Spiritual Care in adult critical care

Nicholas KurekFerris state University

Spiritual care is an essential component of nursing.It is especially important for the critical care nurse, as the patients are sicker and expectations are higher.

Unfortunately, many people in today’s fast paced society never take the time to contemplate their own mortality until they or a loved one become seriously ill and end up in an adult critical care unit.

Adult critical care units are very intimidating and scary places for those that are not in the medical field. The continuous advancement of science, medicine, and technology is readily evident in all the monitors and equipment. Frequently the nurses are very focused on the patient’s physical condition. Moreover with all the technological advances come increased accountabilities and responsibilities for the nurses.

Weiland (2010) states that in the high technical environment of critical care, spiritual care is in danger of being overlooked (p.289-290).

Weiland (2010) further states that all nurses have an obligation to integrate spiritual care because the focus of nursing care is healing (p.290).

Research Question

Spiritual Care in adult critical care: What are we doing and what more should/could we be doing?

Literature ReviewWall, Engelberg, Gries, Glavan, & Curtis (2007)

conducted a cross-sectional study to assess what effects family satisfaction with spiritual care provided at end of life in the Intensive Care Unit. The researchers found that families were more satisfied when clergy was involved in the last 24 hours of the patient’s life. They also recommended that care providers assess spiritual needs sooner than later and that further research should be conducted.

Critique: The study was conducted in the Seattle area and had a 41% response from families of mostly white patients . It is interesting to note that Wall et al (2007) cite research that “physicians perform poorly when it comes to end of life issues like dying and spirituality” (p.1089).

Literature Review

Nixon & Narayanasamy (2010) conducted a qualitative research study to determine what neuro-oncology patients viewed as spiritual needs. The researchers concluded that there is a need for spiritual care amongst neuro-oncology patients and their families and that further research should be conducted.

Critique: The study was conducted abroad in the United Kingdom. The study was based on the results of a questionnaire completed by 21 of 43 respondents (all of whom had brain tumors).

Literature ReviewLundberg & Kerdonfag (2010) conducted an

explorative qualitative study to explore how Thai critical care nurses provided spiritual care to their patients. The researchers found that the nurses identified presencing, supporting and encouraging religion, communication, and education as providing spiritual care. The researchers concluded that spiritual care is important to meet patients’ needs and nurses should be educated to provide spiritual care.

Critique: The study was conducted in Thailand. It consisted of 30 nurses from 5 critical care areas of the same hospital. All of whom volunteered and were asked open-ended questions in an interview.

Literature ReviewCritique: Weiland (2010) wrote a rather interesting article

about spiritual care in the critical care setting and illustrated it with a case study. This is not a research article; however, it was deemed appropriate for inclusion.

Weiland (2010) states:Nurses report feeling confused and uncomfortable providing spiritual care. In part , this dilemma stems from lack of education, knowledge, and confidence in assessing the spiritual domain. The outcome is that patients may not receive the spiritual care they need at a time when they are most vulnerable, feeling loss, seperation from the world, and powerlessness. Thus, ignoring the spiritual dimension of care may impede drawing upon a powerful inner source of strength and hope – it could also be construed as unethical (p. 283-4).

Literature Review

Critique: Timmins & Kelly (2008) researched different methods of spiritual assessment used in critical care and present several spiritual assessment tools. The authors practice in Ireland.

Timmins & Kelly (2008) found that there are several spiritual assessment tools and encourage the adaptation and use of a spiritual assessment tool in both intensive and cardiac care units.

Literature Review

Borneman, Ferrell, & Puchalski (2010) conducted a pilot study to test the use of the FICA scale in the clinical setting. The researchers found it is essential that patients spiritual needs are addressed to improve quality of life and that the FICA tool for spiritual assessment is works. They further suggest more research on it.

Critique: The study was based on FICA interviews of 76 patients at the National Cancer Institute . The majority (59) of patients were female with an average age of 58.7 years.

