The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

The assessment of spiritual well-being in cancer patients with advanced disease: which are its meaningful dimensions?

BACKGROUND: Spirituality is particularly important for patients suffering from life-threatening illness. Despite research showing the benefits of spiritual assessment and care for terminally ill patients, their spiritual needs are rarely addressed in clinical practice. This study examined the factor structure and reliability of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) in patients with advanced cancer. It also examined the clinical meaning and reference intervals of FACIT-Sp scores in cancer patients subgroups through a literature review. METHODS: A forward-backward translation procedure was adopted to develop the Italian version of the FACIT-Sp, which was administered to 150 terminally ill cancer patients. Exploratory factor analysis was used for construct validity, while Cronbach's α was used to assess the reliability of the scale. RESULTS: This study replicates previous findings indicating that the FACIT-Sp distinguish well between features of meaning, peace, and faith. In addition, the internal consistency of the FACIT-Sp was acceptable. The literature review also showed that terminal cancer patients have the lowest scores on the Faith and Meaning subscales, whereas cancer survivors have the highest scores on Faith. CONCLUSIONS: The Italian version of the FACIT-Sp has good construct validity and acceptable reliability. Therefore, it can be used as a tool to assess spiritual well-being in Italian terminally ill cancer patients. This study provides reference intervals of FACIT-Sp scores in newly diagnosed cancer patients, cancer survivors, and terminally ill cancer patients and further highlights the clinical meaning of such detailed assessment.

A Spiritual Well-Being Model for the Healing Arts.

This article presents a theoretical model based on a synthesis of psychological (the word psyche means soul) theories regarding components of the human spirit, human spirituality, and the development of spiritual well-being, with a focus on the relationship between stress and human spirituality. These components include an insightful relationship with both oneself and others, a strong personal value system, and a meaningful purpose in one's life. Additional aspects include a model for spiritual growth (seasons of the soul) and various aspects of one's life experience that hinder or promote greater spiritual growth. Based on this model, holistic nurses may integrate these concepts into their world view of holistic healing and include the health of the human spirit as a greater part of the holistic wellness paradigm.

Remembrance and Renewal: Health Care Staff Spiritual Self-Care.

Relationship-based care (RBC), a holistic framework of caring, models partnerships in caring to permeate at levels of patient, provider-self, provider-teams, and community. Remembrance and Renewal (R&R) is a RBC practice addressing spiritual self-care. At a dedicated time and space, R&R is offered monthly, rotating through six different buildings at an academic, medical center. To date, close to 2,000 visits have occurred. Those engaging in the practice express appreciation for the space to grieve and space to renew their spirit. R&R is a RBC practice in alignment with the scope and standards of holistic nursing practice and addresses the Quadruple Aim of improving health care staff's work-life balance.

Spiritual Care in Holistic Nursing Education: A Spirituality and Health Elective Rooted in T.R.U.S.T. and Contemplative Education.

Research to date demonstrates that spiritual care as an integral part of holistic nursing can be hampered if nurses experience insufficient preparation or organizational cultures that fail to prioritize spiritual well-being. In response, the author has developed a three-credit spirituality and health elective in an undergraduate nursing program to help participants address spiritual needs and mobilize spiritual strengths within themselves, patients, and workplaces. Using the T.R.U.S.T. Model for Inclusive Spiritual Care as its framework, the six-unit course draws on contemplative education practices in hopes of preparing a critical mass of nurses with the ability and confidence to foster safe, relevant spiritual care and promote a holistic, patient-centered health care culture. Course participants regularly demonstrate and report deeper self-awareness, skills development, and confidence in relation to spiritual care; the course also has been positively evaluated and fully subscribed over its seven offerings to date, validating its effectiveness in relation to short-term outcomes. Research is needed to evaluate its long-term effectiveness in helping alumni integrate spiritual care into their holistic practice and workplace culture.

The Invisibility of Spiritual Nursing Care in Clinical Practice.

