Integrating Spirituality and Self-Transcendence in Chronic Kidney Disease Management: A Structural Equation Modeling Approach.
Siti Nurkholifah, Yurika Fauzia Wardhani, Minarti Minarti, Asep Hermawan, Eka Denis Machfutra, Doni Lasut
Journal of holistic nursing : official journal of the American Holistic Nurses' Association April 8, 2026 DOI: 10.1177/08980101261437957 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional analytical study Peer reviewed |
|---|---|
| Sample size | 140 |
| Population | Adults with chronic kidney disease in Surabaya, Indonesia |
| Keywords | Chronic kidney disease Nursing theory Self-transcendence Spirituality Structural equation modeling Well-being |
| Key findings | Spiritual self-transcendence strongly predicted psychological well-being (β = 0.83) and mediated the relationship between predictors and well-being. |
Abstract
PurposeTo test and validate a Spirituality-Based Self-Transcendence (STS) model explaining how personal, external, and behavioral factors influence psychological well-being through spiritual self-transcendence among patients with chronic kidney disease (CKD) in Indonesia.DesignA cross-sectional analytical study.MethodsA total of 140 adults with CKD were recruited using multistage random sampling from 18 primary health centers (PHCs) in Surabaya, Indonesia. Data were collected using culturally validated instruments measuring personal, external, behavioral factors, spiritual self-transcendence, and psychological well-being. Partial least squares-structural equation modeling was used to assess the measurement and structural models.FindingsThe STS model demonstrated acceptable validity, reliability, and strong overall fit (goodness of fit = 0.529). Behavioral and external factors significantly predicted spiritual self-transcendence (β = 0.44 and β = 0.63, p < 0.001). Spiritual self-transcendence strongly predicted psychological well-being (β = 0.83, p < 0.001) and mediated the relationship between predictors and well-being. The model explained 68.6% of the variance in well-being.ConclusionsThe study extends Reed's Self-Transcendence Theory by confirming spirituality as a central pathway to psychological well-being in CKD. The validated STS model provides a culturally grounded framework for designing spirituality-integrated nursing interventions to promote resilience, adaptation, and holistic care in chronic illness.