Jahi McMath: Lessons Learned.

Jahi McMath's story has been an important reference in medicine and ethics as the landscape of the understanding of death by neurologic criteria is shifting, with families actively questioning the once-firm criterion. Palliative care providers have a role in seeking understanding and collaborating with families and clinical teams to navigate the many challenges that arise when a medical team has determined that a child has died, and their parents disagree. In this case-based narrative discussion we consider the complexity of the family experience of brain death.

Emergency Department Patients are Receptive to Prayer-Based Interventions to Reduce Alcohol Use.

Previous studies show that elements of spirituality, including prayer and religious services, may contribute to reductions in harmful alcohol use. The objective of this study was to assess the acceptability of prayer as a component of emergency department (ED) interventions for risky alcohol use. A 12-question multiple-choice questionnaire was developed, piloted, and refined by the study team. The questionnaire included questions about current beliefs and attitudes toward prayer and assessed interest in various means of delivering prayer or prayer support for reducing alcohol use. The questionnaire was administered to a consecutive sample of 111 patients recruited from the 12-month follow-up of a parent RCT study on reducing alcohol use among injured ED patients (ReDIAL). To qualify for the parent study, participants needed an ASSIST v3.0 alcohol score ≥ 11. 90 participants (81%) consented to answer questions about prayer. The participating sample was 38% female and 29% nonwhite; mean age was 36 years. Of these participants, 64% reported that they currently pray; of those, 88% reported praying daily or weekly; 79% agreed that prayer helps with coping in difficult times; 68% agreed that prayer could assist in achieving difficult goals; and 48% agreed that prayer helps reduce alcohol use. Interest in various means of utilizing prayer to reduce alcohol use was assessed in all participants (regardless of whether they currently prayed or not): 45% were interested in having others pray for them to reduce alcohol use; 40% were interested in receiving text reminders to pray; 42% were interested in receiving text messages with specific prayers to use; and 47% were interested in receiving text messages that someone was praying for them. 33.3% of the entire sample stated that they would attend services if provided information on spiritual or religious groups in the community. The incorporation of prayer in alcohol interventions was considered acceptable by a proportion of our sample of risky alcohol users, even those who do not currently use prayer as a resource in their lives. Given the promising data on ED patients' perceptions of the significance and acceptability of spiritual practices in reducing alcohol use, prayer may emerge as a useful adjunctive tool in future ED interventions for alcohol use disorders.

Intercessory Prayer on Spiritual Distress, Spiritual Coping, Anxiety, Depression and Salivary Amylase in Breast Cancer Patients During Radiotherapy: Randomized Clinical Trial.

The goal of this study was to assess the effect of intercessory prayer in the psychological, spiritual and biological scores of breast cancer patients who are undergoing radiotherapy. Double-blind RCT comprising a sample of 31 participants (15 in the Control Group and 16 in the Intervention Group). Data collection was performed in three time points (T0, T1 and T2). Significant changes have been identified in the intra-group analysis, concerning the decrease in spiritual distress score; negative religious/spiritual coping prevailed, while the total religious/spiritual coping increased between the posttest T2 to T0. Intercessory prayer was effective in religious and spiritual scores.

Physicians' Religious Characteristics and Their Perceptions of the Psychological Impact of Patient Prayer and Beliefs at the End of Life: A National Survey.

BACKGROUND:: Physicians who are more religious or spiritual may report more positive perceptions regarding the link between religious beliefs/practices and patients' psychological well-being. METHODS:: We conducted a secondary data analysis of a 2010 national survey of US physicians from various specialties (n = 1156). Respondents answered whether the following patient behaviors had a positive or negative effect on the psychological well-being of patients at the end of life: (1) praying frequently, (2) believing in divine judgment, and (3) expecting a miraculous healing. We also asked respondents how comfortable they are talking with patients about death. RESULTS:: Eighty-five percent of physicians believed that patients' prayer has a positive psychological impact, 51% thought that patients' belief in divine judgment has a positive psychological impact, and only 17% of physicians thought the same with patients' expectation of a miraculous healing. Opinions varied based on physicians' religious and spiritual characteristics. Furthermore, 52% of US physicians appear to feel very comfortable discussing death with patients, although end-of-life specialists, Hindu physicians, and spiritual physicians were more likely to report feeling very comfortable discussing death (adjusted odds ratio range: 1.82-3.00). CONCLUSION:: US physicians hold divided perceptions of the psychological impact of patients' religious beliefs/practices at the end of life, although they more are likely to believe that frequent prayer has a positive psychological impact for patients. Formal training in spiritual care may significantly improve the number of religion/spirituality conversations with patients at the end of life and help doctors understand and engage patients' religious practices and beliefs.

Pain Treatment Practices of Community-Dwelling Black Older Adults.

