California's Central Valley is home to about five Kaiser-affiliated hospitals, offering emergency and other medical services 24 hours a day, seven cslifornia a week. West Lancaster, CA Driving directions References Kaiser Permanente: Quick Facts. Written by Max Stirner. Max Stirner is a New York-based writer and editor with over a decade of experience. Richmond, CA 1 0.
These nurses were assigned to a study or a control group via a coin-toss method. The majority of nurses with more than five working years are mostly clinical teachers in China, which will facilitate the training of other nurses and nursing students in the later period and can create an environment to foster the provision of spiritual care. The exclusion criteria were as follows: nurses receiving other advanced training; individuals who might be expected to drop out of the study due to pregnancy, retirement, or transfers; and individuals joining part way through the intervention.
No significant differences were found with regard to age, work seniority, occupation, religious beliefs, etc. The baseline data for the nurses were uniform across the two groups see Additional file 1 : Table S1. The members of the intervention team consisted of two palliative nursing education experts and three clinical head nurses who specialize in spiritual care.
In addition, one statistical expert with statistical analysis skills was recruited who participated in the analysis of the data but not in the intervention process. The intervention methods included lectures and instruction, case sharing, group discussion, and individual psychological counselling.
Yao Jianan et al. Some scholars [ 47 ] have incorporated religious and communication skills into teaching. Timmins et al. Ross et al. The spiritual care training protocol was drafted based on a literature review, expert recommendations, and the results of a current status survey.
The spiritual health, spiritual care competencies, emotional regulation, and level of psychological resilience of the nurses in the two groups were tested before and after training.
The members of the control group participated in one intensive nursing service training session each month during the training period. The lecturers were senior teaching supervisors of clinical spiritual care education and pastoral counselling in China. The time and place of the event were fixed. The team members participating in the training attended two weeks of special spiritual care group study every year.
Each activity was led by a spiritual care training team leader responsible for organizing and implementation. The team leader had three deputy senior titles and a clinical head nurse who had obtained the qualification of a national second-level counsellor. This protocol included life-and-death education, suicide prevention strategies, end-of-life care, spiritual growth, spiritual care cognition and practice, etc. Each session lasted two hours.
The training received by the control group included nursing research training and the care of commonly observed psychological problems among patients with cancer.
Prior to the start of the intervention, the members of the intervention team performed a baseline survey of all of the participating nurses. The intervention protocol arrangements and the amounts of time required were explained to the nurses before the intervention, and their informed consent was obtained. Authorization of use of all questionnaires was obtained from the authors of the original questionnaires.
The nurses received spiritual care training chiefly in accordance with the intervention protocol developed for this study during the intervention period. Prior to the conclusion of the intensive intervention, the trainees were asked to receive a one-month reinforcement training session and were informed about enhanced training assignments and completion requirements.
After each intervention period concluded, the nurses completed a training class feedback questionnaire to assess their training results. After the spiritual care training concluded, the Spiritual Health Scale SHS and the Chinese version of the Spiritual Care Competency Scale C-SCCS were administered to both groups, and one-on-one interviews were conducted to assess the degree to which the goals of the intervention protocol had been realized.
This scale comprises 24 questions across five dimensions: bonding with others, searching for meaning, overcoming adversity, religious faith, and self-knowledge. Leeuwen et al. The Chinese version was translated and culturally localized by the study team with the permission of Dr.
It was evaluated using the Exploratory factor analysis EFA and Confirmatory factor analysis CFA method [ 34 ] and was divided into three dimensions using factor analysis based on the conceptual framework of the original scale: assessment, implementation, professionalization, and quality improvement of spiritual care AIPI ; personal and team support PTS ; and attitudes towards patient spirituality and communication ATPSC.
Additional file 1 : Table S1 shows the comparison of demographic characteristics between nurses in the two groups. A total of 92 nurses completed the experiment.
All returned questionnaires were suitable for this study. All nurses were female. The basic characteristics of the participants are summarized in Additional file 1 : Table S1.
The effect sizes of sub-scales of the two scales after intervention ranged from 0. See Additional file 2 : Table S3. The above study results indicate that the nurses in the study group had significantly higher total spiritual health and spiritual care competency scores as well as significantly higher individual dimension scores after the intervention with a moderate to intense effect. In addition, compared with the control group, the study group showed significantly better spiritual health and spiritual care competency scores as well as significantly better individual dimension scores following the intervention.
