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Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study: centrality of spirituality in palliative care

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Abstract

Experiencing life-threatening illness could impact on an individual’s spirituality or religious beliefs. In this paper, we report on a study which explored cultural elements that influence the provision of palliative care for people with cancer. A contemporary ethnographic approach was adopted. Observations and interviews were undertaken over 3 months with 48 participants, including palliative care staff, patients, and their families. An ethnographic data analysis framework was adopted to assist in the analysis of data at item, pattern, and structural levels. Religion was identified as central to everyday life, with all participants reporting being affiliated to particular religions and performing their religious practices in their daily lives. Patients’ relatives acknowledged and addressed patients’ needs for these practices. Staff provided spiritual care for the patients and their relatives in the form of religious discussion and conducting prayers together. An understanding that religious and spiritual practices are integral cultural elements and of fundamental importance to the holistic health of their patients is necessary if health-care professionals are to support patients and their families in end-of-life care.

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... 4,5 Thus, family caregiving is perceived as obligatory due to cultural norms, 6 including moral duty, reciprocal responsibility, 6,7 and religious obligation. 8,9 On top of this, lack of alternatives, due to inadequate health care services, 10 leave the family with no option but to be profoundly involved in providing care. ...
... 45,49,52 Religion has a central role in everyday life for many Indonesian people. 8 Our study revealed that caregivers pray more intensively and more frequently than they did before, which confirms previous findings that religion and spirituality are used as a coping mechanism. 8,47,48 In fact, those who use positive religious coping reported higher caregiver satisfaction than those who did not use such coping. ...
... 8 Our study revealed that caregivers pray more intensively and more frequently than they did before, which confirms previous findings that religion and spirituality are used as a coping mechanism. 8,47,48 In fact, those who use positive religious coping reported higher caregiver satisfaction than those who did not use such coping. 48 ...
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Background: Strong family bonds are part of the Indonesian culture. Family members of patients with cancer are intensively involved in caring, also in hospitals. This is considered "normal": a societal and religious obligation. The values underpinning this might influence families' perception of it. Aim: To explore and model experiences of family caregivers of patients with cancer in Indonesia in performing caregiving tasks. Design: A grounded theory approach was applied. The constant comparative method was used for data analysis and a paradigm scheme was employed for developing a theoretical model. Setting/participants: The study was conducted in three hospitals in Indonesia. The participants were family caregivers of patients with cancer. Results: A total of 24 family caregivers participated. "Belief in caregiving" appeared to be the core phenomenon. This reflects the caregivers' conviction that providing care is an important value, which becomes the will power and source of their strength. It is a combination of spiritual and religious, value and motivation to care, and is influenced by contextual factors. It influences actions: coping mechanisms, sharing tasks, and making sacrifices. Social support influences the process of the core phenomenon and the actions of the caregivers. Both positive and negative experiences were identified. Conclusion: We developed a model of family caregivers' experiences from a country where caregiving is deeply rooted in religion and culture. The model might also be useful in other cultural contexts. Our model shows that the spiritual domain, not only for the patient but also for the family caregivers, should be structurally addressed by professional caregivers.
... The multidiscipline collaboration in contemporary psychiatric services has seen SR being included more often as part of a holistic care approach (Ramakrishnan et al. 2015). This approach emphasises the wholeness and multidimensional needs of clients and their families (Rochmawati et al. 2018). In this approach, the interrelation of a client's mind, body and spirit is recognised by acknowledging biopsycho-spirit-sociocultural factors that influence a client's condition (Brown et al. 2013;Suryani et al. 2011). ...
... In this approach, the interrelation of a client's mind, body and spirit is recognised by acknowledging biopsycho-spirit-sociocultural factors that influence a client's condition (Brown et al. 2013;Suryani et al. 2011). Previous studies found that addressing or integrating SR into mental health services had significantly increased clients' coping skills, resilience, and well-being (Chaudhry 2008;Kalra et al. 2015) and helped clients with post-traumatic stress disorder in renewing hope and re-finding life purposes (Harris et al. 2016;Rochmawati et al. 2018). ...
... Indonesia is unique because it is neither a secular nor a religious nation, represented by the nation's official "Five Founding Principles" (known as the Pancasila); the first of which states that Indonesia is founded on the "belief in one supreme God" ("Ketuhanan Yang Maha Esa") (Ropi 2017). Additionally, there are six recognised religions and more than 100 aliran kepercayaan (traditional faith) in Indonesia, though the population is predominately (87%) Muslim (Rochmawati et al. 2018). However, the percentage of population depends on the local culture and area; for instance, in Bali more than 83% adhere to Balinese Hinduism which differs from Hinduism in India (Suryani et al. 2011). ...
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This study aimed to explore how Indonesian clinical psychologists (CPs) address aspects of spirituality and religion (SR), particularly their attitudes towards and experience of it, on the mental health context. Semi-structured interviews were conducted with 43 CPs in public health centres in Yogyakarta Province, Indonesia. Data were analysed using deductive thematic analysis and they generated ten sub-themes which were merged into three central themes. The first theme was experiences related to SR, particularly in Indonesian sociocultural context. The second theme concentrated on participants’ clinical experience related to SR integration into clinical practice. The last theme highlighted the effort made by participants to create holistic mental health services. The originality of this study was represented by the interview quote in the title, “Doing my profession is also part of worship”. It was found that SR is part of culture and belief among Indonesian people, including CPs and mental health treatment clients. In summary, participants genuinely acknowledged that they were not able to completely detach SR from their professional practice. However, participants also pointed out that they were different with spiritual–religious healers (SRHs) and favourably welcomed future collaboration with credible SRHs. This positive attitude embodied a holistic care approach that recognises the diverse biopsycho-social-spiritual needs of clients. Therefore, professional organisations and psychology faculties should establish regulations and education of SR in psychology curricula and conventional psychotherapy to achieve this holistic mental health services in Indonesia.
... Method and technique of data collection: one study refers to ethnography as a 'research approach,' whereas the rest of the studies discuss the ethnographic method [11]. One study combines two methods [positive organization's scholarship in healthcare (POSH) and video-reflexive ethnography (VRE)] [12 && ], two use video-reflexive ethnography [13,14] and one study designates focused ethnography as its main method [15]. ...
... One study combines two methods [positive organization's scholarship in healthcare (POSH) and video-reflexive ethnography (VRE)] [12 && ], two use video-reflexive ethnography [13,14] and one study designates focused ethnography as its main method [15]. The remaining studies are classic or contemporary ethnographies that use interviews (open and in-depth) [11,[13][14][15][16][17][18][19][20][21], participant observation [17,18,[21][22][23] and field notes [13,14,16,19,22,24]. ...
... The studies recommend that, whenever possible, another researcher must be included, and the triangulation of data collection techniques should be implemented. [19,22], delirium [18,20], death or the process of dying [16,23], spirituality and religious practices [11], patient safety [13] and neonatal care [15]. There are cross-cutting research features between these topics. ...
Purpose of review Qualitative research in the field of palliative care allows for a crucial study of the final stage of life from a social point of view and cultural perspective. This review evaluates the advantages and challenges of applying an ethnographic approach to palliative care research. Recent findings Thirteen ethnographic articles on the subject of organization or quality of care, decision-making, delirium, death, and the process of dying, were reviewed. Most studies use interviews, participant observation, and field notes as their primary data collection techniques. In ethnographic research, cultural issues, relationships and interactions of a group, the meanings and perceptions of the participants, the communication process, and the use of language in a particular and natural context were analyzed. Data collection and information analysis took an average of 14 months in the included studies. Summary The ethnographic method, applied with rigor, is valuable in the analysis of a real phenomenon if the particular context in which the study developed is well defined. With an ethnographic approach, researchers can uncover cultural nuances that evidence different realities.
... Kebutuhan spiritual meningkat pada pasien paliatif sehingga keluarga menyediakan sendiri peralatan yang dibutuhkan seperti kitab suci atau perlengkapan ibadah (Rochmawati et al., 2018). Pada layanan perawatan paliatif yang diberikan oleh organisasi non-profit, aspek spiritual saling mendukung antara pasien, keluarga, dan tim paliatif. ...
... Masyarakat Indonesia memandang agama sebagai kebutuhan yang sangat penting dalam sepanjang kehidupan dan akan meningkat ketika seorang individu mengidap suatu penyakit. Pemahaman terhadap religiusitas dan praktik spiritual merupakan elemen yang integral dengan budaya dan menjadi dasar penting yang dibutuhkan dalam memberikan pelayanan kesehatan yang holistik (Rochmawati et al., 2018). ...
... Profesional kesehatan dalam perawatan paliatif dengan prespektif dan praktik spiritual yang kuat berdampak dalam pemenuhan kebutuhan spiritual pasien karena akan membantu memfasilitasi atau dapat berperan sebagai konselor spiritual (Rochmawati et al., 2018). Namun, apabila profesional kesehatan tidak memiliki nilai spiritual yang cukup, akan menjadi hambatan dalam perawatan paliatif karena profesional tersebut akan mengalami kesulitan dalam memfasilitasi kebutuhan spiritual pasien. ...
... Aging appeared to be more common for both patients and caregivers and this is true because they see it is common in elderly people. However, they do not know at which age does it normally happen and also distinguish between what is normal forgetfulness and the abnormal one or the extent to which someone is termed to have a disease (16)(17)(18)(19) while others attribute it to witchcraft and this could explain why most of caregivers and patients do not take the disease to be a medical condition and instead they seek other ways of care like spiritual healing and traditional care (17,19,20) ...
... This is proven in another study where it was found out that basically people lack specific information and treatment about the condition (21). Surprisingly most patients were contrary to their caregivers they think probably medical treatment could be of more relief or alternatively spiritual consecration that is believing and trusting the almighty God though prayers and being laid of hands upon them by the spiritual elders of which they could be church leaders (20). ...
