Spirituality and practice. Stories, barriers and opportunities. Interview by Laurence A. Savett

What are "spiritual matters?" Are "spiritual matters" the same as "religious matters?" What is spiritual inquiry? Are such questions appropriate for those of us in the caring professions, other than clergy, to consider? If we accept that role, how far should we go? When should we call for help? Whom should we call? We convened a gathering of a hospital chaplain, a social worker, a hospice nurse and a physician to discuss many of the dimensions of spirituality and then to apply their personal and professional paradigms of care to a discussion of an actual case. This article is a record of that conversation. It is actually several articles in one, for it deals with their own views of the meaning of spirituality, the degree to which their spirituality has impact on their practice, what they see as the merit of spiritual matters in the caring professions, barriers to collaboration among their professions and to addressing these issues with patients, and boundaries beyond which one should not go. One way to read this conversation is to include yourself; that is, to reflect on the points the participants make and the ways in which you might integrate their insights into your personal practice. We hope that you find this task worthwhile and that it provokes further thought and discussion. The discussion began with participant introductions.     

Ethics in hospice care.

Discusses 4 ethical issues that arise in hospice care: (1) What are the ethical responsibilities to the patient, family, and authorities when hospice workers discover that a patient has been given incompetent and shoddy care at a previous institution? (2) Hospices that advertise themselves as offering complete care should be prepared to deal with psychological and legal issues as well as medical ones. (3) The idea of treating the entire person must include responding to the likelihood that the patient and family may raise profound philosophical and religious questions. (4) Hospice staff should periodically examine themselves on a spiritual or philosophical level. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing, healing and spirituality

The premise of this article is that nurses are healers, primarily through the caring relationships they form with patients. Caring calls out an individual's inner strengths. These strengths include spiritual resources which support integration or wholeness of body, mind and spirit. Many nurses are unsure about giving spiritual care. This author encourages nurses to reflect on their own spirituality and learn spiritual care skills. By addressing the spiritual dimension in patient care, nurses can truly be holistic practitioners and positively affect the mental and physical health of their patients.     

Spiritual nursing interventions

Oncology, parish, and hospice nurses in the Midwest were surveyed to explore what nursing interventions they implement to enhance the spirituality of clients and how they learned about these interventions. Some 95 spiritual nursing interventions were identified and ranked according to frequency of implementation. The most frequently identified nursing interventions were referral, prayer, active listening, facilitation and validation of clients' feelings and thoughts, conveying acceptance, and instilling hope. The most frequently ranked implemented interventions were communication and religious nursing interventions. Only 15% of the participants indicated that they learned the most about spirituality and spiritual nursing interventions from basic and advanced nursing education combined. Findings support the need for increased emphasis of theoretical and clinical spiritual knowledge in nursing education and the development of a typology of spiritual nursing interventions to direct nurses in enhancing the spirituality of clients and implementing holistic nursing care.     

The spiritual work of the dying: a framework and case studies

This article describes a systematic approach to understanding the spiritual work of the dying. It begins by defining "spirituality," "spiritual care" and "spiritual work" in order to create a common vocabulary. The remainder of the article uses vignettes from clinical experience to create a framework for understanding not only the recurrent themes in the spiritual work being done by the terminally ill but the support and interventions of the spiritual counselor as well. These case experiences are clustered under four headings: "remembering," "reassessing," "reconciliation" and "reunion." The article gives serious attention to the "supernatural" experiences of the dying as experienced by the hospice team.     

Videothoracoscopy for diagnosis and treatment of respiratory tract diseases

Orthopaedic nurses often are well-educated in dealing with patients' physical and psychologic needs but lack education in caring for the spiritual needs of man. Nurses must realize they, themselves, have spiritual needs and must invest in clarifying their own values and beliefs as well as their patients. To perform a complete spiritual assessment, nurses need to become familiar with the concept of spirituality and what it means in the care of patients. Providing spiritual care is individualized and often complex. The nursing process enables the nurse to plan patient care. Providing spiritual care is a challenge orthopaedic nurses must recognize and assume responsibility for.     

