1
|
Gaudio J, Markovitz BP. Does the Spirit Move You, or Does It Take Formal Training? Pediatr Crit Care Med 2024; 25:468-470. [PMID: 38695696 DOI: 10.1097/pcc.0000000000003445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Jordan Gaudio
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | |
Collapse
|
2
|
Brooks LA, Manias E, Bloomer MJ. A retrospective descriptive study of medical record documentation of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds. Aust Crit Care 2024; 37:475-482. [PMID: 37339921 DOI: 10.1016/j.aucc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/16/2023] [Accepted: 04/14/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Communication between clinicians and family members of patients about treatment limitation practices is essential to care-planning and decision-making. For patients and family members from culturally diverse backgrounds, there are additional considerations when communicating about treatment limitations. OBJECTIVE The objective of this study was to explore how treatment limitations are communicated with family members of patients from culturally diverse backgrounds in intensive care. METHODS A descriptive study using a retrospective medical record audit was undertaken. Medical record data were collected from patients who died in 2018 in four intensive care units in Melbourne, Australia. Data are presented using descriptive and inferential statistics and progress note entries. RESULTS From 430 adult deceased patients, 49.3% (n = 212) of patients were born overseas, 56.9% (n = 245) identified with a religion, and 14.9% (n = 64) spoke a language other than English as their preferred language. Professional interpreters were used in 4.9% (n = 21) of family meetings. Documentation about the level of treatment limitation decisions were present in 82.1% (n = 353) of patient records. Nurses were documented as present for treatment limitation discussions for 49.3% (n = 174) of patients. Where nurses were present, nurses supported family members, including reassurance that end-of-life wishes would be respected. There was evidence of nurses coordinating healthcare activities and attempting to address and resolve difficulties experienced by family members. CONCLUSIONS This is the first known Australian study to explore documented evidence of how treatment limitations are communicated with family members of patients from culturally diverse backgrounds. Many patients have documented treatment limitations, yet there are a proportion of patients who die before treatment limitations can be discussed with family, which may influence the timing and quality of end-of-life care. Where language barriers exist, interpreters should be used to better ensure effective communication between clinicians and family. Greater provision for nurses to engage in treatment limitation discussions is required.
Collapse
Affiliation(s)
- Laura A Brooks
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia.
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia; Monash University, Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Clayton, VIC, 3800, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, 4102, Australia
| |
Collapse
|
3
|
Corpuz JCG. Integrating spirituality in the context of palliative and supportive care: The care for the whole person. Palliat Support Care 2024; 22:408-409. [PMID: 37606048 DOI: 10.1017/s1478951523001268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Jeff Clyde G Corpuz
- Department of Theology and Religious Education, De La Salle University, Manila, Philippines
| |
Collapse
|
4
|
Throckmorton T, Campbell-Law L. Meeting the Religious and Cultural Needs of Patients at Different Points in Their Care. Nurs Clin North Am 2024; 59:21-35. [PMID: 38272581 DOI: 10.1016/j.cnur.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
True holistic care implies an in-depth assessment and understanding of patient needs based on their physical, social, psychological, and spiritual makeup. These parameters are affected by their native culture as well as their adopted culture. The culture of a patient is composed of beliefs, values, and lifestyles. Understanding the general elements of specific cultures and religions can provide a basis for more insightful inquiry with patients regarding their preferences in health care. This article includes basic beliefs and practices related to 5 patient populations.
Collapse
Affiliation(s)
- Terry Throckmorton
- University of St. Thomas, Peavy School of Nursing, 3800 Montrose Boulevard, Houston, TX 77006, USA
| | - Lucindra Campbell-Law
- University of St. Thomas, Peavy School of Nursing, 3800 Montrose Boulevard, Houston, TX 77006, USA.
