Spiritual Distress Research Articles

Spirituality, Spiritual Distress and Experiences of Joy, Meaning and Growth Among Parkinson's Disease Caregivers in the United States.

Caregiving challenges of Parkinson's disease can result in loss of faith, meaning, and spiritual distress. The purpose of this study is to describe Parkinson's disease caregivers' perceptions and experiences related to spiritual distress, sources of spiritual and religious support, acts, and experiences of growth, and finding meaning and joy in the midst of spiritual distress. We conducted semi-structured interviews with caregivers of persons with Parkinson's disease (n = 16) and identified five themes: (a) Bearing witness to suffering underlies spiritual distress; (b) Prayers are pleas for "soul help"; (c) Spiritual guidance and support are important; (d) Faith and community are sources of spiritual support; and (e) Joy, meaning, and growth help to transcend spiritual distress. Interventions that target sources of spiritual distress and joy are needed.

Exploring Spiritual Care Competency in Palliative Medicine: A Narrative Inquiry of Physician Care Notes on Spiritual Distress.

Background: Spiritual care is a critical component of hospice and palliative medicine; however, physicians frequently lack the necessary competencies to adequately address patients' spiritual needs. This study aims to examine the spiritual care competencies of physicians as reflected in their care notes, thereby providing insights into their approaches for managing spiritual distress. Methods: A narrative inquiry approach was employed to qualitatively analyze interaction notes from 30 palliative care patients experiencing spiritual distress. Data were collected from a medical university professor's care notes between April 2019 and February 2024. Results: The most common form of spiritual distress observed was reluctance to leave life, followed by loss of dignity. Physicians demonstrated expertise in holistic care, addressing physical, psychological, and spiritual needs with a comprehensive approach. Their demeanor reflects acceptance of mortality and acknowledgment of the limitations of medical care, helping foster gratitude and contentment in patients. Effective communication was pivotal, involving the conveyance of information, empathetic engagement, and active listening. Compassionate interactions emphasized the importance of spiritual care in patient-centered care delivery. Conclusions: Spiritual care competencies are essential for improving patient outcomes and advancing comprehensive palliative care. Future efforts should integrate these competencies into communication training within medical education to more effectively enhance health care providers' competencies.

Do nurse spiritual responses to trauma explain nurse outcomes? A correlational observational study

BackgroundVarious facets of spirituality are associated with wellbeing. Given the current urgency to promote nurse wellbeing, nurse spirituality merits exploration. PurposeTo investigate how spiritual distress and growth (i.e., spiritual/religious struggle, moral injury, post-traumatic growth) contributed to nurse outcomes (i.e., burnout, job satisfaction, intent to leave). MethodsRNs providing direct patient care in three Southern California hospitals completed an online survey that included psychometrically robust measures. Hierarchical multiple regression analyses were used to test spiritual variables as predictors of nurse outcomes after accounting for demographic and work-related factors. FindingsIn this sample of 531 demographically diverse RNs, spiritual struggle contributed to burnout and turnover intention; posttraumatic growth and employer respect for nurse wellbeing contributed to all three nurse outcomes. DiscussionSpiritual distress and growth are understudied but potentially important influences on job outcomes for nurses. Results here suggest that continued development of interventions to address spiritual health is worth investment.

Spiritual Well-Being of Cancer Patients Undergoing Chemotherapy in Yogyakarta

Background: In order to provide holistic care and advance spiritual well-being, it is essential to identify and meet the patient's spiritual well-being. Purpose: This study aimed to determine the spiritual well-being of cancer patients undergoing chemotherapy in Yogyakarta. Methods: This study used a cross-sectional approach with a sample of 50 cancer patients undergoing chemotherapy at the One Day Care (ODC) oncology clinic, a private hospital in Yogyakarta, which was taken using a purposive sampling technique. The measurement tool used is the Spiritual Well-Being Scale (SWBS) questionnaire which consists of 20 items. Data analysis in this study used descriptive statistics and cross tabulation to determine the comparison between spiritual well-being of cancer patients undergoing chemotherapy based on their demographic characteristics. Results: Spiritual well-being has a higher score in patients who are female (92.53±10.49), have higher education (92.67±10.84), are widowers/widows (97.00 ± 4.24), receive treatment of the partner (93.81 ± 10.30), and had stage III disease (92.88 ± 9.54). Conclusion: An accurate assessment of spirituality in patients can be a clinical guide in establishing nursing diagnoses of spiritual distress or readiness to improve spiritual well-being.

