key: cord-0742822-l5ld7ae6 authors: Novaes, Dayane Caroline; Grassi, Mariana de Freitas; Nascimento, Tayomara Ferreira; Novelli e Castro, Meire Cristina; Jensen, Rodrigo title: Religious practice in the pandemic of COVID‐19 and the nursing diagnoses date: 2021-10-09 journal: Int J Nurs Knowl DOI: 10.1111/2047-3095.12352 sha: ec653323e7e3526ebcbcfb0c4441ff73675315fe doc_id: 742822 cord_uid: l5ld7ae6 PURPOSE: Identify the elements (defining characteristics, related factors, and risk factors) of the diagnoses of NANDA international impaired religiosity (00169), risk for impaired religiosity (00170), and readiness for enhanced religiosity (00171), in a period of social distancing in the pandemic of COVID‐19, and associate them with the behavior of individual and collective religious practice, before and during the pandemic. METHODS: Survey study, released via social media to members of religious communities in Brazil. Data collection took place in June 2020, by online questionnaire. FINDINGS: Participants were 719 people, 563 (78.3%) were women, with a median age of 39 years (min 18–max 73), of Catholic religion (64.7%), with a median of 29 years of religious practice (min 0–max 70). The participants were from Southeast 652 (90.68%), South 49 (6.82%), Northeast 13 (1.82%), Midwest 4 (0.56%), and North 01 (0.14%) of Brazil. The increase of individual religious practice was associated with two diagnostic elements and the reduction of individual practice to nine elements. The reduction of collective religious practice was associated with seven diagnostic elements and the maintenance of the practice associated with five elements. The increase of collective religious practice was associated with five diagnostic elements. CONCLUSIONS: In individuals who presented during the pandemic reduction of individual religious practice, reduction of collective religious practice, and maintenance of collective religious practice, the elements of the diagnosis impaired religiosity were predominant. In individuals who presented increased practice of collective religious activity during the pandemic, the elements of the diagnosis readiness for enhanced religiosity were predominant. IMPLICATIONS FOR NURSING PRACTICE: This study highlights defining characteristics, risk factors, and related factors of the religiosity diagnoses presented due to social distancing in the pandemic; these should be screened during nursing consultations in primary health care. Religion is an important cultural asset that affects the thoughts, behaviors, and lifestyles of individuals and can positively impact the life of the human beings, as it directs them to have healthy life habits (Chiang et al., 2020) . The terms spirituality and religiosity, although sometimes considered synonymous, constitute distinct nursing diagnoses. Spirituality has several definitions, since its attributes are considered difficult to define and with a subjective, individual, and complex dimension (Mosque et al., 2017) . In the nursing literature, the concept was determined as the search for meaning in life, connection, and transcendence, which is broader than religion, being an important dimension for believers or non-believers (Cabaço et al., 2017) . The concept of religiosity refers to religious practices in which the individual seeks to express his spirituality through rituals, symbols, beliefs, cults, and doctrines that bring the individual closer to the sacred or transcendent (Tavares et al., 2018) . Even if closely related to spirituality, religiosity is a subject poorly described by authors, and until recently, a dimension sometimes forgotten and even neglected (Mosque et al., 2017) . Philosophers stated that religion would disappear as societies modernized, a fact that did not happen, since it is clear how religion is strengthening in some societies (Bentzen, 2020) . The world was more religious in the year 2000 (87.0%) than in 1970 (80.8%), with this trend continuing in 2017 (88.9%), projecting the estimated value of 90.2% for the year 2030 (Grim et al., 2018) . In the study of nursing, it is understood that for some people the involvement in their community of faith, their rituals, and their ministries feeds the spirit; for others, spiritual well-being does not necessarily revolve around participation in a specific religion (Bentzen, 2020; Taylor, 2020) . Nurses, in this regard, must provide assistance to their patient, so that they can provide comfort and safety, which spirituality or religion offers (Tavares et al., 2018) . For this, the professional needs to recognize the needs of individuals, as well as to observe the implications in the use of standardized nursing language systems to document cares that may involve spiritual and religious aspects (Burkhart & Solari-Twadell, 2008; Tavares et al., 2018) . Since the beginning of 2020, due to the emergence of SARS-CoV-2, countries have decreed a quarantine period for the population, aimed at maintaining social distancing. COVID-19 spread rapidly around the world and was declared a pandemic by the World Health Organization (WHO) in March 2020. Social distancing was one of the measures recommended by the WHO, because there is no established treatment and medication for the control and cure of the disease (World Health Organization, 2020). Based on the assumption that religiosity implies religious practices of worship and rituals, the social distancing factor harms such practices, since religiosity is directly linked to the idea of gathering in an environment of its own, usually in temples. The COVID-19 pandemic affected traditions and festivities