Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study

Registered Nurses' beliefs about end-of-life care: A mixed method study

AIMS

To examine registered nurses' (RNs) behavioural, normative and control beliefs about end-of-life care for patients who are diagnosed with advanced and life-limiting illnesses; and to identify the barriers and facilitators they experience when providing end-of-life care.

DESIGN

A sequential explanatory mixed methods study.

METHOD

An online cross-sectional survey was conducted using the Care for Terminally Ill Patient tool among 1293 RNs working across five hospitals in the Kingdom of Saudi Arabia. Online individual semi-structured interviews with a subgroup of survey respondents were then undertaken. Data were collected between October 2020 to February 2021.

RESULTS

A total of 415 RNs completed the online survey, with 16 of them participating in individual interviews. Over half of the participants expressed the belief that end-of-life care is most efficiently delivered through multidisciplinary team collaboration. The majority of participants also believed that discussing end-of-life care with patients or families leads to feelings of hopelessness. Paradoxically, the study revealed that more than half of the participants held the negative belief that patients at the end of life should optimally receive a combination of both curative and palliative care services. The results showed that nurses' beliefs were significantly associated with their age, religion, ward type, level of education and frequency of providing end-of-life care. Data from the qualitative interviews identified four themes that explored RNs' beliefs and its related factors. The four themes were 'holistic care', 'diversity of beliefs', 'dynamics of truth-telling' and 'experiences of providing end-of-life care.'

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Wherever possible, patients at the end-of-life should be cared for in specialist settings by multidisciplinary teams to ensure effective, high-quality care. Where this is not possible, organisations should ensure that teams of multidisciplinary staff, including nurses, receive education and resources to support end-of-life care in non-specialist settings. Hospitals that employ foreign-trained nurses should consider providing targeted education to enhance their cultural competence and reduce the impact of different beliefs on end-of-life care.

Development and Validation of the Nurses' Spiritual Sensitivity Scale in Southeastern Iran

Spiritual sensitivity refers to awareness and perception of the attitudes and feelings of others and helps nurses to recognize and take responsibility for the spiritual values and needs of patients. The dimensions of spiritual sensitivity remain unknown as there is no comprehensive and standardized scale for assessing nurses' spiritual sensitivity; therefore, the current research aimed to design and validate the nurses' spiritual sensitivity scale. We conducted this exploratory sequential study using eight stages suggested by DeVellis (2016) when developing the scale. We conducted this study among Iranian nurses from March 2021 to October 2022. Results suggested a 20-item scale with two components (nurses' professional spiritual sensitivity and nurses' internal spiritual sensitivity) that explained 57.62% of the total variance extracted. We were able to confirm convergent validity based on an acceptable correlation between the nurses' spiritual sensitivity scale and the King's spiritual intelligence scale (r = 0.66), which showed good stability (cronbach's alpha coefficient = 0.927, omega coefficient = 0.923, and icc = 0.937). Spiritual sensitivity in nurses is difficult to evaluate. Considering the acceptability of the psychometric properties of the "Nurses' spiritual sensitivity" scale, this scale can be used in clinical environments to evaluate nurses' spiritual sensitivity. Therefore, it is suggested that managers and policy makers should consider developing related guidelines to help nurses to become more spiritually sensitive and also to meet the spiritual needs of patients. We suggest further studies to confirm the study results in the nursing community.

Unani Tibb practitioners' perceptions and attitudes towards spirituality and spiritual care in Unani Tibb practice in South Africa

BACKGROUND

Unani Tibb is an Arabic term which means Greek medicine. It is an ancient holistic medical system based on the healing theories of Hippocrates, Galen and Ibn Sina (Avicenna). Despite this, spirituality and spiritual care practices are deficient in the clinical setting.

METHODS

This cross-sectional descriptive study was used to describe Unani Tibb practitioners' perceptions and attitudes regarding spirituality and spiritual care in South Africa. A demographic form, Spiritual Care-Giving Scale, Spiritual and Spiritual Care Rating Scale and Spirituality in Unani Tibb Scale were used to collect data.

RESULTS

A response rate of 64.7% (n = 44 out of 68) was achieved. Positive perceptions and attitudes regarding spirituality and spiritual care were recorded for Unani Tibb practitioners. The spiritual needs of their patients were considered vital towards enhancing the Unani Tibb treatment approach. Spirituality and spiritual care were regarded as fundamental to Unani Tibb therapy. However, most practitioners agreed that adequate training in spirituality and spiritual care was lacking and future training initiatives were imperative for Unani Tibb clinical practice in South Africa.