Black older adults often experience disparities in pain treatment that results in unmet pain needs. The aims of this study were to assess the pain management experiences of a group of community dwelling Black older adults and identify gaps in clinical practice. A qualitative, descriptive design was employed using the methodology of ethnography. The setting was an urban, low-income, community elderly housing high-rise facility. Participants included facility residents (n = 106); of these, 20 completed structured qualitative interviews. The Brief Pain Inventory and qualitative interviews were used to determine pain prevalence, treatment practices, and barriers. Eighty-six percent of the participants had severe pain with a mean worst pain rating of 7 on a 0 to 10 scale. Pain interfered moderately with general activity (5.59), walking (5.73) and normal work (5.70), also measured on 0 to 10 scales. Participants preferred non-opioid analgesics, topical over-the-counter treatments, and nonpharmacological interventions such as prayer/meditation, and exercise for treatment. Medications most commonly used by participants for pain management included, hydrocodone with acetaminophen (28.6%), nonsteroidal anti-inflammatory drugs (13.2%), acetaminophen with codeine (12%), and tramadol (9.9). Qualitative interviews revealed that pain management barriers were centered around communication concerns about side effects, fears of addiction, and provider mistrust. A communication gap exists between patients and providers. Discussing patient treatment preferences, providing balanced treatment information, and following-up with patients on treatment plan effectiveness by phone can improve how pain is managed for Black older adults.

Validación de la Escala de Esperanza en Enfermedad Terminal para familiares breve (EEET-fb). Análisis de validez y fiabilidad / Validation of the Scale of Hope in Terminal Illness for relatives brief version (SHTI-b). Validity and reliability analysis

Fundamento: La Escala de Esperanza en Enfermedad Terminal (EEET) de Bermejo y Villacieros recoge específicamente significados de la esperanza ante la terminalidad, incluyendo consideraciones relativas al apoyo psicoemocional y de sentido trascendente. El objetivo de este trabajo fue la validación de la escala EEET abreviada y reformulada (EEET-fb) para adaptar todos los ítems a un solo epígrafe. Material y métodos: Se partió de la EEET publicada para realizar un análisis factorial exploratorio con una muestra de 177 cuestionarios válidos. En una segunda fase, con otra muestra de 180 cuestionarios válidos, se realizó un análisis factorial confirmatorio y un análisis de correlación con medidas externas de bienestar espiritual (Functional Assessment of Chronic Illness Therapy- Sp) y esperanza (Herth Hope Index). Resultados: Se obtuvo un modelo bidimensional con índices de ajuste satisfactorios (GFI = 0,991; CFI = 0,984; SRMR = 0,08; RMSEA = 0,057); el factor Relaciones de trascendencia obtuvo un alfa de Cronbach de 0,872 y el de Relaciones personales un alfa de 0,762. Las correlaciones de la EEET-fb con las medidas externas fueron: r = 0,527 con FACIT, r = 0,266 con HHI, r = 0,667 con el factor Espiritualidad de FACIT y r = 0,348 con el factor Interrelación de HHI. La subescala Relaciones de trascendencia correlaciona tanto con Disposición y expectativa (r = 0,162) como con Interrelación de HHI (r = 0,329), mientras que la escala Relaciones personales solamente lo hace con Interrelación de HHI (r = 0,244). Conclusiones: La EEET-fb es un instrumento válido y fiable, específico para ámbitos de terminalidad (AU)

Background: Bermejo and Villacieros' Scale of Hope in Terminal Disease (SHTD) specifically collects meanings of hope facing terminal disease, including considerations relating to psycho-emotional support and that have a transcendental sense. The objective of this paper is to validate the SHTD abbreviated and rephrased to adapt all the items to a single domain. Methods: Starting from the published SHTD, an exploratory factor analysis (EFA) was carried out with a simple of 177 valid questionnaires. In a second study, with another sample of 180 valid questionnaires, a confirmatory factor analysis (CFA) and a correlation analysis with other measurements of spiritual wellbeing (Functional Assessment of Chronic Illness Therapy-Sp) and hope (Herth Hope Index) were done. Results. A bidimensional model with satisfactory goodness of fit index values was obtained (GFI = 0.991; CFI = 0.984; SRMR = 0.08; RMSEA = 0.057); the Relations of Transcendence factor obtained a Cronbach's alpha of 0.872 and Personal Relations an alpha of 0.762. The correlations of the SHTI-rb with external measures were: r = 0.527with FACIT; r = 0.266 with HHI; r = 0.667 with the Spirituality subscale of FACIT; and r = 0.348 with the Interrelation factor of HHI. The Relations of Transcendence subscale correlated with both Layout and Expectation and Interrelation of HHI (r = 0.162 and r = 0.329 respectively), while the scale of Personal Relations only correlated with Interrelation of HHI (r = 0.244). Conclusions: The Scale of Hope in Terminal Illness for relatives (brief version) is a valid and reliable specific instrument for terminal patients (AU)

The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services.

