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

Spiritual Care in the Intensive Care Unit: Experiences of Dutch Intensive Care Unit Patients and Relatives

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.

Vicarious spiritual distress in intensive care unit healthcare providers: A qualitative study

OBJECTIVES

To explore the impact of caring for family members experiencing spiritual distress on Intensive Care Unit healthcare providers.

DESIGN

A qualitative study involving interviews and focus groups between May 2016 and April 2017.

PARTICIPANTS

Intensive care healthcare providers from nine teaching and three non-teaching units across Alberta, Canada.

MEASUREMENTS

Transcribed data were analysed using interpretive description.

FINDINGS

Forty-two participants variably described experiences of vicarious spiritual distress, along with coping strategies and outcomes related to these experiences. Vicarious spiritual distress was experienced as sorrow/distress, helplessness and preoccupation/rumination. Coping strategies were both adaptive (self-awareness/reflection, reframing/resiliency, team support/debriefing, self-care, accepting limitations) and maladaptive (compartmentalising/distancing, substance use). Lastly, the emotional burden of these experiences resulted in both favourable (satisfaction, appreciation) and unfavourable (moral distress, burnout, hopelessness) outcomes.

CONCLUSION

Our findings describe the novel concept of vicarious spiritual distress as experienced by intensive care healthcare providers and highlight the importance of identifying effective ways to support these professionals throughout their careers to prevent unfavorable outcomes and the perpetuation of maladaptive coping strategies. The adaptive coping strategies described in this study may help inform wellness initiatives and resiliency training tailored to intensive care healthcare providers.

WITHDRAWN: Vicarious spiritual distress in intensive care unit healthcare providers: A qualitative study

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Exploring spiritual health practitioners' roles and activities in critical care contexts

Family members of patients admitted to the intensive care unit (ICU) experience multidimensional distress. Many clinicians lack an understanding of spiritual health practitioners' role and approaches to providing spiritual support. Through semi-structured interviews and focus groups with 10 spiritual health practitioners, we explored how spiritual health practitioners support families of patients in the ICU to better understand their scope of practice and role within an interdisciplinary critical care team. Spiritual health practitioners' work was described through clinical roles (family support, clinician support, bridging family members and clinicians), activities (companioning, counseling, facilitating difficult conversations, addressing individual needs), tensions (within and between roles and activities, navigating between hope and anticipated clinical trajectory, balancing supportive care and workload) and foundational principles (holistic perspective, resilience). A more comprehensive understanding of these roles and skills may enable clinicians to better integrate spiritual health practitioners into the fabric of care for patients, families, and clinicians themselves.

Challenges and Enablers of Spiritual Care for Family Members of Patients in the Intensive Care Unit

Spiritual care has been recognized as important to family members of critically ill patients, although it is often not integrated within clinical practice. We conducted focus groups and interviews with family members, spiritual health practitioners, and clinicians who work in the intensive care unit (ICU) to explore their experiences of working with family members experiencing spiritual distress in this setting. Challenges and factors that enable identification and support for spiritual distress were identified, as well as suggestions for improvement.