Proof of concept, feasibility, and acceptability of spiritual care assessment and intervention-pediatric with caregivers of children receiving home mechanical ventilation

Caregivers of children with medical complexity face daily tasks comparable to pediatric critical care nursing with multiple stressors. This may result in emotional and spiritual distress. Caregivers may also rely on their religion and spirituality to cope. Chaplains have the potential to support caregivers in this setting, beginning with spiritual assessment. This study’s purpose was to verify the feasibility and acceptability of the Spiritual Care Assessment and Intervention framework adapted for home-based chaplaincy with caregivers of children receiving home mechanical ventilation (SCAI-Peds). A quasi-experimental, proof-of-concept trial with N = 6 caregivers and two board certified chaplains was carried out. SCAI-Peds was acceptable and feasible to caregivers, delivered with high fidelity, and was also acceptable to the chaplains. Home-based intervention delivery may provide more room for reflection and reframing than acute care settings. The results warrant advancing SCAI-Peds beyond the pilot stage.

Improving Outcomes for ICU Family Members: The Role of Spiritual Care.

Having a family member hospitalized in the intensive care unit (ICU) can be a stressful experience for family members, encompassing both psychological and spiritual distress. With over 5 million ICU admissions annually in the United States, it is imperative to enhance the experiences and coping mechanisms of ICU family members. In particularly challenging situations, some family members even face psychological effects known as post-intensive care syndrome-family, which includes anxiety, depression, and posttraumatic stress. The distress may be worsened when patients and families experience poor communication or medical care, which has been shown to be more common among minoritized populations including Black and Hispanic patients and families. Family members' emotional and spiritual distress also has an effect on the medical decisions they make for the patient. While research has delved into the impact of spiritual care for ICU family members, further investigation is still needed to determine the most effective approaches for delivering such care. This narrative review will describe a conceptual model aimed at guiding future research in this endeavor. The model proposes that chaplains provide emotional, spiritual, and information support to ICU family members. This affects both their ICU experience, decision making, and outcomes for the patient and family. This process is also affected by characteristics of the family such as race, ethnicity, and economic status. This model helps identify gaps in research, including the need for randomized trials of spiritual care that identify mechanisms underlying outcomes and demonstrate impact of spiritual care, and consider race, ethnicity, and other characteristics.

Improving the detection and documentation of patients’ symptoms in an integrated gastrointestinal oncology and palliative care clinic.

336 Background: Patients with gastrointestinal (GI) malignancies experience a high burden of disease-related symptoms and treatment side effects. We established an integrated GI oncology and palliative care (PC) clinic in which a PC physician is co-located with the oncology team and can provide timely response to patient distress and facilitate communication with the interdisciplinary palliative care team. Yet, even in the integrated clinic, patient symptoms were unreliably assessed, leading to missed opportunities to address patient suffering. Between October 2023 and January 2024 for patients seen in-person in the integrated clinic for oncology or PC visits, the median rate of symptom documentation was 45%. Emotional, financial, and spiritual distress documentation rates were lowest. We hypothesized that by implementing a systematic, comprehensive patient-reported symptom assessment tool, we could increase the detection and documentation of symptoms, and in turn, improve communication around patient distress and timely response to symptoms. Methods: We measured the rate of symptom documentation (primary outcome) and the use of a patient-reported symptom assessment tool for adults with GI cancers seen in-person in the integrated clinic in Spring 2024. Based on the Edmonton Symptom Assessment Scale (ESAS) and expert consensus, we determined which symptoms were most important to identify. Documentation rates were assessed via manual chart review of visit notes and flowsheet data. Prospective post-intervention data (March to May 2024) were compared to retrospective pre-intervention baseline data (October 2023 to January 2024). Interventions included modification of the ESAS to include GI oncology-specific symptoms, implementation of the tool in paper format to encourage patient-clinician communication, frequent staff education and feedback sessions, creation and dissemination of a resource guide for clinicians to respond to identified distress, and patient satisfaction surveys. Results: 126 patients were included in the study (31 pre-intervention and 95 post-intervention). During the post-intervention period, the median rate of symptom documentation increased from 45% to 83% and the median rate of ESAS survey completion increased from 9% to 68%. Documentation of financial and spiritual distress increased from 13% to 71%, for both, and documentation of emotional distress increased from 35% to 72%. On satisfaction surveys (N=20), most patients reported the tool was helpful in sharing their symptoms (70%), was easy to read and understand (100%), and that their clinician was engaged in addressing their symptoms (67%). Conclusions: The implementation of a patient-reported symptom assessment tool in an integrated GI oncology/PC clinic increased documentation of important symptoms, potentially increasing clinician awareness of patient distress.

