Iranian Journal of Critical Care Nursing Winter 2010, Volume 2, Issue 4; 149-152

Relationship between different dimensions of prayer and spiritual health

in hemodialysis patients
Hojjati H.* MSc, Motlagh M.1 MSc, Nuri F.1 BSc, Sharifnia S. H.2 MSc,
Mohammadnejad E.3 MSc, Heydari B.4 MD
*

Young Researchers Club, Aliabad Katool Branch, Islamic Azad University, Aliabad Katool, Iran;
Hemodialysis Department, Imam Reza(AS) Hospital, Mazandaran University of Medical Sciences, Amol, Iran;
2
Zeynab Faculty of Nursing & Midwifery, Babol University of Medical Sciences, Amol, Iran;
3
Nursing office, Imam Khomeini Clinical & Emergency Complex, Tehran University of Medical Sciences, Tehran, Iran;
4
Faculty of Pharmacology, Kerman University of Medical Sciences, kerman, Iran
1

Abstract
Aims: Spiritual, physical and mental health is disturbed in some hemodialysis patients. Religious behaviours specially
prayer can increase spiritual energy and positive attitude in patients. The aim of this study was to analyze the relationship of
prayer with the spiritual health of hemodialysis patients.
Methods: This descriptive correlation study was performed on hemodialysis patients referred to Imam Reza Hospital of
Amol in 2009. 85 patients who had the study conditions were selected by purposive sampling method. Information was
collected through Meraviglia prayer frequency and Palutzian & Ellison spiritual health questionnaires. SPSS 16 statistical
software and descriptive and inferential statistics tests (Pearson correlation, ANOVA and Tukey's post hoc test) were used
to analyze data.
Results: Frequency of prayer was high in 96% of samples. 96% of samples prayed in high level. 85% had the experience of
prayer and 87% had a positive view on it. Spiritual health was high in 75% of samples. There was no significant relation
between the frequency of prayer and spiritual health (p=0.3). Significant relation was seen between frequency of prayer and
marriage (p=0.05) and also between spiritual health and age (p<0.01).
Conclusion: Frequency of prayer has no effect on spiritual health of hemodialytic patients. According to the dominancy of
religious culture and beliefs of Iranian people, it is expected from health care staff to pay more attention to religious and
spiritual dimensions in patients care.
Keywords: Frequency of Prayer Spiritual Health, Hemodialysis Patients, Amol

Introduction
Chronic renal failure is one of the common human
physical diseases, so that today, 2 to 3 % of people are
suffering from this disease. This issue can disturb the
wellbeing and mental health of individuals [1],
because hemodialysis patients are often worried about
the unpredictable future of their disease. They often
lose their job and face with financial problems and are
always depressed and have the fear of death because
of chronic disease [2]. Recent studies have shown that
the spirituality and religious beliefs have a notable
effect and role on physical and mental health of people
and are considered as a common strategy to deal with
problems [3]. Dialysis patients are subjected to stress
like all chronic patients or sometimes more severe
than them and use confronting and adaptation
strategies which are protective processes to continue
their life [1]. Prayer is one of the religious behaviors
related to mental health and well-being [4] which is
used more than other rituals [5]. For James, prayer and
worship and connection with the spirit of world
* Correspondence; Email: h_hojjati1362@yahoo.com

creator have many functions and cause amazing

effects and results. Prayer strengthens the humans
spirit and gives a special value and meaning to life
affairs; because the connection to the eternal power of
God is the single source of energy and renewal of the
lost spiritual forces [6]. Carl, the famous physiologist,
says that for human, communication with God is vital
like water and oxygen; because prayer is the highest
and the strongest trouble-shooter and by using the
power of prayer, the spiritual energy can be released
[7, 8]. Recently, many researchers have assessed the
effectiveness of prayer, in addition to common
treatment for the states such as depression, drug
dependences, marital problems and heart diseases, and
have benefited from it [4]. Koeing believes that
religion can cause a positive attitude towards the
world in individuals and help them cope with the
unfortunate events such as loss or disease and by
creating motivation and energy in person, give him the
hope that the life will get better. This causes the
increase of tolerance and acceptance of intolerable
conditions and in many of emergency cases which
Received 2010/01/06; Accepted 2010/02/03