| |
Collapse
|
5
|
Kruser JM, Ashana DC, Courtright KR, Kross EK, Neville TH, Rubin E, Schenker Y, Sullivan DR, Thornton JD, Viglianti EM, Costa DK, Creutzfeldt CJ, Detsky ME, Engel HJ, Grover N, Hope AA, Katz JN, Kohn R, Miller AG, Nabozny MJ, Nelson JE, Shanawani H, Stevens JP, Turnbull AE, Weiss CH, Wirpsa MJ, Cox CE. Defining the Time-limited Trial for Patients with Critical Illness: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2024; 21:187-199. [PMID: 38063572 PMCID: PMC10848901 DOI: 10.1513/annalsats.202310-925st] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
In critical care, the specific, structured approach to patient care known as a "time-limited trial" has been promoted in the literature to help patients, surrogate decision makers, and clinicians navigate consequential decisions about life-sustaining therapy in the face of uncertainty. Despite promotion of the time-limited trial approach, a lack of consensus about its definition and essential elements prevents optimal clinical use and rigorous evaluation of its impact. The objectives of this American Thoracic Society Workshop Committee were to establish a consensus definition of a time-limited trial in critical care, identify the essential elements for conducting a time-limited trial, and prioritize directions for future work. We achieved these objectives through a structured search of the literature, a modified Delphi process with 100 interdisciplinary and interprofessional stakeholders, and iterative committee discussions. We conclude that a time-limited trial for patients with critical illness is a collaborative plan among clinicians and a patient and/or their surrogate decision makers to use life-sustaining therapy for a defined duration, after which the patient's response to therapy informs the decision to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial's duration. The plan's 16 essential elements follow four sequential phases: consider, plan, support, and reassess. We acknowledge considerable gaps in evidence about the impact of time-limited trials and highlight a concern that if inadequately implemented, time-limited trials may perpetuate unintended harm. Future work is needed to better implement this defined, specific approach to care in practice through a person-centered equity lens and to evaluate its impact on patients, surrogates, and clinicians.
Collapse
|
6
|
Klitzman R. "Why me?": Qualitative research on why patients ask, what they mean, how they answer and what factors and processes are involved. SSM - MENTAL HEALTH 2023; 3:100218. [PMID: 37982046 PMCID: PMC10655635 DOI: 10.1016/j.ssmmh.2023.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Patients often ask, "why me?" but questions arise regarding what this statement means, how, when and why patients ask, how they answer and why. Interviews were conducted as part of several qualitative research studies exploring how patients view and cope with various conditions, including HIV, cancer, Huntington's disease and infertility. A secondary qualitative analysis was performed. Many patients ask, "why me?" but this statement emerges as having varying meanings, and entailing complex psychosocial processes. Patients commonly recognize that this question may lack a clear answer and that asking it is irrational, but they ask nonetheless, given the roles of unknown factors and chance in disease causation, psychological stresses of illness and lack of definitive answers. Patients may focus on different aspects of the question - e.g., on possible causes of illness (Why me? - whether God or randomness is involved) and/or on whether they are being singled out and/or punished (Why me vs. someone else?). Patients frequently undergo dynamic processes, confronting this question at various points, and arriving at different answers, looking for explanations that have narrative coherence for them, and make sense to them emotionally. Social contexts can affect these processes, with friends, family, providers or others rejecting or accepting patients' responses to this question (e.g., beliefs about whether the patient is being punished and/or these questions are worth asking). Anger, depression, despair and/or resistance to notions about the roles of randomness or chaos can also shape these processes. While prior studies have each operationalized "why me?" in differing ways, focusing on varying aspects of it, the concept emerges here as highly multidimensional, involving complex processes and often affected by social contexts. These data, the first to examine key aspects and meanings of the phrase, "why me?" have critical implications for future practice, research and education.