Comprehensive geriatric assessment and palliative care.

The geriatric vision of palliative care is based on a multidisciplinary, patient-centered approach, looking for a balance between human dignity and medical treatments with a particular focus on the social and ethical aspects. In order to develop the best care models, there is a rising need for a tighter collaboration of all the involved players (i.e., doctors, nurses, social workers). Indeed, the idea of a fragmented system without considering the patient or his/her family is not at all applicable to older patients with chronic disease. The causes of death, the phase of death changes, and the extend of last period of life could be a long phase characterized by complicated treatment decisions, difficult management of symptoms, multiple psychosocial problems, and complex spiritual distress. Recently, Italian guidelines on Comprehensive Geriatric Assessment (CGA) have been published. However, none of the identified studies on patients in hospice and other palliative care facilities met the criteria for inclusion. These findings underscore the need for further research to determine the potential benefits of a multidimensional approach for patients in hospice and other palliative care settings. Our reflections and suggestions on the CGA use for older persons in palliative care may be a starting point for an open and continuous dialogue with all the operators concerned.

Pastoral care from the pulpit: preaching as therapy for belief sickness

ABSTRACT It is argued that an important function in pastoral preaching is facilitating self-doctoring for belief sickness. Belief sickness is caused by an element in a personal worldview that is unrealistic, unhelpful, and distorted, and which leads to significant emotional and spiritual distress. There is a tradition in philosophy, beginning with Plato and continuing to the present day, in which the role of the philosopher is construed, in part, as providing a cure for illness in the soul. Taking a lead from Kierkegaard, self-doctoring in pastoral preaching is associated with the method of throwing up competing perspectives to stimulate reflection. Preaching methods such as the story-telling approach, the roundtable, and paradoxical preaching are identified as aligning in a general way with the Kierkegaardian technique. A sermon outline is offered that demonstrates the technique in practice. Though the concentration is on method, the vitally important role of the Word-Spirit partnership in inner transformation and healing is also discussed.

Integrating pastoral care and appreciative inquiry for sex trafficking survivors: A framework for healing

Integrating appreciative inquiry (AI) and pastoral care may help address the complex issues of commercial sexual exploitation and sex trafficking. This article explores the benefits of incorporating AI principles into pastoral care for survivors of commercial sexual exploitation and sex trafficking. Commercial sexual exploitation and trafficking involve exploitation, degradation, and violence, making them complex issues. By understanding the sex trade, we can recognise that prostitution is an act of exploitation. Some scholars believe that prostitution and human trafficking are interconnected, with a focus on exploiting the poor, especially women and children. Commercial sexual exploitation can cause mental, emotional, and spiritual distress. Survivors require comprehensive aftercare to address their spiritual, self-esteem, and dignity needs. Organisational development-based AI is constructive and strength-based. Appreciative inquiry promotes positive development, community and individual strength, and resilience by re-contextualizing narratives and envisioning brighter futures. The use of AI could improve pastoral care and holistic rehabilitation. Pastoral caregivers using AI can promote reconciliation, development, and rehabilitation. Using strengths-based strategies, pastoral care practitioners can help survivors regain agency and purpose. Survivors receive spiritual support through the Appreciative Way, which combines contemplative spirituality and inquiry. Narrative exploration can help trauma survivors envision a bright future based on love and resilience. This study suggests that AI principles may benefit pastoral care recipients who have experienced commercial sexual exploitation and sex trafficking. Pastoral caregivers can help survivors regain dignity, calling, and well-being by implementing an appreciative healing approach.Contribution: The article sheds light on the dehumanising consequences of sex trafficking on vulnerable populations in South Africa, particularly women and children. This article aims to explain how AI concepts can be applied to Practical Theology. Specifically, this article will demonstrate how the Appreciative Way can be utilised in pastoral care for healing from sex trafficking trauma.

