Desarrollo y Validación de una Escala de Espiritualidad para uso en Servicios de Salud Mental
Palabras clave:
espiritualidad, validez de contenido, psicometría, desarrollo de escala análisis factorial
Resumen
Introducción: Recientemente se ha incrementado la evaluación de la espiritualidad en los pacientes como parte esencial de un cuidado integral, sin embargo, las definiciones y los instrumentos que intentan medir la espiritualidad son heterogéneos. Objetivo: el estudio busco desarrollar un concepto y un instrumento de medición de espiritualidad para el servicio de orientación espiritual de la Orden Hospitalaria San Juan de Dios en Latinoamérica. Metodología: Esta investigación utilizó elementos cuantitativos y cualitativos para la delimitación de constructos y creación de ítems. Se realizó una validez de apariencia y contenido de la escala, análisis de los ítems y análisis factorial confirmatorio. El análisis fue realizado con el lenguaje de programación R. Resultados: El estudio permitió la creación de una definición de la espiritualidad y una escala unidimensional de 7 ítems. El Alpha de Cronbach de la escala fue de 0.96 y el Omega de Mc Donald 0.89. El factor 1 explico el 84% de la varianza y se encontraron correlaciones entre los ítems de 0.7 y 0.8. Conclusiones: Se creo la definición de espiritualidad para la Orden hospitalaria San Juan de Dios Latinoamérica. La escala diseñada es un instrumento válido y confiable que puede ser utilizado en los servicios de orientación espiritual.
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2. VanderWeele TJ, Balboni TA, Koh HK. Health and Spirituality. JAMA. 2017 Aug;318(6):519–20.
3. Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001 Dec;76(12):1225–35.
4. Peteet JR, Balboni MJ. Spirituality and religion in oncology. CA Cancer J Clin. 2013;63(4):280–9.
5. Rohde G, Kersten C, Vistad I, Mesel T. Spiritual Well-being in Patients With Metastatic Colorectal Cancer Receiving Noncurative Chemotherapy: A Qualitative Study. Cancer Nurs [Internet]. 2017;40(3):209–16. Available from: https://pubmed.ncbi.nlm.nih.gov/27101099
6. Vallurupalli M, Lauderdale K, Balboni MJ, Phelps AC, Block SD, Ng AK, et al. The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. J Support Oncol. 2012;10(2):81–7.
7. Weber SR, Pargament KI. The role of religion and spirituality in mental health. Curr Opin Psychiatry. 2014 Sep;27(5):358–63.
8. de Oliveira Maraldi E. Response Bias in Research on Religion, Spirituality and Mental Health: A Critical Review of the Literature and Methodological Recommendations. J Relig Health. 2020 Apr;59(2):772–83.
9. Murgia C, Notarnicola I, Rocco G, Stievano A. Spirituality in nursing: A concept analysis. Nurs Ethics. 2020 Aug;27(5):1327–43.
10. King JE, Crowther MR. The measurement of religiosity and spirituality. J Organ Chang Manag [Internet]. 2004 Jan 1;17(1):83–101. Available from:
https://doi.org/10.1108/09534810410511314
11. de Jager Meezenbroek E, Garssen B, van den Berg M, van Dierendonck D, Visser A, Schaufeli WB. Measuring spirituality as a universal human experience: a review of spirituality questionnaires. J Relig Health. 2012 Jun;51(2):336–54.
12. Garssen B, Visser A. Distinguishing spirituality from other constructs: commentary on Lindeman et al. Vol. 202, The Journal of nervous and mental disease. United States; 2014. p. 177.
13. Lindeman M, Blomqvist S, Takada M. Distinguishing spirituality from other constructs: not a matter of well-being but of belief in supernatural spirits. J Nerv Ment Dis. 2012 Feb;200(2):167–73.
14. Gall TL, Malette J, Guirguis-Younger M. Spirituality and Religiousness: A Diversity of Definitions. J Spiritual Ment Heal [Internet]. 2011 Jul 1;13(3):158–81. Available from: https://doi.org/10.1080/19349637.2011.593404
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16. Orden Hospitalaria San Juan de Dios. La pastoral según el estilo de San Juan de Dios. Colombia; 2012. 240 p.
