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Ford JA, Dahlin C. Cultural Advocacy for Indigenous Individuals With Serious Illness. Am J Hosp Palliat Care 2024; 41:1482-1490. [PMID: 38305722 DOI: 10.1177/10499091231224794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Indigenous American (I.A.) individuals with serious illness and their families have unmet needs. Often, this group is viewed as a minority within a minority. Numerous health challenges exist within the I.A. populations resulting in dire health care situations. Historical trauma and mistrust of the healthcare system impacts access to quality palliative care by this marginalized population. Given the range of social, spiritual, and cultural issues, the interprofessional team needs increased knowledge specific to the I.A. population to ensure holistic, culturally sensitive care. Utilizing a case study, this article reviews of the needs of I.A. individuals with serious illness and essential skills. The aim is empower palliative care clinicians the knowledge to provide culturally sensitive and congruent care to I.A. individuals with serious illness and their community.
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Affiliation(s)
- Jeanna A Ford
- Department of Internal Medicine, University of New Mexico Health System, Albuquerque, NM, USA
| | - Constance Dahlin
- Palliative Care Service, Mass General Brigham - Salem Hospital, Salem, MA, USA
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Peralta D, Nanduri N, Bansal S, Rent S, Brandon D, Pollak KI, Lemmon ME. Discussion of Spirituality in Family Conferences of Infants with Neurologic Conditions. J Pain Symptom Manage 2024:S0885-3924(24)01039-X. [PMID: 39326468 DOI: 10.1016/j.jpainsymman.2024.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Spirituality serves as a mechanism to understand and cope with serious illness, yet little is known about how families and clinicians incorporate spirituality in pediatric family conferences. OBJECTIVES We sought to characterize the frequency and nature of spiritual statements in conferences between families and clinicians caring for infants with neurologic conditions. METHODS In this descriptive qualitative study, we used an existing dataset of audio-recorded, de-identified, transcribed family conferences of infants with neurologic conditions. Inclusion criteria for infants were 1) age < 1 year, 2) presence of a neurologic condition, and 3) planned conversation about neurologic prognosis or goals of care. We used a content analysis approach to code the data. RESULTS 68 family conferences were held for 24 infants and 36 parents. Most parents (n=32/36, 89%) self-identified as spiritual. References to spirituality occurred in the 32% of conferences (n=22/68). Spiritual discussion included 3 domains: 1) Spiritual beliefs and practices, 2) Spiritual support, and 3) Parent-child connection as sacred. Clinicians' responses to family member spiritual statements were inconsistent and included providing affirmation, exploring goals of care, and continuing discussion of clinical information. CONCLUSIONS Spirituality was discussed in approximately one-third of family conferences. Clinician engagement with spirituality discussion was variable. These findings highlight a need for training on when and how to discuss spirituality in conversations with families of seriously ill infants.
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Affiliation(s)
- Dana Peralta
- Department of Pediatrics, Duke University School of Medicine, Durham, NC.
| | | | - Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Global Health Institute, Duke University, Durham, NC
| | - Debra Brandon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke University School of Nursing, Durham, NC
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC; Cancer Prevention and Control, Duke Cancer Institute, Durham, NC
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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3
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Schutz REC, Creutzfeldt CJ. Palliative care after stroke survival. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:3-11. [PMID: 36599514 DOI: 10.1016/b978-0-12-824535-4.00003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Stroke is a leading cause of both death and disability worldwide. While most research has focused on the first hours to days after acute stroke, much less is known about the experience of patients and their families living after a stroke. Stroke survivors have a high burden of physical and psychological symptoms such as pain, fatigue, and depression that are often not addressed in the postacute setting. Similarly, goals-of-care conversations that may have started during the acute hospitalization are often not followed up later. This chapter outlines the prevalence and management of common poststroke symptoms, approaches to postacute goals-of-care conversations, family needs after stroke, and provides an overview of stroke-specific hospice and end-of-life care aspects. We emphasize the need for research in each of these areas.
