Spiritual care as a response to an exaptation: how evolutionary psychology informs the debate.

This article has its origins in a 2013 proposal by the author that the concept of 'spiritual care' in clinical settings might fruitfully be grounded in the findings of the Cognitive Science of Religion (CSR). In a recent paper, John Paley rejects the central arguments and asserts his conviction that a model for 'spiritual care' cannot be derived from the insights of evolutionary psychology. In this article, the author employs a modified form of Fichtean dialectic to examine the contrasting positions and, via a process of analysis and synthesis, identify the key areas for further exploration and research. He concludes, first, that CSR in itself does not provide a sufficient theoretical justification for the notion and practice of 'spiritual care'; secondly, that any attempt to develop a general theory of spiritual care would need to pay closer attention to the role of historically situated religious communities; and finally, that these objections nevertheless do not amount to an argument against the attempt to provide spiritual care as part of person-centred care. Instead, a revised model is proposed which has the potential to provide testable predictions in this field.

Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom.

BACKGROUND: The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers. OBJECTIVE: The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers. METHODS: For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia. Secondary outcome measures were empathy, quality of life, burden, and caregivers' sense of competence. RESULTS: STAR was rated positively by all user groups on both usefulness and user friendliness. Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia; both the experimental and the control group increased in score. Regarding empathy, significant improvements were found in the STAR training group on distress, empathic concern, and taking the perspective of the person with dementia. In the experimental group, however, there was a significant reduction in self-reported sense of competence. CONCLUSIONS: The STAR training portal is a useful and user-friendly e-learning method, which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy.

Understanding and Awareness of Dementia in the Pakistani-Origin Community of Stoke-on-Trent, UK: A Scenario-Based Interview Study.

The aim of this project was to explore the understanding and awareness of dementia in the Pakistani-origin community in a deprived urban region of the UK. The study was unique in accessing and interviewing Pothwari speakers, some of whom could not read or understand spoken English. Data generated from an earlier study were used to construct five scenarios, which were used as the basis for face-to-face semi-structured interviews with 11 male and female participants from the Pakistani-origin community spanning two generations. Braun and Clarke's six phases of thematic analysis were used to analyse the data to answer the research questions. Themes constructed from these interviews indicated a lack of awareness and understanding of dementia, a range of attitudes and assumptions, reluctance to seek external support, and a significant role for the cultural background in shaping the individuals' responses. The study found that poor understanding, cultural differences, and language issues presented barriers to accessing services in the British Pakistani community, particularly among those who had been born in Pakistan and/or spoke Pothwari in preference to English. Services and information may need to be offered by Pothwari speakers in order to reach this neglected sector of the population.

Who can give 'spiritual care'? The management of spiritually sensitive interactions between nurses and patients.

AIMS: This article considers the purpose of contemporary 'spiritual care' in order to help managers make informed decisions about its appropriate delivery in a clinical context. BACKGROUND: Although there are national policies in place concerning spiritual care, surveys indicate that nurses are reluctant to engage with the spiritual needs of patients. EVALUATION: A consideration of the character of spiritual care indicates the need to take account of the context of contemporary Western society. A model drawn from the social psychology of religion is used to analyse the different types of nurse-patient interaction available in the provision of spiritual care. KEY ISSUES: Although religious and spiritual commitments can vary widely, they are subject to the same pressures in a secular and pluralist social context. This enables some general guidelines to be developed. CONCLUSIONS: Effective spiritual care requires a consideration of both the patient's and the nurse's implicit and explicit religious commitments. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to take account of the personal commitments of nurses when directing them to offer spiritual care. This article offers a diagnostic tool for deploying nurses in an appropriate way.

Religious Influences on the Experience of Family Carers of People with Dementia in a British Pakistani Muslim Community.

This paper reports on a study that begins to address the paucity of research around the religious motivations of Muslim carers of family members with dementia. Seven carers were recruited for interviews from the British Pakistani Muslim community concentrated in the Midlands and North of England. Interview transcripts were analysed thematically using an iterative collaborative methodology. The findings suggested that the Muslim faith plays a pivotal role as a support mechanism for individual carers and their families, but the wider faith community and its leaders did not typically offer support and could impede access to external care. This was a result of cultural pressure and lack of awareness both among religious leaders and the community as a whole. The study concluded that the inequality in access to dementia services may be constructively addressed if service providers engage with these faith concerns in the community and religious leaders to meet the needs of Muslims of British Pakistani origin.

Custody early warning scores; Do they predict patient deterioration in police custody?

