Integration of Spirituality in Medical Education in Iran: A Qualitative Exploration of Requirements

Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study

AIM

This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease.

METHOD

The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds.

RESULTS

Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions.

CONCLUSION

The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Developing The Spiritual Health Curriculum Approach Based on Tyler's Model in Iran

Background: Spiritual health education is known as an important element in its implementation in the health system, which has different approaches to its implementation. Spiritual health has a positive effect on health, longevity, and recovery from physical ailments. Without spirituality education, education cannot function properly in biological, psychological, spiritual, and social dimensions or reach its maximum capacity. The present study aimed to develop the spiritual health curriculum approach based on Tyler's model in Iran between 2020 and 2021. Methods: In this qualitative study, by using a directed content analysis method and using validated curriculum models (Tyler's model), we developed a new spiritual health curriculum approach for Iranian society. This study was done between April 2021 and February 2022. Results: Because the spiritual health curriculum in Iran should be based on the philosophical and social principles of Iran, a new approach to spiritual health education based on Tyler's model was developed. Conclusion: Tyler's Iranian-Islamic model, which is suitable for our Iranian-Islamic culture and is valid for developing spirituality, was introduced.

Perceived professional competence in spiritual care and predictive role of spiritual intelligence in Iranian nursing students

AIM/OBJECTIVE

The aim of this study was to identify the relationship between perceived competence in spiritual care and spiritual intelligence among nursing students.

BACKGROUND

One of the most important duties of nurses is to pay attention to the spiritual needs of patients and provide them with proper spiritual care. Therefore, professional competence in this area is essential for nurses and nursing students. Also, spiritual intelligence is a factor influencing the caring behaviors of nurses.

DESIGN

A cross-sectional and correlational study SETTINGS/PARTICIPANTS: This study was included 510 undergraduate nursing students in two public faculties of nursing in Iran in the 2018-2019 academic year.

METHODS

The samples were selected using a census method. A demographic information questionnaire, the valid and reliable Iranian questionnaire of nurses' competencies in spiritual care and the spiritual intelligence self-report inventory (SISRI) were used to collect data.

RESULTS

A significant positive correlation was found between nursing students' competence in spiritual care and spiritual intelligence (p < 0.001, r = 0.26). No significant differences were found between the mean competence scores of spiritual care in terms of demographic characteristics. There were significant differences between the mean spiritual intelligence score in terms of age, marital status, history of clinical practice and academic year. The regression model indicated that for increased rates of spiritual intelligence, professional competence in spiritual care would rise as much as 0.39.

CONCLUSION

Spiritual intelligence can affect the competence of nursing students in providing spiritual care to patients. Therefore, to promote students' spiritual intelligence, appropriate plans with the aim of promoting the level of critical thinking and spiritual self-awareness are recommended.

Spirituality and effective factors in education: A qualitative study

BACKGROUND AND AIM

Spirituality in education, as a necessity in improving the quality of teaching and learning, is affected by various personal, social, religious, and cultural factors. Since the identification of these factors can empower the faculties and facilitate the transfer of spiritual concepts through teaching, the aim of this study is explanation of the factors affecting the spirituality transfer in education process.

MATERIALS AND METHODS

This qualitative content analysis approach study included 22 faculty members of medical universities, 25 faculty members of seminary, and 19 medical students interested in participating in the study. They were studied according to purposive sampling method. Data collection was done by interviewing a semi-structured questionnaire. Data were analyzed using conventional content analysis method.

RESULTS

The factors influencing the spiritual transfer in teaching process were classified into two main forms of teacher-related factors and peripheral-related factors. Teacher-related factors include the teacher's insight and worldview, adherence to religious principles, belief in ethical virtues, the positive and constructive interaction of the teacher with the student, and the mastery of teaching skills. The peripheral-related factors include the highly skilled classrooms and the talented learners.