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Background In the treatment and safe service delivery of each disease, it is very important to understand the perceptions of caregivers and patients where they are not well understood because different cultures, regions and ethnicities have different ways how they understand the concept therefore this study aimed at understanding how patients and caregivers perceive Alzheimer’s and related dementias and their coping strategies in south western Uganda. Methods A qualitative cross sectional study was conducted using purposive sampling and 18 and 12 caregivers and patients were recruited respectively where in-depth interviews were conducted and data was analyzed using ATLAS Ti software. Results Five broad themes were used from Kleinmans explanatory model from both 2 objectives which included perceived identity, causes, treatment, effects and coping strategies. Participants had different views about each category. A big number was able to identify the disease as forgetfulness and the perceived causes included physical, psychological, and witch craft and most of caregivers continued to say that this disease does not need treatment since the most cause of it is aging which is a natural process while treatment was only sought secondary after going to the health facility for another cause/disease. The effects on caregivers include strain financial constraint, poor health while patients complained of non-productivity, psychological/emotional torture and lack of independence. In the instance of coping strategies more caregivers had options of seeking help from relatives, community based organizations (CBO) while some had no option but to just believe God. Conclusion Study findings reveal that caregivers and patients of Alzheimer’s and related dementias have both positive and negative perceptions. The negative perceptions lie more on treatment options and these may affect service delivery and reduce patient’s life span when the right treatment is not thought. Therefore continuous community sensitization about the disease is needed more.
... Across cultures, spirituality and religion continue to play an essential role in medical healing, especially when patients face the crisis of advanced illnesses towards the end of life [43]. A study in Southeast Asia [44], specifically Indonesia, supported spirituality/religious aspects as a palliative care provision. They found a significant element in the Indonesian palliative care service and many different religions among the participants. ...
... They found a significant element in the Indonesian palliative care service and many different religions among the participants. All the participants in palliative services reported being affiliated with particular religions and performing their religious practices daily with much comfort [44]. For Myanmar, spirituality plays a crucial role in patients' treatment decisions, and faith-based spiritual techniques used by Buddha monks are standard in community services [45]. ...
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Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.
... been done (Fitriyani, Juniarto, & Utami, 2018;Rochmawati, Wiechula, & Cameron, 2018;Wessner, 2018), yet the focus is more on the family and religion in palliative care. Only one study was found to explore nurse's experience in carrying out EOLC in West Java (Safitri, Trisyani, & Iskandar, 2017) though its results remain inadequate to describe Indonesian critical nurses' experiences providing EOLC within broad literature. ...
... The positive effects of spiritual care have been reported (Chen, Lin, Yan, Wu, & Hu, 2018;Willemse et al., 2020;Zhang, Nilsson, & Prigerson, 2013). A recent ethnographic study in Indonesia found that spirituality/religiosity is very important in the daily lives of patients, family members and healthcare staff (Rochmawati et al., 2018). Even though spiritual care is viewed as an important dimension of end-of-life care, its implementation is still inadequate (Balboni et al., 2013). ...
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Background: Patients admitted to the intensive care unit (ICU) may face terminal illness situations, which may lead to death. In this case, the role of critical care nurses shifts from life-sustaining to end-of-life care (EOLC). Nurses’ involvement in EOLC varies between countries, even in one country due to differences in religion, culture, organization, laws, cases and patient quality. In Indonesia, research on EOLC in ICU has not been carried out. Purpose: This study aimed to explore the experiences of critical care nurses in providing EOLC. Methods: A qualitative study with a phenomenological approach was conducted. Ten critical care nurses having the experiences of caring for dying patients were recruited through a purposive sampling technique for in-depth interviews. Manual content analysis was used to identify themes. Results: The results of the study found five themes, including the challenge of communication with the family, support for the family, support for the patient, discussion and decision making, and nurses’ emotions. Conclusion: Most of EOLC provided by critical care nurses was focused on the family. They had some challenges in communication and decision making. Nurses need to get training and education about how to care for patients towards the end of life.
... In this context, culture and religion have a dominant effect on civil servants values. For palliative care services, the reciprocal spiritual/religious relationship influenced the well-being of patients (Rochmawati et al., 2018). In the non-western countries, public service ethos including both motivations and values (Rayner et al., 2011) is shaped by institutions in which an ethos is considerably affected by corruption issues, volatile and unsafe political dynamics, and capacity problems in the public sectors (Houston, 2014) ...
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The current issue on the capacity of government organisation in the world is how to solve a wicked problem. Wicked problems typically transcend organisational boundaries, administrative levels, and ministerial areas and elude obvious or easily defined solutions; involving multi-level, multi-actor and multi-sectoral challenges, uncertain and contested knowledge; and more complex, uncertain and ambiguous they are, the more ‘wicked’ they become such as social cohesion, climate change, unemployment, security, crime, homelessness, sustainable healthcare, poverty, and immigration (Lægreid and Rykkja, 2014)
... 2021;Ećimović, Lahajnar-Čavlović in Kompan 2009;Picollo in Fachini 2018). Holistični pristop v paliativni oskrbi je bistven, saj na ta način zagotavljamo zdravstveno varstvo večdimenzionalnih potreb bolnikov in njihovih družin (Rochmawati, Wiechula in Cameron 2018). Bistven in sestavni del tega pristopa je tudi duhovna oskrba. ...
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Ethical dilemmas in nursing are most pronounced in palliative and end-of-life care, where we meet the most demanding and complex needs of nursing care. The research discusses the importance of ethics, religion and spirituality in palliative care, from the perspective of three monotheistic religions and the emphasis on end-of-life ethical dilemmas and how religious beliefs can affect end-of-life medical care and nursing. The importance of ethics, religion and spirituality is presented in the research within three basic ethical principles, such as withholding and withdrawal of treatment, unjustified treatment and treatment with palliative sedation, and tried to justify its assessment in light of Jewish, Catholic and Islamic perspectives.
... It was found that the client's decision to visit a SRH was influenced 557 by complex sociocultural factors as is often found in psychiatric care in Asia(Chaudhry, 558 2008; Kalra et al., 2015). Additionally, the finding from this study supported the results of 559 another study into SR integration in palliative care in Indonesia that the family is often deeply 560 involved in a client's health treatment(Rochmawati et al., 2018). ...
Preprint
This study aimed to explore how Indonesian clinical psychologists (CPs) address aspects of spirituality and religion (SR), particularly their attitudes towards and experience of it, on the mental health context. Semi-structured interviews were conducted with 43 CPs in public health centres in Yogyakarta Province, Indonesia. Data were anyalsed using deductive thematic analysis and they generated ten sub-themes which were merged into three central themes. The first theme was experiences related to SR, particularly in Indonesian sociocultural context. The second theme concentrated on participants’ clinical experience related to SR integration into clinical practice. The last theme highlighted the effort made by participants to create holistic mental health services. The originality of this study was represented by the interview quote in the title, “Doing my profession is also part of worship”. It was found that SR is part of culture and belief among Indonesian people, including CPs and mental health treatment clients. In summary, participants genuinely acknowledged that they were not able to completely detach SR from their professional practice. However, participants also pointed out that they were different with spiritual-religious healers (SRHs) and favourably welcomed future collaboration with credible SRHs. This positive attitude embodied a holistic care approach that recognises the diverse biopsycho-social-spiritual needs of clients. Therefore, professional organisations and psychology faculties should establish regulations and education of SR in psychology curricula and conventional psychotherapy to achieve this holistic mental health services in Indonesia.
... A notable finding from our study was Spiritual and religious discussion. Interview data revealed a strong emphasis on this, and this is not surprising as a previous study found that spirituality and religion is a central part in Indonesian daily life and increasingly crucial in times of illness (Rochmawati et al. 2018). Patients and relatives expressed that they obtain religious advice from the nurses which helps them psychologically. ...
Article
Aim: The study aimed to illuminate the experiences of patients, relatives and nurses in an oncology setting by exploring communication in cancer care. Background : Like elsewhere in health settings, communication is a major component in cancer care and has an impact on patient’s outcome. However, nurse–patient/relatives communication is still recognized as an ongoing challenge. Evidence is lacking on the nurse–patient communication in Indonesia particularly in oncology settings. Method: The current study explored the lived experiences of patients, relatives and nursing regarding communication in an oncology setting at a private Islamic hospital. A phenomenological research design on the basis of the naturalistic paradigm was employed. The researchers purposely selected 16 participants and conducted semi‐structured interviews using an interview guide. Colaizzi’s naturalistic phenomenological approach was utilized to analyse the data. Result: Three themes emerged from the data: Building a compassionate relationship, Spiritual and religious discussion, Maintaining hope. Developing trust and providing empathy as well as showing genuineness are elements in building the compassionate relationship. The religious and spiritual discussion includes reminders to pray and increase self‐transcendence awareness. Patients and their relatives welcome such discussion. Maintaining hope is part of communication that can preserve positive feelings, goals and beliefs of patients and their families for their well‐being. Conclusion: Establishing compassionate relationship is the basis of communication in cancer care. Spiritual and religion, and hope are aspects that nurses and patients and their relatives discuss among themselves. These aspects may affect patient’s outcome and quality of care and require further research. Implication for nursing & health : Findings suggest that it is important to have communication during cancer care, which includes compassion, spiritual and religious aspect, and hope as it potentially enables patients and relatives to deal with their cancer journey. Our findings have implications for nursing practice, education and policy so that there is an integration of biopsychosocial, and spiritual and religious aspects in cancer communication.
... Religion is an inseparable thing in life for Indonesians [15]. Indonesia adopts monotheistic concept as the nation"s philosophy and allows religious freedom of the six officially recognized religions (Catholicism, Protestantism, Hinduism, Buddhism, Confucianism/Kong Hu Cu, and Islam) [16]. ...
