Spiritual Care for Individuals with Cancer: The Importance of Life Review as a Tool for Promoting Spiritual Well-Being

ObjectiveTo discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer.Data SourcesLiterature regarding spirituality and life review of the author in cancer care provided the foundation for this article.ConclusionReliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer.Implications for Nursing PracticeNurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being.     

Biopsychosocial benefits of spirituality in adults aging with HIV: implications for nursing practice and research

More than 100,000 adults above the age of 50 have been diagnosed with HIV in the United States. It is important to understand how to promote successful aging in this growing population. With the positive effects of spirituality on biopsychosocial functioning in aging, HIV, and chronic diseases, accessing the strengths associated with spirituality may facilitate successful aging in adults surviving to older ages. The inherent nature of the nurse-patient relationship means nurses are in a key position to actively listen, assess spiritual needs, and make clinical referrals. In providing holistic care to patients, nurse scientists are encouraged to study and address the spiritual needs in this growing population.     

Religious involvement, spirituality, and medicine: implications for clinical practice.

Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (e.g., chaplains) are available to clinicians to address the spiritual needs of patients.     

Spirituality, religiosity, and spiritual pain in advanced cancer patients

ContextSpirituality, religiosity, and spiritual pain may affect advanced cancer patients’ symptom expression, coping strategies, and quality of life.ObjectivesTo examine the prevalence and intensity of spirituality, religiosity, and spiritual pain, and how spiritual pain was associated with symptom expression, coping, and spiritual quality of life.MethodsWe interviewed 100 advanced cancer patients at the M.D. Anderson palliative care outpatient clinic in Houston, TX. Self-rated spirituality, religiosity, and spiritual pain were assessed using numeric rating scales (0 = lowest, 10 = highest). Patients also completed validated questionnaires assessing symptoms (Edmonton Symptom Assessment Scale [ESAS] and Hospital Anxiety and Depression Scale), coping (Brief COPE and Brief R-COPE), the value attributed by the patient to spirituality/religiosity in coping with cancer (Systems of Belief Inventory-15R), and spiritual quality of life (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded [FACIT-Sp-Ex]).ResultsThe median age was 53 years (range 21–85) and 88% were Christians. Almost all patients considered themselves spiritual (98%) and religious (98%), with a median intensity of 9 (interquartile range 7–10) of 10 and 9 (range 5–10) of 10, respectively. Spiritual pain was reported in 40 (44%) of 91 patients, with a median score of 3 (1–6) among those with spiritual pain. Spiritual pain was significantly associated with lower self-perceived religiosity (7 vs. 10, P = 0.002) and spiritual quality of life (FACIT-Sp-Ex 68 vs. 81, P = 0.001). Patients with spiritual pain reported that it contributed adversely to their physical/emotional symptoms (P < 0.001). There was a trend toward increased depression, anxiety, anorexia, and drowsiness, as measured by the ESAS, among patients with spiritual pain (P < 0.05), although this was not significant after Bonferroni correction.ConclusionA vast majority of advanced cancer patients receiving palliative care considered themselves spiritual and religious. Spiritual pain was common and was associated with lower self-perceived religiosity and spiritual quality of life.     

Spiritual issues and quality of life assessment in cancer care

Being diagnosed with cancer forces most human beings to face their own death. The comfortable sense of both invulnerability and immortality is shattered, making the patient thoroughly aware that life is finite and limited. Approaching death, cancer patients commonly embark on an inner journey involving a search for meaning as well as a reordering of priorities involving physical, psychological, social, and spiritual needs. Although interest in the role of spirituality, relating to both adjustment to cancer and the overall quality of life of cancer patients, has increased in recent years, most of the commonly used quality of life (QOL) instruments in oncology typically do not include spiritual issues. In this article, it is argued that assessing QOL effectively should involve all aspects of the personality, including mind, body, and spirit as well. This article also reviews recent studies, which have shown that spiritual well-being, although a many-sided and difficult construct to define, is closely related to the QOL of cancer patients. It is also suggested that further research is needed to understand how the new focus on spirituality can contribute to a more comprehensive assessment of patient's QOL in cancer care.     