Collapse
|
7
|
Alim-Marvasti A, Jawad M, Ogbonnaya C, Naghieh A. Workforce diversity in specialist physicians: Implications of findings for religious affiliation in Anaesthesia & Intensive Care. PLoS One 2023; 18:e0288516. [PMID: 37611011 PMCID: PMC10446200 DOI: 10.1371/journal.pone.0288516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/29/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Minority ethnic identification between physician and patient can reduce communication and access barriers, improve physician-patient relationship, trust, and health outcomes. Religion influences health beliefs, behaviours, treatment decisions, and outcomes. Ethically contentious dilemmas in treatment decisions are often entangled with religious beliefs. They feature more in medical specialties such as Anaesthesia & Intensive Care, with issues including informed consent for surgery, organ donation, transplant, transfusion, and end-of-life decisions. METHODS We investigate diversity in religious affiliation in the UK medical workforce, using data from the General Medical Council (GMC) specialist register and Health Education England (HEE) trainee applications to medical specialties. We performed conservative Bonferroni corrections for multiple comparisons using Chi-squared tests, as well as normalised mutual-information scores. Robust associations that persisted on all sensitivity analyses are reported, investigating whether ethnicity or foreign primary medical qualification could explain the underlying association. FINDINGS The only significant and robust association in both GMC and HEE datasets affecting the same religious group and specialty was disproportionately fewer Anaesthesia & Intensive Care physicians with a religious affiliation of "Muslim", both as consultants (RR 0.57[0.47,0.7]) and trainee applicants (RR 0.27[0.19,0.38]. Associations were not explained by ethnicity or foreign training. We discuss the myriad of implications of the findings for multi-cultural societies. CONCLUSIONS Lack of physician workforce diversity has far-reaching consequences, especially for specialties such as Anaesthesia and Intensive Care, where ethically contentious decisions could have a big impact. Religious beliefs and practices, or lack thereof, may have unmeasured influences on clinical decisions and on whether patients identify with physicians, which in turn can affect health outcomes. Examining an influencing variable such as religion in healthcare decisions should be prioritised, especially considering findings from the clinician-patient concordance literature. It is important to further explore potential historical and socio-cultural barriers to entry of training medics into under-represented specialties, such as Anaesthesia and Intensive Care.
Collapse
Affiliation(s)
- Ali Alim-Marvasti
- UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Mohammed Jawad
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Chibueze Ogbonnaya
- Institute of Child Health, University College London, London, United Kingdom
| | - Ali Naghieh
- School of Public Policy, University College London, London, United Kingdom
- Middlesex University Business School, London, United Kingdom
| |
Collapse
|
8
|
Bıngol B, Yılmaz M, Weathers E. Validity and Reliability of the Turkish Version of the Spirituality Instrument-27 (SpI-27©). J Holist Nurs 2023:8980101231193943. [PMID: 37605885 DOI: 10.1177/08980101231193943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Introduction: This methodological study aimed to adapt the Spirituality Instrument-27 (SpI-27©) to the Turkish language and culture. Design: The psychometric study was carried out with 267 individuals who were hospitalized in the cardiology clinic and who were diagnosed with a chronic disease. Data collection tools were the demographic questionnaire and the SpI-27©. The Statistical Package for Social Sciences was used for data analysis and confirmatory factor analysis. Results: The Kaiser-Meyer-Olkin index was 0.848 and Bartlett's test of sphericity was statistically significant (p = 0.000). The root mean square error of approximation was 0.05, the standardized root mean squared residual was 0.04, the adjusted goodness-of-fit index was 0.87, the goodness-of-fit index was 0.92, the nonformed fit index was 0.91, and the comparative fit index was 0.90. Connectedness with others accounted for 38.24 of the total variance, self-transcendence accounted for 11.71, self-cognizance accounted for 10.56, and conservationism and belief accounted for 9.82 of the total variance (total variance was 70.34%). The highest item factor loading of the scale was 0.812 and the lowest one was 0.398. Cronbach's alpha coefficient of the scale was 0.927. Conclusion: This measurement tool will enable researchers to plan and implement nursing interventions accurately and effectively by assessing the spiritual needs of individuals with nonmalignant chronic diseases. The use of this tool in different languages can help diagnose the spiritual needs of nurses working with multicultural and multilingual patients.
