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"Spirituality is everybody's business": an exploration of the impact of spiritual care training upon the perceptions and practice of rehabilitation professionals
Disability and Rehabilitation
Abstract
Purpose:
This study explored the impact of a brief spiritual care training program upon the perceptions and self-reported practice of rehabilitation professionals working in traumatic injury.
Methodology and methods:
A qualitative study. Semi-structured interviews were held with staff from a rehabilitation hospital in Sydney, Australia, between six and eight weeks after participation in spiritual care training. A thematic analysis was conducted.
Results:
Of the 41 rehabilitation professionals who attended the training (1 h online, 1.5 h face to face), 16 agreed to be interviewed. The majority worked in spinal cord injury and were female. Half reported holding a Christian affiliation. One overarching theme and six sub-themes were identified from the qualitative data. The overarching theme was "spirituality is everybody's business". The six sub-themes were: (i) increased awareness of the nature of spirituality, (ii) realisation of the importance of spirituality to clients, (iii) a desire to keep spirituality on the radar, (iv) identifying barriers to providing spiritual care (v) incorporating spirituality into practice, and, (vi) recognising spirituality as personally meaningful.
Conclusions:
A brief spiritual care training program can impact positively upon perceptions and practice of rehabilitation professionals. Ongoing training is needed to ensure that staff retain what was learnt. IMPLICATIONS FOR REHABILITATION Brief spiritual care training can impact positively upon rehabilitation professionals' perceptions of spirituality and lead to practice change in the delivery of spiritual care across many clinical disciplines. The stories of patients and family members are powerful staff education tools in spiritual care training. Client spirituality is an under recognised resource that staff can draw upon in supporting and enhancing the rehabilitation process.
... Furthermore, spiritual well-being has a protective role against burn-out and stress for those providing care (Bar-Sela et al., 2019;Chiang et al., 2021;De Diego-Cordero et al., 2022). Studies have shown that many of those entering health or aged care services wish to discuss their spiritual beliefs with healthcare staff (Best et al., 2014(Best et al., , 2015, and that staff believe spiritual care is the responsibility of all members of the multidisciplinary team when providing person-centred, holistic care (Jones et al., 2020b(Jones et al., , 2022b. Although spiritual care is most often provided by spiritual care specialists (also known as pastoral care practitioners or chaplains) patients may want general staff to be aware of their spiritual needs (Best et al., 2015(Best et al., , 2022b. ...
... This may be a nurse, doctor, or member of the allied health or aged care team. Findings from recent studies suggest that such staff often do not feel equipped to provide spiritual care to the patients or residents they work with, (Best et al., 2016b(Best et al., , 2016cJones et al., 2020b;McSherry & Jamieson, 2011) but that provision increases with spiritual care training of staff (Jones et al., 2022b). ...
... Most of these were developed in the USA and Europe and included a range of content and formats. Only two of the 55 programs were conducted in Australia, with a third recently conducted with rehabilitation professionals (Jones et al., 2020a(Jones et al., , 2022b. ...
The aim of this study was to evaluate a new spiritual care training program with health and aged care staff. A four-module program was delivered to 44 participants at a large Catholic health and aged care provider in Australia. Pre, post and 6 week follow-up surveys were administered and included measures of spiritual care competency, confidence, perspectives of spirituality and spiritual care, spiritual well-being, and satisfaction. Paired sample t-tests showed total scores of participants’ spiritual well-being, spiritual care competency and confidence significantly improved following the training and were largely maintained at follow-up. Perspectives on spirituality and spiritual care did not significantly change over time.
... Studies have shown that spirituality is closely associated with a range of positive health outcomes (Ahmadi et al., 2015;Jim et al., 2015;Jones et al., 2016Jones et al., , 2018 and an aspect of well-being that patients appreciate being asked about (Best et al., 2015). Although spiritual care practitioners (also known as chaplains or pastoral carers) are often available to discuss spiritual needs, any member of the multidisciplinary team might be approached to have an initial discussion with a patient (Hilbers et al., 2010;Best et al., 2016a;Jones et al., 2020c). One study in Australia found that, although over 70% of patients or family members felt it was important for hospital staff to ask about their beliefs, less than 40% indicated they would like to speak to a chaplain (Hilbers et al., 2010). ...
... Several spiritual care programs have been developed for healthcare professionals in Australia (Meredith et al., 2012;Bridge and Bennett, 2014;Cooper and Chang, 2016;Jones et al., 2020a). These have been conducted within the contexts of rehabilitation (Jones et al., 2020a(Jones et al., , 2020c, palliative care (Meredith et al., 2012;Bridge and Bennett, 2014), and undergraduate nurse education (Cooper and Chang, 2016). Findings from these studies suggest that spiritual care training enabled healthcare professionals to view spirituality as something broader than religion (Cooper and Chang, 2016;Jones et al., 2020c) to understand that they could address patient spiritual needs through listening and compassionate care (Bridge and Bennett, 2014;Cooper and Chang, 2016) and to build levels of confidence, comfort, and competency in spiritual care delivery (Meredith et al., 2012;Bridge and Bennett, 2014;Jones et al., 2020a). ...
... These have been conducted within the contexts of rehabilitation (Jones et al., 2020a(Jones et al., , 2020c, palliative care (Meredith et al., 2012;Bridge and Bennett, 2014), and undergraduate nurse education (Cooper and Chang, 2016). Findings from these studies suggest that spiritual care training enabled healthcare professionals to view spirituality as something broader than religion (Cooper and Chang, 2016;Jones et al., 2020c) to understand that they could address patient spiritual needs through listening and compassionate care (Bridge and Bennett, 2014;Cooper and Chang, 2016) and to build levels of confidence, comfort, and competency in spiritual care delivery (Meredith et al., 2012;Bridge and Bennett, 2014;Jones et al., 2020a). ...
Objective
The aim was to to establish core components of spiritual care training for healthcare professionals in Australia.
Methods
This study used the Delphi technique to undertake a consensus exercise with spiritual care experts in the field of healthcare. Participant opinion was sought on (i) the most important components of spiritual care training; (ii) preferred teaching methods; (iii) clinical scenarios to address in spiritual care training; and (iv) current spiritual assessment and referral procedures.
Results
Of the 107 participants who responded in the first round, 67 (62.6%) were female, 55 (51.4%) worked in pastoral care, and 84 (78.5%) selected Christian as their religious affiliation. The most highly ranked components of spiritual care training were “relationship between health and spirituality,” followed by “definitions of spirituality and spiritual care.” Consensus was not achieved on the item “comparative religions study/alternative spiritual beliefs.” Preferred teaching methods include case studies, group discussion, role-plays and/or simulated learning, videos of personal stories, and self-directed learning. The most highly ranked clinical scenario to be addressed in spiritual care training was “screening for spiritual concerns for any patient or resident.” When asked who should conduct an initial spiritual review with patients, consensus was achieved regarding all members of the healthcare team, with most nominating a chaplain or “whoever the patient feels comfortable with.” It was considered important for spiritual care training to address one's own spirituality and self-care. Consensus was not achieved on which spiritual care assessment tools to incorporate in training.
Significance of results
This Delphi study revealed that spiritual care training for Australian healthcare professionals should emphasize the understanding of the role of spirituality and spiritual care in healthcare, include a range of delivery methods, and focus upon the incorporation of spiritual screening. Further work is required to identify how spiritual care screening should be conducted within an Australian healthcare setting.
... 65-89;Sorrentino and Hardy 1974, pp. 372-80;Jones et al. 2018Jones et al. , 2022Wilson et al. 2017). Studies by Aydoǧdu (2019, pp. ...
... It is noteworthy that proposals for multidimensional support systems for people with disabilities are increasingly emphasising the need for spiritual support (Harris 2006, pp. 393-411;Jones et al. 2022Jones et al. , pp. 1409. ...
The family holds a special place in human life. Given the importance of marriage and family for the welfare of people, the Catholic Church strives to protect these values. The Church’s stance towards people with disabilities is unequivocally protective and inclusive, but it also recognises that the right to marriage and family life is not absolute. Not all people with disabilities are able to start a family or fulfil the obligations of marriage and family life. In canon law, the Church sets forth certain conditions for contracting a valid marriage, taking into account the human resources that make a person capable of such a commitment. This article examines the narratives of people with disabilities who participated in a study on religiosity, faith, and prayer, and how these can provide meaning to disability in the context of marital and family life. The research findings confirm our hypothesis that faith and religious practices provide people with disabilities with a sense of meaning in life and help them stabilise difficult moments and experiences; prayer is a source of peace, patience, and gentleness, and it improves the quality of life of both people with disabilities and their families; faith and religious practices help people with disabilities make sense of everyday difficulties, gain perspective, and overcome their weaknesses or egocentrism; religiousness is a source of meaning in life. Faith and religion play an important role in participants’ efforts to accept their lives, provide care, and show love. Moreover, they have a positive impact on the rehabilitation process.
