Religious importance and practices of patients with a life-threatening illness: implications for screening protocols

Loneliness and Mental Health: Recommendations for Primary Care Intakes

Introduction/Objectives

The healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that could be included in intake forms independently, but this study analyzed loneliness, religiousness, household income, and social integration together to see how the combined effect influences mental and physical health status. This study aims to determine which of those 4 variables better inform patients’ mental versus physical health status.

Methods

One hundred and seventy-nine participants completed surveys, including the SF-12^® Health Survey, measuring perceived physical and mental health, UCLA 3-item Loneliness Scale, and a demographics questionnaire with questions about household income and time spent dedicated to religious practice, if applicable. Additionally, individuals answered social integration questions about how often they contact close family and friends or volunteer in the community. Using loneliness, household income, religiousness, social integration as independent variables, and controlling for demographic variables such as age, gender, and race, 2 regression models were built with Mental and Physical Health Composite Scores from the the SF-12^® Health Survey as dependent variables.

Results

Loneliness was associated with mental health measures (b = −2.190, P < .001), while household income was associated with physical health measures (b = 0.604, P = .019) above and beyond other variables in the regression models.

Conclusions

Integrating the 3 loneliness questions into intake forms can help approximate an individual’s mental health status. This would allow the provider to be able to assess mental health problems more effectively and provide needed resources.

Transforming Chaplaincy Requires Transforming Clinical Pastoral Education

Clinical Pastoral Education (CPE) is a process focused on developing students' personal integration. Outcomes for CPE need to expand to reflect current research in religion and spirituality because religion and spirituality impacts coping, meaning making, decision-making, and health care outcomes. Focusing CPE outcomes on religious/spiritual beliefs and practices used by patients will equip chaplains to provide research-informed spiritual care for families and discipline-specific information for the interdisciplinary team.

Caring for terminally ill Muslim patients: Lived experiences of non-Muslim nurses

Objective:

The nursing profession demands knowledge, awareness, and experience regarding the ethnic, religious, cultural, and social constructs involved in patient care. Non-Muslim nurses must have theoretical and empirical insights into treatment methods and caring for terminally ill Muslim patients. In particular, non-Muslim nurses should acquire knowledge of Islamic rules and regulations. They should also be familiar with the unique religious and sociocultural practices that pertain to healthcare practices. Our study aimed to explore non-Muslim nurses' experiences in caring for terminally ill Muslim patients and their families regarding physical, social, cultural, spiritual, and religious practices. The study also sought to investigate the context or situations that influence these experiences as described by the nurses.

Method:

In this qualitative descriptive study, 10 nurses working in medical, oncology, and oncology/palliative care units in a tertiary care hospital in Saudi Arabia were interviewed. A modified Stevick–Colaizzi–Keen method was employed for data analysis.

Results:

Three main themes constituted the nurses' lived experiences: family matters, end-of-life practices, and nurse challenges. Cultural values, religious practices, and a family approach to the process of care influenced nurses' experiences. Issues related to an absence of palliative care integration and the unavailability of members in the interdisciplinary team also influenced their experiences. Nurses showed a lack of cultural knowledge of some practices due to a lack of awareness of cultural diversity and the unavailability of formal cultural education.

Significance of Results:

Provision of culturally competent care at the end of life for Muslim patients in Saudi Arabia requires a thoughtful understanding of religious and cultural practices as well as knowledge of the role of the family throughout the care process. The introduction of a cultural care nursing delivery model that incorporates a cultural education program with Islamic teachings and practices at its core is recommended.

Patterns of self-management practices undertaken by cancer survivors: variations in demographic factors

The study purpose was to examine self-management (SM) use among cancer survivors; and to explore variations in uptake of SM in survivorship and whether these differed in relation to age, income, gender, ethnicity, cancer type and treatment type. This is an important area for exploration as SM utilisation has the potential to impact on the health status, health behaviours and quality of life (QoL) of cancer survivors. A postal survey was conducted among 445 cancer survivors identified from a hospital in the West Midlands, UK. Demographic data were collected and respondents were asked to identify which practices across six SM categories - diet, exercise, complementary and alternative medicine (CAM), psychological therapies, support groups and spirituality/religion - they had used (if any). The findings indicate that the large majority (91%) had used some form of SM after their cancer treatment. Exercise (84%) and diet (56%) were the most popular SM interventions for cancer survivors and socio-demographic and cancer-related factors were associated with SM uptake. These findings can form the basis for designing and implementing appropriate SM interventions aimed at improving the health, well-being and QoL of cancer survivors.

What can we learn about the spiritual needs of palliative care patients from the research literature?

CONTEXT

Spirituality is a distinctive subject within palliative care practice and literature, but research to date is relatively undeveloped in this field and studies often throw more light on conceptual and methodological issues than producing reliable data for clinical practice.

OBJECTIVES

To determine what is known about the spiritual needs of palliative care patients from the evidence presented in published research.

METHODS

Specialist online databases were interrogated for primary empirical studies of patients with a chronic disease unresponsive to curative treatment. Studies that only used a proxy for the patient or reported expert opinion were excluded. Each study was critically appraised for quality and the strength of its evidence to determine if any data could be pooled.

RESULTS

Thirty-five studies were identified, equating to a total of 1374 patients. Study populations were typically people with advanced-stage cancer, older than 60 years, who were English speaking, and with a Christian or Jewish religious affiliation, reflecting the predominance of Anglo-American studies. Studies fell into two groups: those that investigated the nature of spiritual experience and those that examined the relationship of spirituality with other phenomena. The evidence was insufficiently homogeneous to pool.