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Affiliation(s)
- Rachael E C Schutz
- Department of Neurology, University of Washington, Seattle, WA, United States
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Coyne HL, Arp R, Kumar LT, Smith GT, Mims L. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Pentecostal Patients. J Palliat Med 2022; 26:559-563. [PMID: 36327106 DOI: 10.1089/jpm.2022.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
People of the Pentecostal faith are a grouping of Protestant Christians. Pentecostals are a growing group not only in the United States, but also worldwide. This article focuses on the Pentecostal beliefs and spiritual practices in North America and their implications in the clinical environment. As the population of this faith group continues to grow, palliative care clinicians will need a basic understanding of the values and practices of Pentecostal spirituality and its potential impact on goals-of-care discussions. This article offers 10 recommendations for clinicians to better understand and support Pentecostal patients and families. These overarching concepts of Pentecostal faith and practices are presented as a point of initiation for further exploration of the support that may be needed, and not as a comprehensive guide.
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Affiliation(s)
- Hannah L. Coyne
- Palliative Care Department, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rob Arp
- Pastoral Care Department, Roper St. Francis Healthcare, Charleston, South Carolina, USA
| | - Lephen T. Kumar
- International Pastor, Refuge Church, Walterboro, South Carolina, USA
| | - Gordon T. Smith
- President, Ambrose University and Seminary, Calgary, Alberta, Canada
| | - Lauren Mims
- Department of Internal Medicine-Palliative Care Department, Medical University of South Carolina, Charleston, South Carolina, USA
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Woodrell CD, Patel AA, Wilder JM, Sundaram V, Chung RT, Ufere NN. Cultural humility and end-of-life communication with people with advanced liver disease. Clin Liver Dis (Hoboken) 2022; 20:81-85. [PMID: 36187374 PMCID: PMC9512448 DOI: 10.1002/cld.1225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Christopher D. Woodrell
- Brookdale Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Geriatric Research, Education and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA
| | - Arpan A. Patel
- Vatche and Tamar Manoukian Division of Digestive DiseasesDepartment of MedicineDavid Geffen School of Medicine at University of California Los AngelesLos AngelesCaliforniaUSA
- Veterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Julius M. Wilder
- Division of GastroenterologyDepartment of MedicineDuke UniversityDurhamNorth CarolinaUSA
| | - Vinay Sundaram
- Karsh Division of Gastroenterology and Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Raymond T. Chung
- Liver Center, Gastrointestinal DivisionMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nneka N. Ufere
- Liver Center, Gastrointestinal DivisionMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Byrne-Martelli S, Rosenberg LB. Communication Strategies When Patients Utilize Spiritual Language to Hope for a Miracle #433. J Palliat Med 2022; 25:506-507. [PMID: 35230904 DOI: 10.1089/jpm.2021.0553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Background: Racial and ethnic disparities in end-of-life healthcare can be reduced by showing physicians how to best respond to a documented underlying cause: African American families’ hopes for a miracle via divine intervention influence their end-of-life medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Autoethnographic research probing the author’s Spiritual Care experience in this context yields a nuanced, 90-second point-of-care spiritual intervention physicians can use to address the religious aspect of African American families who base end-of-life medical decisions on their hopes for a miracle via divine intervention. Autoethnographic analysis is framed by physician-author, Dr. Jessica Zitter’s documented journey of grappling with this context. The evolution of Dr. Zitter’s responses to miracle-hoping African American families provides a framework for applying autoethnographic analysis to a critical appropriation of the Johns Hopkins “AMEN” communication protocol for families hoping for a miracle. Results: The common instinct of white physicians to remain neutral, holding miracle-hoping African American families at arm’s length, rather than supportively engaging their hopes, is shown to be an intellectual ruse for emotional avoidance. A novel, counterintuitive spiritual intervention for the religious aspect of miracle-hoping African American families is integrated into an existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of African American families hoping for a miracle may help physicians to increase their therapeutic connection with families, decrease their own stress/burnout levels, and eliminate racial and ethnic disparities in end-of-life healthcare.
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Bril E, Khasina A, Zimnyakova O, Fedorova N. Communication with a neurological patient. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:36-42. [DOI: 10.17116/jnevro202212202136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kestenbaum A, Fitchett G, Galchutt P, Labuschagne D, Varner-Perez SE, Torke AM, Kamal AH. Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness. J Palliat Med 2021; 25:312-318. [PMID: 34871044 DOI: 10.1089/jpm.2021.0522] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Assessment of spiritual suffering and provision of spiritual care are a central component of palliative care (PC). Unfortunately, many PC clinicians, like most medical providers, have received limited or superficial training in spirituality and spiritual distress. This article, written by a group of spiritual care providers, and other PC and hospice clinicians, offers a more in-depth look at religion and spirituality to help to enhance readers' current skills while offering a practical roadmap for screening for spiritual distress and an overview of partnering with colleagues to ensure patients receive values-aligned spiritual care provision.
