applied for the purpose of making a conceptual framework in the profession? (Walker and Avant 2005). While designing a macro-theory in nursing without any presuppositions, one would face a serious challenge regarding its met paradigms: we need to create new concepts and methods for explaining and defining those concepts (Walker and Avant 2005). While reviewing main and meta-paradigm concepts, one may come across some concepts whose nature is such that a special method cannot be helpful alone. Under such circumstances, we need to use simultaneous or combined methods to get an accurate definition of the concepts. The method we recommend for the definition of concepts is only a guideline, not an unchangeable procedure. Therefore, the researcher can change his method whenever he wants to (Meleis 1991). Naust The more abstract the concepts are, the more important the role of the researcher’s creativity becomes in defining them. The principle of creativity itself is an obstacle to methodology (Fawcett 1984, 2006). Rogers When we want to choose a suitable method for defining concepts, we need to consider the concept development philosophy. Any element in that philosophy which would lead the researcher to the concept development is acceptable. The reason is that
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researcher’s creativity in abstract concepts plays a key role. The more abstract the concept in point is and the bigger the researcher’s theory is, the more difficult the choice of a method for concept development. Subsequently, the researcher will need to choose more flexible methods and will be ready for change at any stage of conceptualization (Rodgers and Kanf 2000). Rogers and Neff One of the best methods used for conceptualizing in an academic course is defining main concepts of that course within the paradigm in question by using the definitions of other theories (Rodgers and Kanf 2000). Meliss believes that there is not just a single way to identify a phenomenon and that the next stage after conceptualization is the description of the phenomenon. While describing a phenomenon, we need to answer questions as to the nature, time of happening, limits, commonalities, internal changes, functions, habits, etc., related to phenomenon (Streubert 1990). Therefore, in the second stage of the research on the paradigm of Abrahamic religions and Islam, we referred to main sources in Islam like the Holy Quran and credible interpretations and hadiths for the purpose of knowing the nature of human soul and unseen world (Gheraati 2006a, b; Tabatabaee 1971; Pouryousef 2004; Abdulbaghi 1966; Koleini 1791). We then used the method employed by the seminary and extracted the meaning of soul (heart) (Beheshti 1978). In recognition of human, we identified heart status (sound heart, oft-retuning heart, unsound heart) (Dastgheib 1963), and the features of the perfect human being were defined according to Nahj al-Balaqah (Asadzandi 2004a, b, c, d, e, f, g, 2005a, b, c, d, e, f) and then attaining the sound heart (moral characteristics) was introduced as the main characteristic of the sound spirit. Then, the meaning of health, having the sound heart was recognized as the central concept of the model and the state (national) concept (Asadzandi 2003). Other meta-paradigm concepts of the model were defined within the paradigm of monotheistic religions (Asadzandi 2002, 2003, 2006a, b, c, d, e, f). In this way, we used credible books on ethics (Zukav and Francis 2008a, b). In the first stage of the research, we extensively studied the following: 1—Models and theories of nursing care. 2—Viennese psychotherapy methods (Freud, Yung, Adler, Frankel) (Asadzandi 2004a, b, c, d, e, f, g, 2006a, b, c, d, e, f). 3—Biological and physiological study, quantum theory and physics laws (Asadzandi 2006a, b, c, d, e, f). 4—Studying significant theories of psychology (Maslow’s human needs and perfect man, stress theory of Hans Selye) (Memarian 1997). Thus, we adopted the concepts from more inclusive sciences and redefined them in the field of nursing (which is comparable to Walker and Avant concept analysis).
Third Stage of Research: Designing a Model by Using the Concept Analysis Walker Avant Strategy After deriving the concept of sound heart (as the characteristic of the perfect human being), the existence aspects of human being and needs of each aspect were outlined and the three conditions of heart (sound, unsound and oft-returning) were specified (Dastgheib 1963). Ethical virtues as the basic characteristics cause people to live in the present time and not to regret the loss of health and not to be anxious about the future (Asadzandi 2007a, b, c, d, e). The ethical virtues also make people patient in calamities and thank God for His blessings and protect them against mental problems. Knowing such people’s characteristics made it possible to devise practical ways for providing health care for patients (Asadzandi 2007a, b, c, d, e). Sadness and fear in the face of disease were called the features of an unsound heart (Asadzandi 2007a, b, c, d, e). 5—The Prophet Muhammad (Peace be upon
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him) and the twelve Imams as well as other messengers of God like Abraham, Noah, Moses and Jesus were introduced as models of ethical excellence with all the characteristics of a sound heart (Gheraati 2006a, b; Motahari 1983a, b, c). 6—Providing models with definitional description (borderline models) and models related to the concept, the pious characteristics were introduced and compared to many aspects of the perfect human being in today’s science (Asadzandi 2004a, b, c, d, e, f, g). 7—As for the conditions needed for acquiring a sound heart, we spoke about the role of one’s will in deciding his destiny by choosing the four types of relations and also his lifestyle. We also discussed the effect of vices and virtues on the spirit and then on the body of people and the results of having a sound heart were identified (Motahari 1983a, b, c; Asadzandi 2006a, b, c, d, e, f, 2007a, b, c, d, e). 8—Assessing the concept in real world, outlining the experimental indices, categories of the concept (sound heart versus unsound heart were performed in the fourth stage of this research (Asadzandi 2013a, b, c). And in the fifth stage, spiritual nursing guidelines (based on the model) were conducted.