Galactic transmissions from tantra bros, pu$$y priestesses, red-pilled starseeds, and ayahuasca girls: Decoding the pedagogies of conspiritual life coaching

The COVID-19 pandemic spurred the growth of online wellness influencers who promote products and treatments to address spiritual distress by incorporating conspiracy theories into their messaging. In this article we investigate the rise of the “conspiritual life coach,” a subset of wellness influencers that emerged during the pandemic. We analyze their pedagogical approaches, illustrating how they exploit the ambiguity of life coaching as a therapeutic or organizational tool to promote disinformation and establish authority. Drawing on almost a year of netnographic research into the online presence of prominent coaches (Aubrey Marcus, JP Sears, Teal Swan, Kaia Ra, and others), we identify five pedagogical strategies that characterize their messaging. These coaches (1) focus on bodily purity and body fascism, (2) reinforce gender binaries, (3) exploit client trauma, (4) appropriate Indigeneity and perpetuate coloniality, and (5) commercialize spirituality through "enlightened" goods and services. We argue that these strategies work together to enact a curriculum of spiritual bypassing that serves as the main driving force of conspiritual life coaching, which we discuss in the final section of this article.

Clinical validation of "spiritual distress (00066)" in parents of children with chronic diseases.

This study aimed to determine the clinical validation of the nursing diagnosis (ND) of "spiritual distress (00066)" and the sensitivity, specificity, likelihood ratio, and predictive value in parents of children with chronic diseases. This cross-sectional study was conducted using the clinical diagnostic validity method proposed by Fehring. The data were collected through structured interviews and using a researcher-made list that included 5 parts of demographic information, parents' opinions about spiritual distress, the researcher's diagnosis, 74 defining characteristics (DCs) of the ND of spiritual distress, and the Spiritual Well-being Questionnaire. Data were analyzed using descriptive statistics as well as sensitivity, specificity, likelihood ratio, and predictive value. The prevalence of diagnosis was 70% in a sample of 120 parents. Out of the 74 DCs, 39 criteria were validated. Questioning meaning of illness and suffering had the highest sensitivity (98.8%), the highest negative predictive value (88.88%), and the lowest negative likelihood ratio (0.05%). Expressing the lack of meaning in life demonstrated the highest specificity (97.22%), the highest positive predictive value (98.33%), and the highest positive likelihood ratio (25.26%). Parents who search for meaning of illness and suffering related to a lack of meaning in life are in spiritual distress. The ND was validated. These findings can empower clinical nurses to confidently assess and identify patients experiencing spiritual distress, bridging the gaps caused by the absence of standardized tools for assessing spiritual distress in the inpatient setting.

Resistance to Change or Transformation After Involuntary Unemployment and Underemployment: A Theoretical Model

Significant changes in workplace strategy or economic instability can lead individuals into emotional and spiritual crises, triggering identity transformations. This paper explores the effects of involuntary unemployment, underemployment, compromised employment, and mandatory retirement, referred to as involuntary second-order employment disruptions, on personal identity. Drawing from theories of quantum personal change and positive psychology, the paper discusses how these changes can lead to emotional and spiritual distress, akin to a “dark night of the soul,” potentially resulting in posttraumatic transformation. The transition through this crisis involves stages of resistance and adaptation, ultimately leading to a profound shift in identity and purpose. The process includes disengagement, disidentification, disenchantment, and disorientation, which can create significant psychological challenges, and involuntary opportunities for spiritual growth and self-actualization. The paper proposes that these employment disruptions are catalysts for deep personal transformation, highlighting the importance of managing such transitions effectively to foster resilience and positive outcomes.

“Not me!” a qualitative, vignette-based study of nurses’ and physicians’ reactions to spiritual distress on neuro-oncological units

PurposePeople 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.MethodsNeurospirit-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.ResultsA 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.ConclusionsMost 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.

Practice-based evidence for spiritually integrated psychotherapies: Examining trajectories of psychological and spiritual distress.

The aims of this practice-based evidence study were to (a) examine clients' trajectories of psychological and spiritual distress over the course of spiritually integrated psychotherapies (SIPs) and (b) explore the role of varying types of spiritual interventions in these outcomes. In total, 164 practitioners of SIPs from 37 settings in a practice-research network administered the Clinically Adaptive Multidimensional Outcome Survey (Sanders et al., 2018) at each session with 1,227 clients and reported their use of theoretical orientations and spiritual interventions on an after-session summary checklist. Focusing on sessions over an initial 12-week period, latent growth curve modeling analyses revealed that clients, on average, experienced significant reduction of psychological distress during their engagement in SIPs with improvements occurring most sharply in the first month. Further, other findings revealed a salient reciprocal interplay with spiritual distress throughout treatment, such that clients who were struggling with their religious faith and/or spirituality were more psychologically distressed and displayed a more attenuated and gradual pattern of symptom reduction. In such cases, clinicians frequently utilized spiritual interventions involving basic skills (e.g., spiritual assessment), virtues (e.g., discuss self-control), and religious attachment (e.g., encourage acceptance of divine love) that were uniquely associated with clients' rate and duration of decline in psychological and spiritual distress. The present findings affirm the routine effectiveness of SIPs along with highlighting the potential value of certain spiritual interventions in supporting holistic recovery among clients who want clinicians to be culturally responsive to their spiritual and/or religious identities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregivers

