Religious/spiritual care needs and treatment alliance among clinical mental health patients

Spiritual care for clients with mental illness from an Islamic background: Nursing students' perspectives

WHAT IS KNOWN ON THE SUBJECT?: Spirituality is an important aspect for clients with mental illness. Spirituality is essential to holistic care in mental health nursing. Nurses found an apparent disconnection between the theory and practice of spiritual care.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Nurses acknowledged that attitudes that allocate blame towards clients with mental illness have the most negative impact on clients' spiritual wellbeing. The conflicting worldviews between spiritual healing and a biomedical approach impact the provision of care as relationships among the mental health team are disrupted. The non-assessment of the client's spirituality hindered nurses from providing spiritual care. Language differences between nurses and clients impede nurses from providing spiritual care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The use of spiritual therapy as an element of nursing care works if clients and nurses are both aware of the importance of spirituality. Nursing staff must also be aware of several issues that may make it difficult for nurses to provide such therapy, including specific symptoms of mental illness. Nurses can apply spiritual care effectively when they have significant spirituality. Nurses with good competency in mental health nursing skills are more likely to provide efficient spiritual care as part of holistic care.

ABSTRACT

INTRODUCTION: Spiritual care is essential to clients with mental illness.

AIM

To explore mental health nursing students' perspectives on spirituality and spiritual care and how this impacts clients with mental illness in an Islamic context (Saudi Arabia).

METHOD

Thematic analysis is used to analyse data from two focus groups of mental health nursing students (one comprising eight, the other six).

RESULTS

Six themes emerged: factors affecting spirituality in mental illness, the impact of mental illness on spirituality, the use of spiritual healing in mental illness, nurses' use of spiritual healing; challenges in providing spiritual care and recommendations for improving spiritual care.

DISCUSSION

Clients being blamed for having mental illness by health professionals and the community harmed their spirituality. The religious support of peers was a practical approach to spiritual therapy, asserted as a beneficial element of nursing care. However, nurses found providing such therapy challenging because of the language barrier and the lack of any assessment of clients' spirituality. It was also challenging when dealing with specific symptoms of mental illness.

IMPLICATIONS FOR PRACTICE

The study asserts that spiritual therapy in nursing care will work if the client knows its importance. Nurses who have significant spirituality can apply it effectively.

Acknowledging religion in cognitive behavioural therapy: The effect on alliance, treatment expectations and credibility in a video-vignette study

OBJECTIVES

Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims.

METHODS

A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process.

RESULTS

One hundred twenty-nine British Muslim adults aged 18-70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the 'therapist', but that acknowledging religion did not impact upon anticipated alliance.

CONCLUSIONS

These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups.

Spiritual care needs and their attributes among Chinese inpatients with advanced breast cancer based on the Kano model: a descriptive cross-sectional study

BACKGROUND

Numerous previous research have established the need for spiritual care among patients with cancer globally. Nevertheless, there was limited research, primarily qualitative, on the spiritual care needs of Chinese inpatients with advanced breast cancer. Furthermore, the need for spiritual care was rarely explored using the Kano model. To better understand the spiritual care needs and attributes characteristics of inpatients with advanced breast cancer, this study examined the Kano model.

METHODS

A descriptive cross-sectional design study was conducted in the oncology departments of three tertiary grade-A hospitals in China from October 2022 to May 2023. To guarantee high-quality reporting of the study, the Strengthening the Reporting of Observational Studies in Epidemiology Checklist was used. Data on the demographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale (NSTS), and the Kano model-based Nurse Spiritual Therapeutics Attributes Scale (K-NSTAs) were collected through convenience sampling. The Kano model, descriptive statistics, two independent samples t-tests, and one-way analysis of variance were used to analyze the data.