... Ob in Prävention, Akutbehandlung, Rehabilitation, Palliation oder Versorgung am Lebensende, Spiritual Care wird stets als interprofessionelle Aufgabe dargestellt (Aebi und Mösli 2020). Es wird davon ausgegangen, dass die bio-psycho-sozio-spirituelle Versorgung einen interprofessionellen Ansatz benötigt(Puchalski et al. 2019;Siler et al. 2019;Puchalski et al. 2022) und "jeden etwas angeht"(Jones et al. 2022). Außerhalb des klinischen Kontexts, wie in ambulanten Settings, finden interprofessionelle Spiritual-Care-Ansätze nur wenig Berücksichtigung (Boettcher 2018). ...
... The EAPC recommends basic spiritual care training for every healthcare worker to become a spiritual care generalist through interdisciplinary shared training for which the participants wish for but so far not been offered. Spiritual care is neither a sole nurses' practice nor a psychologists' practice, but rather a human practice and should be understood as everybody's responsibility [34]. Nonetheless, when everybody is equally responsible for spiritual care, nobody may consider it their explicit duty and spiritual care might remain a neglected area of patient care. ...
Purpose
People with primary malignant brain tumors experience serious health-related suffering caused by limited prognosis and high symptom burden. Consequently, neuro-oncological healthcare workers can be affected emotionally in a negative way. The aim of this study was to analyze the attitudes and behavior of nurses and physicians when confronted with spiritual distress in these patients.
Methods
Neurospirit-DE is a qualitative vignette–based, multicenter, cross-sectional online survey that was conducted in Bavaria, Germany. Reflexive thematic analysis was used for data analysis.
Results
A total of 143 nurses and physicians working in neurological and neurosurgical wards in 46 hospitals participated in the survey. The participants questioned if the ability to provide spiritual care can be learned or is a natural skill. Spiritual care as a responsibility of the whole team was highlighted, and the staff reflected on the appropriate way of involving spiritual care experts. The main limitations to spiritual care were a lack of time and not viewing spiritual engagement as part of the professional role. Some were able to personally benefit from spiritual conversations with patients, but many participants criticized the perceived emotional burden while expressing the imminent need for specific training and team reflection.
Conclusions
Most neuro-oncological nurses and physicians perceive spiritual care as part of their duty and know how to alleviate the patient’s spiritual distress. Nonetheless, validation of spiritual assessment tools for neuro-oncology and standardized documentation of patients’ distress, shared interprofessional training, and reflection on the professional and personal challenges faced when confronted with spiritual care in neuro-oncology require further improvement and training.
... Coaching was found to be an effective method in the education of HPs [9,10], as well as reflexivity [11] in groups and among peers, in particular for the development of non-technical skills [12], with long-term supervision [13]. A multidisciplinary approach was recognized as indispensable for all spiritual training, as expressed in the title of the study by Jones et al. "Spirituality is everybody's business" [14]. All HPs should have some tools to increase awareness of the spiritual dimension and work with it as a team. ...
Background
There is widespread agreement about the importance of spiritual training programs (STPs) for healthcare professionals caring for cancer patients, and that reflecting on one’s spirituality is the first step. Health professionals (HPs) working in hospitals must develop this dimension to guarantee the quality of life as well as spiritual and emotional support. In this paper, we propose a possible training format for hospital professionals and assess its implementation.
Methods
This is a phase 0-I study that follows the Medical Research Council (MRC) framework. The program was implemented for hospital palliative care specialists. The program included one theory lesson, three spiritual interactions, four pieces of reflective writing, and two individual follow-up sessions for each participant. The evaluation was performed quantitatively according to the MRC framework and qualitatively according to Moore’s framework with data triangulation from interviews, reflective writings, and indicators.
Results
The program was implemented for palliative care physicians, nurses, psychologists, and bioethicists according to the plan, and the program components were highly appreciated by the participants. The results suggest the feasibility of a training course with some corrections, regarding both the components of the training and organizational issues. The qualitative analysis confirmed a shift in the meaning of the themes we identified. The trainees went from intrapersonal spirituality to interpersonal spirituality (engagement with the other person’s spirituality, acknowledging their unique spiritual and cultural worldviews, beliefs, and practices), with colleagues, patients, and people close to them. The training had an impact on Moore’s Level 3b.
Conclusions
Spiritual training for hospital professionals working in palliative care is feasible. Having time dedicated to spirituality and the ongoing mentorship of spiritual care professionals were suggested as key elements. The next step is increasing awareness of spirituality from our hospital reality and creating a stable competent group (with nurses, chaplains, nuns, counselors, etc.) with the support of the management.
... The EAPC recommends basic spiritual care training for every healthcare worker to become a spiritual care generalist through interdisciplinary shared training for which the participants wish for but so far not been offered. Spiritual care is neither a sole nurses' practice nor a psychologists' practice, but rather a human practice and should be understood as everybody's responsibility [31]. Nonetheless, when everybody is equally responsible for spiritual care, nobody may consider it their explicit duty and spiritual care might remain a neglected area of patient care. ...
Purpose
People with primary malignant brain tumors experience serious health-related suffering caused by limited prognosis and high symptom burden. The aim of this study was to analyze the attitudes and behavior of nurses and physicians when confronted with spiritual distress in these patients.
Methods
Neurospirit-DE is a qualitative vignette-based, multicentre, cross-sectional online survey that was conducted in Bavaria, Germany. Reflexive Thematic Analysis was used for data analysis.
Results
A total of 143 nurses and physicians working in neurological and neurosurgical wards in 46 hospitals participated in the survey. The participants questioned if the ability to provide spiritual care can be learned or is a natural skill. Spiritual care as a responsibility of the whole team was highlighted and the staff reflected on the appropriate way of involving spiritual care experts. The main limitations to spiritual care were a lack of time and not viewing spiritual engagement as part of the professional role. Some were able to personally benefit from spiritual conversations with patients, but many participants criticized the perceived emotional burden while expressing the imminent need for specific training and team reflection.
Conclusions
Most neuro-oncological nurses and physicians perceive spiritual care as part of their duty and know how to alleviate the patient’s spiritual distress. Nonetheless, validation of spiritual assessment tools for neuro-oncology and standardized documentation of patients' distress, shared interprofessional training, and reflection on the professional and personal challenges faced when confronted with spiritual care in neuro-oncology require further improvement.
... Fourthly, the principle of equal opportunities will be negated, as access to spiritual life will be reserved for the well-to-do. In this case, I am concerned about the violation of the right to contemplation and spirituality to which each individual and community is entitled (Hart 2003;Tacey 2004;Watson 2006;Sheldrake 2013;Stockinger 2019;Jones et al. 2020;Bryant et al. 2020;Hyde 2021). ...
People have a claim-right to spirituality. It is therefore the duty of society, including secular societies, to enable its members to exercise this right. This means that spirituality should not be left to the realm of laissez-faire, and that society has a moral duty to nurture spiritual opportunities for children and adults. Moreover, I uphold the idea that all people, including those who live in secular societies, have the right not only to any spiritual life, but to their own, that is, spiritual values consistent with their particular upbringing. Unfortunately, secular societies do not see themselves as responsible for the cultivation of their members’ spirituality. At the same time, they suffer from a public spiritual void. I claim that this void is due to the overwhelming role occupied by work in the lives of people of secular societies, as well as to an overly narrow understanding of leisure, here referred to as leisure-1. The combination of work and leisure-1 has marginalized practices of contemplation that are the core of any spiritual practice. These practices constitute a special kind of leisure, leisure-2, that forms the foundation of spiritual life. I argue that secularism need not be characterized as an un-spiritual, worldly culture, and demonstrate that philosophy as practice and tradition belongs to the particular spiritual tradition of the democratic secular culture—that is, philosophy is secularism’s own spiritual practice. It is the duty of governments to provide secularists with the opportunity to practice philosophy.
... Within the fields of health and aged care, spirituality has been highlighted as a key component of person-centred care, and therefore of relevance for all staff (Carey & Mathisen, 2018;Gijsberts et al., 2019;Jones et al., 2020b;McSherry et al., 2020;Meaningful Ageing Australia, 2016). Research studies have demonstrated that spirituality is closely associated with a range of positive healthcare outcomes including lower levels of depression and anxiety (Braam & Koenig, 2019;Jones et al., 2019), and higher levels of life satisfaction, quality of life and resilience (Cheng et al., 2019;Jones et al., 2018Jones et al., , 2019. ...