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table width="593" border="1" cellspacing="0" cellpadding="0"> This study aimed to determine a relationship between religious affiliation, religiosity and health behaviors among high school students in Jakarta, Indonesia. This cross-sectional study was conducted in 9 high schools in Jakarta, Indonesia. A total of 767 respondents joined this study. A multivariate analysis was conducted to determine the associations between dependent and independent variables by adjusting age, sex, school type and economic status. Lower non-organized religious activity had a significant association with higher addictive behaviors (AOR: 0.577 95% CI: 0.340-0.979). In case of nutrition behaviors, there were no significant associations among all aspects of religiosity. Lower organized religious activity was associated with physical inactivity (AOR: 0.323 95% CI: 0.170-0.614). In addition, lower non-organized and intrinsic religiosity had significant association with lower personal hygiene behaviors (AOR= 0.433 95% CI: 0.272-0.688; AOR: 0.436 95% CI: 0.198-0.958). Students with higher religiosity tend to engage less in risky health behaviors. Religious leaders and organizations may be engaged in health promotion activities to disseminate and create better understanding of religious values and beliefs regarding health behaviors. </table
... Spirituality can contribute to reduce anxiety and support health protection by the power of faith [29,30]. Indonesia is unique because most of the population has a higher level of positive spirituality related to health conditions [31,32]. Improving the level of spirituality is potentially a valuable strategy to restrain mental illness [32], psychological impacts, post-traumatic stress disorder, and anxiety [33]. ...
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Background: Currently, the determinants of anxiety and its related factors in the general population affected by COVID-19 are poorly understood. We examined the effects of spirituality, knowledge, attitudes, and practices (KAP) on anxiety regarding COVID-19. Methods: Online cross-sectional data (n = 1082) covered 17 provinces. The assessment included the Daily Spiritual Experiences Scale, the Depression, Anxiety, and Stress Scale, and the KAP-COVID-19 questionnaire. Results: Multiple linear regression revealed that individuals who had low levels of spirituality had increased anxiety compared to those with higher levels of spirituality. Individuals had correct knowledge of early symptoms and supportive treatment (K3), and that individuals with chronic diseases and those who were obese or elderly were more likely to be severe cases (K4). However, participants who chose incorrect concerns about there being no need for children and young adults to take measures to prevent COVID-19 (K9) had significantly lower anxiety compared to those who responded with the correct choice. Participants who disagreed about whether society would win the battle against COVID-19 (A1) and successfully control it (A2) were associated with higher anxiety. Those with the practice of attending crowded places (P1) had significantly higher anxiety. Conclusions: Spirituality, knowledge, attitudes, and practice were significantly correlated with anxiety regarding COVID-19 in the general population.
... Brown ve ark.'nın (13) yaptıkları literatür taramasında, ailelerin sağlık ve hastalık gibi kavramları nasıl algıladıklarını; dil, aile değerleri, inanç, kişisel deneyim ve kültürel etkileşimlerin belirlediği sonucuna ulaşılmıştır. Başka bir çalışma sonucunda, sağlık personelinin palyatif bakımda hasta ve ailelerini bütüncül olarak destekleyebilmesi için dini ve manevi uygulamalarının farkında olması gerektiği vurgulanmaktadır (14) . Ülkemizde birçok farklı kültürlerden insanın yaşadığı ve son yıllarda göçmen ve mültecilerin sayısının da giderek artmasıyla kültürel çeşitliliğin daha da farklılaştığı göz önünde alındığında hemşirelerin kültüre uygun bakım vermede zorlandıkları düşünülmektedir. ...
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Objective: This study was carried out to determine the difficulties that nurses working at palliative clinic had while caring dying patients. Method: The research was designed as a qualitative research design. The sample consisted of 9 nurses working in the palliative care clinic of a state hospital in Istanbul. Results: The findings of the study were examined under 5 themes which are nurses’ opinions on the concept of death, the difficulties they experience in caring for the dying patient, the difficulties they experience with patients’ relatives, the changes they experience in their private lives and their thoughts about death. When these themes were examined, the difficulties nurses had while providing care to dying patients were to be as follows: feeling the necessity to give constant positive feedback, not being able to communicate, the abundance of intercultural differences, the inability to relieve the pain, the excess of the reactions and expectations of the relatives of the patients, the patients and their families’ not being informed enough about the process by other health personnel. Conclusion: As a result of the study, it was found that nurses had difficulties in caring for the dying patient and meeting the expectations of patients’ relatives, and meanwhile, working in palliative care unit caused changes in their personal characteristics and perspectives on death.
... 2,6 Masyarakat Indonesia menganggap agama memegang peranan penting dalam kehidupan mereka terutama saat mereka menderita penyakit. 12 Sebagian pasien di Indonesia menyinggung masalah spiritual dan agama saat berkonsultasi dengan dokter. 13 Standar Kompetensi Dokter Indonesia (SKDI) pun menyatakan mahasiswa kedokteran harus mampu melaksanakan praktik kedokteran yang profesional sesuai dengan nilai dan prinsip Ketuhanan dan mampu menunjukkan kepekaan terhadap aspek biopsikososiokultural dan spiritual pasien dan keluarga. ...
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Background: Indonesian society assume spirituality as an important aspect in life especially in sickness. Spiritual care can restore patients’ quality of life by providing them comfort, strength, and compassion. Because lack of education about spiritual care, doctors often feel not fully equipped. Reflection has proven to increase awareness of spiritual care, but the impact of this method still needs further research. This study aims to explore the impact of reflection on student awareness about spiritual care. Methods: This study used Interpretative Phenomenological Analysis with reflective writing and in-depth interview. Nine clinical medical students divided into four groups which was facilitated by clinical teacher. Intervention were three reflective writings interspersed with two small group discussion. The writings were analyzed using Transtheoretical Model to identify behavioral change then content analysis for the transcript to explore the study’s impact and the feasibility. Results: Five students increased their awareness because clinical experience, time-management, writing volume, and reflective thinking. Three students increase faster because learning from peers, engage with patient, and role-model. Two students increase slower because lack understanding of reflection and incorrect facilitators’ feedbacks. Two students stable because lack understanding of discussion and low engagement with patient. One student experienced a decrease because lack of task-commitment and interest. One student did not get awareness because difficulty interpreting emotions. Conclusion: Reflection method can be used to teach spiritual care to clinical medical students by considering several factors that might play a role. Further research with improvement to the method is still needed. Keywords: Spiritual care; spirituality; reflection; clinical medical student
... Faith is generally a dominant force in the daily lives of individuals and communities worldwide. In the Indonesian context, religion is an inseparable element in people's lives [37]; hence the country adopts a monotheistic concept as the nation's philosophy while still allowing the religious freedom of the six officially recognized religions (Catholicism, Protestantism, Hinduism, Buddhism, Confucianism/Kong Hu Cu, and Islam) [38]. Therefore, religious leaders, particularly Islamic scholars, crucially influence the community to prevent public misbehaviour during the COVID-19 pandemic. ...
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This study aimed to examine the strengths of Indonesia's two largest Islamic Faith-Based Organizations (FBOs) and the challenges experienced while performing activities on countermeasures against COVID-19 in Indonesia. In-depth interviews, focused group discussions, and document analysis were used to collect data. The participants (informants) were administrators of a special Islamic FBOs unit that handles COVID-19 programs at central and regional levels and the beneficiaries of Islamic FBOs COVID-19 programs, selected using expert sampling. As part of data collection, an interview guideline was set to explore the participants’ strengths and challenges in performing various programs for overcoming the pandemic. The data was analyzed using the thematic content analysis. The results showed that Islamic FBOs had special units that performed various countermeasures against COVID-19, including primary prevention like delivering health education and psychological consultation, and secondary prevention, mainly treating the pandemic, managing its prevailing conditions, and minimizing its economic impact, and supporting its vaccine. Moreover, the large members and participants, organizational structures involving grassroots levels, and financial support from the organizations’ reputable philanthropic agencies were their strengths in performing those activities. However, coordination in the organization from central board to branch level was considerably challenging, especially where the coordination path was long. The insufficient information technology facilities also made the process difficult online. Therefore, profound religious FBOs served indispensable contributions and potencies in directing the community and minimizing the impact of the pandemic and other disasters in terms of health and social-economic welfare.
... Indonesian communities view cancer as a particularly insidious and deadly disease (Handayani et al., 2016) and associate cancer with pain and suffering beyond that experienced with other diseases, such as heart disease or diabetes. Hence, suffering a disease such as cancer is viewed as part of one's destiny and God's will (Rochmawati et al., 2018). Future research can explore how to leverage cultural power to enhance maternal coping strategies without delaying treatment. ...
... increase their emotional resilience [30], [31], [32]. Numerous studies reported the importance of religion and spirituality as patients' primary sources of the strength needed to cope with chronic and life-threatening diseases [33], [34], [35], [36]. ...
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BACKGROUND: Cardiovascular disease (CVD) is the number one killer of women. Suffering from illness causes a significant challenge for women’s day-to-day lives. Understanding the women’s experiences and descriptions of managing their illness, strategies are essential for minimizing CVDs negative consequences. AIM: This study aims to investigate cultural adjustment to CVD among women in Indonesia. METHODS: This study employed a qualitative research design with in-depth interviews. Twenty-six women who had an experience of the cardiac event participated in this study. A qualitative framework analysis was used to analyze the data. RESULTS: Five themes were identified from data analysis. These themes were (1) making meaning of the situation, (2) feeling grateful amidst suffering, (3) submission to the will of God, (4) accepting fate, and (5) getting closer to God. CONCLUSION: Spiritual and religious beliefs played an enormous role in the participants’ illness experience, irrespective of their religions. Nurses should incorporate a religious and spiritual approach to facilitate patients’ coping behaviors when providing care for the Indonesian population.
... This is certainly a major point of concern for sociology of religion and non-religion studies-which can in turn accelerate its institutionalization within sociology of religion and further support its emerging theoretical interests through an increased big data usage. Nevertheless, the implications of an improvement in the scientific study of non-religion go beyond sector-specific theoretical interests: social and institutional trust, political participation, political orientation, civic engagement, business strategies, palliative care, general patient care, and social integration 89,90,[147][148][149][150][151][152][153][154] are, in fact, some of the research areas frequently associated with religious (non)affiliation. These fields can thus greatly benefit from an improvement in the parallel field of non-religion studies by further exploring empirical implications of a better understanding of religious nones. ...
