The influence of spirituality and religion on critical care nursing: An integrative review

Caregiver burden, religious coping, and spiritual well-being among caregivers of elderly stroke patients and predictors affecting spiritual well-being

BACKGROUND

Stroke is a disease that affects the arteries leading to and within the brain. Stroke usually creates a range of disabilities such as physical deficits and difficulty in performing daily activities. These long-term needs and the continuous caregiving sequence affect the care burden and spiritual well-being of caregivers.

METHOD

The correlational study population consisted of caregivers of stroke older patients (N = 100). Burden Interview Scale, Spiritual Well-Being Scale and Religious Coping Scale were used. Descriptive analyses, independent sample t-test, one-way analysis of variance, correlation, regression analyses were used to evaluate the data.

RESULTS

The mean age of caregivers was 48.38 ± 13.52 years. The score of Burden Interview Scale was 31.41 ± 15.13 (light/moderate), Negative Religious Coping was 7.39 ± 3.17 (moderate), Positive Religious Coping was 24.30 ± 4.34 (high), and Spiritual Well-Being was 21.65 ± 6.73 (low). There is a significant relationship between Burden Interview and Negative Religious Coping (r = 0.274; P = 0.006), Burden Interview and spiritual well-being (r = -0.563; P = 0.000), and spiritual well-being and positive religious coping (r = 0.228; P = 0.026). The predictors that affect the spiritual well-being of caregivers were found to be Burden Interview (β = -0.571) and Positive Religious Coping (β = 0.181) (P < 0.05).

CONCLUSION

Nurses play an important role in increasing the spiritual well-being levels and religious coping behaviours of caregivers. Nurses should communicate empathically with caregivers, understand their feelings, and provide emotional support.

[Spiritual care competences of healthcare workers in emergency and intensive care-a prospective questionnaire study]

BACKGROUND

In intensive and emergency care, patients and their relatives are confronted with potentially existential crises. Spiritual care can be an additional resource to address related psychosocial and physical symptoms and to support patients and their relatives. Accordingly, healthcare workers need spiritual skills to recognize and respond to these needs.

OBJECTIVES

What spiritual competencies do healthcare workers in intensive and emergency care have? Are there differences between professions and genders? What factors influence spiritual competencies?

MATERIALS AND METHODS

The prospective questionnaire study included physicians participating in intensive care and emergency medicine courses and nurses who were training or working in intensive and emergency care. Self-reported spiritual competencies were assessed using the Spiritual Care Competence Questionnaire (SCCQ), which captures the following areas: perceptual competence, team-spirit, documentation competence, self-awareness and proactive opening, knowledge about other religions, competence in conversation techniques and proactive empowerment-competence.

RESULTS

We included 465 physicians (50% female, years in profession: mean = 4.0, standard deviation [SD] = 3.5) and 86 nurses (80% female, years in profession: mean = 12.7, SD = 10.7). The average SCC was 2.3 (SD 0.4) out of a maximum of 4 points, with higher spiritual competences among spiritual and religious respondents. There were differences in specific competencies between the professions and genders. Women indicated a higher level of competence in the area of perception and conversation skills, physicians in documentation skills.

CONCLUSIONS

Overall, there is a clear need to train healthcare staff in the field of intensive care and emergency medicine.

Profiles of Geriatric Syndromes and Resources in Older Patients with Atrial Fibrillation

