RESUMO
In the Intensive Care Unit (ICU), family members experience psychological and spiritual distress as they cope with fear, grief, and medical decisions for patients. The study team developed and pilot tested a semistructured chaplain intervention that included proactive contact and spiritual assessment, interventions, and documentation. An interdisciplinary team developed the intervention, the Spiritual Care Assessment and Intervention (SCAI) Framework. Three chaplains delivered the intervention to surrogates in two ICUs. There were 25 of 73 eligible patient/surrogate dyads enrolled. Surrogates had a mean age of 57.6, were 84% female and 32% African American. The majority (84%) were Protestant. All received at least one chaplain visit and 19 received three visits. All agreed they felt supported by the chaplains, and qualitative comments showed spiritual and emotional support were valued. A semistructured spiritual care intervention for ICU surrogates is feasible and acceptable. Future work is needed to demonstrate the intervention improves outcomes for surrogates and patients.
Assuntos
Serviço Religioso no Hospital , Família/psicologia , Melhoria de Qualidade/organização & administração , Serviço Religioso no Hospital/métodos , Serviço Religioso no Hospital/organização & administração , Estudos de Viabilidade , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Desenvolvimento de Programas , EspiritualidadeRESUMO
Community health workers (CHWs) can engage elderly persons in advance care planning (ACP) conversations. We report how trained CHWs used Go Wish cards (GW R cards) to identify patients' highest priority preferences and evaluated whether engaging in ACP conversations was associated with subsequent health care utilization. A one-year long, pre-post longitudinal design was used to evaluate our educational intervention using mixed-methods. 392 patients (mean of 73.3 years, 82% women, 48% African American, 43% Caucasian) enrolled in the Aging Brain Care (ABC) program and participated in ACP discussions with CHWs. We expanded the role of the ABC's CHW, who work directly with individuals and caregivers during home visits to monitor bio-psycho-social needs, to include ACP conversations. The CHWs received ACP training, practice with tools such as GW R cards, and support from an electronic health record (EHR) clinical decision support tool. Quantitative measures of patients' ACP preferences and health care utilization were abstracted from the EHR. Qualitative data about patients' perceptions of CHWs in facilitating ACP discussions was obtained through semi-structured interviews. Eighty-six patients' data indicated that they had engaged in a preferences-for-care process using GW R cards. The top-three card choices by patients was attending to spirituality and religious concerns, preparing for end of life, and maintaining personal wholeness. CHWs were able to effectively engage in ACP conversations with patients and GW R cards were a positive way to stimulate discussion of issues previously undiscussed.
Assuntos
Planejamento Antecipado de Cuidados , Agentes Comunitários de Saúde , Preferência do Paciente , Saúde Pública/métodos , Assistência Terminal , Idoso , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences. OBJECTIVE: To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment. RESEARCH DESIGN: A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation. SUBJECTS: The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white. MEASURES: Documentation of ACP conversation in electronic health record fields and health care utilization outcomes. RESULTS: In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45-0.97), and similar effects are apparent on ED use independent of age and prior ED use effects. CONCLUSIONS: Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.
Assuntos
Planejamento Antecipado de Cuidados , Agentes Comunitários de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Relações Profissional-Paciente , Idoso , Doença Crônica , Comunicação , Documentação , Feminino , Humanos , Entrevistas como Assunto , Masculino , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. METHOD: Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. RESULTS: Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. SIGNIFICANCE OF RESULTS: Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for "sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers.
Assuntos
Planejamento Antecipado de Cuidados/tendências , Educação em Saúde/métodos , Cuidados Paliativos/métodos , Ensino/normas , Educação em Saúde/normas , Humanos , Indiana , Autocuidado , Autoeficácia , Inquéritos e Questionários , Recursos HumanosRESUMO
We conducted semi-structured interviews with 46 surrogate decision makers for hospitalized older adults to characterize the role of spirituality and religion in decision making. Three themes emerged: (1) religion as a guide to decision making, (2) control, and (3) faith, death and dying. For religious surrogates, religion played a central role in end of life decisions. There was variability regarding whether God or humans were perceived to be in control; however, beliefs about control led to varying perspectives on acceptance of comfort-focused treatment. We conclude that clinicians should attend to religious considerations due to their impact on decision making.
