Sound Heart Spiritual Combined With Dhikr for Patients 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.