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https://revistas.usantotomas.edu.co/index.php/hallazgos/article/view/5232
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26. Mytko JJ, Knight SJ. Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psychooncology. 1999;8(5):439–50.
27. Hers M-A. Pre Columbian Art, de Lee A. Parsons. An del Inst Investig Estéticas [Internet]. 1983 Aug 6;13(52 SE-Notas bibliográficas). Available from:
http://www.analesiie.unam.mx/index.php/analesiie/article/view/1196
28. Piedmont RL, Friedman PH. Spirituality, religiosity, and subjective quality of life. In: Handbook of social indicators and quality of life research. Springer; 2012. p. 313–29.
29. Cobb MR, Puchalski CM, Rumbold B. Oxford Textbook of Spirituality in Healthcare [Internet]. Oxford, UK: Oxford University Press; 2012. Available from:
https://oxfordmedicine.com/view/10.1093/med/9780199571390.001.0001/med-9780199571390
30. Nolan S, Saltmarsh P, Leget CJW. Spiritual care in palliative care : Working towards an EAPC task force. Eur J Palliat Care. 2011;86–9.
31. Weathers E, McCarthy G, Coffey A. Concept Analysis of Spirituality: An Evolutionary Approach. Nurs Forum. 2016 Apr;51(2):79–96.
32. Clark M, Emerson A. Spirituality in Psychiatric Nursing: A Concept Analysis. J Am Psychiatr Nurses Assoc. 2021;27(1):22–32.
33. Shek DTL. Spirituality as a positive youth development construct: a conceptual review. ScientificWorldJournal. 2012;2012:458953.
34. Núñez P, Enríquez D, Irarrázaval ME. La espiritualidad en el paciente oncológico: Una forma de nutrir la esperanza y fomentar un afrontamiento positivo a la enfermedad. Vol. 10, Ajayu Órgano de Difusión Científica del Departamento de Psicología UCBSP. scielobo; 2012. p. 84–100.
35. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res Social Adm Pharm. 2019 Feb;15(2):214–21.
36. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006 Oct;29(5):489–97.
37. Polit DF, Beck CT, Owen S V. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007 Aug;30(4):459–67.
38. Hively W. Introduction to domain-referenced testing. Educ Technol. 1974;14(6):5–10.
39. Gable RK, Wolf MB, Hively W. Instrument Development in the Affective Domain [Internet]. Vol. 14, Educational Technology. Dordrecht: Springer Netherlands; 1993. 285 p. Available from: http://link.springer.com/10.1007/978-94-011-1400-4
40. Ware JEJ. Standards for validating health measures: definition and content. J Chronic Dis. 1987;40(6):473–80.
41. Poll JB, Smith TB. The Spiritual Self: Toward a Conceptualization of Spiritual Identity Development. J Psychol Theol [Internet]. 2003 Jun 1;31(2):129–42. Available from: https://doi.org/10.1177/009164710303100204
42. Torralba Rosello F. Necesidades Espirituales del ser humano. Cuestiones preliminares. Labor hospitalaria; 2003. 271 p.
43. Jomain C. Morir en la ternura: vivir el último instante [Internet]. Ediciones Paulinas; 1987. (Biblioteca hospitalaria). Available from:
https://books.google.com.co/books?id=dlETAAAACAAJ
44. Care WHOEC on CPR and AS, Organization WH. Cancer pain relief and palliative care : report of a WHO expert committee [meeting held in Geneva from 3 to 10 July 1989] [Internet]. Geneva PP - Geneva: World Health Organization; 1990. (World Health Organization technical report series ; no. 804). Available from: https://apps.who.int/iris/handle/10665/39524
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46. Zohar D, Marshall IN. Sq - Spiritual Intelligence: The Ultimate Intelligence. In 1999.