Assuntos
Tomada de Decisões , Pacientes Internados/psicologia , Religião e Medicina , Espiritualidade , Assistência Terminal/psicologia , Idoso , Atitude Frente a Morte , Feminino , Humanos , Masculino , Terapias Mente-CorpoRESUMO
On August 20, 2013, Terry Bard, John Carr, and Steve Ivy had a 50-minute conversation about the shift that has been taking place in Canada and the United States in the practice, and the language about that practice, of persons and professional associations that have historic roots in the modern pastoral care and counseling movement. The conversation was digitally recorded, by agreement among the three participants, and is posted on the internet as a stimulus to further conversation.
Assuntos
Serviço Religioso no Hospital/normas , Aconselhamento/normas , Assistência Religiosa/normas , Competência Profissional/normas , Espiritualidade , Canadá , Humanos , Papel Profissional , Relações Profissional-Paciente , Estados UnidosRESUMO
OBJECTIVE: To understand high-performing frontline employees' values as reflected in their narratives of day-to-day interactions in a large health care organization. METHODS: A total of 150 employees representing various roles within the organization were interviewed and asked to share work-life narratives (WLNs) about value-affirming situations (i.e. situations in which they believed their actions to be fully aligned with their values) and value-challenging situations (i.e. when their actions or the actions of others were not consistent with their values), using methods based on appreciative inquiry. RESULTS: The analysis revealed 10 broad values. Most of the value-affirming WLNs were about the story-teller and team providing care for the patient/family. Half of the value-challenging WLNs were about the story-teller or a patient and barriers created by the organization, supervisor, or physician. Almost half of these focused on "treating others with disrespect/respect". Only 15% of the value-challenging WLNs contained a resolution reached by the participants, often leaving them describing unresolved and frequently negative feelings. CONCLUSIONS: Appreciative inquiry and thematic analysis methods were found to be an effective tool for understanding the important and sometimes competing role personal and institutional values play in day-to-day work. There is remarkable potential in using WLNs as a way to surface and reinforce shared values and, perhaps more importantly, respectfully to identify and discuss conflicting personal and professional values.
RESUMO
This study tested whether two 1-day retreats focused on spiritual self-care would positively change nurse participants' spirituality. A total of 199 critical care nurses were accepted into this study; 87 were randomized to receive the retreat intervention. All 199 nurses were tested preretreat, 1 month and 6 months postretreat. Retreat participants demonstrated increased spirituality.
Assuntos
Educação Continuada em Enfermagem/organização & administração , Recursos Humanos de Enfermagem Hospitalar , Autocuidado , Espiritualidade , Adaptação Psicológica , Adulto , Análise de Variância , Atitude do Pessoal de Saúde , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Currículo , Empatia , Feminino , Seguimentos , Saúde Holística , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Papel do Profissional de Enfermagem/psicologia , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Autocuidado/métodos , Autocuidado/psicologia , Autoavaliação (Psicologia)RESUMO
This qualitative study was designed to cull the wisdom of CPE supervisors doing especially competent supervisory education and to develop a theory of CPE supervisory education. Grounded theory methodology included interviewing 11 supervisors and coding the data to identify themes. Four primary dimensions emerged along with a reciprocal core dimension, Supervisory Wisdom, which refers to work the supervisors do in terms of their continuing growth and development.
Assuntos
Competência Clínica , Relações Interprofissionais , Liderança , Mentores , Assistência Religiosa/educação , Assistência Religiosa/organização & administração , Adulto , Idoso , Anedotas como Assunto , Catolicismo , Serviço Religioso no Hospital , Educação Profissionalizante/organização & administração , Ética Profissional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Teologia/educaçãoRESUMO
The authors report the pragmatic elements of conducting an empirical chaplaincy research project. The article offers the step-by-step process of implementing, coordinating, and completing a sound quantitative research project. The authors offer a definitive answer to the question, "Can a staff chaplain integrate providing pastoral care and doing a quantitative research project as principle investigator"?
Assuntos
Serviço Religioso no Hospital , Estudos de Casos Organizacionais , Pesquisa , Humanos , Indiana , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
This article supports chaplain investment in research activities. These activities should be guided by recognition of the complexity of human experience, integrative theologies and philosophies, and systemic consciousness.