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Mohsen Rezazadeh+Essay

1. Introduction

Spirituality is a complex, but important concept. Its importance is reflected in the increased research on the topic (Lucchetti and Lucchetti 2014), as well as the inclusion of spirituality and spiritual care in healthcare policy across the globe. For example, the National Health Service (NHS) Scotland published an educational document for healthcare staff (NHS 2009). Similarly, the government in Manitoba in Canada, published a list of core competencies for spiritual health care practitioners (Manitoba’s Spiritual Health Care Partners 2017). Furthermore, many professional regulatory bodies now include the provision of spiritual care in their recommendations and guidance to healthcare professionals. For example, the International Council of Nurses refers to spiritual care in their Code of Ethics document (ICN 2012). Similarly, in the UK, the Nursing and Midwifery Council (NMC) have referred to spiritual care in their standards for both pre-registration nurses and registered nurses (NMC 2010, 2014). In Ireland, the Nursing and Midwifery Board of Ireland refer to spiritual aspects of care in their scope of practice framework (NMBI 2015), requirements for nurse registration education programmes (NMBI 2005) and guidance for working with older people (NMBI 2009).

The increasing interest in spirituality has stemmed from changes in culture, religion and society. This has been particularly evident in Western Society in terms of a shift away from institutionalized religion and movement towards more individualised type religion e.g., a personal search for meaning, a sense of self and enhanced connection with others (Puchalski et al. 2014). This has led to an increased focus on spirituality and spiritual concepts across many fields including healthcare (Cockell and McSherry 2012; Monod et al. 2011; Pike 2011; Williams and Sternthal 2007) and business or workplace literature (Crossman 2010, 2011; Karakas 2010; Pawar 2009; Phipps 2012). Spirituality has almost become regarded as a new concept, with a lack of recognition amongst some authors of the historical and traditional association between spirituality, religion and health. The discourse and language used to describe spirituality and spiritual concepts has changed. Consequently, there has been a search for words to describe the concept of spirituality that are not couched in religious meaning. From a healthcare perspective, this has been a challenge, and is reflected in the many published papers that strive to clarify the concept of spirituality and differentiate it from related concepts such as religiosity, spiritual wellbeing, spiritual health etc. (Weathers et al. 2016).

The majority of previous research on spirituality has been conducted with Western populations (Moberg 2002; Koenig et al. 2012). Yet, an increasing number of studies are emerging from Middle Eastern countries conducted with predominantly Muslim populations and investigating relationships between spirituality and variables such as wellbeing, hope, meaning, self-esteem and depression (Jafari et al. 2014b; Koenig et al. 2012). In terms of understandings of spirituality in a Middle Eastern and Muslim context, Rassool (2000) published seminal work on the topic of healing, nursing and the spiritual dimension. According to Rassool, there is no distinction between spirituality and religion in a Muslim context. Muslim individuals live in a manner in which their religious beliefs pervade all of their actions and across all facets of human life, including their work life (Rassool 2000). With regard to spiritual care, Rassool (2000) concluded that nursing care models practised within a Judeo-Christian tradition lack a religious focus and thus are not appropriate to meet the needs of Muslim patients. The need to develop nursing models of care that are appropriate to both Muslims and non-Muslims was emphasised by Rassool (2000). Similarly, Jafari et al. (2014a) reported that in an Islamic context, religion and spirituality are often not differentiated and practical models of care are needed to better integrate spirituality into healthcare. However, Jafari et al. (2014a) further concluded that while spirituality and religion may not be differentiated in an Islamic context, spiritual care consists of more than just religious care; it provides a framework for healthcare professionals to connect with patients and deliver person-centered, holistic care. Seeking further clarity of spiritual concepts in an Islamic context, Heydari et al. (2016) conducted a concept analysis using a modified hybrid model to better understand the concept of spiritual health in the context of the practice of Islam among Iranian patients. The analysis consisted of five phases: theoretical phase, initial fieldwork phase, initial analytical phase, final-fieldwork phase and final analytical phase. Findings of this study identified the following six critical attributes of spiritual health: love of the Creator, duty-based life, religious rationality, psychological balance, attention to afterlife, and holy morals. Heydari et al. (2016) concluded that spiritual health from a Muslim perspective does not develop with consideration of any god, but rather with consideration only of Allah as the Ultimate. Similar to above earlier findings, Heydari et al. (2016) also concluded that spiritual health from a Muslim perspective encompasses all aspects of a person’s life. Meanwhile, Ahmad and Khan (2016) expanded on the above prior research by proposing a model of spirituality that is applicable to Muslims of any age, but especially applicable to older Muslims. The model was informed by the teachings of Islam and consisted of seven basic functions of spirituality: translation of life’s experiences and events into a deeper understanding; transaction i.e., relationships with every living human and thing; transformation of self through cleansing and religious purification; transition into an afterlife; transference i.e., moving from feelings of frustration to seeking relief from life’s burdens and anxieties by trusting in Allah; transcendence i.e., coming closer than ever before to Allah through an extraordinary experience; and transposition i.e., a change in priorities when a Muslim pursues less and less of the material world and more connection with Allah.

