Service user views of spiritual and pastoral care (chaplaincy) in NHS mental health services: a co-produced constructivist grounded theory investigation

Black African international nurses' experiences of pastoral support: A scoping review

Purpose

Overseas nurses are not new to the United Kingdom (UK), and neither is the concept of pastoral care. The immense contributions of international nurses are so obvious that it would be commonly assumed that there will be a strong literature base on pastoral care for these nurses. However, the opposite is very much the case. Pastoral support is crucial to the successful adaptation and integration of nurses who are recruited outside the United Kingdom to work within the NHS. To offer comprehensive fit-for-purpose support, the perspective of the nurses is important.

Objective

This scoping review aims to identify what is known about pastoral support for internationally educated nurses in the UK.

Methods

A scoping review method was used to review literature on pastoral support.

Results

Existing literature provided evidence on current practices, the challenges, and outcome criteria for successful pastoral support. It also provided evidence on how early pastoral support can fortify the nurses or deskill them. Finally, it revealed significant disparities in the support received by overseas nurses.

Conclusion

While the nurses' experience of the previous adaptation programme has been explored, evidence on the current pastoral care practices is mostly found in policy guidelines, trainers' reports, and opinion pieces. Since the inception of the NMC test of competence in 2014, the voice of the recipients of pastoral care is yet to be heard. This scoping review suggests that there is a difference in understanding of pastoral care practices. Therefore, the perspectives of specific groups such as Black African nurses should be explored on this issue.

Improving psychiatric nurses' competencies in spiritual care and integration of clients' religion/spirituality into mental healthcare: outcomes of an online spiritual care training program

BACKGROUND

Religion/spirituality (R/S), which is associated with individuals' well-being and psychological health, plays a significant role in most clients' lives in healthcare systems. Although clients in mental healthcare settings prefer their R/S to be employed in nursing care, R/S has neither been adequately integrated into mental healthcare nor discussed in the assessment and nursing interventions of mental healthcare. Evidence shows that most psychiatric nurses receive little or no training in spiritual care (SC) and are unable to integrate clients' R/S into mental healthcare. To address this gap, the present study aimed to investigate the effects of an online SC training program on psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare.

METHODS

This experimental study was conducted with nurses working in a psychiatric hospital affiliated with a large University of Medical Sciences in southeast Iran. Random sampling was performed and 95 nurses were assigned to the intervention (n = 50) and control (n = 45) groups. Online SC training was conducted for the intervention group in four sessions over four weeks. Data were collected using the Self-Assessment of Spiritual Care Competency and R/S Integrated Practice Assessment Scale before and one month after the training program.

RESULTS

There were no significant differences between the two groups before training (p > 0.05). After the training, nurses in the intervention group obtained significantly higher scores in competencies in SC and integration of clients' R/S into mental healthcare compared to the control group, with a considerable effect size (P < 0.05).

CONCLUSION

The online training program positively affected psychiatric nurses' competencies in SC and the integration of clients' R/S into mental healthcare. Since SC is a critical need for clients, specifically in mental healthcare settings, nurses must receive continuous education to provide SC to various clients.

Can mental healthcare for Muslim patients be person-centred without consideration of religious identity? A concurrent analysis

BACKGROUND

Muslims constitute the largest, fastest growing religious minority in the UK. Globally, nurses are legally, morally and ethically obliged to provide non-discriminatory, person-centred, culturally sensitive care. This obligation includes supporting people with their religious needs where appropriate, but there is evidence this is not always happening, particularly for Muslims in mental health care.

AIMS

This paper reviewed primary research to address the question: Can mental healthcare for Muslims be person-centred without consideration of religious identity?

METHODS

Narrative synthesis and concurrent analysis. Searches were conducted post 2000 in MEDLINE, CINAHL, SAGE, PsychINFO and ASA with terms: 'Muslim', 'Islam* ', 'mental health', 'nurs* ', 'person-cent* ', 'religio* '. Narrative data were analysed for commonalities and themes.

