Meeting patients' spiritual needs

The PD-1 expression balance between effector and regulatory T cells predicts the clinical efficacy of PD-1 blockade therapies

Immune checkpoint blockade has provided a paradigm shift in cancer therapy, but the success of this approach is very variable; therefore, biomarkers predictive of clinical efficacy are urgently required. Here, we show that the frequency of PD-1⁺CD8⁺ T cells relative to that of PD-1⁺ regulatory T (T_reg) cells in the tumor microenvironment can predict the clinical efficacy of programmed cell death protein 1 (PD-1) blockade therapies and is superior to other predictors, including PD ligand 1 (PD-L1) expression or tumor mutational burden. PD-1 expression by CD8⁺ T cells and T_reg cells negatively impacts effector and immunosuppressive functions, respectively. PD-1 blockade induces both recovery of dysfunctional PD-1⁺CD8⁺ T cells and enhanced PD-1⁺ T_reg cell-mediated immunosuppression. A profound reactivation of effector PD-1⁺CD8⁺ T cells rather than PD-1⁺ T_reg cells by PD-1 blockade is necessary for tumor regression. These findings provide a promising predictive biomarker for PD-1 blockade therapies.

Components of Spiritual Nursing Care from the Nurse's Perspective

The purpose of this exploratory study was to discover the components of spiritual nursing care as described by nurses who provide such care. The phenomenon was investigated through indepth interviewing of ten registered nurses actively practicing in North America. The method evoked a rich understanding of the components of spiritual nursing care from the perspective of nurses who say they provide such care. This study represents an important first step in understanding this little understood phenomenon.

Investigating spiritual care perceptions and practice patterns in Hong Kong nurses: results of a cluster analysis

AIM

Nurses' spiritual care perceptions and practices are explored by identifying profiles of nurses studying in a part-time baccalaureate course in a local Hong Kong university. Relationships between nurses' spiritual care perceptions and their practices are explored.

RESEARCH METHOD

Hundred and ninety three nurses completed a structured questionnaire.

OUTCOME MEASURES

Spiritual care perceptions and practices.

RESULTS

Two-step cluster analysis yielded three clusters. Clusters A, B, and C consisted of 15.0% (n = 29), 44.6% (n = 86), and 40.4% (n = 78), respectively. Cluster A nurses were characterized by relatively negative spiritual care perceptions and practices. Cluster C nurses reported positive perceptions, but negative practices; they mainly chose 'uncertain' for most items on both scales. Cluster B was a large group of nurses holding both positive spiritual care perceptions and practices. Significant differences towards spiritual care were found among clusters. Nurses' perceptions were significant positively correlated with practices (r = 0.62). High positive correlations were found between the two scales (r = 0.83) for nurses in Cluster A, for nurses in Clusters B and C, low positive correlations (r = 0.37) were found.

CONCLUSION

Three clusters of Hong Kong nurses were differentiated. They showed differences in the level of their spiritual care perceptions and practices. Despite their level of spiritual care perceptions, nurses seldom incorporated spiritual care practices into their daily nursing care, and the level of spiritual care awareness of some nurses was low. Findings may be used to improve support of nurses, to ensure sensitive spiritual care in their daily practices, and to enhance nursing curricula.

Spiritual coping strategies: a review of the nursing research literature

AIMS OF THE PAPER

This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care.

LITERATURE SEARCH

The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used.

THEORETICAL BACKGROUND

Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers.

IMPLICATIONS

This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.

The essential elements of spirituality among rural Thai elders

The purpose of the study reported here was to understand and describe the essential elements of spirituality among rural Thai elders. The research question that guided the study was: How do rural Thai elders experience and describe spirituality in their daily lives? This question was explored through in-depth, audio-taped, face-to-face interviews with 12 rural Thai elders living in the Nakhorn Prathom Province in the central part of Thailand during the period from January to March 1998. Prior to implementing the study, approval to conduct this study was granted from the Institutional Review Broad of the University of Alabama at Birmingham. Through the process of hermeneutic phenomenological data analysis, three categories and nine themes emerged. The findings of the study provide a knowledge base for Thai nurses to explore and explain spirituality to enhance nursing science and provide holistic nursing care. Further research should be conducted throughout the health and illness continuum with all age groups and with individuals of different cultures and belief systems.

Spirituality in aging: spiritual need or spiritual journey?

1. The current approach to spiritual assessment often makes the older client uncomfortable discussing his or her spiritual and religious orientation. 2. To provide therapeutic interventions, nurses must first become aware of themselves and their clients as spiritual beings. 3. A spiritual journey perspective views the nurse as one who can enhance the unique journey and growth of the individual client.

The rehabilitation nurse's role in spiritual care

For the ill or disabled patient, spiritual distress can prove to be a major nursing care problem that interferes with positive patient outcomes. This article explores major factors involved in spiritual distress and illustrates them through case studies and selected interventions. Nurses should be aware of the possibility that unidentified spiritual distress often is the culprit in an unsuccessful plan of care.

The spiritual dimension of individuals: conceptual development

The concept of spirituality (the spiritual dimension of an individual) is discussed related to concept development using the Path Associated with Differences. Spirituality is discussed as being different from religion and the psychosocial dimension of individuals. Methods for concept development--e.g., concept derivation, intuition, and qualitative analysis--are explored.