Background and Purpose: Spirituality has been identified as the essence of being human and is recognized, by many health care professionals, as a central component in health and healing. Scholars have identified spiritual nursing care as essential to nursing practice and include caring for the human spirit through the development of relationships and interconnectedness between the nurse and the patient. However, despite the recognition of spiritual practices as important to health, little attention has been given to spirituality in nursing practice and education in the literature. The purpose of this article is to explore factors contributing to the invisibility of spiritual nursing care practices (SNCP), recognition and offer strategies to enhance the visibility of SNCP. Two major factors that reduce visibility of SNCP are conceptual confusion differentiating between spirituality and religion and limited education in the area of spirituality including nursing curricula and organizations. Strategies to enhance visibility of SNCP include educational approaches in nursing curricula and health care organizations. to influence nurses' perceptions about spirituality and creation of a culture of spiritual care. Conclusion: Holistic nursing includes assessing and responding to the spiritual needs of patients. Changes in nursing education and health care systems are needed to increase the visibility of SNCP.

One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients Receiving Dialysis.

BACKGROUND: This study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis. STUDY DESIGN: Longitudinal observational study. SETTING & PARTICIPANTS: 227 patients recruited from 12 dialysis centers. FACTORS: Sociodemographic and clinical characteristics. MEASUREMENTS/OUTCOMES: Participants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient's Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time. RESULTS: Although dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (all P<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (all P<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time. LIMITATIONS: Study was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied. CONCLUSIONS: Multidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.

Is There a Need for Including Spiritual Care in Interdisciplinary Rehabilitation of Chronic Pain Patients? Investigating an Innovative Strategy.

OBJECTIVE: Chronic noncancer pain influences patient's quality of life and their ability to cope. Pain relieving medication and other specific treatments commonly integrated in biopsychosocial rehabilitation demonstrate modest benefits in pain relief and improved functioning of individuals. Spiritual care, covering the fourth dimension provides insight, inspires hope and purpose, and is thought to mediate mental and physical health for patients. This study explores the need for its inclusion in interdisciplinary pain rehabilitation and describes the requirements and test environment for evaluation. METHODS: Outcomes of spiritual care and interdisciplinary pain rehabilitation in follow-up studies of randomized controlled trials contained in systematic reviews were summarized. Pubmed, Cochrane, and PsycINFO were searched, citation tracking was applied, articles of follow-up studies therein were located. Literature was searched for insights pertaining to requirements for an assessment of including this fourth dimension. RESULTS: No systematic reviews for spiritual care were identified. Five systematic reviews of biopsychosocial rehabilitation containing 14 studies describing long-term outcomes were retrieved. The importance of coping in maintaining long-term outcomes was empirically illustrated. The required test environment is provided by a structured multidimensional care pathway separating spirituality from well-being and mental health, with measures of treatment outcome installed enabling a comparison with benchmarks. CONCLUSIONS: Active coping seems beneficial for maintaining positive long-term outcomes of interdisciplinary pain rehabilitation Spiritual care may be conducive to active coping. Further research is warranted to explore the additive value of this spiritual care in the context of a multidimensional care pathway.

The integration of the "spirituality in medicine" curriculum into the osteopathic communication curriculum at Kansas City University of Medicine and Biosciences.

With grant funding from the John Templeton Spirituality and Medicine Curricular Award to the George Washington Institute for Spirituality and Health, faculty at Kansas City University of Medicine and Biosciences (KCUMB) developed the "Spirituality in Medicine" curriculum. In developing the curriculum, faculty took into consideration competencies required by the Association of American Medical Colleges and qualitative results from surveys of medical school applicants and enrolled students. Strategies for curriculum delivery included lectures, panel discussions, role-playing, and training in the use of a spirituality assessment tool. A majority of the 250 students who received the training in 2010-2011 were able to demonstrate the following competencies: (1) being sensitive to patients' spiritual and cultural needs, (2) assessing patients' and their own spiritual needs, (3) appropriately using chaplain services for patient care, and (4) understanding the effects of health disparities and ethical issues on patient care. Challenges to implementation included a reduction in chaplain availability due to the economic downturn, a lack of student exposure to direct patient care during shadowing, too little religious diversity among chaplains, and changes in assignment schedules. New competencies required by the National Board of Osteopathic Medical Examiners overlap with and help ensure sustainability of the Spirituality in Medicine curriculum. KCUMB leaders have incorporated the use of the spirituality assessment tool into other parts of the curriculum and into service experiences, and they have introduced a new elective in palliative care. Synergistic efforts by faculty leaders for this initiative were critical to the implementation of this curriculum.

Comparing clinician ratings of the quality of palliative care in the intensive care unit.