Although the control group had higher spiritual care competency scores prior to the intervention this result is likely because the nurses in the control group were slightly younger than those in the study group and therefore had less exposure to the spiritual care concept , the nurses in the study group displayed greater spiritual care competency than the nurses in the control group after the month intervention.
Based on the results of a survey of the prevailing state of affairs and using spiritual growth as a point of entry, this study designed a spiritual care training protocol for clinical nurses to address their perceptions of spirituality and spiritual care competencies.
The results of this study indicated that this protocol supported specific achievements. The goal of spiritual care training for nurses is to help them understand the methods and techniques that they can use to provide spiritual care to their patients. Through the group intervention, the nurses expressed their feelings, which gave them an opportunity to review their own spiritual needs. When nurses transform the knowledge and skills that they learn in training into active, conscious clinical practice e.
After being in contact with each other for a certain period of time, the team members formed a cooperative learning team that enjoyed mutual growth.
Motivated by the growing importance placed on the provision of spiritual care to patients, research on spiritual care has recently increased [ 34 ]. However, although previous research has shown that both patients and their family members have great spiritual needs and that medical personnel must show concern for and satisfy these needs, this issue has not received sufficient attention in nursing practice [ 37 , 61 ].
One obstacle to spiritual care practice is that nurses—the chief healthcare providers—are insufficiently prepared to take on this role because of their inadequate education in this area [ 28 , 29 , 30 , 31 , 43 , 45 ]. To provide more effective spiritual care to patients, it is urgent that nurses receive education or training to improve their spiritual care knowledge and skills.
Clinical nursing managers should use this protocol as a reference to help clinical nurses improve their spiritual health. Therefore, the results of this study have great relevance at a time when a worldwide shortage of nurses exists. All participants in this study included nurses in various departments of a single cancer hospital. Furthermore, to facilitate the continued provision of spiritual care training to all nurses, a considerable portion of these participants consisted of head nurses or nursing staff members in their respective departments.
As a consequence, most of the nurses in this study were senior personnel with over seven years of experience. Although these individuals had a certain degree of representativeness, some uncertainty remains concerning the effectiveness of the intervention protocol when applied to nurses with less seniority. Subsequent research should therefore examine the effectiveness of the training protocol in the case of less experienced nurses.
The transcultural validity of the intervention requires further consideration and verification. Moreover, nurses who were originally unfamiliar with spiritual concepts became conscious that everyone has a spiritual nature and uncovered their own spiritual nature.
Third, nurses with spiritual care experience will value the opportunity for a healthy life even more and will show greater tolerance for the challenges that they encounter. During the process of helping patients find meaning in life and overcoming adversity, nurses will also gain a greater ability to make their lives meaningful and overcome adversity, which will make this process mutually influencing and mutually reinforcing. Future research may evaluate these potential benefits for nurses.
This spiritual care training protocol might be worth additional promotion and application among nurses. The data of this study can be obtained by any reasonable request.
If needed, please contact the author of this article. Ellison CW. Spiritual well-being: conceptualization and measurement. Article Google Scholar. Review of spiritual health: definition, role, and intervention strategies in health promotion. American Journal of Health Promotion Ajhp. Effect of cognitive adaptation process on spiritual well-being of patients with advanced lung cancer [J].
Guangdong Medical Journal. Google Scholar. Progress in the study of spiritual health in cancer patients [J]. Chin J Nurs. Kolander C, Chandler C. Health Educ. Gaur K L, Sharma M. Int J Innovative Res Dev, , 3 3 — Pastor Psychol. Fisher JW. Care and Wellbeing Springer Netherlands. Research progress on spiritual care at home and abroad [J]. Nurs Res. Spiritual well-being as a component of health-related quality of life: the functional assessment of chronic illness therapy—spiritual well-being scale FACIT-Sp [J].
Lee YH, Salman A. The mediating effect of spiritual well-being on depressive symptoms and health-related quality of life among elders. Arch Psychiatr Nurs. Article PubMed Google Scholar. Spiritual well-being and its relationship with mindfulness, self-compassion and satisfaction with life in baccalaureate nursing students: a correlation study [J]. Work values and job satisfaction: a qualitative study of Iranian nurses. Nurs Ethics. The association between spiritual well-being and burnout in intensive care unit nurses: a descriptive study [J].
Intensive Crit Care Nurs. J Clin Nurs. PubMed Google Scholar. Spiritual care by nurses in curative cancer care: Protocol for a national, multicentre, mixed method study [J]. J Adv Nurs. The effects of spiritual care on quality of life and spiritual well-being among patients with terminal illness: a systematic review. Palliat Med. Relationship between oncology Nurses' spiritual wellbeing with their attitudes towards spiritual care providing based on Neuman system model: evidences from IRAN.