47. FRANKL VE. El hombre en busca del sentido. 6a. ed. BARCELONA: HERDER; 1985.
48. Willis G. Cognitive Interviewing. 2013.
49. Guadagnoli E, Velicer WF. Relation of sample size to the stability of component patterns. Psychol Bull. 1988 Mar;103(2):265–75.
50. Comrey AL. Factor-analytic methods of scale development in personality and clinical psychology. Vol. 56, Journal of Consulting and Clinical Psychology. US: American Psychological Association; 1988. p. 754–61.
51. Revelle W. psych: Procedures for Psychological, Psychometric, and Personality Research. [Internet]. Evanston, Illinois; 2022. Available from: https://cran.r-project.org/package=psych
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53. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2020.
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57. Kaiser HF. An index of factorial simplicity. Psychometrika [Internet]. 1974;39(1):31–6. Available from: https://doi.org/10.1007/BF02291575
58. Manuel Batista-Foguet J, Coenders G, Alonso J. Análisis factorial confirmatorio. Su utilidad en la validación de cuestionarios relacionados con la salud. Med Clin (Barc) [Internet]. 2004;122:21–7. Available from: https://www.elsevier.es/es-revista-medicina-clinica-2-articulo-analisis-factorial-confirmatorio-su-utilidad-13057542
59. Streiner DL. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry. 1994 Apr;39(3):135–40.
60. Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997 Jun;68(3):532–60.
61. Wong CL, Chu H-E, Yap KC. A Framework for Defining Scientific Concepts in Science Education. Asia-Pacific Sci Educ [Internet]. 2020;6(2):615–44. Available from:
https://brill.com/view/journals/apse/6/2/article-p615_15.xml
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63. Sisto A, Vicinanza F, Campanozzi LL, Ricci G, Tartaglini D, Tambone V. Towards a Transversal Definition of Psychological Resilience: A Literature Review. Medicina (Kaunas). 2019 Nov;55(11).
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Rodríguez Gómez, J. C. (2023). La importancia de la diversidad y la inclusión en el ámbito educativo. Estudios Y Perspectivas Revista Científica Y Académica , 3(2), 16-47. https://doi.org/10.61384/r.c.a.v3i2.30
Acosta Silva, S., & Paredes Cruz, I. (2022). Prevención y tratamiento de la litiasis renal: Medidas dietéticas y farmacológicas. Revista Científica De Salud Y Desarrollo Humano, 3(1), 148-170. https://doi.org/10.61368/r.s.d.h.v3i1.50
Naranjo , F. (2023). Diplomado sobre la transformación digital empresarial: reduciendo las brechas digitales. Emergentes - Revista Científica, 3(2), 56-69. https://doi.org/10.60112/erc.v3i2.33
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2. VanderWeele TJ, Balboni TA, Koh HK. Health and Spirituality. JAMA. 2017 Aug;318(6):519–20.
3. Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin Proc. 2001 Dec;76(12):1225–35.
4. Peteet JR, Balboni MJ. Spirituality and religion in oncology. CA Cancer J Clin. 2013;63(4):280–9.
5. Rohde G, Kersten C, Vistad I, Mesel T. Spiritual Well-being in Patients With Metastatic Colorectal Cancer Receiving Noncurative Chemotherapy: A Qualitative Study. Cancer Nurs [Internet]. 2017;40(3):209–16. Available from: https://pubmed.ncbi.nlm.nih.gov/27101099
6. Vallurupalli M, Lauderdale K, Balboni MJ, Phelps AC, Block SD, Ng AK, et al. The role of spirituality and religious coping in the quality of life of patients with advanced cancer receiving palliative radiation therapy. J Support Oncol. 2012;10(2):81–7.
7. Weber SR, Pargament KI. The role of religion and spirituality in mental health. Curr Opin Psychiatry. 2014 Sep;27(5):358–63.
8. de Oliveira Maraldi E. Response Bias in Research on Religion, Spirituality and Mental Health: A Critical Review of the Literature and Methodological Recommendations. J Relig Health. 2020 Apr;59(2):772–83.