Relationship between different dimensions of prayer and spiritual health of patients treated with hemodialysis ___________________

science cannot help the person, this issue is very

important [9]. Spirituality, along with religious forces
such as prayer, has an important role in disease
acceptance [10]. For this purpose, nursing must have a
complete dominance on physical, mental, and spiritual
aspect of individual, but unfortunately in Iran, in many
cases nursing still helps identifying the patients
surface problems [11]. Accordingly, the aim of this
study was to investigate the relationship between
frequency of prayer and spiritual health of
hemodialysis patients.
Methods
This research is a descriptive correlational study. The
study population was all patients treated with
hemodialysis who had referred to the hemodialysis
centers of Imam Reza hospital in Amol in 2009. 85
people who all had the least literacy and were able to
communicate were selected by purposive sampling.
Those with chronic psychological or psychiatric
disease and with the history of narcotics and
psychedelic drugs were excluded from the study.
Paloutzian and Allison "spiritual well-being" standard
questionnaire contained 20 questions, and scoring was
based on Likert 6-option scale from "completely
disagree" to "completely agree". In negative questions,
scoring was done reversely. Finally, the spiritual
wellbeing score (20-120) was classified into three
levels: low (20-40), medium (41-99) and high (100120). Reliability of this instrument was confirmed in
2006 with alpha Chronbach's coefficient of 0.82, by
Rezaei in Tehran.
Prayer frequency questionnaire was developed by
Paloma and Pendleton in 1991 and was revised by
Meraviglia at the same year. This questionnaire had 32
questions. 17 questions were about the "prayer
rituals," which were classified in Likert seven-option
scale from "Im not sure" (1 point) to "I do constantly
(7 points). Range of scores was from 17 to 119. 9
questions were about the "previous experience of
prayer" with the scoring similar to praying rituals.
About the questions 4, 7 and 9 the scoring was done
reversely. Prayer previous experiences scores range
was from 9 to 63. The final 6 questions assessed the
attitude of patients toward prayer. The answers of
these questions were classified according the 7-option
Likert scale from "completely disagree" (1 point) to
"completely agree" (7 score). About questions 2 and 4
the scoring was done reversely. The total score range
of attitude toward prayer was from 6 to 42. Total score
range of prayer was considered from 32 to 224. The
rate of prayer was classified into three levels of low

(0-81), medium (81-162) and high (163-224). The

reliability of three parts of prayer frequency
questionnaire namely prayer rituals, prayer previous
experiences and attitude toward prayer has been
determined by Meraviglia as 0.75, 0.78 and 0.72 and
was also confirmed in Iran, after the translation by
Rezaei by Chronbach's alpha coefficient of 0.79.
In order to collect data, after receiving permission
from university officials and researcher visit from
Amol Imam Reza hospital and selecting subjects and
introducing themselves and providing sufficient
explanation about the purpose of study and taking a
written consents, each participant completed the
questionnaire voluntarily. The questionnaires were
supposed to be filled within 20 to 30 minutes.
Concerning some patients who were very ill or
according their request, questionnaire was completed
by
researcher
through
interview.
Apart from the researcher himself, two other
instructed individuals helped in presenting the
questionnaires to patients. Data was collected within
four weeks and analyzed by statistical SPSS 16
software. Data were analyzed using descriptive
statistics (tables, graphs, mean and standard deviation)
and inferential statistics (Pearson correlation
coefficient, ANOVA and Turkeys post hoc test).
Results
The average age of subjects was 66.27.5 years that
47% were in age group of 60-70 years. 60% of
samples were women, 74% married, 43% illiterate,
55% rural and 48% were unemployed. On average,
patients had been treated with hemodialysis for four
years. 7% of subjects had the history of renal surgery
and 48% were kidney transplant candidates.
The mean of the total score of pray dimension (total
score of prayer rituals, previous experience of prayer
and attitude toward prayer) was calculated as 172 10.
96% of the subjects prayed in high level. 85% of
subjects had the previous experience of prayer and
87% of them had a high attitude toward prayer
(Table1).
Table 1- Distribution of the absolute and relative frequency of
prayer dimensions in hemodialysis patients
Medium
High
Frequency
MSD
Dimensions
Freq. Perce. Freq. Perce.
4
82
96
93.36
Prayer rituals(17-119) 3
Previous experience
11
15
72
85
47.55
of prayer(9 -63)
Attitude toward
11
13
74
87
323
prayer(6 -42)
Total score of prayer
3
4
82
96 172.210
(32 -224)