J Caring Sci. BMC Palliat Care. Musa AS. Spiritual care intervention and spiritual well-being [J]. Nurse Spiritual Care: Prevalence and Correlates. West J Nurs Res. Timmins F. Understanding spirituality and spiritual care in nursing [J]. Nursing standard: official newspaper of the Royal College of Nursing. Nurse Educ Today, , — Spiritual wellbeing, attitude toward spiritual care and its relationship with spiritual care competence among critical care nurses [J].
Spiritual care in cancer patients: a need or an option? Curr Opin Oncol. The meaning of spirituality and spiritual care among the Hong Kong Chinese terminally ill [J]. Journal of Advanced Nursing. The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring [J].
Nurs Outlook. Doka KJ. Spiritual Care in General Practice: rushing in or fearing to tread? An integrative review of qualitative literature [J]. Timmins F, Caldeira S. Nurs Stand. Holmes C. Stakeholder views on the role of spiritual care in Australian hospitals: an exploratory study [J]. Health Policy. Another study points to a possible mechanism: interleukin IL Increased levels of IL-6 are associated with an increased incidence of disease. A research study involving older adults showed that those who attended church were half as likely to have elevated levels of IL-6 The authors hypothesized that religious commitment may improve stress control by offering better coping mechanisms, richer social support, and the strength of personal values and worldview.
Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Some studies indicate that those who are spiritual tend to have a more positive outlook and a better quality of life. For example, patients with advanced cancer who found comfort from their religious and spiritual beliefs were more satisfied with their lives, were happier, and had less pain Positive reports on those measures—a meaningful personal existence, fulfillment of life goals, and a feeling that life to that point had been worthwhile— correlated with a good quality of life for patients with advanced disease Some studies have also looked at the role of spirituality regarding pain.
One study showed that spiritual well-being was related to the ability to enjoy life even in the midst of symptoms, including pain. This suggests that spirituality may be an important clinical target Pain medication is very important and should be used, but it is worthwhile to consider other ways to deal with pain as well. Spiritual beliefs can help patients cope with disease and face death. Among 90 HIV-positive patients, those who were spiritually active had less fear of death and less guilt A random Gallup poll asked people what concerns they would have if they were dying.
Those who were surveyed cited several spiritual reassurances that would give them comfort. The most common spiritual reassurances cited were beliefs that they would be in the loving presence of God or a higher power, that death was not the end but a passage, and that they would live on through their children and descendants Bereavement is one of life's greatest stresses.
Those parents had better physiologic and emotional adjustment. These findings are not surprising. We hear them repeated in focus groups, in patients' writings and stories: When people are challenged by something like a serious illness or loss, they frequently turn to spiritual values to help them cope with or understand their illness or loss.
Spiritual commitment tends to enhance recovery from illness and surgery. For example, a study of heart transplant patients showed that those who participated in religious activities and said their beliefs were important complied better with follow-up treatment, had improved physical functioning at the month follow-up visit, had higher levels of self-esteem, and had less anxiety and fewer health worries In general, people who don't worry as much tend to have better health outcomes.
Maybe spirituality enables people to worry less, to let go and live in the present moment. Related to spirituality is the power of hope and positive thinking. I see this as an ability to tap into one's inner resources to heal. Benson, myself, and others see the physician-patient relationship as having placebo effect as well—i. Benson suggests that there are 3 components that contribute to the placebo effect of the patient-physician relationship: positive beliefs and expectations on the part of the patients, positive beliefs and expectations on the part of the physician or health care professional, and a good relationship between the 2 parties Specific spiritual practices have been shown to improve health outcomes.
In the s, Benson began research on the effect of spiritual practices on health. Some people who practiced transcendental meditation approached him in the s and asked him to determine if meditation had beneficial health effects. He found that 10 to 20 minutes of meditation twice a day leads to decreased metabolism, decreased heart rate, decreased respiratory rate, and slower brain waves. Further, the practice was beneficial for the treatment of chronic pain, insomnia, anxiety, hostility, depression, premenstrual syndrome, and infertility and was a useful adjunct to treatment for patients with cancer or HIV.
I teach the relaxation response to many of my patients, and I have found it particularly useful for patients with chronic pain, high blood pressure, headaches, and irritable bowel syndrome. It takes only a few minutes to describe the meditation and to practice it with your patient in the office. The patient then needs to practice the technique at home. I usually suggest people follow up with me in the office more frequently initially as they are learning the technique.
