Aiming Toward the High Mark of Holistic Wellness: Q & A

The practice of mental health care performed by nurses in mental hospitals requires nurses to also provide spiritual care. Nurses who have a healthy spiritual state can certainly provide good spiritual care to their patient. Unfortunately, nurses admit that in practice, this spiritual element is often overlooked and not considered important in practice. This study aims to examine the health and spiritual well-being of mental health nurses working in mental health care facilities (hospital based). This research was a pilot study using Mix Method (MM), the design of this study was a sequential research design (Qual-Quant) between quantitative and qualitative study. Data collection was carried out using a self-administered survey and using the SHALOM (Spiritual Health and life orientation measure) instrument from Fisher which had a total of 22 questions. Quantitative data analysis was performed using descriptive statistics, while qualitatively, the data were analyzed using the thematic analysis method. A total of 22 mental health nurses participated in this research project. This number represents the nurses who work in all wards in mental hospitals. Researchers used the cluster sampling method to select participants who were given questionnaires and the snowball sampling method to find suitable informants to be interviewed. This research shows nurses expressing worship of the Creator (Mean = 4.54, SD = 0.59) as the most important thing in the ideal standard of health and spiritual well-being. Likewise, with daily life and practice (Mean = 3.81, SD = 1.68). Nurses assess their health and spiritual well-being were more determined by the transcendental domain, especially with religious rituals. This study concluded that nurses have a well-distributed state of health and spiritual well-being ranging from the personal domain to transcendence, with dominance in the transcendence domain.

Background: In recent decades, spiritual well-being has gained fundamental importance in many healthcare environments. Spiritual well-being is important information about healthcare needs, allowing people to deal with mental stress. Objectives: The present study aimed to determine the spiritual well-being of nurses working in Birjand University of Medical Sciences hospitals in 2022. Methods: In this cross-sectional study, 354 nurses working in the hospitals of the University of Medical Sciences in Birjand City in 2022 were selected by proportional stratified random sampling, and they completed the questionnaire related to demographic information and the standard questionnaire of spiritual well-being. Data were analyzed by SPSS v26 software and ANOVA with Tukey's post hoc test, Pearson correlation, and chi-square at 0.05 significant level. Results: The mean age of the nurses participating was 35.76 ± 7.29 years, and the mean total score of nurses' spiritual well-being was 180.55 ± 16.95. Most of the people in the field of communication with God (78.5%), self (58.8%), others (75.1%), and nature (78.5%), and the total score (52%) were in the medium level of spiritual well-being. There was a significant direct correlation between all dimensions of spiritual well-being (P < 0.001). Also, there was a statistically significant relationship between the mean score of spiritual well-being and age, employment status, and workplace hospital (zage = 7.76; z employment = 18.95; z workplace = 18.62; P < 0.05). Conclusions: Considering that the nurses were medium in terms of spirituality and spiritual well-being, it is suggested to hold educational workshops to improve the level of spiritual well-being of nurses.

본 연구는 노인요양병원 간호사의 죽음 인식, 영적 안녕, 임종간호 스트레스의 정도를 파악하고 그 관련요인을 분석하여 임종간호 스트레스를 감소시키기 위한 중재 개발의 기초자료로 제공하기 위한 목적으로 시도 되었다. 연구 대상은 노인요양병원 6곳에 근무하는 간호사 181명이었고, 자료 수집은 2015년 7월 16일부터 2015년 8월 1일 까지 구조화된 자기기입식 설문지로 하였다. 연구결과 노인요양병원 간호사의 죽음 인식은 평균 4.30점, 영적 안녕은 평균 3.40점, 임종간호 스트레스는 평균 3.84점이었고, 일반적인 특성에 따른 임종간호 스트레스는 종교, 총 임상경력에서 유의한 차이를 보였다. 임종간호 스트레스의 평균 점수를 기준으로 차이를 분석한 결과 영적 안녕은 임종간호 스트레스에 유의한 영향을 주는 것으로 나타났으며(p=.047), 영적 안녕이 평균 평점 1단위 증가할 때마다 임종간호 스트레스가 '상'그룹에 속할 확률이 Odds비 1.702로 나타났다. 노인요양병원의 임종간호 스트레스를 감소시키기 위한 교육프로그램과 간호중재 개발이 요구되며, 임종간호 스트레스 감소를 통해 임종간호의 질을 높이기 위한 노력을 기울여야 할 것이다. The purpose of this study was to understand death perception, spiritual well-being, and terminal care stress in geriatric hospital nurses and analyze related factors affecting terminal care stress. The participants were 181 nurses working in six geriatric hospitals located in Seoul and Gyonggi Province, Korea. Data were gathered from July 16 to August 1, 2015. The data were analyzed using ANOVA, t-test, Duncan test, and logistic regression. Death perception of geriatric hospital nurses had an average score of 4.30, spiritual well-being 3.40, and terminal care stress 3.84. Terminal care stress in relation to general characteristics showed a meaningful difference in religion and total clinical career. The terminal care stress level was divided into two groups using average score as a standard, and the results revealed that spiritual well-being had a significant impact on terminal care stress of geriatric hospital nurses. These factors need to be considered when developing an educational program to reduce terminal care stress of nurses working in a geriatric hospital.