Objective: Older patients with nonvalvular atrial fibrillation (AF) are at high risk for frailty and geriatric syndromes (GSs), which modulate their individual prognosis and are therefore relevant for further management. Because few studies have evaluated the geriatric profile of older AF patients, this secondary analysis aims to further characterize the patterns of GSs and geriatric resources (GRs) in AF patients and their association with anticoagulation use. Methods: Data from 362 hospitalized patients aged 65 years and older with AF (n = 181, 77.8 ± 5.8 years, 38% female) and without AF (non-AF [NAF]; n = 181, 77.5 ± 5.9 years, 40% female) admitted to an internal medicine and nephrology ward of a large university hospital in Germany were included. All patients underwent usual care plus a comprehensive geriatric assessment (CGA) including calculation of the Multidimensional Prognostic Index (MPI) and collection of 17 GSs and 10 GRs. Patients were followed up by telephone 6 and 12 months after discharge to collect data on their health status. Results: The mean MPI score of 0.47 indicated an average risk of poor outcome, and patients with AF had a significantly higher MPI than those without AF (p = 0.040). After adjustment for chronological age, biological sex, Cumulative Illness Rating Scale (CIRS) for relevant chronic diagnoses and MPI as a proxy for biological age, AF patients had significantly more mnestic resources (63.5% vs. 33.1%, p < 0.001), a tendency for less age-appropriate living conditions (56.4% vs. 72.9%, p = 0.051) and more sensory impairment (78.5% vs. 52.5%, p < 0.001) than NAF patients. They also had a higher number of GSs (p = 0.046). AF patients on oral anticoagulants (OACs, n = 91) had less age-appropriate living conditions (48.4% vs. 64.4%, p < 0.05) and mnestic resources (36.3% vs. 54.4%, p < 0.01), but more emotional resources (80.2% vs. 65.6%, p < 0.05) and chronic pain (56% vs. 40%, p < 0.05) than patients without OACs (n = 90). Overall, mortality at 1 year was increased in patients with a higher MPI (p < 0.009, adjusted for age, sex and CIRS), with a diagnosis of AF (p = 0.007, adjusted for age, sex, CIRS and MPI), with of male sex (p = 0.008, adjusted for age, CIRS and MPI) and those with AF and treated with hemodialysis (p = 0.022, compared to AF patients without dialysis treatment). Conclusions: Patients with AF and patients with AF and OACs show differences in their multidimensional frailty degree as well as GR and GS profiles compared to patients without AF or with AF not treated with OACs. Mortality after 1 year is increased in AF patients with a higher MPI and dialysis, independently from OAC use and overall burden of chronic disease as assessed per CIRS. GRs and GSs, especially age-appropriate living conditions, emotional resources, sensory impairment and chronic pain, can be considered as factors that may modify the individual impact of frailty, underscoring the relevance of these parameters in the management of older patients.

Spirituality and Influencing Factors in Parkinson's Disease: A Scoping Review

Although the effect of spirituality in chronic disease has been discussed in recent years, little is known about spirituality and spiritual beliefs in Parkinson's disease. In this scoping review, the databases PubMed, Scopus and Web of Science were searched and initially identified 914 studies. A total of nine studies satisfied the inclusion criteria. It was found age, gender, education level, emotional changes, region of onset of Parkinson's disease, severity of symptoms, quality of life, religion affiliation and acceptance of Parkinson's disease influence spirituality in people with Parkinson's disease. In this context, future studies should focus on the relationship between Parkinson's disease and spirituality.

Bridging Communication Gaps: A Study on Effective Patient Communication Among Respiratory Therapy Students and Interns

Introduction Effective communication in healthcare plays a pivotal role, significantly impacting patient experiences and outcomes. While much of the current literature focuses on communication dynamics among physicians and nurses, a gap exists in understanding these dynamics within allied health professions such as respiratory therapy. This study explores the knowledge, attitudes, and awareness of patient communication among respiratory therapy students and interns. Methods This descriptive cross-sectional study investigated the knowledge, attitudes, and awareness of effective communication methods with patients among respiratory therapy students and interns in Jeddah, Saudi Arabia. Using a validated self-administered questionnaire, the study surveyed 350 individuals from three universities and associated hospitals. Results The analysis involved 350 participants, with females comprising 55.1%. The study found that the highest level of agreement (mean 4.6±0.62) was regarding essential knowledge related to introducing respiratory therapists to patients during communication. Female students demonstrated significant proficiency in concluding patient interviews (P=0.033), while male students excelled in comprehending communication methods with unconscious patients (P=0.010). Interns exhibited the most comprehensive understanding of patient communication skills, particularly in employing open-ended questions (P=0.009) and allowing adequate time for patients to express their concerns (P=0.020). Gender and academic progression were identified as factors influencing patient communication skills in respiratory therapy students and interns. Conclusion This study highlights the need for tailored communication training for respiratory therapy students and interns. It emphasizes the importance of enhancing proficiency in this vital field by addressing knowledge gaps and identifying areas for improvement.