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The shift of attention from the decline of organized religion to the rise of post-Christian spiritualities, anti-religious positions, secularity, and religious indifference has coincided with the deconstruction of the binary distinction between “religion” and “non-religion”—initiated by spirituality studies throughout the 1980s and recently resumed by the emerging field of non-religion studies. The current state of cross-national surveys makes it difficult to address the new theoretical concerns due to (1) lack of theoretically relevant variables, (2) lack of longitudinal data to track historical changes in non-religious positions, and (3) difficulties in accessing small and/or hardly reachable sub-populations of religious nones. We explore how user profiling, text analytics, automatic image classification, and various research designs based on the integration of survey methods and big data can address these issues as well as shape non-religion studies, promote its institutionalization, stimulate interdisciplinary cooperation, and improve the understanding of non-religion by redefining current methodological practices.
... However, the uptake of advance care planning may be influenced by Indonesia's culture of collectivism, in which family plays a major role in medical decision-making [9,10]. In addition to this, it may be further influenced by most Indonesian people's religious devotion [10][11][12][13][14]. ...
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Background Most studies on advance care planning in Asia originate in high-income Asian countries. Indonesia is a middle-income Asian country characterized by its religious devoutness and strong family ties. This study aims to explore the perspectives and experiences of Indonesian healthcare professionals on advance care planning for cancer patients. Methods Focus-group discussions were conducted in July and August 2019 and were analysed using thematic content analysis enhanced by dual coding and exploration of divergent views. Purposive sampling of physicians and nurses actively engaged in cancer care in a national cancer centre and a national general hospital. Results We included 16 physicians and 16 nurses. These participants were open to the idea of advance care planning. We further identified four aspects of this planning that the participants considered to be important: 1) the family’s role in medical decision-making; 2) sensitivity to communication norms; 3) patients’ and families’ religious beliefs regarding the control and sanctity of life; and 4) the availability of a support system for advance care planning (healthcare professionals’ education and training, public education, resource allocation, and formal regulation). Participants believed that, although family hierarchical structure and certain religious beliefs may complicate patients’ engagement in advance care planning, a considerate approach to involving family and patients’ religious perspectives in advance care planning may actually facilitate their engagement in it. Conclusion Indonesian healthcare professionals believed that, for culturally congruent advance care planning in Indonesia, it was essential to respect the cultural aspects of collectivism, communication norms, and patients’ religious beliefs.
... The spiritual/religious domain presented the biggest gap between Indonesian and Taiwanese participants. Religion is fundamental in most Indonesians' lives, therefore, they try their best to sustain their religious practices until their death 27 . However, having advanced cancer may limit their ability to perform certain practices. ...
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Background We assumed that patients in a country with lower economic development will have more psychological distress and problems than an economically stronger country. Therefore, the aims of this study were to determine whether advanced cancer patients in Indonesia have more psychological distress and experience more problems contributing to distress than a similar group of patients in Taiwan. We also examined the determinants of psychological distress. Methods We conducted a secondary data analysis comparing the data from 286 Indonesian and 70 Taiwanese participants, focusing on distress score and the Problem List (PL) of the Distress Thermometer. Descriptive analysis, Chi-Square test, independent t-test, One-way Anova and multiple linear regression with enter method were applied to analyse the data. Results Overall, more Indonesian respondents experienced distress and had more problems across all PL domains than Taiwanese participants. Being an early adult, having problems with childcare, housing and transportation were associated with higher distress while a higher depression score and having stage 4 cancer demonstrated lower distress among Indonesians. For Taiwanese respondents, appearance, bathing/dressing and pain determined psychological distress. Conclusions Differences in the healthcare system, economic level, culture, gender and age influenced the problems experienced by patients. Finding from our comparative study provide important insight into understanding distress and PL among ACPs in economically advanced countries compared with economically weak countries. Future collaboration to deliver interventions considering cultural and healthcare system differences between two countries should be developed
... 35 Furthermore, in the context of healthcare few studies have shown that Indonesian healthcare providers were more likely to believe R/S influenced patients health, believed it is appropriate to talk and discuss R/S with patients and were willing to provide R/S support to the patients and their families, ie, by praying together. [36][37][38] These results further explained how R/S is embedded in Indonesian people's ideas about well-being and health. ...
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Purpose: The use of mHealth has great potential to overcome many barriers in healthcare and become powerful tools to promote health. We developed Jaga Sehat ("Stay Healthy"), an Indonesian version of the mHealth app which was created as a form of health education for the general population. The current study aimed to test the usability and acceptability of the Jaga Sehat mHealth app. Patients and methods: A total of 113 dentistry students who participated in the first-year initiation program at a state university in West Java, Indonesia were recruited. Participants were asked to download, use the app and complete an online questionnaire. Open response questions explored participants' recommendations for future improvement. Descriptive statistics were used to analyze participants responses, and content analysis was carried out to analyze open-ended responses. Results: In general, participants perceived that Jaga Sehat mHealth app was useful, well-designed app, functional, and easy to use. We found that most of participants gave positive feedback and considered it as having high usability and acceptability. Conclusion: Participants reported that Jaga Sehat mHealth app was functional, easy to use and have a good design. The language and material were clear and easy to understand. The app could encourage and help them lead a healthy lifestyle; therefore, they would recommend this app for others.
... Indonesian communities view cancer as a particularly insidious and deadly disease (Handayani et al., 2016) and associate cancer with pain and suffering beyond that experienced with other diseases, such as heart disease or diabetes. Hence, suffering a disease such as cancer is viewed as part of one's destiny and God's will (Rochmawati et al., 2018). Future research can explore how to leverage cultural power to enhance maternal coping strategies without delaying treatment. ...
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Purpose This study aimed to explore the experience and views of mothers with children who have been diagnosed with retinoblastoma. Design and methods A descriptive qualitative study was conducted in the period of 2019–2021. Interviews were conducted with 21 mothers of children diagnosed with retinoblastoma in Indonesia. Data were collected by semi-structured interviews and examined by content analysis. Results Mothers evolved from a sense of unacceptability to accepting challenges and gaining inner strength. Three themes were identified: 1) physical and psychological suffering, 2) awareness of changes and demands, and 3) keep moving forward. Mothers developed positive adaptive mechanisms for coping with the problems associated with having a child with retinoblastoma. Psychological adjustment and religious beliefs were key elements in their journeys toward embracing life in the moment. Conclusion Findings illuminated psychological adaptation and coping strategies of mothers with seriously ill children and highlighted how difficulties and cultural norms shaped the adaptative process. Religion and health beliefs played varied and important roles in helping mothers to manage their stress and enhance their coping strategies. Practice implications Our findings revealed that it is important to routinely assess social support, traditional health beliefs, and spirituality on mothers, facilitate mentoring to help mothers find their inner strengths, and develop intervention programs designed to promote psychological adjustment without delaying treatment.
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Introduction: Community pharmacists are one of the most frequently accessed health professionals who can be involved in the provision of ongoing asthma management within the primary care setting. The aim of this study was to identify patients’ views regarding current asthma care provided by their pharmacists and their perspectives on future pharmacy-based asthma services. Methods: This is a qualitative approach with an interview guide. Asthma patients were purposively selected. Interviews were conducted from April to June 2017. Patient’s opinions about asthma and its management and their experiences regarding asthma care provided by pharmacists were collected. Data were analyzed using content analysis. Results: Thirty-three interviews were conducted. Asthma literacy was low. There was dis-engagement with the health care system, with only a few participants trusting conventional health care professionals. Alternative medicine systems and practitioners were better trusted and participants had strong preferences for family/peer involvement in their asthma care. Participants also had misunderstandings regarding their asthma disease and medications. Participants had experienced little pharmaceutical care provided by pharmacists but would welcome it in the future. Conclusion: Given the accessibility of community pharmacy venues and readiness of the profession for more involved care of chronic disease patients, it may be recommended that Indonesian community pharmacists should adopt the provision of pharmaceutical care models for asthma. Such pharmaceutical care models need to incorporate patients’ unique sociocultural health beliefs, preferences for alternative medicines and family/social peer involvement as well as stronger collaboration between pharmacists and physicians.
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Background: Nurse profession is a profession obtained through higher education of professional nursing and is a profession that has the greatest opportunity to provide comprehensive nursing care services to patients, not only focused on the physical patient, but spiritual needs also take the most important place in helping the patient's healing process. Objective: The purpose of this study is to explore the experience of nursing students in learning spiritual care in the application of spiritual nursing care in the environment of nursing education. Methods: This qualitative research was carried out with a descriptive phenomenological approach through in-depth interviews using structured interview guidelines as a research instrument involving 10 nursing students who were undergoing the process of lecturing the selected extension program with a purposive sampling technique. Results: Data analysis was performed by data abstraction, filtering data, coding and arranging categories, sub themes and themes so that the interpretation of research data through the Collaizi method resulted in 2 main themes. Conclusion: The themes are the learning of spiritual care has not been maximally discussed, and the application of spiritual care nursing in clinical practice has not been well implemented.
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Background: Nurse profession is a profession obtained through higher education of professional nursing and is a profession that has the greatest opportunity to provide comprehensive nursing care services to patients, not only focused on the physical patient, but spiritual needs also take the most important place in helping the patient's healing process. Objective: The purpose of this study is to explore the experience of nursing students in learning spiritual care in the application of spiritual nursing care in the environment of nursing education. Methods: This qualitative research was carried out with a descriptive phenomenological approach through in-depth interviews using structured interview guidelines as a research instrument involving 10 nursing students who were undergoing the process of lecturing the selected extension program with a purposive sampling technique. Results: Data analysis was performed by data abstraction, filtering data, coding and arranging categories, sub themes and themes so that the interpretation of research data through the Collaizi method resulted in 2 main themes. Conclusion: The themes are the learning of spiritual care has not been maximally discussed, and the application of spiritual care nursing in clinical practice has not been well implemented.
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Context Quality of palliative care and death in mainland China is at a low level of the rest of the world, the public is lacked of proper understanding of the relevant information is one of the important reasons. There has been a shift in policy of palliative care in municipalities recently in mainland China. Objectives To measure the advance care planning-related knowledge and attitudes of Chinese community-dwelling older adults, in the hope of presenting a specific implementation of the strategy. Methods We conducted a mixed-method sequential explanatory study, composed of a quantitative survey followed by qualitative interviews. The first quantitative phase included 523 community elderly individuals, who completed a validated questionnaire. After statistical analysis, a semistructured qualitative interview has been developed and conducted with 16 of them in order to help explain findings obtained in the first phase. Results The study was conducted with 523 community-dwelling older adults. The cognition level of advance care planning (ACP) was low, and attitude toward ACP was active. Living alone or living with a spouse (and children), have a religion, poor health condition, and life-sustaining treatment-related experience can affect how they behave with ACP. However, lack of trust in ACP, lack of life education and relevant legislation or policies, and Chinese traditional culture and emotion may impede their take-up. Conclusions This study indicated that the awareness and participation of ACP of community-dwelling older adults in mainland China are not enough. The influence of national conditions and culture should be fully considered during the process of ACP development.