The value of spiritual care training for all staff working in health and aged care has been demonstrated. This study investigated how spiritual care specialists (SCSs) perceive their role in delivering spiritual care education to other staff. Fourteen SCSs participated in three online focus groups. Two key themes were identified: First, SCSs build upon existing capacity of staff by: (i) recognising existing strengths and capabilities; (ii) using relevant stories; (iii) using language which makes spiritual care accessible; (iv) making training relevant and practical; (v) tapping into staff vocation or calling; and (vi) building awareness of one's own spirituality. Second, SCSs assist staff to draw upon SCS expertise by establishing a trusting relationship and developing staff awareness of the SCS role. The SCS's role in delivering spiritual care education is an important one, and further consideration regarding how to support them in this role is warranted.
... To help address these barriers, spiritual care training programs have been introduced in healthcare settings. There is a growing belief that awareness of spiritual care is important for all healthcare professionals, 24 not just those with specialist training in spiritual care. Furthermore, although often considered to be the domain of palliative or end of life care, the relevance of spiritual care for a wide range of healthcare contexts is also recognised. ...
Context
Spirituality has been demonstrated to play an important role in healthcare, yet many staff feel ill-equipped to deliver spiritual care. Spiritual care training programs have been developed to address this need.
Objective
The aim of this mixed-methods systematic review was to identify spiritual care training programs for healthcare professionals or students, and to investigate program content, teaching methods, key outcomes, and identified challenges and facilitators.
Methods
A mixed-methods systematic review was conducted. The search terms (‘religio*’ OR ‘spiritual*’ OR ‘existenti*’) were combined with (‘educat*’ OR ‘train*’ OR ‘curricul*’ OR ‘program*’), AND (‘care’ OR ‘therap*’ OR ‘treatment’ OR ‘competenc*’). Search terms were entered into the following data bases: PsycINFO, Medline, Cinahl and Web of Science. Findings were restricted to peer-reviewed studies published in English between January 2010 and February 2020.
Results
Fifty-five studies were identified. The quality of studies was mixed. Programs encompassed a range of content and teaching methods. Reported outcomes included increased levels of competency across intrapersonal spirituality, interpersonal spirituality, and spiritual assessment and interventions. Identified barriers included competing healthcare priorities, negative perceptions of spirituality and spiritual care, resistance towards focusing on one's own spirituality, staff feeling inadequate, and the need for ongoing training. Facilitators included opportunities for reflection, involvement of chaplains, application of practical tools, opportunities for practice, online training, and managerial support.
Conclusions
Positive outcomes following spiritual care training were identified. Further research is needed to identify patient-related outcomes of staff training, and to examine how the benefits of such training can be maintained over time.
Foi realizado um estudo transversal quali-quantitativo para traçar o perfil do fisioterapeuta brasileiro quanto à sua própria espiritualidade e analisar sua percepção sobre o efeito da espiritualidade ou da religiosidade na recuperação do paciente. Um questionário autoaplicável do Google Forms, incluindo a Escala de Bem-Estar Espiritual e o Índice de Religião da Duke University, além de duas questões abertas foi aplicado em 374 fisioterapeutas. As mulheres apresentaram maior religiosidade não organizacional e intrínseca, enquanto os homens apresentaram maior religiosidade intrínseca (p=0,005). Aqueles que viviam com companheiros também apresentaram maior nível de espiritualidade (p<0,005). Os fisioterapeutas brasileiros acreditam que o nível de espiritualidade interfere nos resultados do tratamento, muitas vezes incentivam a fé, a esperança, o otimismo, as práticas meditativas, as músicas relaxantes e os exercícios respiratórios e a busca de significado nos problemas de saúde.
Little is known about the spirituality of people with logopenic aphasia (language-led dementia), including assessment and support. This article presents a single case study from a case series of ten people with various aphasia-types and different religious backgrounds who were recruited after discharge from speech and language therapy (SLT). Based on work with ‘Mr Grey’, it illustrates the use of the ‘WELLHEAD Toolkit’ for assessing and supporting spiritual health. A group of people with aphasia and diverse backgrounds co-produced the resources and steered the research. The Toolkit provides communication support and structure for eliciting interviews about ‘meaning and purpose’ in life. It enables religiously neutral non-judgmental listening and facilitates reflection using Picture and Word Resources, incorporating self-scores, an agreed summary, and goal-setting. Sessions were videoed along with a feedback interview. Participants’ reflections, measures, and verification were integral to the findings from the case series. Findings were analysed via systematic interpretive thematic analysis, verified by an independent researcher. Key themes in Mr Grey’s case are presented in narrative form to respect his own words, interpreted and verified for meaning, within his search for synthesis of his fragmented story. His story-telling brought him catharsis concerning relationships, religious beliefs and sense of self, whilst helping him to frame future goals. Follow-up confirmed the value of enabling chaplaincy referral as a result of the interviews. This helped him towards resolving historical grief before further language deterioration. Limitations and potential future applications of the WELLHEAD Toolkit are discussed.
Background: There is widespread agreement about the importance of Spiritual Training Programs (STPs) for healthcare professionals caring for cancer patients, and that reflecting on one’s own spirituality is the first step. Health Professionals (HPs) working in hospitals must develop this dimension to guarantee quality of life as well as spiritual and emotional support. In this paper, we propose a possible training format and assess its implementation.
Methods: This is a Phase 0-I study that follows the Medical Research Council (MRC) framework. The program was implemented for hospital palliative care health professionals. The study included one theory lesson, three spiritual interactions, four pieces of reflective writing, and two individual follow-up sessions for each participant. The evaluation was performed according to Moore’s framework using data triangulation from 3 rounds of semi-structured interviews, reflective writing, and a meeting to validate the results from the whole group.
Results: The program was implemented according to the plan and the program components were highly appreciated by the participants. Analysis of the interviews confirmed a shift in meaning in what we defined as (1) What is spirituality?, (2) Getting spiritual experience at work, (3) Spirituality and the need for nourishment, (4) Self-reflection on one’s own spirituality. Reflective journals written by the participants confirmed the results and highlighted a) the value of time dedicated to spirituality, b) the role of other colleagues, and c) the transferability to care relationships.The training had an impact on Moore’s Level 3B.
Conclusions: Spiritual training for hospital professionals working in different disciplines is feasible. Reflecting on their own spirituality spontaneously raised the need for health professionals to have spiritual tools to care for patients. Having time dedicated to spirituality and the ongoing mentorship of Spiritual Care Professionals (SCPs) were suggested as key elements for success and to gain support from management. Future research will need to expand this Spiritual Care Training (SCT) to other Specialist Palliative Care Services (SPCSs) in a hospital setting.
Introduction:
Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear.
Aim:
To conduct a questionnaire-based survey on mental health nurses from eight hospitals.
Method:
A total of 239 psychiatric nurses were assessed based on (1) "big-five Mini-Markers" questionnaire, and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality.
Results:
A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion", "Openness/Intellect", "Conscientiousness", and "Agreeableness" DISCUSSION: Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care.
Implications for practice:
Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on-the-job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care.
While patients value engagement concerning their spirituality as a part of holistic healthcare, there is little evidence regarding the preferred way to engage in discussions about spirituality. This study investigated inpatient preferences regarding how they would like spirituality to be raised in the hospital setting. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia ( n = 897), with a subset invited to participate in qualitative interviews ( n = 41). There was high approval for all proposed spiritual history prompts (94.0–99.8%). In interviews, the context dictated the appropriateness of discussions. Findings indicated a high level of patient acceptability for discussing spirituality in healthcare. Further research and more detailed analysis is required and proposed to be undertaken.
Much of the research which has investigated adaptation after spinal cord injury (SCI) has focused upon the physical and psychological challenges confronting the injured person. There is a growing body of evidence however which suggests that many people with SCI and their family members can overcome these challenges and move forward, drawing upon a range of resources and strengths. Spirituality, hope, and resilience are three constructs that have been associated with positive outcomes after SCI. This chapter outlines the research findings to date about these constructs within the field of SCI. The relationship between these variables will be examined and explored, with parallels drawn with the quest narrative proposed by Frank (1995). Implications for SCI practice will be discussed, and the findings from the trial of one intervention program conducted with rehabilitation staff outlined.
Aims and objectives:
To map existing evidence about educational interventions or strategies in nursing and allied healthcare concerning students' and staffs' spiritual care provision.
Background:
Spiritual care is an important part of whole person care, but healthcare staff lack competence and awareness of spiritual issues in practice. To rectify this, it is important to identify what educational approaches are most helpful in supporting them to provide spiritual care.
Design:
A scoping review using the PRISMA-ScR checklist.
Method:
Searches in the databases CINAHL, MEDLINE, ATLA and ERIC were conducted for papers spanning January 2009-May 2020. Search terms were related to spirituality, spiritual care, education and clinical teaching. Appraisal tools were used.
