Religious beliefs and practices in acute mental health patients

BACKGROUND: Holistic practice involves caring for the physical, psychological, social and spiritual needs of patients. Spiritual assessment is an important part of the patient's overall assessment. Religion is a component of spirituality and is supported by a recognisable formal system of beliefs. Religious beliefs might help patients in their search for meaning in life, especially in difficult circumstances such as during an episode of illness. A small, retrospective anonymous audit of patients' notes (n = 23) was undertaken to assess the recording of patients' religious affiliations, beliefs and practices in an acute mental health unit for older people. CONCLUSION: All individuals had a religious affiliation documented in their notes, but there was a lack of recorded information about their beliefs and practices. The findings showed that religious beliefs were only discussed with patients who had psychotic symptoms that had a religious content. Therefore, it would seem that patients on this unit are not having their spiritual and religious needs met. Staff training on religious awareness might help to address these issues.     

How religious and spiritual beliefs explain prolonged grief disorder symptoms

This study investigated the importance of religious and spiritual beliefs in daily life in explaining prolonged grief disorder (PGD) symptomatology. Participants were 588 bereaved adults who completed a questionnaire. The importance of spiritual beliefs in daily life explained a small to medium, significant 3% of variance in PGD symptoms, but religious beliefs in daily life did not. Individuals who placed moderate importance on spiritual beliefs in their daily life may experience more intense grief.     

Living with rheumatoid arthritis: the role of daily spirituality and daily religious and spiritual coping.

The objective of this preliminary study was to evaluate more fully the role of daily spiritual experiences and daily religious/spiritual coping in the experience of individuals with pain due to rheumatoid arthritis (RA). Thirty-five individuals with RA were asked to keep a structured daily diary for 30 consecutive days. The diary included standardized measures designed to assess spiritual experiences, religious and spiritual pain coping, salience of religion in coping, religious/spiritual coping efficacy, pain, mood, and perceived social support. The participants in this study reported having spiritual experiences, such as feeling touched by the beauty of creation or feeling a desire to be closer or in union with God, on a relatively frequent basis. These participants also reported using positive religious and spiritual coping strategies much more frequently than negative religious and spiritual coping strategies. Although most of the variance in these measures was due to differences between persons, each measure also displayed a significant variability in scores from day to day. Indeed, there was just as much (or more) variability in these measures over time as there was variability in pain. Individuals who reported frequent daily spiritual experiences had higher levels of positive mood, lower levels of daily negative mood, and higher levels of each of the social support domains. Individuals who reported that religion was very salient in their coping with pain reported much higher levels of instrumental, emotional, arthritis-related, and general social support. Coping efficacy was significantly related to pain, mood, and social support in that on days that participants rated their ability to control pain and decrease pain using spiritual/religious coping methods as high, they were much less likely to have joint pain and negative mood and much more likely to have positive mood and higher levels of general social support. Taken together, these results suggest that daily spiritual experiences and daily religious/spiritual coping variables are important in understanding the experience of persons who have RA. They also suggest that newly developed daily diary methods may provide a useful methodology for studying religious and spiritual dimensions of living with arthritis.     

Spiritual Well-Being, Spiritual Practices, and Depressive Symptoms among Elderly Patients Hospitalized with Acute Heart Failure

This was an exploratory study because there was no previous research on the relationship between spiritual well-being and depression among hospitalized older adults with acute heart failure. In addition, there was no previous report of use of spiritual practices among this group of older adults. Thus, this study provides beginning insights among this population and important information for future research.     

Spirituality and well-being in terminally ill hospitalized adults

Initial research into the significance of spirituality among terminally ill adults was extended. Two hypotheses were examined using three groups of 100 adults matched on age, gender, education, and religious background: a) Terminally ill hospitalized adults indicate a greater spiritual perspective than nonterminally ill hospitalized adults and healthy nonhospitalized adults. b) Spiritual perspective is positively related to well-being among terminally ill hospitalized adults. All 300 participants completed the Spiritual Perspective Scale, Index of Well-Being, and other information. Planned comparisons analysis results supported the first hypothesis; low but significant correlation lent support to the second hypothesis. Differences among groups on recent change in spiritual views also were examined; a significantly larger number of terminally ill adults indicated a change toward increased spirituality than did nonterminally ill or healthy adults.     

