Biopsychosocial-spiritual Model Research Articles

A Theological Framework for Understanding Hope in the Clinic

Abstract Appeals to the miraculous are common in healthcare, and arguments about end-of-life decision-making can quickly become theological. Assessments of hope have been recommended within the biopsychosocialspiritual model of medicine, but these assessments fail to account for the theological dimension of hope. Examples of failed assessments include recent efforts in palliative care and classic works, such as On Death and Dying by Elisabeth Kübler-Ross. To adequately address the patient’s and family members’ hopes without patronizing or harming the patient, assessments must be done by a person trained in theology.

The Efficacy of Biopsychosocial-Spiritual Model for Women with Polycystic Ovary Syndrome

The Efficacy of Biopsychosocial-Spiritual Model for Women with Polycystic Ovary Syndrome

BEYOND LIMITS: SIX YEARS OF COMMUNITY-BASED PALLIATIVE CARE EFFORTS FOR A CHILD WITH SPINAL MUSCULAR ATROPHY (SMA) TYPE-1

Purpose: Spinal Muscular Atrophy (SMA) is a rare neuromuscular disease that results in muscle weakness and atrophy, where symptoms appear at the first six months of life and most die by two years. Pediatric palliative care (PPC) prevents and relieves suffering in children with life-threatening illnesses. The study aims to enumerate the challenges encountered in rendering PPC for a child with SMA Type I and describe the best available community-based PPC practices in a resource-limited country. Case Description: CM was referred to community-based PPC when she was 15 months old. At that time, she needed respiratory aid via ventilator through tracheostomy, feeding aid via percutaneous endoscopic gastrostomy tube, and she was confined to bed. She was taken cared for by the PPC team for six years and nine months delivered through home visits and continued through telemedicine during the pandemic. The care team comprises doctors, nurses, physical therapists, social workers, counselor, and administrative support. Outcomes: Upon referral to PPC, examinations were conducted on biological, social, emotional, and spiritual dimensions. Interprofessional goal setting yielded the following consensual goals: Provide adequate control for impairments and optimum nutritional support, assist with family's needs, maintain a sense of peace among family members and care providers, and achieve the best possible quality of life. Interventions were based on the biopsychosocial-spiritual model (BSM) delivered across professions. The care team initiated creative ways to convert limited resources to optimum PPC. Throughout the provision of best available care to CM, the set goals were generally achieved, with positive feedback from the family and the benefit of surpassing the patient’s life expectancy. Conclusion: Children with conditions like SMA-Type 1 and their families may benefit from PPC employing a BSM approach.

Trauma, genes, or spirits? Development of a scale to provide a more nuanced understanding of refugees' causal attributions for mental health problems

Only a small proportion of refugees requiring treatment actually receive psychotherapy. Alongside structural barriers, it has been hypothesized that causal attributions for mental health problems that deviate from Western explanatory models may reduce refugees' help-seeking behavior. Prevailing assumptions suggest that refugees predominantly hold causal beliefs that are incompatible with the rationales of psychotherapy. Testing these assumptions requires a reliable assessment tool to evaluate refugees' causal beliefs. Therefore, we developed the Causal Attributions for Mental Health Problems Scale (MH-CAUSE) and validated it in a sample of Middle Eastern refugees living in Germany (N = 429). The outcomes of the psychometric analysis, which included exploratory and confirmatory factor analysis, internal consistency, and convergent validity, indicate that the MH-CAUSE is a suitable instrument for assessing refugees' causal beliefs about mental health problems. Our findings suggest that refugees' causal attributions are in line with a biopsychosocial-spiritual model of mental illness. Contrary to common assumptions, the majority of participants predominantly explained mental illness via psychosocial and biomedical causes, whereas spiritual beliefs were relevant only for a minority of participants. We observed significant associations between causal beliefs and help-seeking attitudes and behavior. However, effect sizes were only small to moderate. While mental health beliefs might contribute to mental health inequities, alleged cultural differences of refugees should not be overemphasized.