The importance of spiritual assessment: one clinician's journey

Assessing spiritual values of a patient causes the nurse to assess and or re-examine his or her own beliefs. Self- reflection makes one aware of how spirituality affects the individual's life and nursing practice. Those who find themselves uncomfortable with spiritual issues may have difficulty in delivering spiritual care to others. Nonetheless, the ability to seek appropriate assistance should be possible, but in-depth conversation regarding spirituality may need delivery by another caregiver.[8]Before assessing spirituality, examine your own beliefs to provide compassionate care related to meeting the patient's spiritual needs. Today, I regularly ask if the elder has a religious or faith-based belief he or she follows. If so, I probe further to determine how this belief system helps them with their health care concerns. I watch for symbols such as a Bible, inspirational readings, or religious items in the home or health care setting. A practice choice I have made is to offer prayers together with my patients and families. This is an individualized involvement that some believe crosses the boundaries of professionalism and political correctness. However, this level of involvement provides a positive opportunity to provide fulfillment in my nursing practice for my patient and myself. I will continue this added dimension of care.Spiritual assessment involves the evaluation of spiritual needs and the relationship to health care issues, whereas spiritual care involves compassion, presence, listening, and the encouragement of hope. It may or may not involve God or religion. To best serve the elderly patient, nurses should examine their own spirituality and how this may affect their own unique ability to assess or deliver spiritual care.     

SPIRITUAL ISSUES AND QUALITY OF LIFE ASSESSMENT IN CANCER CARE

Being diagnosed with cancer forces most human beings to face their own death. The comfortable sense of both invulnerability and immortality is shattered, making the patient thoroughly aware that life is finite and limited. Approaching death, cancer patients commonly embark on an inner journey involving a search for meaning as well as a reordering of priorities involving physical, psychological, social, and spiritual needs. Although interest in the role of spirituality, relating to both adjustment to cancer and the overall quality of life of cancer patients, has increased in recent years, most of the commonly used quality of life (QOL) instruments in oncology typically do not include spiritual issues. In this article, it is argued that assessing QOL effectively should involve all aspects of the personality, including mind, body, and spirit as well. This article also reviews recent studies, which have shown that spiritual well-being, although a many-sided and difficult construct to define, is closely related to the QOL of cancer patients. It is also suggested that further research is needed to understand how the new focus on spirituality can contribute to a more comprehensive assessment of patient's QOL in cancer care.     

The concept of spiritual care in mental health nursing

AIM: In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. BACKGROUND: The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. METHODS: A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. RESULTS: According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person's sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the 'mechanics of nursing'. CONCLUSIONS: The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.     

Caregiver care

In 2009, nearly 66 million Americans (three in 10 U.S. households) reported at least one person providing unpaid care as a family caregiver. More adults with chronic conditions and disabilities are living at home than ever before, and family caregivers have an even higher level of responsibility. Caring for loved ones is associated with several benefits, including personal fulfillment. However, caregiving is also associated with physical, psychological, and financial burdens. Primary care physicians can aid in the identification, support, and treatment of caregivers by offering caregiver assessments-interviews directed at identifying high levels of burden-as soon as caregivers are identified. Repeat assessments may be considered when there is a change in the status of caregiver or care recipient. Caregivers should be directed to appropriate resources for support, including national caregiving organizations, local area agencies on aging, Web sites, and respite care. Psychoeducational, skills-training, and therapeutic counseling interventions for caregivers of patients with chronic conditions such as dementia, cancer, stroke, and heart failure have shown small to moderate success in decreasing caregiver burden and increasing caregiver quality of life. Further research is needed to further identify strategies to offset caregiver stress, depression, and poor health outcomes. Additional support and anticipatory guidance for the care recipient and caregiver are particularly helpful during care transitions and at the care recipient's end of life.     

The meanings and correlates of spirituality: suggestions from an exploratory survey of experts

There has been an increasing interest in spirituality among health care professionals over the last several decades. Specialists in the areas of trauma, grief, and death and dying have been among those who have shown particular interest in religious and spiritual issues. Recent efforts to distinguish religiosity from spirituality have stimulated inquiries into the changing meanings of these dimensions. Drawing on prior and parallel works, the authors created a questionnaire and asked for responses to it from convenience samples of experts in death studies (n = 22) and spiritual studies (n = 13). Our findings are suggestive of possible lines of convergence and divergence. Both groups considered themselves to be spiritual but not religious, and there was consensus that the meaning of the term spirituality is currently changing. There was also general agreement that spiritual experiences are meaningful learning opportunities and that spiritual individuals tend to be more hopeful and to experience more meaning or purpose in life than their nonspiritual peers. The themes most strongly associated with spirituality in both groups were charity, community or connectedness, compassion, forgiveness, hope, meaning, and morality. Future research should be directed toward clarifying what people mean by "spiritual" and how they experience and express this dimension of their lives.     

