White’s Theory of Spirituality and Spiritual Self-Care (WTSSSC)

Author – Mary L. White, PhD, RN, APRN-BC Certified Caritas Coach, End-of-Life-Doula

First published – 2011

Substruction of White’s Theory of Spirituality and Spiritual Self-Care (WTSSSC)

Major Concepts

Spirituality — beliefs reflecting subjective existential connectedness with others, a higher power, and/or the broader world.
Spiritual self-care — spiritually based actions undertaken to support continuing personal development and well-being in health and illness.
Spiritual beliefs and spiritual self-care practices — intentionally differentiated in the theory; beliefs influence practices, but the practices are the observable actions that can be measured.
Self-care agency and foundational disposition — Orem-derived concepts; spirituality is proposed as a foundational disposition influencing the capacity and motivation to engage in self-care.
Health and well-being — intended outcomes of self-care and spiritual self-care.

Typology

Middle-range nursing theory developed through substruction from Orem’s Self-Care Deficit Nursing Theory. It is a theoretical extension of Orem’s grand theory that specifies spirituality as a foundational disposition within self-care agency and identifies spiritual self-care as a distinct set of purposeful, spiritually based self-care actions. WTSSSC proposes relationships that can be empirically examined in nursing research and applied in holistic nursing assessment and care. The Spiritual Self-Care Practices Scale is an associated instrument developed to operationalize and measure spiritual self-care practices.

Brief Description

In WTSSSC, spirituality is defined as the beliefs individuals hold related to their subjective sense of existential connectedness, meaning, and place in the world. This connectedness may involve relationships with other persons, nature, the broader world, personal values, or, for individuals for whom it is meaningful, a higher power or religious tradition. The theory is applicable to people who identify as religious, spiritual, agnostic, atheist, or nonreligious. Formal religious affiliation and belief in a higher power are not requirements for applying the theory. Religious affiliation is recognized as one possible aspect of sociocultural orientation that may influence spirituality and self-care choices when it is important to the individual.

Spiritual self-care is the set of personally meaningful, spiritually based actions in which people engage to promote continued personal development and well-being during health and illness. These actions may be individual or communal and religious or nonreligious. Examples may include prayer, worship, or sacred-text reading for persons who value religious practices; they may also include reflection, meditation, values clarification, time in nature, music, maintaining or repairing meaningful relationships, service to others, or finding meaning in life experiences.

The theory proposes that spirituality influences self-care agency by affecting how individuals understand and value health, illness, the body, relationships, and self-care. Spirituality may influence motivation, goals, decisions, sources of health information, and the operations people use to meet self-care requirements. Spiritual self-care practices are purposeful actions that may support health and well-being.

The Spiritual Self-Care Practices Scale was developed as an associated measurement instrument to operationalize the frequency of spiritual self-care practices. Initial testing identified personal, spiritual, physical, and interpersonal dimensions of spiritual self-care practices. The tool supports empirical examination of WTSSSC and may guide nursing assessment, intervention, and research.

Primary Sources

White, M. L. (2010). Spirituality and spiritual self-care: Expanding self-care deficit nursing theory (Doctoral dissertation, Wayne State University). Retrieved from https://digitalcommons.wayne.edu/oa_dissertations/191

White, M. L., Peters, R., & Schim, S. M. (2011). Spirituality and spiritual self-care: Expanding self-care deficit nursing theory. Nursing Science Quarterly, 24(1), 48–56. doi:10.1177/0894318410389059

White, M. L. (2012). Spirituality self-care effects on quality of life for patients diagnosed with chronic illness. Bulletin Luxembourgeois des Questions Sociales Congress Papers, 29, 285–304.

White, M. L. (2013). Spirituality self-care effects on quality of life for patients diagnosed with chronic illness. Self-Care, Dependent Care & Nursing: The Journal of the International Orem Society, 20(1), 23–32.

White, M. L., & Myers Schim, S. (2013). Development of a spiritual self-care practice scale. Journal of Nursing Measurement, 21(3), 450–462. doi:10.1891/1061-3749.21.3.450

White, M. L. (2016). Spirituality self-care practices as a mediator between quality of life and depression. Religions, 7(5), Article 54. doi:10.3390/rel7050054

Application Sources

White, M. L. (2012). Spirituality self-care effects on quality of life for patients diagnosed with chronic illness. Bulletin Luxembourgeois des Questions Sociales Congress Papers, 29, 285–304.

White, M. L., & Myers Schim, S. (2013). Development of a spiritual self-care practice scale. Journal of Nursing Measurement, 21(3), 450–462. doi:10.1891/1061-3749.21.3.450

White, M. L. (2016). Spirituality self-care practices as a mediator between quality of life and depression. Religions, 7(5), Article 54. doi:10.3390/rel7050054

Author – Mary L. White (1960)

Dr. White earned her PhD in Nursing Science from Wayne State University, with a focus on Urban Health, and is a board-certified Family Nurse Practitioner. She holds certification in online teaching and development and is a certified Caritas Coach through the Watson Caring Science Institute, supporting the integration of caring science across teaching, practice, and research.

Dr. Mary L. White, PhD, MSN, FNP-BC, is a Professor at the McAuley School of Nursing at the University of Detroit Mercy, where she has served since 2002. She is the developer of White’s Spirituality and Spiritual Self-Care Theory, a middle-range nursing theory that emerged from her clinical and research work with heart failure patients. This work led to the development of a globally used measurement tool and has contributed to a deeper understanding of spirituality as an essential component of health, well-being, and nursing care.

Her teaching focuses on nursing theory, medical-surgical nursing, advanced pathophysiology, and advanced pharmacology. She has demonstrated strong academic leadership through service on multiple university committees, including Junior/Senior Faculty Mentoring, and as co-chair of the Outcomes Assessment Committee, where she contributed to the development of university-wide learning outcomes still in use today. Within the College of Health Professions and McAuley School of Nursing, she remains actively engaged in committee work and was instrumental in developing a state-of-the-art RN to BSN program, serving as its chair for several years.

Dr. White’s research has led to significant clinical impact. As principal investigator of a five-year study comparing heparin and saline, her findings resulted in hospital-wide practice changes. She has also contributed to research on myocardial infarction in women and improvements in pediatric care at Children’s Hospital Detroit. Since 2014, she has volunteered at Henry Ford Macomb Hospital, where she has served on committees and helped establish a spiritual caring science unit for nursing students.
Her scholarship has been disseminated through peer-reviewed publications and presentations at international, national, and local conferences. Dr. White has held numerous leadership roles, including President Emeritus of Sigma Theta Tau Lambda Zeta Chapter, past President of the American Heart Association Southeast Michigan Division, and past President of the International Orem Society. She also served as co-editor of the Self-Care, Dependent-Care & Nursing Journal.

n addition to her professional work, Dr. White has served her community as an elected City Commissioner in Huntington Woods for over 20 years and as Mayor Pro Tem.

“Spirituality is a set of beliefs a person holds which relate to their subjective sense of existential connectedness, including beliefs that reflect relationships with others, acknowledge a higher power, recognize an individual’s place in the world, and lead to spiritual practices. Spiritual self-care is the set of spiritually-based practices in which people engage to promote continued personal development and well-being in health and illness.”
– Dr. Mary L. White