The paradoxical position of nurses regarding euthanasia and its legalisation: A descriptive quantitative study

AIMS AND OBJECTIVES

To learn about the attitudes of nurses working in the Andalusian Public Health System regarding euthanasia and its legalisation.

BACKGROUND

Euthanasia often finds itself in the crosshairs of ethical and political debate on an international scale. Currently, the Spanish Organic Law 3/2021 of 24 March, 2021, recognises euthanasia as a fundamental right in Spain. It is of particular interest to know about the views, attitudes and stances that Andalusian nurses have of euthanasia as they are key players within the framework of euthanasia and administration of life-ending drugs. They play a central role in guiding patients through the euthanasia application process.

DESIGN

Observational descriptive study.

METHODS

A study of Andalusian Public Health System nurses was carried out using non-probability convenience sampling. 518 nurses with an average age of 44.75 years answered in a questionnaire that was distributed on an online platform. Socio-demographic and occupational variables were assessed, together with the Death Anxiety Scale and the Euthanasia Attitude Scale. A bivariate analysis and a multivariate linear regression model were performed. The STROBE checklist was used.

RESULTS

The mean score obtained on the Euthanasia Attitude Scale was 75.95 (SD = 16.53). The mean score obtained on the Death Anxiety Scale was 7.56 (SD = 3.05). The variables age and work experience were negatively correlated with the total scores of the Euthanasia Attitude Scale and the categories 'Ethical considerations', 'Practical considerations' and 'Treasuring life'. On the other hand, there was a significant positive correlation between age and work experience and 'Spiritual beliefs' category.

CONCLUSIONS

The current situation shows a worrying paradox. There is a stark difference between positive professional attitudes towards euthanasia and the desire to participate in its application.

RELEVANCE TO CLINICAL PRACTICE

It is vital that educational and healthcare institutions make the necessary efforts to ensure that nurses develop sound moral judgement, displaying the moral conscience and ethical commitment required of this established profession.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The Knowledge, Practices, and Perceptions of Surgical Nurses Concerning Spirituality and Spiritual Care

PURPOSE

The purpose of this descriptive study was to describe the knowledge, practices and perceptions of nurses concerning spirituality and spiritual care.

DESIGN

A descriptive study.

METHODS

The study was performed with 142 surgical nurses working in three public hospitals in a city in Turkey. A "Personal Information Form" and the "Spirituality and Spiritual Care Grading Scale" were used for data collection. The data were analysed on SPSS 25.0 software.

FINDINGS

While 77.5% of the nurses reported having heard about the concepts of spirituality and spiritual care, 17.6% reported having received instruction concerning spirituality and spiritual care during their initial nursing education and 19.0% after graduation. In addition, 78.2% provided spiritual care in the clinics where they worked, 40.5% reported that patients were given religious support and 37.8% stated that patients were given the opportunity to be involved in their own care. The nurses' total mean spirituality and spiritual care grading scale score was 57.6±5.6. A statistically significant difference was determined in mean scale scores between nurses who had and had not heard about the concepts of spirituality and spiritual care (P=0.049) and between those who practiced and did not practice spiritual care in the clinics where they worked (P=0.018).

CONCLUSIONS

The majority of surgical nurses had heard about the concepts of spirituality and spiritual care but had not been exposed to them during their initial nursing education. However, the majority practiced spiritual care in their clinics, and their perception levels were above average.

Nursing professionals' education on the spiritual dimension of critical patients

OBJECTIVE

To describe and analyze the nursing professionals' education on the spiritual dimension of critically ill patients.

METHODOLOGY

A qualitative, descriptive, exploratory study, using the Thematic Oral History as a framework. Fourteen nursing professionals from a teachinghospital in the city of São Paulo participated in the study from March to April 2021. The professionals were interviewed by following a script of questions and their speeches were transcribed, transcreated and submitted to Bardin's content analysis, in the thematic modality.

RESULTS

Three categories emerged from the analysis of the narratives: Concept of spirituality; Spirituality in Nursing education and Spirituality in the intensive care unit.