Results:
From the 2128 potentially relevant papers, 36 were included. The studies were from 15 different countries and involved nurses, physicians and other health-related professions, and both quantitative, qualitative and mixed methods were used. The results are presented in three themes: Understanding of spirituality, Strategies in educational settings, and Strategies in practice settings. The review points to great diversity in the content, lengths and setting of the educational interventions or strategies.
Conclusions:
Courses in spiritual care should be implemented in curricula in both undergraduate and postgraduate education, and several studies suggest it should be mandatory. Courses should also be available for healthcare staff to raise awareness and to encourage the integration of spiritual care into their everyday practice. There is a need for greater consensus about how spirituality and spiritual care are described in healthcare settings.
Relevance to clinical practice:
Spiritual care must be included both in monodisciplinary and multidisciplinary educational settings. The main result of spiritual care courses is in building awareness of spiritual issues and self-awareness. To ensure the provision of spiritual care for patients in healthcare practices, continuing and multidisciplinary education is recommended.
Objective
To discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer.
Data Sources
Literature regarding spirituality and life review of the author in cancer care provided the foundation for this article.
Conclusion
Reliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer.
Implications for Nursing Practice
Nurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being.
Globally, spiritual care is recognized as an important component of palliative care. In the Global North spiritual care training is gaining momentum and being prioritized, but not so in the Global South. This study seeks to establish what the national spiritual care training needs are in hospice palliative care settings with formalized spiritual care services in a middle-income country in the Global South. This was a three-part study: a quantitative national online survey of hospices in South Africa establishing what their spiritual care training needs were – survey results were collated, analyzed and filtered for key issues and overarching themes; a qualitative study consisting of focus group discussions with hospices in the Western Cape Province, South Africa, who have formalized spiritual care services, with the aim of understanding their spiritual care practices and workforce needs – the discussions were analyzed using thematic analysis; and a qualitative study drawing on the experiences of a cohort of spiritual care workers from an established hospice in Cape Town to understand their training needs in spiritual care and explore their workforce issues. Results revealed a chorused need for the development of a national training curriculum in spiritual care for hospices providing palliative care in South Africa and a chorused recognition that spiritual care services are nuanced and require both formalization and flexibility for spiritual care workers to be led by patient needs. Two elements – finance and human capital – were identified as key barriers to developing a spiritual care curriculum.
We designed the online Spiritual Competency Training in Mental Health (SCT-MH) program to train providers across mental health fields in basic religious and spiritual (RS) competencies. The goal was to help address the professional training gap in RS aspects of multicultural diversity and integration. We hypothesized that providers completing the program would demonstrate an increase in attitudes, knowledge, and skills relevant to RS issues in mental health care. The SCT-MH program, offered online through the edX platform, consists of 8 hr of multimedia content. Participants (N = 169) across a broad range of mental health disciplines completed a pre- and posttraining survey, which evaluated their spiritual competency using measures assessing their attitudes, knowledge, and skills in the intersection of RS and mental health. We also collected qualitative data to evaluate participants’ levels of satisfaction with the content and format of the program. Participants showed significantly increased spiritual competency in all measures of attitudes, knowledge, and skills following their participation in the course. Participants reported high satisfaction with both the content and the online format of the training program, and a decrease in perceived barriers to integrating RS in practice. These results demonstrate that a brief, novel online training program can help address the current gap between the clinical need and professional requirements for spiritual competency and the general lack of graduate training in this area of multiculturalism. Suggestions for how this program and others like it can be integrated into graduate education and impact clinical care are discussed.
Background:
Despite the importance patients place on religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many nonchaplain clinicians feel unprepared to address religious and spiritual issues in their practice.
Objectives:
The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for nonchaplain clinicians who provide care to elderly long-term care patients.
Methods:
Clinician participants (N = 68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three-month follow-up survey to evaluate their comfort in engaging in spiritual issues before and after the workshop. An average ability score of 13 items in the survey was calculated as well as an average comfort score, which was an average of three items in the survey. Ability scores and comfort scores were analyzed using a pairwise t-test, comparing pre- versus post-workshop and post- versus three-month scores.
Results:
Overall average scores for clinicians' self-reported perceived ability in engaging in issues around spirituality with patients and their families increased from before the workshop to the post-workshop and three months later. Participants' self-perceived comfort increased from before the workshop to immediately following the workshop.
Discussion:
This study suggests that a spiritual care training program targeted toward geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.
Religion and spirituality are areas of diversity and multiculturalism that have yet to be comprehensively addressed in most mental health training programs. Without this type of training, many practitioners lack the competence and confidence to engage in spiritually competent care-clinical practice that recognizes the importance of religion and spirituality in people's identity, worldview, meaning-making, and, therefore, their psychological well-being. Emerging research on treatment outcomes and client preferences, as well as professional ethical mandates, support the need for training in spiritual competencies for mental health care. To address the gap between current professional training and the needs and realities of clinical practice, we have developed an online training program to assist practitioners in building their competency and comfort levels in integrating religion and spirituality into treatment. Spiritual Competency Training in Mental Health (SCT-MH) is a 7-hour asynchronous, online program consisting of 8 modules. The modules are designed to develop basic competency in 16 empirically derived spiritual competencies in mental health. The content was derived from numerous instructional materials and peer-reviewed publications, with input from leading experts in the field of spirituality and mental health. It is a multidisciplinary program, allowing mental health providers from any discipline and orientation to participate. The material is applicable for working with clients with a wide range of mental health issues from diverse religious and spiritual backgrounds. In this article, we will discuss how the program was developed, what it entails, who it was developed for, and future efforts to test it empirically.
Religion and spirituality have been shown to provide older patients and their families with a source of strength, hope, coping, and a sense of meaning in their life (Koenig et al. 1997; Krause et al. 2003). Despite the importance patients place in religion and spirituality, many patients with advanced diseases report that their religious and spiritual needs are not met by their health care team, and many non-chaplain clinicians feel unprepared to address religious and spiritual issues in their clinical practice (Balboni et al. 2013; Puchalski 2012). The purpose of this study was to assess the efficacy of a one-day workshop on spiritual care for non-chaplain clinicians who provide care elderly long-term care patients. Clinician participants (N=68) were given a pre-survey at the beginning of the workshop, a post-survey at the conclusion of the workshop, and a three month follow-up survey to evaluate their comfort in engaging in spiritual issues with patients and families before and after the workshop. Overall scores for clinicians’ self-reported perceived ability and comfort in engaging in issues around spirituality with patients and their families increased significantly right after the training and after three months, although this improvement slightly diminished after three months compared to at the end of the day of the spiritual generalist workshop. This study suggests that a spiritual care training program targeted towards geriatric clinicians has the potential to provide clinicians with the tools, skills, and support they need to approach basic spiritual care with their patients and family members.
Purpose/objective:
The aim of this exploratory study was to consider how spirituality (encompassing meaning, hope and purpose), may facilitate family resilience after spinal cord injury (SCI) over time. Research Method/Design: A qualitative, longitudinal study design was adopted. Semistructured interviews were conducted with 10 family dyads (consisting of the individual with SCI and a nominated family member) on 2 occasions, 6 months apart. A thematic analysis was conducted.
Results:
Participants reported drawing upon a range of different sources of spirituality, including religious faith, the natural world, inner strength, and meaningful connectedness with others. These sources of spirituality were often tested in some way after the SCI. Meaning-making responses to these tests were linked with 3 key outcomes: gratitude, hope, and deeper connectedness with others, assisting families to move forward in their journey after SCI. Over time sources of spirituality did not change significantly; however, the intensity of spiritual experience lessened for some families.
Conclusions:
This study indicated that spirituality after SCI plays an important role for both the injured individual and their family members. Families draw upon a range of sources of spirituality, and these sources of spirituality may assist the family to move forward together after SCI. Further investigation of how health professionals can better address spirituality during spinal rehabilitation is warranted. (PsycINFO Database Record
Objective
Physicians and nurses do not assess spirituality routinely, even though spiritual care is a vital part of palliative care for patients with an advanced serious illness. The aim of our study was to determine whether a training program for healthcare professionals on spirituality and the taking of a spiritual history would result in improved patient quality of life (QoL) and spiritual well-being.
Method
This was a cluster-controlled trial of a spiritual care training program for palliative care doctors and nurses. Three of seven clinical teams (clusters) received the intervention, while the other four served as controls. Included patients were newly referred to the palliative care service, had an estimated survival of more than one month, and were aware of their diagnosis and prognosis. The primary outcome measure was the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT–Sp) patient-reported questionnaire, which patients completed at two timepoints. Total FACIT–Sp score includes the Functional Assessment of Cancer Therapy–General (FACT–G) questionnaire, which measures overall quality of life, as well as a spiritual well-being score.