Disability,spiritual beliefs and the church: the experiences of adults with disabilities and family members

AIMS: This paper reports the findings of a qualitative interpretive study that explored how people with disabilities and family members use their spiritual beliefs to establish meaning for disability, and to respond to the challenges of lived experience with disability. The participants' perceptions of the evangelical Christian church's influence on their spiritual experiences related to disability suggest recommendations for improved integration by the church. Applications are drawn for helping professionals and religious leaders who provide holistic care. BACKGROUND/RATIONALE: Although there is a well-established literature on coping in families with disabled children, little is known about how people use spiritual beliefs to establish meaning for and respond to life with disability. Even less is known about how people with a particular set of shared spiritual beliefs make meaning for lived experience with disability. DESIGN/METHODS: The author interviewed 30 persons, comprising two major groups: 13 parents of children with mixed developmental disabilities and nine adults with physical disabilities. Predominantly white, the participants lived in a south-western metropolitan area in the United States of America (USA) in 1998. FINDINGS: Trial or difficulty contributed to spiritual challenge, the breaking of self, reliance on God, and strengthened faith in God. The participants chose to live with thankfulness and joy despite difficulties common to experience with disability. The participants' spiritual beliefs stabilized their lives, providing meaning for the experience of disability, assistance with coping and other benefits. The participants' recommendations include increased assistance by the church in promoting theological understanding of disability, and religious support using a continuing model of caring. CONCLUSIONS: Although the study design limits the generalizability of the findings, applications can be drawn for helping professionals and religious leaders who provide holistic care     

Spiritual well-being among older adults

1. Older adults are a highly spiritual and religious group of individuals. 2. Nurses neglect spiritual interventions for older adults because of a fear of imposing their own philosophies, and lack of knowledge about the abstract. 3. Nurses need to be aware of spiritual needs not related to Judeo-Christian concepts. 4. The profound benefits to humankind of religious practice and spiritual well-being among most life forms has been reported.     

Spiritual coping strategies: a review of the nursing research literature

AIMS OF THE PAPER: This paper reviews some of the limited nursing research-based literature, orientated towards the use of spiritual coping strategies in illness. This review aims at identifying those spiritual coping strategies used by the believers and nonbelievers followed by implications for holistic nursing care. LITERATURE SEARCH: The CINAHL and MEDLINE CD Rom databases were searched, identifying literature published from 1975 onwards which amounted to 187 articles. The majority of the literature traced were found anecdotal with only few studies investigating directly spiritual coping strategies. Following scrutiny of the available articles, only five research studies explored directly the spiritual coping strategies used in various illness, four of which were conducted in USA and one in UK. Because of the small scale research studies, generalization of the findings of this review is limited to the samples used. THEORETICAL BACKGROUND: Research suggests that spiritual coping strategies, involving relationship with self, others, Ultimate other/God or nature were found to help individuals to cope with their ailments. This may be because of finding meaning, purpose and hope, which may nurture individuals in their suffering. Spirituality is oftenly referred by literature as being synonymous with religiosity. Thus the use of spiritual coping strategies is restricted to individuals who hold religious beliefs. However, the definition of spirituality indicates that this concept is broader than religiosity. The theories on stress-coping (Folkman & Lazarus 1984) and the numinous experience (Otto 1950) outline the rationale for the use of these strategies which are applicable to both the believers and nonbelievers. IMPLICATIONS: This review suggests that the onset of illness may render the individual, being a believer or nonbeliever to realize the lack of control over his/her life. However the use of spiritual coping strategies may enhance self-empowerment, leading to finding meaning and purpose in illness. This implies that holistic care incorporates facilitation of various spiritual coping strategies to safeguard the wholeness and integrity of the patients.     

The influence of information leaflets on morphine consumption in postoperative patients using patient-controlled analgesia

Negative preconceived beliefs about the benefits of morphine use are frequently seen in hospitalized patients and may be associated with reports of severe pain, poor patient satisfaction, impaired rehabilitation, and possibly more chronic postsurgical pain. In some patients, providing information through instructive leaflets may modify negative beliefs that limit proper medication use. The purpose of this study was to determine whether the morphine-related information provided through leaflets during the postoperative period led to increased use of morphine and lower pain scores in patients using patient-controlled analgesia. One hundred patients scheduled for surgery were randomly assigned to the experimental (n = 53) or control group (n = 38). Patients included in the former group received detailed information on morphine; those in the latter group received only general information on postoperative acute pain. The results indicated that during the immediate postoperative period, morphine use was directly associated with pain intensity and satisfaction with pain management and inversely related with side effects. These results show that pain intensity is the most relevant issue in the decision to use morphine. Information leaflets did not change morphine consumption.     