Collapse
|
9
|
You H, Ma JE, Haverfield MC, Oyesanya TO, Docherty SL, Johnson KS, Cox CE, Ashana DC. Racial Differences in Physicians' Shared Decision-Making Behaviors during Intensive Care Unit Family Meetings. Ann Am Thorac Soc 2023; 20:759-762. [PMID: 36790912 PMCID: PMC10174123 DOI: 10.1513/annalsats.202212-997rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
| | - Jessica E. Ma
- Durham Veterans Affairs Health SystemDurham, North Carolina
| | | | | | | | | | | | | |
Collapse
|
10
|
Klitzman R, Di Sapia Natarelli G, Garbuzova E, Al-Hashimi J, Sinnappan S. Barriers and facilitators faced by hospital chaplains in communicating with lesbian, gay, bisexual, transgender and questioning patients. PATIENT EDUCATION AND COUNSELING 2023; 113:107753. [PMID: 37087876 DOI: 10.1016/j.pec.2023.107753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Chaplains address religious, spiritual and existential issues with heterosexual patients but critical questions arise of whether chaplains do so with lesbian, gay, bisexual, transgender and questioning (LGBTQ) patients, too, and if so, how. METHODS Chaplains were interviewed for ∼1 h each. Four spontaneously discussed LGBTQ issues. RESULTS Chaplains described several challenges communicating with LGBTQ patients. These patients may confront existential, spiritual/religious questions, but be wary of religion, and hence of chaplains, whom they may thus reject. Chaplains can help LGBTQ patients, addressing existential, spiritual and/or religious issues and related parental rejections these patients may then face. Yet LGBTQ patients vary widely: while some eschew chaplains, others are receptive. These providers may also not always know patients' LGBTQ status, and may vary in sensitivity towards these issues, and not always succeed in overcoming families' religion-based homophobia. CONCLUSION Chaplains can potentially help LGBTQ patients in crucial ways, but face obstacles that need to be carefully recognized, examined and addressed through, practice, research and enhanced education of chaplains, medical staff, patients, family members and others. PRACTICE IMPLICATIONS Chaplains and other providers should be more aware of, and ready to address the potential existential, spiritual and religious issues that LGBTQ patients may confront.
Collapse
Affiliation(s)
- Robert Klitzman
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA.
| | | | | | - Jay Al-Hashimi
- Masters of Bioethics Program, Columbia University, New York, NY, USA
| | | |
Collapse
|
11
|
Spiritual Care in the Intensive Care Unit: Experiences of Dutch Intensive Care Unit Patients and Relatives. Dimens Crit Care Nurs 2023; 42:83-94. [PMID: 36720033 DOI: 10.1097/dcc.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/OBJECTIVE To gain insight into both patients' and relatives' experiences with spiritual care (SC) in the intensive care unit (ICU). METHODS Method used was qualitative interviewing. This was a thematic, topic-centered, biographical, and narrative approach, using semistructured interviews with thematic analysis. A purposive sampling method was used to select a sample of ICU patients and ICU patients' relatives. An interview guide facilitated individual, semistructured interviews. The interview data were recorded by means of note-taking and audio-recording. Verbatim transcripts were compiled for analysis and interpretation. RESULTS All 12 participants-7 ICU patients and 5 family members of 5 other ICU patients-experienced ICU admission as an existential crisis. Participants would appreciate the signaling of their spiritual needs by ICU health care professionals (HCPs) at an early stage of ICU admission and subsequent SC provision by a spiritual caregiver. They regarded the spiritual caregiver as the preferred professional to address spiritual needs, navigate during their search for meaning and understanding, and provide SC training in signaling spiritual needs to ICU HCPs. DISCUSSION Early detection of existential crisis signals with ICU patients and relatives contributes to the mapping of spiritual and religious needs. Spiritual care training of ICU HCPs in signaling spiritual needs by ICU patients and relatives is recommended. Effective SC contributes to creating room for processing emotions, spiritual well-being, and satisfaction with integrated SC as part of daily ICU care.
Collapse
|
12
|
Toates SE, Hickey VKD. Relationships Between the Number of Chaplain Visits and Patient Characteristics: A Retrospective Review of a Large Suburban Midwest Hospital, USA. JOURNAL OF RELIGION AND HEALTH 2023; 62:39-54. [PMID: 36566479 PMCID: PMC9790087 DOI: 10.1007/s10943-022-01717-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
It is critical to understand the characteristics of patients who receive spiritual care through chaplain visits. This study evaluated 2373 records from chaplain visits provided to 1315 patients over a three-month period (March-May 2021) at a large suburban teaching hospital, Midwest, USA. Approximately 70% of patients received one chaplain visit. However, data revealed that when patients were admitted emergently, or received visits for reasons related to self-harm or suicidality, the frequency of chaplain visits significantly increased. This study suggests a need for spiritual care services for patients with emergency or mental health conditions. Furthermore, it highlights the need for further training and resources for chaplains to increase clinical competencies in providing specialized spiritual care support to specific patient populations.