3 Instruments for obtaining a spiritual history

• HOPE

• FICA

• SPIRIT

HOPE *DOMAIN EXAMPLE

H: sources of hope H: What gives you hope (or strength or comfort or peace) in a time of illness?

O: organized religion O: Are you a part/member of a religious or spiritual community? Does it help you? How?

P: personal spirituality & practices

P: what aspects of your spiritual beliefs do you find most helpful and meaningful personally?

E: effect in medical care & end -of-life issues

E: how do your s beliefs affect the kind of medical care you would like me to provide ?

FICA*Domain Example

F: FAITH F: What is your faith?

I: Importance/influence I: How important is it?

C: Community C: Are you a part of a religious community?

A: Address/apply A: How would you like me as your provider to address these issues in your care?

SPIRIT*Domain Example

S: Spiritual belief system S: Do you have a formal religious affiliation?

P: Personal spirituality P: In what ways is your spirituality important to you?

I: Integration with a spiritual community

I: Do you belong to any religious or spiritual groups or communities?

R: Ritualized practices & restrictions

R: What specific practices do you carry out as part of religious or spiritual life?

I: Implications for medical care I: Would you like to discuss religious or spiritual implications of health care?

T: Terminal events T: Are there particular aspects of medical that you wish to forego or have withheld because of your religion/spirituality?

Conclusions & Implications for practice

The need for spiritual assessment and care is essential and well documented in many different countries with different cultures, religions and beliefs.

In fact, we must educate ourselves about and be sensitive to other cultures, religions, and beliefs.

There are many different spiritual assessment tools available - use one. The FICA is simple and works.

The sooner we address our patients’ and families’ spiritual needs, the sooner their needs will be met.

Conclusions & implications for practice

Include, acknowledge, explain things to, and communicate with both patients and their families.

Remember, presencing and active listening are very effective spiritual interventions.

Failure to address spiritual needs can be construed as unethical and potentially neglectful.

Address your patients spiritual needs!

References

Anadaraja, G. & Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. American Family Physician 63:81-89. Retrieved from: http:www.uptodate.com/online/content/image.do?imageKey=ONC%2F17411&view=print

Borneman, T., Ferrell, B., & Puchalski, C. M. (2010). Evaluation of the FICA tool for spiritual assessment. Journal of Pain and Symptom Management 40 (2)163-173. doi: 10.1016/j.jpainsymman.2009.12.019

Lundberg, P. C. & Kerdonfag, P. (2010). Spiritual care provided by Thai nurses in intensive care units. Journal of Clinical Nursing 19, 1121-1128. doi: 10.1111/j.1365-2702.2009.03072.x

Maugans, T. A. (1996). The SPIRITual history. Archives of Family Medicine 5:11-16 . Retrieved from: http:www.uptodate.com/online/content/image.do?imageKey=ONC%2F17411&view=print

ReferencesNixon, A. & Narayanasamy, A. (2010). The spiritual needs of neuro-

oncology patients from patients’ perspective. Journal of Clinical Nursing 19, 2259-2270. doi: 10.1111/j.1365-2702.2009.03112.x

Puchalski, C. M. & Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. Journal of Palliative Medicine 3,129-137. Retrieved from: http:www.uptodate.com/online/content/image.do?imageKey=ONC%2F17411&view=print

Timmins,F. & Kelly, J. (2008). Spiritual assessment in intensive and cardiac care nursing. Nursing in Critical Care 13(3), 124-131.

Wall, R. J., Engelberg, R. A., Gries, C. J., Glavan, B., & Curtis, J. R. (2007). Spiritual care of families in the intensive care unit. Critical Care mMedicine 35(4), 1084-1090. doi: 101097/01.CCM.0000259382.36414.06

Weiland, S. A. (2010). Integrating spirituality into critical care: An APN perspective using Roy’s adaptation model. Critical Care Nursing Quarterly 33(3), 282-291

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