Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation.

BACKGROUND: The concept of "total pain" plays an important role in palliative care; it means that pain is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension. Understanding what spirituality entails, however, is a challenge for health care professionals, as is screening for the spiritual needs of patients. OBJECTIVE: This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format. METHODS: In a mandatory seminar within the palliative care curriculum at our university, both a physician and a hospital chaplain teach strategies in symptom control from different perspectives (somatic domain - spiritual domain). For evaluation purposes of the content taught on the spiritual domain, we conducted a questionnaire consisting of two parts: specific outcome evaluation making use of the comparative self-assessment (CSA) gain and overall perception of the seminar using Likert scale. RESULTS: In total, 52 students participated. Regarding specific outcome evaluation, the greatest gain was achieved in the ability to define total pain (84.8%) and in realizing its relevance in clinical settings (77.4%). The lowest, but still fairly high improvement was achieved in the ability to identify patients who might benefit from spiritual counselling (60.9%). The learning benefits were all significant as confirmed by confidence intervals. Overall, students were satisfied with the structure of the seminar. The content was delivered clearly and comprehensibly reaching a mean score of 4.3 on Likert scale (4 = agree). The content was perceived as overall relevant to the later work in medicine (mean 4.3). Most students do not opt for a seminar solely revolving around spiritual care (mean 2.6). CONCLUSIONS: We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. Students do not wish for a seminar which solely revolves around spiritual care but prefer a close link to clinical practice and strategies.

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.

Bio-Psycho-Spiritual Perspectives on Psychedelics: Clinical and Ethical Implications.

Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects-specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward.

Spiritual Experiences, Attitudes, and Behaviors of Yoga Practitioners: Findings from a Cross-Sectional Study in Germany.

The present study aimed to analyze the extent to which yoga practitioners (n = 784) live by their faith/spirituality and how this influences their perceived prosocial behaviors. For that purpose, the model of transformational spirituality was applied. This model assumes that people who experience the sacred in their lives change their attitudes and behaviors and take responsibility in the world. Data from this cross-sectional anonymous online survey with standardized questionnaires (e.g., Franciscan-Inspired Spirituality Questionnaire, Awe/Gratitude Scale, World Health Organization Five Well-Being Index) showed that for most of the enrolled yoga practitioners, yoga is a conscious way of life and a path of spiritual development. Thus, they search for the Divine in the world, live in accordance with their spiritual convictions, and regard their faith/spiritual convictions as an orientation in their lives. Moreover, they score highly on peaceful attitudes and respectful treatment of others, and on commitment to disadvantaged people and the environment. Although the frequency of asana (postural) or pranayama (breathwork) practices was only marginally related to the indicators of spirituality, the frequency of meditation and studying the philosophical background of yoga was weakly to moderately related to Spiritual Experiences, Awe/Gratitude, and Living by Faith. Respondents' well-being was best predicted by experiential aspects of spirituality, inner congruence/emotional involvement with yoga, and with yoga seen as a spiritual path (R2 = 0.21). Regression analyses (R2 = 0.32) further showed that participants' inner congruence with yoga practices could best be predicted by the experiential aspects of spirituality and, to a lesser extent, by the frequency of asana practices, duration of yoga practice, and Peaceful Attitude/Respectful Treatment. The core dimension of faith and the related experiential aspect of spirituality were thus crucial for the ways the enrolled yoga practitioners behave in the world and interact with others and the environment.

Attitude towards Spirituality and Spiritual Care among Nurses of Bharatpur Hospital.

BACKGROUND: Understanding spirituality and spiritual care is a prerequisite for holistic care in nursing. Spirituality is an important dimension of human existence with a crucial role in health promotion. The objective of this study was to assess the level of attitude towards spirituality and spiritual care among nurses. METHODS: A cross-sectional analytical study design was used among 208 nurses to assess attitude toward spirituality and spiritual care among nurses of Bharatpur Hospital. A pretested semi-structured, self-administered questionnaire was used to collect data from the respondents. The instrument spirituality and spiritual care rating scales were used. Collected data were coded and entered in Microsoft office excel and SPSS version 22 was used for analysis. RESULTS: The finding of the study revealed that, out of 208 respondents, the majority (74.0%) of respondents were of age 20-29 years with a mean and SD of 28.2±5.510. Among all, 125(60.1%) respondents had a moderate attitude score of 32-62, 83(39.9%) had a high level of attitude score of 63-92, whereas 0.5% had a low level of attitude towards spirituality and spiritual care score (0-31).There is no statistically significant relationship between the level of attitude and socio-demographic variables. CONCLUSIONS: It is concluded that most of the respondents had a moderate level of attitude. In-service education and awareness on providing spiritual care among nurses needs to be focused.