Collapse
Affiliation(s)
- Sarah E Toates
- Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
| | - Ven Kevin D Hickey
- Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA
- Corewell Health William Beaumont University Hospital, 3601 W 13 Mile Rd., Royal Oak, MI, 48073, USA
| |
Collapse
|
13
|
Akbari O, Dehghan M, Tirgari B. Muslim nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care: a qualitative study in southeast Iran. BMC Nurs 2022; 21:270. [PMID: 36199137 PMCID: PMC9533603 DOI: 10.1186/s12912-022-01044-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Omolbanin Akbari
- Department of Medical Surgical Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Batool Tirgari
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
14
|
Spirituality in a Doctor's Practice: What Are the Issues? J Clin Med 2021; 10:jcm10235612. [PMID: 34884314 PMCID: PMC8658590 DOI: 10.3390/jcm10235612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is becoming increasingly important to address the spiritual dimension in the integral care of the people in order to adequately assist them in the processes of their illness and healing. Considering the spiritual dimension has an ethical basis because it attends to the values and spiritual needs of the person in clinical decision-making, as well as helping them cope with their illness. Doctors, although sensitive to this fact, approach spiritual care in clinical practice with little rigour due to certain facts, factors, and boundaries that are assessed in this review. Objective: To find out how doctors approach the spiritual dimension, describing its characteristics, the factors that influence it, and the limitations they encounter. Methodology: We conducted a review of the scientific literature to date in the PubMed, Scopus, and CINAHL databases of randomised and non-randomised controlled trials, observational studies, and qualitative studies written in Spanish, English, and Portuguese on the spiritual approach adopted by doctors in clinical practice. This review consisted of several phases: (i) the exclusion of duplicate records; (ii) the reading of titles and abstracts; (iii) the assessment of full articles and their methodological quality using the guidelines of the international Equator Network. Results: A total of 1414 publications were identified in the search, 373 of which were excluded for being off-topic or repeated in databases. Of the remaining 1041, 962 were excluded because they did not meet the inclusion criteria. After initial screening, 79 articles were selected, from which 17 were collected after reading the full text. A total of 8 studies were eligible for inclusion. There were three qualitative studies and five cross-sectional observational studies with sufficient methodological quality. The results showed the perspectives and principal characteristics identified by doctors in their approach to the spiritual dimension, with lack of training, a lack of time, and fear in addressing this dimension in the clinic the main findings. Conclusions: Although more and more scientific research is demonstrating the benefits of spiritual care in clinical practice and physicians are aware of it, efforts are needed to achieve true holistic care in which specific training in spiritual care plays a key role.
Collapse
|
15
|
de Diego-Cordero R, López-Gómez L, Lucchetti G, Badanta B. Spiritual care in critically ill patients during COVID-19 pandemic. Nurs Outlook 2021; 70:64-77. [PMID: 34711420 PMCID: PMC8226065 DOI: 10.1016/j.outlook.2021.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
Introduction Spiritual care has a positive influence when patients are subjected to serious illnesses, and critically ill situations such as the case of the COVID-19 pandemic. Purpose The purpose of this study was to investigate the perceptions and attitudes of nurses working at critical care units and emergency services in Spain concerning the spiritual care providing to patients and families during the COVID-19 pandemic. Methods A qualitative investigation was carried out using in-depth interviews with 19 ICU nursing professionals. Findings During the pandemic, nurses provided spiritual care for their patients. Although they believed that spirituality was important to help patients to cope with the disease, they do not had a consensual definition of spirituality. Work overload, insufficient time and lack of training were perceived as barriers for providing spiritual healthcare. Discussion These results support the role of spirituality in moments of crisis and should be considered by health professionals working in critical care settings.