In their review, Love et al. 1 explore the Aboriginal and Western concepts of spiritual well-being. They describe the difficulties in defining spiritual well-being due to cultural, religious and environmental diversity. To contribute to current understandings of spiritual well-being, Love et al. 1 recommend exploring the Aboriginal worldview of spirituality. Aboriginal Australians have long recognised that spirituality is at the core of well-being and is connected to all other factors influencing well-being, including health 2, 3. The Aboriginal Inner Spirit (Ngarlu) Model developed by the late Karajarri and Yawuru Elder Joe Roe illustrates this concept 3. As described by Roe [3; p.452] When people's emotional, spiritual, physical and social needs are met, then their Inner Spirit feels strong because they are in a good state of health. When one or more of these needs are not met, people's health deteriorates. This will affect your Inner Spirit and make you feel weak or no good. Spirituality defines the relationships of indigenous peoples with their environment as custodians of the land; it helps construct social relationships, gives meaning, purpose and hope to life. It is not separated but is an integral, infused part of the whole in the indigenous worldview…It is important to realise that a healthy spirit is essential for indigenous people to live a healthy life. Love et al. 1 highlight that spirituality becomes increasingly important as people age. It is necessary for aged care providers to understand how contact with the aged care system may impact on an older person's spiritual well-being. Past events have impacted on the spirituality of many older Aboriginal Australians. When a person from the Stolen Generation moves into residential aged care, traumatic memories may resurface. The experience of being away from family, community, culture and country, and adjusting to a highly structured routine and environment, may retraumatise survivors and their family members, disrupting their spiritual well-being and leading to symptoms such as anxiety, fear, grief, loss and depression. In this instance, aged care providers need to identify the risk to their client and determine appropriate best practice care. This may involve tailored strategies to enhance spirituality such as visiting country and family regularly, and also assisting the person to access culturally appropriate healing programs and counselling, although there is a need to determine whether they are suitable for people who are frail or have cognitive impairment. Community-led initiatives such as Yokai (http://www.Yokai.com.au) in Western Australia can assist older Aboriginal people who were forcibly removed from their families to access appropriate healing programs. The Marumali (put back together) Program is a healing program developed in New South Wales specifically for Stolen Generations 5. This healing program centres on reconnecting with spirituality to bring about well-being. Love et al. 1 highlight that spiritual well-being needs differ between individuals, and consequently service providers need to tailor strategies to address each older Aboriginal person's needs. However, there is currently no culturally informed assessment for service providers to determine the spiritual and overall well-being needs of individual older Aboriginal clients. To achieve this, the 'Well-being of Aboriginal Elders' study is currently underway by the authors (Smith and Gilchrist) and their co-researchers, supported by NHMRC-ARC-funded research at the University of Western Australia. This study is investigating the key factors important to the well-being of older urban living Aboriginal people, including spirituality. These factors are being determined through individual interviews and yarning circles and will inform items for an assessment tool. This tool will be validated and incorporated into a well-being package, including Aboriginal informed strategies to support the spiritual and overall well-being of this older age group. The aim is for the well-being package to be utilised by health and aged care providers to assess a person's self-identified well-being, enabling strategies to be implemented to support older Aboriginal individuals, including those with cognitive impairment, to nurture their well-being. The spiritual well-being of Aboriginal caregivers of older people is also vital for the well-being of the older person, their families and the community. Research in this area is currently being conducted in conjunction with Kimberley Aboriginal caregivers by the NHMRC-funded project Strong Carers, Strong Communities: Keeping Kimberley Spirit Strong by the author (Smith) and colleagues. This participatory action research is currently determining the effectiveness of empowering family caregivers of older Aboriginal people to determine and implement methods to 'Keep Spirit Strong'. In conclusion, the Aboriginal worldview highlights that spirituality is at the core of overall well-being. The factors important to spiritual well-being may differ for each individual. To provide culturally appropriate care, aged care providers must understand the possible impact of the aged care system on older Aboriginal Australians, ensure older Aboriginal Australians are given the opportunity to identify their spiritual well-being needs and tailor strategies around these. Facilitating access to activities that are self-identified as important to the spiritual well-being of an older Aboriginal person will have a positive impact not only on spiritual well-being, but also on all other aspects of well-being, including health. Given that spirituality becomes more important as people age, these principles may also inform the care of all older Australians. Formal procedures need to be integrated into aged care to identify spiritual well-being needs; develop effective and culturally appropriate strategies to facilitate spiritual well-being; and monitor and improve the effectiveness of implemented strategies.