Fourth Stage of Research: Designing the Tool for Patient’s Psychological Response to the Disease Given the results of the third stage that was mainly built on the comparative method, we had to assess the concepts in an inductive stage in real condition and to bring out the phenomenon based on experiences of individuals so that we could make the conceptual model and apply it through comparison (Asadzandi 2013a, b, c). Diseases force human to react in all dimensions including spiritual dimension. This originates from the four types of individual relationships (Asadzandi 2013a, b, c; Farahzad 2011a, b). Therefore, in my interviews with the patients and their families, I always used clinical observation throughout my career as a nurse. During interviews with clinical nurses, professors of nursing and clinical psychologist and psychiatrists, the items were extracted and a tool for assessing the patient’s mental response to disease was designed (Asadzandi 2013a, b, c). The tool diagnoses patient’s spiritual problems and enables us to devise a healthcare program to achieve spiritual health (Asadzandi 2013a, b, c).
The Fifth Stage of Research: Design of Spiritual Healthcare Guidelines for Patient’s Base on Religion (Asadzandi 2013a, b, c) Accuracy and Reliability of the Qualitative Data Analysis The data and findings of qualitative research must be acceptable and reliable. The methods we have used for this purpose are as follows: 1.
2.
3.
Long-term study and consistent observation By allocating sufficient time to collect data (throughout my professional life, particularly the past 15 years) and by involvement with the patient for a long time, I have developed strong communication and I have been able to understand the language, culture and views of the participants. Incorporation in research By using numerous sources, I sought the opinion of experts and the families of the patients participating in the study. I also conducted this research over a period of 15 years and enjoyed the instructions from professors of related academic courses at 50 different congresses. Reviewing by supervisors Offering the model at academic circles as well as national and international congresses helped me enjoy the views of colleagues, and the publication of books also helped me in this way.
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4.
5. 6. 7.
Searching for opposing evidence The researcher has made efforts to use opposing views to modify the model in an objective way (Critique of the model at university classes). Acceptance of the researcher The researcher tried to convey what she learned to the patients sincerely. Evaluation The initial findings of the research were offered to the honorable professors of nursing, psychology, science academy etc., so that they would review it. Review of participants The model was given to a group of participants (patients, nurses, clinical) in order to express their modifying views (Streubert 1990).
Presuppositions Based on the verses of Quran (which confirm all other Abrahamic religions) and the hadiths (sayings) of the progeny of the Prophet Muhammad (Peace be upon him) (Gheraati 2006a, b; Tabatabaee 1971; Pouryousef 2004; Abdulbaghi 1966; Koleini 1791) 1—Faith in the only God, who has not given birth to anyone and has not been born and has no match and faith in His power and deity (None of His laws have tied his hands; He is always in the process of creating a new creature) (Hosseini al-Hashemi 1996). 2—Faith in His endless mercy; He has created the universe based on prudence and mercy and His mercy prevails his wrath (Farahzad 2011a, b; Asadzandi 2013a, b, c). 3—Faith in the unseen world. 4—Faith in the existence of soul which is the essence of human’s life and itself is alive eternally (Motahari 1982a, b, c, 1983a, b, c). 5—Faith in the prophet hood and the resurrection day, which exists in all divine religions and faith in the existence of angels who fulfill God’s orders (Motahari 1983a, b, c). 6—Admitting that all divine religions are unique religion of Islam (surrendering to God) and Prophet Abraham (Peace be upon Him) was the father of messengers of God (Hosseini al-Hashemi 1996). 7—Faith in the existence of a savior who will fill the world with justice (Akbari 2011; Shahmiri 2010). 8—Accepting that all creatures have degrees of soul and live in a cohesive system and they are always eulogizing God (Hosseini al-Hashemi 1996).
