Integration Of Spiritual Care Research Articles

Spirituality in advanced cancer: implications for care in oncologic emergencies.

Spirituality-defined as "the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred"-plays important roles in the setting of serious illnesses such as cancer. The nature of oncologic emergencies, with their attendant imminent threat to life and urgent medical decision-making, renders more salient the frequent role of spirituality in the context of coping, spiritual needs, and medical decisions. Furthermore, these roles highlight the importance of spiritual care: recognition of and attention to patients' and their family's spirituality within medical care. Extant palliative care quality guidelines include spiritual care as a core domain of palliative care provision. Generalist spiritual care requires spiritual history-taking by clinicians and respect and integration of spirituality and spiritual values into medical care. Specialty spiritual care involves the integration of professionally trained spiritual care providers into the care of patients facing oncologic emergencies. Spiritual care is associated with better patient quality of life and greater transitions to more comfort-focused care; among family caregivers, it is associated with greater care satisfaction. Spiritual care is always patient-centered, and hence can be provided by clinicians regardless of their spiritual backgrounds. The integration of spiritual care into the care of patients and their families holds promise to advance holistic care and improve well-being in this setting of oncologic emergencies.

Integrating Spiritual Care in Population Health and Care Management: Two Case Examples.

The purpose of this case study is to describe the movement of spiritual care into outpatient, managed care and population health settings, as it has evolved in a major not-for-profit health care system in the United States. The objective is to begin to establish the effectiveness of integrating spiritual care as a part of the interdisciplinary team (IDT) in these contexts. The case study presents two practice settings: a remote patient monitoring program for patients with complex medical conditions, and integration into population health as a part of a Medicare Advantage Insurance program that is a cooperative venture between the health care system (Ascension) and an established insurance program (Centene). The cases presented suggest that the integration of spiritual care into the outpatient, managed care and population health contexts has a threefold benefit: enhancing patient care, increasing the effectiveness of the IDT, and providing for the care and support of the members of the IDTs themselves. The cases presented suggest inclusion of spiritual care in the care management/population health approach to patient care is viable and valuable both for the benefit of the patient and the functioning of the care team.

Comparing perspectives: patients\u2019 and health care professionals\u2019 views on spiritual concerns and needs in chronic pain care - a qualitative study

BackgroundThe spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients’ (CPP) and health care professionals’ (HCP) perceptions on the integration of spiritual care into multimodal pain therapy.MethodsWe conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP.ResultsViews on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed.ConclusionsAlthough there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain.Trial registrationThis study was part of a larger research project, registered in a primary (clinicaltrial.gov: NCT03679871) and local (kofam.ch: SNCTP000003086) clinical trial registry.

Spiritual Well-Being in Older Adults: A Concept Analysis.

This concept analysis of spiritual well-being (SWB) in the older adult seeks to improve nurses' integration of spiritual care. Using Walker and Avant's method, the author identified five defining attributes of SWB: personal faith, religious practices, spiritual contentment, productive engagement, and healthy interpersonal relationships. Antecedents to SWB include awareness of one's spiritual needs and seeking to live a meaningful and purposeful life. Model, borderline, and contrary cases are presented to illustrate the defining attributes of SWB. Nursing implications for practice are discussed.

A Survey on the Integration of Spiritual Care in Medical Schools from the German-Speaking Faculties.

ObjectiveTeaching about spirituality and health is recommended by the American Association of Medical Colleges and partially implemented in some US medical schools as well as in some faculties of other countries. We systematically surveyed Medical School Associate Deans for Student Affairs (ADSAs) in three German-speaking countries, assessing both projects on and attitudes towards Spiritual Care (SC) and the extent to which it is addressed in undergraduate (UME), graduate (GME), and continuing (CME) medical education (in this article, UME is understood as the complete basic medical education equivalent to college and Medical School. GME refers to the time of residency).MethodsWe executed a cross-sectional qualitative complete online-survey, addressing ADSAs of all accredited 46 medical schools in these countries. Anonymized responses could be analyzed from 25 (54.3%).ResultsNo faculty provides a mandatory course exclusively dedicated to SC. Fourteen medical schools have UME courses or contents on SC, and 9 incorporate SC in mandatory classes addressing other topics. While most of the respondents indicate that spirituality is important for (a) the patients for coping and (b) for health care in general and thus, support the teaching of SC in UME, only half of them indicate a need for an SC curriculum in UME. Even if funding and training support were available, only a few of the respondents would agree to provide more of the sparse curricular time.ConclusionA majority of the participating medical schools have curricular content on SC, predominantly in UME. However, most of the content is based on voluntary courses. Despite acknowledging its importance to patients, ADSAs and medical teachers are still reflecting on the divergences in patients’ and doctors’ spiritual orientations and its consequences for implementing spirituality into the medical education.