Collapse
Affiliation(s)
- Rocío de Diego-Cordero
- Faculty of Nursing, Physiotherapy and Podiatry. University of Seville, Spain. Research Group CTS 969 "Innovation in HealthCare and Social Determinants of Health". School of Nursing, Physiotherapy and Podiatry. University of Seville
| | - Lorena López-Gómez
- Faculty of Nursing, Physiotherapy and Podiatry. University of Seville, Spain
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Brazil
| | - Bárbara Badanta
- Department of Nursing; Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Spain. Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes".
| |
Collapse
|
16
|
Badanta B, Rivilla-García E, Lucchetti G, de Diego-Cordero R. The influence of spirituality and religion on critical care nursing: An integrative review. Nurs Crit Care 2021; 27:348-366. [PMID: 33966310 DOI: 10.1111/nicc.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/21/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spiritual care could help family members and critically ill patients to cope with anxiety, stress and depression. However, health care professionals are poorly prepared and health managers are not allocating all the resources needed. AIMS AND OBJECTIVES To critically review the empirical evidence concerning the influence of spirituality and religion (S-R) on critical care nursing. METHODS An integrative review of the literature published in the last 10 years (2010-2019) was conducted in PubMed, Scopus, CINHAL, PsycINFO, Web of Science, Cochrane and LILACS. In addition, searches were performed in the System for Information on Grey Literature in Europe and the Grey Literature Report. Quantitative and/or qualitative studies, assessing S-R and including health care professionals caring for critically ill patients (i.e. adults or children), were included. RESULTS Forty articles were included in the final analysis (20 qualitative, 19 quantitative and 1 with a mixed methodology). The studies embraced the following themes: S-R importance and the use of coping among critical care patients and families; spiritual needs of patients and families; health care professionals' awareness of spiritual needs; ways to address spiritual care in the intensive care unit (ICU); definition of S-R by health care professionals; perceptions and barriers of addressing spiritual needs; and influence of S-R on health care professionals' outcomes and decisions. Our results indicate that patients and their families use S-R coping strategies to alleviate stressful situations in the ICU and that respecting patients' spiritual beliefs is an essential component of critical care. Although nurses consider spiritual care to be very important, they do not feel prepared to address S-R and report lack of time as the main barrier. CONCLUSION AND IMPLICATIONS FOR PRACTICE Critical care professionals should be aware about the needs of their patients and should be trained to handle S-R in clinical practice. Nurses are encouraged to increase their knowledge and awareness towards spiritual issues.
Collapse
Affiliation(s)
- Bárbara Badanta
- Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes", Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
| | | | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Brazil
| | - Rocío de Diego-Cordero
- Research Group CTS 969 "Innovation in HealthCare and Social Determinants of Health", School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| |
Collapse
|
17
|
Klitzman R. Doctor, Will You Pray for Me? Responding to Patients' Religious and Spiritual Concerns. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:349-354. [PMID: 33003037 PMCID: PMC7933033 DOI: 10.1097/acm.0000000000003765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Religion and spirituality in the United States have been shifting, and physicians are treating patients with increasingly diverse beliefs. Physicians' unfamiliarity with these beliefs poses critical challenges for medical education and practice. Despite efforts to improve medical education in religion/spirituality, most doctors feel their training in these areas is inadequate. This article draws on the author's conversations with providers and patients over several years in various clinical and research contexts in which religious/spiritual issues have arisen. These conversations provided insights into how patients and their families commonly, and often unexpectedly, make religious/spiritual comments to their providers or question their providers about these topics, directly or indirectly. Comments are of at least 9 types that fall within 4 broad domains: (1) perceiving God's role in disease and treatment (in causing disease, affecting treatment outcomes, and knowing disease outcomes), (2) making medical decisions (seeking God's help in making these decisions and determining types/extents of treatment), (3) interacting with providers (ascertaining providers' beliefs, having preferences regarding providers, and requesting prayer with or by providers), and (4) pondering an afterlife. Because of their beliefs or lack of knowledge, doctors face challenges in responding and often do so in 1 of 4 broad ways: (1) not commenting, (2) asking strictly medical questions, (3) referring the patient to a chaplain, or (4) commenting on the patient's remark. Medical education should thus encourage providers to recognize the potential significance of patients' remarks regarding these topics and to be prepared to respond, even if briefly, by developing appropriate responses to each statement type. Becoming aware of potential differences between key aspects of non-Western faiths (e.g., through case vignettes) could be helpful. Further research should examine in greater depth how patients broach these realms, how physicians respond, and how often medical school curricula mention non-Western traditions.