Determinants of mental health service use in the national mental health survey of the elderly in Singapore

Background

Despite high prevalence of mental health problems, only a minority of elderly people seek treatment. Although need-for-care factors are primary determinants of mental health service use, personal predisposing or enabling factors including health beliefs are important but are not well studied.

Method

In the National Mental Health Survey of Elderly in Singapore, 2003, 1092 older adults aged 60 and above were interviewed for diagnosis of mental disorders (using Geriatric Mental State) and treatment, and their health beliefs about the curability of mental illness, embarrassment and stigma, easiness discussing mental problems, effectiveness and safety of treatment and trust in professionals.

Results

The prevalence of mental disorders was 13%, but only a third of mentally ill respondents had sought treatment. Increased likelihood of seeking treatment was significantly associated with the presence of a mental disorder (OR = 5.27), disability from mental illness (OR = 79.9), and poor or fair self-rated mental health (OR = 2.63), female gender (OR = 2.25), and formal education (OR = 2.40). The likelihood of treatment seeking was lower in those reporting financial limitations for medical care (OR = 0.38), but also higher household income (OR = 0.31). Negative beliefs showed no meaningful associations, but the positive belief that 'to a great extent mental illness can be cured' was associated with increased mental health service use (OR = 6.89). The availability of family caregiver showed a negative association (OR = 0.20).

Conclusion

The determinants of mental health service use in the elderly included primary need factors, and female gender and socioeconomic factors. There was little evidence of influences by negative health beliefs, but a positive health belief that 'mental illness can be cured' is a strongly positive determinant The influence of family members and care-givers on senior's use of mental health service should be further explored.

     

Managing costly Medicare patients in the hospital

Cost-effective strategies must be developed to address the rapidly rising number of hospitalized older adults. Medicare cost outliers represent substantial unrecovered cost to hospitals caused by limited reimbursement based on diagnosis-related groups. A predictive model is used to identify potential cost outliers during admission, and a registered nurse inpatient case manager with geriatric expertise is the intervention to tailor the care to the unique needs of older adults. Community follow up is provided by social workers to complete the continuum. Positive outcomes from this project suggest that nursing can identify and successfully intervene with high-cost Medicare patients.     

Attitudes of occupational therapists toward spirituality in practice.

OBJECTIVE: This study examined (a) occupational therapists' attitudes about spirituality in practice on the basis of whether they identified themselves as religious, (b) whether their personal definition of spirituality related to their religiousness, (c) whether their definition related to their attitude about spirituality in practice, and (d) the methods they used to address the spiritual needs of clients. METHOD: An attitude questionnaire was developed and mailed to 396 American occupational therapists. Fifty-two percent (n = 206) of the mailed questionnaires were analyzed. RESULTS: Overall, participants indicated a slightly positive attitude toward spirituality in occupational therapy practice. Participants who considered themselves to be religious indicated a more positive view toward spirituality in practice than those who did not consider themselves to be religious. Religiousness accounted for only 28% of the variance in choice of spirituality definition, indicating that additional variables account for what determines therapists' definitions of spirituality. No relationship was found between personal definition choice and attitude regarding spirituality in practice. The three methods most commonly used to address the spiritual needs of their clients were to (a) pray for a client, (b) use spiritual language or concepts with a client, and (c) discuss with clients ways that their religious beliefs were helpful. CONCLUSION: Therapists' conceptualization of spirituality and attitudes about spirituality in occupational therapy practice are quite diverse.     

The Influence of Information Leaflets on Morphine Consumption in Postoperative Patients Using Patient-Controlled Analgesia

ABSTRACT

Negative preconceived beliefs about the benefits of morphine use are frequently seen in hospitalized patients and may be associated with reports of severe pain, poor patient satisfaction, impaired rehabilitation, and possibly more chronic postsurgical pain. In some patients, providing information through instructive leaflets may modify negative beliefs that limit proper medication use. The purpose of this study was to determine whether the morphine-related information provided through leaflets during the postoperative period led to increased use of morphine and lower pain scores in patients using patient-controlled analgesia. One hundred patients scheduled for surgery were randomly assigned to the experimental (n = 53) or control group (n = 38). Patients included in the former group received detailed information on morphine; those in the latter group received only general information on postoperative acute pain. The results indicated that during the immediate postoperative period, morphine use was directly associated with pain intensity and satisfaction with pain management and inversely related with side effects. These results show that pain intensity is the most relevant issue in the decision to use morphine. Information leaflets did not change morphine consumption.