CONCLUSION

The intensification of the insight, religious worldview and the basic of beliefs, consolidating ethics and empowering faculty members in teaching skills along with building a positive and constructive relationship with the students, as well as institutionalizing spirituality as the inseparable teaching element can facilitate the transfer of spirituality concepts. More studies are needed in this regard.

Formulating a Need-Based Faculty Development Model for Medical Schools in Indonesia

Background

The focus of medical schools in developing countries is on fulfilling a quantity of faculty members. A faculty development model will help formulate programmes that accommodate faculty members’ needs as well as institutional demands. This study aims to formulate a faculty development model relevant for medical schools in developing countries, specifically Indonesia.

Methods

This is a qualitative study with a phenomenological approach. It starts with a literature review using large databases, followed by interviews with 10 representative experts from medical schools in Indonesia.

Results

Based on the 10 studies retrieved, several components of faculty development were identified as the basis for the model. Ten experts gave input for the model. Components of the model can be grouped into: (i) content, which is materials that need to be delivered; (ii) process components, which depict aspects related to the preparation, execution and evaluation of sustainable faculty development; and (iii) components in the educational system that affect faculty development implementation.

Conclusion

A comprehensive review and development process has likely made this faculty development model suitable for medical schools in Indonesia. Breaking the model into components may help medical schools to prioritise certain aspects related to faculty development programmes.

A Survey on the Integration of Spiritual Care in Medical Schools from the German-Speaking Faculties

OBJECTIVE

Teaching about spirituality and health is recommended by the American Association of Medical Colleges and partially implemented in some US medical schools as well as in some faculties of other countries. We systematically surveyed Medical School Associate Deans for Student Affairs (ADSAs) in three German-speaking countries, assessing both projects on and attitudes towards Spiritual Care (SC) and the extent to which it is addressed in undergraduate (UME), graduate (GME), and continuing (CME) medical education (in this article, UME is understood as the complete basic medical education equivalent to college and Medical School. GME refers to the time of residency).

METHODS

We executed a cross-sectional qualitative complete online-survey, addressing ADSAs of all accredited 46 medical schools in these countries. Anonymized responses could be analyzed from 25 (54.3%).

RESULTS

No faculty provides a mandatory course exclusively dedicated to SC. Fourteen medical schools have UME courses or contents on SC, and 9 incorporate SC in mandatory classes addressing other topics. While most of the respondents indicate that spirituality is important for (a) the patients for coping and (b) for health care in general and thus, support the teaching of SC in UME, only half of them indicate a need for an SC curriculum in UME. Even if funding and training support were available, only a few of the respondents would agree to provide more of the sparse curricular time.

CONCLUSION

A majority of the participating medical schools have curricular content on SC, predominantly in UME. However, most of the content is based on voluntary courses. Despite acknowledging its importance to patients, ADSAs and medical teachers are still reflecting on the divergences in patients' and doctors' spiritual orientations and its consequences for implementing spirituality into the medical education.

Evaluation of Health-Care Providers' Perception of Spiritual Care and the Obstacles to Its Implementation

Objective:

Cancer patients face many health challenges, including spiritual issues. Therefore, an awareness of health-care providers’ perspective on spiritual care provision is important. This study aimed to determine health-care providers’ perception of spiritual care and to examine the individual barriers to its implementation in cancer patients.

Methods:

The present descriptive study included 136 physicians and nurses. The Spiritual Care Survey was used as a research tool. Data were analyzed through descriptive statistics using IBM SPSS Statistics for Windows, version 20.0.

Results:

In this study, 70.6% of the participants considered spiritual care to be influential in the patients’ quality of life. However, 64.7% had received no spiritual care training, while 82.4% indicated a willingness to attend these courses. Regarding the obstacles to providing spiritual care, the highest and lowest scores, respectively, belonged to the lack of time and the person's reluctance to talk about spiritual issues.

Conclusions:

Spiritual care has not yet found its proper place in the care setting of Iran, and health-care team members do not have sufficient training to provide this kind of care despite their belief in its positive impact on patients’ quality of life.