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Affiliation(s)
- Allison Kestenbaum
- Spiritual Care Services, UC San Diego Health, San Diego, California, USA
| | - George Fitchett
- Department of Religion, Health & Human Values, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul Galchutt
- Spiritual Health Services, M Health Fairview, Minneapolis, Minnesota, USA
| | - Dirk Labuschagne
- Supportive Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Shelley E Varner-Perez
- Indiana University (IU) Health, Indianapolis, Indiana, USA.,IU Center for Aging Research, Regenstrief Institute, Inc., Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
| | - Alexia M Torke
- Indiana University School of Medicine, Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA
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10
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Abstract
Many childhood neurologic conditions are first diagnosed in the perinatal period and shorten or seriously alter the lives of affected infants. Neonatal neuropalliative care incorporates core practices and teachings of both neurology and palliative care and is directed toward patients and families affected by serious neurologic conditions in the antenatal and immediate newborn period. This review outlines key considerations for neurologists hoping to provide a neuropalliative care approach antenatally, in the neonatal intensive care unit, and around hospital discharge. We explore 4 core domains of neuropalliative care: (1) family-centered communication, (2) prognostication, (3) decision making, and (4) pain and symptom management. We address special considerations in care at the end of life and in varied cultural and practice contexts.
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Affiliation(s)
- Sharla Rent
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Margaret H. Bost
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Chi Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Monica E. Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Smith WR, Audi R. Religious Accommodation in Bioethics and the Practice of Medicine. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2021; 46:188-218. [PMID: 33822131 DOI: 10.1093/jmp/jhaa038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical research, and treatment of patients' religious views in doctor-patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine.
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Affiliation(s)
| | - Robert Audi
- University of Notre Dame, South Bend, Indiana, USA
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Cosentino C, Harrad RA, Sulla F, Bertuol M, Sarli L, Artioli G. Nursing spiritual assessment instruments in adult patients: a narrative literature review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020015. [PMID: 33263349 PMCID: PMC8023116 DOI: 10.23750/abm.v91i12-s.10998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Spiritual care in nursing is a critical part of providing holistic care. Whilst patients might desire spiritual care and value the opportunities that nurses take to engage with them to meet their spiritual needs, research suggests that nurses do not consistently engage in spiritual care with their patients. To identify instruments available to nurses to assess spirituality in different patient groups and highlight the characteristics and psychometric properties of these instruments. METHOD A narrative literature review of the relevant literature published after 2008 was carried out in CINAHL, PsycINFO, MEDLINE and Google scholar databases in October 2020. Narrative review synthesized key findings and grouped instruments into macro areas by content. RESULTS After the screening, based on inclusion criteria, 31 articles were identified. 17 instruments were identified and divided into 4 macro areas: wellbeing (N = 4), attitude (N = 5) needs (N =6) and multiple domains (N = 2). CONCLUSIONS This review enables an increased awareness of the variety of instruments available to aid spiritual care and therefore increase their use within nurse clinical practice. The widening of the patient group to be considered (i.e., non-oncological) may have a significant impact on the practice, causing professionals to reflect on the necessity to investigate spiritual needs even at an early stage of a disease process. Future studies should aim to test reliability and validity of existing instruments rather than develop further ones.
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Affiliation(s)
| | - Rachel A Harrad
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom.
| | - Francesco Sulla
- DEpartment f Medicine and Surgery, university of Parma; Department of Education and Humanities, University of Modena and Reggio Emilia.
| | - Maria Bertuol
- Department of Medicine and Surgery, University of Parma.
| | - Leopoldo Sarli
- Department of Medicine and Surgery, University of Parma.