9. Murgia C, Notarnicola I, Rocco G, Stievano A. Spirituality in nursing: A concept analysis. Nurs Ethics. 2020 Aug;27(5):1327–43.
10. King JE, Crowther MR. The measurement of religiosity and spirituality. J Organ Chang Manag [Internet]. 2004 Jan 1;17(1):83–101. Available from:
https://doi.org/10.1108/09534810410511314
11. de Jager Meezenbroek E, Garssen B, van den Berg M, van Dierendonck D, Visser A, Schaufeli WB. Measuring spirituality as a universal human experience: a review of spirituality questionnaires. J Relig Health. 2012 Jun;51(2):336–54.
12. Garssen B, Visser A. Distinguishing spirituality from other constructs: commentary on Lindeman et al. Vol. 202, The Journal of nervous and mental disease. United States; 2014. p. 177.
13. Lindeman M, Blomqvist S, Takada M. Distinguishing spirituality from other constructs: not a matter of well-being but of belief in supernatural spirits. J Nerv Ment Dis. 2012 Feb;200(2):167–73.
14. Gall TL, Malette J, Guirguis-Younger M. Spirituality and Religiousness: A Diversity of Definitions. J Spiritual Ment Heal [Internet]. 2011 Jul 1;13(3):158–81. Available from: https://doi.org/10.1080/19349637.2011.593404
15. de Brito Sena MA, Damiano RF, Lucchetti G, Peres MFP. Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework. Vol. 12, Frontiers in psychology. 2021. p. 756080.
16. Orden Hospitalaria San Juan de Dios. La pastoral según el estilo de San Juan de Dios. Colombia; 2012. 240 p.
17. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front public Heal. 2018;6:149.
18. Ministerio de Salud. Resolución 8430 de 1993. Ministerio de Salud y Protección Social, República de Colombia BOGOTA: MINISTERIO DE SALUD Y PROTECCION SOCIAL; 1993 p. 1–19.
19. Quiceno JM, Vinaccia S. La salud en el marco de la psicología de la religión y la espiritualidad . Vol. 5, Diversitas: Perspectivas en Psicología . scieloco ; 2009. p. 321–36.
20. Sarrazin Martínez JP. La relación entre religión, espiritualidad y salud: una revisión crítica desde las ciencias sociales. Hallazgos [Internet]. 2021 Jun 17; Available from:
https://revistas.usantotomas.edu.co/index.php/hallazgos/article/view/5232
21. Navas C, Hyxia V. Spirituality and health. Rev Ciencias la Educ. 2006;1(27):29–45.
22. Lavorato Neto G, Rodrigues L, Silva DAR da, Turato ER, Campos CJG. Spirituality review on mental health and psychiatric nursing. Rev Bras Enferm. 2018;71(suppl 5):2323–33.
23. Cook CCH. Addiction and spirituality. Addiction. 2004 May;99(5):539–51.
24. Florczak KL. Gathering information on spirituality: from whose perspective? Nurs Sci Q. 2010 Jul;23(3):201–5.
25. Paul Victor CG, Treschuk J V. Critical Literature Review on the Definition Clarity of the Concept of Faith, Religion, and Spirituality. J Holist Nurs Off J Am Holist Nurses’ Assoc. 2020 Mar;38(1):107–13.
26. Mytko JJ, Knight SJ. Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psychooncology. 1999;8(5):439–50.
27. Hers M-A. Pre Columbian Art, de Lee A. Parsons. An del Inst Investig Estéticas [Internet]. 1983 Aug 6;13(52 SE-Notas bibliográficas). Available from:
http://www.analesiie.unam.mx/index.php/analesiie/article/view/1196
28. Piedmont RL, Friedman PH. Spirituality, religiosity, and subjective quality of life. In: Handbook of social indicators and quality of life research. Springer; 2012. p. 313–29.
29. Cobb MR, Puchalski CM, Rumbold B. Oxford Textbook of Spirituality in Healthcare [Internet]. Oxford, UK: Oxford University Press; 2012. Available from:
https://oxfordmedicine.com/view/10.1093/med/9780199571390.001.0001/med-9780199571390
30. Nolan S, Saltmarsh P, Leget CJW. Spiritual care in palliative care : Working towards an EAPC task force. Eur J Palliat Care. 2011;86–9.