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Introduction: Although Muslims constitute nearly one fourth of the global population, many non-Muslims are not familiar with Islam. To address this unique need from such a specific cultural context, the present study aimed to examine the spiritual needs and influencing factors of Indonesian Muslims with cancer. Method: A cross-sectional research design with 122 cancer patients was conducted by using the Bahasa-version Spiritual Needs Questionnaire. Results: The degree of spiritual needs was generally high. Religious needs were the strongest aspect, and “praying five times a day” was the highest scoring item. Gender ( p = .04), age ( p = .01), and duration of being diagnosed with cancer ( p = .01) were associated with spiritual needs. Female gender ( p = .005) and older age ( p < .001) were predictors of spiritual needs. Discussion: As expected to provide cultural-congruent spiritual interventions, nurses could meet Muslim patients’ need to pray five times a day during hospitalization, thus help them manage and endure the illness.
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This study aims to describe the relationship between spirituality and quality of life in HIV patients, where spirituality is understood as experience and religiosity as religious rituals of religious groups. This approach emphasizes the wholeness and multidimensional needs of HIV patients, besides reviewing their lives, interpreting what they find, and applying what they have learned to their new lives with HIV. The type of research used is Literature Review. A sample of 45 people was taken from 1,595 HIV patients. There are four articles stating the relationship between spirituality and quality of life considered in this article, that is, the value obtained (p-value: p <.01.) Keywords: spirituality, quality of life, HIV, Systematic Literature Review
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Background: Family caregiving is common globally, but when a family member needs palliative and end-of-life care, this requires knowledge and expertise in dealing with symptoms, medication, and treatment side effects. Caring for a family member with advanced prostate cancer in the home presents practical and emotional challenges, especially in resource-poor contexts, where there are increasing palliative cases without adequate palliative care institutions. Aim: The study explored palliative and end-of-life care experiences of family caregivers and patients living at home in a resource-poor context in Ghana. Design: This is a qualitative study using thematic analysis of face-to-face interviews at two-time points. Participants: Men living with advanced prostate cancer (n = 23), family caregivers (n = 23), healthcare professionals (n = 12). Findings: Men with advanced prostate cancer face complex issues, including lack of access to professional care and a lack of resources for homecare. Family caregivers do not have easy access to professional support; they often have limited knowledge of disease progression. Patients have inadequate access to medication and other practical resources for homecare. Caregivers may be overburdened and perform the role of the patient’s ‘doctor’ at home-assessing patient’s symptoms, administering drugs, and providing hands-on care. Conclusion: Home-based care is promoted as an ideal and cost-effective model of care, particularly in Westernised palliative care models. However, in resource-poor contexts, there are significant challenges associated with the implementation of this model. This study revealed the scale of challenges family caregivers, who lack basic training on aspects of caring, face in providing home care unsupported by healthcare professionals.
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Chronic pain is a significant health problem in many countries including Indonesia, with high prevalence and the possibility to increase in the future. Individuals experiencing chronic pain elicit cognitive and behavioral responses, including pain catastrophizing which can cause high pain interference. Effective coping ability can help reduce the impact of pain catastrophizing on pain interference. Previous research focused on emotion-focused and problem-focused coping in dealing with chronic pain. However, Indonesia as a country with a strong influence from religious values and practices encourages the exploration of positive religious coping. A part of a longitudinal study on psychological factors in chronic pain development, this study aimed to examine the moderating role of three coping styles on pain catastrophizing and pain interference associations. Results from 368 participants male and female with chronic pain showed that positive religious coping and problem-focused coping significantly moderated the effects of pain catastrophizing on pain interference. Seeking help from God helped individuals deal with chronic pain problems, as well as actively resolving difficulties. The use of these two coping styles in the Indonesian population can be useful for managing chronic pain.
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La última década ha estudiado la faceta “espiritualidad” en el contexto de cuidados paliativos oncológicos en personas mayores desde perspectivas cuantitativas, cualitativas y mixtas. El estudio busca develar –en este contexto– el significado de espiritualidad. Se revisa literatura indexada en buscador PubMed vía Medline entre los años 2009 y 2019, con acceso on line, a texto completo, en forma anónima, en idiomas inglés-español y, análogamente, con búsqueda manual en la Revista Medicina Paliativa. Los resultados arrojan 50 artículos de pertinencia temática y cuatro categorías. Se concluye que existen desafíos relacionados con el significado de espiritualidad y calidad de vida, formación y perspectivas de invetigación.
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Introduction: Cancer patients often experience sleep disorders. One of the non-pharmacological treatments that can improve sleep quality is the spiritual, emotional freedom technique (SEFT). Objectives: The study aimed to identify the effectiveness of SEFT on sleep quality among cancer patients. Methods: This research applied a quasi-experiment with a pre-test and post-test approach using a non-equivalent control group design. The total sample of this study was 30 respondents collected by purposive sampling. The sleep quality index questionnaires measured sleep quality. Results: In the pre-test, the average sleep quality score among respondents in the experimental group was 12.33, then became 8.93 after the post-test with a p-value < 0.007. Meanwhile, the pre-test score for sleep quality among respondents in the control group was 13.40, then became 13.20 after the post-test with a p-value of 0.026. Conclusion: it can be concluded that SEFT can improve the sleep quality of cancer patients. Improving the quality of sleep in cancer patients can reduce fatigue, the main side effect of undergoing therapy.
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This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.
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In this paper I focus on a distinctive kind of sociological ethnography which is particularly, though not exclusively, adopted in applied research. It has been proposed that this branch of ethno­graphy be referred to as focused ethnography. Focused ethnography shall be delineated within the context of other common conceptions of what may be called conventional ethnography. However, rather than being opposed to it, focused ethno­graphy is rather complementary to conventional ethnography, particularly in fields that are charac­teristic of socially and functionally differentiated contemporary society. The paper outlines the back­ground as well as the major methodological features of focused ethnography, such as short-term field visits, data intensity and time intensity, so as to provide a background for future studies in this area. URN: urn:nbn:de:0114-fqs0503440
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Background: Although it is widely acknowledged that spiritual care is an important component of good palliative care, there remains a lack of confidence about it among healthcare providers. This paper analyses the benefits and drawbacks of using spiritual history-taking tools to address the problem, considering four of the most widely used tools-FICA, FAITH, SPIRITual and HOPE. Method: The authors conducted a literature review to establish the main themes identified as important to spirituality at the end of life. They then applied these findings to the spiritual history-taking tools to determine the extent to which they may be of assistance in identifying the spiritual needs of patients receiving palliative care. Conclusion: The authors conclude that spiritual history-taking tools do have an important role in identifying the spiritual needs of patients at the end of life, with the 'HOPE' tool most comprehensively addressing the spirituality themes identified as important within the healthcare literature.
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One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA. A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.
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This study was conducted to describe strategies used by social work researchers to enhance the rigor of their qualitative work. A template was developed and used to review a random sample of 100 articles drawn from social work journals listed in the 2005 Journal Citation Reports: Science and Social Sciences Edition. Results suggest that the most commonly applied strategies were use of a sampling rationale (67%), analyst triangulation (59%), and mention of methodological limitations (56%); the least common were negative or deviant case analysis (8%), external audit (7%), and specification of ontology (6%). Of eight key criteria, researchers used an average of 2.0 (SD = 1.5); however, the number used increased significantly between 2003 and 2008. The authors suggest that for this trend to continue, social work educators, journal editors, and researchers must reinforce the judicious application of strategies for enhancing the rigor of qualitative work.
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Many individuals with coronary heart disease (CHD) experience disease-related anxiety, depressive symptoms, and anger. Spirituality may be helpful to cope with these negative emotions. Research findings on the role of spirituality in dealing with negative emotions are inconsistent. In this study, we examined the associations between 7 dimensions of spirituality (ie, meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities) and negative emotions among individuals with CHD in Indonesia, controlling for perceived social support as well as demographic and clinical characteristics. In total, 293 individuals with CHD were recruited from the 3 largest hospitals in Bandung, Indonesia. They completed the Spiritual Attitude and Involvement List, the Beck Depression Inventory-II, the Trait Anxiety Scale of the State Trait Anxiety Inventory, the Multidimensional Anger Inventory, and the Multidimensional Scale of Perceived Social Support. Hierarchical linear regression analyses indicated that a higher overall level of spirituality was associated with lower levels of depressive symptoms, less anxiety, and less anger. Specifically, a higher level of trust was significantly associated with both less depressive symptoms and less anxiety. Higher levels of caring for others and spiritual activities were associated with less anxiety, and a higher level of connectedness with nature was associated with less anger. These findings underscore the importance of specific dimensions of spirituality as a potentially independent buffer against negative emotions in individuals with CHD.
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Purpose/Objectives: To evaluate the effects of a spiritual intervention in patients with cancer. Data Sources: Databases searched included both international electronic databases (MEDLINE® via PubMed, Cochrane Library CENTRAL, EMBASE, and CINAHL®) as well as Korean electronic databases (KMBASE, KOREAMED, RISS, KISS, and NANET) through December 2013. Data Synthesis: A meta-analysis was conducted of 15 studies involving 14 controlled trials (7 randomized and 7 nonrandomized) with 889 patients with cancer. Spiritual interventions were compared with a usual care control group or other psychosocial interventions. The weighted average effect size across studies was -0.48 (p = 0.006, I2 = 65%) for spiritual well-being, -0.58 (p = 0.02, I2 = 70%) for meaning of life, -0.87 (p = 0.02, I2 = 87%) for anxiety, and -0.62 (p = 0.001, I2 = 73%) for depression. Conclusions: The findings showed that spiritual interventions had significant but moderate effects on spiritual well-being, meaning of life, and depression. However, the evidence remains weak because of the mixed study design and substantial heterogeneity. Implications for Nursing: Oncology nurses increasingly recognize the significance of the spiritual domain of care. The current study indicates that facilitating spiritual awareness and needs may be a worthwhile nursing intervention for patients with cancer.