CONCLUSION

Nursing practice in assisting critical patients' spiritual dimension is based on their religious practices and professional experiences, because the theme is not part of the basic curriculum in nursing education, whether at a technical or at an academic level.

Spiritual needs during COVID 19 pandemic in the perceptions of Spanish emergency critical care health professionals

OBJECTIVES

To investigate the perceptions and attitudes of health professionals working in emergency services and critical care units in Spain about spiritual care provided during the COVID-19 pandemic.

METHODS

A qualitative investigation was carried out using in-depth interviews.

SETTING

Emergency and emergency and ICU health professionals from different regions of Spain.

FINDINGS

The sample consisted of 47 nursing and one nursing assistant. The qualitative analysis yielded four main themes that reflect the following categories: "the experience with spirituality in clinical practice"; "resources and barriers to provide spiritual care"; "the COVID pandemic and spiritual care" and "training in spiritual care". In addition, two subdeliveries were also obtained: "ethical dilemma" and "rituals of death".

CONCLUSIONS

The majority of emergency and critical care nurses believe spiritual care is important to their clinical practice, but there are still several barriers to address patients' spiritual needs. During the COVID-19 pandemic in Spain, professionals felt that spiritual beliefs have emerged as important needs of patients and the restrictions imposed by the pandemic made health professionals more exposed to ethical dilemmas and end-of-life religious issues. The general impression of health professionals is that more training and resources are needed on this topic.

IMPLICATIONS FOR CLINICAL PRACTICE

Health professionals in emergency intensive care must provide nursing care that meets the spiritual needs of their patients to improve care in crisis situations such as the one suffered by the COVID-19 pandemic. For this, emergency services professionals must work and participate in the development of measures to overcome certain barriers present in emergency services, such as lack of time, lack of training and misconceptions that make it difficult to approach emergency services these needs.

Coping strategies adopted by frontline nurses in dealing with COVID-19 patients in a developing country during the pandemic: A qualitative study

AIM

This study aimed to explore the coping strategies adopted by frontline nurses in dealing with COVID-19 patients during the pandemic in Bangladesh.

DESIGN

A qualitative descriptive study.

METHODS

Purposive sampling was used to recruit seventeen frontline nurses from three COVID-19-specific hospitals in Dhaka City. In-depth online interviews and semi-structured questionnaires were used to collect data through the Google Meet platform. Interview sessions audio-video were recorded, interpreted, analysed, verbatim transcribed and quotes of the participants were verified by member checking. Thematic analysis was used in this research. The study's reporting guidelines were based on the consolidated criteria for reporting qualitative research.

RESULTS

Seven themes were identified after careful data analysis: (i) A positive attitude in dealing with challenging situation, (ii) Intimate partner's influence, (iii) Self-emotional regulation, (iv) The tendency to avoid negativity, (v) Motivated by professional obligations, (vi) Religious influence, (vii) Recreational activities.

NO PATIENT OR PUBLIC CONTRIBUTION

This study explored various coping strategies employed by frontline nurses in caring for COVID-19 patients. No patient or public contribution was investigated.

The effects of spiritual care intervention on spiritual well-being, loneliness, hope and life satisfaction of intensive care unit patients

BACKGROUND

The intensive care unit is a place where patients try to cope with pain and question the meaning and purpose of life and spiritual needs emerge.

OBJECTIVE

The present study was conducted to examine the effects of spiritual care interventions on the spiritual well-being, loneliness, hope, and life satisfaction of patients treated in intensive care.

RESEARCH METHODOLOGY

The study was conducted in an intensive care unit as an interventional study with a randomized pre-test, post-test, and control group between September and December 2021. A total of 64 patients, 32 in the intervention group and 32 in the control group, were included in the sample. The patients in the intervention group received eight sessions (twice a week) of spiritual nursing interventions according to the Traditions-Reconciliation-Understandings-Searching-Teachers model in the intensive care unit, while the control group received routine nursing care.

RESULTS

The mean age of the participants was 63.53 ± 4.10 years in the intervention group and 63.37 ± 3.18 years in the control group. Most of the participants in both the intervention (59.4 %) and control (68.7 %) groups were female. Following the intervention, the findings showed that the intervention had positive effects on patients' spiritual well-being (t = -10.382), loneliness (t = 13.635), hope (t = -10.440), and life satisfaction (t = -10.480) levels (p < 0.001).