31. Weathers E, McCarthy G, Coffey A. Concept Analysis of Spirituality: An Evolutionary Approach. Nurs Forum. 2016 Apr;51(2):79–96.
32. Clark M, Emerson A. Spirituality in Psychiatric Nursing: A Concept Analysis. J Am Psychiatr Nurses Assoc. 2021;27(1):22–32.
33. Shek DTL. Spirituality as a positive youth development construct: a conceptual review. ScientificWorldJournal. 2012;2012:458953.
34. Núñez P, Enríquez D, Irarrázaval ME. La espiritualidad en el paciente oncológico: Una forma de nutrir la esperanza y fomentar un afrontamiento positivo a la enfermedad. Vol. 10, Ajayu Órgano de Difusión Científica del Departamento de Psicología UCBSP. scielobo; 2012. p. 84–100.
35. Almanasreh E, Moles R, Chen TF. Evaluation of methods used for estimating content validity. Res Social Adm Pharm. 2019 Feb;15(2):214–21.
36. Polit DF, Beck CT. The content validity index: are you sure you know what’s being reported? Critique and recommendations. Res Nurs Health. 2006 Oct;29(5):489–97.
37. Polit DF, Beck CT, Owen S V. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007 Aug;30(4):459–67.
38. Hively W. Introduction to domain-referenced testing. Educ Technol. 1974;14(6):5–10.
39. Gable RK, Wolf MB, Hively W. Instrument Development in the Affective Domain [Internet]. Vol. 14, Educational Technology. Dordrecht: Springer Netherlands; 1993. 285 p. Available from: http://link.springer.com/10.1007/978-94-011-1400-4
40. Ware JEJ. Standards for validating health measures: definition and content. J Chronic Dis. 1987;40(6):473–80.
41. Poll JB, Smith TB. The Spiritual Self: Toward a Conceptualization of Spiritual Identity Development. J Psychol Theol [Internet]. 2003 Jun 1;31(2):129–42. Available from: https://doi.org/10.1177/009164710303100204
42. Torralba Rosello F. Necesidades Espirituales del ser humano. Cuestiones preliminares. Labor hospitalaria; 2003. 271 p.
43. Jomain C. Morir en la ternura: vivir el último instante [Internet]. Ediciones Paulinas; 1987. (Biblioteca hospitalaria). Available from:
https://books.google.com.co/books?id=dlETAAAACAAJ
44. Care WHOEC on CPR and AS, Organization WH. Cancer pain relief and palliative care : report of a WHO expert committee [meeting held in Geneva from 3 to 10 July 1989] [Internet]. Geneva PP - Geneva: World Health Organization; 1990. (World Health Organization technical report series ; no. 804). Available from: https://apps.who.int/iris/handle/10665/39524
45. James W. The self. In: Gordon C, Gergen K., editors. The self in social interaction. New York: J.Willey & Sons; 1968. p. 41–9.
46. Zohar D, Marshall IN. Sq - Spiritual Intelligence: The Ultimate Intelligence. In 1999.
47. FRANKL VE. El hombre en busca del sentido. 6a. ed. BARCELONA: HERDER; 1985.
48. Willis G. Cognitive Interviewing. 2013.
49. Guadagnoli E, Velicer WF. Relation of sample size to the stability of component patterns. Psychol Bull. 1988 Mar;103(2):265–75.
50. Comrey AL. Factor-analytic methods of scale development in personality and clinical psychology. Vol. 56, Journal of Consulting and Clinical Psychology. US: American Psychological Association; 1988. p. 754–61.
51. Revelle W. psych: Procedures for Psychological, Psychometric, and Personality Research. [Internet]. Evanston, Illinois; 2022. Available from: https://cran.r-project.org/package=psych
52. Fox J, Dusa A. polycor: Polychoric and Polyserial Correlations [Internet]. 2022. Available from: https://r-forge.r-project.org/projects/polycor/
53. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2020.
54. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika [Internet]. 1951;16(3):297–334. Available from: https://doi.org/10.1007/BF02310555
55. McDonald RP. The theoretical foundations of principal factor analysis, canonical factor analysis, and alpha factor analysis. Br J Math Stat Psychol. 1970;23(1):1–21.
56. Lévy Mangin JP, González N. Modelización y Causalidad. In: Lévy Mangin JP, Varela Mallou J, editors. Modelización con estructuras de covarianzas en ciencias sociales. Coruña: Netbiblo; 2006. p. 155–75.
57. Kaiser HF. An index of factorial simplicity. Psychometrika [Internet]. 1974;39(1):31–6. Available from: https://doi.org/10.1007/BF02291575
58. Manuel Batista-Foguet J, Coenders G, Alonso J. Análisis factorial confirmatorio. Su utilidad en la validación de cuestionarios relacionados con la salud. Med Clin (Barc) [Internet]. 2004;122:21–7. Available from: https://www.elsevier.es/es-revista-medicina-clinica-2-articulo-analisis-factorial-confirmatorio-su-utilidad-13057542
59. Streiner DL. Figuring out factors: the use and misuse of factor analysis. Can J Psychiatry. 1994 Apr;39(3):135–40.
60. Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997 Jun;68(3):532–60.
61. Wong CL, Chu H-E, Yap KC. A Framework for Defining Scientific Concepts in Science Education. Asia-Pacific Sci Educ [Internet]. 2020;6(2):615–44. Available from:
https://brill.com/view/journals/apse/6/2/article-p615_15.xml
62. Allport GW, Ross JM. Personal religious orientation and prejudice. Vol. 5, Journal of Personality and Social Psychology. US: American Psychological Association; 1967. p. 432–43.
63. Sisto A, Vicinanza F, Campanozzi LL, Ricci G, Tartaglini D, Tambone V. Towards a Transversal Definition of Psychological Resilience: A Literature Review. Medicina (Kaunas). 2019 Nov;55(11).
64. Galderisi S, Heinz A, Kastrup M, Beezhold J, Sartorius N. A proposed new definition of mental health. Psychiatr Pol. 2017 Jun;51(3):407–11.
65. World Health Organization (WHO). Promoting mental health: concepts, emerging evidence, practice. Geneva, Switzerland; 2004.
66. Manwell LA, Barbic SP, Roberts K, Durisko Z, Lee C, Ware E, et al. What is mental health? Evidence towards a new definition from a mixed methods multidisciplinary international survey. BMJ Open. 2015 Jun;5(6):e007079.
67. BEGIN AWTO. ARCHIVED-The Human Face of Mental Health and Mental Illness in Canada 2006.
Rodríguez Gómez, J. C. (2023). La importancia de la diversidad y la inclusión en el ámbito educativo. Estudios Y Perspectivas Revista Científica Y Académica , 3(2), 16-47. https://doi.org/10.61384/r.c.a.v3i2.30
Acosta Silva, S., & Paredes Cruz, I. (2022). Prevención y tratamiento de la litiasis renal: Medidas dietéticas y farmacológicas. Revista Científica De Salud Y Desarrollo Humano, 3(1), 148-170. https://doi.org/10.61368/r.s.d.h.v3i1.50
Naranjo , F. (2023). Diplomado sobre la transformación digital empresarial: reduciendo las brechas digitales. Emergentes - Revista Científica, 3(2), 56-69. https://doi.org/10.60112/erc.v3i2.33
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Publicado
2024-04-02
Cómo citar
García Granada, J. M., & Castaño Ramirez, O. M. (2024). Desarrollo y Validación de una Escala de Espiritualidad para uso en Servicios de Salud Mental. Ciencia Latina Revista Científica Multidisciplinar, 8(1), 8970-8986. https://doi.org/10.37811/cl_rcm.v8i1.10220
Número
Sección
Ciencias de la Salud
Derechos de autor 2024 Juan Manuel García Granada, Oscar Mauricio Castaño Ramirez
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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