RESULTS

The overall score for spiritual care needs was 31.16 ± 7.85. The two dimensions with the highest average scores, "create a good atmosphere" (3.16 ± 0.95), and the lowest average scores, "help religious practice" (1.72 ± 0.73). The 12 items were distributed as follows: three attractive attributes were located in Reserving Area IV; five one-dimensional attributes were distributed as follows: three one-dimensional attributes were located in Predominance Area I, and two were found in Improving Area II; two must-be attributes were located in Improving Area II; and two indifference attributes were located in Secondary Improving Area III.

CONCLUSION

The Chinese inpatients with advanced breast cancer had a middle level of spiritual care needs, which need to be further improved. Spiritual care needs attributes were defined, sorted, categorized, and optimized accurately and perfectly by the Kano model. And "create a good atmosphere" and "share self-perception" were primarily one-dimensional and must-be attributes. In contrast, the items in the dimensions of "share self-perception" and "help thinking" were principally attractive attributes. Nursing administrators are advised to optimize attractive attributes and transform indifference attributes by consolidating must-be and one-dimensional attributes, which will enable them to take targeted spiritual care measures based on each patient's characteristics and unique personality traits.

Effects of non-pharmacological interventions on pain in wound patients during dressing change: A systematic review

BACKGROUND

Changes to the wound dressing frequently cause pain. Some adverse side effects of pharmacologic pain management may cause problems or even impede wound healing. There is no systematic study of non-pharmacologic therapies for pain during wound dressing changes, despite the gradual promotion of non-pharmacologic pain reduction methods.

OBJECTIVES

To give clinical wound pain management a new direction, locating and assessing non-pharmacological interventions regarding pain brought on by wound dressing changes are necessary.

METHOD

The researchers conducted a comprehensive literature review on non-pharmacological interventions for pain during wound dressing changes across five databases: PubMed, Web of Science, Medline, Embase, and the Cochrane Library spanning the period from January 2010 to September 2022. The evaluation of literature and data extraction was carried out independently by two researchers, and in cases of disagreement, a third researcher participated in the deliberation. To assess the risk of bias in the literature, the researchers utilised the Cochrane Handbook for Reviews of Interventions, version 5.1.0.

RESULTS

In total, 951 people were involved in 11 investigations covering seven non-pharmacological therapies. For pain triggered by dressing changes, virtual reality (VR) distraction, auditory and visual distractions, foot reflexology, religious and spiritual care, and guided imaging demonstrated partially positive effects, with hypnosis therapy and jaw relaxation perhaps having a weak effect.

CONCLUSION

The key to managing wounds is pain management. According to our review, there is some indication that non-pharmacologic interventions can help patients feel less discomfort when having their wound dressings changed. However, the evidence supporting this view is weak. It needs to be corroborated by future research studies with multicentre and large samples. To promote and use various non-pharmacologic interventions in the future, it is also necessary to build standardised and homogenised paths for their implementation.

Factors affecting spiritual care competency of mental health nurses: a questionnaire-based cross-sectional study

BACKGROUND

Although providing spiritual care is an important part of holistic nursing care for psychiatric patients, factors associated with spiritual care competency in mental health nurses remain unclear. The aim of our study was to explore a possible association of personal and external factors with spiritual care competency in mental health nurses.

METHODS

This prospective questionnaire-based cross-sectional study was conducted by inviting mental health nurses from mental health hospitals and tertiary referral centers. Personality traits and spiritual care competency were assessed by using [1] "big-five Mini-Markers" questionnaire, and [2] spiritual care competency scale, respectively. From the 250 mental health nurses being invited, 239 valid questionnaires were valid for final analysis. Statistical analyses including descriptive statistics, ANOVAs, t-tests, and hierarchical multiple regression models were used to investigate the associations between personal/external factors and their spiritual care competency in mental health nurses.

RESULTS

The mean age of the 239 participants was 35.96 ± 8.11 and the mean years of working experience was 9.41 ± 7.06. Over 90% of them had no experience of providing spiritual care. There were significant positive correlations of spiritual care competency with the experience of delivering spiritual care (p < 0.001), previous participation in spiritual care education programs (p = 0.045), a longer working experience (p = 0.014), and a higher education level (postgraduate vs. college, p = 0.006), as well as the personality components of "Conscientiousness" (p < 0.001), "Agreeableness" (p < 0.001), "Extraversion" (p = 0.03), and "Openness/Intellect" (p < 0.001).