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Simas C, Penn-Kekana L, Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, de Melo APL, Figueira Mendes CH, Nunes Moreira MC, Ferreira do Nascimento MA, Pimentel C, Pinto M, Valongueiro S, Larson H. Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil. Health Policy Plan 2020; 35:953-961. [PMID: 32681164 PMCID: PMC7553755 DOI: 10.1093/heapol/czaa042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother's associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Tereza Maciel Lyra
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Department of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Avenida da Engenharia, S/N, Bloco D, 1º Andar, Cidade Universitária. CEP: 50.740-600 Recife, PE, Brazil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Maria do Socorro Veloso de Albuquerque
- Postgraduate Programme in public Health, Center of Medical Sciences, Federal University of Pernambuco. Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E, 4o.andar. Cidade Unitersitária, CEP 50.670-901, Recife -PE, Brazil
| | - Thália Velho Barreto de Araújo
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Ana Paula Lopes de Melo
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Núcleo de Saúde Coletiva da Universidade Federal de Pernambuco R. Alto do Reservatório - Alto José Leal, Vitória de Santo Antã - PE-Brasil, 55608-250l
| | - Corina Helena Figueira Mendes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Marcos Antonio Ferreira do Nascimento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Camila Pimentel
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
| | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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Torke AM, Fitchett G, Maiko S, Burke ES, Slaven JE, Watson BN, Ivy S, Monahan PO. The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions. J Pain Symptom Manage 2020; 59:261-269. [PMID: 31539603 PMCID: PMC6989362 DOI: 10.1016/j.jpainsymman.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022]
Abstract
CONTEXT Although religion and spirituality are important to surrogate decision makers, little is known about the role of religion in decision making regarding life-sustaining treatments. OBJECTIVES To determine the relationships between dimensions of religion and spirituality and medical treatment decisions made by surrogates. METHODS This prospective observational study enrolled patient/surrogate dyads from three hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed seven dimensions of religion and spirituality. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of life-sustaining treatments and hospice for patients who died. RESULTS There were 291 patient/surrogate dyads. When adjusting for other religious dimensions, demographic, and illness factors, only surrogates' belief in miracles was significantly associated with a lower surrogate preference for do-not-resuscitate status (adjusted odds ratio [aOR] 0.39; 95% CI 0.19, 0.78). Among patients who died, higher surrogate intrinsic religiosity was associated with lower patient receipt of life-sustaining treatments within the last 30 days (aOR 0.66; 95% CI 0.45, 0.97). Belief in miracles (aOR 0.30; 95% CI 0.10, 0.96) and higher intrinsic religiosity (aOR 0.70; 95% CI 0.53, 0.93) were associated with lower hospice utilization. CONCLUSION Few religious variables are associated with end-of-life preferences or treatment. Belief in miracles and intrinsic religiosity may affect treatment and should be identified and explored with surrogates by trained chaplains or other clinicians with appropriate training.
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Affiliation(s)
- Alexia M Torke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; IU Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana, USA; Daniel F. Evans Center for Spiritual and Religious Values in Healthcare, IU Health, Indianapolis, Indiana, USA.
| | - George Fitchett
- Department of Religion, Health and Human Values, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Saneta Maiko
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA; Indiana Conference, United Methodist Church, Greenwood, Indiana, USA
| | - Emily S Burke
- Indiana University (IU) Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - James E Slaven
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
| | | | - Steven Ivy
- Association for Clinical Pastoral Education, Decatur, Georgia, USA
| | - Patrick O Monahan
- IU Department of Biostatistics, IU School of Medicine, Indianapolis, Indiana, USA
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Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:187-191. [PMID: 31975573 DOI: 10.1002/ajmg.c.31767] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 11/08/2022]
Abstract
Medical and surgical approaches to children with trisomy 13 and 18 are evolving, and an increasing number of patients are being considered for simple and complex cardiac procedures. This review describes how the shifts in medical and social considerations for children with trisomy 13 and 18 mirror the shifts that occurred 50 years ago for children with trisomy 21. Yet the variability in cardiac lesions, and variability in non-cardiac comorbidities, is much greater for patients with trisomy 13 and 18 than for those with trisomy 21. That variability, combined with the severe neurologic impairment in survivors, complicates the current risk: benefit balance of surgical intervention. Consistent approaches to care for these patients should be built on an evidence base, and should include contributions from specialists in medical ethics and palliative care.