The Findings of Modern Sciences are Recognized 1—Holistic approach to nursing (Asadzandi 2006a, b, c, d, e, f). 2—Necessity of social view in health care (Asadzandi 2006a, b, c, d, e, f). 3—Necessity of helping patients and their families to be independent of the healthcare system (self-care approach) (Asadzandi 2013a, b, c). 4—Paying attention to the psycho-neuro-immunological findings of Ader and cohen (Asadzandi 2004a, b, c, d, e, f, g). 5—Paying attention to human needs and how it is influenced by the philosophy and culture of societies (social findings of medicine) (Mohseni 1995). 6—Emphasizing the necessity of meaning-therapy (existence of a logos that would give meaning to patient’s life) (Asadzandi 2006a, b, c, d, e, f). 7—Necessity of hope-therapy in treatment of patient and health care (Asadzandi 2007a, b, c, d, e). 8— Paying attention to the applications of supplementary nursing interventions (based on patient’s interest) particularly faith-therapy, Love-therapy, art-therapy, story-therapy and touch associated with healing prayers (Asadzandi 2006a, b, c, d, e, f). 9—Paying attention to the deep effect of beliefs on the psychological aspects of the patients (necessity of positively thinking and cognition-therapy) (Asadzandi 2007a, b, c, d, e). 10—Viewing human being as a multi-dimensional creature whose dimensions are inseparable from one another (Asadzandi 2013a, b, c). 11—Necessity of caring at home.
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12—Veiwing the whole universe as a system (systemic view) (Hosseini al-Hashemi 1996).
Meta-Paradigm Concepts of the Model Concept of Human Being The master of creatures and God’s representative on earth has a soul which gives him existence. Perception, feeling, movement, consciousness and will of human being are capabilities that originate from his soul. Human beings have authority and power to choose. Human beings held accountable for choosing their relationships (with God, people, themselves and nature), and they decide their fate based on their choice (Motahari 1986; Dastgheib 1984a, b). Human begins are not at the mercy of fatalism or determinism, and they have full power of choosing. They only have no authority over the place and time of their birth as well as over death, their family, genetic code and the society of their birth place (Motahari 1982a, b, c). Their power to choose makes them responsible for their thoughts and actions (Dastgheib 1962). Human beings shape their different ethical (heart) conditions by making their choices (Dastgheib 1964).
Concept of Health The highest level of health is having a sound heart that originates from faith. Sound heart gives humans a sense of security, peace, trust, hope, love and energy and happiness. Sound heart helps one get rid of fears and anxiety about future and regret about the past and live in the present time. Those who have sound hearts have ethical virtues and are optimistic. The actions and thoughts and remarks of any individual are decided by his intentions (Asadzandi 2006a, b, c, d, e, f, 2007a, b, c, d, e). Humans have different heart conditions (Dastgheib 1963). Worshipping is an optional matter for human beings. If they manage to adapt themselves to the world, they will achieve health (Asadzandi 2013a, b, c).
Concept of Environment The relationship between an individual and God shapes his internal environment and eliminates such vices as jealousy, grudge, hunger for vengeance and pessimism. The external environment involving inanimate objects, plants, animals and other human beings (tangible world) and the unseen world (souls and angels) has surrounded human beings. Any stimulation from the outside world is from God and originates from His mercy and prudence and is a test for humans and those around him; a human’s reactions to such tests vary according to his spiritual growth (Asadzandi 2003).
Concept of Illness Feeling regretful about the past and living in anxiety about the future are symptoms of illness and are the result of one’s lifestyle and the four types of his relationships (Asadzandi 2007a, b, c, d, e). The thoughts and intentions of any human being impact his tempers, behaviors and manners. Therefore, optimism (thinking about the good side of everything) brings health and anything other than this will lead to disease (Farahzad 2011a, b). Wrath, grudge, hopelessness, jealousy, pessimism, belligerence, etc., are morbid traits
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and fills one’s life with insecurity, despair and depression and leads to illness (Asadzandi 2007a, b, c, d, e). Hence, we should consider these feelings as the root of many diseases.