Results
Some 144 patients completed the FACIT–Sp at both timepoints—74 in the control group and 70 in the intervention group. The change in overall quality of life, measured by change in FACT–G scores, was 3.89 points (95% confidence interval [ CI95% ] = –0.42 to 8.19, p = 0.076) higher in the intervention group than in the control group. The difference between the intervention and control groups in terms of change in spiritual well-being was 0.32 ( CI95% = –2.23 to 2.88, p = 0.804).
Significance of results
A brief spiritual care training program can possibly help bring about enhanced improvement of global patient QoL, but the effect on patients' spiritual well-being was not as evident in our participants. Further study with larger sample sizes is needed to allow for more definite conclusions to be drawn.
Context:
Although spiritual care (SC) is recognized as important in whole-person medicine, physicians infrequently address patients' spiritual needs, citing lack of training. Although many SC curricula descriptions exist, few studies report effects on physicians.
Objectives:
To broadly examine immediate and long-term effects of a required, longitudinal, residency SC curriculum, which emphasized inclusive patient-centered SC, compassion and spiritual self-care.
Methods:
We conducted in-depth individual interviews with 26 physicians (13 intervention;13 comparison) trained at a 13-13-13 residency. We interviewed intervention physicians 3 times over 10-years - (a) pre-intervention, as PGY1s; (b) post-intervention, as PGY3s; (c) 8-years post-intervention, as practicing physicians. We interviewed comparison physicians as PGY3s. Interviews were audio-recorded, transcribed and analyzed by four researchers.
Results:
49 interviews were analyzed. General: Both groups were diverse regarding personal importance of spirituality/religion. All physicians endorsed the value of SC, sharing rich patient stories particularly related to end-of-life and cultural diversity. Curricular effects: (a)Skills/Barriers - Intervention physicians demonstrated progressive improvements in clinical approach, accompanied by diminishing worries related to SC. PGY3 comparison physicians struggled with SC skills and worries more than PGY3 intervention physicians; (b)Physician Formation - Most physicians described residency as profoundly challenging/transformative. Even after 8-years many intervention physicians noted that reflection on their diverse beliefs/values in safety, coupled with compassion shown to them through this curriculum, had deeply positive effects. High impact training: patient-centered spiritual assessment; chaplain rounds; spiritual self-care workshop/retreats; multicultural SC framework.
Conclusion:
A longitudinal, multifaceted residency SC curriculum can have lasting positive effects on physicians' SC skills and their professional/personal formation.
Background:
Despite known health benefits of spiritual care and high patient interest in discussing spirituality with their physicians, the frequency of spiritual discussions in the medical consultation is low. We investigated spiritual conversations for doctors caring for patients with advanced cancer; why these conversations so difficult; and what the underlying challenges are for discussing spirituality with patients;
Methods:
Participants were contacted through the Australian and New Zealand Society of Palliative Medicine and the Medical Oncology Group of Australia, including physicians from two secular countries. Semi-structured interviews were taped and transcribed verbatim. The text was analyzed using thematic analysis;
Results:
Thematic saturation was reached after 23 participants had been interviewed. The following themes were identified: (1) confusing spirituality with religion; (2) peer pressure; (3) personal spirituality; (4) institutional factors; (5) historical factors;
Conclusion:
This study explored the underlying attitudes contributing to the reluctance doctors have to discuss spirituality in the medical consultation. Underlying confusion regarding the differences between religion and spirituality, and the current suspicion with which religion is regarded in medicine needs to be addressed if discussion of spirituality in the medical consultation is to become routine. Historical opposition to a biopsychosocial-spiritual model of the human being is problematic.
Purpose:
A previous survey of the Multinational Association of Supportive Care in Cancer (MASCC) members found low frequency of spiritual care provision. We hypothesized that physicians with special training in palliative medicine would demonstrate an increased sense of responsibility for and higher self-reported adequacy to provide spiritual care to patients than health professionals with general training.
Methods:
We surveyed members of the Australian and New Zealand Palliative Medicine Society (ANZSPM) to ascertain their spiritual care practices. We sent 445 e-mails on four occasions, inviting members to complete the online survey. Tabulated results were analyzed to describe the results.
Results:
One hundred and fifty-eight members (35.5 %) responded. Physicians working primarily in palliative care comprised the majority (95 %) of the sample. Significantly more of the ANZSPM than MASCC respondents had previously received training in spiritual care and had pursued training in the previous 2 years. There was a significant difference between the two groups with regard to interest in and self-reported ability to provide spiritual care. Those who believed it was their responsibility to provide spiritual care were more likely to have had training, feel they could adequately provide spiritual care, and were more likely to refer patients if they could not provide spiritual care themselves.
Conclusions:
Training in spiritual care was more common in healthcare workers who had received training in palliative care. ANZSPM members gave higher scores for both the importance of spiritual care and self-reported ability to provide it compared to MASCC members.
Most measures of spirituality privilege religious spirituality, but people may experience spirituality in a variety of ways, including a sense of closeness, oneness, or connection with a theistic being, the transcendent (i.e., something outside space and time), oneself, humanity, or nature. The overall purpose of the present 4 studies was to develop the Sources of Spirituality (SOS) Scale to measure these different elements of spirituality. In Study 1, we created items, had them reviewed by experts, and used data from a sample of undergraduates (N = 218) to evaluate factor structure and inform initial measurement revisions. The factor structure replicated well in another sample of undergraduates (N = 200; Study 2), and in a sample of community adults (N = 140; Study 3). In a sample of undergraduates (N = 200; Study 4), we then evaluated evidence of construct validity by examining associations between SOS Scale scores and religious commitment, positive attitudes toward the Sacred, and dispositional connection with nature. Moreover, based on latent profile analyses results, we found 5 distinct patterns of spirituality based on SOS subscales. We consider implications for therapy and relevance of the findings for models of spirituality and future research. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
This systematic review was conducted to assess the outcomes of spiritual care training. It outlines the training outcomes based on participants’ oral/written feedback, course evaluation and performance assessment. Intervention was defined as any form of spiritual care training provided to healthcare professionals studying/working in an academic and/or clinical setting. An online search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, ERIC, PsycINFO, ASSIA, CSA, ATLA and CENTRAL up to Week 27 of 2013 by two independent investigators to reduce errors in inclusion. Only peerreviewed journal articles reporting on training outcomes were included. A primary keyword-driven search found 4912 articles; 46 articles were identified as relevant for final analysis. The narrative synthesis of findings outlines the following
outcomes: (1) acknowledging spirituality on an individual level, (2) success in integrating spirituality in clinical practice, (3) positive changes in communication with patients. This study examines primarily pre/post-effects within a single cohort. Due to an average study quality, the reported findings in this review are to be seen as indicators at most. Nevertheless, this review makes evident that without attending to one’the repeliefs and needs, addressing spirituality in patients will not be forthcoming. It also demonstrates that spiritual care training may help to challenge the spiritual vacuum in healthcare institutions.
Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients' family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary.
Study design:
Qualitative research design involving semi-structured focus groups.
Objectives:
To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others.
Setting:
Inpatient rehabilitation program in a large urban city in the Southwestern United States.
Methods:
A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators.
Results:
Through a constant comparative analysis of the data, six themes emerged in participants' responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others.
Conclusion:
Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI. Findings provide richness and depth to current empirical conceptualizations of resilience.
To provide optimal services, a spiritual assessment is often administered to understand the intersection between clients'
spirituality and service provision. Traditional assessment approaches, however, may be ineffective with clients who are uncomfortable
with spiritual language or who are otherwise hesitant to discuss spirituality overtly. This article orients readers to an
implicit spiritual assessment, an alternative approach that may be more valid with such clients. The process of administering
an implicit assessment is discussed, sample questions are provided to help operationalize this approach, and suggestions are
offered to integrate an implicit assessment with more traditional assessment approaches. By using terminology that is implicitly
spiritual in nature, an implicit assessment enables practitioners to identify and operationalize dimensions of clients' experience
that may be critical to effective service provision but would otherwise be overlooked.
Abstract Introduction: The deleterious consequences of traumatic brain injury (TBI) impair capacity to return to many avenues of premorbid life. However, there has been limited longitudinal research examining outcome beyond five years post-injury. The aim of this study was to examine aspects of function, previously shown to be affected following TBI, over a span of 10 years. Materials and Methods: One hundred and forty one patients with TBI were assessed at two, five, and 10 years post-injury using the Structured Outcome Questionnaire. Results: Fatigue and balance problems were the most common neurological symptoms, with reported rates decreasing only slightly over the 10-year period. Mobility outcomes were good in over 75 percent, with few participants requiring aids for mobility. Changes in cognitive, communication, behavioral and emotional functions were reported by approximately 60% of the sample at all time-points. Levels of independence in activities of daily living were high over the 10-year period, and up to 70 percent return to driving. Nevertheless, approximately 40% required more support than before their injury. Only half of the sample returned to previous leisure activities and less than half were employed at each assessment time post-injury. Whilst marital status remained surprisingly stable over time, approximately 30% reported difficulties in personal relationships. Older age at injury did not substantially alter the pattern of changes over time, except in employment. Conclusions: Overall, problems that were evident at 2 years post-injury persisted until 10 years post-injury. The importance of these findings is discussed with reference to rehabilitation programs. Keywords: traumatic brain injury, functional outcome, structured outcome questionnaire.