__________________________________________________________________________________________________ Hojjati H. et al.

75% of subjects had high spiritual health and 25% had

an average spiritual health. 52% of the subjects were
"completely agree" that connection with God helped
them not to feel alone. Studies of the frequency of
prayer and spiritual health showed no significant
relation (p=0.31); i.e., the frequency of prayer has no
effect on the spiritual health of patients (Table 2).
Table 2- The relationship between the frequency of prayer and
spiritual health in hemodialysis patients
The frequency of Medium
High
Total
P
prayer
value
Freq.
Perce.
Freq.
Perce.Freq.
Perce.
Spiritual health
0
0
21 100 21 25
Medium
3
4
61
96 64 75 0.3
High
3
4
82
96 85 100
Total

Also, the ANOVA between the overall dimensions of

prayer and marriage (p=0.049) and Tukey's post hoc
test between spiritual health and the age in the group
of over 60 years presented a significant correlation
(p<0.01).
Discussion
Results showed that the amount of prayer and spiritual
health in hemodialysis patients are at high level.
Various studies show that patients with physical
injuries are impelled toward religious beliefs. Because
religion helps them tolerate the pain and torment of
the disease [12]. Among the religious references,
prayer has the most use for compatibility with such
circumstances [13].
Some studies show the relationship between religion
and faith is necessary for survival and resistance to
disease, because religion can reduce depression and
mental illness and increase the longevity and improve
the life and physical-psychological condition [14].
Prayer therapy is a way by which the spiritual
relationship between God and human beings in need
has been created, and this relationship leads to
renewing of the patient's morale and breaking of the
disappointment wall in his self; this affects the
acceptance and admittance of the disease [7]. Spiritual
support and religious resources and having a strong
relationship with the higher power can improve the
quality of life and interpersonal supports and reduce
the severity of symptoms that its results will be
beneficial for medical care and treatment [15].
Results of this study showed that married people prey
more. Rezaei in his study also has shown a significant
relationship between the frequencies of pray and
marital status in cancer patients under chemotherapy
treatment [16]. Yet Riliey et al. in their study showed

that married people have more spiritual health [17].

Also in this study there was significant correlation
between spiritual health and age of patients. Rezaei in
his study has shown that there is a direct relationship
between spiritual health and the age of cancer patients,
i.e. with increase in age, the spiritual health will
increase in cancer patients, which corresponds with
the results of this study [16]. Increase in spirituality at
the end of life is considered as the normal aging
process [4], because the person encounters the reality
of death and becomes compatible with it.

Conclusion
Finally, with regard to the importance of doing
spiritual and religious cares that today is considered as
one of the duties of nurses, nurses as a key member of
health team are responsible to not only consider the
physical and psychological aspects of patients but also
respect their opinions and values. Considering the
religious dimensions, nurses should better understand
the cultural, indigenous and religious status of
patients. Therefore, we hope that by implementation
of religious commandments which today are referred
as religious cares, lead to tranquility and accelerated
healing of patients.
Acknowledgement: At the end of this research it is
necessary to express gratitude for the efforts of
hemodialysis staff of Imam Reza hospital and the
sincere cooperation and tolerance of patients.
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