Effect of Spiritual Care Based on “Ghalbe Salim” Model on Anxiety among Mothers with Premature Newborns Admitted to Neonatal Intensive Care Units

Document Type: Original Article


1 Community-Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

3 Neonatology Research Center, Department of Pediatrics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


Background: When a neonate is born prematurely and admitted to the Neonatal Intensive Care Unit (NICU), the mother usually experiences high levels of anxiety that can disrupt the maternal bond, as well as the natural course of neonatal development. Since spirituality is one of the significant factors affecting anxiety, the present study was designed to evaluate the effect of spiritual care based on the “Ghalbe Salim” model on anxiety in mothers with premature neonates.
Methods: In this clinical trial, a total of 60 mothers with premature neonates who were admitted to the NICUs of Hafez and Hazrat-e-Zainab hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, were recruited through convenience sampling during January to November 2017. The study was conducted in two stages. In the first stage, one of the hospitals was randomly designated as the control group, and the other one was selected as the intervention group. In the second stage, the interventions commenced again after switching the sampling setting. Mothers in the intervention group received four 30-minute sessions of spiritual care based on the “Ghalbe Salim” model every other day, and their anxiety level was assessed before and after the intervention using State-Trait Anxiety Inventory (STAI-Y) by Spielberger. The data were analyzed using Chi-squared test, independent t-test, paired sample t-test, and Mann-Whitney U test.
Results: There were no significant differences between the intervention and control groups before the intervention in terms of mean state and trait anxiety scores (P>0.05). However, after the intervention, a significant difference was observed between the two groups in terms of both state and trait anxiety scores (P=0.001).
Conclusion: According to our findings, spiritual care based on the “GhalbeSalim” model was effective in reducing the anxiety level in mothers with premature neonates.


1. Verklan MT, Walden M. Core curriculum for neonatal intensive care nursing. 5th ed. St. Louis: Elsevier Saunders; 2015. P. 168-511.

 2. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates ofpreterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012; 379(9832):2162-72.

 3. Keshavarz M, Eskandari N, Jahdi F, Ashaieri H, Hoseini F, Kalani M. The effect of holly Quran recitation on physiological responses of premature infant. Koomesh. 2010; 11(3):169-77.

 4. Althabe F. Born too soon: the global action report on preterm birth. Geneva: World Health Organization; 2012. P. 1-26.

 5. Vafaei Fooladi A, Rassouli M, Yaghmaie F, Shakeri N. Assessing correlation between spiritual wellbeing and stress of mothers of hospitalized newborns in neonatal intensive care units. Iran J Nurs. 2015; 28(95):54-62.

6. D'Souza SR, Karkada S, Lewis LE, Mayya S, Guddattu V. Relationship between stress, coping and nursing support of parents of preterm infants admitted to tertiary level neonatal intensive care units of Karnataka, India: a cross-sectional survey. J Neonatal Nurs. 2009; 15(5):152-8.

 7. Parker L. Mothers’ experience of receiving counselling/psychotherapy on a neonatal intensive care unit (NICU). J Neonatal Nurs. 2011; 17(5):182-9.

8. Ghodrati A, Abbaspour S, Hassanzadeh M, Erami E, Zandi Z. The effect of neonatal care trainingon anxiety in mothers of premature infants. J Torbat Heydariyeh Univ Med Sci. 2014; 2(2):25-30.

9. Carter JD, Mulder RT, Darlow BA. Parental stress in the NICU: the influence of personality, psychological, pregnancy and family factors. Personal Mental Health. 2007; 1(1):40-50.

 10. Zelkowitz P, Na S, Wang T, Bardin C, Papageorgiou A. Early maternal anxiety predicts cognitive and behavioural outcomes of VLBW children at 24 months corrected age. Acta Paediatr. 2011; 100(5):700-4.

11. Zelkowitz P, Papageorgiou A, Bardin C, Wang T. Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months. Early Hum Dev. 2009; 85(1):51-8.

 12. Pierrehumbert B, Nicole A, Muller-Nix C, ForcadaGuex M, Ansermet F. Parental post-traumatic reactions after premature birth: implications for sleeping and eating problems in the infant. Arch Dis Child Fetal Neonatal Ed. 2003; 88(5):F400-4.

13. Seaward BL. Managing stress: principles and strategies for health and wellbeing. 1st ed. Sudbury, MA: Jones and Bartlett; 2001. P. 13-69.