This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Objective:
To investigate the relationship between resilience and affective state, caregiver burden and caregiving strategies among family members of people with traumatic brain or spinal cord injury.
Design:
An observational prospective cross-sectional study.
Setting:
Inpatient and community rehabilitation services.
Subjects:
Convenience sample of 61 family respondents aged 18 years or older at the time of the study and supporting a relative with severe traumatic brain injury (n = 30) or spinal cord injury (n= 31).
Main measures:
Resilience Scale, Positive And Negative Affect Schedule, Caregiver Burden Scale, Functional Independence Measure, Carer's Assessment of Managing Index.
Results:
Correlational analyses found a significant positive association between family resilience scores and positive affect (r(s) = 0.67), and a significant negative association with negative affect (r(s) = -0.47) and caregiver burden scores (r(s) = -0.47). No association was found between family resilience scores and their relative's severity of functional impairment. Family members with high resilience scores rated four carer strategies as significantly more helpful than family members with low resilience scores. Between-groups analyses (families supporting relative with traumatic brain injury vs. spinal cord injury) found no significant differences in ratings of the perceived helpfulness of carer strategies once Bonferroni correction for multiple tests was applied.
Conclusions:
Self-rated resilience correlated positively with positive affect, and negatively with negative affect and caregiver burden. These results are consistent with resilience theories which propose that people with high resilience are more likely to display positive adaptation when faced by significant adversity.
Purpose/objective:
To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories.
Research method/design:
A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories.
Results:
Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement.
Conclusion/implications:
Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.
Although people with life-limiting conditions report a desire to have spiritual concerns addressed, there is evidence that these issues are often avoided by health care professionals in palliative care. This study reports on the longitudinal outcomes of four workshops purpose-designed to improve the spiritual knowledge and confidence of 120 palliative care staff in Australia. Findings revealed significant increases in Spirituality, Spiritual Care, Personalised Care, and Confidence in this field immediately following the workshops. Improvements in Spiritual Care and Confidence were maintained 3 month later, with Confidence continuing to grow. These findings suggest that attendance at a custom-designed workshop can significantly improve knowledge and confidence to provide spiritual care.
The purposes of this study were to (a) identify changes in resilience and indicators of adjustment (i.e., satisfaction with life, depressive symptomatology, spirituality, functional independence) during inpatient rehabilitation after spinal cord injury (SCI) and (b) examine the relationship between each variable at different stages of the rehabilitation process.
The sample consisted of 42 individuals with a SCI, including 33 men and 9 women who were inpatients for a mean stay of 51 days (SD = 14.63). A repeated measures design was employed, with questionnaires completed at 3 times during the rehabilitation program (admit, 3 weeks, and discharge).
Results from the repeated measures multivariate analysis of covariance and post hoc follow-up tests indicated that there was no significant change in resilience, but that there was significant change for each indicator of adjustment during inpatient rehabilitation. Findings also indicated significant correlations between resilience, satisfaction with life, spirituality, and depressive symptoms.
Future studies that focus on developing interventions and examine the factors that predict resilience could help build resilience, which in turn may improve rehabilitation outcomes.
As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes.
A community-based sample of 140 adults (19-82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question.
After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance).
Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.
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.
Many previous studies investigating long-term cognitive impairments following traumatic brain injury (TBI) have focused on extremely severely injured patients, relied on subjective reports of change and failed to use demographically relevant control data. The aim of this study was to investigate cognitive impairments 10 years following TBI and their association with injury severity. Sixty TBI and 43 control participants were assessed on tests of attention, processing speed, memory, and executive function. The TBI group demonstrated significant cognitive impairment on measures of processing speed (Symbol Digit Modalities Test [SDMT], Smith, 1973; Digit Symbol Coding, Wechsler, 1997), memory (Rey Auditory Verbal Learning Test [RAVLT]; Rey, 1958; Lezak, 1976), Doors and People tests; Baddeley, Emslie & Nimmo-Smith, 1994) and executive function (Hayling C [Burgess & Shallice, 1997] and SART errors, Robertson, Manly, Andrade, Baddeley & Yiend, 1997). Logistic Regression analyses indicated that the SDMT, Rey AVLT and Hayling C and SART errors most strongly differentiated the groups in the domains of attention/processing speed, memory and executive function, respectively. Greater injury severity was significantly correlated with poorer test performances across all domains. This study shows that cognitive impairments are present many years following TBI and are associated with injury severity.
Spirituality and healthcare is an emerging field of research, practice and policy, and healthcare organisations and practitioners are therefore challenged to understand and address spirituality, develop their knowledge and implement effective policy. This is the first reference resource to provide a comprehensive overview of the key topics.
Background:
Spirituality has been positively associated with key adjustment indicators for individuals affected by traumatic brain injury or spinal cord injury.
Objective:
To explore the perceptions of health professionals working in rehabilitation in relation to spirituality and spiritual care practice.
Methods:
An observational study. An adapted version of the Royal College of Nursing Spirituality Survey was emailed to specialty networks of rehabilitation health professionals across Australia.
Results:
The majority of the 125 participants were female (92.8%), from a nursing (67.2%) background, and selected 'Christian' as their religious affiliation (68.8%). A range of spiritual needs for rehabilitation clients were identified, including a source of hope and strength. Although 84% agreed that spirituality was a fundamental aspect of healthcare, 85% agreed that staff did not receive enough education or training. Thematic analysis identified three key ways participants felt their workplaces could better address spirituality: increasing staff knowledge and skills in providing spiritual care, incorporating spirituality into rehabilitation processes, and providing patients with access to spiritual resources.
Conclusions:
Spirituality is considered to play an important role after traumatic injury, but most staff do not feel well equipped to provide spiritual care. Training in spiritual care for rehabilitation professionals is warranted.
Background:
A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI).
Objective:
To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM).
Methods:
A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor -Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale.
Results:
SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers.
Conclusions:
This study contributes to better targeting strength-based family interventions.
Objective:
To test a model of spiritual well-being and resilience among individuals with spinal cord injuries and their family members.
Design:
Prospective cross-sectional observational data were analyzed by structural equation modelling.
Setting:
Inpatient and community services at one rehabilitation hospital.
Subjects:
Individual with spinal cord injury (n = 50) and family member (n = 50) dyads.
Interventions:
Standard rehabilitation, both inpatient and community.
Main measure(s):
Functional assessment of chronic illness therapy - spiritual well-being scale - expanded, Connor-Davidson resilience scale, positive and negative affect scale, depression anxiety and stress scale-21, satisfaction with life scale.
Results:
Median time post-injury was 8.95 months (IQR (interquartile range) = 14.15). Individuals with spinal cord injury and family members reported high scores for both spiritual well-being (66.06 ± 14.89; 68.42 ± 13.75) and resilience (76.68 ± 13.88; 76.64 ± 11.75), respectively. Analysis found the model had acceptable fit (e.g. chi-square goodness of fit statistic = 38.789; P = .263). For individuals with spinal cord injury, spiritual well-being was positively associated with resilience which, in turn, was associated with increasing positive affect and satisfaction with life. Among family members, spiritual well-being was positively associated with resilience. Resilience was then associated with lowered levels of depression and mediated the impact of depression on satisfaction with life. Limited evidence was found for mutual dyadic links, with the only significant pathway finding that resilience in the individual with spinal cord injury was associated with increased satisfaction with life among family members.
Conclusion:
Increased spirituality and resilience make a significant contribution (both independently and in combination) to positive psychological outcomes for both individuals with spinal cord injury and their family members.
Objective
When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.
Method
We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.
Result
We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual ( p < 0.001) and not having received training ( p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision ( p < 0.001). Self-perceived barriers were quite similar across cultures.
Significance of results
Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
Objective: To identify the extent of research which has investigated spirituality or closely related meaning-making constructs after traumatic brain injury (TBI).
Design: A scoping review was employed to capture the broadest possible range of studies.
Methods: Search terms ‘spirituality’, ‘religion’, ‘beliefs’, ‘faith’, ‘hope’, ‘meaning’, ‘purpose in life’, ‘sense of coherence’ and ‘posttraumatic growth’ were combined with search terms related to TBI. Findings were restricted to empirical studies published in English, in peer-reviewed journals and conducted over a 20-year period between 1997 and 2016.