Interventions to enhance the spiritual aspects of dying

In recent years, medical and allied health publications have begun to address various topics on spirituality. Scholars have posited numerous definitions of spirituality and wrestled with the notion of spiritual pain and suffering. Researchers have examined the relationship between spirituality and health and explored, among other topics, patients' perceptions of their spiritual needs, particularly at the end of life. This paper summarizes salient evidence pertaining to spirituality, dying patients, their health care providers, and family or informal caregivers. We examine the challenging issue of how to define spirituality, and provide a brief overview of the state of evidence addressing interventions that may enhance or bolster spiritual aspects of dying. There are many pressing questions that need to be addressed within the context of spiritual issues and end-of-life care. Efforts to understand more fully the constructs of spiritual well-being, transcendence, hope, meaning, and dignity, and to correlate them with variables and outcomes such as quality of life, pain control, coping with loss, and acceptance are warranted. Researchers should also frame these issues from both faith-based and secular perspectives, differing professional viewpoints, and in diverse cultural settings. In addition, longitudinal studies will enable patients' changing experiences and needs to be assessed over time. Research addressing spiritual dimensions of personhood offers an opportunity to expand the horizons of contemporary palliative care, thereby decreasing suffering and enhancing the quality of time remaining to those who are nearing death.     

A concept analysis of spirituality

According to the holistic model of care, nurses must consider their patients' spiritual needs in order to provide total patient care (Govier, 2000). There is growing awareness of the contribution that spiritual wellbeing can make to a patient's actual and perceived health and quality of life (Chibnall et al, 2002; Mount, 2003). Spirituality and spiritual care has gained much momentum in the current nursing arena. Draper and McSherry (2002) assert that it has emerged from the shadows to occupy a prominent part of contemporary health care. Moreover, within the nursing profession, a focus on individuals as biopsychosocial-spiritual beings is gaining recognition. This notion is based on the premise that there should be balance of mind, body and spirit for the maintenance of health in a person (Stoll, 1989; Stooter, 1995). However, there is evidence that many nurses, including nurse educators, have difficulty with the concept of spirituality and consequently, may neglect this aspect of care (Greenstreet, 1999; McSherry, 2000). The aim of this article is to contribute towards clarifying the concept of spirituality.     

Family caregiving in cancer pain management

The experience of cancer pain is known to greatly affect family caregivers as well as patients. There are many demands placed on caregivers of cancer patients with pain at home as a result of the shifting of care from the acute setting to the home. These complex demands significantly affect caregiver quality of life. The purpose of this study was to describe the experience of pain management from the perspective of family caregivers of patients with cancer amidst the current healthcare environment. This quasi-experimental study involved 231 family caregivers of patients with cancer pain receiving home care. Family caregivers were assessed in conjunction with a pain education program that provided patient and. family education regarding pain assessment, drug and nondrug interventions. Assessment measures used were the Quality of Life (QOL)-Family Caregiver Tool, Knowledge and Attitudes about Pain (K&A) Tool, and Caregiver Finances Tool. Study findings reveal disruption to family caregiver quality of life in the areas of physical, psychological, social, and spiritual well-being. There is also a continued need for education regarding cancer pain management. Comparison between patients and family caregivers demonstrates that pain impacts both the patient experiencing it and their caregivers.     

Issues in aging. The role of the nurse in the care of older people with intellectual and developmental disabilities

Many people with I/DD are growing older and in increasing numbers. Generally people with I/DD experience the same physical process of aging as do individuals without lifelong disabilities with the exception of those individuals who have Down syndrome who may show physical signs of aging as much as 20 years earlier. Individuals with I/DD may experience some unique concerns associated with aging with similar or even higher rates of age-related conditions than do older persons without lifelong disabilities [20]. Geriatric care principles will guide nurses caring for older people with I/DD, beginning with the assessment of functional status to determine interventions for developmental, aging, and health concerns and health promotion. Nursing interventions must be individualized both according to the person's preferences and health status. A primary goal is to prevent acute exacerbation of any underlying pathological process, prevent unnecessary deterioration of the older individual's physical condition, and maintain optimum physical and mental function. Nurses can provide individuals who are aging and their families or caregivers the needed anticipatory guidance about life transitions during the aging years, including palliative end-of-life care. This is an exciting and challenging time for nurses who care for aging people with I/DD. John F. Kennedy once said, "It is not enough for a great nation to have added new years to life. Our objective must be to add new life to those years." As a profession, nurses have historically added years to life. The challenge of nursing is now to add quality life to those years for all older persons with I/DD.     

