{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:56:09Z","timestamp":1790628969650,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 112\u20102410\u2010H\u2010255\u2010009"],"award-info":[{"award-number":["NSTC 112\u20102410\u2010H\u2010255\u2010009"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["501100004824"],"award-info":[{"award-number":["501100004824"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CDRPF1N001"],"award-info":[{"award-number":["CDRPF1N001"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["BMRP704"],"award-info":[{"award-number":["BMRP704"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,3]]},"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n To examine the relationships among spirituality, happiness, life attitude and posttraumatic growth in haemodialysis patients, and to test whether life attitude and posttraumatic growth acted as potential mediators in the association between spirituality and happiness.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A cross\u2010sectional correlational study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We recruited 299 maintenance haemodialysis patients from nine dialysis clinics in Taiwan using convenience sampling. Participants completed validated self\u2010report questionnaires measuring spirituality, happiness, life attitude and posttraumatic growth. Pearson's correlation coefficients and mediation analyses using the PROCESS 4.2 macro for SPSS were conducted to test associations and mediating effects.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean age of participants was 60.90\u2009years (SD\u2009=\u200912.39), and the average duration of haemodialysis was 5.32\u2009years (SD\u2009=\u20095.30). Spirituality was significantly positively correlated with happiness, life attitude, and posttraumatic growth (\n r<\/jats:italic>\n \u2009=\u20090.571, 0.643 and 0.473; all\n p<\/jats:italic>\n \u2009<\u20090.001). Mediation analysis revealed a significant total effect of spirituality on happiness (\n B<\/jats:italic>\n \u2009=\u20090.196, 95% CI [0.164, 0.228]) and a direct effect (\n B<\/jats:italic>\n \u2009=\u20090.060, 95% CI [0.024, 0.096]). Life attitude and posttraumatic growth significantly mediated this relationship (\n B<\/jats:italic>\n \u2009=\u20090.082, 95% CI [0.055, 0.110]) and (\n B<\/jats:italic>\n \u2009=\u20090.054, 95% CI [0.035, 0.075]), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Spirituality is associated with higher happiness in haemodialysis patients, and this pattern was consistent with potential indirect pathways via positive life attitudes and promoting posttraumatic growth. These findings offer insight into the psychological mechanisms linking spirituality and well\u2010being in chronically ill patients.<\/jats:p>\n <\/jats:sec>\n \n Impact<\/jats:title>\n Integrating spiritual assessment and tailored interventions into clinical care may be relevant for psychological well\u2010being and overall quality of life in this population. This highlights the importance of addressing spiritual dimensions in chronic care settings.<\/jats:p>\n <\/jats:sec>\n \n Reporting Method<\/jats:title>\n Study methods and results were reported in accordance with the STROBE checklist.<\/jats:p>\n <\/jats:sec>\n \n Patient or Public Contribution<\/jats:title>\n No patient or public contribution.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov<\/jats:ext-link>\n : NCT06098924\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/nop2.70479","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T08:40:31Z","timestamp":1773132031000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spirituality and Happiness in Haemodialysis Patients: The Mediating Roles of Life Attitude and Posttraumatic Growth"],"prefix":"10.1002","volume":"13","author":[{"given":"Hsiang\u2010Chun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Nursing, Chang Gung University of Science and Technology, Division of Nursing Department, New Taipei municipal Tucheng Hospital New Taipei City Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2835-898X","authenticated-orcid":false,"given":"Yi\u2010Chien","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Chang Gung University of Science and Technology, Division of Pediatric Hematology and Oncology Chang Gung Memorial Hospital, Linkou Main Branch Taoyuan City Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun\u2010Hung","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine Taipei City Hospital Taipei City Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5674-6253","authenticated-orcid":false,"given":"Chizimuzo","family":"Okoli","sequence":"additional","affiliation":[{"name":"University of Kentucky College of Nursing Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-4974","authenticated-orcid":false,"given":"Tsung\u2010Lan","family":"Chu","sequence":"additional","affiliation":[{"name":"Administration Center of Quality Management Department Chang Gung Medical Foundation Taoyuan City Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1672-6266","authenticated-orcid":false,"given":"Ya\u2010Chu","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Administration Center of Quality Management Department Chang Gung Medical Foundation Taoyuan City Taiwan, ROC"},{"name":"Department of Nursing, Chang Gung University of Science and Technology Chang Gung Medical Foundation Taoyuan City Taiwan, ROC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255\u2010019\u201002129\u2010x"},{"key":"e_1_2_14_3_1","volume-title":"APA Dictionary of Psychology","author":"American Psychological Association","year":"2014"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.5505\/kpd.2024.60465"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4426"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.explore.2022.04.004"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.33879\/amh.144.2023.08080"},{"key":"e_1_2_14_8_1","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J.","year":"1988"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1037\/pspp0000225"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.15386\/mpr\u20101623"},{"key":"e_1_2_14_11_1","volume-title":"Man's Search for Meaning","author":"Frankl V. 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