CONCLUSIONS

Both personal and external factors may be related to the self-perception of spiritual care competency among mental health nurses. These findings may help mental health nurses understand the possible positive and negative associations of their personality components with their spiritual care abilities. Moreover, our identification of the positive impacts of educational programs and previous experience of spiritual care on spiritual care competency may underscore the importance of tailoring appropriate training programs to cater for the individual needs of mental health nurses.

Spiritual care needs among Chinese elders hospitalized for severe chronic heart failure: An observational study

OBJECTIVES

To investigate the spiritual care needs and their attributes among Chinese elders hospitalized for severe chronic heart failure (CHF) based on the Kano model, in order to provide a reference for improving the quality and satisfaction of spiritual care.

METHODS

An observational design was implemented, and the STROBE Checklist was used to ensure quality reporting of the study. The demographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, and the Kano model-based Nurse Spiritual Therapeutics Attributes Scale were used. A convenience sample of 451 patients were selected from 2 hospitals. Descriptive statistics, and Kano model were used to analyze the data.

RESULTS

The total score of spiritual care needs was 29.95 ± 7.51. Among the 12 items, 3 items were attractive attributes, all of which were located in Reserving Zone IV; 5 items were one-dimensional attributes, of which 3 were located in Predominance Zone I and 2 were located in Improving Zone II; 2 items were must-be attributes, all of which were located in Improving Zone II; and 2 items were indifference attributes, all of which were located in Secondary Improving Zone III.

SIGNIFICANCE OF RESULTS

The spiritual care needs among Chinese elders hospitalized for severe CHF were moderate. The must-be and one-dimensional attributes mainly focus on "creating a good atmosphere" and "sharing self-perception" dimensions, while attractive attributes mainly focus on "sharing self-perception" and "helping thinking" dimensions. It is suggested that hospital authority should develop and innovate attractive attributes on the basis of maintaining and perfecting must-be and one-dimensional attributes, and objectively analyze and optimize indifference attributes.

Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients

BACKGROUND

Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance.

AIMS

To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period.

METHOD

201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling.

RESULTS

R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p < .001), and unmet R/S care needs with lower WAI score (β = -.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (β = -.13; p < .05).

CONCLUSIONS

Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

Impacts of extrinsic and intrinsic factors on psychiatric nurses' spiritual care attitudes

WHAT IS KNOWN ON THE SUBJECT?: Because the definition of spirituality is complex and has cultural and individual dimensions, it is important to be receptive to individual differences in the perception of spirituality during clinical practice of mental health nurses. Although enhancing spiritual care is beneficial to patients diagnosed with mental illnesses, the extrinsic (e.g., education) and intrinsic factors that would affect nurses' attitudes towards spiritual care have not been investigated. Notwithstanding the known impact of certain intrinsic factors (e.g., personality-related) of mental health nurses on their coping strategies as well as their emotional and mental health, the link to their spiritual care attitudes has received little attention. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper is the first to identify the beneficial impacts of extrinsic factors including postgraduate education, working experience, participation in palliative care education programmes, and spiritual care experience on spiritual care attitudes among mental health nurses. Certain intrinsic factors, including those personality-related such as "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness," were also associated with higher awareness of providing spiritual care among mental health nurses. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The finding of an association of certain intrinsic factors with more positive attitudes towards spiritual care could encourage further studies to explore possible links between these factors and attitudes of spiritual care. Those less aware of the patients' spiritual needs may benefit through participating in relevant education and on-the-job training programmes that involves actual practice and collaboration in a multidisciplinary team. ABSTRACT: Introduction Although enhancing spiritual care can facilitate the communication of mental health nurses with patients diagnosed with mental illnesses, extrinsic and intrinsic factors that may influence their spiritual care attitudes remain unclear. Aim To conduct a questionnaire-based survey on mental health nurses from eight hospitals. Method A total of 239 psychiatric nurses were assessed based on (1) "big-five Mini-Markers" questionnaire and (2) spiritual care attitudes scale on three components (i.e., core values, growth, and nursing) to investigate the associations of spiritual care attitudes with social/occupational characteristics and personality. Results A positive attitude was significantly associated with working experience, higher educational level, previous participation in palliative care education programmes, spiritual care experience, and personality factors including "Extraversion," "Openness/Intellect," "Conscientiousness," and "Agreeableness." Discussion Despite demonstrating impacts of intrinsic factors (e.g., personality) on mental health nurses' spiritual care attitudes, other modifiable extrinsic factors (e.g., education) were important in enhancing their awareness towards spiritual care. Implications for Practice Our findings encourage further studies to explore possible links between intrinsic factors and attitudes of mental health nurses towards spiritual care as well as suggest benefits of continuing education and on-the-job training that involves actual practice and collaboration in a multidisciplinary team to provide spiritual care.