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Affiliation(s)
- Kathryn Neubauer
- Pediatric Palliative Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Renee D Boss
- Pediatric Palliative Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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George LS, Balboni TA, Maciejewski PK, Epstein AS, Prigerson HG. "My doctor says the cancer is worse, but I believe in miracles"-When religious belief in miracles diminishes the impact of news of cancer progression on change in prognostic understanding. Cancer 2019; 126:832-839. [PMID: 31658374 DOI: 10.1002/cncr.32575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/23/2019] [Accepted: 09/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND News of cancer progression is critical to setting accurate prognostic understanding, which guides patients' treatment decision making. This study examines whether religious belief in miracles modifies the effect of receiving news of cancer progression on change in prognostic understanding. METHODS In a multisite, prospective cohort study, 158 patients with advanced cancer, whom oncologists expected to die within 6 months, were assessed before and after the visit at which scan results were discussed. Before the visit, religious belief in miracles was assessed; after the visit, patients indicated what scan results they had received (cancer was worse vs cancer was stable, better, or other). Before and after the visit, prognostic understanding was assessed, and a change score was computed. RESULTS Approximately 78% of the participants (n = 123) reported at least some belief in miracles, with almost half (n = 73) endorsing the strongest possible belief. A significant interaction effect emerged between receiving news of cancer progression and belief in miracles in predicting change in prognostic understanding (b = -0.18, P = .04). Receiving news of cancer progression was associated with improvement in the accuracy of prognostic understanding among patients with weak belief in miracles (b = 0.67, P = .007); however, among patients with moderate to strong belief in miracles, news of cancer progression was unrelated to change in prognostic understanding (b = 0.08, P = .64). CONCLUSIONS Religious belief in miracles was highly prevalent and diminished the impact of receiving news of cancer progression on prognostic understanding. Assessing patients' beliefs in miracles may help to optimize the effectiveness of "bad news" scan result discussions.
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Affiliation(s)
- Login S George
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tracy A Balboni
- Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul K Maciejewski
- Department of Medicine, Weill Cornell Medicine, New York, New York.,Deparment of Radiology, Weill Cornell Medicine, New York, New York
| | - Andrew S Epstein
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
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Wholihan D. Psychological Issues of Patient Transition from Intensive Care to Palliative Care. Crit Care Nurs Clin North Am 2019; 31:547-556. [PMID: 31685121 DOI: 10.1016/j.cnc.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
End-of-life care in the intensive care unit is fraught with complicated psychological responses by patients, families, and staff. Empathic and mindful communication, inclusion of all integral staff in decision-making meetings, and multidimensional support of patients and families can ease the transition away from aggressive life-prolonging to comfort-oriented end of life care. Primary palliative care communication strategies can help clarify goals of care and facilitate transitions. Early integration of specialist palliative care is recommended.
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Affiliation(s)
- Dorothy Wholihan
- NYU Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA.
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18
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Derry HM, Epstein AS, Lichtenthal WG, Prigerson HG. Emotions in the room: common emotional reactions to discussions of poor prognosis and tools to address them. Expert Rev Anticancer Ther 2019; 19:689-696. [PMID: 31382794 PMCID: PMC6709526 DOI: 10.1080/14737140.2019.1651648] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022]
Abstract
Introduction: Advanced cancer patients often want prognostic information, and discussions of prognosis have been shown to enhance patient understanding of their illness. Such discussions can lead to high-quality, value-consistent care at the end of life, yet they are also often emotionally challenging. Despite how common and normal it is for patients to experience transient emotional distress when receiving 'bad news' about prognosis, emotional responses have been under-addressed in existing literature on prognostic discussions. Areas covered: Drawing upon psychology research, principles of skilled clinical communication, and published approaches to discussions of serious illness, we summarize patients' common emotional reactions and coping strategies. We then provide suggestions for how to respond to them in clinic. Expert opinion: Ultimately, effective management of emotional reactions to bad news may lead to earlier, more frequent, and more transparent discussions of prognosis, thus promoting cancer patients' understanding of, and adjustment to, their illness and improving the quality of their end-of-life care.
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Poncin E, Brandt PY, Rouiller F, Drouin M, Dandarova Robert Z. Mapping the Healthcare Chaplaincy Literature: An Analytical Review of Publications Authored by Chaplains and Theologians Between 2000 and 2018. J Health Care Chaplain 2019; 26:16-44. [PMID: 30982461 DOI: 10.1080/08854726.2019.1593722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The body of theoretical and empirical research led by chaplains and theologians between 2000 and 2018 is developing into a rich, diverse, and methodologically rigorous healthcare chaplaincy literature, which this review proposes to map. Online keyword and bibliographical searches and specialist recommendations yielded 199 relevant publications, which we analyzed in terms of methodology, topic, and results. On this basis, this article identifies and describes five key areas of the literature: chaplains' practices, spirituality, research, impact, and healthcare professionals' practices of spiritual care. The discussion further highlights that publications would benefit from greater conceptual clarity, common research standards, and more critical research designs.
