Purpose: Forgiveness is associated with a variety of health-related outcomes; however much of this work has been in the context of forgiveness of others, direct associations and otherwise healthy samples. This study examined associations involving multiple dimensions of forgiveness, including indirect effects through health behavior, among outpatients receiving physical therapy. Methods: Participants from southern Appalachia (n=141) completed cross-sectional self-report measures of forgiveness, lifetime religiousness, health behavior, health status and pain. Mediation analysis was employed to examine the direct and indirect relationships between forgiveness and health. Results: Forgiveness of self was associated with: (i) overall health status, physical health status and current pain in an indirect-only fashion and (ii) mental health status and chronic pain in a direct-only fashion. Feeling forgiven by God was associated with health-related social functioning in a direct-only fashion. Forgiveness of others was not associated with the health-related outcomes. Conclusions: Forgiveness of self appears to be the most important to health, yet the most difficult to achieve. Religious culture may influence whether feeling forgiven by God is also important. Forgiveness-based intervention may be useful in the context of rehabilitation, in general, and physical therapy, in particular.

Violence is a serious health concern on and around college campuses in the United States. While spirituality is associated with health-related issues, little is known regarding its association with aggression among college students. Cross-sectional associations between forgiveness and aggression were examined among college students in Southern Appalachia (n = 494; ♀ = 74%; M age = 22). Using multiple regression analyses and independent of demographic variables and religiousness, forgiveness of self and forgiveness of others but not feeling forgiven by God, were associated with lower levels of a variety of forms of aggression, with mostly medium effect sizes.

While forgiveness appears to be directly associated with treatment outcomes for alcohol problems, it may have indirect effects through mental health symptoms. We examined multiple dimensions of forgiveness: of self (ForSelf), of others (ForOthers), and by God (ByGod). Both ForSelf and ForOthers were strongly related to mental health at baseline (N = 157), whereas at 6 months, ForSelf was strongly related to mental health (N = 126). Longitudinally, baseline ForOthers predicted 6-month mental health symptoms. Forgiving oneself and others has implications for the mental health of alcoholics entering treatment.

It is impossible to teach students all characteristics of the myriad cultures present in the United States. Providing students with a framework to assess the cultural traits of any client and to understand how those traits may influence the helping relationship gives them a tool to use in any clinical setting. This article presents a systematic process for considering the ways in which cultural values may differ between worker and client. This involves identifying areas of human functioning relevant to the helping relationship which need to be assessed or considered with all clients. This systematic process also prevents the worker from assuming cultural congruence when the client and worker are from the same cultural group.

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A thesis submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy in the Department of Psychology at the University of Zululand, South Africa, 2013. / Art therapy is very popular amongst therapists, and Bonsai art adds another dimension to the intervention stratagem. One aspect of an intervention strategy is to reduce the burden of mental illness and related conditions. Bonsai as an intervention combines meditation, spirituality, responsibility and the ability to express oneself through this timeless art. An international study was conducted of the habits, health and spirituality of bonsai practitioners. Participants completed the Spirituality Scale, Patient Health Questionnaire and the Quality of Life Scales, as well as a questionnaire about their interest in Bonsai. Results indicated that although the participants were not necessarily healthier than the general population, they experienced peace by being actively involved in Bonsai. Bonsai is proposed as a new expanded category of supportive therapeutic mechanism, along with an elaboration of expressive therapeutic mechanisms such as when working in groups,such as hospitals,old age homes and prisons.

A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor Of Philosophy (D.Phil) in the Department of Psychology at the University Of Zululand, 2017 / In South Africa, one of the most distressing concerns of many people living with HIV/AIDS is the stigma attached to this diagnosis. This intense stigma is psychologically traumatic, even leading to levels of depression. Religion or spirituality has come to be one of the most essential and effective coping strategies to live with the pandemic and depression as its consequence. This study sought to establish the impact of religion/spirituality on people living with HIV/AIDS using a convenient sample in South Africa. Using quantitative research methods, the study used the Beck Depression Inventory (BDI-II) to assess the severity of depression on HIV/AIDS victims. The BDI-II is presently one of the most commonly used scales for rating depression to indicate the level of distress the respondent is experiencing. To assess spirituality among people living with HIV, the Religious Coping (RCOPE) was used to measure the coping measures used by people living with HIV and AIDS. The results of the study established that, in both samples, respondents having a HIV positive status with depression levels within the spiritual/religious cohort, are different from those of the nonspiritual/religious cohort. Expressed differently, spirituality or religion seems to have a calming effect on the respondents to the extent that it lessens their level of depression. Furthermore, it was established that there is a considerably strong inverse relationship between religion/spirituality and depression. In fact, the correlation coefficient is -0.89 suggesting a near perfect negative relationship between the variables. In other words, as one’s spirituality/religious quotient increases, one’s depression levels decreases. The study concludes that, spirituality and religiousness plays an important role in the lives of patients with depression and HIV, and is the corner stone of coping strategies and longevity. Moreover, the study recommends that physicians should consider fusing in spirituality coping strategies in treating depressed HIV positive patients.

This DNP project focused on the spiritual aspects of care that are often neglected in the outpatient setting. Most patients value their spiritual health and believe that it is just as important as their mental and physical health. The purpose of this project was to improve the overall spiritual care provided to patients, their families, and/or caregivers in times when they were experiencing spiritual distress. This quality improvement (QI) project was designed to determine whether embedding a chaplain in an outpatient clinic instead of providing a pamphlet about chaplain services increases patient satisfaction. Secondary analysis of the data in this project show that of 306 patients who completed the 4-item screener, 70 patients were identified as having spiritual distress. There were 34 people who benefited from having an embedded chaplain. Spiritual distress was measured using a 10-item survey prior to and after seeing the chaplain; a 3.7 point decrease was seen across 6 patients. It was not a statistically significant improvement, largely due to the small sample (p=.08). Non-parametric chi square fisher exact results showed that satisfaction scores were higher in 5 patients seen by the chaplain (p=. 048) versus 4 not seen by the chaplain. Qualitative results were obtained from 5 chaplain participants were all positive. Though a very small sample, this QI project emphasizes that spiritual care needs are an integral part of holistic care provided through nursing practice. Nursing is tasked to be concerned with each person's human experience, which includes spirituality. This QI projects' contribution to positive social change is that it enhanced the health outcomes and quality of life of those participants involved.

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