Needs for nurses to provide spiritual care and their associated influencing factors among elderly inpatients with stroke in China: A cross-sectional quantitative study

OBJECTIVES

To investigate the spiritual care needs and associated influencing factors among elderly inpatients with stroke, and to examine the correlations among spiritual care needs, spiritual well-being, self-perceived burden, self-transcendence, and social support.

METHODS

A cross-sectional quantitative design was implemented, and the STROBE Checklist was used as the foundation of the study. A convenience sample of 458 elderly inpatients with stroke was selected from three hospitals in China. The sociodemographic characteristics questionnaire, the Nurse Spiritual Therapeutics Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being, the Self-Perceived Burden Scale, the Chinese Self-Transcendence Scale, and the Perceived Social Support Scale were used. Descriptive statistics, correlation, Student's t-test, ANOVA, non-parametric, and multiple linear regression analyses were used to analyze the data.

RESULTS

The total score of spiritual care needs was 29.82 ± 7.65. Spiritual care needs were positively correlated with spiritual well-being (r = 0.709, p < 0.01), self-transcendence (r = 0.710, p < 0.01), and social support (r = 0.691, p < 0.01), whereas being negatively correlated with self-perceived burden (r = -0.587, p < 0.01). Religious beliefs, educational level, residence place, disease course, spiritual well-being, self-perceived burden, self-transcendence, and social support were found to be the main influencing factors.

SIGNIFICANCE OF RESULTS

The spiritual care needs were prevalent and moderate. It is suggested that nurses should enhance spiritual care knowledge and competence, take targeted spiritual care measures according to inpatients' individual personality traits or characteristics and differences of patients, reduce their self-perceived burden and improve their spiritual well-being, self-transcendence and social support in multiple ways and levels, so as to meet their spiritual care needs to the greatest extent and enhance their spiritual comfort.

Current Mental Health Clients’ Attitudes Regarding Religion and Spirituality in Treatment: A National Survey

Over the last several years, there has been a growing interest in clients’ views toward integrating their religion and spirituality (RS) into mental health treatment. However, most of these studies have been limited to small samples and specific populations, regions, and/or clinical issues. This article describes the first national survey of current mental health clients across the US regarding their attitudes towards integrating their RS in treatment using a revised version of the Religious/Spiritually Integrated Practice Assessment Scale-Client Attitudes, version 2 (RSIPAS-CAv2) with a sample of 989 clients. Our findings indicate mental health clients have overwhelmingly positive attitudes regarding integrating their RS into mental health treatment. Additionally, we explored what background characteristics predict clients’ attitudes toward this area of practice and found the top predictor was their intrinsic religiosity, followed by whether they had previously discussed RS with their current provider, age, gender, organized and non-organized religious activities, belief in God/Higher Power, and frequency of seeing their mental health provider. The reliability and validity of the RSIPAS-CAv2 was also explored and this scale is recommended for future use. Implications and recommendations for practice, research, and future training efforts are discussed.