FINDINGS

Seven studies of sufficient quality were analysed. Unconscious religious bias was the overarching theme linking the findings that healthcare staff felt ill-prepared and lacked necessary knowledge and experience to work with diverse patient groups. Unconscious racial bias contributed to limited cultural/ religious competence in treatment and care.

CONCLUSION

Religious identity is core for Muslim patients, so this group may not be receiving the person-centred care they deserve. Nurses need cultural and religious competence to deliver person-centred, holistic care to diverse patient populations, yet the importance of religious practice can be overlooked by staff, with harmful consequences for patient's mental and spiritual welfare. This paper introduces a welcome pack that could help staff support the religious observance of those Muslim patients/service-users wishing to practice their faith during their stay in health services.

A Thematic Analysis of Dimensions of Spiritual Care

BACKGROUND

An overview of spiritual care studies can help reveal the dimensions of spiritual care and summarize the findings of available studies. Thus, we designed the present study based on existing studies to explain the dimensions of spiritual care.

MATERIALS AND METHODS

In this thematic analysis, we gathered the related articles published in Persian and English in the last 8 years (2013-2021) with the help of the keywords of Care, Support, Spirituality, Religion, Treatment, Hospice, and Palliative, and searching in electronic databases, including PubMed, Scopus, Web Of Sciences, Magiran, Islamic Science Citation (ISC), and Scientific Information Database (SID). We accurately studied 79 articles that met the inclusion criteria, and then the spiritual care components were extracted and coded, and finally, the codes were categorized as themes and sub-theme.

RESULTS

Thematic analysis of available studies revealed that the dimensions (theme) of spiritual care include: spiritual and religious assessment, developing a structure for providing spiritual care, establishing effective and supportive communication with the patient, training the patient, answering his questions, encouraging, maintaining, and improving social communications, encouraging the patient to live happily, helping the patient to achieve peace and calmness, supporting for spiritual rituals and activities, supporting and training the patient's family, and supporting the dying patient.

CONCLUSIONS

Spiritual care includes various and numerous dimensions. Considering the widespread dimensions of spiritual care, it seems necessary to design and plan appropriate studies to reveal other spiritual care dimensions from the perspective of patients and care providers in different cultures.

Conversations and Beyond: Religious/Spiritual Care Needs Among Clinical Mental Health Patients in the Netherlands

This study examines religious/spiritual (R/S) care needs and their possible determinants among mental health patients in the Netherlands. Patients in a Christian (CC, n = 100) and a secular (SC, n = 101) mental health clinic completed a questionnaire. Analysis revealed three factors on the R/S care needs measure: (1) "R/S conversations," (2) "R/S program and recovery," and (3) "R/S similar outlook on life." The presence of R/S care needs was predicted by the following: site (CC versus SC), R/S involvement, and religious strain. Most commonly, unmet R/S care needs were explanation about R/S and illness by the practitioner, prayer with a nurse, conversations about religious distress with a nurse, conversation when R/S conflicts with treatment, help in finding a congregation, and contact between chaplain and practitioner. "R/S similar outlook on life" was equally important to patients with and without R/S involvement. Patients appreciate a match in worldview with health professionals, either religious or secular.

The experiences of spirituality among adults with mental health difficulties: a qualitative systematic review

AIMS

Despite an increasing awareness of the importance of spirituality in mental health contexts, a 'religiosity gap' exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people's spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research.

METHODS

An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty-eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566).

RESULTS

A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC.

CONCLUSIONS

This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people's spiritual needs as part of an integrated holistic approach towards care.

Concepts, Practices and Advantages of Spirituality Among People with a Chronic Mental Illness in Melbourne

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia.

The barriers and facilitators in providing spiritual care for parents who have children suffering from cancer

Background:

Given the importance of spirituality in crisis situations including life-threatening diseases such as cancer, paying due attention to this aspect of care is of great importance. This study aims to investigate the barriers and facilitators in providing spiritual care for parents who have children suffering from cancer.