BackgroundNature-based and other outdoor virtual reality (VR) experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Hospice care services and healthcare need strategies to help patients and informal caregivers with EOL transitions. MethodsOur study uses the synchronized Tandem VRTM approach where patient-caregiver dyads experience immersive nature-based and other outdoor VR content. This mixed methods study will recruit 20 patient-caregiver dyads (N = 40) enrolled in home hospice services nearing EOL. Dyads will experience a personalized nature-based and other outdoor VR experience lasting 5–15 min. Self-reported questionnaires and semi-structured interviews will be collected pre/post the VR intervention to identify the impacts of Tandem VRTM experiences on the QOL, pain, and fear of death in patient-caregiver dyads enrolled with hospice services. Additionally, this protocol will determine the acceptance of Tandem VRTM experiences by dyads as a non-pharmacological modality for addressing patient and caregiver needs. Acceptance will be quantified by the number of dyads accepting or declining the VR experience during recruitment. DiscussionUsing personalized, nature-based and other outdoor VR content, the patient-caregiver dyads can simultaneously engage in an immersive encounter may help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress. Trial registrationNCT06186960.

Palliative Care for Patients With Cancer: ASCO Guideline Update.

To provide evidence-based guidance to oncology clinicians, patients, nonprofessional caregivers, and palliative care clinicians to update the 2016 ASCO guideline on the integration of palliative care into standard oncology for all patients diagnosed with cancer. ASCO convened an Expert Panel of medical, radiation, hematology-oncology, oncology nursing, palliative care, social work, ethics, advocacy, and psycho-oncology experts. The Panel conducted a literature search, including systematic reviews, meta-analyses, and randomized controlled trials published from 2015-2023. Outcomes of interest included quality of life (QOL), patient satisfaction, physical and psychological symptoms, survival, and caregiver burden. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. The literature search identified 52 relevant studies to inform the evidence base for this guideline. Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions. Oncology clinicians from across the interdisciplinary cancer care team may refer the caregivers (eg, family, chosen family, and friends) of patients with cancer to palliative care teams for additional support. The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care.Additional information is available at www.asco.org/supportive-care-guidelines.

Spiritual Distress, Hopelessness, and Depression in Palliative Care: Simultaneous Concept Analysis.

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention.

Narrative review: what constitutes contemporary, high-quality end-of-life care and can lessons be learned from medieval history?

In modern Britain, palliative and end-of-life care is governed by quality standards and guidance, which should consider spiritual and psychological needs. However, there are significant gaps in provision of services which was highlighted during the coronavirus disease 2019 (COVID-19) pandemic where many individuals and families suffered profound spiritual and existential distress. Significant gaps remain in the provision of services to support patients with spiritual and psychological needs which can affect the management of physical symptoms. During the medieval period in Western Europe, it was important to prepare well for death throughout life. It has been suggested that lessons may be learned from medieval preparations for death which might benefit those approaching end-of-life in contemporary society. It is therefore timely to consider medieval attitudes to death and reflect on how these might inform modern end-of-life care. The objective of this review is to synthesise literature addressing modern end-of-life care in the UK and contrast this with literature on preparations for death during the medieval period in Western Europe. Our aim is to determine whether there is wisdom to be gained from history which could inform our approaches to end-of-life care today. Using online databases and broad keyword searches along with experts in the field of medieval history, we identified literature and translations of texts with a focus on preparations for death during both periods. These were narratively synthesised and discussed. A key finding is that the medieval attitude to death was as an integral part of life, whereas in modern society death is not usually considered until the situation arises. The review highlights a need for a better understanding of the individuality of spiritual and existential needs during end-of-life care in modern society, which will vary according to individual choice, culture, societal group, religion, and belief. The lessons we can learn from our medieval counterparts include the need for lifelong and individual preparations for the end of life, with emphasis on spiritual needs. Alongside palliative interventions, we need to take time to appreciate what gives individuals spiritual support and provide the resources to facilitate this.

Embers in Existence: Spiritual and Existential Distress in a Burn Injury Resulting from Spiritual Practice

Embers in Existence: Spiritual and Existential Distress in a Burn Injury Resulting from Spiritual Practice