Impairment and Disability: A Journey of Understanding

Abstract The inaugural issue of the American Medical Association's (AMA's) Guides Newsletter in 1996 ignited a conversation about the concepts of impairment and disability. Although the AMA Guides to the Evaluation of Permanent Impairment has evolved significantly with evidence-based medicine from the third edition (1990) to the current 2023 version of the sixth edition, conflating impairment and disability ratings continues. Impairment and disability are distinct terms. The extent of an injury does not necessarily predict the effects on activities of daily living, including work, given other clinical factors, comorbidities, motivation, technology, and accommodations. Patients with disabilities are best understood by embracing a biopsychosocial-spiritual model that reflects a humanistic and holistic view because disability is a multifaceted concept that is influenced by evolving physical, psychological, and psychosocial factors. Evaluating impairment is a challenging undertaking and physicians tasked with impairment evaluations must be trained to use the AMA Guides appropriately.

The experiences of mothers of children with food allergy: A qualitative study

BackgroundFood allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model. MethodsThis study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist. FindingsThree themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme. DiscussionIt has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health. Application to practiceThe findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.

Innovation in Health Programming: College Students Benefit from an Array of Complementary Approaches to Health Improvement Framed by the Biopsychosocial-Spiritual Model

ABSTRACT Background The American Psychological Association reports that Generation Z are suffering mentally and physically more than any other group. Purpose Measure the effects of a 16-week, online college-level “Complementary Therapies in Health Course” through the lens of the biopsychosocial-spiritual model on measures of health and aspects of well-being in college students. Methods A mixed method, controlled, repeated measures study delivered in an online synchronous college-level health course. The course curriculum included the science and practice of compassion, happiness, mindfulness, meditation, yoga, service, gratitude, longevity, movement, and more. Results 42 students 18–23 participated. A significant between subjects cross-over effect demonstrating improvements in the intervention group and deterioration in the control group was found using the Self Compassion Scale (p < .005), Self-Compassion subscale of Judgment (p < .001), Spiritual Well-being Scale (p < .047), and the Pemberton Happiness Index (p < .007). The Self Compassion Scale also revealed a within subjects significant effect (p < .001). Qualitative data revealed improvements in compassion, feelings of happiness, sleep, exercise and health habits, gratitude, mindfulness, spiritual feelings, and more. Discussion Health education predicated on the biopsychosocial-spiritual model is efficacious. Translation to Health Education Practices A whole person, complementary health approach to education programming has widespread, positive effects on college students. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

The Nature of Religious and Spiritual Needs in Palliative Care Patients, Carers, and Families and How They Can Be Addressed from a Specialist Spiritual Care Perspective

This paper is written from the perspective of a specialist religious and spiritual care practitioner who practises in major referral hospitals in Sydney, Australia. In these hospitals, religious care and ward-based spiritual care chaplaincy services are offered in tandem. The perspective offered is based on the author’s knowledge, research, and experience in how people make the necessary religious or spiritual adjustments to their deep view of reality when faced with severe or chronic pain or terminal illness. Religious and/or Spiritual Care (R/SC) are interventions that scaffold people through a process of sense-making which helps them find meaning in their new reality. These R/SC adjustments concern conscious and unconscious beliefs about ultimate meaning, morality, justice, transcendence, and relationships within themselves, and with others and the supernatural. Palliative care practitioners described the importance of spiritual care and integrated spiritual care principles into their biopsychosocial-spiritual model of care in the 1960s. As palliative care practitioners have increasingly clarified their discipline as a distinct discipline in medicine, religious and spiritual care practitioners have struggled to define their place. These concerns merit a fresh evaluation of the religious and spiritual needs of patients, carers, and families of those suffering chronic pain and terminal illness and further clarification of the specialist discipline of religious and spiritual care.

