The use of islamic spiritual care practices among critically ill adult patients: A systematic review

Abstract

Spiritual care is essential to the healthcare plans of critically ill patients and their families. However, spiritual care remains neglected and requires healthcare institutions and providers’ attention to be incorporated into healthcare management plans, especially for critically ill Muslim patients and their families. To date, no review has been conducted to discuss spiritual care in adult critical care Muslim patients. Spiritual care and Holy Quran recitation have been reported to be practical non-pharmacological interventions for critically ill Muslim patients. However, there is a need for Islamic healthcare institutions and providers to pay further attention to including spiritual care in the healthcare management plans of their patients. Also, future research is recommended to test the effectiveness of incorporating spiritual care in the healthcare plans of critical care patients.

1. Introduction

Pain management for critically ill adult patients is classified into pharmacological and non-pharmacological treatment [2]. Pharmacological interventions (e.g., analgesia) are considered the most effective methods of relieving nociceptive pain [3,4]. However, while treating critically ill adult patients’ pain, it is crucial to minimize the side effects of analgesics as much as possible [65].

Several studies have reported potential misuse and severe consequences of prolonged analgesic use among critically ill adult patients [5,6]. For example, even though opioid analgesics are the first-line treatment for moderate to severe pain relief, they have several adverse effects like dizziness, physical dependence, vomiting, intolerance, respiratory depression [7], delayed extubation [8], and induced bowel dysfunction [9]. These adverse effects can lead to increased length of hospitalization, as well as increased mortality and morbidity rates [10]. Furthermore, opioid dependence does not only affect patients' status but also significantly increases healthcare costs [11]. According to Ref. [12]; the extra annual costs of pain management in the healthcare system were between $261-$300 billion in the United States in 2010. Moreover, in Spain [13], reported that pain management with intravenous morphine administration in emergency departments costs 18.31 euros per patient.

Critically ill patients are exposed to multiple intrinsic and extrinsic sources of pain daily [14]. Therefore, minimizing the potentially harmful side effects of prolonged and frequent use of analgesics among critically ill patients is crucial, and it may be achieved by using alternative and complementary non-pharmacological interventions for pain control. The guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) recommend using non-pharmacological interventions to target pain among critically ill adult patients [15]. Several non-pharmacological therapies are cost-effective, easy to use, and free of adverse effects [15]. For example, music therapy, massage, and calming voice are recommended for relaxation and pain relief [16,17]. Moreover, deep breathing exercise is the most effective and frequent non-pharmacological intervention used during painful procedures for conscious and cooperative patients [17]. For critically ill patients, non-pharmacological pain interventions aim to treat pain from its multiple dimensions, including sociocultural, behavioral, and cognitive [18].

Many studies have revealed that music therapy has many therapeutic effects and is easy to use for critically ill patients [[66], [68], [69]]. Music therapy decreases anxiety and reduces analgesia consumption among mechanically ventilated patients [67]. Further, music therapy can act as an adjuvant pain treatment by decreasing pain signals transmitted to the central nervous system [70]. Moreover, listening to familiar and preferred music can promote relaxation, reduce discomfort and uncertainty, and act as a distraction during painful nursing care procedures, such as suctioning and bed bathing [67] . However, in conservative Islamic societies, listening to Holy Quran recitation is more religiously and culturally acceptable for patients and their families [19]. Very few studies have discussed the physiological and psychological effects of listening to Holy Quran recitation on the health outcomes of critically ill patients [19] or its effectiveness in relieving pain [71].

Furthermore, spiritual care for patients and their families has improved patients' health outcomes and quality of life [20]. Several recommendations suggest providing spiritual care as an essential element in patients' healthcare plans [21,22]. However, the pain treatment guidelines/protocols currently applied in intensive care units (ICUs) neglect spiritual care and consider it the last option for pain control [20]. A recent systematic review that discussed spiritual care in ICUs reported the importance of spiritual care in improving critically ill patients’ quality of life [23]. However, limited studies have discussed the use of Islamic religious and spiritual practices among ICU patients. Therefore, this review aims to examine these practices and how they relate to physical and psychosocial outcomes among critically ill adult patients.