OBJECTIVE: There are numerous challenges to successfully integrating palliative care in the intensive care unit. Our primary goal was to describe and compare the quality of palliative care delivered in an intensive care unit as rated by physicians and nurses working in that intensive care unit. DESIGN: Multisite study using self-report questionnaires. SETTING: Thirteen hospitals throughout the United States. PARTICIPANTS: Convenience sample of 188 physicians working in critical care (attending physicians, critical care fellows, resident physicians) and 289 critical care nurses. MEASUREMENTS AND MAIN RESULTS: Clinicians provided overall ratings of the care delivered by either nurses or physicians in their intensive care unit for each of seven domains of intensive care unit palliative care using a 0-10 scale (0 indicating the worst possible and 10 indicating the best possible care). Analyses included descriptive statistics to characterize measurement characteristics of the ten items, paired Wilcoxon tests comparing item ratings for the domain of symptom management with all other item ratings, and regression analyses assessing differences in ratings within and between clinical disciplines. We used p < .001 to denote statistical significance to address multiple comparisons. The ten items demonstrated good content validity with few missing responses or ceiling or floor effects. Items receiving the lowest ratings assessed spiritual support for families, emotional support for intensive care unit clinicians, and palliative-care education for intensive care unit clinicians. All but two items were rated significantly lower than the item assessing symptom management (p < .001). Nurses rated nursing care significantly higher (p < .001) than physicians rated physician care in five domains. In addition, although nurses and physicians gave comparable ratings to palliative care delivered by nurses, nurses' and physicians' ratings of physician care were significantly different with nurse ratings of this care lower than physician ratings on all but one domain. CONCLUSION: Our study supports the content validity of the ten overall rating items and supports the need for improvement in several aspects of palliative care, including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the intensive care unit. Furthermore, our findings provide some preliminary support for surveying intensive care unit clinicians as one way to assess the quality of palliative care in the intensive care unit.

Religiosidade, espiritualidade e doenças cardiovasculares / Religiosity, spirituality and cardiovascular diseases

A relação entre religiosidade/espiritualidade (R/E) e o processo saúde-doença se faz de longa data. Estudos epidemiológicos têm mostrado uma relação entre R/E e doenças cardiovasculares, incluindo menores prevalências de depressão, maior sobrevida, menores níveis pressóricos e menores complicações pós-cirúrgicas. Entretanto, ainda são poucos os médicos que abordam esse tema na sua consulta. Os pacientes cardiológicos, por apresentarem doenças crônicas e muitas vezes de desfechos fatais, podem se beneficiar de uma história espiritual para que o cardiologista possa conhecer como as crenças do paciente podem influenciar em seu tratamento e de que forma isso lhe traz conforto ou sofrimento.

Clinical holistic health: advanced tools for holistic medicine.

According to holistic medical theory, the patient will heal when old painful moments, the traumatic events of life that are often called "gestalts", are integrated in the present "now". The advanced holistic physician's expanded toolbox has many different tools to induce this healing, some that are more dangerous and potentially traumatic than others. The more intense the therapeutic technique, the more emotional energy will be released and contained in the session, but the higher also is the risk for the therapist to lose control of the session and lose the patient to his or her own dark side. To avoid harming the patient must be the highest priority in holistic existential therapy, making sufficient education and training an issue of highest importance. The concept of "stepping up" the therapy by using more and more "dramatic" methods to get access to repressed emotions and events has led us to a "therapeutic staircase" with ten steps: (1) establishing the relationship; (2) establishing intimacy, trust, and confidentiality; (3) giving support and holding; (4) taking the patient into the process of physical, emotional, and mental healing; (5) social healing of being in the family; (6) spiritual healing--returning to the abstract wholeness of the soul; (7) healing the informational layer of the body; (8) healing the three fundamental dimensions of existence: love, power, and sexuality in a direct way using, among other techniques, "controlled violence" and "acupressure through the vagina"; (9) mind-expanding and consciousness-transformative techniques like psychotropic drugs; and (10) techniques transgressing the patient's borders and, therefore, often traumatizing (for instance, the use of force against the will of the patient). We believe that the systematic use of the staircase will greatly improve the power and efficiency of holistic medicine for the patient and we invite a broad cooperation in scientifically testing the efficiency of the advanced holistic medical toolbox on the many chronic patients in need of a cure. The level-8 tools can traumatize the patient if used incorrectly. Some of the level 9 tools and most of the level-10 tools can be severely traumatising for the patient, even when used correctly, so there must be compelling reasons for using them, and the patient must know, understand, and accept the risk before the onset of treatment.