Multidisciplinary staff perspectives on the integration of spiritual care in a new setting: Israel.

Integrating spiritual care into multidisciplinary care teams has seen both successful thoughtful collaboration and challenges, including feelings of competition and poor cross-disciplinary understanding. In Israel, where the profession is new, we aimed to examine how spiritual care is perceived by other healthcare professionals learning to integrate spiritual caregivers into their teams. Semi-structured qualitative interviews of 19 professionals (seven physicians, six nurses, three social workers, two psychologists, and one medical secretary) working with spiritual caregivers in three Israeli hospitals, primarily in oncology/hematology. The interviews were transcribed and subjected to thematic analysis. Respondents' overall experience with adding a spiritual caregiver was strongly positive. Beneficial outcomes described included calmer patients and improved patient-staff relationships. Respondents identified reasons for a referral not limited to the end of life. Respondents distinguished between the role of the spiritual caregiver and those of other professions and, in response to case studies, differentiated when and how each professional should be involved. Despite its relative newness in Israel, spiritual care is well received by a wide variety of professionals at those sites where it has been integrated. Steps to improve collaboration should include improving multidisciplinary communication to broaden the range of situations in which spiritual caregivers and other professionals work together to provide the best possible holistic care.

‘Two-eyed seeing’: the integration of spiritual care in Aboriginal residential aged care in South Australia

ABSTRACTIt is argued that spirituality acts as a powerful determinant of health and influences the general care experiences of older people living in residential aged care. This impact is significant, especially for Aboriginal residents, whose cultural and spiritual well-being is shown to be strongly connected with divine beliefs, land and community. This study, a qualitative exploration from conversational interviews with 7 Aboriginal residents and 19 carers, aimed to investigate how the Aboriginal residents’ spiritual well-being related to living in residential aged care in South Australia. Participants shared what spirituality meant to them and how spiritual needs are met in aged care centres for Aboriginal residents. Three major themes emerged from the views of the residents and carers: a lack of understanding of spiritual well-being; challenges around aged care plan; and practice and inadequate resources and funding. The main themes and sub-themes contributed to carers’ unawareness around the spiritual care needs of Aboriginal residents. This study concluded there was a requirement for changes in care management and staff approach, and management structure in order to integrate spiritual care into general care for Aboriginal residents in aged care.

Integration of Spiritual Care in Hospital Care System in Iran.

There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.

Spiritual care is stagnating in general practice: the need to move towards an embedded model.

In the past two decades, research into GPs’ provision of spiritual care has made little progress, and the clinical application of such care has remained limited. GPs’ interest in spirituality is generally seen as beneficial, both in terms of doctor–patient communication and of patients’ wellbeing. However, the literature has failed to address key issues for GPs’ daily practice. Primary health care (PHC) journals have published numerous articles about spirituality and spiritual care since the early 2000s. Illustrating this literature, Anandarajah and Hight present a review and a concrete tool (HOPE questions) for integrating spirituality into medical practice.1 In turn, Vermandere et al offer a systematic review of qualitative evidence.2 They discuss GPs’ perception of their role as spiritual care providers and the factors that facilitate or constrain their practice.2 By contrast, Hamilton et al discuss the evidence and ethical issues around the integration of spiritual care into general practice.3 These three review articles address similar themes and share the same definition of spirituality.4 They regard GPs’ provision of spiritual care as beneficial in terms of health and whole-person care, a common view in the PHC literature on spirituality. They also identify a set of qualities that may help GPs to address their patients’ spiritual needs — including communication skills, awareness of one’s own spirituality, and a respectful, confidential, and patient-centred approach. However, the articles highlight some limitations to the provision of spiritual care in general practice. Although several studies have …