Background: Low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients' carers. Methods: This was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings: Eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions: Although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting.

Therapeutic Effects of Islamic Intercessory Prayer on Warts.

The present study aimed to examine the therapeutic effects of Islamic intercessory prayer on warts. Forty-five participants who are mostly Muslims and infected with warts were randomized into three groups: Group-1 (uncertain, with intercessory prayer), Group-2 (uncertain, no intercessory prayer), and control group (informed, no intervention). Stress symptoms were also measured before and after prayer sessions for these three groups. The results revealed that there were no significant differences between the groups in terms of healing. Although participants believed in the therapeutic effects of prayer, when participants did not trust the intercessor, prayer had no effect on warts.

Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications.

BACKGROUND: Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. AIM: To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. METHOD: A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. RESULTS: There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. CONCLUSION: Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances.

Neural correlates of healing prayers, depression and traumatic memories: A preliminary study.

Depression is a global health concern and when rooted in childhood adversity is particularly difficult to treat. In a previous study, we found that healing prayer was effective in reducing depressive symptoms. Subjects suffering with depression according to HAM-D scores underwent task-based brain functional MRI (fMRI) prior to and after a 6-week prayer intervention, and depression symptoms were assessed at both time points and at a 12-month follow-up. Average HAM-D scores decreased from 21.6±3.0 prior to the intervention to 4.0±2.7 immediately afterwards (14 subjects) and remained low (3.7±3.4) at 12-month follow-up (11 subjects). fMRI demonstrated increased activity in the medial prefrontal cortex during focus on the traumatic memory after the prayer intervention. Changes in activity in the left inferior frontal gyrus correlated with improvement in depressive symptoms. Activity in the precuneus region decreased after the prayer intervention when subjects focused on the negative feelings associated with the trauma. We conclude that increased activity in the prefrontal cortex after healing prayer may be associated with increased cognitive control over emotions. Healing prayer may help to dissociate the memory of the trauma from feelings associated with it, as evidenced by changes in the precuneus region.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake.

BACKGROUND: This study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. METHOD: We used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC) RESULTS: Among our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (ß=.366, p<.001) and Depression symptoms (ß=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors.

As crenças religiosas e espirituais no enfrentamento de desafios advindos das feridas crônicas em idosos / The religious beliefs and spiritual in facing challenges arising in elderly chronic wounds / Las creencias religiosas y espirituales en el enfrentamiento de desafíos surgidos de las heridas crónicas en personas mayores

Este estudo objetiva investigar como as crenças religiosas, espirituais, e a fé do idoso podem contribuir para o enfrentamento de desafios advindos das feridas crônicas. Trata-se de um estudo do tipo descritivo observacional, com delineamento transversal e abordagem qualitativa e quantitativa. Os resultados permitiram identificar que os idosos portadores de feridas crônicas, além de recorrem à ajuda médica, valem-se da sua religiosidade e fé em busca da cura e da melhoria da sua qualidade de vida.

This study aims to investigate how religious beliefs, spiritual and elderly faith can help address challenges arising from chronic wounds. It is a study of observational descriptive, cross-sectional design and qualitative and quantitative approach. The results showed that elderly people with chronic wounds, and turn to medical help, avail themselves of their religiosity and faith in search of healing and improving their quality of life.

Este estudio pretende investigar cómo las creencias religiosas, la fe espiritual y la fe de los ancianos pueden ayudar a enfrentar los desafíos que surgen de las heridas crónicas. Se trata de un estudio de observación descriptiva, diseño transversal y enfoque cualitativo y cuantitativo. Los resultados mostraron que las personas mayores con heridas crónicas, y recurren a la asistencia médica, se valen de su religiosidad y fe en la búsqueda de la curación y mejorar su calidad de vida.

Brain science and illness beliefs: an unexpected explanation of the healing power of therapeutic conversations and the family interventions that matter.

Paradigm families and paradigm practice moments have shown me that therapeutic conversations between nurses and families can profoundly and positively change illness beliefs in family members and nurses and contribute to healing from serious illness. The integration of brain science into nursing practice offers further understanding of the importance of illness beliefs and the role they may play in helping individual and family healing. Brain science offers explanations that connect how certain family nursing interventions that soften suffering and challenge constraining illness beliefs may result in changes in brain structure and functioning. New illness beliefs may result in new neural pathways in the brain, and therefore, possibilities for a new way of being in relationship with illness and in relationship with others can also develop. Newly acquired practice skills and interventions that have emerged from an understanding of brain science plus the reemphasis of other interventions utilized in the Illness Beliefs Model are offered to enhance our care of families suffering with illness.