Expert Discussion on Taking a Spiritual History.

This article elaborates on the hazards of spiritual history taking. It provides expert insights to consider before entering the field. In summer 2012, a group of spiritual care experts were invited to discuss the complexity of taking spiritual histories in a manner of hermeneutic circle. Thematic analysis was applied to define the emerging themes. The results demonstrate that taking a spiritual history is a complex and challenging task, requiring a number of personal qualities of the interviewer, such as 'being present', 'not only hearing, but listening', 'understanding the message beyond the words uttered', and 'picking up the words to respond'. To 'establish a link of sharing', the interviewer is expected 'to go beyond the ethical stance of neutrality'. The latter may cause several dilemmas, such as 'fear of causing more problems', 'not daring to take it further', and above all, 'being ambivalent about one's role'. Interviewer has to be careful in terms of the 'patient's vulnerability'. To avoid causing harm, it is essential to propose 'a follow-up contract' that allows responding to 'patient's yearning for genuine care'. These findings combined with available literature suggest that the quality of spiritual history taking will remain poor unless the health-care professionals revise the meaning of spirituality and the art of caring on individual level.

'Spiritual care is not the hospital's business': a qualitative study on the perspectives of patients about the integration of spirituality in healthcare settings.

BACKGROUND: Several studies have investigated the relationship between spirituality and health. They claim the need to develop spiritual care to answer patients' spiritual suffering and to promote spiritual well-being. However, the present study critically analyses the following idea: we ought to take care of the spiritual dimension of patients. Does this interest for spirituality not come from healthcare professionals' desire more than from the patients themselves? OBJECTIVE: To answer this question, we explored the perspectives of individuals with cancer regarding the integration of spirituality in the healthcare setting. DESIGN: Qualitative design using semistructured interviews to focus on subjective experience. SETTING: One of the major public hospitals of Paris, France. PARTICIPANTS: 20 participants (n=11 men and n=9 women) with advanced cancer (stage IV). Age ranges from 37 to 80 years with a mean age of 58.7 years. RESULTS: Findings demonstrated that participants do not expect help from the hospital to handle spiritual issues but they wish for their spiritual dimension to be simply recognised as a part of their identity and dignity. CONCLUSIONS: Findings invite us to view the question of spirituality not as a new dimension of care but as a new challenge for healthcare institutions to recognise that the persons they are working for are not just 'patients' but human beings with a precious interior life.

The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons.

BACKGROUND: Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically acceptable instrument to assess spiritual distress in hospitalized elderly patients. METHODS: A three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT): 1) Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model) to define the different dimensions characterizing a patient's spirituality and their corresponding needs; 2) Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs related to each of the defined dimensions; 3) Qualitative assessment of the instrument's acceptability and face validity in hospital chaplains. RESULTS: Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups. CONCLUSIONS: The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patient's plan of care.

What Motivates Healthcare Professionals' Referrals to Chaplains, and How to Help Them Formulate Referrals that Accurately Reflect Patients' Spiritual Needs?

As many hospitals lack standardized referral protocols for spiritual care, healthcare professionals' perceptions and preferences play an important role in their decisions to refer patients to chaplains. To better understand what motivates these professionals to refer patients and how they approach spiritual care, this article examines referral requests from twelve healthcare professionals to a chaplain at the Lausanne University Hospital Department of Physical and Rehabilitation Medicine. Comparative discourse analysis highlights that requests are largely driven by difficulties in patient-professional relationships. Yet, further interviews reveal that healthcare professionals construct spiritual care as a way to access patients' sense of identity and explore the meaning they give to their lives and experiences, for the benefit of both patients and professionals. The discussion considers how chaplains could help healthcare colleagues formulate referrals that accurately reflect patients' spiritual needs, thus improving the relevance and quality of spiritual care.

When is knowledge ripe for primary care? An exploratory study on the meaning of evidence.

The objectives of this study were to explore the meaning of scientific evidence as it is understood by primary care physicians. Individual interviews were conducted with actors chosen for their roles in the production and use of knowledge: 22 family physicians, 13 specialist physicians, and 6 researchers. Two situations served as points of reference for these discussions: screening for genetic breast cancer and treatment of hypertension. The results suggest that there may be a misunderstanding between the producers of knowledge and primary care practitioners with respect to what constitutes "evidence"--knowledge ready for integration into the clinical practice of primary care. These potential differences go beyond the issues of how information is disseminated. Rather, many of the questions raised by family physicians concern how knowledge is developed. In the interests of fostering better dissemination of new knowledge and encouraging its adoption, new links should be created between knowledge "producers" and potential users.

[Development of nursing pratice in family medecine groups]. / L'essor des soins infirmiers en GMF.