The Sacred Circle: a conceptual framework for spiritual care in hospice

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).     

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.     

Endonasal sinus surgery improves mucociliary transport in severe chronic sinusitis

OBJECTIVES: To explore the spiritual needs of the family caregiver and to provide suggestions for giving spiritual care to this caregiver. DATA SOURCES: A caregiver's personal experience and nursing texts. CONCLUSION: Providing care for a loved one with cancer can be stressful for the family caregiver; yet, it can also produce spiritual growth. By providing care for the caregiver, the oncology nurse is equipping this caregiver to address the spiritual needs of the patient. IMPLICATIONS FOR NURSING PRACTICE: Nurses can assist caregivers by offering actions that communicate love, support, acceptance, and faithfulness. Such measures can ease the pain and encourage spiritual wellness.     

Developing curricula in spirituality and medicine

In recent years patients and some members of the medical community have expressed the concern that doctors have forgotten about compassion and too often ignore their patients' spiritual concerns. Patients can and should expect their physicians to respect their beliefs and be able to talk with them about spiritual concerns in a respectful and caring manner. Medical schools must teach their students how to meet these expectations, and health care systems need to provide practice environments that foster compassionate caregiving. Medical educators are recognizing the need to bring the art of compassionate caregiving back into the medical school curriculum. This paper focuses on one approach to achieving this goal, the study of spirituality and medicine. The authors discuss the relationship of spirituality and healing, and describe studies that have shown patients' desire to have spiritual issues addressed by their physicians and the potential health benefits of spiritual beliefs. Finally, they describe common elements of the spirituality courses offered by approximately 50 U.S. medical schools, including 19 schools that have been awarded grants from the National Institute for Healthcare Research for the development of curricula in spirituality and medicine.     

A federal role in hospice care?

Discusses the advantages of hospice care for dying patients and how the federal government should support such care. Support could include the use of restricted drugs (such as heroin) to relieve pain in terminal illness, the allowance of Medicare patients to transfer their coverage from hospital to hospice if they so choose, and the initiation of a meaningful debate on the appropriate federal role in hospice funding and support. Current bills pending in Congress that concern such measures are described. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feasible criteria for enrolling end-stage dementia patients in home hospice care

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.     

The relevance of a psychoanalytic perspective in exploring religious and spiritual identity in psychotherapy.

The attempt to make meaning of the soul is inherent to psychoanalytic inquiry, despite its historical diminution of religion and spirituality. Feminist ideology and multicultural psychology have played a critical role in challenging traditional psychoanalytic conceptions of the practice of religion and spirituality as pathological and/or regressive. Contemporary psychoanalysis that emphasizes two-person psychology, and the intersubjective aspects of the analytic space has also allowed for more open inquiry into the spiritual lives of clients and therapists. Both psychoanalysis and spirituality share the goal of a search for particular aspects of one's identity. This search for one's real or true self becomes particularly poignant for both the therapist and the client, as it is highly reliant on the therapist's and the client's specific religious and spiritual contexts. This paper examines the development of identity as influenced by religious and spiritual beliefs. The author discusses a clinical case to illustrate the complex interaction between religious traditions and individual experiences of religion and spirituality, and related implications of a contemporary psychoanalytic approach to psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiritual disclosure between older adolescents and their mothers.