2. Method

2.1. Study design

This study reviewed the nursing literature relevant to Islamic religious and spiritual care in critical care settings. The authors reviewed each selected study independently and assessed the studies carefully to avoid discrepancies until a consensus was reached. The following questions guided this systematic review: (a) what are the Islamic religious and spiritual care practices provided in critical care units? Moreover, (b) What is the effect of Islamic religious and spiritual care on critically ill patients' health outcomes in critical care units?

2.2. Inclusion criteria

The studies included in the review were: (1) peer-reviewed quantitative or qualitative, (2) written in English, (3) targeting critical care patients, and (4) discussing Islamic religious and spiritual care in critical care settings.

2.3. Exclusion criteria

Studies were excluded if they were: (1) books, (2) dissertations, (3) not targeted at critically ill patients, (4) not conducted in adult clinical care settings, (5) not written in English, or (6) discussing spiritual care related to a religion other than Islam.

2.4. Search strategy

Five electronic databases (EBSCO, PubMed, Google Scholar, CINAHL, and MEDLINE) were thoroughly searched in June 2020 using the following keywords: “critical care,” “critically ill patients,” “adult,” “mechanically ventilated patients,” “critical care unit,” “intensive care unit,” “spirituality,” “spiritual care,” “religion,” “prayer,” “Holy Quran listening,” “non-pharmacological,” “Holy Quran recitation,” and “Islamic.” There were no restrictions regarding the publication date or study design. Special features (e.g., explosion) and hand searching (e.g., reference lists of the selected articles) was used to recognize synonyms and expand the search.

The authors used the Boolean operators “AND” and “OR” to expand the search and obtain the maximum number of relevant articles. Also, terms ending in special characters (e.g., asterisk “*“), were utilized to retrieve papers that had variations of the search terms. An initial search using the keywords mentioned earlier yielded 2050 studies. After excluding overlapping or duplicate studies, 525 studies remained, and only 30 of these studies met the inclusion criteria. The reference list of all 30 studies was then reviewed to identify other relevant studies that had yet to appear in the database search. Then, the authors carefully screened these studies for the title, main objectives, abstract, keywords, and Islamic spiritual care in critical care settings as the primary study aim, which resulted in a total of thirteen studies being included in this review. Fig. 1 below shows the eligible studies selected for this review using the Preferred Reporting Items for Meta-Analysis (PRISMA) checklist.

Fig. 1.

Prisma flow chart.

2.5. Quality of evidence appraisal assessment

The authors independently screened each study following the guidelines of Melnyk and Fineout-Overholt [24] until consensus regarding the selected studies' level of evidence was reached [24]. ranked articles on a seven-level scale, in which systematic reviews, meta-analyses are on the top of the scale (Table 1).

Table 1.

Summary of studies included in the review.