Collapse
Affiliation(s)
- Robert Klitzman
- R. Klitzman is professor of psychiatry and director, Master of Bioethics Program, Columbia University, New York, New York; ORCID: https://orcid.org/0000-0002-6827-8063
| |
Collapse
|
18
|
Simeone IM, Berning JN, Hua M, Happ MB, Baldwin MR. Training Chaplains to Provide Communication-Board-Guided Spiritual Care for Intensive Care Unit Patients. J Palliat Med 2021; 24:218-225. [PMID: 32639178 PMCID: PMC7840304 DOI: 10.1089/jpm.2020.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Chaplain-led communication-board-guided spiritual care may reduce anxiety and stress during an intensive care unit (ICU) admission for nonvocal mechanically ventilated patients, but clinical pastoral education does not teach the assistive communication skills needed to provide communication-board-guided spiritual care. Objective: To evaluate a four-hour chaplain-led seminar to educate chaplains about ICU patients' psychoemotional distress, and train them in assistive communication skills for providing chaplain-led communication-board-guided spiritual care. Design: A survey immediately before and after the seminar, and one-year follow-up about use of communication-board-guided spiritual care. Subjects/Setting: Sixty-two chaplains from four U.S. medical centers. Measurements: Multiple-choice and 10-point integer scale questions about ICU patients' mental health and communication-board-guided spiritual care best practices. Results: Chaplain awareness of ICU sedation practices, signs of delirium, and depression, anxiety, and post-traumatic stress disorder in ICU survivors increased significantly (all p < 0.001). Knowledge about using tagged yes/no questions to communicate with nonvocal patients increased from 38% to 87%, p < 0.001. Self-reported skill and comfort in providing communication-board-guided spiritual care increased from a median (interquartile range) score of 4 (2-6) to 7 (5-8) and 6 (4-8) to 8 (6-9), respectively (both p < 0.001). One year later, 31% of chaplains reported providing communication-board-guided spiritual care in the ICU. Conclusions: A single chaplain-led seminar taught chaplains about ICU patients' psychoemotional distress, trained chaplains in assistive communication skills with nonvocal patients, and led to the use of communication-board-guided spiritual care in the ICU for up to one year later.
Collapse
Affiliation(s)
- Ilaria M. Simeone
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Joel N. Berning
- Pastoral Care and Education Department, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - May Hua
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Mary Beth Happ
- Center for Research and Health Analytics, Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Matthew R. Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| |
Collapse
|
19
|
Alch CK, Collier KM, Yeow RY. Addressing Spiritual and Religious Needs in Advanced Illness: A Teachable Moment. JAMA Intern Med 2021; 181:115-116. [PMID: 33226413 DOI: 10.1001/jamainternmed.2020.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Raymond Y Yeow
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| |
Collapse
|
20
|
Moale A, Teply ML, Liu T, Singh AL, Basyal PS, Turnbull AE. Intensivists' Religiosity and Perceived Conflict During a Simulated ICU Family Meeting. J Pain Symptom Manage 2020; 59:687-693.e1. [PMID: 31678463 PMCID: PMC7024641 DOI: 10.1016/j.jpainsymman.2019.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022]
Abstract
CONTEXT Conflict is frequently reported by both clinicians and surrogate decision makers for adult patients in intensive care units. Because religious clinicians view religion as an important dimension of end-of-life care, we hypothesized that religious critical care attendings (intensivists) would be more comfortable and perceive less conflict when discussing a patient's critical illness with a religious surrogate. OBJECTIVES The objective of this study was to assess if religious intensivists are more or less likely to perceive conflict during a simulated family meeting than secular colleagues. METHODS Intensivists were recruited to participate in a standardized, simulated family meeting with an actor portraying a family member of a critically ill patient. Intensivists provided demographic information including their current religion and the importance of religion in their lives. After the simulation, intensivists rated the amount of conflict they perceived during the simulation. The association between intensivist's self-reported religiosity and perceived conflict was estimated using both univariate analysis and multivariable logistic regression. RESULTS Among 112 participating intensivists, 43 (38%) perceived conflict during the simulation. Among intensivists who perceived conflict, 49% were religious, and among those who did not perceive conflict, 35% were religious. After adjusting for physician race, gender, years in practice, intensive care unit weeks worked per year and actor, physician religiosity was associated with greater odds of perceiving conflict during the simulated family meeting (adjusted prevalence ratio = 2.77, [95% CI 1.12-7.16], P = 0.03). CONCLUSION Religious intensivists were more likely to perceive conflict during a simulated family meeting.