Spiritual crisis: a concept analysis

Title.  Spiritual crisis: a concept analysis.
Aim.  This paper is a report of an analysis of the concept of spiritual crisis.
Background.  The term spiritual crisis has been used ambiguously in the literature, resulting in lack of clarity. A holistic approach includes spirituality in nursing care of the whole person.
Data sources.  Papers available online between 1998 and 2007 in the CINAHL, Medline and PsycInfo databases were retrieved for analysis. The search engine Google was also used to examine additional references to 'spiritual crisis'.
Review methods.  Spiritual crisis, spiritual emergency and life crisis were the terms initially used to search each database. The search was expanded to include spirituality to draw more literature into the review.
Findings.  Using Walker and Avant's method of concept analysis, a definition of spiritual crisis was identified. Spiritual crisis can be described as a unique form of grieving or loss, marked by a profound questioning of or lack of meaning in life, in which an individual or community reaches a turning point, leading to a significant alteration in the way life is viewed. Possible antecedents include sudden acute illness and loss of important relationships. Potential consequences may include physical and emotional responses.
Conclusion.  People with terminal illness, depression, and those who are grieving losses may be at special risk of spiritual crisis. The literature suggests an interdisciplinary approach, nurses' self-exploration of spirituality, and refraining from defining spirituality by religious affiliation as part of improving practice.     

From private to public: negotiating professional and personal identities in spiritual care

AIM: This paper is an exploration of the challenge of negotiating the highly personalized concept of spirituality within the public sphere of professional-patient interactions. BACKGROUND: Spirituality has become increasingly prominent within the nursing discourse, and providing spiritual care is often positioned as an ethical obligation of care. However, bringing such a personal concept into the public domain of care creates some unique tensions and ethical risks. DISCUSSION: Nurses bring three potentially competing identities to spiritual care encounters with patients. Firstly, they are professionals with a public trust in health promotion and restoration, including those areas that intersect with spiritual health. Secondly, they are citizens of a liberal society where non-judgmental pluralism as it relates to spirituality is enshrined. Thirdly, they are individuals who hold particular beliefs and values about spirituality. Each of these identities may result in particular, and potentially conflicting, approaches to spiritual care. Ultimately, the identity which nurses choose to adopt is often determined by how they view themselves in the spiritual care encounter, either as experts with legitimate authority to intervene in the spiritual lives of patients or as people in a shared relational encounter. Each of these approaches carries ethical risks, although the nature of these risks is different. CONCLUSION: The identities which nurses bring to spiritual care encounters have far-reaching implications for patient experiences in those encounters. Nurses who position themselves as experts run the risk of objectifying the spiritual, being experienced as coercive and transcending nursings' competence. The work of Martin Buber is presented as a model that, while acknowledging competing identities, sets forth a vision of spirituality and spiritual care based upon relational reciprocity.     

Spiritual care

The essence of spirituality and spiritual care is too complex for clear definition. Topics of personal religious belief about life and death, an understanding or sensing of the process of dying, and the various means of influencing a patient's s body and mind may all be implied by the term "spiritual care". All care involving the patient's s thoughts or emotions tends to be put in the same basket, without any distinction between psychic needs, spiritual nature and religious belief. Spirituality connotes a person's s wholeness (body, mind and soul). Spirituality not only affects the individuals psychosocial activities, but also his or her physical condition and behavior. So, what is the scope of spiritual care? Does it include physical and psychological elements? Using clinical examples, the author seeks to clarify the role of spirituality in the process of adapting to a disease, and to expound a definition and goals of spiritual care. In addition, human spiritual needs and the elements of spiritual care are also outlined. It is hoped that this article will be helpful to nurses in their spiritual growth and to those who practice holistic care.     

Quality of life,life satisfaction,and spirituality: comparing outcomes between rehabilitation and cancer patients

OBJECTIVE: To determine differences in quality of life, life satisfaction, and spirituality across different patient groups and to determine what factors may relate to these three outcomes across rehabilitation and cancer patients. DESIGN: Subjects were first stratified by five diagnostic groupings. Patient data were then regrouped for additional analytic purposes into two large cohorts. All subjects completed questionnaires once. Differences in scores and correlations were computed, and regression models were specified. RESULTS: Group differences were found across the quality of life measures used in the study. There were also differences in life satisfaction and spiritual well-being. Spirituality was found to be associated with both quality of life and life satisfaction, although it was not a significant predictor in a multivariate context. CONCLUSIONS: In general, subjects with prostate cancer reported higher scores across all measures. Spirituality showed a strong association with both life satisfaction and quality of life, and it was a significant predictor of life satisfaction among rehabilitation subjects. Factors such as age, marital status, and work status, in addition to specific dimensions of quality of life, such as social functioning and functional well-being, were found to be associated with total quality of life.