Authors/Country	Design	Purpose	Response Rate	Participants	Instrument	Key Findings	LOE
[25] Iran	Semi-Experimental	To compare the effect of listening to Holy Quran recitation and instrumental music on acute coronary syndrome patients' level of anxiety.	100%	96 ACS patients	The 20-item Spielberger state-trait anxiety inventory (STAI)	Both interventions effectively improved acute coronary syndrome patients' level of anxiety but listening to Holy Quran recitation had a better effect in decreasing the level of anxiety.	III
[26] Iran	RCT	To examine the effect of listening to the Holy Quran recitation on critical care units' patients' hemodynamics and level of consciousness.	100%	30 ICU patients	Glasgow coma and bio-physiological tools	The Holy Quran recitation effectively improved critically ill patients' level of consciousness and decreased vital signs readings.	II
[27] Iran	RCT	To describe critical care nurses' experiences assessing and managing postoperative ICU patients' pain.	100%	60 critically ill patients	The State-Trait Anxiety Inventory (STAI)	Listening to the Holy Quran recitation significantly reduced cardiac catheterization patients' level of anxiety.	II
[28] Eygpt	Quasi-experimental	To examine the effect of listening to Holy Quran recitation on mechanically ventilated patients' health outcomes who underwent weaning.	87%	60 ICU patients	Physiological parameters record, Dyspnea visual analogue scale (DVAS), Visual Analogue Scale of Anxiety (VASA)	The Holy Quran recitation improved mechanically ventilated patients' hemodynamics, oxygen saturation, anxiety level, and shortness of breath during weaning.	III
[29] KSA	RCT	To examine the effect of the Holy Quran recitation on mechanical ventilated patients' hemodynamics during weaning.	100%	55 ICU patients	Measurements of physiological parameters	There was no adverse effect of listening to Holy Quran recitation during mechanically ventilated patients. However, there was no statistically significant positive effect for HQR.	II
[30] Iran	RCT	To examine the effect of spiritual care for burn patients on pain intensity during the dressing changes.	100%	68 ICU patients	Visual Analogue Scale (VAS) and Numerical Rating Scale (NRS)	Providing spiritual and religious care decreased burn patients' pain intensity during dressing changes and improved pain control.	II
[31] Jordan	Qualitative	To discuss Jordanian Muslim women's suffering experiences in ICUs.	43%	16 ICU patients	Interviews	The study highlighted the importance of spirituality and religiosity for critically ill Muslim women patients from patients' perceptions.	VI
[32] Malaysia	Pre/posttest Quasi-experimental	To examine the effect of listening to Surah Yasiin recitation on critically ill patients' hemodynamics.	100%	5 ICU patients	Measurements of physiological parameters	There was no effect of Yasiin Surah recitation on mechanically ventilated patients' hemodynamics.	III
[33] Iran	RCT	To examine the effect of Holy Quran recitation on critically ill patients' level of consciousness in the Intensive Care Unit.	100%	66 ICU patients	The Glasgow Coma Scale (GCS)	Listening to Holy Quran recitation can increase critically ill patients' level of consciousness and.	II
[34] Indonesia	Pre/posttest Quasi-experimental	To examine the effect of the Holy Quran recitation as comfort care on mechanically ventilated Muslim patients' comfort.	33%	10 ICU patients	Shortened General Comfort Questionnaire (SGCQ) and physiological parameters	The Holy Quran recitation can enhance mechanically ventilated Muslim patients' comfort and hemodynamic stability in ICUs.	III
[35] KSA	Phenomenological Qualitative	To discuss the critical care nurses' experiences who care for Muslim patients in KSA.	100%	6 critical care nurses	Unstructured interviews	The study results highlight the methods nurses used while caring for critically ill Muslim patients, such as spiritual care.	VI
[72] Songwathana, 2017 Indonesia	Phenomenological Qualitative	To discuss Islam-based caring behaviors provided by nurses for critically ill patients in the intensive care unit.	100%	14 critical care nurses and 10 families	In-depth interviews	The study highlights the importance of providing Islamic-based care by nurses to enhance the balance of body and mind among critically ill patients.	VI
[36] Iran	Prospective observational study	To discuss the correlation between critically ill patients' religiosity and level of delirium or patients' health outcomes, including the severity of illness, level of consciousness, length of hospitalization, and survival.	55.6%	4200 ICU patients	The delirium rating scale-revised-98 (DRS-R-98)	Higher religiosity was associated with lower delirium scores, shorter duration of intubation, and shorter ICU stay.	IV

2.6. Data synthesis

An evidence-based table was developed to summarize the detailed information of the selected studies (Table 1). Data synthesis was carried out as follows: (1) description of the purposes, design, sample, level of evidence, and significant findings of all selected studies, and (2) description of each study's strengths and limitations.

3. Results

3.1. Description of the selected studies

The 13 selected studies used various methodologies. Three studies were qualitative [35, 72, 31], four were quasi-experimental [25,28,32,34], five were randomized control trials [26,27,29,30,33], one was observational [36], and all 13 were cross-sectional [[25], [26], [27], [28],30,[32], [33], [34], [35], [36], 72, 29,31].