Collapse
Affiliation(s)
- Amanda Moale
- Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Melissa L Teply
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tiange Liu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arun L Singh
- Division of Pediatric Palliative Care, Department of Pediatrics, Prisma Health Children's Hospital-Upstate, Greenville, South Carolina, USA
| | - Pragyashree Sharma Basyal
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA; Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alison E Turnbull
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Kruser JM, Aaby DA, Stevenson DG, Pun BT, Balas MC, Barnes-Daly MA, Harmon L, Ely EW. Assessment of Variability in End-of-Life Care Delivery in Intensive Care Units in the United States. JAMA Netw Open 2019; 2:e1917344. [PMID: 31825508 PMCID: PMC6991207 DOI: 10.1001/jamanetworkopen.2019.17344] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Overall, 1 of 5 decedents in the United States is admitted to an intensive care unit (ICU) before death. OBJECTIVE To describe structures, processes, and variability of end-of-life care delivered in ICUs in the United States. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study used data on 16 945 adults who were cared for in ICUs that participated in the 68-unit ICU Liberation Collaborative quality improvement project from January 2015 through April 2017. Data were analyzed between August 2018 and June 2019. MAIN OUTCOMES AND MEASURES Published quality measures and end-of-life events, organized by key domains of end-of-life care in the ICU. RESULTS Of 16 945 eligible patients in the collaborative, 1536 (9.1%) died during their initial ICU stay. Of decedents, 654 (42.6%) were women, 1037 (67.5%) were 60 years or older, and 1088 (70.8%) were identified as white individuals. Wide unit-level variation in end-of-life care delivery was found. For example, the median unit-stratified rate of cardiopulmonary resuscitation avoidance in the last hour of life was 89.5% (interquartile range, 83.3%-96.1%; range, 50.0%-100%). Median rates of patients who were pain free and delirium free in last 24 hours of life were 75.1% (interquartile range, 66.0%-85.7%; range, 0-100%) and 60.0% (interquartile range, 43.7%-85.2%; range, 9.1%-100%), respectively. Ascertainment of an advance directive was associated with lower odds of cardiopulmonary resuscitation in the last hour of life (odds ratio, 0.70; 95% CI, 0.49-0.99; P = .04), and a documented offer or delivery of spiritual support was associated with higher odds of family presence at the time of death (odds ratio, 1.95; 95% CI, 1.37-2.77; P < .001). Death in a unit with an open visitation policy was associated with higher odds of pain in the last 24 hours of life (odds ratio, 2.21; 95% CI, 1.15-4.27; P = .02). Unsupervised cluster analysis revealed 3 mutually exclusive unit-level patterns of end-of-life care delivery among 63 ICUs with complete data. Cluster 1 units (14 units [22.2%]) had the lowest rate of cardiopulmonary resuscitation avoidance but achieved the highest pain-free rate. Cluster 2 (25 units [39.7%]) had the lowest delirium-free rate but achieved high rates of all other end-of-life events. Cluster 3 (24 units [38.1%]) achieved high rates across all favorable end-of-life events. CONCLUSIONS AND RELEVANCE In this study, end-of-life care delivery varied substantially among ICUs in the United States, and the patterns of care observed suggest that units can be characterized as higher and lower performing. To achieve optimal care for patients who die in an ICU, future research should target unit-level variation and disseminate the successes of higher-performing units.
Collapse
Affiliation(s)
- Jacqueline M. Kruser
- Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - David A. Aaby
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - David G. Stevenson
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Brenda T. Pun
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Lori Harmon
- Society of Critical Care Medicine, Mount Prospect, Illinois
| | - E. Wesley Ely
- Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Pulmonary and Critical Care, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|