After a few semimonthly visits, they switch to brief monthly visits, which can then be tapered. Some of my patients follow up with me by phone if coming to my office frequently is difficult. Do patients want physicians to address their spirituality? Research studies have also addressed this issue.
From a physician's standpoint, understanding patients' spirituality is quite valuable as well:. What is involved in serving patients and providing compassionate care? Physicians can begin with the following:. Throughout these activities, it is important to understand professional boundaries. In-depth spiritual counseling should occur under the direction of chaplains and other spiritual leaders, as they are the experts. The physician should not initiate prayer with patients, as this blurs the boundary of physician and clergy.
Leading prayer involves specific skills and training that physicians do not have. Furthermore, a physician leading a prayer might lead a prayer from his or her tradition, which could be offensive or inappropriate for the patient. If the patient requests prayer, the physician can stand by in silence as the patient prays in his or her tradition or can contact the chaplain to lead a prayer.
Finally, the spiritual history is patient centered, and proselytizing and ridiculing patients' beliefs are not acceptable. It is important to recognize that patients come to physicians to seek care for their medical condition.
In delivering this care, physicians can be respectful and understand the spiritual dimension in patients' lives. But to go beyond that, e. Physicians are in a position of power with patients. Most patients come to us in vulnerable times.
Therefore, it is critical that when discussing spiritual issues with patients, the physician listens and supports and does not guide or lead. Many physicians are not familiar with spiritual histories. I teach medical students and physicians to take a spiritual history as part of a social history, at each annual exam, and at follow-up visits as appropriate.
A spiritual history helps physicians recognize when cases need to be referred to chaplains. It opens the door to conversation about values and beliefs, uncovers coping mechanisms and support systems, reveals positive and negative spiritual coping, and provides an opportunity for compassionate care.
Several prominent organizations have recognized the importance of spiritual care. The American College of Physicians convened an end-oflife consensus panel that concluded that physicians should extend their care for those with serious medical illness by attention to psychosocial, existential, or spiritual suffering It convened a consensus group of deans and faculty of medical schools to determine the key elements of a medical school curriculum.
In its first report, it listed the essential attributes of physicians. In , 3 medical schools offered courses on spirituality and health. In , 75 of the schools offer courses. Many of those courses are required. At The George Washington University School of Medicine, spirituality is interwoven with the rest of the curriculum throughout the 4 years of medical school so that the students learn to integrate it into all of their care.
Most of the other schools follow this model of integrating spirituality into ongoing parts of the medical school curriculum. The reason for this is that it is a good model for teaching principles of care.
Since the goal of good medical care is attention to the whole patient, not just the specific illness, courses that are taught holistically, rather than by symptoms only, emphasize whole patient care.
So, when learning about a patient with diabetes, students learn not only about the pathophysiology of diabetes but also about the psychosocial and spiritual issues that patients with diabetes may face. Thus, when learning to take a history, students learn all aspects of the history—physical, social, emotional, and spiritual.
The John Templeton Foundation supports the development of curricula on spirituality and medicine in medical schools and in residency training programs. The grant program has been successful: not only do the schools and programs continue the curricula after the funding ends, but even schools that have applied and not received funding continue to offer the course. One of the requirements to apply for the award is to have approval from the dean and necessary education committees to offer the course.
Once this is done, many schools elect to offer the course even if funding is not awarded. This suggests that medical school faculty find the topic of spirituality and health relevant to medical education and patient care.
The AAMC has also addressed the curriculum in spirituality, cultural issues, and end-of-life care. First, the consensus group noted that we are coming to understand health as a process by which individuals maintain their sense of coherence and meaning in life in the face of changes in themselves such as illness So, spirituality can be seen as that part of people that sees coherence, meaning, and purpose in their lives.
The AAMC's definition of spirituality is a broad one:. Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. All of these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another Furthermore, the consensus group of faculty that developed the definition also developed guidelines and learning objectives for teaching these courses.
One of the basic premises of these courses is that focusing on the spiritual aspect of patients enables one to deliver more compassionate care.
In summary, spirituality can be an important element in the way patients face chronic illness, suffering, and loss. Physicians need to address and be attentive to all suffering of their patients—physical, emotional, and spiritual.
Doing so is part of delivery of compassionate care. I think we can be better physicians and true partners in our patients' living and in their dying if we can be compassionate: if we truly listen to their hopes, their fears, and their beliefs and incorporate these beliefs into their therapeutic plans. Proc Bayl Univ Med Cent.