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Religious/spiritual (r/s) characteristics of physicians influence their attitude toward integrative medicine and spiritual care. Indonesia physicians collaborate with traditional, complementary, and alternative medicine (TCAM) professionals within modern healthcare system, while Indian physicians are not reported to do so. The aim of the study was to understand the r/s characteristics and their influence on Indian and Indonesian physicians' acceptance of TCAM/spirituality in modern healthcare system. An exploratory, pilot, cross-cultural, cross-sectional study, using Religion and Spirituality in Medicine, and Physician Perspectives (RSMPP) survey questionnaire, compared r/s characteristics and perspectives on integrative medicine of 169 physicians from two allopathic, Sweekar-Osmania University (Sweekar-OU), India, University of Airlanga (UNAIR), Indonesia, and a TCAM/Central Research Institute of Unani Medicine (CRIUM) institute from India. More physicians from UNAIR and CRIUM (89.1 %) described themselves as "very"/"moderately" religious, compared to 63.5 % Sweekar-OU (p = 0.0000). Greater number of (84.6 %) UNAIR physicians described themselves as "very" spiritual and also significantly high (p < 0.05) in intrinsic religiosity as compared to Sweekar-OU and TCAM physicians; 38.6 % of UNAIR and 32.6 % of CRIUM participants reported life-changing spiritual experiences in clinical settings as against 19.7 % of Sweekar-OU; 92.3 % of UNAIR, compared to CRIUM (78.3 %) and Sweekar-OU (62 %), felt comfortable attending to patients' spiritual needs, (p = 0.0001). Clinical comfort and not r/s characteristics of participants was the significant (p = 0.05) variable in full regression models, predictive of primary outcome criteria; "TCAM or r/s healing as complementary to allopathic treatment." In conclusion, mainstreaming TCAM into healthcare system may be an initial step toward both integrative medicine and also improving r/s care interventions by allopathic physicians.
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To provide an overview of the relevance and strengths of focused ethnography in nursing research. The paper provides descriptions of focused ethnography and discusses using exemplars to show how focused ethnographies can enhance and understand nursing practice. Orthodox ethnographic approaches may not always be suitable or desirable for research in diverse nursing contexts. Focused ethnography has emerged as a promising method for applying ethnography to a distinct issue or shared experience in cultures or sub-cultures and in specific settings, rather than throughout entire communities. Unfortunately, there is limited guidance on using focused ethnography, particularly as applied to nursing research. Research studies performed by nurses using focused ethnography are summarised to show how they fulfilled three main purposes of the genre in nursing research. Additional citations are provided to help demonstrate the versatility of focused ethnography in exploring distinct problems in a specific context in different populations and groups of people. The unique role that nurses play in health care, coupled with their skills in enquiry, can contribute to the further development of the discipline. Focused ethnography offers an opportunity to gain a better understanding and appreciation of nursing as a profession, and the role it plays in society. Focused ethnography has emerged as a relevant research methodology that can be used by nurse researchers to understand specific societal issues that affect different facets of nursing practice. IMPLICATIONS FOR PRACTICE/RESEARCH: As nurse researchers endeavour to understand experiences in light of their health and life situations, focused ethnography enables them to understand the interrelationship between people and their environments in the society in which they live.
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Being ill and near to the end of life can raise questions such as "Why me? Why now?". The experience may start or increase thoughts of a spiritual or religious nature. Some research has found that having spiritual or religious awareness, or both, may help a person cope with disease and dying. We conducted our review through searches for studies that were randomised controlled trials. We only included such studies if they evaluated an intervention that involved a spiritual or religious aspect, such as prayer and meditation, and aimed to support adults in the terminal phase of a disease. We found five studies. In total, the studies involved 1130 participants. Two studies evaluated meditation. Three evaluated the work of a palliative care team that involved physicians, nurses and chaplains. Studies compared those who received the intervention with those who did not. Studies evaluated the interventions in various ways including whether it helped in any way a person's quality of life. There was inconclusive evidence that meditation and palliative care teams that involve a chaplain or spiritual counsellor help patients feel emotionally supported. The findings of the review are limited. This is because none of the studies measured whether the intervention helped the person cope with the disease process, and also it is unclear whether all participants receiving the palliative care team interventions were offered support from a chaplain. All the studies were undertaken in one country, making it difficult to draw conclusions as to whether the intervention would work elsewhere.
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Qualitative data analysis is a complex process and demands clear thinking on the part of the analyst. However, a number of deficiencies may obstruct the research analyst during the process, leading to inconsistencies occurring. This paper is a reflection on the use of a qualitative data analysis program, NVivo 8, and its usefulness in identifying consistency and inconsistency during the coding process. The author was conducting a large-scale study of providers and users of mental health services in Ireland. He used NVivo 8 to store, code and analyse the data and this paper reflects some of his observations during the study. The demands placed on the analyst in trying to balance the mechanics of working through a qualitative data analysis program, while simultaneously remaining conscious of the value of all sources are highlighted. NVivo 8 as a qualitative data analysis program is a challenging but valuable means for advancing the robustness of qualitative research. Pitfalls can be avoided during analysis by running queries as the analyst progresses from tree node to tree node rather than leaving it to a stage whereby data analysis is well advanced.
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Although prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness. To inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer. This is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n=70), oncology physicians (n=206), and oncology nurses (n=115). Semistructured interviews were used to assess respondents' attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory. Most advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents' viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives. Most patients and practitioners view patient-practitioner prayer as at least occasionally appropriate in the advanced cancer setting, and most patients view prayer as spiritually supportive. However, the appropriateness of patient-practitioner prayer is case specific, requiring consideration of multiple factors.
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Spirituality and spiritual care are gaining increasing attention but their potential contribution to palliative care remains unclear. The aim of this study was to synthesize qualitative literature on spirituality and spiritual care at the end of life using a systematic (‘meta-study’) review. Eleven patient articles and eight with healthcare providers were included, incorporating data from 178 patients and 116 healthcare providers, mainly from elderly White and Judaeo-Christian origin patients with cancer. Spirituality principally focused on relationships, rather than just meaning making, and was given as a relationship. Spirituality was a broader term that may or may not encompass religion. A ‘spirit to spirit’ framework for spiritual care-giving respects individual personhood. This was achieved in the way physical care was given, by focusing on presence, journeying together, listening, connecting, creating openings, and engaging in reciprocal sharing. Affirmative relationships supported patients, enabling them to respond to their spiritual needs. The engagement of family caregivers in spiritual care appears underutilized. Relationships formed an integral part of spirituality as they were a spiritual need, caused spiritual distress when broken and were the way spiritual care was given. Barriers to spiritual care include lack of time, personal, cultural or institutional factors, and professional educational needs. By addressing these, we may make an important contribution to the improvement of patient care towards the end of life.
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This study sought to inductively derive core themes of religion and/or spirituality (R/S) active in patients' experiences of advanced cancer to inform the development of spiritual care interventions in the terminally ill cancer setting. This is a multisite, cross-sectional, mixed-methods study of randomly-selected patients with advanced cancer (n = 68). Scripted interviews assessed the role of R/S and R/S concerns encountered in the advanced cancer experience. Qualitative and quantitative data were analyzed. Theme extraction was performed with interdisciplinary input (sociology of religion, medicine, theology), utilizing grounded theory. Spearman correlations determined the degree of association between R/S themes. Predictors of R/S concerns were assessed using linear regression and analysis of variance. Most participants (n = 53, 78%) stated that R/S had been important to the cancer experience. In descriptions of how R/S was related to the cancer experience, five primary R/S themes emerged: coping, practices, beliefs, transformation, and community. Most interviews (75%) contained two or more R/S themes, with 45% mentioning three or more R/S themes. Multiple significant subtheme interrelationships were noted between the primary R/S themes. Most participants (85%) identified 1 or more R/S concerns, with types of R/S concerns spanning the five R/S themes. Younger, more religious, and more spiritual patients identified R/S concerns more frequently (beta = -0.11, p < 0.001; beta = 0.83, p = 0.03; and beta = 0.89, p = 0.04, respectively). R/S plays a variety of important and inter-related roles for most advanced cancer patients. Future research is needed to determine how spiritual care can incorporate these five themes and address R/S concerns.
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To determine whether spiritual care from the medical team impacts medical care received and quality of life (QoL) at the end of life (EoL) and to examine these relationships according to patient religious coping. Prospective, multisite study of patients with advanced cancer from September 2002 through August 2008. We interviewed 343 patients at baseline and observed them (median, 116 days) until death. Spiritual care was defined by patient-rated support of spiritual needs by the medical team and receipt of pastoral care services. The Brief Religious Coping Scale (RCOPE) assessed positive religious coping. EoL outcomes included patient QoL and receipt of hospice and any aggressive care (eg, resuscitation). Analyses were adjusted for potential confounders and repeated according to median-split religious coping. Patients whose spiritual needs were largely or completely supported by the medical team received more hospice care in comparison with those not supported (adjusted odds ratio [AOR] = 3.53; 95% CI, 1.53 to 8.12, P = .003). High religious coping patients whose spiritual needs were largely or completely supported were more likely to receive hospice (AOR = 4.93; 95% CI, 1.64 to 14.80; P = .004) and less likely to receive aggressive care (AOR = 0.18; 95% CI, 0.04 to 0.79; P = .02) in comparison with those not supported. Spiritual support from the medical team and pastoral care visits were associated with higher QOL scores near death (20.0 [95% CI, 18.9 to 21.1] v 17.3 [95% CI, 15.9 to 18.8], P = .007; and 20.4 [95% CI, 19.2 to 21.1] v 17.7 [95% CI, 16.5 to 18.9], P = .003, respectively). Support of terminally ill patients' spiritual needs by the medical team is associated with greater hospice utilization and, among high religious copers, less aggressive care at EoL. Spiritual care is associated with better patient QoL near death.