Concept of Nursing Nursing is a valuable social and religious service and ranks among top religious values (Majlisi 1699a, b). The nurse solves problems based on nursing procedures (Alfaro 1995). The nurse initiates relationships with patients and gives them advice throughout the treatment as a counselor. The core of nursing care is the patient and his family. The nurse tries to make it possible for the health care to be provided mainly at home where the patient feels calm and safe. The nurse uses the logos of the patient to create love and hope in him throughout the treatment process. After establishing a relationship and winning the trust of the patient and his family, the nurse studies patient’s spiritual reaction to the disease and she pays attention to patient’s thoughts and feelings while trying to solve their physical problems caused by his illness. Feeling angry over one’s disease; feeling jealous of others who are healthy; and feeling like taking revenge on the agents of my illness and suspicious that other people planned to make me sick; all these feelings are abnormal, and they need to be assessed and resolved through appropriate ways. Nursing aims to change reactions caused by fear and sadness to feelings of love, trust, security, calm, peace, hope and energy. The patient should not think that he is a victim of fate and that he is involved in the surrounding environment. Instead, he should accept that his choices and lifestyle impact his illness and health (Asadzandi 2013a, b, c) Feeling optimistic that problems will be resolved and good things will happen after seeking refuge in God’s mercy will help dispel sadness and fear and are a basic principle of health care and they are accessible through faith-therapy (Dastgheib 1984a, b). Optimism should be created in the patient (Farahzad 2011a, b). During the treatment, besides secondary nursing interventions, religious techniques of alleviating patient’s pains and suffering such as narrating stories, Islamic dream-therapy (Sayyari et al. 2009), meditation, touching associated with healing worship (Asadzandi 2007a, b, c, d, e), prayertherapy (Taghizadeh et al. 2010, 2011) etc., are used as desired by the patient and his family.
The Objective of the Model The model based on holistic viewpoint identifies the spiritual reactions of the patient besides his physical, mental and social reactions according to content of assessment. Then, the model moves toward creating a feeling of hope, security, peace, love and energy for the patient. In this way, the patient develops a capability of taking care of himself, adapting himself to his new condition so as to go on his daily activities and performing his social role. In addition, he feels calm and satisfied and feels that he is immune to any harm (Asadzandi 2013a, b, c).
Applications of the Model The model can be used for chronic or acute patients who are hospitalized at clinics, hospitals or other healthcare centers. It helps change the beliefs of the patient, causes him to believe that he will be cured and gives him hope. Thus, the model enables the patient to confront his disease and keep up his hopes with the help of his family. It also helps the patient achieve spiritual growth and content with divine will by stressing the need for selfcare at home (Asadzandi 2013a, b, c).
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Conclusion Therefore, each person adopts his own lifestyle based on his choice of manner of the four types of relationships and acquires special vices or virtues. Many diseases stem from wrong lifestyles and many of them come from bad ethical characteristics like fear, sadness, jealousy, grudge, suspicion, etc. Those who have sound hearts contract diseases because they are more loved by God and He wants to make them suffer so that they always remember God and acquire ego at peace. Of course, there is also a divine tradition to test the faith of humans so that it is known what hearts they have. However, to alleviate the pains of patients, because the Almighty is: 1—kinder than anyone else and we should make the patient take refuge to Him (supplication). 2—Is knowledgeable and is sympathetic and we should leave everything to Him and make Him our agent (recourse and trust). 3—Sees and hears everything and is a close prayer responder, we should ask Him for healing, as others are only means (prayer-therapy). 4—Is the kind reward-giver, the passions of the patient are sacred for Him (sanctity of patience and gratitude). 5—Does not turn down the needy, we should not be disappointed (hope-therapy). 6—Only ordains good for His servant, there is something good in the sufferings (positive thought). 7—Loves His servant very much, he deserves to be loved (love-therapy). 8—Has a place in the broken heart, the bed of a patient is a place for worshipping (faith-therapy). 9—I am partly to blame for the disease; hence, I have to be held accountable and I should take corrective actions (cognition-therapy). The nurse is a messenger with good tidings who gives hope to the patient and kindles the light of divine love in his heart; she strengthens patient’s will for healing and considers him God’s trust and holds the patient in high respect. She seeks help form close relatives of the patients and helps make the hospital’s environment safe like home through the patient’s love for his wife and children and she also encourages friends to visit him. God told Moses: ‘‘I fell ill, but you did not come to visit me?’’ Moses said: ‘‘You do not become ill.’’ God said: ‘‘My servant was ill; had you gone to visit him, you would have visited me.’’ During treatment, the nurse relates to the patient the story of Ayub’s passions, Moses’ supplication to God, Jesus Christ’s miracles, the cooling of the fire for Abraham, the love of Prophet Muhammad for God and the sufferings of Imam Hussein so that the patient does know that there were many people with higher degrees of faith before him who were tested and there will be many people after him. She amuses the patient and reads poetry for him. Lights, colors, twittering of birds, fragrance of plants, sports including swimming, modifying the patient’s diet, good sleeping habits, growing flowers, showing compassion for animals (to attract God’s compassion), the sound of flowing water and raining, beautiful natural scenes, the green color of grass, the beauty of his room and clothes, prayers, etc., are supplementary methods that could be used for speeding up the patient’s recovery and for providing him with health care. These are all aimed at strengthening love and hope in him. The nurse prays to God for him, and such a prayer will be fulfilled.
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