This paper analyses the results of a three month trial based in a police custody suite, where we assigned a value; using the recently developed Custody Early Warning Score, to detainees arriving into police custody, as part of their 'booking in' process. We then compared this to the more established National Early Warning Scoring system and then looked at the predictive accuracy of these two systems and how they correlated to one another, when applied to three different clinical groups of detainees in police custody. Police Custody Sergeants and Custody Detention Officers continue to experience difficulties in identifying those detainees with health care needs; be they subtle, emerging or more evident. The introduction of a 'track and trigger' physiological scoring system has been seen to reduce morbidity in health care settings and so the adoption of an altered custodial version of such a system is an effort by some police forces to do likewise. Recent innovations in police custody have focussed on identifying and appropriately referring those detainees with mental health needs. There is a lack of research that examines the physical health needs of the custodial population and the risks that they might present. With detainee deaths and serious adverse events continuing to occur in police custody, forces are looking at ways to identify risk early on in the custodial process, to reduce such high profile occurrences. Police use of the Custody Early Warning Score system, is one effort to try and identify and reduce this risk, early on in the custodial process. OBJECTIVE: In an increasing number of police custody suites, the Custody Early Warning Score system has been, added to the normal, standardised police risk assessment process. This 'track & trigger' system has been adapted to the custody environment and is conducted by non-medical detention staff upon detainee arrival, in order to identify detainee morbidity and mortality risk. We wanted to test the predictive accuracy of this system at identifying detainee health need and prioritisation. We also wanted to know how well this tool correlated to another well-established monitoring tool and how accurate these two systems are at pre-empting the medical emergencies and hospital referrals that occur in police custody. RESULTS: 1'163 detainees were assessed by medical staff over a three month period, with staff blinded to the assigned scoring. 276 of these were identified as requiring further clinical assessment following this scoring with 29 of the 33 patients referred to hospital by medical staff, also scored, with some declining assessment or were serious enough to abandon scoring. Whilst we found a small correlation between increased scores and referral to hospital; we found that there was little correlation between assessment scores in general and the need for referral to hospital. We also found that most clinical risk was associated with lower or low scores. CONCLUSIONS: The scoring systems that we assessed were not sensitive enough to identify health need in the detainee population, due to frequent, altered physiological parameters. Life threatening conditions have low assessment scores, not reflective of the seriousness of medical conditions, nor the potential for rapid deterioration. Such scoring systems add little to the risk assessment process, with low scores allowing for complacency and a false reassurance, when using a system designed for very different circumstances.

"Chaplains for Wellbeing" in Primary Care: A Qualitative Investigation of Their Perceived Impact for Patients' Health and Wellbeing.

Although Health Chaplaincy services are well-established in hospitals in the United Kingdom and across the world, Primary Care Chaplaincy is still in its infancy and much less extensively developed. This study explored the impact the introduction of a Primary Care "Chaplains for Wellbeing" service had upon patients' experience and perceived health and well-being. Sixteen patients participated in one-one interviews. Transcripts were analyzed using interpretative phenomenological analysis (IPA). Patients reported circumstances that had eroded perceived self-efficacy, self-identity, and security manifesting as existential displacement; summarized under the superordinate theme of "loss." "Loss" originated from a number of sources and was expressed as the loss of hope, self-confidence, self-efficacy, and sense of purpose and meaning. Chaplains used a wide range of strategies enabling patients to rebuild self-confidence and self-esteem. Person-centered, dignified, and responsive care offered in a supportive environment enabled patients to adapt and cope with existential displacement.

'Chaplains for well-being' in primary care: analysis of the results of a retrospective study.

AIM: To analyse quantitative changes in patient well-being concurrent with chaplaincy interventions in a retrospective study of a group of Primary Care centres in Sandwell and West Birmingham, United Kingdom. BACKGROUND: Anecdotal evidence suggests that support from trained Primary Care Chaplains may be particularly useful for those with subclinical mental health issues; it can reduce the tendency to 'medicalise unhappiness' and is a positive response to patients with medically unexplained symptoms. However, to date there has been no published research attempting to quantify their contribution. METHOD: Data were gathered from a group of Primary Care Centres, which make use of a shared Chaplaincy service. Demographic data and pre-post scores on the Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS) were collected for patients who had attended consultations with a Chaplain. These were subjected to tests of statistical significance to evaluate the possible contribution of chaplaincy to patient well-being along with possible confounding variables. FINDINGS: a substantial improvement in WEMWBS scores (mean=9 points, BCa 95% CI [7.23, 10.79], P=0.001) post-intervention. The improvement in scores was highest for those with initially lower levels of well-being. There is therefore evidence that chaplaincy interventions correlate with an improvement of holistic well-being as measured by a WEMWBS score. A prospective study on a larger scale would provide more detailed information on the interaction of possible variables. Further study is also required to evaluate the implications of this result for patient outcomes and GP resources. The efficacy of Primary Care Chaplaincy is under-researched and difficult to measure. This paper represents the first attempt to quantify a measurable improvement in the well-being of patients who are referred to the service.

Liminality in preregistration mental health nurse education: a review of the literature.

This paper provides an analysis of the anthropological concept of liminality in relation to undergraduate preregistration mental health nurse education, and considers implications both for students and nurse educators working in this field. A review of educational and professional literature was undertaken in order to clarify the concept of liminality within the context of nurse education to aid in understanding how nurse educators could maximise the potential of liminality within the mental health preregistration nursing programme, and to consider the relationship between liminality and the preparation of future mental health nursing practitioners. A survey of the findings and conclusions of the selected studies yielded two key areas in which the concept has an explanatory function: in relation to "threshold concepts" in nurse education and as a way of describing a stage in the development of a role and identity. Discussion of each of these areas points to suggestions for changes in the understanding of education and training for mental health nurses, particularly in the context of the United Kingdom.

Spirituality in pre-registration nurse education and practice: A review of the literature.

Spirituality is known to be an integral part of holistic care, yet research shows that it is not well valued or represented in nurse education and practice. However, the nursing profession continues to make efforts to redress the balance by issuing statements and guidance for the inclusion of spirituality by nurses in their practice. A systematic literature review was undertaken and confirms that nurses are aware of their lack of knowledge, understanding and skills in the area of spirituality and spiritual care, and desire to be better informed and skilled in this area. Consequently, in order for nurses to support the spiritual dimension of their role, nurse education has a vital part to play in raising spiritual awareness and facilitating competence and confidence in this domain. The literature review also reveals that studies involving pre-registration are few, but those available do provide examples of innovation and various teaching methods to deliver this topic in nursing curricular.