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A Consensus Conference sponsored by the Archstone Foundation of Long Beach, California, was held February 17-18, 2009, in Pasadena, California. The Conference was based on the belief that spiritual care is a fundamental component of quality palliative care. This document and the conference recommendations it includes builds upon prior literature, the National Consensus Project Guidelines, and the National Quality Forum Preferred Practices and Conference proceedings.
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Palliative care professionals promote well-being and ease suffering at the end-of-life through holistic care that addresses physical, emotional, social and spiritual needs. The ways that individuals cope with serious illness and prepare for death are often done so within a religious context. Therefore, it is essential that palliative care practitioners are sensitive to and have an appreciation of different religious perspectives and rituals to meet the unique needs of their patients and families. This paper provides a brief overview of the five major world religions - Buddhism, Christianity, Hinduism, Islam and Judaism - with particular emphasis of the respective perspectives on suffering, death and afterlife. Despite wide variation in these traditions, an understanding of common rituals surrounding death, funerals and bereavement can improve care for patients, families and communities facing the end-of-life.
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Patients and palliative care experts endorse the importance of spiritual care for seriously ill patients and their families. However, little is known about spiritual care during serious illness, and whether it satisfies patients' and families' needs. The objective of this study was to describe spiritual care received by patients and families during serious illness, and test whether the provider and the type of care is associated with satisfaction with care. Cross-sectional interview with 38 seriously ill patients and 65 family caregivers about spiritual care experiences. The 103 spiritual care recipients identified 237 spiritual care providers; 95 (41%) were family or friends, 38 (17%) were clergy, and 66 (29%) were health care providers. Two-thirds of spiritual care providers shared the recipient's faith tradition. Recipients identified 21 different types of spiritual care activities. The most common activity was help coping with illness (87%) and the least common intercessory prayer (4%). Half of recipients were very or somewhat satisfied with spiritual care, and half found it very helpful for facilitating inner peace and meaning making. Satisfaction with spiritual care did not differ by provider age, race, gender, role, or frequency of visits. Types of care that helped with understanding or illness coping were associated with greater satisfaction with care. Seriously ill patients and family caregivers experience spiritual care from multiple sources, including health care providers. Satisfaction with this care domain is modest, but approaches that help with understanding and with coping are associated with greater satisfaction.
Article
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Cancer in the developing world, of which the Islamic world is a substantial component, is characterized by far more advanced stages at diagnosis, fewer allocated resources for prevention and treatment, and higher incidence than in countries with more developed health systems.1 The top five cancers in the emerging world are (in descending order) stomach, lung, liver, breast, and cervix, and in developed countries the most common cancers are those of the lung, colorectum, breast, stomach, and prostate.2 In Indonesia, which has an estimated total cancer incidence of about 300,000 cases per year, only 10% are seen in the health care system.3 Similarly, only one cancer unit is available for about 120 million people in Bangladesh.4 Because preventive and curative services for cancer control are underdeveloped in many Islamic countries, the development of palliative care services is a more realistic option for most patients in these countries who have cancer. The available health care services in the Islamic world clearly do not meet patients' needs, and there is little sign that this situation will improve in the foreseeable future. Even if palliative care development is placed on an Islamic country's health care agenda, such development might be handicapped by technical and economic constraints. However, despite this gloomy picture, there are signs that palliative medicine is beginning to take off in the Islamic world. For example, the medical use of morphine for cancer pain control has been steadily increasing during the past few years in many Islamic countries.5 Once a palliative care program takes root in an Islamic country, it usually grows into a thriving service.3,6,7,8,9,10
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To determine the problems and issues of accessing specialist palliative care by patients, informal carers and health and social care professionals involved in their care in primary and secondary care settings. Eleven electronic databases (medical, health-related and social science) were searched from the beginning of 1997 to October 2003. Palliative Medicine (January 1997-October 2003) was also hand-searched. Systematic search for studies, reports and policy papers written in English. Included papers were data-extracted and the quality of each included study was assessed using 10 questions on a 40-point scale. The search resulted in 9921 hits. Two hundred and seven papers were directly concerned with symptoms or issues of access, referral or barriers and obstacles to receiving palliative care. Only 40 (19%) papers met the inclusion criteria. Several barriers to access and referral to palliative care were identified including lack of knowledge and education amongst health and social care professionals, and a lack of standardized referral criteria. Some groups of people failed to receive timely referrals e.g., those from minority ethnic communities, older people and patients with nonmalignant conditions as well as people that are socially excluded e.g., homeless people. There is a need to improve education and knowledge about specialist palliative care and hospice care amongst health and social care professionals, patients and carers. Standardized referral criteria need to be developed. Further work is also needed to assess the needs of those not currently accessing palliative care services.
Book
There is an increasing divergence of focus group practice between social researchers and commercial market researchers. This book addresses the key issues and practical requirements of the social researcher, namely: the kinds of social research issues for which focus groups are most and least suitable; optimum group size and composition; and the designing of focusing exercises, facilitation and appropriate analysis. The authors use examples, drawn from their own focus groups research experience, and provide exercises for further study. They address the three main components of composition, conduct and analysis in focus group research and also acknowledge the increasing impact the Internet has had on social research by covering the role and conduct of `virtual focus groups'.
Article
Aim: To review healthcare literature in relation to the provision of palliative care in Indonesia and to identify factors that may impact on palliative care development. Background: People living with life-limiting illness benefit from access to palliative care services to optimize quality of life. Palliative care services are being expanded in developing countries but in Indonesia such services are in their infancy with many patients with life-limiting illnesses having access to appropriate health care compromised. Methods: Relevant healthcare databases including CINAHL, PubMed, Science Direct and Scopus were searched using the combinations of search terms: palliative care, terminal care, end-of-life care, Indonesia and nursing. A search of grey literature including Internet sites was also carried out. Results: Nine articles were included in the review. Facilitating factors supporting the provision of palliative care included: a culture of strong familial support, government policy support, volunteering and support from regional organizations. Identified barriers to palliative care provision were a limited understanding of palliative care among healthcare professionals, the challenging geography of Indonesia and limited access to opioid medications. Conclusions: There are facilitators and barriers that currently impact on the development of palliative care in Indonesia. Strategies that can be implemented to improve palliative care include training of nurses and doctors in the primary care sector, integrating palliative care in undergraduate medical and nursing curriculum and educating family and community about basic care. Nurses and doctors who work in primary care can potentially play a role in supporting and educating family members providing direct care to patients with palliative needs.
Article
Nurses are often the clinicians who conduct at least an initial spiritual assessment; they do so typically by verbally asking questions. This study explores what is the client perspective about nurses asking spiritual assessment questions. A convenience sample of 70 Aotearoa/New Zealand hospice inpatients and family carers completed an investigator-designed questionnaire developed for the purpose of this study. Nonparametric statistics measured associations between variables. No significant differences were observed between patients’ and carers’ perspectives on being asked spiritual assessment questions. In general, respondents were “okay” with being asked spiritual assessment questions. However, some did not relate to or want to be asked spiritual assessment questions; likewise, some wanted to be asked. These perspectives about being asked spiritual questions were associated with self-reported religiosity, spirituality, and ethnicity. Findings can help nurses to understand that diverse client perspectives exist and can give nurses an informed sensitivity with which to approach spiritual assessment.
Article
Spirituality is a critical dimension of comprehensive palliative care. Scholars have contributed numerous definitions of spirituality and perspectives on the relationship between spiritual pain and suffering. Much research has been done to demonstrate the need to address the patient's spiritual preferences and needs when considering medical interventions. There is also consensus that there is an improvement in the patient's quality of life when spiritual needs have been addressed. Spiritual assessment tools have been developed to better assist healthcare professionals in planning and implementing spiritual interventions that may be offered by the multidisciplinary team.
Article
Purpose: To investigate which activities from the 'Spiritual Support' intervention of the Nursing Interventions Classification (NIC) are used in patients with the nursing diagnosis 'Death Anxiety' in the Czech Republic, and which activities could feasibly be implemented into practice. Method: The study surveyed 468 Czech nurses using a quantitative questionnaire with Likert scales. Results: The most frequently used activity was 'Treat individual with dignity and respect' and the least frequently used was 'Pray with the individual'. 'Treat individual with dignity and respect' was also thought to be the most feasible activity for Czech nursing practice. Significant differences were found between nurses working in hospices and those in other sites and between religious believers and non-believers. Conclusion: Even in the secularised Czech Republic, nurses can make use of the NIC Spiritual Support intervention in end-of-life care.
Article
Despite the difficulty in clearly defining and measuring spirituality, a growing literature describes its importance in oncology and survivorship. Religious/spiritual beliefs influence patients' decision-making with respect to both complementary therapies and aggressive care at the end of life. Measures of spirituality and spiritual well-being correlate with quality of life in cancer patients, cancer survivors, and caregivers. Spiritual needs, reflective of existential concerns in several domains, are a source of significant distress, and care for these needs has been correlated with better psychological and spiritual adjustment as well as with less aggressive care at the end of life. Studies show that while clinicians such as nurses and physicians regard some spiritual care as an appropriate aspect of their role, patients report that they provide it infrequently. Many clinicians report that their religious/spiritual beliefs influence their practice, and practices such as mindfulness have been shown to enhance clinician self-care and equanimity. Challenges remain in the areas of conceptualizing and measuring spirituality, developing and implementing training for spiritual care, and coordinating and partnering with chaplains and religious communities. CA Cancer J Clin. 2013; (©) 2013 American Cancer Society.
Article
To explore the use of paradigms as ontological and philosophical guides for conducting PhD research. A paradigm can help to bridge the aims of a study and the methods to achieve them. However, choosing a paradigm can be challenging for doctoral researchers: there can be ambiguity about which paradigm is suitable for a particular research question and there is a lack of guidance on how to shape the research process for a chosen paradigm. The authors discuss three paradigms used in PhD nursing research: post-positivism, interpretivism and pragmatism. They compare each paradigm in relation to its ontology, epistemology and methodology, and present three examples of PhD nursing research studies to illustrate how research can be conducted using these paradigms in the context of the research aims and methods. The commonalities and differences between the paradigms and their uses are highlighted. Creativity and flexibility are important when deciding on a paradigm. However, consistency and transparency are also needed to ensure the quality and rigour necessary for conducting nursing research. IMPLICATIONS FOR RESEARCH/PRACTICE: When choosing a suitable paradigm, the researcher should ensure that the ontology, epistemology and methodology of the paradigm are manifest in the methods and research strategies employed.