Also, all of the interventional studies provided Holy Quran recitation as a form of spiritual care for critically ill patients [[25], [26], [27], [28], [29], [30],[32], [33], [34]]. The majority of these studies used recitations by famous Holy Quran reciters [[25], [26], [27], [28], [29], [30],33,34], except for one study which had used recitations either by the authors themselves or the patients' relatives [32]. Further, three qualitative studies discussed prayer as a spiritual care practice for critically ill patients [35, 72, 31].

The proportions of male and female participants in the chosen studies ranged from 40% to 71% and 29–60%, respectively. Most of the studies were conducted in Iran [[25], [26], [27],30,33,36]. As for the remaining studies, two were conducted in Saudi Arabia [29,35], two in Indonesia [34, 72], and one in Egypt [28], one in Jordan [31], and one in Malaysia [32]. The 13 reviewed studies are summarized in Table 1.

3.2. Strengths and limitations

There were some limitations to the selected studies. For example, the small sample sizes used in some of the studies may limit the generalizability of their findings [[25], [26], [27], [28], [29], [30],[32], [33], [34]]. The generalizability of the findings of some of the studies may also be limited due to the use of convenience and purposive sampling techniques [25,27,28,32,[34], [35], [36], 72, 31]. Also, some studies only included male [32] or female participants [31,35]. In addition, in the majority of the remaining studies, most of the participants were male, which is an indication of selection bias [26,[28], [29], [30],33,34].

Further, different reactions to spiritual care interventions were recorded due to variations in people's beliefs [27,33]. Also, in none of the selected studies had the participants or their families been given a choice of Holy Quran Surah or reciter [[25], [26], [27], [28], [29], [30],[32], [33], [34]]. Other limitations were associated with environmental restrictions and patients' clinical characteristics, including open ICU settings [29], limited time [[29], [30], [31],34], patients' deep sedation [34], and noisy ICU environment [29]. However, there were strengths to some of the reviewed studies. Some studies used random sampling methods [26,29,30,33], and most of the studies reported using valid instruments to examine the intervention effectiveness and main study variables.

3.3. Spiritual care and patient clinical outcomes

Nine of the thirteen selected studies in this review examined the effect of spiritual care on critically ill patients' clinical health outcomes. Three of these studies examined the impact of listening to Holy Quran recitation on the level of anxiety among ICU patients, and the results indicated significant improvements in patients' anxiety levels [25,27,28]. Also, five of the reviewed studies examined the effect of listening to Holy Quran recitation on critically ill patients’ hemodynamics (i.e., blood pressure, heart rate, respiratory rate, and oxygen saturation) [26,28,29,32,34], and three of these studies reported significant improvements post-intervention [26,28,34]. According to Refs. [26,28]; mean blood pressure, heart rate, and the respiratory rate decreased significantly after the interventions, while oxygen saturation increased [28]. Meanwhile [29,32], reported no statistically significant differences in hemodynamics between the control and experimental groups. However, in the study of [29]; there were slight differences in blood pressure between the groups, and the mean heart rate was higher for the experimental group than for the control group.

Only two of the selected studies examined the effect of listening to Holy Quran recitation on ICU patients' level of consciousness. Both studies reported a significant increase in the level of consciousness among patients in the intervention group [26,33]. Furthermore, only one study examined the effect of listening to the Holy Quran recitation on critically ill burn patients' pain during dressing changes. The results showed a significant decrease in pain levels and improved pain control [30]. Also [36], found higher levels of religiosity to be associated with lower delirium scores, shorter duration of intubation, and shorter ICU length of stay. However, patients with higher levels of religiosity had higher mortality rates than patients with lower levels of religiosity [36].

