The Fifth Domain of Palliative Care

2018 ◽  
Author(s):  
E. Alessandra Strada
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Interdisciplinary Collaboration ◽  
Spiritual Needs ◽  
Care Providers ◽  
Spiritual Assessment ◽  
Palliative Care Setting ◽  
The Family ◽  
Spiritual Screening ◽  
Spiritual History

This chapter presents palliative psychology competencies in the fifth domain of palliative care, which addresses the existential and spiritual needs of the patient and the family. The constructs of spiritual screening, spiritual history, and spiritual assessment are discussed with attention to their application to the palliative care setting. Through clinical case vignettes and discussions, the chapter discusses how psychologists can effectively use spiritual screening and spiritual history to fully understand spiritual and existential needs. Ways of integrating spiritual concerns and needs during the therapy session are highlighted in this chapter. The interplay of psychological and spiritual concerns offers the opportunity for palliative psychologists and spiritual care providers to collaborate in the psychospiritual care of the patient and the family. Because interdisciplinary collaboration is a hallmark of palliative care, the chapter also describes examples of effective collaboration between psychologists and spiritual care providers, from assessment to treatment planning.

Spiritual Screening, History, and Assessment

2019 ◽  
pp. 432-446 ◽  
Author(s):  
Elizabeth Johnston Taylor
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Well Being ◽  
Care Recipient ◽  
Spiritual Needs ◽  
History Taking ◽  
Spiritual Assessment ◽  
Spiritual Well Being ◽  
Spiritual Screening ◽  
Screening History

Spiritual care is integral to palliative care. Palliative care patients and their family members often use spiritual coping strategies, and spiritual well-being is a commonly high-ranked pursuit for those at the end of life. Appropriate spiritual care, however, must reflect the spiritual needs and preferences of the care recipient. Thus, numerous approaches to spiritual screening, history-taking, and assessment exist. Whereas the spiritual screening is proposed as a skill and expectation that nurses and others can be trained to complete, the spiritual assessment is the domain of the spiritual care expert—typically, a skilled chaplain. These diverse approaches are described here along with some additional observations that can guide the process.

scholarly journals The spiritual experience of dementia from the health care provider perspective: Implications for intervention

2021 ◽  
Author(s):  
Jennifer A Palmer ◽  
Michelle Hilgeman ◽  
Tracy Balboni ◽  
Sara Paasche-Orlow ◽  
Jennifer L Sullivan
Keyword(s):  
Health Care ◽  
Spiritual Care ◽  
Spiritual Experience ◽  
Assessment Tools ◽  
Spiritual Needs ◽  
Medical Conditions ◽  
Care Providers ◽  
Spiritual Assessment ◽  
Spiritual Distress ◽  
Loss Of Self

Abstract Background and Objectives Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development. Health care providers are well-situated to observe the nature of spiritual needs across and within medical conditions. Research Design and Methods We conducted semi-structured qualitative interviews with providers. We sampled purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about, e.g., the nature of spiritual needs in dementia and stakeholders’ roles in addressing them. Inductive / deductive thematic analysis was employed. Results Twenty-four providers participated. The thematic structure consisted of two themes: 1) spiritual experience in dementia differs from that in other medical conditions (sub-themes: fear, profound loss of self, progressive and incurable nature, and impacted ability to access faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: awareness in mild dementia and its influence on spiritual distress, and a window of opportunity). Discussion and Implications We learned about the potential “what” of spiritual needs and “who” and “when” of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss of self early in symptom progression, and stakeholder training. Researchers should study additionally the “how” of dementia-appropriate spiritual care. Conjointly, these efforts could promote spiritual well-being in persons living with dementia worldwide.

Spiritual issues in palliative medicine

2015 ◽  
Author(s):  
Susan E. McClement
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Spiritual Care ◽  
Future Research ◽  
Care Providers ◽  
Care Needs ◽  
Spiritual Assessment ◽  
Future Research Directions

The focus of palliative care is the whole person, including biopsychosocial, cultural, and spiritual dimensions of patient needs. The burgeoning literature examining the topic of spirituality within health care in general, and within palliative care in particular, underscores the notion that attending to patients’ spiritual care needs is a vital part of providing optimal palliative care. Yet health-care providers frequently report that they feel ill equipped to provide spiritual care at the end of life and wrestle with many questions and uncertainties: What is spiritual care? What is spiritual suffering? Who should provide spiritual care? How is a spiritual assessment conducted? What are some spiritual interventions for end of life care? What are some future research directions in the area of spiritual care? Answers to these questions form the basis of this chapter.