Article
This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.
Article
Identify and compare spiritual caring practice by palliative care and acute care registered nurses (RNs), determine any correlation between nurses' spiritual perspective and their spiritual caring, and to investigate perceived barriers to spiritual caring. Over the past decade there has been growing interest in spiritual caring in nursing. Professional nursing bodies have proposed spirituality and spiritual caring as an integral component of holistic nursing. Cross sectional study. Palliative care RNs (n = 42) from one community palliative care service and three hospices, and acute care RNs (n = 50) from three major acute care hospitals all in metropolitan Sydney, Australia completed a research questionnaire. Two validated tools and a demographic survey were used to collect data. These tools measured spiritual perspectives including saliency of personal spirituality, spiritual views and engagement in spiritually-related activities; and spiritual practice including assessment, interventions and barriers to spiritual caring. Data were collected over a six-month period and interpreted with both descriptive and analytical statistics. Significant differences were seen between the two RN groups. Palliative care RNs' spiritual caring practice was more advanced and their spiritual perspective stronger; this relationship was positive. Both RN groups identified 'insufficient time' as the most common barrier to spiritual caring practice; 'patient privacy' was also common for acute care RNs. Palliative care RNs' spiritual perspectives influenced their spiritual caring. These nurses were older and more career-advanced than the acute care RNs, which may explain the differences observed. Acute care RNs may benefit from additional support for their spiritual caring and to address perceived barriers. The development of nurses' spiritual perspective early in their preparation for practice, and the articulation and documentation of spiritual caring may enhance their spiritual caring practice. Further research on barriers to spiritual caring in acute care nursing environments is recommended.
Article
Psychologists' emerging interest in spirituality and religion as well as the relevance of each phenomenon to issues of psychological importance requires an understanding of the fundamental characteristics of each construct. On the basis of both historical considerations and a limited but growing empirical literature, we caution against viewing spirituality and religiousness as incompatible and suggest that the common tendency to polarize the terms simply as individual vs. institutional or ′good′ vs. ′bad′ is not fruitful for future research. Also cautioning against the use of restrictive, narrow definitions or overly broad definitions that can rob either construct of its distinctive characteristics, we propose a set of criteria that recognizes the constructs' conceptual similarities and dissimilarities. Rather than trying to force new and likely unsuccessful definitions, we offer these criteria as benchmarks for judging the value of existing definitions.
Article
The extent to which religion and spirituality are integrated into routine psychiatric practice has been a source of increasing controversy over recent years. While taking a patient's spiritual needs into account when planning their care may be less contentious, disclosure to the patient by the psychiatrist of their own religious beliefs or consulting clergy in the context of treatment are seen by some as potentially harmful and in breach of General Medical Council guidance. Here, Professor Rob Poole and Professor Christopher Cook debate whether praying with a patient constitutes a breach of professional boundaries in psychiatric practice.
Article
How parents of children with life threatening conditions draw upon religion, spirituality, or life philosophy is not empirically well described. Participants were parents of children who had enrolled in a prospective cohort study on parental decision-making for children receiving pediatric palliative care. Sixty-four (88%) of the 73 parents interviewed were asked an open-ended question on how religion, spirituality, or life philosophy (RSLP) was helpful in difficult times. Responses were coded and thematically organized utilizing qualitative data analysis methods. Any discrepancies amongst coders regarding codes or themes were resolved through discussion that reached consensus. Most parents of children receiving palliative care felt that RSLP was important in helping them deal with tough times, and most parents reported either participation in formal religious communities, or a sense of personal spirituality. A minority of parents, however, did not wish to discuss the topic at all. For those who described their RSLP, their beliefs and practices were associated with qualities of their overall outlook on life, questions of goodness and human capacity, or that "everything happens for a reason." RSLP was also important in defining the child's value and beliefs about the child's afterlife. Prayer and reading the bible were important spiritual practices in this population, and parents felt that these practices influenced their perspectives on the medical circumstances and decision-making, and their locus of control. From religious participation and practices, parents felt they received support from both their spiritual communities and from God, peace and comfort, and moral guidance. Some parents, however, also reported questioning their faith, feelings of anger and blame towards God, and rejecting religious beliefs or communities. RSLP play a diverse and important role in the lives of most, but not all, parents whose children are receiving pediatric palliative care.
Article
Indonesia is a large archipelago with an estimated 203,000-365,400 new cancer cases a year. Most cases present in the advanced stage. Pain is the chief complaint in 89% of the patients of the palliative care unit at Dr. Soetomo hospital. The program is a community-based, family-oriented, and culturally adapted home care, widely applicable throughout the country. The service and medication should be affordable, simple, and available. The WHO three-step ladder has been adopted as the method of choice in cancer pain relief. Facilities supportive for the program are the existing health-care delivery system and non-formal support system (Indonesian Cancer Foundation and Organization for Family Welfare Promotion, PKK). The chief constraints for program implementation are the geographical and population problems, lack of resources and funding for the training of health-care workers, and limited availability of oral morphine.
Article
Patients' religious commitments and religious communities are known to influence their experiences of illness and their medical decisions. Physicians are also dynamic partners in the doctor-patient relationship, yet little is known about the religious characteristics of physicians or how physicians' religious commitments shape the clinical encounter. To provide a baseline description of physicians' religious characteristics, and to compare physicians' characteristics with those of the general U.S. population. Mailed survey of a stratified random sample of 2,000 practicing U.S. physicians. Comparable U.S. population data are derived from the 1998 General Social Survey. The response rate was 63%. Fifty-five percent of physicians say their religious beliefs influence their practice of medicine. Compared with the general population, physicians are more likely to be affiliated with religions that are underrepresented in the United States, less likely to say they try to carry their religious beliefs over into all other dealings in life (58% vs 73%), twice as likely to consider themselves spiritual but not religious (20% vs 9%), and twice as likely to cope with major problems in life without relying on God (61% vs 29%). Physicians' religious characteristics are diverse and they differ in many ways from those of the general population. Researchers, medical educators, and policy makers should further examine the ways in which physicians' religious commitments shape their clinical engagements.
Article
To review literature documenting the frequency of use and efficacy of spiritual complementary therapies. Implications for clinical practice and research that reflect this literature are offered. Data based research on complementary therapy usage and clinical articles about selected mind/body therapies. Spiritual complementary therapies are among the most frequently used. Prayer, spiritual healing, and meditation are the most frequently used spiritual therapies. Equivocal evidence supports their efficacy. Although spiritual practices may not be considered a "therapy," clinicians should assess and support these practices. Clinicians should only pray with patients when observing ethical guidelines.
Article
Although the nursing literature overflows with references to the myriad things for which nurses and patients are de facto responsible, nurses have never explicitly examined the social construction of responsibility in any clinical context. This article reviews and integrates the empirical and philosophical literature on moral responsibility in the context of mental health nursing. It selectively reviews both traditional and feminist philosophical accounts to more deeply understand the socially constructed nature of responsibility and the implications for understanding morality in practice. It seeks to illuminate the concept of "taking responsibility" qua moral responsibility and asks what makes this notion of responsibility particularly "moral."
Article
This article is a sequel to 'Spirituality in palliative care: what language do we need?' (Byrne, 2002). It looks at the language of pastoral care, its place in palliative settings and how it is regarded by patients and carers. Spirituality and spiritual need is multifaceted, and the various beliefs regarding the concept of spirituality and the spiritual needs of terminally ill patients are appraised, and the methods of spiritual assessment reviewed. The role of the chaplain in spiritual care is also assessed, and an ability to move beyond the boundaries of their own denominational position addressed. Several components of the language of pastoral care are identified.
Focused ethnography. Qualitative
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Americans are in the middle of the pack globally when it comes to importance of religion
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Theodorou A. (2015). Americans are in the middle of the pack globally when it comes to importance of religion. Retrieved from www.pewresearch. org/fact-tank/2015/12/23/americans-are-in-the-middle-of-the-packglobally-when-it-comes-to-importance-of-religion/
Demystifying nursing research. Why not ethnography?
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Ethnography: Theory and applications in health research
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de Laine, M. (1997). Ethnography: Theory and applications in health research. Sydney, Australia: Maclennan & Petty.
Ethography step-by-step
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Fetterman, D. M. (2010). Ethography step-by-step. Los Angeles, CA: Sage.
Analysis & interpretation of etnographic data: A mixed method approach
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LeCompte, M. D., & Schensul, J. J. (2013). Analysis & interpretation of etnographic data: A mixed method approach. Lanham: AltaMira.
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Demystifying nursing research. Why not ethnography? Urologic Nursing
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Oliffe, J. (2005). Demystifying nursing research. Why not ethnography? Urologic Nursing, 25, 395-399.
RoI: Pedoman teknis pelayanan paliatif kanker [Technical guideline for palliative cancer service
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Ministry of Health (2013). RoI: Pedoman teknis pelayanan paliatif kanker [Technical guideline for palliative cancer service]. Jakarta: DIT.P2PTM.
Conceptualizing religion and spirituality: Points of commonality
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Hill, P. C., Pargament, K. I., & Hood, R. W., Jr. (2000). Conceptualizing religion and spirituality: Points of commonality. Journal for the Theory of Social Behaviour, 30, 51-77. https://doi.org/10.1111/1468-5914.
WHO definition of palliative care. Retrieved from www.who.int/cancer/palliative/definition/en/ How to cite this article: Rochmawati E, Wiechula R, Cameron K. Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study
World Health Organization. (2010). WHO definition of palliative care. Retrieved from www.who.int/cancer/palliative/definition/en/ How to cite this article: Rochmawati E, Wiechula R, Cameron K. Centrality of spirituality/religion in the culture of palliative care service in Indonesia: An ethnographic study.