Methods:

This study was conducted using a qualitative approach and the common content analysis method. Fifteen people who participated in the study included 11 mothers and 4 fathers. A purposive sampling method was used. The environment for the research included the oncology and hematology departments of state children's hospitals around the country. Semi-structured interviews were conducted individually.

Results:

Analyzing the data yielded “crossing the rocky route” as the main category in barriers to spiritual care, which included the subcategories “spiritual escape,” “lack of supporting resources,” and “family influenceability.” In addition, “multiple support” was obtained as the main category in facilitators of spiritual care, which included the subcategories “emotional support,” “healthcare support,” “social support,” “spiritual support,” and “supporting the child.”

Conclusion:

The results of the study showed that spirituality plays an important role in helping parents deal with and adjust to their children's disease. Therefore, it is of great importance to pay due attention to the different aspects of spiritual care and enforce factors that can act as facilitators in this area and remove the barriers to spiritual care. This aim is attainable through educating the parents and medical staff.

Integrating spirituality into the care of older adults

ABSTRACTWe examine how to sensibly integrate spirituality into the care of older adult medical and psychiatric patients from a multi-cultural perspective. First, definitions of spirituality and spiritual integration are provided. Second, we examine the logic that justifies spiritual integration, including research that demonstrates an association between religious/spiritual (R/S) involvement and health in older adults and research that indicates widespread spiritual needs in later life and the consequences of addressing or ignoring them. Third, we describe how and when to integrate spirituality into the care of older adults, i.e. taking a spiritual history to identify spiritual needs and then mobilizing resources to meet those needs. Fourth, we examine the consequences of integrating spirituality on the well-being of patients and on the doctor-patient relationship. Finally, we describe boundaries in addressing R/S issues that clinicians should be cautious about violating. Resources will be provided to assist with all of the above.

Patient Reported Outcomes of Pastoral Care in a Hospital Setting

This study aimed to establish whether Pastoral Care (PC) visits were an effective component of a hospitalized patient's overall health experience. Outcomes of PC visits were reported by 369 patients in 7 sites across Australia. The patient reported outcomes of PC visits included: the patients felt they could be honest with themselves, with a sense of peace, a better perspective of their illness, less anxiety, and felt more in control. Five factors of the PC visit significantly related to higher patient's overall outcomes: (a) having more Pastoral Care visits (p < 0.5 0 R 0.778, CI 0.17-1.38); (b) the patient was able to talk about what was on their mind (p < 0.01, OR1.48, CI 0.58-2.37); (c) they had something to be hopeful about (p < 0.01 OR1.18, CI 0.51-1.85); 4); the visit focused on decisions about the patient's health care (p < 0.05, OR0.70, CI 0.05-1.35); and (d) a belief in God/Higher Being (p < 0.01, OR 1.01, CI 0.43-1.71).

Psychological Limbo as a Barrier to Spiritual Care for Parents of Children with Cancer: A Qualitative Study

Background:

Pediatric cancer causes reduced life quality and psychological problems for parents. It is necessary to pay attention to spirituality, which plays a significant role in increasing the life quality of these parents and their patient children and managing the conditions associated with the disease. This study was performed to determine factors predisposing to spiritual care in parents of children suffering from cancer.

Methods:

This qualitative study was conducted by conventional content analysis. Fifteen parents of children with cancer hospitalized in the oncology and hematology wards of governmental hospitals in Iran were selected using a purposive sampling method and underwent semi-structured deep interviews from 2015.1.10 until 2017.3.10.

Results:

On data analysis, 12 subcategories emerged leading to extraction of three : “projection”, “mental concern”, and “psychological pains”. The final result was a focus on the theme “psychological limbo”.

Conclusion:

Our findings showed that cancer induces psychological problems in parents, which may serve as factors that drive them towards spiritual affairs. Hence, attention should be paid to predisposing factors of spiritual care to facilitate tranquility and an ability to adapt to their circumstances in affected parents.