The purpose of the study was to analyze the development of nursing practice in family medicine groups (FMGs). The two-year case study consisted of 73 semi-directed interviews ofnurses, physicians and managers in five FMGs. The findings led to three main observations: nursing practice varies considerably from one FMG to another, the development of nurses' practice seems to be associated with the development of a collaborative relationship, and the satisfaction of the professionals in the FMG, nurses in particular, depends on the type of practice. It is important to implement measures to encourage the optimal use ofnurses' skills in a FMG.

Hyped biomedical science or uncritical reporting? Press coverage of genomics (1992-2001) in Québec.

Genomics integrates the promises and perils of modern biomedical science. Canada and the province of Québec embarked late but aggressively in genomics research based on the 'discourse of promise' in which genomics is embedded. This did not prevent the emergence of a 'discourse of concerns', and debates on the wider meaning of genomics and on the risks related to genomics applications such as gene therapy and gene testing. Given this context, this study aims to understand the evolution of genomics press coverage from the early days up to the publication of the draft sequence of the human genome. Accordingly, we performed a press content analysis on 749 articles reporting genomics research in Québec from 1992 to 2001. We focused on coverage of benefits and ethical issues, tone, and differences in reporting practices between press agencies and journalists. Results show an increasing number of articles, a general decline in the proportion of articles featuring ethical issues, an increased focus on the economy, and greater optimism from 1992 to 2001. In comparison to articles written by journalists, articles signed by press agencies are more optimistic and less often feature ethical issues. Results are discussed following two non-exclusive interpretations: (1) the successes of genomics and its institutionalization in Québec and Canada brought hype and greater social acceptance, and (2) uncritical reporting practices have emerged under pressures for expedient and consumable writing. We are left with two concerns: given worldwide media concentration movements, what are the challenges for the dissemination of diversified and critical information in print media? And, given limited coverage of ethical issues, and concerns about bioethics being too narrowly focused, should public debates on frontier biomedical science be promoted to broaden the scope of biomedical ethics?

[Discursiveness and co-authority in clinical ethics]. / Discursivite et co-autorite en ethique clinique: regard critique sur le role et les fonctions de la deliberation ethique en comite

Clinical ethics, as instituted in committees, aims to solve ethical problems by means of interdisciplinary deliberation. Elucidation and deliberation are used a s pragmatic means whose finality is decision-making. This being so, it may be wondered if clinical ethics has not been pruned of its more global critical potential. Narrative approaches open some ways of thinking of this critical function, but they seem to us to be nevertheless still insufficient for the task. We propose to explore the heuristic and practical fertility of the concepts of discursiveness--more inclusive than narrativity--, and co-authority--that we will have to situate and relate to notions of power, expertise and normativity--, in order to give fresh thought to the role and functions of a clinical ethics committee in a health care institution, and consequently the possible contribution of clinical ethics both as deliberation process and critical reflection of practices. To achieve this result, we propose the following approach. First of all, we will identify the limits of current narrative proposals. Secondly, we will present the concept of discursiveness based on work that follows on from the ethics of discussion. Thirdly, we will expose our definition of the concept of co-authority in a discursive space which includes both the actors of the clinical situation and the actors of the deliberation. Fourthly and finally, we will draw the consequences for a critical theory of the role and functions of a clinical ethics committee.

Microscopic examination of chitosan-polyphosphate beads with entrapped spores of the biocontrol agent, Streptomyces melanosporofaciens EF-76.

Spores of the biocontrol agent, Streptomyces melanosporofaciens EF-76, were entrapped by complex coacervation in beads composed of a macromolecular complex (MC) of chitosan and polyphosphate. A proportion of spores entrapped in beads survived the entrapment procedure as shown by treating spores from chitosan beads with a dye allowing the differentiation of live and dead cells. The spore-loaded chitosan beads could be digested by a chitosanase, suggesting that, once introduced in soil, the beads would be degraded to release the biocontrol agent. Spore-loaded beads were examined by optical and scanning electron microscopy because the release of the biological agent depends on the spore distribution in the chitosan beads. The microscopic examination revealed that the beads had a porous surface and contained a network of inner microfibrils. Spores were entrapped in both the chitosan microfibrils and the bead lacuna.

Streptomycete spores entrapped in chitosan beads as a novel biocontrol tool against common scab of potato.

Spores of Streptomyces melanosporofaciens EF-76, an actinomycete that inhibits the growth of several plant pathogens, were incorporated in beads of chitosan and polyphosphate using the entrapment technique called complex coacervation. The degradation of spore-loaded beads was monitored by measuring the residual amount of chitosan in soil and by enumerating the S. melanosporofaciens population over time. After the introduction of spore-loaded chitosan beads into soil, the amount of chitosan in sterile soil remained at 1.550 mg/g throughout the first week and diminished to 0.101 mg/g after 7 weeks. Bead degradation proceeded faster in non-sterile soil but a progressive release of both chitosan oligomers and the antagonistic microbial agent was nevertheless observed. Application of these spore-loaded chitosan beads to seed potato tubers protected progeny tubers against common scab.