related to religion and the maintenance of religious practices in Brazil and the world, as well as pilgrimages and religious tourism resulting from them, where high-visibility religious mass meetings are held (Yezli & Khan, 2020) . Even with the restrictions imposed by distancing, the literature points out that disasters and tragedies lead individuals to connect with some higher being in whom they place their faith. A study pointed to a substantial increase in the search term "prayer" in the pandemic period, reaching unprecedented numbers from mid-March 2020 worldwide, doubling its results for every 80,000 new cases of COVID-19 (Bentzen, 2020) . In the pandemic of COVID-19 it is understood that there was the emergence of new health demands, as well as social, psychological, and spiritual. Investigating nursing diagnoses involving religiosity during the pandemic became relevant, considering the individual as a biopsychosocial-spiritual being. Given the importance of religiosity in human experience, including the search for balance and hope, and the change of this experience due to social distancing, this study sought to identify the elements (defining characteristics-DC, related factors-ReF, and risk factors-RiF) of the diagnoses of NANDA International (NANDA-I) impaired religiosity (00169), risk for impaired religiosity (00170), and readiness for enhanced religiosity (00171) (Herdman et al., 2021) , in a period of social distancing in the pandemic of COVID-19, and associate them with the behavior of individual and collective religious practice, before and during the pandemic. A survey study was conducted by online questionnaire, in a convenience sample. The research was disseminated via social media (Facebook, Instagram, and WhatsApp) , shared in pages and profiles of religious communities in Brazil. A promotional material was posted in social media websites with information about the research and instructions on how to participate. Participants answered the questionnaire via Google Forms. In the electronic questionnaire, the second page had all information about the research, the purpose, the ethical aspects considerations, and the informed consent to participate in the study. To have access and answer the questions, all participants needed to give consent in the electronic questionnaire. The inclusion criteria were >18 years old and declared to be a member of a religious community. Only participants who answered the questionnaire in full were included. Data collection took place in June 2020. The theoretical framework of Jean Watson was used, with the presupposition of care practice the integration between biophysical knowledge and human behavior, to generate or promote health. The faith-hope is one of the care factors presented by Watson as essential for the healing process (George, 2011) . Individual and collective religious practices were variables of interest to the study, considering the period before and during the pandemic of COVID-19, also the elements (DC, ReF, and RiF) of the diagnoses impaired religiosity (00169), risk for impaired religiosity (00170), and readiness for enhanced religiosity (00171) (Herdman et al., 2021) . The diagnosis "impaired religiosity," approved in 2004, revised in 2017, with evidence level 2.1 is defined as "impaired ability to exercise reliance on beliefs and/or participate in rituals of a particular faith tradition" (Herdman et al., 2021) . The diagnosis "risk of impaired religiosity" was approved in 2004, revised in 2013 and 2017 with evidence level 2, and is defined as "susceptible to an impaired ability to exercise reliance on religious beliefs and/or participate in rituals of a particular faith tradition, which may compromise health" (Herdman et al., 2021) . The diagnosis "Readiness for Enhanced Religiosity" approved in 2004, revised in 2013, level of evidence 2.1, is defined as "a pattern of reliance on religious beliefs and/or participation in rituals of a particular faith tradition, which can be strengthened" (Herdman et al., 2021) . The measures of central tendency were analyzed, and tests of association between the diagnoses studied and the behavior of the population in individual and collective religious practice were performed. Cox regression models were adjusted to explain the occurrence of individual and collective changes. In the models, associations were considered statistically significant if p < 0.05. The analyses were performed with Software SPSS 22. Assuming simple random sampling, type I and II errors equal to 0.05 and 0.20, respectively, allocation ratio of 1:5:1 between reduction, maintenance and increase levels of individual religious practices, allocation ratio of 15:10:1 between reduction, maintenance, and increase in the levels of collective religious practices, assuming a scenario of uncertainty where the prevalence of diagnostic elements oscillates around 33%, and assuming a minimum difference between the levels of individual religious practices of 20%, it is estimated that at least 62 subjects are needed at each level of individual religious practices and at least 62 subjects at each level of collective religious practice. Brazil (Approval Number: 4.059.323) and ethical aspects involving research with human beings were respected. The study followed the STROBE checklist as a recommendation for observational studies. The study included 719 people, 563 (78.3%) were women, with a median age of 39 years (min 18-max 73), of Catholic religion (64.7%), with a median of 29 years of religious practice (min 0-max 70). The participants were from Southeast 652 (90.68%), South 