In summary, the majority of people in the Middle East follow Islamic religion and traditions and thus, it is evident that conceptualisations of spirituality amongst populations in the Middle East differ from Western populations. From an Islamic perspective, spirituality and religion are often intertwined with one another and pervade all aspects of a person’s life (Ahmad and Khan 2016; Heydari et al. 2016; Jafari et al. 2014a; Rassool 2000). Yet, it is acknowledged that spiritual care does not equate only to religious care and there is a need to develop models for the provision of spiritual care that are appropriate in an Islamic healthcare context (Jafari et al. 2014a; Rassool 2000). Ahmad and Khan (2016) developed a model of spirituality based on the teachings of Islam to help contextualize spirituality from a Muslim’s perspective, and especially an ageing Muslim. In light of this increased interest in spirituality amongst scholars in the Middle East, there is a need to review the current status of research in this region and identify priorities for future research. A review of the Middle Eastern literature would also highlight any similarities or differences from research conducted with Western populations.

3. Results

Eighteen quantitative studies and ten qualitative studies that have been conducted in the Middle Eastern region on the topic of spirituality were sourced (see Table 1 for an overview of included studies). A total of 3096 participants were included in the studies ranging from 2004 to 2017. Most studies were conducted in Iran (n = 16). The remaining studies were conducted in Jordan (n = 6), Pakistan (n = 2), Saudi Arabia (n = 2), Turkey (n = 1), and Israel (n = 1). Nine studies were conducted with cancer patients, 4 of which were women with breast cancer and 1 study was with breast cancer survivors. Six studies included nurses and one of these studies recruited a mixed patient, nurse and doctor sample. The remaining studies included patients on haemodialysis (n = 3), patients with Type 2 Diabetes Mellitus (n = 1), older adults with hypertension (n = 1), men with Coronary Artery Disease (n = 1), pregnant mothers (n = 1), children with asthma (n = 1), men with post-traumatic stress disorder (n = 1), men in addiction treatment (n = 1), parents of patients with thalassemia (n = 1), patients with anxiety disorder (n = 1) and high school female students (n = 1).

3.1. Quantitative Research

Eighteen quantitative studies met the inclusion criteria. Two of the studies were randomised controlled trials (Moeini et al. 2016; Hosseini et al. 2016) conducted in Iran. One of the trial studies examined the effect of an Islam-based religious program on spiritual wellbeing in elderly patients with hypertension (n = 52) in two health centres (Moeini et al. 2016). Spiritual wellbeing was measured using the Spiritual Well-Being scale (Paloutzian and Ellison 1982). No significant differences were noted between the groups before the intervention. However, mean spiritual wellbeing scores were significantly higher in the intervention group post-test and at 1 month follow up than the control group. The second trial study tested the effect of a spiritual intervention on biopsychological health as displayed by gene expression in breast cancer patients (n = 57) (Hosseini et al. 2016). The intervention focused on the concepts of prayer, reliance, self-sacrifice, forgiveness, altruism, kindness, remission, repentance, thankfulness, meditation, mantra and death. Findings showed a significant reduction in dopamine gene receptor DRD1-5 expressions in the intervention group in comparison with pre-test scores and the control group. Reduced DRD1-5 gene expression results in reduced cell proliferation, thus better prevention and management of breast cancer patients. Yet, the authors did not specify whether participants were receiving active treatment for their disease, which might have contributed to alternations in gene expression. Furthermore, it was unclear whether other factors, such as demographics, were accounted for in the analysis.