CONCLUSION

The findings of this study recommends further research in this field by means of qualitative and mixed methods approaches to provide a deeper understanding to this phenomenon. Clear guidelines on spirituality and spiritual care for Unani Tibb clinical practice are essential to ensure the integrity of the holistic approach required by the profession.

Factors influencing nurse spiritual care practices at the end of life: A systematic review

OBJECTIVES

The aim was to identify determinants of nurse spiritual/existential care practices toward end-of-life patients. Nurses can play a significant role in providing spiritual/existential care, but they actually provide this care less frequently than desired by patients.

METHODS

A systematic search was performed for peer-reviewed articles that reported factors that influenced nurses' spiritual/existential care practices toward adult end-of-life patients.

RESULTS

The review identified 42 studies and included the views of 4,712 nurses across a range of hospital and community settings. The most frequently reported factors/domains that influenced nurse practice were patient-related social influence, skills, social/professional role and identity, intentions and goals, and environmental context and resources.

SIGNIFICANCE OF RESULTS

A range of personal, organizational, and patient-related factors influence nurse provision of spiritual/existential care to end-of-life patients. This complete list of factors can be used to gauge a unit's conduciveness to nurse provision of spiritual/existential care and can be used as inputs to nurse competency frameworks.

Muslim nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care: a qualitative study in southeast Iran

BACKGROUND

Spiritually sensitive nurses perceive the spiritual attitudes and feelings of others. They play a positive role in providing spiritual care to patients. Spiritually sensitive nurses deal appropriately with suffering, frustration, and spiritual dysfunction. Therefore, the present study aimed to explain Iranian nurses' experiences of spiritual sensitivity.

METHODS

This qualitative descriptive explorative study used conventional content analysis and purposeful sampling to explain the experiences of Iranian nurses (n = 19). This study used in-depth semi-structured interviews with 19 nurses, as well as maximum variation sampling to gather rich information (age, sex, religion, work experience, level of education, marital status, type of hospital and ward) from March 2021 to January 2022. The current study also employed Guba & Lincoln criteria to increase data trustworthiness and Graneheim and Lundman approach to analyze the content.

RESULTS

The research data showed 497 codes, 1 theme, 3 categories, and 6 subcategories. The theme of "Nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care" included three categories of the spiritual and professional character of the nurse, perception of the spiritual needs of patients and their families, and the nurse's reflection on the religious beliefs of patients and their families.

CONCLUSION

Spiritual sensitivity helps a nurse to provide holistic care for patients and their families. Therefore, managers and policymakers should create guidelines to help nurses become more spiritually sensitive as well as to meet spiritual needs of patients. Further quantitative and qualitative research should confirm these results in other social and cultural contexts.

Exploring the Concept of Spiritual Sensitivity from the Perspectives of Healthcare Providers in Iran

Spiritual sensitivity (SS) is defined as attention to the available spiritual values in a conflicting situation and awareness of one's roles and responsibilities in that situation. It helps differentiate between the right and the wrong and leads to sound practice. This study explored the concept of SS from the perspectives of healthcare providers in Iran. This qualitative study was carried out in 2017-2019 using conventional content analysis. Twenty-two physicians, faculty members with clinical work experience, and healthcare providers were purposefully recruited. Data were collected using unstructured interviews and were analyzed using conventional content analysis. Participants' experiences of the concept of SS were grouped into three main themes, namely sense of value, spiritual growth and morale boosting, and SS as a motivator for purposeful service delivery. The findings of the present study will help healthcare managers develop programs for improving healthcare providers' spiritual sensitivity and also will help healthcare providers develop spirituality-based holistic care plans.

Death-coping self-efficacy and its influencing factors among Chinese nurses: A cross-sectional study

Background

Nurses are the main caregivers of dying patients. Facing or dealing with death-related events is inevitable. Death-coping self-efficacy (DCS) is very important, as it can reduce the risk of nursing staff to adverse emotional distress, help them participate in end-of-life care and improve the quality of care of patients.

Methods

Using the convenient sampling method, this study included a total of 572 nurses from a tertiary hospital in Hangzhou, China. The status and influencing factors of the DCS of nurses were explored using a general information questionnaire and DCS scale.

Results

The scores of each parameter, ranging from low to high, were in the order of coping with grief, preparation for death and hospice care. Factors influencing nurses’ DCS included attendance in hospice care education courses within the previous year, experience of accompanying the family members of the deceased and attitude towards death.

Conclusions

The overall self-efficacy of nurses in palliative care was at a medium level. Moreover, their self-efficacy in coping with grief and preparation for death should be strengthened. Managers of medical institutions can assess the death-coping ability of nurses, which helps provide corresponding support and training for nurses at an early stage. Nurses should receive guidance in grief adjustment and emotion regulation. Medical units should provide nurses with a platform for continuous training and education, use of death-related theoretical models and frameworks to guide nurses in dealing with death-related events, reduce nurses’ negative mood and jointly promote their mental health.