Christina M. Puchalski , MD, MS 1. Find articles by Christina M. Author information Copyright and License information Disclaimer. Corresponding author. Corresponding author: Christina M. Rachel Naomi Remen, MD, who has developed Commonweal retreats for people with cancer, described it well: Helping, fixing, and serving represent three different ways of seeing life.
Mortality Some observational studies suggest that people who have regular spiritual practices tend to live longer 9. Coping Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life stresses. Recovery Spiritual commitment tends to enhance recovery from illness and surgery.
From a physician's standpoint, understanding patients' spirituality is quite valuable as well: Spirituality may be a dynamic in the patient's understanding of the disease. For example, when I was a resident I saw a 28 year-old woman whose husband had just left her. She found out that her husband had AIDS, and she asked to be tested. When I met with her to tell her that the test result came back positive, I tried to explain that her illness was diagnosed early and that there had been recent advances in the treatment of HIV that were allowing people to live longer with their illness.
She kept referring to God and about why God was doing this to her. I recognized that we weren't connecting, so I asked her about her comments.
She proceeded to tell me about being raped as a teenager and having an abortion. In her belief system, that was wrong. I encouraged her to see a chaplain, which she did regularly. In the meantime, I kept seeing her, and I talked with her about her issues of guilt and punishment as well as some education about HIV.
But it was not until 1 year later that she was willing to seek treatment. She needed time to work out her own issues of guilt before being able to accept her illness and deal with it. Now, she tells me that had I not addressed her spiritual issues in that first visit, she would never have returned to see me or any other physician. In many patients' lives, spiritual or religious beliefs may affect the decisions they make about their health and illness and the treatment choices they make.
It is critical that we as physicians and health care providers listen to all aspects of our patients' lives that can affect their decision making and their coping skills. Religious convictions may affect health care decision making. Jehovah's Witness patients rejecting blood transfusions is a classic example, but there are also beliefs around use of ventilators and feeding tubes.
One of my patients was an year old man dying of pancreatic cancer in the intensive care unit. He was on a ventilator. When the treatment team approached his family about withdrawing support, at first they refused, saying that their father was in God's hands and keeping him on support might make a miracle possible. After an ethics consult and a consult with a chaplain, the family had the chance to reframe their own thinking.
Eventually, they saw that a peaceful death and their father's union with God could be the miracle. The critical elements in helping the family deal with the situation were the medical team's respecting and not ridiculing the family's beliefs and the chaplain's skill in counseling and helping the family reconcile their religious beliefs with the reality of their father's dying.
Spirituality may be a patient need and may be important in patient coping. This was true of a patient of mine who died 2 weeks ago.
She used her religious beliefs and practices to help her live with serious chronic illness. Many of the people at her funeral commented on her deep faith and how her spirituality helped her cope with her multiple strokes and diabetes. Towards the end of her life, she was in a coma. Her family asked me to join them in their prayer around their mother's bedside. During the prayer, the family was able to express both their hope in her recovery, but also their request to God for strength to deal with her death if that was to be the outcome.
So, for both my patient and my patient's family, spiritual beliefs and practices were the main resource they used to cope with suffering and loss. And this patient and her family wanted me, their physician, to be aware of these beliefs and to be open to hearing their spiritual expressions in the clinical setting.
Patients may want to discuss their spirituality with their physician, to use their church group as a social support, or to join faith-based organizations for support and guidance.
An understanding of the patient's spirituality is integral to whole patient care. One of my patients, a year-old woman with irritable bowel syndrome, had several signs of depression, including insomnia, excessive worrying, decreased appetite, and anhedonia.
Overall, she felt she had no meaning and purpose in life. She did not respond to medication and diet changes alone. I taught this patient the relaxation response as an adjunct to the medical treatment and counseling she received.
She improved when meditation and counseling were added to the treatment regimen. As shown in the first example of the woman who was HIV positive, some spiritual stances can lead to negative coping: more depression, poorer quality of life, and callousness towards others.
This is seen when patients view a crisis as a punishment from God, have excessive guilt, or have absolute belief in prayer and a cure and then can't resolve their anger when the cure does not occur.
Generally, however, spirituality leads to positive coping. Patients seek control through a partnership with God, ask God's forgiveness and try to forgive others, draw strength and comfort from their spiritual beliefs, and find support from a spiritual or religious community.
These actions lead to less psychological distress Physicians can begin with the following: Practicing compassionate presence—i.
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