Religiosidade/espiritualidade no processo de formação do profissional de saúde: relato de experiência / Religiosity/spirituality in the health professional training process: experience report / Religiosidad/espiritualidad en el proceso educativo de profesionales de la salud: relato de experiencia

INTRODUÇÃO: Por muito tempo os profissionais de saúde seguiram um modelo com uma visão fragmentada do cuidado, focado apenas na doença. Atualmente, esse modelo tem mudado e os profissionais têm adotado uma visão integral do sujeito, ampliando o entendimento de saúde para aspectos biopsicossociais e espiritual no conceito multidimensional de saúde. OBJETIVOS: analisar o processo de formação do profissional de saúde durante a pós-graduação sobre a inclusão da religiosidade e espiritualidade como prática de cuidado em saúde, e identificar as etapas vivenciadas. MÉTODO: Trata-se de uma pesquisa qualitativa, que tem como base metodológica um relato de experiência de março de 2021 a novembro de 2022, a partir da prática de uma residente fisioterapeuta do Programa Multiprofissional em Clínica da Pessoa e da Família. RESULTADOS E DISCUSSÃO: Foram definidos a divisão e o compartilhamento de algumas fases de aprendizado durante a residência: (1) Desconhecimento sobre o tema na graduação, (2) Introdução teórica ao tema da Espiritualidade e (3) Abordagem com os pacientes e os impactos na minha formação. A análise das etapas foi realizada com base nas leituras de artigos científicos realizadas para embasamento do presente estudo. CONSIDERAÇÕES FINAIS: É importante que mais estudos sobre o tema sejam desenvolvidos, com objetivo de incentivar discussões sobre o assunto nas universidades, para que futuros profissionais de saúde tenham uma formação humanizada, ademais, desenvolver métodos eficazes para integração da espiritualidade na prática clínica e construir/validar escalas no Brasil.

INTRODUCTION: For a long time, health professionals followed a model with a fragmented view of care, focused only on the disease. Currently, this model has changed and professionals have adopted an integral view of the subject, expanding the understanding of health to biopsychosocial and spiritual aspects in the multidimensional concept of health. OBJECTIVES: analyze the training process of health professionals during postgraduate studies on the inclusion of religion and spirituality as a health care practice, identifying the stages experienced. METHOD: This is qualitative research and its methodological basis is an experience report from March 2021 to November 2022, based on the practice of a physiotherapist resident of the Multiprofessional Program in Clínica da Pessoa e da Família. RESULTS AND DISCUSSION: It was defined the division and sharing of some learning phases during the residency: (1) Lack of knowledge about the subject in graduation, (2) Theoretical introduction to the theme of Spirituality and (3) Approach with patients and the impacts on my training. The analysis of the stages was carried out based on the readings of scientific articles carried out for the basis of the present study. FINAL CONSIDERATIONS: It is important that more studies on the subject be developed with the aim of encouraging discussions on the subject in universities so that future health professionals have a humanized training, in addition, to develop effective methods for integrating spirituality into clinical practice and to build/validate scales in Brazil.

INTRODUCCIÓN: Durante mucho tiempo, los profesionales de la salud siguieron un modelo con una visión fragmentada del cuidado, centrado únicamente en la enfermedad. Actualmente, ese modelo ha cambiado y los profesionales han adoptado una visión integral del tema, ampliando la comprensión de la salud a aspectos biopsicosociales y espirituales en el concepto multidimensional de la salud. OBJETIVOS: analizar el proceso de formación de los profesionales de la salud durante los estudios de posgrado sobre la inclusión de la religión y la espiritualidad como práctica de atención a la salud, identificando las etapas vividas. MÉTODO: Esta es una investigación cualitativa y su base metodológica es un relato de experiencia de marzo de 2021 a noviembre de 2022, basado en la práctica de un fisioterapeuta residente del Programa Multiprofesional en la Clínica da Pessoa e da Família. RESULTADOS Y DISCUSIÓN: Se definió la división y puesta en común de algunas fases de aprendizaje durante la residencia: (1) Falta de conocimiento sobre el tema en la graduación, (2) Introducción teórica al tema de la Espiritualidad y (3) Acercamiento con los pacientes y los impactos en mi entrenamiento. El análisis de las etapas se realizó a partir de las lecturas de artículos científicos realizadas para la base del presente estudio. CONSIDERACIONES FINALES: Es importante que se desarrollen más estudios sobre el tema con el objetivo de incentivar discusiones sobre el tema en las universidades para que los futuros profesionales de la salud tengan una formación humanizada, además de desarrollar métodos efectivos para integrar la espiritualidad en la práctica clínica y para construir/validar escalas en Brasil.

Longitudinal association of spirituality with depressive symptom trajectories among older adults in mainland China.