This study examines the role of spiritual disclosure within older adolescent-mother relationships. Spiritual disclosure is defined as mutual disclosure of personal religious and spiritual beliefs and practices. Three hundred 18- to 20-year-old college students and 130 of their mothers reported on spiritual disclosure in their relationships. According to both parties, greater spiritual disclosure was related to higher relationship satisfaction, greater use of collaborative conflict resolution strategies, less dysfunctional communication patterns, less verbal aggression, and increased general disclosure in mother-adolescent relationships beyond global religiousness and demographics. Spiritual disclosure also predicted unique variance in collaborative conflict resolution strategies beyond these factors and general disclosure. The findings underscore the value of attending to the interpersonal dimension of religion/spirituality. More specifically, the results suggest that spiritual disclosure is an indicator of relationship quality, one that is tied to better relationship functioning, and one that merits further attention in studies of family dynamics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and hospice: Where we are and where we can be.

Since the early days of the hospice movement, the role of psychologists in hospice care has been discussed. This study is based on questionnaire responses from hospice programs randomly drawn from those who were members of the National Hospice and Palliative Care Organization. The results clearly demonstrate the need for psychology's role in hospice, but there is much to do to clarify and develop this role. Although psychologists have much to offer in the hospice field and end-of-life care in general, this study found that there are not many psychologists actively working in these settings. Suggestions are made for how psychologists can become more involved in the provision of hospice and other end-of-life care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology, spirituality, and end-of-life care: An ethical integration?

With an increased focus on multidisciplinary care, psychologists are being called to work within palliative care teams. Spirituality is often a salient issue for palliative individuals, and has significant implications with respect to psychological functioning. This paper discusses the incorporation of spirituality/religion into psychological end of life care, with a focus on the biopsychosocial-spiritual model of health, and the consideration of spirituality/religion as an aspect of cultural diversity. Discussion also surrounds the ethical integration of spirituality/religion into psychological assessment and treatment, as well as recommendations for clinical training. An overall theme of this article is that attending to the spiritual needs of palliative individuals is important to fulfill one's ethical responsibilities as a psychologist. Thus, seeking ways to ethically integrate these concepts into psychology training and practice remains an essential endeavour. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing religious and spiritual issues in trauma-focused cognitive behavior therapy for children and adolescents.

Psychologists have become increasingly concerned with the role of religion and spirituality in resolving childhood physical and sexual abuse, particularly religion-related abuse. In treating victims of child abuse, trauma-focused cognitive behavior therapy has emerged as a leading treatment for recovery. In this article, we discuss the relevance of religious and spiritual issues in trauma-focused cognitive behavior therapy for children and teens. Using three case studies, we then present a model for assessing and treating religion and spirituality in trauma-focused cognitive behavior therapy. This model focuses on the client’s pre-existing religious and spiritual functioning as well as changes in religion/spirituality after abuse. We suggest that this approach will assist clients from various religious and spiritual affiliations to process childhood abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spirituality in medical practice

Body, mind, and spirit are integrally connected. Medical training in the Western world has been strong concerning the more easily measured physical aspects, and on the mental needs it has been virtually mute on how to minister to the spiritual needs of our patients. Learning the spiritual aspects of medical care is not a typical part of the medical school curriculum, and yet it is emerging as something that our patients want and expect us to do as part of our caring for them. Herein I discuss the role of spirituality in medical practice, how it relates to alternative medical practices, methods to use to grow spiritually, and ways to apply your spirituality to medical practice.     

The meaning and impact of empathic relationships in hospice nursing

This naturalistic field study was designed to explore the patient's perspective of the nature, meaning, and impact of empathic relationships with hospice nurses. The findings are part of a larger study, focused on the meaning and impact of empathic relationships that develop between hospice nurses and their patients. Data were generated through in-depth interviews with 14 terminally ill adults receiving home-based hospice care. According to the hospice patient, an empathic relationship developed through a process of reciprocal sharing and revealing of personhood within a context of caring and acceptance. The experience of an empathic relationship meant being acknowledged as an individual, a person of value. The outcome of the empathic relationships between hospice nurses and their patients was the improvement and maintenance of patients' physical and emotional well-being. Understanding the patient's perspective is critical for effective nursing interventions and meaningful outcomes. Future research needs to explore empathic relationships between the nurse and family caregivers in various settings.