49 (6.82%), Northeast 13 (1.82%), Midwest 4 (0.56%), and North 01 (0.14%) of Brazil. Participants predominantly declared to perform daily individual religious practice before the pandemic (48.7%) and daily practice during the pandemic (55.5%); they indicated maintaining the frequency of individual religious practice during the pandemic (70.8%). TA B L E 1 Characterization of participants and profile of individual and collective religious practice before and during the COVID-19 pandemic (n = 719). Brazil, 2020 Regarding collective religious practice, predominantly before the pandemic, they performed one to two times a week (53.7%), and during the pandemic they did not perform regular religious practice (69.9%); they indicated a reduction in collective religious practice (55.9%). The characterization of the participants and the profile of religious practice is presented in A study conducted with Nigerian and Indian participants showed a decrease in religious practice during the pandemic in Nigeria, due to the characteristics of performing them in collective places, contrary to what was found in India, which keeps them in their homes (Fatima et al., 2020) . A study in Colombia showed that individual religious practice intensified during isolation by the pandemic, in relation to collective practice, with greater evidence in the female population. For nonpractitioners, in both sexes, the tendency was not to perform religious activities. For the practitioners, there was a decrease in the time dedicated to their practices, being performed in a simpler and shorter way (Meza, 2020) . Some conflicts arose around the world when health institutions did not consider religious temples as essential, since, for example, in some U.S. states, certain stores that sell alcoholic beverages maintained their operations and were considered essential. In some European countries, practitioners held protests when they view the closure of temples as a violation of their rights to worship. The continuity of religious practice in temples during the pandemic is conflicting, as it must follow measures to contain biological risk. In the opposite direction to the recommendations of sanitary institutions, some religious leaders defend the need for the opening and maintenance of the operation of temples (Capponi, 2020; Quadri, 2020) . It is inferred that religiosity after the pandemic may change the forms of practice (Norman & Reiss, 2020) . A Brazilian study showed increased religious and spiritual practice during the pandemic, with an impact on the improvement of the mental health of the population, lower rates of sadness, fear and concern, and higher levels of hope . Belief in the sacred and positive spiritual experience induces the individual to a state of peace, healing, contentment, hope, and joy (Del Castillo, 2021). Spiritual well-being is a protective factor for symptoms such as depression, anxiety, and posttraumatic stress disorder during the coronavirus pandemic. The negative impact of the pandemic on the mental health of the population and the measures adopted of social isolation influence negatively these symptoms (González-Sanguino et al., 2020) . For this reason, religion can offer coping mechanisms in times of stress and anxiety, producing a feeling of hope in moments of doubts and uncertainties, and can be justified as a means of support and security in extreme situations, such as the COVID-19 pandemic (Barmania, 2021a (Barmania, , 2021b . There are reports of spiritual renewal after individuals experience critical moments and uncertainties, when people experience feelings of fear, suffering, and illness. It is possible that there is a new generation of experiences regarding spirituality, faith, and religion after the coronavirus pandemic worldwide (Kowalczyk et al., 2020) . Association between diagnosis elements of impaired religiosity (00169), risk for impaired religiosity (00170), and readiness for enhanced religiosity (00171) and the change in individual and religious practice during the COVID-19 pandemic (n = 719 Religion can contribute to the promotion of health in the collective sphere, because it approaches the perspectives of life and death in different aspects. The support of religious leaders to disseminate reliable information to the population could be part of health policy strategies, assisting the population in health promotion, which should be improved and strengthened, considering the rapid communication with the religious population, when compared with government communication (Barmania, 2021a (Barmania, , 2021b . Although religious leaders adapt to maintaining collective religious practices using electronic communication channels, such as radio broadcasting and other innovative technologies such as videos, virtual conferences, online broadcast sermons and prayers, religious followers in Brazil find it difficult to maintain the usual practice by these means (Ameyaw et al., 2020; Barmania, 2021a Barmania, , 2021b Frei-Landau, 2020) . In some countries, there is experience of implementing actions such as telephone calls by health professionals and religious leaders with the objective of analyzing people at high risk of negative impacts on mental health, for referrals to specialized services, and also religious support using prayer (Galiatsatos et al., 2020; Ribeiro et al., 2020) . The link between religious leaders/religious institutions/religious communities, health authorities, and health professionals has extreme relevance to contain emergencies in the field of public and collective health, and plays an important role in