How Understanding Our Multi-Dimensional Humanity Clarifies Medical Ethics

Medical ethics is increasingly culturally subjective. A clear understanding of medical ethics must be grounded in a clear philosophy of medicine and philosophical anthropology. Philosophically, medicine is a profession dedicated to the patient’s health. A better understanding of health or wholeness will lead to better healing. Health or wholeness is best understood as well-functioning. The philosophical and anthropological biopsychosocial-spiritual model informs the roots of well-functioning. These four interrelated dimensions must be balanced and work in harmony, ultimately aimed at the basic goods (e.g., health, life, and personal integrity among others) and should be strived for but never harmed. This holistic approach helps determine the primary cause of unwellness while also explaining that biologic healing frequently relies as much on the other dimensions as the biologic treatment. Historically, physicians refined their skills ensuring that the best biologic means addressed the most well-defined biological diseases. This dimension-specific philosophical framework formed the basis of a physician’s diagnostic investigation. If the source of unwellness was primarily in another dimension, then appropriate therapeutic referrals to dimension-specific experts were offered. This framework prevented or corrected egregious excesses due to medicalization of social issues. Traditional boundaries of medicine are now challenged by contraceptives, elective abortion, cosmetic procedures, and euthanasia/physician-assisted suicide, steering medicine away from treating biologic problems with biologic solutions towards treating psychologic and/or social problems with biologic solutions. Countries now inconsistently require their physicians to provide biologic means aimed at specific psychologic and/or social goals to advance sexual and/or economic goals, the country’s laws, or patient autonomy. This is conceptually flawed requiring special exemptions from the profession of medicine while also resulting in biologic harm, damage to the basic goods, and negative psychologic and/or social effects, while transforming medicine into a commodity. Physicians have an ethical obligation to provide effective biologic means to treat biologic diseases while promoting healing and wholeness among all four dimensions. On the other hand, physicians have no obligation to use biologic means for non-biologic problems. This multi-dimensional model with dimension-specific therapies is conceptually consistent, socially agnostic, empirically sound, and provides a clearer understanding of medical ethical obligations.

Adolescents’s Perception of Healthy Sexual Behavior: Containing Indonesian’s Philosophy of Life

The construct of healthy sexual behavior needs to consider the context in which the behavior will be applied by examining behavior based on a biopsychosocial-spiritual model approach. This study aims to describe the profile of adolescent healthy sexual behavior containing the Indonesian philosophy of life, both from the biological, psychological, social and spiritual aspects. The research design used was the development of a descriptive method, involving 1855 public and private high school students in the city of Bandung, West Java. Data was revealed by using a questionnaire and processed qualitatively through theme analysis and quantitatively by using Paired Samples Test and Manova.&#x0D; Based on the data processing, it was revealed that the profile of healthy sexual behavior of adolescents with the status of high school students in the city of Bandung, more than half of them had healthy sexual behavior, but there were still students who had healthy sexual behavior in the medium category and only a small proportion in the low category. Based on the aspects, the general picture of healthy sexual behavior on the physical and spiritual aspects tends to be high, while the psychological and social aspects tend to be moderate. The standard deviation of each school is fairly even, with a range of 0.475 to 0.723. The standard deviation by age with a range of 12 to 20 years varied from 0.524 to a high of 1.491. The standard deviation by class is almost equivalent, i.e. 0.570 to 0.645.&#x0D; Descriptive data shows that in general counseling teachers have provided sexual guidance services related to adolescent sexual development, dating and gender roles, but none of them have provided guidance on healthy sexual behavior, or vice versa the dangers of homosexual sexual behavior for adolescents. The data also shows that only 1 in 12 Guidance and Counseling teachers or 8.33% have heard and understood sexual guidance containing indigenous values, namely Pancasila as the philosophy of life of the Indonesian nation.

Spiritual needs and their associated psychosocial factors among women with breast cancer: A cross-sectional study.