This study examined the effect of a spirituality training program on the spiritual well-being, spiritual integrity, leadership practice, job satisfaction, and burnout of hospital middle manager nurses in Korea. In an experimental study with a two-group (experimental vs. control) design, participants were enrolled for 5 weeks, with 24 nurses in the spirituality program and 27 in the control group. After the spirituality training program, spiritual well-being, spiritual integrity, and leadership practice improved and burnout was reduced significantly in the experimental group compared with the control group. The program was effective in improving psychosocial and spiritual well-being of middle manager nurses. Thus, this program could be a resource for continuing education and staff development offerings to enhance the well-being of nurses and the spiritual care of patients.

Aim: A descriptive study was conducted to assess the spirituality and spiritual among nursing students in a selected college of nursing in Ernakulum District, Kerala. Background: Spirituality and spiritual care are of great importance as fundamental principles in health care. With the introduction of important changes in the health care system, nurses use the concept of holism in patient care and the spiritual aspect of health care is steadily gaining importance. The World Health Organization (WHO) announced that the health needs should include spiritual well-being in addition to physical, mental, and social domains .Spirituality is a positive dimension of the human being and care and might help patients reframe their experiences and condition of illness as well as find meaning in life and in that circumstance.Spiritual well being is one of a core human component that provides driving force to give person stability, meaning, and fulfillment in life, faith in self. The purpose of this study is to assess the spirituality, spiritual wellbeing and perception towards spiritual care among nursing students. Methods: A Descriptive analytical study was conducted among 129 BSc Nursing students studying in a Nursing College attached to a Medical College Hospital of South India during the month of December 2020.Convenience sampling technique was adopted for the study. Spirituality assessment scale and spiritual well being assessment scale were used to collect the data.Pilot study was conducted and the study was found to be feasible. Permission from the authorities was obtained and data collection was done. The data analysis was done using descriptive and inferential statistics and R software used for the analysis. Results: The result revealed the mean score of spirituality and spiritual wellbeing as 84.40(SD+_8.45) and 65.81(SD+_6.09) respectively and a statistically significant strong positive correlation was found between spirituality and spiritual wellbeing with correlation coefficient ( r ) 0.806 at p value < 0.0001. Conclusion: Spirituality is a significant concept for the discipline of nursing with profound consequences for caring patients. Spirituality is an important aspect of holistic care This study identified that there is a strong relationship between spirituality and spiritual wellbeing.So this study convey the significance of spirituality and spiritual well being in holistic care.

To investigate the effects of death anxiety and spirituality on the psychological well-being of geriatric home care patients. A descriptive cross-sectional design was conducted between January and June 2024 with 280 individuals aged ≥65 years living in a provincial center in eastern Türkiye. Data were collected using the personal information form, Spiritual Orientation Scale, Psychological Well-being Scale, and Death Anxiety Scale. Descriptive statistics, t-tests, and machine learning based Shapley value analysis were applied. Psychological well-being was significantly associated with death anxiety and spirituality. Lower death anxiety (t=-4.253, p<0.001) and higher spirituality (t=4.728, p<0.001) were linked to better psychological well-being. Shapley value analysis identified spirituality as the strongest predictor. Reducing death anxiety and enhancing spirituality may improve psychological well-being in geriatric home care patients. Integrating spirituality-based psychosocial interventions into geriatric care may strengthen emotional resilience and quality of life. Future longitudinal studies are recommended to better understand the causal relationships between death anxiety, spirituality, and psychological well-being in geriatric home care populations.

Geriatric health care policy in the United States and Canada: A comparison of facts and values in defining the problems

2020 International Journal of Older People Nursing awards: Celebrating excellence and innovation in gerontological nursing.

Texas Tech University Health Sciences Center School of Medicine.

