Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Patricia A. Roth, EdD, RN, Chairperson; Jane M. Georges, PhD, RN; Denise M. Boren, PhD, RN


Coping mechanism, demoralization, Depression, Heart Failure, nursing, patients, quality of life, religion, spirituality


Background: Research suggests that the heart failure (HF) population is particularly vulnerable to depression. Other factors may also affect quality of life such as religious/spiritual coping, and demoralization. Purpose: The purpose of this descriptive correlational study was to examine factors that predict health-related quality of life (HRQoL) in adults with heart failure. Specific Aims: (1) to examine level of religious/spiritual coping, spiritual distress, demoralization, depression and HRQoL among adults with heart failure; (2) to examine the relationships of religious/spiritual coping, spiritual distress demoralization, depression and selected demographic variables (age, gender, race/ethnicity and length of living with HF) with HRQoL. Methods: A cross-sectional correlation design conducted at a large regional cardiomyopathy clinic in Southern California (N=115). Participants completed a survey containing demographic questions, the Duke University Religion Index, Religious Coping Scale, the Demoralization Scale, the Beck Depression Inventory-II and the Kansas City Cardiomyopathy Questionnaire. Results: T-tests revealed significant differences for positive religious/spiritual coping t(113) = 2.72, 95, 84, p< .05 by gender. Women reported lower mean HRQoL scores 58.86 (SD 26.59) than men 68.57 (SD 24.77); and used more positive religious coping 20.95 (SD 4.97) than men 18.05(SD 6.20) p< .05. Correlation analysis found depression and demoralization to be positively correlated (r = .801; p<.05). A significant negative relationship between depression and HRQoL (r = -.645, p<.001), demoralization (r = -507; p<.001) and spiritual distress (r = -.218; p<.05) was found. There is a trend towards statistical significance with Hispanics 21.26 (SD 5.04) more likely to use positive religious/spiritual coping than non-Hispanic participants 17.96 (SD = 6.42, p = 0.54). Regression analysis indicate the overall model significantly predicted HRQoL R2 = 0.424, F (4,110) = 20.267, p<. 001. The model found depression accounted for 42% of the variance in HRQOL. Implications: A holistic approach to managing HF patients that considers the varied human responses of stress and coping that is culturally sensitive and gender appropriate would be beneficial. Future qualitative research methods may capture the phenomenon of spiritual coping more completely. Also, use of other HF quality of life scales may find other significant factors important to patient management.

Document Type

Dissertation: Open Access



Included in

Nursing Commons