Death, Dying, and End-of-Life Care Provision by Doctors and Nurses in the Emergency Department: A Phenomenological Study

There have been significant advancements in the fields of medicine, demography, and pathology. These disciplines have contributed to the classification and control of death and dying. People are now living longer with numerous comorbidities, and there is a significant aging population. Consequently, there have been increases in the numbers of people who present to emergency departments across Australia seeking access to care at the end of life. Emergency department staff must have the knowledge and skills required to provide end-of-life care in a setting that traditionally contradicts the goals of comfort care. With the increase in demand for end-of-life care in emergency departments, a gap exists in the experiences of how staff provide such care in this setting. As a result of this gap, it is important to understand the lived experiences of emergency department doctors and nurses who provide end-of-life care. The aim of this research is to understand the lived experiences of emergency department doctors and nurses concerning death, dying, and end-of-life care provision. Data were analyzed using Diekelmann's 7-step analysis to support Gadamer's phenomenological approach. Results indicate that challenges exist in the decision-making process of end-of-life care in emergency departments.

Spiritual care interventions in nursing: an integrative literature review

As an important part of the holistic care, spiritual care is considered an indicator of care quality. This study aims to identify and characterize nursing spiritual care interventions. In order to identify and select resources, an integrative review was done. The search was conducted in national and international databases such as Google Scholar, Scopus, INML, Iran Medex, Iran Doc, Web of Science, Wiley, SID, ProQuest, Ovid, Science Direct, PubMed, ebrary, Sage, CINAHL, and Magiran from 1994 to 2018. As a result, 1625 articles were detected, 59 of which were included in synthesis. Data extraction and analysis presented eight categories of spiritual care interventions in the field of nursing including (1) the exploration of spiritual perspective, (2) healing presence, (3) the therapeutic use of self, (4) intuitive sense, (5) patient-centeredness, (6) meaning-centered therapeutic interventions, (7) the creation of a spiritually nurturing environment, and (8) the documentation and evaluation of spiritual care.

Development of a Clinical Guide for Identifying Spiritual Distress in Family Members of Patients in the Intensive Care Unit

Background: Spirituality is important for many family members of patients in the intensive care unit (ICU). Clinicians without training in spiritual care experience difficulty identifying when family members are experiencing distress of a spiritual nature. Objective: The purpose of this study was to develop a guide to help clinicians working in the ICU identify family members who may benefit from specialized spiritual support. Design: Cross-sectional study. Setting/Subjects: A national sample of spiritual health practitioners, family members, and ICU clinicians. Subjects: A panel of 21 spiritual health practitioners participated in a modified Delphi process to achieve consensus on items that suggest spiritual distress among family members of patients in the ICU through three rounds of remote review followed by an in-person conference and a final round of panelist feedback. Feedback on the final set of items was obtained from an end-user group of four family members and six ICU clinicians. Measurements: Quantitative data were summarized with descriptive statistics. Content analysis was used to analyze written comments. Results: A total of 220 items were iteratively reviewed and rated by panelists. Forty-six items were identified as essential for inclusion and developed into a clinical guide, including an introduction (n = 1), definitions (n = 2), risk factors (n = 10), expressed concerns (n = 12), emotions (n = 7) and behaviors (n = 7) that may suggest spiritual distress, questions to identify spiritual needs (n = 6), and introducing spiritual support (n = 1). Conclusions: We have developed an evidence-informed clinical guide that may help clinicians in the ICU identify family members experiencing spiritual distress.

Care received at the end of life in emergency services from the perspective of caregivers: A qualitative study

OBJECTIVE

To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit.

METHOD

A qualitative approach study, based on the paradigm of hermeneutical phenomenology. In total, 81 family caregivers participated. The techniques used were the in-depth interview and the discussion group, with a total of 5 discussion groups and 41 interviews. The period of data collection was carried out between January 2013 and June 2014.

RESULTS

In the network of discourses obtained with respect to "Urgent Care", all the codes were grouped in relation to a single argumentative line: deficiencies in urgent care. Among them, we found different dimensions that are established depending on the different times of care, or the different determinant aspects of these deficiencies: disorganization of the care received, lack of experience of the professionals in emergencies, application of general protocols in the emergency services, inadequate care in the treatment received, delays in emergency care.

CONCLUSIONS

In general, we highlight the dissatisfaction of the family members with respect to the care received from the emergency services. The needs of these types of situation are not covered from these services and are of low quality. Therefore, it is necessary to reorient the care protocols for these patients.