CONCLUSIONS

It was found that the spiritual care provided in the intensive care unit positively affected patients' spiritual well-being, hope, loneliness, and life satisfaction levels. It can be recommended that nurses working in intensive care develop a spiritually supportive environment by addressing the spiritual issues of patients and their relatives and using existing spiritual care services.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care nurses should provide an environment and nursing care that meet their patients' spiritual needs. Spiritual care can be given to improve spiritual well-being, hope, and life satisfaction levels and to alleviate loneliness in intensive care patients.

Effect of sterile ice water versus menthol spray on thirst symptoms of fasted children in the intensive care unit: A prospective cohort study

BACKGROUND

Thirst is a very common symptom in fasted children in intensive care unit (ICU). This study aimed to evaluate the effect of sterile ice water versus menthol spray in ICU fasted children, to provide insights to the clinical care of fasted children.

METHODS

The children admitted to the ICU of our hospital from June 1, 2021 to August 31, 2022 and needed to fast were included. Children were randomly assigned to the ice water group or menthol group. We evaluated and compared the thirst distress scale (TDS), oral mucosa wetness scale (OMWS), children medical fear scale (CMFS), numerical rating scale (NRS), unstimulated whole saliva (UWS) flow rate between 2 groups.

RESULTS

A total of 139 children were included, involving 69 children in ice water group and 70 children in menthol group. There were no significant differences in the baseline characteristics, TDS, OMWS, OMWS, CMFS, and NRS score, UWS flow rate before intervention between ice water group and menthol group (all P > .05). After intervention, the TDS, OMWS, NRS score of menthol group was statistically less than that of ice water group (all P < .05), the UWS flow rate of menthol group was statistically higher than that of ice water group (P = .034).

CONCLUSIONS

Compared with ice water spray, menthol spray may be more beneficial to relieve the thirst and increase the comfort in ICU fasted children. Future studies with larger sample size and rigorous design are needed to evaluate the effects and safety of ice water and menthol spray in the nursing care of children.

Frequency of nurse-provided spiritual care: An international comparison

AIMS AND OBJECTIVES

To compare the frequency of nurse-provided spiritual care across diverse cultures.

BACKGROUND

Given an ethical imperative to respect patient spirituality and religiosity, nurses are increasingly taught and expected to provide spiritual care. Although nurses report positive attitudes toward spiritual care, they typically self-report providing it infrequently. Evidence about the reported frequency of spiritual care is constrained by substantial variation in its measurement.

DESIGN

This cross-sectional, descriptive study involved secondary analysis of data collected in multiple sites globally using one quantitative instrument.

METHODS

Data were collected from practicing nurses using the Nurse Spiritual Care Therapeutics Scale and analysed using descriptive statistics and a meta-analysis procedure with random-effect modelling. Datasets from 16 studies completed in Indonesia, Iran, Malaysia, Philippines, Portugal, Taiwan, Turkey and the United States contributed to a pooled sample (n = 4062). STROBE guidelines for cross-sectional observational studies were observed.

RESULTS

Spiritual care varied between countries and within countries. It was slightly more frequent within Islamic cultures compared with predominantly Christian cultures. Likewise, frequency of spiritual care differed between nurses in palliative care, predominantly hospital/inpatient settings, and skilled nursing homes. Overall, "Remaining present…" was the most frequent therapeutic, whereas documenting spiritual care and making arrangements for the patient's clergy or a chaplain to visit were among the most infrequent therapeutics.

CONCLUSIONS

In widely varying degrees of frequency, nurses around the world provide care that is cognisant of the spiritual and religious responses to living with health challenges. Future research should be designed to adjust for the multiple factors that may contribute to nurses providing spiritual care.

RELEVANCE TO CLINICAL PRACTICE

Findings offer a benchmark and begin to inform nurse leaders about what may be normative in practice. They also encourage nurses providing direct patient care that they are not alone and inform educators about what instruction future nurses require.

Spirituality in a Doctor's Practice: What Are the Issues?

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.