the prevention and protection of the population in relation to coronavirus (Ameyaw et al., 2020; Miller et al., 2020) . Communication must be effective and act to promote health education; otherwise the population will be at risk, as they will hardly comply with measures to contain the spread of coronavirus (Barmania, 2021a) . Religious leaders are expected to have a social responsibility to disseminate scientifically based information, in addition to promoting psychological, social, economic, sentimental, religious and spiritual support, and maintaining the interaction of their institutions with governments and health institutions, resulting in the realization of holistic care to the individual (Hashmi et al., 2020; Modell & Kardia, 2020; Roman et al., 2020; Weinberger-Litman et al., 2020) . Among those who manifested increased individual and collective religious practice, it was present feelings such as anxiety, desire to enhance religious options, spiritual distress, desire to enhance forgiveness, desire to enhance use of religious material, and desire to reestablish religious customs. An American study that evaluated religious confrontation among the Orthodox Jewish population in the United States during the COVID-19 pandemic found that positive religious confrontation, intrinsic religiosity, and trust in God are associated with less stress and greater positive impact. Another factor related to exposure to coronavirus is the increasing of religious practice as a coping mechanism in situations of adversity (Pirutinsky et al., 2020) . Other strategies to cope with stress during the pandemic include recreation activities, exercises, relaxation, sleep quality, weighing and maintaining healthy eating, in addition to staying hydrated, listening to music, practicing online learning activities, practicing yoga, meditation, and prayer (Fatima et al., 2020; Koenig, 2020; Puyat et al., 2020) . Positive religious confrontation strengthens the individual's relationship with God and is beneficial especially in the case of depressed people, as it generates a sense of support and guidance to face the challenges of life. Therefore, it is essential to implement collective coping strategies to provide the well-being and emotional, social, physical, and spiritual resilience of the population (Koenig, 2020; Mahamid & Bdier, 2021 There was an increase in daily individual religious practice during the pandemic; however, most of the participants maintained the frequency in individual religious practice. Collective religious practice showed a significant reduction in the studied population during the pandemic. In individuals who presented during the pandemic reduction of individual religious practice, reduction of collective religious practice and maintenance of collective religious practice, the elements of the diagnosis "impaired religiosity" were predominant. In individuals who presented increased practice of collective religious activity during the pandemic, the elements of the diagnosis readiness for enhanced religiosity were predominant. Implications for nursing practice: This study sheds light on nursing phenomena that are latent in the population during the recommendations of social distancing and the restriction of religious practice in churches and temples. Negative feelings in individuals, due to social distancing and the pandemic, may be influenced by religious practices in the proposal to improve health outcomes. This study highlights defining characteristics, risk factors, and related factors of religiosity diagnoses that should be screened in nursing consultations. The results of this study may influence the construction of public health policies to consider that religiosity may be a relevant factor to human experience, with positive impacts on health, when considered with respect to individual beliefs and values. There are still few studies involving nursing diagnoses that investigate human religiosity in the population. This study contributes to the construction of knowledge about the prevalence of religiosity diagnoses and their impact due to social distancing and the pandemic. Implications for education: Nursing education is still predominantly directed to biological aspects; it is considered that factors involving religiosity related to health are still little explored in the preparation of nurses for clinical practice. Dayane Caroline Novaes contributed to the study conception, acquisition of data, and in the writing of the manuscript. Mariana de Freitas Grassi contributed to the acquisition of data, analysis, interpretation of data, and in the writing of the manuscript. Tayomara Ferreira Nascimento contributed to the acquisition of data, analysis, interpretation of data, and in the writing of the manuscript. Meire Cristina Novelli e Castro contributed to the study conception, design, acquisition of data, analysis, interpretation of data, and in the writing of the manuscript. Rodrigo Jensen contributed to the study conception, design, acquisition of data, analysis, interpretation of data, and in the writing of the manuscript. The authors declared no potential conflict of interest with respect to the research, authorship, and publication of this article. Rodrigo Jensen PhD, MSN, RN https://orcid.org/0000-0001-6191- One novel virus, different beliefs as playmakers towards disease spread in Africa: Looking at COVID-19 from a religious lens Hajj in the time of COVID-19. Infection, Disease, and Health Health promotion perspectives on the COVID-19 pandemic: The importance of religion. 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