OBJECTIVES: The relationship between spirituality and depressive symptoms among the Chinese elderly is not well known. The current study explores this relationship using longitudinal data and trajectory modeling of depressive symptoms. METHODS: A longitudinal study design was used to measure depressive symptoms repeatedly from 2012 to 2021 using the Geriatric Depression Scale (GDS). Group-based trajectory modeling analysis was conducted to determine the trajectories of depressive symptoms, and multiple logistic regression was used to explore the association between spirituality and depressive symptom trajectories. RESULTS: A total of 2333 participants completed at least two GDS measures, and these were included in the Group-based trajectory modeling analysis. An optimal model of three trajectories was derived: no depressive symptoms group (75.2%), new-onset depressive symptoms group (14.4%), and persistent depressive symptoms group (10.4%). Logistic regression modeling revealed that higher spirituality was associated with a lower risk of both new-onset depressive symptoms (OR = 0.68, 95% CI = 0.49-0.93) and persistent depressive symptoms (OR = 0.32, 95% CI = 0.23-0.45). CONCLUSIONS: Spirituality predicts a lower risk of new-onset depressive symptoms and persistent symptoms among older adults in mainland China.

[The Effects of Stress Vulnerability and Parental Burnout on Mental Health in Women with Early School-Age Children during the COVID-19 Pandemic: Mediating Effect of Spirituality].

PURPOSE: This study examined the effects of stress vulnerability and parental burnout on the mental health of women with early school-aged children, with a focus on the mediating role of spirituality. METHODS: A survey was conducted among 171 women with early school-aged children in Gyeonggi Province, Gangwon Province, and Seoul. Data were collected from September to December 2022 using the Korean-Symptom Check List 95, the Parental Burnout Assessment, and the Spirituality Assessment Scale. The data were analyzed using structural equation modeling with SPSS/WIN 22.0 and AMOS 20.0. RESULTS: The study model demonstrated a good fit, explaining 40.5% of the variance in mental health through stress vulnerability, parental burnout, and spirituality. Spirituality had a significant direct impact on mental health. Additionally, participants' spirituality directly influenced their mental health, while stress vulnerability and parental burnout indirectly affected their mental health and were mediated through spirituality. CONCLUSION: Stress vulnerability and parental burnout are negatively associated with mental health, while spirituality partially mediates these effects. Implementing a program to promote spirituality is suggested to assist mothers in recognizing the value and meaning of parenting activities during nursing interventions for mental health.

Understanding Suicide from an Indigenous Cultural Lens: Insights from Elders in Canada.

In this study, Indigenous Elders in Canada were interviewed to explore their conceptualizations of death and dying, particularly in relation to suicide. Through reflexive thematic analysis, three key themes were developed: Indigenous conceptions of death and dying, Christian influences on views of suicide, and indirect suicide. The theme of Indigenous conceptualizations of death and dying included the subthemes of spirituality and life after death, highlighting the importance of spiritual beliefs in Indigenous culture and knowledge systems. The impact of Christian influences on views of suicide was also explored, with participants discussing the complex nature of the relationship between Christianity and Indigenous peoples. Finally, the theme of indirect suicide was analyzed, referring to deaths resulting from behaviors that do not necessarily fit within the conventional definition of suicide. Overall, this study highlights the importance of honoring Indigenous cultural knowledge in research related to suicide prevention in Indigenous communities.

Faith and Science: Sacred Decision-Making in Cancer Care.

Many people view health, wellness, and illness through a lens of religion and spirituality (R&S), modern science, and culture. Faith and science are not dichotomous in health care; they are complementary and even intercon.

How to provide existential and spiritual support to people with mild to moderate dementia and their loved ones. A pilot study.

BACKGROUND: People with mild to moderate dementia and their loved ones may experience strong existential and spiritual challenges due to the disease. People with dementia could therefore benefit greatly from ongoing conversational support. Within the literature and in supportive practice, there are very few tools that help professionals provide this type of support. Professionals may therefore be unaware of, or uncertain of, how support can be given. OBJECTIVE: To develop and test support approaches that may enable professionals to better conduct conversations with attention for existential and spiritual issues. METHODS: Participatory action research was conducted with dementia care professionals who spoke to 62 clients and 36 loved ones. Research consisted of two cycles of analyzing support, formulating strategies to try, testing and reflecting on the success of these actions and formulating new ones. The Diamond model for existential and spiritual issues regarding mild to moderate dementia, developed in previous research, was used as a framework. RESULTS: Five types of approaches, corresponding to the five fundamental polarities within the basic framework, were found to be helpful in alleviating tensions and bolstering strengths. For issues of self-confidence and -worth, an approach of exploring the felt self was developed; for issues of capacity and adaptability, an exploring daily routines approach; for issues of security and loss, an exploring a trinity of needs approach; for issues of burden and enrichment, an exploring memory approach; and for issues of faith and meaning, an exploring ones' predicament approach. When exploring these approaches, participants found sets and sequencing of questions and prompts to be helpful and transformative. CONCLUSION: Professionals can use the Diamond framework to provide conversational support to alleviate tension, enhance meaning and bolster strength for clients and loved ones.