Who Can Provide Spiritual Counseling? A Qualitative Study from Iran

Background and Aim:

Given the increased prevalence of mental illnesses in recent years, many therapists and researchers use spiritual counseling (SC), which is one of the spiritual interventions. However, unfortunately, the use of this intervention by the therapists is nonscientific because the ambiguities of this issue are high in the mental health field of Iran. The aim of this study is to survey the following most important challenges: what groups are qualified to provide SC, what kind of knowledge should be known by suitable individuals, who can train spiritual counselors, what they should teach, and what teaching methods should be used.

Methods:

The present conventional qualitative content analysis used deep semi-structured interview to collect data from the view of stakeholders. A total of 15 people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Lundman model.

Results:

Results obtained from data analysis covered five main themes including SC candidates, general conditions, sciences required, SC curriculum, and spiritual counselors' training method.

Conclusions:

The present study has answered to the most basic questions in SC scope. Since spiritual services are rooted in our culture and religion, native guidelines should be created for them as soon as possible through conducting similar qualitative researches. Furthermore, it is worth considering teaching and training case in this scope to make spiritual service providers concern about solutions to promote these services.

Developing a Training Course for Spiritual Counselors in Health Care: Evidence from Iran

Background:

Spiritual health can cause mental health promotion and well-being of the people's lives but it is still neglected in practice so that there is no trace of spiritual training in medical education in Iran. This study was conducted to develop a training course for spiritual counselors in the Iranian health-care system.

Methods:

In this qualitative study, senior managers of the Ministry of Health (MOH) and experts in the related fields were purposively selected as the participants. Semi-structured interviews and focused group discussions (FGDs) were conducted to collect the data. After transcription of the interviews and FGDs, the data were analyzed using content analysis.

Results:

In this package, community-based spiritual health services are offered in three forms of spiritual lifestyle education, introducing social facilities, and collaborating with the related organizations. Hospital services are offered in four forms of assessment of the spiritual status and referral, spiritual care, spiritual counseling, and providing a spiritual environment in the hospital.

Conclusion:

According to the results of the study, it is suggested that a strategic committee be established at the MOH level for establishment of these training courses as well as another strategic committee for evaluation, review, and service package promotion, and its training courses should be formed. In addition, a set of skills for spiritual assessment of patients and the related interventions should be designed for clinical skill centers of the country in the form of skill training packages.

Content of Spiritual Counselling for Cancer Patients Undergoing Chemotherapy in Iran: A Qualitative Content Analysis

Background: Cancer is one of the leading causes of human death. Besides clinical treatment, cancer patients may need emotional and spiritual counselling to overcome their mental and morale problems. Such counselling sessions have been reported influential by many patients. We aimed to explore the structure of spiritual counselling sessions and their content as one of services provided to patients who experience chemotherapy in Iranian hospitals. Methods: Through a qualitative content analysis study, we recorded the discussions between a counsellor, who was a cleric as well, and cancer cases who were undergoing chemotherapy in a hospital in Tehran. The sessions were only recorded if the patient consented to attend at the study. All consideration were taken to avoid release of patients’ identity. The recorded discussions were transcribed verbatim and analyzed thematically after each session, until no new theme was emerged. Result: Twenty two sessions were held. The patients aged 53 years old on average. The content of discussions were analyzed along which 165 codes emerged. Four general themes or phases were recognized through counseling as (i) history-Taking (including demographic, disease-related and spiritual history and characteristics), (ii) general advice, (iii) spiritual-religious advice, and (iv) dealing with patients’ spiritual or religious ambiguities and paradoxes. Conclusion: Counselling of cancer patients needs special and in depth knowledge on spiritual and religious issues. The counsellor should be able to motivate patients, among whom many are disappointed, to follow the curative instructions well and stay hopeful about their treatment and life. Exploring and understanding what happens during a spiritual counselling session can counselling to the conformity and standardization of such interventions.