CONCLUSION

Relevant accounts of what spirituality means for palliative care patients and evidence of how it operates in the lives of people with life-limiting disease can be derived from research. Studies to date are limited by reductive representations of spirituality and the conduct of research by health professionals within health care communities demarcated from disciplines and interpretive traditions of spirituality.

Adjunctive therapies for the chronically critically ill

Along with the well-known pharmacological and technological advances in the treatment of the critically ill, nurses have made significant contributions in the realm of more holistic approaches to care, advancing well-known nursing therapies such as physical activity, music, and relationship-based care. The purpose of this article is to review current literature regarding adjunctive therapies used for the care for the critically ill, and, by extension, the chronically critically ill. The review describes the application of interventions using physical activity, spirituality, music, complementary and alternate therapies, relationship-focused care, and pet visitation. The authors conducted a multidisciplinary review of literature published between 1990 and 2009, using the Cochrane Database system and PubMed. The main focus was intervention studies; articles in which authors reviewed evidence and made suggestions for practice or further research were also examined.

Psychological, social and spiritual distress at the end of life in heart failure patients

PURPOSE OF REVIEW

Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs.

RECENT FINDINGS

The high prevalence of depression (9-77.5%) among chronic heart failure patients is well documented. Clinical assessment and treatment of depression and anxiety are key to good patient care, although no model for assessment has been agreed. Evidence suggests that social support and spiritual belief are important coping resources, but there is a dearth of research into social and spiritual distress in chronic heart failure. Patients rarely access social services support, and family carers experience considerable burden. Little is known about how psychosocial and spiritual variables influence each other, and the impact of social and spiritual distress on outcomes such as quality of life.

SUMMARY

We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.

Spiritual care of families in the intensive care unit

OBJECTIVES

There is growing recognition of the importance of spiritual care as a quality domain for critically ill patients and their families, but there is a paucity of research to guide quality improvement in this area. Our goals were to: 1) determine whether intensive care unit (ICU) family members who rate an item about their spiritual care are different from family members who skip the item or rate the item as "not applicable" and 2) identify potential determinants of higher family satisfaction with spiritual care in the ICU.

DESIGN

Cross-sectional study, using data from a cluster randomized trial aimed at improving end-of-life care in the ICU.

SETTING

ICUs in ten Seattle-area hospitals.

SUBJECTS

A total of 356 family members of patients dying during an ICU stay or within 24 hrs of ICU discharge.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

Family members were surveyed about spiritual care in the ICU. Chart abstractors obtained clinical variables including end-of-life care processes and family conference data. The 259 of 356 family members (73%) who rated their spiritual care were slightly younger than family members who did not rate this aspect of care (p = .001). Multiple regression revealed family members were more satisfied with spiritual care if a pastor or spiritual advisor was involved in the last 24 hrs of the patient's life (p = .007). In addition, there was a strong association between satisfaction with spiritual care and satisfaction with the total ICU experience (p < .001). Ratings of spiritual care were not associated with any other demographic or clinical variables.

CONCLUSIONS

These findings suggest that for patients dying in the ICU, clinicians should assess each family's spiritual needs and consult a spiritual advisor if desired by the family. Further research is needed to develop a comprehensive approach to ICU care that meets not only physical and psychosocial but also spiritual needs of patients and their families.

Women Undergoing Breast Diagnostics: The Lived Experience of Spirituality

PURPOSE/OBJECTIVES

To explore perceptions of spirituality in women who had undergone a breast diagnostic experience.

RESEARCH APPROACH

Qualitative, phenomenologic study using Giorgi's approach.

SETTING

An outpatient comprehensive breast assessment center.

PARTICIPANTS

20 Caucasian women, aged 30-89, who had just completed the diagnostic process, including definitive diagnosis, regarding a breast abnormality.

METHODOLOGIC APPROACH

In-depth, semistructured, tape-recorded, and transcribed interviews analyzed using the Giorgi method of coding, transforming, and synthesizing data.

MAIN RESEARCH VARIABLES

Descriptions of spirituality, spiritual needs, and supporting spirituality.

FINDINGS

Two themes emerged: creating a focused isolation and seeking connections. Women created a private mental world in which to concentrate on the stressful diagnostic process. Within the isolation, women explored their personal strength and their connection to God or their spiritual beliefs. When the stress began to overwhelm, they sought out loved ones for support and diversion. Women found the center's staff to be supportive; however, many did not wish to speak to an agency chaplain during the uncertain period.

CONCLUSIONS

Women needed to handle the stress alone, with reliance on spirituality and God that was balanced with a need for specific connections to family members or close friends.

INTERPRETATION

Nurses can support women's need to focus and can assist family members to understand their role during the diagnostic period. The diagnostic period can be used to talk with women about their spiritual beliefs, their needs, and possible referral to a chaplain.

Mending Broken Hearts

This research synthesis analyzed research on spirituality in cardiac illness from 1991 to 2004 to identify progress, gaps, and priorities for research. Articles were retrieved from PubMed and CINAHL. Twenty-six studies met inclusion criteria. Moody's Research Analysis Tool, Version 2004, was used to analyze studies. Lack of conceptual model and universal definition of spirituality are major knowledge gaps. A proposed conceptual model is presented.

Spiritual distress in adult cancer patients: toward conceptual clarity

Spiritual distress is conceptualized as impairments in 7 constructs of a person's sense of spirituality: (1) connectedness, (2) faith and religious belief system, (3) value system, (4) meaning and purpose in life, (5) self-transcendence, (6) inner peace and harmony, and (7) inner strength and energy. This article clarifies spiritual distress through concept analysis and provides nurses with cues for its recognition in adult patients with cancer.