14. Kadivar M, Seyedfatemi N, Shojaee Jeshvaghanee S, Cheraghi MA, Haghani H. Exploring the relationship between spiritual well-being and stress and coping strategies in the mothers of infants hospitalized in the neonatal intensive care units. Daneshvar Med. 2015; 22(118):67-76.

 15. Seaward BL. Stress and human spirituality 2000: at the cross roads of physics and metaphysics. Appl Psychophysiol Biofeedback. 2000; 25(4):241-6.

16. Catlin EA, Guillemin JH, Thiel MM, Hammond S, Wang ML, O'Donnell J. Spiritual and religious components of patient care in the neonatal intensive care unit: sacred themes in a secular setting. J Perinatol. 2001; 21(7):426-30.

17. Reyhani T, Sekhavat Pour Z, Heidarzadeh M, Mousavi SM, Mazloom SR. Investigating the effects of spiritual self-care training on psychological stress of mothers with preterm infants admitted in neonatal intensive care unit. Iran J Obstet Gynecol Infertil. 2014; 17(97):18-27.

 18. Asadi M, Asadzandi M, Ebadi A. The effect of spiritual care based on «GHALBE SALIM» model on spiritual experiences of patients undergoing coronary artery bypass surgery. Iran J Cardiovasc Nurs. 2013; 2(2):30-9.

 19. Asadi M, Asadzandi M, Ebadi A. Effects of spiritual care based on Ghalb Salim nursing model in reducing anxiety of patients undergoing CABG surgery. Iran J Crit Care Nurs. 2014; 7(3):142-51.

 20. Akbarpour Mazandarani H, Asadzandi M, Saffari M, Khaghanizadeh M. Effect of spiritual care based on sound-heart consulting model (SHCM) on spiritual health of hemodialysis patients. Iran J Crit Care Nurs. 2017; 10(4):1-5.

21. Asadzandy M. Concepts and theories of nursing. 1st ed. Tehran: The University Baghiyat Allah; 2010. P. 460.

22. Fathi Ashtiani A. Psychological tests: personality and mental health. 11th ed. Tehran: Besat; 2013. P. 337-44.

 23. Hasani J, Rezaee Jamalouee H. Assessment of information processing speed with regard to statetrait anxiety. J Cognit Psychol. 2014; 2(3):12-9.

24. Asadzandi M. Spiritual care. 1st ed. Tehran: Rasane Takhassosi; 2016. P. 13-256.

25. Carter JD, Mulder RT, Bartram AF, Darlow BA. Infants in a neonatal intensive care unit: parental response. Arch Dis Child Fetal Neonatal Ed. 2005; 90(2):F109-13.

26. Cherry AS, Mignogna MR, Vaz AR, Hetherington C, McCaffree MA, Anderson MP, et al. The contribution of maternal psychological functioning toinfant length of stay in the Neonatal Intensive Care Unit. Int J Womens Health. 2016; 8:233-42.

27. Carvalho AE, Linhares MB, Padovani FH, Martinez FE. Anxiety and depression in mothers of preterm infants and psychological intervention during hospitalization in neonatal ICU. Spanish J Psychol. 2009; 12(1):161-70.

 28. Lindberg B, Öhrling K. Experiences of having a prematurely born infant from the perspective of mothers in northern Sweden. Int J Circumpolar Health. 2008; 67(5):461-71.

29. Sharifnia M, Hasanzadeh MH, Asadi Kakhaki SM, Mazlom SR, Karbandi S. The impact of praying on stress and anxiety in mothers with premature infants admitted to NICU. Iran J Neonatol. 2016; 7(4):15-22.

30. Boelens PA, Reeves RR, Replogle WH, Koenig HG. The effect of prayer on depression and anxiety: maintenance of positive influence one year after prayer intervention. Int J Psychiatry Med. 2012; 43(1):85-98.

 31. Küçük Alemdar D, Kardaş Özdemir F, Güdücü Tüfekci F. The effect of spiritual care on stress levels of mothers in NICU. Western J Nurs Res. 2018; 40(7):997-1011.

32. Allameh T, JabalAmeli M, Lorestani K, Akbari M. The efficacy of Quran sound on anxiety and pain of patients under cesarean section with regional anesthesia: a randomized case-controlled clinical trial. J Isfahan Med Sch. 2013; 31(235):601-10.

33. Bolhari J, Nazari GH, Zamaniyan S. Effectiveness of spiritual group therapy in reducing depression, anxiety, and stress of women with breast cancer. Sociol Women. 2012; 3(9):85-115.