Other quantitative studies investigated the relationship between spirituality (or a related spiritual concept such as spiritual wellbeing or spiritual health) and quality of life (Al-Natour et al. 2017; Cruz et al. 2017; Jafari et al. 2013, 2014b; Lazenby and Khatib 2012; Saffari et al. 2013), caregiver burden (Anum and Dasti 2016), psychological well-being (Anum and Dasti 2016), sleep quality (Khoramirad et al. 2015), and coping strategies (Amjad and Bokharey 2015). Three studies focused on instrument design and validation (Cruz et al. 2016; Jafari et al. 2013; Lazenby et al. 2013).

Three quantitative studies have been conducted with a sample of nurses. The first study investigated the relationship among the antecedent factors of age, ethnicity and education and the mediating variable of intrinsic religiosity, extrinsic religiosity, and spiritual wellbeing on Israeli oncology nurses’ (n = 155) attitudes towards spiritual care using a descriptive correlational design (Musgrave and McFarlane 2004). Spiritual wellbeing, extrinsic religiosity and education demonstrated direct relationships with attitudes towards spiritual care. Intrinsic and extrinsic religiosity, mediated through spiritual wellbeing, demonstrated indirect relationships with attitudes towards spiritual care. Spiritual wellbeing was reported as a good predictor of nurses’ positive attitudes towards spiritual care and it was recommended by Musgrave and McFarlane (2004) that educational initiatives should be developed and implemented to support spiritual wellbeing amongst oncology nurses. Similarly, Musa (2017) used a descriptive correlational design to investigate the frequency of providing aspects of spiritual care intervention and its association with Jordanian Arab Muslim nurses’ (n = 355) own spiritual wellbeing. Nurses most frequently provided spiritual care that was existential, not overly religious, was commonly used, more traditional and did not require direct nurse involvement. Spiritual wellbeing was important to this sample of nurses. Musa (2017) recommended the need for studies that elicit what kind of spiritual care is being provided by Muslim nurses and the need for further education for nurses on this topic. The third study determined the experiences and perceptions of ICU nurses (n = 145) about spirituality and spiritual care using a quantitative descriptive design (Bakir et al. 2017). The Spirituality and Spiritual Care rating scale (McSherry et al. 2002) was used in this study. Almost half of nurses reported that they received spiritual care training and over 60% provided spiritual care to their patients. Some nurses were found to have insufficient knowledge about spirituality and spiritual care. Only nurses with sufficient knowledge provided spiritual care to patients.

One study recruited a sample of female high school students (n = 340) in Iran to investigate determinants of responsibility for health, spiritual health and interpersonal relations and predictive factors based on the theory of planned behaviour (Rezazadeh et al. 2015). Attitude, subjective norms and perceived behavioural control predicted 56% of behavioural change in spiritual health. The authors’ recommended that components of the theory of planned behaviour should be considered in developing spiritual health interventions.

3.2. Qualitative Research

Ten qualitative studies were sourced. Eight studies were conducted in Iran and two in Jordan. All of the qualitative studies focused on gaining a deeper understanding of the concept of spirituality from a Muslim-Arabic perspective. Three studies included nurses in the sample. The first study used semi structured interviews to explore how spirituality is experienced by Muslim oncology nurses (n = 24) in Iran (Markani et al. 2013). Religious and existential themes emerged. The most prominent theme described by the sample was searching for God. The nurses performed practices such as reciting a blessing before starting work, reading the Qur’an, and praying to God. The authors concluded that findings were consistent with the holistic view of Islam that considers all dimensions of personhood simultaneously. The second study, by Davoodvand et al. (2016), also used semi-structured interviews to explore the concept of spiritual development in Iranian Muslim nurses (n = 17). Three themes for spiritual development were found: obligation to religion, commitment to ethics, and commitment to law. Factors identified included connection to the limitless divine power, personal and society-orientated ethical codes, and commitment to law. The authors recommended that education for nurses should focus on humanistic principles, ethics and law to improve community and health development. The third study aimed to clarify the meaning and nature of the spiritual health concept in the context of the practice of Islam by conducting a concept analysis using the modified traditional hybrid model of concept analysis (Heydari et al. 2016). This study consisted of a literature review, semi-structured interviews and observations. Data were analysed using content analysis. A purposive sample of 2 nurses, 1 midwife, 5 patients and 1 doctor, was recruited. Attributes of spiritual health included love of the Creator, duty-based life, religious rationality, psychological balance and attention to afterlife. A concept map of spiritual health from an Islamic perspective was developed. Some comparisons were drawn between Western and Islamic culture. For example, the authors stated that in Western culture, spirituality goes beyond religious affiliation and spiritual health embraces a universal concept that is relevant to all. However, by contrast, it is stated that this view of spiritual health is not appropriate within an Islamic perspective where spiritual health is primarily based on a connection with Allah. The authors recommended further studies exploring the difference between Islamic spiritual health and that of other religions and ideologies, to help meet the spiritual needs of patients in the Middle East.