3.4. Spiritual care and patients’ spiritual beliefs

A limited number of the reviewed studies discussed critical care patients' spiritual beliefs and spiritual care practices provided in acute care settings. According to Refs. [31,35]; critically ill Muslim patients believed their stressful situation to be a test from Allah, specifically a test of their patience and ability to endure suffering. Also, the patients emphasized the importance of spirituality and seeking help from Allah to overcome grief, pain, and critical illness [31]. Three of the four studies reported prayer as the essential spiritual practice from critically ill Muslim patients' perspectives [35, 72, 31]. According to Ref. [31]; critically ill Muslim patients consider prayer essential for survival and a way to remain close to God, seek help, and refrain from losing hope. Also, according to Ref. [35]; critical care nurses reported that performing the five daily prayers was more important to their Muslim patients than sleep or food.

Only two studies discussed the role of nurses in providing spiritual care in critical care units [35, 72]). In the study of [35]; the participating nurses reported that they helped their critically ill patients meet their spiritual needs, including assisting them to pray, helping them perform ablution, and positioning them towards the Qibla. Meanwhile, Songwathana [72] reported that nurses provided spiritual care and performed Islamic rituals, such as reciting the Holy Quran and Hadiths and praying for patients and their families. Also, the nurses reported barriers to achieving spiritual care in critical care settings, such as insufficient knowledge, limited resources for learning about spiritual care, and limited time due to nurses' heavy workloads [72].

4. Discussion

4.1. Spiritual care and patient clinical outcomes

This review included 13 studies published over the past fifteen years (between 2006 and 2020), focusing on Islamic spiritual care provided to critically ill patients in critical care settings. Most selected studies examined Holy Quran recitation as a form of Islamic spiritual care for critically ill patients. Three of these studies examined the effect of listening to Holy Quran recitation on critically ill patients' anxiety and reported the practical method. This finding is consistent with a recent systematic review that found listening to Holy Quran recitation to be an effective, safe, accessible, and cost-effective non-pharmacological intervention for reducing stress and anxiety among critically ill Muslim patients [19]. Also, the results of a systematic review by Ref. [37] showed that listening to Quran recitation can decrease the severity of women's anxiety and pain during labor. Moreover [38], found listening to Holy Quran recitation effective in reducing stress and depression among Muslim and non-Muslim patients and improving their emotions. Also [39,40], found that listening to Al-Ruqya Al-Shariya, which includes Holy Quran recitation, is an effective complementary and alternative medicine for relieving pain and anxiety in non-Muslim patients.

In this review, most studies used recorded Holy Quran recitations by famous reciters. Several studies have reported that using recorded recitations by famous, familiar reciters who recite in calming and soothing voices can reduce patients' anxiety and prompt their relaxation [[41], [42], [43]]. On the other hand, similar to the study of [32] included in this review, some studies have reported that it is better to have patients listen to Holy Quran recitations by their family members or relatives, as this can promote attachment bonds between them [[44], [45], [46]].

Regarding the required duration of listening to Holy Quran recitation to gain the benefit, most of the studies in this review exposed patients to recitations ranging between 15 and 20 min. Similarly, the systematic review of [19] investigated the effects of listening to the Holy Quran recitation on ICU patients' psychological and physiological status. Most studies had exposed patients to recitations between 15 and 20 min.

Continuous hemodynamic monitoring for critically ill patients provides essential information on cardiovascular and respiratory performance, and any fluctuation in hemodynamics may have severe complications and may be life-threatening [47]. Therefore, maintaining hemodynamic stability among critically ill patients is essential for better health outcomes [47]. However, many physiological and psychological problems are experienced by critically ill patients daily, such as anxiety and pain, which put these patients at risk of becoming hemodynamically unstable (Malbrain et al., 2016). Therefore, three reviewed studies examined the effect of listening to Holy Quran recitation on critically ill patients' hemodynamics and reported significant improvements after the interventions ([26,28,34]. According to these studies, mean blood pressure, heart rate, and the respiratory rate decreased significantly after the interventions, while oxygen saturation increased. According to Rustam et al. alpha brain waves raised signifcantly after listening to the Quran recitation which elicits a state of relaxation, calmness, and hemodynamic stability. Moreover, listening to the Quran recitation has a special effect on Muslim patients’ hearts, leading to chemical and hormonal changes responsible for relaxation and hemodynamic stability. Consistently, the systematic review of Mat-Nor et al. [71] reported that listening to Holy Quran recitation significantly improved ICU patients' hemodynamic stability.