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Affiliation(s)
- Emmanuelle Poncin
- Chaplaincy Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pierre-Yves Brandt
- Faculty of Theology and Religious Sciences, Institute for Social Sciences of Religions, University of Lausanne, Lausanne, Switzerland
| | - François Rouiller
- Chaplaincy Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Mario Drouin
- Chaplaincy Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Zhargalma Dandarova Robert
- Faculty of Theology and Religious Sciences, Institute for Social Sciences of Religions, University of Lausanne, Lausanne, Switzerland
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20
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Abusamaan MS, Quillin JM, Owodunni O, Emidio O, Kang IG, Yu B, Ma B, Bailey L, Razzak R, Smith TJ, Bodurtha JN. The Role of Palliative Medicine in Assessing Hereditary Cancer Risk. Am J Hosp Palliat Care 2018; 35:1490-1497. [PMID: 29843526 PMCID: PMC6385866 DOI: 10.1177/1049909118778865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Hereditary cancer assessment and communication about family history risks can be critical for surviving relatives. Palliative care (PC) is often the last set of providers before death. METHODS: We replicated a prior study of the prevalence of hereditary cancer risk among patients with cancer receiving PC consultations, assessed the history in the electronic medical record (EMR), and explored patients' attitudes toward discussions about family history. This study was conducted at an academic urban hospital between June 2016 and March 2017. RESULTS: The average age of the 75 adult patients with cancer was 60 years, 49 (55%) male and 49 (65%) white. A total of 19 (25%) patients had no clear documentation of family history in the EMR, sometimes because no family history was included in the admission template or an automatically imported template lacked content. In all, 24 (32%) patients had high-risk pedigrees that merited referral to genetic services. And, 48 (64%) patients thought that PC was an appropriate venue to discuss the implications of family history. The mean comfort level in addressing these questions was high. CONCLUSIONS: At an academic center, 25% of patients had no family history documented in the EMR. And, 32% of pedigrees warranted referral to genetic services, which was rarely documented. There is substantial room for quality improvement for oncologists and PC specialists-often the last set of providers-to address family cancer risk before death and to increase use and ease of documenting family history in the EMR. Addressing cancer family history could enhance prevention, especially among high-risk families.
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Affiliation(s)
| | | | | | | | | | - Brandon Yu
- Johns Hopkins University, Baltimore MD, USA
| | | | | | - Rab Razzak
- Johns Hopkins University School of Medicine, Baltimore MD, USA
| | - Thomas J. Smith
- Johns Hopkins University School of Medicine, Baltimore MD, USA
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21
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Lemmon ME, Strowd RE. Right Brain: Breaking bad news: Communication education for neurology trainees. Neurology 2018; 87:e285-e287. [PMID: 27956571 DOI: 10.1212/wnl.0000000000003433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Monica E Lemmon
- From the Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC; Department of Neurology (M.E.L., R.E.S.), Johns Hopkins Hospital, Baltimore, MD; and Department of Neurology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC.
| | - Roy E Strowd
- From the Department of Pediatrics (M.E.L.), Duke University Medical Center, Durham, NC; Department of Neurology (M.E.L., R.E.S.), Johns Hopkins Hospital, Baltimore, MD; and Department of Neurology (R.E.S.), Wake Forest School of Medicine, Winston-Salem, NC
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22
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Grinstead WD. In Search of a Place for Mystery in Clinical Bioethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:69-70. [PMID: 29697343 DOI: 10.1080/15265161.2018.1431718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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23
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Antommaria AHM, Ragsdale JR. Shaken not Stirred: What Are Ethicists Licensed to Do? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:56-58. [PMID: 29697345 DOI: 10.1080/15265161.2018.1431719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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24
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Bibler TM, Shinall MC, Stahl D. Responding to Those Who Hope for a Miracle: Practices for Clinical Bioethicists. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:40-51. [PMID: 29697329 DOI: 10.1080/15265161.2018.1431702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, "How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?" We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle.