Tribal Healing, Suicide, Ethical Issues, Cancer and Measuring Religiosity and Spirituality.

This issue of JORH considers the 'good, the bad and the ugly' of tribal or traditional healers, as well as articles relating to ethical challenges due to contemporary medicine and environmental issues. The concluding series on suicide (Part 2) is also finalized in this issue, as well as a number of research articles from multiple countries relating to cancer. Similar to previous issues, JORH once again adds to its increasing collection of articles relating to the empirical measurement of religion, spirituality and health. Readers are also reminded of the European Congress on Religion, Spirituality and Health (ECRSH) (Salzburg, Austria, May 2024), as well as the inaugural International Moral Injury and Wellbeing Conference (IMIWC) (Brisbane, Australia, September 2024).

The mediating role of workplace spirituality: Exploring the relationship between, self-transcendence, spiritual transcendence, and innovative work behavior.

This study aims to investigate the intricate interplay between self-transcendence, spiritual transcendence, innovative work behavior, and the mediating role of workplace spirituality. Utilizing structural equation modeling, it examines the associations among these variables. Mediation analysis explores the extent to which workplace spirituality mediates these relationships. The findings reveal positive connections between self-transcendence, spiritual transcendence, workplace spirituality, and innovative work behavior. Specifically, workplace spirituality partially mediates the relationship between self-transcendence and innovative work behavior while fully mediating the connection between spiritual transcendence and innovative work behavior. These results underscore the pivotal role of spirituality in the workplace in nurturing innovative behavior among employees. The practical implication emphasizes cultivating workplace spirituality to foster innovative work behavior. This study contributes to existing literature by elucidating the underlying mechanisms linking self-transcendence, spiritual transcendence, workplace spirituality, and innovative work behavior, underscoring the significance of workplace spirituality as a catalyst for enhancing innovative work behavior.

An integrated model of workplace spirituality: The past, present and future - A systematic literature review.

BACKGROUND: Because of the continually changing nature of work, workplace spirituality (WPS) has drawn more attention in recent years from studies, organizations, and both public and private sectors. Organizations strive to enhance employee well-being and general job satisfaction while developing a feeling of community inside the workplace through fostering WPS. OBJECTIVE: The study aims to assess the literature on WPS in an attempt to provide a broader perspective on the impact of spirituality in the workplace to strengthen and comprehend how an individual or collective spirituality is integrated and manifested in the workplace. METHODS: The literature was reviewed between 1994-2022 (including articles published online in 2023) and the deductive method was used. RESULTS: As a new and significant contribution to knowledge in this study, maintaining a work environment of otherworldliness can help to advance work commitment (sympathy, mindfulness, significant work). Human resources practices should consider including care contemplation as an individual development program that results in increased empathy for others to support care and sympathy in the workplace. WPS centers around the humanistic idea of representatives in the work environment regarding how they experience a feeling of association, which means satisfaction and arrangement with the working environment. There are three ways to look at WPS: individual, authoritative, and intuitive. CONCLUSION: This study has a significant contribution to knowledge enhancement and development. Such an approach to the development of a spirituality program within an organization can make a positive contribution to the improvement of business achievement and competitive gain. This model has some implications for organizational management where an internal spirituality program is desired. Future and additional research on model assessment under the same topic is strongly recommended.

Spiritual care models of patients living with cancer in Taiwan.

BACKGROUND: Psychological, social and spiritual needs are often unmet during the care of patients with cancer in Taiwan. AIM: The purpose of this study was to confirm the spiritual care models including the spiritual distress symptoms (SDS), spiritual distress symptoms interventions (SDSI), and spiritual distress outcomes criteria (SDOC) of patients with cancer in the initial, relapse and terminal stages. METHOD: This cross-sectional survey collected data from 150 professional nurses about their perceptions of the SDS, SDSI and SDOC for patients with cancer. RESULTS: The significant total effects of SDS on SDOC by SDSI of the patients with cancer in the initial, relapse and terminal stages were found. Additionally, the direct effects of SDS on SDOC by SDSI of the patients with cancer from the initial, relapse to terminal stage were gradually enhanced. CONCLUSIONS: The relationship between spiritual distress symptoms, interventions and outcomes was significantly higher from the initial to relapse state until at the end of life, based on the perceptions of 150 professional nurses.