Spiritual care: What do cancer patients and their family members want? A co-design project

ABSTRACTPurpose: Through active participant engagement, this project aimed to better comprehend the spiritual care needs of New Zealand cancer patients and their families and friends, and to gain further insight from others, including healthcare practitioners. Methods: A co-design process was undertaken, which involved presentations and interactive group workshops on the topic of spirituality and spiritual care. A facilitated, semi-structured discussion centred around three main topic areas: the meaning of spirituality; the documentation of spirituality in healthcare settings; current spiritual care development needs; and areas for improvement. The Framework Method was used to undertake an inductive analysis of the qualitative data in order to develop key themes according to topic area. Results: Key concepts constructed from our analysis of the three main topic areas include: Participants broadly understood spiritualty to be characterized by core values, expressions of love and kindness, and connectedness with others and/or with the environment; participants felt as if documentation of spiritual beliefs had the potential to inform others about their needs and wishes participants also recommended that opportunities be created for people to engage in conversation about spirituality, and that this should be undertaken purposefully. Importantly, responses often alluded to the great diversity of need when it comes to spiritual care. Conclusions: Integration of spiritual care into health system policies, intake and assessment processes, care plans, and training and professional development opportunities, are all required in order to reflect relevant national guidelines and strategies more effectively.

Evaluation of spiritual needs assessments in oncology palliative care: Results of an improvement project.

161 Background: Addressing all facets of serious illness requires attention to patients’ spiritual concerns. At our Cancer Center, we sought to ensure that palliative care (PC) inpatients received evidence-based spiritual care. Methods: Chaplaincy Care, Supportive Care Medicine, and Quality and Safety Departments partnered to improve spiritual care using an iterative Plan-Do-Check-Act Cycle approach. Evidence-based spiritual practices were defined in accordance with the Association of Professional Chaplains and Clinical Practice Guidelines for Quality PC of the National Consensus Project. As a member of the Global Palliative Care Quality Alliance, we also used the web-based Quality Data Collection Tool (QDACT) to guide spiritual assessment. Electronic health record templates were revised to support complete and timely documentation. We monitored performance based on National Quality Forum Measure #1647 for discussion of spiritual/religious concerns. Performance was reviewed monthly by Leadership and with the Chaplaincy Staff. Opportunities to improve performance were discussed and adjustments in practice were made. Results: A total of 1609 oncology patients (average of 89/month) were seen by the inpatient PC team from November 2013–April 2015. With transparent performance reporting and resolution of barriers to spiritual assessment, an increase from 36 to 96% was noted for the percentage of patients with documented spiritual or religious concerns. Spiritual assessment using QDACT indicated that most patients report high spiritual well-being, spiritual peace, and a religious affiliation. Conclusions: As the result of our efforts, the majority of PC oncology patients at our center now have assessment and documentation of spiritual and religious concerns. A team-based approach to quality improvement successfully fostered the integration of spiritual care into oncology palliative care. [Table: see text]

Communication in cancer care: psycho-social, interactional, and cultural issues. A general overview and the example of India.

Communication is a core aspect of psycho-oncology care. This article examines key psychosocial, cultural, and technological factors that affect this communication. Drawing from advances in clinical work and accumulating bodies of empirical evidence, the authors identify determining factors for high quality, efficient, and sensitive communication and support for those affected by cancer. Cancer care in India is highlighted as a salient example. Cultural factors affecting cancer communication in India include beliefs about health and illness, societal values, integration of spiritual care, family roles, and expectations concerning disclosure of cancer information, and rituals around death and dying. The rapidly emerging area of e-health significantly impacts cancer communication and support globally. In view of current globalization, understanding these multidimensional psychosocial, and cultural factors that shape communication are essential for providing comprehensive, appropriate, and sensitive cancer care.