Results: Nine studies were identified, conducted in the USA, Canada and the UK. These included eight quantitative studies and one qualitative study. Definitions and measurement of spirituality varied widely among the studies. Findings revealed that spirituality was closely related to a number of positive outcomes following TBI including psychological coping, physical health, mental health, productivity, life satisfaction, functional independence and posttraumatic growth.
Conclusions: The limited research conducted into spirituality following TBI suggests it can play an important role in the recovery process. Further research is necessary to identify the particular spiritual needs of this population, and how clinical staff may be supported to address such needs.
Aim and objectives
To explore nurses’ and healthcare professionals’ perceptions of spiritual care and the impact of spiritual care training on their clinical roles.
Background
Many nurses and healthcare professionals feel unprepared and lack confidence, competence and skills, to recognise, assess and address patients’ spiritual issues. Patients with unmet spiritual needs are at increased risk of poorer psychological outcomes, diminished quality of life and reduced sense of spiritual peace. There are implications for patient care if nurses and healthcare professionals cannot attend to patients’ spiritual needs.
Design
A qualitative methodology was adopted.
Methods
Recruitment was purposive. 21 generalist and specialist nursing and healthcare professionals from Northwest and Southwest England, who undertook spiritual care training between 2015‐2017 were recruited. Participants were a minimum of three months post‐training. Digitally audio‐recorded semi‐structured interviews lasting 11‐40 minutes were undertaken in 2016‐2017. Data were subject to thematic analysis. Ethical committee approval was obtained. COREQ reporting guidelines were utilized.
Results
Two main themes were identified; recognising spirituality, with sub‐themes of what spirituality means and what matters, and supporting spiritual needs with sub‐themes of recognition of spiritual distress, communication skills, not having the answers and going beyond the physical.
Conclusions
Supporting patients as they approach the end‐of‐life needs a skilled workforce; acknowledging the importance of spiritual care and having skills to address it are central to delivery of best holistic care.
This article is protected by copyright. All rights reserved.
Study design:
Descriptive, qualitative study.
Objectives:
To explore the perspectives of health professionals (HPs) regarding the role of spirituality in spinal cord injury (SCI) rehabilitation.
Setting:
Single centre rehabilitation hospital, NSW, Australia.
Methods:
Two focus groups (n = 12) were conducted with HPs (e.g., nursing, allied health, medical) working in SCI inpatient rehabilitation. A semi-structured interview was employed, consisting of questions about spirituality and its role in SCI rehabilitation. The groups were audio recorded and transcribed. An inductive thematic analysis was conducted.
Results:
Six themes were identified from the focus group data: (i) the meaning of spirituality; (ii) spirituality as a help; (iii) spirituality as a hindrance; (iv) how spirituality is indirectly addressed in practice; (v) perceived barriers to incorporating spirituality into practice; (vi) how spirituality can be better integrated into practice. HPs recognised that spirituality played an important role in the adjustment of many individuals and their families after SCI. However, spirituality was not proactively addressed during SCI rehabilitation, and most often arose during informal interactions with clients. Spirituality, and specifically religious belief, was perceived to sometimes raise difficulties for clients and staff. The use of physical space and a review of rehabilitation processes were suggested by HPs as two ways spirituality could be better incorporated into practice.
Conclusions:
The findings of this study reveal that spiritual needs of clients and their family members during SCI rehabilitation are important and could be better addressed. A range of initiatives are proposed, including staff training and the use of standardised spiritual assessment tools.
Increasing focus is being placed on providing spiritual care for patients as a component of holistic nursing care. Studies indicate that patients whose spiritual needs are met report higher quality of and satisfaction with their care. However, nurses are not including spiritual assessment and care into their practice. One barrier cited by nurses is that they lack educational preparation. A 2-hour, face-to-face educational module about the provision of spiritual care was implemented for inpatient nursing staff at a large academic medical center. Program evaluations of the module suggested an increase in the comfort of nurses providing spiritual care. This article describes the development and implementation of this educational program, with preliminary results.
J Contin Educ Nurs. 2017;48(8):358–364.
The purpose of this scoping review was to investigate the role of spirituality in facilitating adjustment and resilience after spinal cord injury (SCI) for the individual with SCI and their family members. Method - data sources: Peer reviewed journals were identified using PsychInfo, MEDLINE, CINAHL, Embase and Sociological Abstracts search engines.
After duplicates were removed, 434 abstracts were screened applying inclusion and exclusion criteria.
The selected 28 studies were reviewed in detail and grouped according to methodological approach.
Of the 28 studies relating to spirituality and related meaning-making constructs, 26 addressed the adjustment of the individual with SCI alone. Only two included family members as participants. Quantitative studies demonstrated that spirituality was positively associated with life satisfaction, quality of life, mental health and resilience. The utilisation of meaning-making and hope as coping strategies in the process of adjustment were highlighted within the qualitative studies. Clinical implications included recommendations that spirituality and meaning-making be incorporated in assessment and interventions during rehabilitation. The use of narratives and peer support was also suggested.
Spirituality is an important factor in adjustment after SCI. Further research into the relationship between spirituality, family adjustment and resilience is needed. Implications for Rehabilitation Higher levels of spirituality were associated with improved quality of life, life satisfaction, mental health, and resilience for individuals affected by spinal cord injury. Health professionals can enhance the role that spirituality plays in spinal rehabilitation by incorporating the spiritual beliefs of individuals and their family members into assessment and intervention. By drawing upon meaning-making tools, such as narrative therapy, incorporating peer support, and assisting clients who report a decline in spirituality, health professionals can provide additional support to individuals and their family members as they adjust to changes after spinal cord injury.
To examine relationships between psychological distress, health-related quality of life (HR-QOL) and burden among caregivers of people with a traumatic spinal cord injury (SCI) over time, and determine whether the data are more consistent with a "wear and tear" or "adaptation" trajectory.
Prospective longitudinal cohort study with measurements at four time points (6 weeks prior to discharge from subacute inpatient rehabilitation and 6 weeks, 1 year, 2 years post-discharge to community).
Two inpatient spinal cord injury rehabilitation units in New South Wales, Australia.
Participants (n=44; spouses, parents, others) nominated by the person with SCI as their primary caregiver.
Not applicable.
General Health Questionnaire-28 (GHQ-28), Medical Outcomes Survey Short Form-36 (SF-36), Carer Strain Index (CSI) assessed extent of psychological distress, HR-QOL and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the Functional Independence Measure™ (FIM) and Craig Handicap Assessment and Reporting Technique (CHART) respectively.
Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate = -0.03, p < 0.008). At the pre-discharge time point, the caregivers' mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from the pre discharge to 6 weeks post discharge (slope estimate = 0.39, p < 0.001) but did not change significantly across the following two time points (slope estimate = 0.02, p = 0.250). At all three post-discharge time points, the mental component summary scores were not significantly different to the national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the pre- and 6 weeks post-discharge time points (slope estimate = -0.14, p =0.121), nor across the three post-discharge time points (slope estimate <0.01, p = 0.947). Scores at all four time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (pre to 6 weeks post-discharge slope estimate = 0.02, p = 0.426; three post-discharge time points slope estimate < -0.01, p = 0.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% at the fourth (2 year) time-point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver, and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at Time 2 and Time 3, but not at Time 4.
The trajectory of scores for psychological distress and health-related quality of life were consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early post-discharge period. Caregiver burden did not display similar reductions but did not worsen over the study period.
Objective:
Investigate the prevalence, comorbidities, and correlates of challenging behaviors among clients of the New South Wales Brain Injury Rehabilitation Program.
Setting:
All community-based rehabilitation services of the statewide program.
Participants:
Five hundred seven active clients with severe traumatic brain injury.
Design:
Prospective multicenter study.
Main measures:
Eighty-eight clinicians from the 11 services rated clients on the Overt Behaviour Scale, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, and Health of the Nation Outcome Scale-Acquired Brain Injury.
Results:
Overall prevalence rate of challenging behaviors was 54%. Inappropriate social behavior (33.3%), aggression (31.9%), and adynamia (23.1%) were the 3 most common individual behaviors, with 35.5% of the sample displaying more than 1 challenging behavior. Significant associations were found between increasing levels of challenging behavior and longer duration of posttraumatic amnesia, increasing functional disability, greater restrictions in participation, increased support needs, and greater degrees of psychiatric disturbance, respectively (P < 0.004). Multivariate binomial logistic regression found that premorbid alcohol abuse, postinjury restrictions in participation, and higher levels of postinjury psychiatric disturbance were independent predictors of challenging behavior.
Conclusions:
Challenging behaviors are widespread among community-dwelling adults with severe traumatic brain injury. Services need to deliver integrated anger management, social skills, and motivational treatments.
biro a.l. (2012) Journal of Nursing Management 20, 1002–1011 Creating conditions for good nursing by attending to the spiritual
Aim To note similarities, differences, and gaps in the literature on good nursing and spiritual care.