Most studies included patient samples. For example, Harandy et al. (2009) studied the role of spirituality on feelings and attitudes about breast cancer among breast cancer survivors (n = 39) using semi-structured interviews. Spirituality was the primary source of psychological support among participants and almost all participants attributed their cancer to the will of God. Yet they actively engaged in medical treatment. This contrasts with Western cultures, in which a belief in an external health locus of control diminishes participation in cancer screening, detection and treatment. The authors stated that findings can help researchers to provide a framework for the development of appropriate and effective culturally sensitive health interventions. Another study by Nabolsi and Carson (2011) used semi-structured interviews and Colaizzi’s phenomenological analysis to explore the meaning of spirituality amongst Jordanian Muslim men with CAD (n = 19). Parse’s Theory of Human Becoming (Parse 1999) served to understand the findings better. The following themes emerged: developing faith; faith facilitated acceptance of illness and enhanced coping strategies; seeking medical treatment did not conflict with their belief in fate; and spirituality enhanced their inner strength, hope and acceptance of self-responsibility as well as helping them to find meaning and purpose in life. Faith was found to play a major role in the choices made by patients and their acceptance or rejection of personal responsibility in promoting their own future health. It was concluded by the authors that nurses should be present with patients and that true presence is an intentional and reflective approach to care that is grounded in knowledge. Renani et al. (2014) explored the viewpoints of children with asthma (n = 9) and their parents (n = 10) on spiritual and psychological resources that help adaptation to the disease using semi structured interviews. Two main categories emerged: contrive to religious belief consisting of three subcategories—religious beliefs, belief in a divine predestination, and Islamic based patience; and psycho-intellectual management that included five subcategories (psycho-intellectual attention, maintaining family’s mental peace, reduction in negative burden of disease, satisfaction from optimal treatment, and matching internal desires with disease conditions). Hatamipour et al. (2015) sought to explain the spiritual needs of cancer patients (n = 18) using semi-structured interview and content analysis. Four themes emerged: connection, seeking peace, meaning and purpose, and transcendence. The spiritual needs highlighted in this study are similar to findings from studies conducted in other parts of the world (Murray et al. 2004; Hocker et al. 2014; Stein et al. 2015).


Graphene is an ultimate membrane that mixes both flexibility and mechanical strength, together with many other remarkable properties. A good knowledge of the elastic properties of graphene is prerequisite to any practical application of it in nanoscopic devices. Although this two-dimensional material is only one atom thick, continuous-medium elasticity can be applied as long as the deformations vary slowly on the atomic scale and provided suitable parameters are used. The present paper aims to be a critical review on this topic that does not assume a specific pre-knowledge of graphene physics. The basis for the paper is the classical Kirchhoff-Love plate theory. It demands a few parameters that can be addressed from many points of view and fitted to independent experimental data. The parameters can also be estimated by electronic structure calculations. Although coming from diverse backgrounds, most of the available data provide a rather coherent picture that gives a good degree of confidence in the classical description of graphene elasticity. The theory can than be used to estimate, e.g., the buckling limit of graphene bound to a substrate. It can also predict the size above which a scrolled graphene sheet will never spontaneously unroll in free space. View Full-Text

Keywords: graphite; elasticity; elastic constants; phonons; van der Waalsgraphite; elasticity; elastic constants; phonons; van der Waals

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This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Lambin, P. Elastic Properties and Stability of Physisorbed Graphene. Appl. Sci.2014, 4, 282-304.

AMA Style

Lambin P. Elastic Properties and Stability of Physisorbed Graphene. Applied Sciences. 2014; 4(2):282-304.

Chicago/Turabian Style

Lambin, Philippe. 2014. "Elastic Properties and Stability of Physisorbed Graphene." Appl. Sci. 4, no. 2: 282-304.

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