REVISING THE GUIDELINES

This article describes the launch and content of Revised Guidelines on Spiritual Care and Chaplaincy in NHS Scotland 2008. A Chief |executive's Letter based on the report is under consultation before being distributed. The report consolidates and develops the guidance of HDL (2002) 76. A survey of developments was carried out. Relevant recent documents were consulted and their function explained. A series of recommendations was made concerning work in boards concerning policies, service provision and employment. Relationships with faith/belief communities, Data protection, and chaplaincy provision were examined. Feedback has been and is being welcomed prior to finalised CEL. The integration of spiritual care to health and wellbeing is an ongoing journey.

A Valuable Resource for All Palliative Care Disciplines

Drs. Puchalski and Ferrell have written a fine book on Integrating Spirituality Into Patient Care, which should be useful and accessible to palliative care clinicians of all disciplines. The authors, a physician and a nurse, are well known and respected in palliative care. As a hospice and palliative care chaplain, I found their perspectives on spirituality refreshing and informative. Works on spirituality can suffer from an excessive focus on lofty ideals at the expense of specific details, and the authors, to their great credit, avoid this mistake. This book presents specific and practical strategies for better integration of spiritual care into clinical work. In the chapter entitled “Spiritual History Taking and Assessment,” concrete instruction is provided on how best to perform a history and initial assessment. As a hospice chaplain, I found the clinical suggestions well informed, effective, and empowering for all members of the interdisciplinary team, to identify and explore spiritual issues facing patients. Suggestions for taking a history and doing an assessment are well summarized in a handy appendix. Although the advice offered is practical, the task at hand should not be taken lightly. As the authors stress, skilled spiritual assessment and care requires compassion and deep respect for the patient’s unique expression of his or her spirituality. It also takes a lot of practice. I was struck by the book’s handling of the difficult, but important, balance between the specific and the transcendental. The authors note that patients often want to address existential questions, whether there are “answers.” Some patients find answers to their questions, but many do not, and that is acceptable. Simply listening, hearing, and respecting their questions can bring comfort, even when there is no clear answer. This is particularly relevant for those of us working in palliative care. When faced with suffering, we tend to want to provide specific answers and fix things. The authors of this book remind us that this is not always optimal for honoring patients’ concerns. They also note that spiritual beliefs and concerns are expressed differently across cultures. Therefore, a deeper understanding of these cultural differences will inform our work in addressing and alleviating suffering. The book addresses a number of topics not commonly found in books on spirituality. For example, Chapter 9 presents an excellent discussion of the value of understanding the professional training and qualifications of other palliative care team members. Too often we do not know enough about each other’s backgrounds. Specific to chaplaincy, there are significant differences among chaplains in the nature of their training and different certification levels, which are of relevance to their work in palliative care and yet unfamiliar to other team members. Chapter 10 provides a useful reference on specific training programs for clergy, psychologists, physician assistants, and nurses that have been implemented and address spiritual care. In summary, this book provides a well-written practical discussion of how to improve the quality of spiritual care delivered by clinicians and palliative care teams. As the authors state, “All members of the palliative care team should be trained in spiritual care. This training should be part of continuing education for all clinicians.” I wholeheartedly agree and believe that this book will be a valuable asset and tool for others working toward that end. Penny V. Phillips, MA, MDiv, BCC, is a Hospice and Palliative Care Chaplain at the Palo Alto VA Hospice Care Center, Palo Alto, CA, USA.

Family Presence in Final Moments

The experience of a family and nurse who shared the acute illness of a teenager illustrates advocacy for family presence in the ICU and during resuscitation as well as integration of spiritual care in complex nursing practice. Family participation supports physical, emotional, and spiritual needs, allowing for open communication and the comfort of knowing that a loved one is receiving care. Although critical care, heart, and emergency nursing associations support family presence and holistic care, family presence remains controversial.

Settings for Terminal Care

The leading questions about delivery of terminal care have shifted somewhat over recent years. Not long ago the major questions were a) Is there a need for palliative care services? b) Does hospice care make a difference to the well-being of the patient and family?, and c) Is hospice care less costly than conventional care? Although continued investigation is needed into these questions, another set of issues has started to take precedence: the ability of various hospice programs to survive financially, the contributions of various models of hospice care, the impact of Medicare legislation on the hospice movement, the demonstration of an unique hospice intervention, the integration of spiritual care into hospice programs, and the role of hospice in the care of individuals with AIDS. These topics are examined, with reference to existing studies where available, and suggestions for future research are given.