Background : With reference to the demographic change and the growing number of the elderly, inappropriate health care bears a great challenge for geriatric care management and especially for the health care expenditures. Inappropriate health care may refer to unnecessary medical interventions which, on the one hand, relate to unjustifiably high costs in health care systems, and on the other hand, leads to an inadequate supply of geriatric patients, with high risks of reducing their quality of life. Considering that, the need for improving individual pathways as well as the quality of an integrated geriatric care management should obtain high priority within policy developments. The Geriatric Health Care Centers (GGZ) have built up different departments in order to offer a Staged Model of Care for all geriatric patients to provide the best possible and demand-oriented care for this particular target group. The GGZ run more than 10 inpatient, part-inpatient departments and day care units for geriatric patients. Methods : In order to analyze the effectiveness of this Staged Model of Care for geriatric patients, a study was performed. The patient population includes a total number of 6120 geriatric patients (average age: 82 years, average number of diagnosis 5), who were treated in one of four different inpatient departments of the GGZ (Acute Geriatric Care Unit, Intermediate Care Unit, Medical Geriatric Care Unit and Nursing Homes) between January 2014 and December 2015. The study is based on indicators such as the average length of stay, the Barthel Index Score, the incidence of falls and pressure ulcers, staffing in full-time equivalent per patient and the therapeutic services per patient. In addition to the comparative evaluation study, a process analysis of the Comprehensive Geriatric Assessment prior to admission was conducted. Based on three documents–a process description of the different departments, the patients’ registration forms and referral criteria–three different interdisciplinary assessment teams (#1: Acute Geriatric Care Unit, #2: Intermediate & Medical Geriatric Care Unit, #3: Nursing Homes) decide on the admission of patients to a specific department. The performance of a Comprehensive Geriatric Assessment prior to admission is appropriate to ensure an adequate multidisciplinary treatment and achieve the aims of treatment. Results : The results of the study show that the indicators reflect the structure of care and the aims of treatment through the different stages of care. Within the departments Acute Geriatric Care and Intermediate Care Unit they focus on remobilization with the aim of discharging patients home or to institutions with lower care intensity. Therefore the indicators show that the average period of hospitalization is much shorter (approx. 20 days) than in long term care institutions, e.g. the Medical Geriatric Care Unit (approx. 147 days) or in Nursing Homes (approx. 635 days). In comparison to long term care units therapeutic services are provided more often to patients at the Acute Geriatric Care Unit and Intermediate Care Unit (approx. 0.7 hours/day). The indicators of staffing also demonstrate that there is no need for the attendance of physicians 24/7 in Nursing Homes. This is due to the fact that it is a residential facility where quality of life until one’s death and caregiving has priority. At the Acute Geriatric and Intermediate Care Unit the number of physicians in full-time equivalent per patient (approx. 0.12) is much higher than in Nursing Homes (approx. 0.02), because the patients’ general health condition has to be compiled first to give therapy advices and regain the patients’ independence by increasing their health literacy. Conclusions : To conclude, it can be said that the intensity of care in each stage of supply correlates with the demands and needs of geriatric patients. Therefore it provides the best point of service not only for patients but also achieves health economic advantages (e.g. usually adequate care can be offered at lower daily fees than in acute hospitals). Moreover, this Staged Model of Care allows, if necessary, the exchange of patients within the organization. A decision-tree is designed to keep high quality standards and facilitate the admission assessment for new employees. For this purpose factors of patient groups are defined in order to allocate patients more easily to different units of care (e.g. high remobilization potential as an indicator for the Acute Geriatric Care Unit etc.). However the findings show a definite need of further development towards home care concepts like ambulatory or mobile care services.

Ayurveda, the ancient Indian traditional system of medicine is essentially the science of life and longevity. It carries a treasure of pro-nature holistic geriatric health care modalities. It deliberates on the science and philosophy of life and longevity with the goal of healthy aging and long life to achieve the Purusartha catustaya ie the Four fundamental Instincts of human life viz. Dharma, Artha, Kama, Moksa. It considers aging as Swabhava or the natural tendency of life and describes in details the pattern of sequential losses of biological strength with advancing age in relation to the doctrine of Tridosa. The central focus of strength of Ayurveda in geriatric care swings around the concept of Rasayana/Rejuvenation therapy which compensates the age-related biological losses in the mind-body system and affords comprehensive rejuvenative effect. Combining Ayurvedic Rasayana, healthy dietetics, positive life style, yoga and spirituality it is possible to develop an effective package for geriatric care today for global use. New scientific evidences have been accumulating during last few decades which validate the age-old time tested science of life and health warranting further research and development. This strength of Ayurveda in geriatric health care is becoming more relevant today than ever before because of the rapid rate of population aging world over including India with an obvious shift in the age distribution denoting population aging with increased life expectancy of the people. Such an increase in the number of elderly people in the society is reflecting overtly in rapid rise in the incidence of diseases of old age warranting strategic plans for Geriatric health care and hence Geriatrics is fast emerging as an important medical discipline where the elements of holistic Ayurvedic geriatrics will find an important place.