Furthermore, according to Refs. [48,49]; hemodynamics improved significantly after exposure to Holy Quran recitation among congestive heart failure patients and neonatal ICU patients, respectively. According to Qolizadeh et al. listening to the Quran recitation reduces the activity of sympathetic nervous system, leading to reduced anexity, slow breathing, increased O2 saturation, and a lower heart rate. Moreover, listening to the recitation acts as a distraction from noisy sounds in the neonatal ICUs, leading to relaxation and hemodynamic stability [49]. However, in our review [29,32], reported no statistically significant effect of listening to the Holy Quran recitation on critically ill patients' hemodynamics. Consistent with this finding [50], showed no significant improvement in women's hemodynamics after listening to the Holy Quran recitation post-cesarean section. This inconsistency suggests the need to examine further the effects of listening to Holy Quran recitation on patients' physical and psychological outcomes, particularly critically ill patients. Mat-Nor et al. [71] found listening to Holy Quran recitation effective in improving critically ill patients' comatose levels of consciousness. These findings support the finding of the present review that listening to Holy Quran recitation significantly increases patients' levels of consciousness.

In the current review, one study was found to have examined the effect of spiritual care, explicitly listening to Holy Quran recitation, on critically ill patients and found this intervention to significantly decrease the level of pain in burn patients during dressing changes. However, this finding is supported by several studies which have reported spiritual care to be an effective non-pharmacological intervention for reducing pain among various populations [51]; Fauzi Kamal & Dahlia, 2019 [52]; Putri et al., 2020 [73, 53]. For example, several studies have evidenced the effectiveness of listening to Holy Quran recitation in relieving pain. This includes labor pain among nulliparous [51] and multiparous [52] women, pain among hypertension patients [53], musculoskeletal pain among college students [73], and pain among cancer patients [75]. Furthermore, a recent systematic review showed that listening to Holy Quran recitation could reduce pain during labor [37].

One reviewed study reported that religiosity has a favorable effect on lowering delirium scores among critically ill patients, similar to Farzanegan et al. [36] that religiosity and spirituality decrease the incidence of delirium among ICU patients. Further, the reviews of [54,55] showed that religion and spirituality could reduce patient mortality rates. Moreover, a meta-analysis by Ref. [56] showed that religiosity and spirituality play the most considerable role in reducing patients' mortality rates compared to other healthcare interventions. Specifically, an 18% reduction in mortality among patients with higher levels of religiosity was identified. However, conflicting findings were reported in the review by Ref. [36]; whereby patients with higher levels of religiosity had higher mortality rates.

Furthermore, according to the systematic review and meta-analysis of [56]; religiosity and spirituality were not associated with mortality rate reduction among diseased people. However, they were associated with reduced mortality rates in healthy people. This inconsistency in the available evidence suggests that further research controlling for certain anticipated confounding variables is required to examine the unique contribution of religiosity in predicting patient outcomes.

4.2. Spiritual care and patients’ spiritual beliefs

In this review, four studies discussed critical care patients' spiritual beliefs and spiritual care practices provided in acute care settings. However, several previous studies have examined spiritual care and beliefs differently. For example, a recent systematic review by Ref. [57] conducted among palliative care patients and explored the perceptions of healthcare providers and patients reported similar findings regarding the importance of spirituality for overcoming illness and achieving better patient health outcomes. As reported by the systematic reviews of [20,58]; prayer is the religious ritual that is most commonly reported by patients, which is in line with our review findings.

