Sound Heart Spiritual Combined With Dhikr for Patients With Heart Failure

Effects of the Sound Heart Spiritual Intervention Combined With Dhikr (SHS-Zikir) on Spiritual Well-Being, Fatigue, and Quality of Life in Patients With Heart Failure

Heart failure can cause persistent fatigue, impaired quality of life, and spiritual distress. This interventional study will evaluate a 12-week Sound Heart Spiritual intervention combined with dhikr (SHS-Zikir) among Muslim adults with New York Heart Association functional class II or III heart failure at RSUD Kota Kendari, Indonesia. SHS-Zikir integrates structured spiritual nursing care with Islamic remembrance practices to strengthen the participant's relationship with Allah, self, other people, and the environment. The program includes guided sessions, education, home practice, family support, and daily monitoring. Spiritual well-being, fatigue, and quality of life will be assessed at baseline and at the end of the program. The findings will indicate whether SHS-Zikir can support holistic nursing care for people living with heart failure.

The SHS-Zikir intervention is based on the Sound Heart Spiritual model and integrates structured spiritual nursing care with Islamic dhikr. The intervention addresses four dimensions of spiritual relationships: the relationship with Allah, the relationship with oneself, relationships with other people, and the relationship with the environment.

The intervention is delivered over 12 weeks. Week 1 includes participant orientation, informed consent, education about SHS-Zikir, and baseline assessment of spiritual well-being, fatigue, and quality of life. During Weeks 2 through 7, participants receive structured facilitator-guided sessions addressing tauhid, tawakkal, husnuzan, the meaning of illness, gratitude, forgiveness, prayer, Qur'an recitation or listening, dhikr, family support, and appropriate self-care. During Weeks 8 through 11, participants continue independent SHS-Zikir practice at home with support and monitoring from a family member. Home activities are documented using a daily monitoring form. Week 12 includes the final assessment of spiritual well-being, fatigue, and quality of life.

The study will examine changes in participants' spiritual well-being, fatigue, and quality of life following completion of the SHS-Zikir program. The study is expected to provide evidence regarding the use of culturally and religiously appropriate spiritual nursing care for Muslim patients living with heart failure.

Inclusion Criteria:

• Aged 23 to 69 years.
• Muslim.
• Regularly performs obligatory Islamic worship according to their health condition.
• Diagnosed with heart failure classified as New York Heart Association functional class II or III.
• Heart failure primarily attributable to coronary artery disease or hypertension, as documented in the medical record and confirmed by the treating physician.
• Receives outpatient care at the cardiology clinic of Bahteramas Regional General Hospital or Kendari City Regional General Hospital.
• Willing and able to participate in the study and provide informed consent.

Exclusion Criteria:

• Acute decompensated heart failure at the time of recruitment.
• Acute stroke at the time of recruitment.
• Diabetes mellitus.
• Renal failure.
• Verbal communication impairment that prevents participation in the intervention or completion of study assessments.
• Hearing impairment that prevents participation in the intervention.
• A diagnosed mental disorder that prevents informed participation or completion of the intervention.