Elements of healthy death: a thematic analysis

Background: Death is a natural and frightening phenomenon, which is inevitable. Previous studies on death, which presented a negative and tedious image of this process, are now being revised and directed towards acceptable death and good death. One of the proposed terms about death and dying is "healthy death", which encourages dealing with death positively and leading a lively and happy life until the last moment. This study aimed to explain the views of Iranians about the elements of healthy death. Methods: This qualitative study was conducted for 12 months in two general hospitals in Tehran (capital of Iran), using the thematic analysis method. After conducting 23 in-depth interviews with 21 participants, transcription of content, and data immersion and analysis, themes, as the smallest meaningful units were extracted, encoded and classified. Results: One main category of healthy death with 10 subthemes, including dying at the right time, dying without hassle, dying without cost, dying without dependency and control, peaceful death, not having difficulty at dying, not dying alone and dying at home, inspired death, preplanned death, and presence of a clergyman or a priest, were extracted as the elements of healthy death from the perspective of the participants in this study. Conclusion: The study findings well explained the elements of healthy death. Paying attention to the conditions and factors causing healthy death by professionals and providing and facilitating quality services for patients in the end stage of life make it possible for patients to experience a healthy death.

Spirituality and spiritual care perspectives among baccalaureate nursing students in Saudi Arabia: A cross-sectional study

BACKGROUND

No study has been undertaken to understand how spirituality and spiritual care is perceived and implemented by Saudi nursing students undergoing training for their future professional roles as nurses.

OBJECTIVES

This study was conducted to investigate the perception of Baccalaureate nursing students toward spirituality and spiritual care.

DESIGN

A descriptive, cross-sectional design was employed.

SETTINGS AND PARTICIPANTS

A convenience sample of 338 baccalaureate nursing students in two government-run universities in Saudi Arabia was included in this study.

METHODS

A self-administered questionnaire, consisting of a demographic and spiritual care background information sheet and the Spiritual Care-Giving Scale Arabic version (SCGS-A), was used for data collection. A multivariate multiple regression analysis and multiple linear regression analyses were performed accordingly.

RESULTS

The mean value on the SCGS-A was 3.84±1.26. Spiritual perspective received the highest mean (4.14±1.45), followed by attribute for spiritual care (3.96±1.48), spiritual care attitude (3.81±1.47), defining spiritual care (3.71±1.51) and spiritual care values (3.57±1.47). Gender, academic level and learning spiritual care from classroom or clinical discussions showed a statistically significant multivariate effect on the five factors of SCGS-A.

CONCLUSIONS

Efforts should be done to formally integrate holistic concept including all the facets of spirituality and spiritual care in the nursing curriculum. The current findings can be used to inform the development and testing of holistic nursing conceptual framework in nursing education in Saudi Arabia and other Arab Muslim countries.

Spirituality Concept by Health Professionals in Iran: A Qualitative Study

Background. For years, researchers have sought to provide a clear definition of spirituality and its features and consequences, but the definitions provided of this concept still lack transparency. The present qualitative research was conducted to clarify this concept within the religious-cultural context of Iran. Materials and Methods. The present conventional qualitative content analysis was conducted with an inductive approach. Data were collected through semistructured interviews with 17 spiritual health experts and activists selected through purposive sampling. Results. Three themes emerged from the analysis of the data, including (1) the structure of spirituality, (2) defects in the conceptualization of spirituality, and (3) spirituality in practice, which are explained in this paper with their relevant subthemes and codes. The definition which this study proposes for this concept is that “spirituality is the sublime aspect of human existence bestowed on all humans in order for them to traverse the path of transcendence that is closeness to God (Allah).” Conclusion. The definition provided by this study is similar to the previous definitions of this concept in its main part (transcendence) and in incorporating a God-centered view of spirituality within the context of an Islamic society. This definition has implications for health services' education, research, and practice in similar societies.