Daily Spiritual Experiences in Nursing Care and Research

Oncology Nursing NewsApril 2015
Volume 9
Issue 3

Research on the role of spirituality in healthcare continues to grow, and for patients with cancer, religious and spiritual values can be especially important to their overall quality of life throughout their cancer journey.

Sharon M. Kern, CRNP

Sharon M. Kern is a PhD candidate at Duquesne University School of Nursing in Pittsburgh, Pennsylvania.

Research on the role of spirituality in healthcare continues to grow, and for patients with cancer, religious and spiritual values can be especially important to their overall quality of life throughout their cancer journey.

A Gallup poll found that 69% of Americans reported being very or moderately religious in interviews conducted between January 2, 2012 and November 30, 2012.1 The term spirituality is multifaceted, with numerous definitions.2 Meraviglia defined spirituality “as experiences and expressions of one’s spirit in a unique and dynamic process reflecting faith in God or a supreme being; it is connectedness with oneself, others, nature, or God; and an integration of the dimensions of mind, body, and spirit.”3

Based on sound conceptual underpinnings, 12 spiritual domains of the larger construct of religiousness/spirituality, including Daily Spiritual Experiences, were identified by the Fetzer Institute/ National Institute of Aging Working Group for use in healthcare research.4 The domain of daily spiritual experiences focuses on “those aspects of life that represent day-to day spiritual experiences particularly well.”5

The Daily Spiritual Experience Scale (DSES6 was developed after comprehensive research, including extensive interviews with people from various religious traditions, focus groups, analysis of other scales measuring some facet of spiritual experience, and reading theological and religious scripts.6 It is designed to measure types and frequencies of spiritual experiences in healthcare research.7 Additionally, “The experiences reflected in the DSES may be evoked by a religious context or by other events of daily life or by the individual’s religious history or religious or spiritual beliefs.”6

The DSES targets an individual’s ordinary spiritual feelings, not mystical experiences.6-8

The DSES response categories measure spiritual experience frequencies.7 The six-item short DSES is included in the Brief Multidimensional Measure of Religiousness/Spirituality that is part of the US General Social Services Survey; however, Underwood recommended the 16-item long form DSES for research.7 The DSES includes items in an adjusted Likert format that measure specific constructs (Box).8

Research using the DSES has been increasing,8,9 and it has been used in a variety of clinical populations, including those with different types of cancer. In a sample of people with diverse cancers, including 47% with breast cancer, Park et al found that daily spiritual experiences had a positive association with diet, exercise, and following medical advice.10

Main Constructs of the Daily Spiritual Experience Scale8

  • Feelings of Connection
  • Perception of Divine Love
  • Joy and the Transcendent Sense of Self
  • Awe
  • Strength and Comfort
  • Thankfulness and Appreciation
  • Peace
  • Compassionate Love
  • Divine Help
  • Union and Closeness
  • Divine Guidance

However, few studies were found that examined daily spiritual experiences in women with breast cancer. My research as a doctoral candidate at Duquesne University School of Nursing, under the guidance of Associate Professor Linda Goodfellow, PhD, RN, FAAN, addressed this gap in the literature. Daily spiritual experiences were measured using the DSES, as well as responses to a researcher-generated questionnaire in a sample of 110 women with breast cancer.

Additionally, phenomenological inquiry explored the nature and transition of daily spiritual experiences in 17 of the women with breast cancer.

Results showed that daily spiritual experiences were an integral part of the participants’ lives. The three highest item frequency scores on the DSES in my study are shown in the table. Interview analysis revealed all 16 DSES items were embedded within the participants’ narratives.

Appreciation of family, faith, friends, and nature were reported by several women.

Table. DSES Items With Highest Frequencya

Daily Spiritual Experience


I feel thankful for my blessings.

Many times a day to every day.

I feel a selfless caring for others.

Every day to most days.

I am spiritually touched by the beauty of creation.

Every day to most days.

DSES = Daily Spiritual Experience Scale.

aBased on author’s doctoral research

Nurses can suggest activities that may foster sensitivity to daily spiritual experiences. First, nurses can recommend that patients explore their spiritual experiences with the DSES. However, one should not judge how spiritual they are based on the DSES score.6,11 In Spiritual Connection in Daily Life, Underwood describes the salient features of each daily spiritual experience question and offers suggestions for raising and cultivating one’s awareness of them.11 For example, daily reflection on one’s activities may prompt the identification of the good within a situation that leads to thankfulness.

Gardens, terrariums, nature photographs and art, and walking in parks or along tree-lined streets are some examples of how one can experience the spiritual aspects of nature. Volunteering offers the opportunity for giving back and provides a network to socialize. Active participation in support groups may also be recommended during early phases of breast cancer. Several women in my study found satisfaction in taking on a leadership role within a support group.

Sometimes nurses feel uncomfortable addressing spiritual needs. However, as nurses we need to be sensitive to the spiritual needs of our patients. The DSES is a quick and easy tool to administer and is appropriate to use across all religious affiliations. More information about the DSES may be obtained from The Daily Spiritual Experience Scale website at www.dsescale.org.


  • Newport F. Seven in 10 Americans Are Very or Moderately Religious. Gallup website. http://www.gallup.com/poll/159050/seven-americans-moderately-religious.aspx. Published December 4, 2012. Accessed March 11, 2015.
  • Pesut B, Fowler M, Taylor EJ, et al. Conceptualizing spirituality and religion for healthcare. J Clin Nurs. 2008;17(21):2803-2810.
  • Meraviglia MG. Critical analysis of spirituality and its empirical indicators: prayer and meaning in life. J Holist Nurs. 1999;17(1):18-33.
  • Fetzer Institute/National Institute of Aging Working Group. Multidimensional Measurement of Religiousness/Spirituality for Use in Health Research: A report of the Fetzer Institute/National institute on Aging Working Group. Kalamazoo, MI: John E. Fetzer Institute; 2003.
  • Underwood LG. Daily spiritual experiences. In: Multidimensional Measurement of Religiousness/ Spirituality for Use in Health Research: A report of the Fetzer Institute/National institute on Aging Working Group. Kalamazoo, MI: John E. Fetzer Institute; 2003:11
  • Underwood LG, Teresi JA. The daily spiritual experience scale: development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health-related data. Ann Behav Med. 2002;24(1):22-33.
  • Underwood LG. The daily spiritual experience scale: overview and results. Religions. 2011;2(1):29-50.
  • Underwood LG. Ordinary spiritual experience: qualitative research, interpretive guidelines, and population distribution for the daily spiritual experience scale. Archive for the Psychology of Religion/ Archiv für Religionspsychologie. 2006;28(1):181-218.
  • Underwood L. Introduction to the DSES. Daily Spiritual Experience Scale website. http://www.dsescale.org/. Updated November, 2014. Accessed March 23, 2015.
  • Park CL, Edmondson D, Hale-Smith A, Blank TO. Religiousness/spirituality and health behaviors in younger adult cancer survivors: does faith promote a healthier lifestyle? J Behav Med. 2009;32(6):582-591.
  • Underwood L. Spiritual Connection in Daily Life: 16 Little Questions That Can Make a Big Difference. West Conshohocken, PA: Templeton Press; 2013.

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