Guided by the biopsychosocial-spiritual model, this study aimed to evaluate the spiritual needs of Chinese women with breast cancer and explored factors associated with those spiritual needs. This study has a cross-sectional design. This cross-sectional study involved 228 breast cancer patients in China, between May 2019 and July 2019. Data were collected using the general information form, the Spiritual Needs Scale, the Perceived Social Support Scale and the Hospital Anxiety and Depression Scale. Data were analysed by Spearman correlation analysis, univariate analysis and multiple linear regression, and a structural equation model (SEM) was constructed by maximum likelihood estimation. There was a slightly higher average score for spiritual needs. Of the five dimensions of spiritual needs, those with the highest and lowest levels were 'meaning and purpose' and 'relationship with transcendence' respectively. Religion, time since confirmed diagnosis and education level were related to spiritual needs. The proposed model linking spiritual needs perceived social support, anxiety, and depression revealed a satisfactory fit to the data. Specifically, a higher level of social support predicted lower levels of anxiety and depression, which in turn predicted stronger spiritual needs. The spiritual needs of breast cancer patients were associated with individual characteristics and psychosocial elements. Patients' spiritual needs should therefore be effectively evaluated, especially the needs of those who are not religious. Furthermore, comprehensive, needs-tailored interventions that incorporate spiritual, biological, psychological and social support should be formulated. Nurses should become more aware of the spiritual needs of breast cancer patients, incorporate a spiritual focus into their care and develop comprehensive needs tailored to their characteristics as well as interventions based on biopsychosocial factors.

The Body, the Mind, and the Spirit: Including the Spiritual Domain in Mental Health Care.

This article supports the expansion of Engel’s (Science (AAAS) 196(4286):129–136, 1977) biopsychosocial model into a biopsychosocial-spiritual model, as Sulmasy (The Gerontologist 42(5):24–33, 2002) and others have suggested. It utilizes case studies to describe five areas of clinical work within mental health (religious grandiosity, depression and grief, demoralization and suicidality, moral injury, and opioid use disorder) with emerging evidence for the inclusion of the spiritual domain in addition to the biological, psychological, and social. For each clinical area, an underutilization of the spiritual domain is compared with a more developed and integrated use. An argument is made for continuing to develop, understand, and utilize a biopsychosocial-spiritual model in mental health.

African cultural values in the biopsychosocial-spiritual care model to manage psychological symptoms in adults with sickle cell disease in Ghana, West Africa

ABSTRACT The study examined whether African cultural values promise psychological health of adults with sickle cell disease (SCD) in Ghana. Using simultaneous equation modelling and survey data from purposively sampled 220 adults with SCD, we tested the usefulness of an African-enhanced biopsychosocial-spiritual model, thereby filling the gap of absence of a culturally relevant management model for patients. The study revealed that the model holistically predicts the psychological health of the patients better than single therapy models. Social support and ritual-centred Africultural coping significantly benefitted women than men and reduced psychological symptoms among those with HbSS. We conclude that an African-centred Biopsychosocial-spiritual model is more helpful in managing SCD patients. We further settle that some African cultural values are significant moderators in coping with psychological issues in sickle cell illness. This research distinctively contributes theoretical, methodological, and cultural knowledge to clinical practice and research from an African cultural perspective.

Consumer Medicine's Origins and Harms.

Consumer medicine consists of medical interventions pursued for non-health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non-health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non-health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine's origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health's redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.

Spirituality as an Essential Element of Person-Centered Care

Data demonstrate that the majority of patients with serious or chronic illness would like their clinicians to address their spirituality but that the majority of clinicians do not provide such care. Reasons cited include lack of training. Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illness. There is mounting evidence that spiritual care is a fundamental component of all high-quality compassionate health care, and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers. We conducted focus groups as a first step in the process to arrive at a consensus definition of “spiritual care.” A second step involved collecting and comparing frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The study group developed and piloted curriculum to train health care providers. The created curricula covered the definitions of a spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany skill development . Our work demonstrated the need for compassionate presence during encounters, for applying the spirituality in professional life; and for identifying ethical issues in inter-professional spiritual care. We concluded that it is feasible to train clinicians to address spirituality and provide holistic and patient-centered care in an effort to minimize suffering.