What are the core elements of oncology spiritual care programs?

2009 ◽  
Vol 7 (4) ◽  
pp. 415-422 ◽  
Author(s):  
Shane Sinclair ◽  
Marlene Mysak ◽  
Neil A. Hagen
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Best Practice ◽  
Participant Observation ◽  
Care Center ◽  
Academic Program ◽  
Therapeutic Interventions ◽  
Spiritual Needs ◽  
Care Providers ◽  
Factors Affecting

AbstractObjective:Tending to the spiritual needs of patients has begun to be formally recognized by professional spiritual care providers, health care councils, and health delivery systems over the last 30 years. Recognition of these programs has coincided with evidence-based research on the effect of spirituality on health. Palliative care has served as a forerunner to an integrated professional spiritual care approach, recognizing the importance of addressing the spiritual needs of the dying from its inauguration within Western medicine almost 50 years ago. Oncology programs have also begun to recognize the importance of spirituality to patients along the cancer continuum, especially those who are approaching the end of life. Although standards and best practice guidelines have been established and incorporated into practice, little is known about the actual factors affecting the practice of spiritual care programs or professional chaplains working within an oncology setting.Methods:Participant observation and interactive interviews occurred at five cancer programs after we conducted a literature search.Results:This study identified underlying organizational challenges, cultural and professional issues, academic program development challenges, administrative duties, and therapeutic interventions that determined the success of oncology spiritual care programs in practice.Significance of results:Although spiritual care services have developed as a profession and become recognized as a service within oncology and palliative care, organizational and operational issues were underrecognized yet significant factors in the success of oncology spiritual care programs. Spiritual care programs that were centrally located within the cancer care center, reported and provided guidance to senior leaders, reflected a multifaith approach, and had an academic role were better resourced, utilized more frequently, and seen to be integral members of an interdisciplinary care team than those services who did not reflect these characteristics.

Clinical psychology in palliative care

2021 ◽  
pp. 241-247
Author(s):  
E. Alessandra Strada
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Transitions Of Care ◽  
Family Coping ◽  
Psychotherapy Session ◽  
Specialist Knowledge ◽  
Professional Self ◽  
Psychiatric Intervention ◽  
Spiritual Screening ◽  
Anxiety Depression

Clinical psychologists with specialist knowledge and skills in palliative care can be described as palliative psychologists. Whether as core members of a palliative care team or as consultants, palliative psychologists can become involved soon after a diagnosis of serious illness and continue to provide care during treatment, transitions of care, during the dying process, and in bereavement. The distress patients and family caregivers may experience is on a continuum and may involve both psychological and spiritual factors. When the patient and family coping strategies become depleted or are inadequate to face the challenges imposed by illness, suffering can ensue. The palliative psychologist may offer assessment and management of anxiety, depression, and other types of psychological distress. Grief reactions should always receive special and ongoing attention to determine whether the distress is manageable or whether psychological or psychiatric intervention is warranted. Because of the ongoing interplay of psychological and spiritual concerns, palliative psychologists can effectively use spiritual screening and the spiritual history to understand spiritual and existential needs, and help integrate spiritual care into the psychotherapy session. This offers the opportunity to collaborate with spiritual care providers in the psychospiritual care of the patient and the family. Maintaining professional self-care is also a mandate for palliative psychologists and includes the timely recognition of risk factors for professional distress, protective factors, and meaningful interventions.