Healthcare providers, especially nurses, play an essential role in delivering adequate spiritual care by assessing patients’ spiritual needs and providing effective spiritual interventions [59]. A systematic review conducted to discuss spiritual assessment and spiritual care among pediatric cancer patients reported the need for early spiritual assessment with adequate management and continuous support for suffering patients and their families [60]. In the current review, two studies reported that nurses were already providing critically ill patients and their families with the required spiritual care, which includes providing access to Holy Quran recitation and Hadiths and facilitating prayer.

Healthcare providers face various barriers to patient spiritual care [20, 72]). However, in this review, only one study reported nurse-related barriers to the provision of spiritual care in critical care settings, including insufficient knowledge, limited resources for learning about spiritual care, and limited time [20]. conducted a systematic review to gain an overview of the spiritual care provided in critical care units and reported similar findings. However, in addition to the barriers mentioned above, inadequate assessment of spiritual distress and patient-related barriers like altered level of consciousness and severe mental illness were also reported.

Differences in religious values, language, cultural values, and social issues across various countries and healthcare settings may pose obstacles for healthcare providers in providing optimal healthcare for patients [61]. Therefore, providing a high level of spiritual care for patients regardless of the differences in patients' and their healthcare providers' religiosity levels can ensure better patient health outcomes [62]. For example [63], found that the higher the levels of spirituality and religiosity of cancer patients and their healthcare providers, the better the patients' quality of life. Moreover [64], investigated the impacts of providing high-quality religious care within the healthcare system in America for American Muslims, including providing halal food and a private space for prayer. The results showed that understanding and accommodating Muslim patients’ spiritual needs in healthcare settings improve these patients' overall healthcare experience.

4.3. Implications for practice

Healthcare settings need to be aware of the health benefits of spiritual care and listening to Holy Quran recitation for Muslim patients and provide this form of care when requested. Other related forms of spiritual care which may be offered in healthcare settings may include providing spiritual counseling, directing Muslim patients to the area's place of worship and religious leader, and making patients aware of the availability of religious items like prayer rugs, religious texts, and recordings of recitations of religious texts. High-quality speakers are also necessary for patients to hear recorded recitations well. Knowing where the Qibla faces and positioning beds towards it so that Muslim patients can offer their prayers is another way for healthcare providers to be sensitive to the religious needs of patients. It is highly recommended to provide spiritual/pastoral care education on religion, spirituality, and psychology for nurses as part of their clinical training requirements to offer this type of spiritual support. Chaplains are responsible for advocating for people to access religious practices that belong to a significant religion like Islam. Therefore, Hospital administrators should emphasize the role of the chaplain or spiritual care provider in healthcare settings in offering spiritual counseling and accommodating patients' spiritual and religious needs.

4.4. Limitations of the review

This review has various limitations. Many articles discussed the main study variables and may have reported significant results but were not included in this review because they were published in languages other than English. Furthermore, most of the selected studies were conducted on small samples, which may limit the generalizability of their findings. Also, all the selected studies were conducted in different Muslim countries, which may restrict their findings' generalizability. Finally, the determination of causality was limited because all of the selected studies were cross-sectional cohort studies.

5. Conclusion

Care providers for critically ill patients should consider the various spiritual needs of these patients and their family members. Exposure to Holy Quran recitation and spiritual care has been evidenced as practical non-pharmacological interventions. Specifically, these interventions effectively reduce anxiety and pain levels among critically ill patients. Furthermore, the incorporation of spiritual care in the healthcare management plans of patients requires more attention from healthcare institutions and providers. Further research on spiritual care in critical care settings is recommended.

Author contribution statement

Mohammad Rababa: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Shatha Al-Sabbah: Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.

Funding statement

Dr. Mohammad Rababa was supported by Deanship of Research, Jordan University of Science and Technology [20200669].

Data availability statement

Data will be made available on request.

Declaration of interest's statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

CRediT author statement

Mohammad Rababa: Conceptualization, Methodology, Data curation, Writing- Original draft, Reviewing, and Editing. Shatha Al-Sabbah: Visualization, Investigation, Supervision, Writing- Original draft, Reviewing and Editing.