A relational model for spiritually-sensitive hospice care.
ABSTRACT When faced with terminal illness, it is natural for hospice patients to question the meaning of life. Hospice workers need to have the ability to assist patients in dealing with these questions in case patients need their assistance. Helping patients deal with questions about life meaning is associated with spiritual care. The following article presents a qualitative study on the provision of spiritual care by hospice workers. The results are used to inform a relational model for spiritually-sensitive hospice care that demonstrates how a variety of individual factors have the potential to influence the delivery of spiritual care.
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ABSTRACT: To identify dying patients' definitions of spirituality and their spiritual needs. Descriptive, qualitative. Participants' places of residence. 19 hospice patients (10 females and 9 males), mean age 72, with a range of length of time as a hospice patient of 2 weeks to 12 months. Semistructured interviews were conducted. Interview transcripts and field notes were analyzed to reduce data into codes and themes. Data were coded by extracting verbatim phrases used to describe spirituality and spiritual needs. Themes emerged from the data as commonalities among the codes developed. Meaning of "spiritual" and perceived spiritual needs. Participants initially defined spiritual as relating to God or religion; however, as interviews progressed, it was apparent that their spirituality was a part of their total existence. Twenty-nine unique spiritual needs were identified and grouped into six themes: need for religion, need for companionship, need for involvement and control, need to finish business, need to experience nature, and need for positive outlook. Participants perceived spirituality as a broad concept that may or may not involve religion. Spiritual needs were likewise broad in scope and were linked closely to purpose and meaning in life. Spiritual care of dying patients is within the scope of nursing practice. Spiritual needs are quite varied and encompass more than religion. If nurses are to enhance the quality of life of dying patients, spiritual needs must be addressed.Oncology nursing forum 01/2001; 28(1):67-72. · 2.83 Impact Factor
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ABSTRACT: The importance of the 'therapeutic alliance' has long been recognized in psychotherapeutic theory and research, but is also increasingly researched in psychiatry. This paper examines the clinical and empirical literature on the alliance and asks, first, whether the concept is unrecognizably distorted when it travels from the psychoanalytic context to other therapies and to psychiatry, or when translated into research instruments; and, second, how we are to understand the apparent anomaly whereby its proponents have defined it as a 'vehicle' for treatment rather than curative, whereas quantitative research increasingly associates it with outcome. This paper reviews the evolution of the concept in clinical theory, traces the development of empirical research on the subject and considers its use in psychiatry. It argues that the empirical research misleadingly suggests a curative paradigm, and that it may be unable to illuminate some of the clinical controversies, although its implications for theory demand consideration. It argues for the retention of the alliance concept in psychiatry distinct from the broader spectrum of the 'relationship'. Finally, it argues that the debate about the concept's curative properties may, paradoxically, be more pressing within psychotherapy than psychiatry, and endorses calls for more theoretically driven empirical research into the alliance.Psychology and Psychotherapy Theory Research and Practice 07/2004; 77(Pt 2):255-72. DOI:10.1348/147608304323112528 · 1.82 Impact Factor
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ABSTRACT: Citizens have conveyed to professionals that care at the end of life is less than optimal. Efforts to improve matters have tended to work in piecemeal fashion, on tangible more than personal aspects of care, and without the benefit of documented perspectives of those who face dying. Policy initiatives and clinical interventions need guidance from a broad framework that is validated by patients' perspectives. Our goals were to: (1) assess the construct validity and stability over time of the portions of a conceptual framework that concern patients' subjective experiences; (2) develop a foundation for measurement of these personally meaningful factors; and (3) examine these factors' associations for potential clinical or policy significance. Patients were from six diverse geographical areas whose physicians judged their survival prognosis to be 6 months or less. Physicians who referred the patients were randomly selected from state and specialty association lists. We used in-person survey methodology and multivariate analysis of patient responses. The analysis fell into two parts. Using exploratory factor analysis, we looked for evidence of discrete dimensions of experiences. Using regression analysis, we examined associations among them. Of 1,131 eligible patients, 988 were interviewed (87.4% response rate). Of 682 patients who survived to follow-up interview 4-6 months later, 650 were interviewed (95.3% response rate). Exploratory factor analysis identified 12 discrete factors (accounting for 55% of variance; maximum Spearman's p = 0.24), 8 of which met criteria for representing measurable dimensions (accounting for 46% of variance). These 8 were: patient-clinician relationship; social connectedness; caregiving needs; psychological distress; spirituality/religiousness; personal acceptance; sense of purpose; and clinician communication. Eigenvalues ranged from 1.45 to 6.30 and Cronbach's alpha from 0.63 to 0.85. The concordance between these dimensions and those in the proposed framework indicated that two dimensions required minor modifications and six were confirmed, providing evidence of good construct validity for this portion of the framework. The same dimensions were also evident at follow-up except that the first two above-listed loaded on one combined factor, clinician interaction (eigenvalues 1.83-7.92; Cronbach's alpha from 0.64 to 0.86). This provides evidence of the construct's stability over time. Clinical communication and patient-clinician relationship were associated (odds ratio [OR] 2.79, 2.31-3.36). Better clinician communication correlated with somewhat better personal acceptance (OR 1.10,1.02-1.19), and a better patient-clinician relationship correlated with less psychological distress (OR 0.84, 0.75-0.95). We conclude that: (1) Personally meaningful aspects of patients' experience of terminal illness can be represented in valid, multidimensional constructs that are stable over time; (2) They are measurable; and (3) Aspects of the therapeutic relationship appear to correlate with patients' experience of the dying process.Journal of Palliative Medicine 02/2000; 3(4):419-31. DOI:10.1089/jpm.2000.3.4.419 · 2.06 Impact Factor