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25
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Shinall MC, Stahl D, Bibler TM. Addressing a Patient's Hope for a Miracle. J Pain Symptom Manage 2018; 55:535-539. [PMID: 29030208 PMCID: PMC10182410 DOI: 10.1016/j.jpainsymman.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022]
Abstract
Ill patients may make decisions to continue aggressive life-prolonging care based on hope for a miraculous recovery, and clinicians can find goals of care discussions with these patients extremely challenging. Thus, palliative care providers may be asked to help in these discussions. The concept of "miracle" can express a multitude of hopes, fears, and religious commitments. Effective, sensitive engagement requires the palliative care provider to attend to these variegated hopes, fears, and commitments. This case presents a typology of ways patients express hope for a miracle along with analysis of the motivations and beliefs underlying such hopes and suggestions for tailored responses by palliative care providers.
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Affiliation(s)
- Myrick C Shinall
- Vanderbilt University Medical Center Section of Palliative Care, Nashville, Tennessee, USA.
| | - Devan Stahl
- Michigan State University Center for Ethics and Humanities in the Life Sciences, East Lansing, Michigan, USA
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26
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Ellington L, Billitteri J, Reblin M, Clayton MF. Spiritual Care Communication in Cancer Patients. Semin Oncol Nurs 2017; 33:517-525. [PMID: 29107530 DOI: 10.1016/j.soncn.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To provide a definition of spirituality, define the scope and nature of spiritual care communication, describe how to initiate communication about, and elicit, a spiritual history, and introduce the AMEN protocol to support patient/family hopes for a miracle. DATA SOURCES Literature review. CONCLUSION Spiritual communication is important throughout cancer care. Nurses can assess and integrate patient and family caregivers' spiritual needs in clinical care by practicing self-awareness and engaging in spiritual care communication strategies. IMPLICATIONS FOR NURSING PRACTICE Spirituality is recognized as an essential component of quality care. Spiritual conversations can increase patients' satisfaction with care and improve well-being.
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27
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Encarnação P, Oliveira CC, Martins T. A generalized resistance resource: faith. A nursing view. Health Promot Int 2017; 32:577-580. [PMID: 26681769 DOI: 10.1093/heapro/dav114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Based on Aaron Antonovsky's salutogenic model, the authors of this article aim to analyze the term Faith as a Generalized Resistance Resource (GRR) of people's health and to delve the relevance of this construct to clinical practice in Nursing. The authors consider that, in order for nurses to intervene in the promotion of faith so as to bring health benefits to people, a solid educational training in this subject area is required by nursing students.
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Affiliation(s)
- Paula Encarnação
- Biomedical Sciences Abel Salazar, Porto, Portugal.,School of Nursing, University of Minho, Braga, Portugal
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Chronic Critical Illness in Infants and Children: A Speculative Synthesis on Adapting ICU Care to Meet the Needs of Long-Stay Patients. Pediatr Crit Care Med 2016; 17:743-52. [PMID: 27295581 DOI: 10.1097/pcc.0000000000000792] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES In this review, we examine features of ICU systems and ICU clinician training that can undermine continuity of communication and longitudinal guidance for decision making for chronically critically ill infants and children. Drawing upon a conceptual model of the dynamic interactions between patients, families, clinicians, and ICU systems, we propose strategies to promote longitudinal decision making and improve communication for infants and children with prolonged ICU stays. DATA SOURCES We searched MEDLINE and PubMed from inception to September 2015 for English-language articles relevant to chronic critical illness, particularly of pediatric patients. We also reviewed bibliographies of relevant studies to broaden our search. STUDY SELECTION Two authors (physicians with experience in pediatric neonatology, critical care, and palliative care) made the final selections. DATA EXTRACTION We critically reviewed the existing data and models of care to identify strategies for improving ICU care of chronically critically ill children. DATA SYNTHESIS Utilizing the available data and personal experience, we addressed concerns related to family perspectives, ICU processes, and issues with ICU training that shape longitudinal decision making. CONCLUSIONS As the number of chronically critically ill infants and children increases, specific communication and decision-making models targeted at this population could improve the feedback between acute, daily ICU decisions and the patient's overall goals of care. Adaptations to ICU systems of care and ICU clinician training will be essential components of this progress.
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