Background Good nursing care is essential for meeting patient health needs. With growing recognition of the role of spirituality in health, understanding spiritual care as it relates to good nursing is important, especially as spiritual care has been recognized as the most neglected area of nursing care.
Methods Nursing research, reports and discussion articles from a variety of countries were reviewed on the topics of good nursing, spiritual care and spirituality.
Key issues A nurse’s spirituality and the nurse–patient relationship are integral to spiritual care and good nursing.
Conclusions There are many commonalities between good nursing and spiritual care. Personal attributes of the nurse are described in similar terms in research on spiritual care and good nursing. Professional attributes common to good nursing and spiritual care are the nurse–patient relationship, assessment skills and communication skills.
Implications for nursing management Good nursing through spiritual care is facilitated by personal spirituality, training in spiritual care and a culture that implements changes supportive of spiritual care. Further research is needed to address limitations in the scope of literature.
This study explored the experience of gratitude in everyday life following traumatic spinal cord injury (SCI) by applying thematic analysis to personal experience narratives. Fifteen participants including two negative cases with SCI shared individual experiences of gratitude according to five themes: (a) everyday life, (b) family support, (c) new opportunities, (d) positive sense of self, and (e) gratitude to God. The findings demonstrated that participants benefited from their efforts to appraise challenging life experiences as positive. Therapists could apply intentional and guided gratitude interventions so that individuals would practice and embrace gratitude in adjusting, coping, and adapting positively to various life changes following trauma.
This study explored the degree to which current cognitions, in terms of appraisals and hope, are associated with the use of coping strategies and psychological adjustment to spinal cord injury (SCI). A cross-sectional survey design was used. A range of comprehensive, standard self-report measures were administered to 54 newly injured people with SCI. Correlation analyses were used to explore associations between factors. Forward hierarchical multiple regression analyses were also employed to examine the degree to which appraisals and hope predicted coping and adjustment. Hope and primary appraisals of threat were significantly correlated with the coping strategy of fighting spirit. Hope was a better predictor of coping than appraisals were. Of all the variables considered, appraisals showed the strongest association with adjustment, accounting for 12 per cent of the variance in anxiety and 34 per cent of the variance in depression. Coping variables did not explain more variance in depression than threat and challenge appraisals. Current cognitions, in particular primary appraisals of threat, are important in the process of psychological adjustment to SCI. Greater emphasis needs to be placed on appraisals in future coping research and interventions.
The relationship between spirituality and medicine has been the focus of considerable interest in recent years. Studies suggest that many patients believe spirituality plays an important role in their lives, that there is a positive correlation between a patient's spirituality or religious commitment and health outcomes, and that patients would like physicians to consider these factors in their medical care. A spiritual assessment as part of a medical encounter is a practical first step in incorporating consideration of a patient's spirituality into medical practice. The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows: H--sources of hope, strength, comfort, meaning, peace, love and connection; O--the role of organized religion for the patient; P--personal spirituality and practices; E--effects on medical care and end-of-life decisions.
This article presents a model for research and practice that expands on the biopsychosocial model to include the spiritual concerns of patients.
Literature review and philosophical inquiry were used.
The healing professions should serve the needs of patients as whole persons. Persons can be considered beings-in-relationship, and illness can be considered a disruption in biological relationships that in turn affects all the other relational aspects of a person. Spirituality concerns a person's relationship with transcendence. Therefore, genuinely holistic health care must address the totality of the patient's relational existence-physical, psychological, social, and spiritual. The literature suggests that many patients would like health professionals to attend to their spiritual needs, but health professionals must be morally cautious and eschew proselytizing in any form. Four general domains for measuring various aspects of spirituality are distinguished: religiosity, religious coping and support, spiritual well-being, and spiritual need. A framework for understanding the interactions between these domains is presented. Available instruments are reviewed and critiqued. An agenda for research in the spiritual aspects of illness and care at the end of life is proposed.
Spiritual concerns are important to many patients, particularly at the end of life. Much work remains to be done in understanding the spiritual aspects of patient care and how to address spirituality in research and practice.
Survey.
Insight in (1) the changes in participation in vocational and leisure activities and (2) satisfaction with the current participation level of people with spinal cord injuries (SCIs) after reintegration in society.
Descriptive analysis of data from a questionnaire.
Rehabilitation centre with special department for patients with SCIs, Groningen, The Netherlands.
A total of 57 patients with traumatic SCI living in the community, who were admitted to the rehabilitation centre two to 12 years before the current assessment.
Changes in participation in activities; current life satisfaction; support and unmet needs.
Participation expressed in terms of hours spent on vocational and leisure activities changed to a great extent after the SCI. This was mainly determined by a large reduction of hours spent on paid work. While 60% of the respondents successfully reintegrated in work, many changes took place in the type and extent of the job. Loss of work was partially compensated with domestic and leisure activities. Sports activities were reduced substantially. The change in participation level and compensation for the lost working hours was not significantly associated with the level of SCI-specific health problems and disabilities. As was found in other studies, most respondents were satisfied with their lives. Determinants of a negative life satisfaction several years following SCI were not easily indicated. Reduced quality of life was particularly related to an unsatisfactory work and leisure situation.
Most people with SCI in this study group were able to resume work and were satisfied with their work and leisure situation.
Dr. Christina Puchalski is an internist and geriatrician who has recently designed a Spiritual Assessment consisting of four basic questions that physicians or others can integrate into patient interviews. The assessment is remembered by the acronym FICA, for the four domains it touches on: Faith, Importance, Community, and Address. In this interview with Innovations associate editor Anna L. Romer, Dr. Puchalski explores how she came to develop the spiritual history, how she sees it as distinct from a careful psychosocial history, and what she has learned as she has trained physicians across the United States to incorporate it into their medical interviews. This interview is excerpted from a thematic issue, 'Spirituality and End-of-Life Care,' Vol. 1, No. 6, 1999 of the online journal Innovations in End-of-Life Care. an archived version through the following link: https://web.archive.org/web/20121230024120/http://www2.edc.org:80/lastacts/issues.asphttp:/www.edc.org/lastacts/.
To describe the epidemiology of depression following traumatic spinal cord injury (SCI) and identify risk factors associated with depression.
This population-based cohort study followed individuals from date of SCI to 6 years after injury. Administrative data from a Canadian province with a universal publicly funded health care system and centralized databases were used. A Cox proportional hazards model was developed to identify risk factors.
Of 201 patients with SCI, 58 (28.9%) were treated for depression. Individuals at highest risk were those with a pre-injury history of depression [hazard rate ratio (HRR) 1.6; 95% CI: 1.1-2.3], a history of substance abuse (HRR 1.6; 95% CI: 1.2-2.3) or permanent neurological deficit (HRR 1.6; 95% CI: 1.2-2.1).
Depression occurs commonly and early in persons who sustain an SCI. Both patient and injury factors are associated with the development of depression. These should be used to target patients for mental health assessment and services during initial hospitalization and following discharge into the community.
A phenomenological study was conducted with 20 spinal cord injured persons and their family members to examine the meaning of living with spinal cord injury 5 to 10 years after the initial injury. Seven themes emerged from the data. The themes are looking for understanding to a life that is unknown, stumbling along an unlit path, viewing self through a stained glass window, challenging the bonds of love, being chained to the injury, moving forward in a new way of life, and reaching normalcy. The uncovered meanings enhance our understanding and appreciation that living with spinal cord injury is a continuous learning experience. The study findings may be useful in the development of self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for both spinal cord injured persons and their family members throughout the course of living with the disability.
To examine the association between coping style and emotional adjustment following traumatic brain injury.
Thirty three individuals who had sustained a traumatic brain injury (mean duration of posttraumatic amnesia = 32 days) between 1(1/2) months and almost 7 years previously.
Coping Scale for Adults, Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale, State-Trait Anger Expression Inventory, and the Sickness Impact Profile.
Approximately 50% of the sample reported clinically significant levels of anxiety and depression. Coping characterized by avoidance, worry, wishful thinking, self-blame, and using drugs and alcohol was associated with higher levels of anxiety, depression, and psychosocial dysfunction and lower levels of self-esteem. Coping characterized by actively working on the problem and using humor and enjoyable activities to manage stress was associated with higher self-esteem. Lower premorbid intelligence (measured via the National Adult Reading Test) and greater self-awareness (measured via the Self-Awareness of Deficits Interview) were associated with an increased rate of maladaptive coping.
The strong association between the style of coping used to manage stress and emotional adjustment suggests the possibility that emotional adjustment might be improved by the facilitation of more adaptive coping styles. It is also possible that improving emotional adjustment may increase adaptive coping. The development and evaluation of interventions aimed at facilitating adaptive coping and decreasing emotional distress represent important and potentially fruitful contributions to enhancing long-term outcome following brain injury.