The Family Conference

2019 ◽  
pp. 238-249
Author(s):  
Melissa Red Hoffman
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Surgical Procedure ◽  
Shared Decision ◽  
Treatment Team ◽  
Care Providers ◽  
Time Saving ◽  
Family Conference ◽  
Short Period ◽  
The Family

The family conference chapter explores, in detail, one of the primary interventions performed by palliative care providers. A successful meeting can actually be viewed as time saving as it offers an opportunity for many issues to be reviewed and for multiple important decisions to be made in a relatively short period of time. By describing the conference in terms of a surgical procedure, during which we prepare, do, and close, this chapter offers specific guidance in a way most likely to resonate with a surgeon. It reviews the steps necessary to prepare for a family conference and describes how such steps may aid the family and the treatment team in managing uncertainty. It introduces the ask-tell-ask model of communication and discusses how this model can help to facilitate shared decision-making.

Spiritual care for the critically ill

1995 ◽  
Vol 4 (1) ◽  
pp. 77-81 ◽  
Author(s):  
C Clark ◽  
T Heidenreich
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Spiritual Care ◽  
Well Being ◽  
Nursing Interventions ◽  
Negative Feeling ◽  
Technical Competence ◽  
Care Providers ◽  
Spiritual Assessment ◽  
Spiritual Well Being

BACKGROUND: Spiritual well-being is the center of a healthy lifestyle and enables holistic integration of one's inner resources. However, the professional education process does not adequately provide socialization of nurses in the provision of spiritual care. Few studies exist that adequately address the spiritual aspect of nursing care. PURPOSE: To identify factors that contribute to providing spiritual care for patients in intensive care units. METHODS: A descriptive research design was used for this replication study conducted on a convenience sample of 63 patients in the critical care unit of a large midwestern military hospital. A trained interviewer asked each participant three open-ended questions regarding events that had created hope or meaning, created negative feeling, and could have contributed to hope or meaning. The interview took place 1 to 2 days after discharge from the intensive care unit. Predominant patterns were determined by content analysis. RESULTS: Three themes were identified as integral to the spiritual well-being of critical care patients: care providers, family/friends, and religion/faith. Nursing interventions identified for the three themes include establishing trusting relationships, providing in-depth spiritual assessment, conveying technical competence, and acting as facilitator among family, clergy, and other providers. CONCLUSIONS: We conclude that the key nursing interventions derived from this study include listening to patients' concerns and maintaining and conveying technical competence.

The Fourth Domain of Palliative Care

2018 ◽  
Author(s):  
E. Alessandra Strada
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Psychosocial Interventions ◽  
Social Needs ◽  
Family Meeting ◽  
Management Of Complications ◽  
Palliative Care Setting ◽  
The Family ◽  
The Many ◽  
Clinical Case Scenarios

This chapter proposes palliative psychology competencies in the fourth domain of palliative care, which addresses the social needs of the patient and the family. The unit of care in palliative care is represented by the patient and the family; thus, this chapter highlights the unique needs of family caregivers. The many challenges of caregiving are described by reviewing the literature and using clinical case scenarios. The risk factors and protective factors in caregiving are discussed and incorporated in assessment templates. Psychological and psychosocial interventions that can effectively support family caregivers are discussed. The function, structure, and execution of a family meeting in the palliative care setting is described. This chapter also describes bereavement support for family caregivers and the management of complications of bereavement.

The Physician’s Role in Responding to Existential Suffering: What Does It Mean to Comfort Always?

2019 ◽  
Vol 35 (1) ◽  
pp. 8-12
Author(s):  
Hermioni L. Amonoo ◽  
Jennifer H. Harris ◽  
William S. Murphy ◽  
Janet L. Abrahm ◽  
John R. Peteet
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
Spiritual Care ◽  
Psychological Symptoms ◽  
Time Constraints ◽  
Care Providers ◽  
Existential Suffering ◽  
Existential Distress ◽  
Existential Needs ◽  
Instrumental Role

Existential suffering is commonly experienced by patients with serious medical illnesses despite the advances in the treatment of physical and psychological symptoms that often accompany incurable diseases. Palliative care (PC) clinicians wishing to help these patients are faced with many barriers including the inability to identify existential suffering, lack of training in how to address it, and time constraints. Although mental health and spiritual care providers play an instrumental role in addressing the existential needs of patients, PC clinicians are uniquely positioned to coordinate the necessary resources for addressing existential suffering in their patients. With this article, we present a case of a patient in existential distress and a framework to equip PC clinicians to assess and address existential suffering.

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