There was a projected growth of up to 80% between 1990 and 2025 in an older adult of Nigeria above 60 years of age. This projected growth assumes an increased workload for almost every healthcare provider to ensure optimal geriatric care. This study aimed to assess preventive geriatrics as a way of geriatric health care. Self-administered questionnaires were distributed among elderly people (60 years and above) residing in the Akure South Local Government Area for at least a year. The survey included several sections to assess multiple aspects such as sociodemographic information, assessment of primary preventive geriatrics, secondary preventive geriatrics as well as tertiary preventive geriatrics as methods of receiving geriatric health care. The response rate was around 96% of the respondents. The mean (± standard deviation) age of the cohort was 72.3 (±8.4) years. The primary (χ² =39.498, df = 12 p-value=0.000), secondary (χ² =58.5003, df = 12, p-value=0.000), and tertiary (χ² =35.8994, df = 12, p-value=0.000) preventive geriatrics were shown to be a way of geriatric health care. Geriatric health care should focus on prevention, medication use, personalized health management, fall prevention, and vaccination uptake. The study thus recommends that institutions in geriatric care provide educational programs, gratuitous medical evaluations, and social support strategies that can reduce the burden of preventive geriatric care for Nigerian elderly.

According to the United States Census Bureau, there was a 15.1% increase in the sixty-five and older population between 2000 and 20101 and is expected to climb to 16.3% by 2020.2 In addition, older adults have shown a greater need for health care resource utilization in America; while only 12.8% of the U.S. population in 2008, older adults accounted for 26% of office visits, 35% of hospital stays, and 38% of emergency medical services.3The increase in care necessary for the aging population paired with the ebb of resident interest in geriatrics4 has prompted many to call for a more focused effort toward expanding awareness of and recruitment to geriatrics.5-8 Toward these ends, Saint Louis University (SLU) developed a university-level undergraduate course in ethics and geriatric care designed to expose students to the field prior to beginning formal post-baccalaureate medical education. In addition to regular classroom discussion of issues in geriatric care, students spend significant time learning through direct exposure to geriatrics by spending one hour shadowing clinicians and two hours visiting an elder at the nursing home. Students are assessed on classroom participation, completion of required hours, regular reflection papers integrating nursing-home experiences with classroom discussion, and completion of a quality improvement (QI) project.This course is unique for three reasons. First, it is one of the only university-level undergraduate courses engaging students in direct experiences with long term care residents. Second, it was designed in collaboration with undergraduate pre-professional students, who were surveyed to incorporate their needs into the course curriculum (pre-development needs analysis). Finally, it integrates reflection on and discussion of ethical issues related to geriatric long-term care with the students’ time at the nursing home, thereby grounding the practical experiences in theory and animating theory with real-world examples. Course design The course was designed to meet several stakeholders’ interest simultaneously. First, the Division of Geriatric Medicine at SLU School of Medicine expressed a desire to increase awareness of common geriatric care issues and to pursue more volunteers to spend meaningful time with nursing home residents. Second, the pre-professional students at SLU completed a needs-based assessment to delineate student-driven course objects. The survey answers were qualitatively analyzed for common themes: 1) gaining experience with patients, 2) improving medical school applications, 3) increasing shadowing opportunities, 4) understanding the geriatric population, and 5) exposure to medical-ethical discussion. Finally, the University’s Center for Health Care Ethics was seeking opportunities for students to engage in real-world health care experiences while receiving course credit toward a minor degree in Health Care Ethics.The interests of these three stakeholders were combined to develop an internship-based service-learning course with resident companion contact hours, shadowing hours, classroom discussion, and ethics education. Students gain relevant knowledge and skills through real-world learning contexts and insight through volunteer and community service experiences. Upon completion of the course, students should be able to identify: (1) medical and professional challenges to geriatric care, (2) related ethical issues inherent in geriatric and end-of-life care, (3) effective communication and patient-centered skills with elder patients, and (4) principles of ethical care-giving.

World Congress Integrative Medicine & Health 2017: part three