Spirituality Training as an Essential Element of Person-Centered Care

Abstract Palliative Medicine, built on the biopsychosocial-spiritual model of care, has long recognized the critical role of spirituality in the care of patients with complex, serious, and chronic illnesses. We conducted focus groups to arrive at a consensus definition of “spiritual care.” Additionally, we collected and compared frameworks and models that recognize that providers cannot be made compassionate simply through the imposition of rules; methods were needed to achieve behavior change. The created curricula covered the definitions of spiritual care, self-awareness, cultural sensitivity, assessment, and skills. As part of ongoing curriculum development processes, training included evaluation tools to accompany competency standards. Results demonstrated improvements in self- reported abilities to (a) establish appropriate boundaries with patients; (b) apply the concept of compassionate presence to clinical care; (c) understand the role of spirituality in professional life; (d) identify ethical issues in inter-professional spiritual care. Clinicians need to address patients’ spiritual needs.

Biopsychosocial-Spiritual Model of COVID-19 for Healthcare Practitioners Amidst and Post-COVID-19.

It can spread from one person to another, is contagious, independent of physical contact, and extremely dangerous - its fear. This review evaluates and examines the distinction between COVID-19 and fear of COVID-19, biopsychosocial-spiritual model of Coronavirus-related anxiety, internalization and externalization of consequential psychological issues. It further offer facilitation of health care practitioners' uniqueness in offering short-term and long-term support for psychosocial, emotional, cognitive, behavioral and mental health repercussions of COVID-19 on individual and community level.

Heart led psychotherapy: A biopsychosocial spiritual model for clinical practice

This paper introduces a spiritually informed heart led psychotherapy (HLP) model as part of a biopsychosocialspiritual (BPSS) approach in clinical practice. HLP model is based on the premise that everyone is on an individual life journey to understand and experience life lessons such as assertiveness, joy, forgiveness. When clients experience traumas, these can create blocks and restrictions, resulting in repeated cycles of psychological distress in an individual’s life. HLP regards the ego as being responsible for maintaining the psychological distress. HLP teaches clients to recognise the impact of their ego, become an observer to challenges so that they can understand that the challenges are the life lesson. Honouring the ‘heart and soul’ rather than the ego enables clients to experience the lesson, make new choices in keeping with their authentic selves and freedom from suffering. HLP can be integrated into traditional psychotherapies or applied as a standalone therapy as part of the BPSS approach.

Biopsychosocial and Spiritual Implications of Patients With COVID-19 Dying in Isolation

Critically ill patients with the Coronavirus disease 2019 (COVID-19) are dying in isolation without the comfort of their family or other social support in unprecedented numbers. Recently, healthcare teams at COVID-19 epicenters have been inundated with critically ill patients. Patients isolated for COVID-19 have had no contact with their family or loved ones and may have likely experienced death without closure. This situation highlights concerns about patients’ psychological and spiritual well-being with COVID-19 and their families, as they permanently part ways. While palliative care has advanced to adequately address these patients’ needs, the COVID-19 pandemic presents several barriers that force healthcare teams to deprioritize these essential aspects of patient care. The severe acute respiratory syndrome (SARS) outbreak in 2003 gave us a glimpse of these challenges as these patients were also isolated in hospitals. Here, we discuss the importance of the biopsychosocial spiritual model in end-of-life care and its implications on patients dying with COVID-19. Furthermore, we outline an integrative approach to address the unique and holistic needs of critically ill patients dying with COVID-19. These include intentional and increased coordination with trained palliative care staff, early and frequent goals of care including discussion of end-of-life plans, broader use of technology to improve connectedness, and shared decision making with patients’ families.

How Can We Decide? When Ought a Person with Disabilities Be Moved from Their Home to Full-Time Residential Care?

A family member with disabilities is usually moved to full-time residential care when a crisis occurs in the home. Alternatively, this paper creates criteria to decide if a family member ought to be moved before a crisis occurs. The quality of relationships in the home and the likelihood that crises will occur are determined by both caregiver mental health and the behaviors of the person with disabilities. Improving caregiver mental health can keep more persons with disabilities at home. A biopsychosocial-spiritual model of healthcare, John Wesley’s sermon “On Family Religion,” and caregiver health research are used to construct effective criteria.