A Conceptual Framework for Assessing the Spiritual Functioning and Fulfillment of Older Adults in Long-Term Care Settings

ABSTRACT

The 1971 White House Conference on Aging asserted that all persons are spiritual, and that the spiritual well-being of older adults is a significant area of concern for both researchers and practitioners. Many attempts have been made to define and describe spirituality, using instruments designed to measure religious functioning and behavior. While these have been helpful to researchers, they have been of little practical use.

This paper presents a conceptual framework for the operationalization of the variable, “spirituality.” Using this framework, the authors chose three qualitative research questions related to spiritual values which were asked of both older adults and service providers. The results were factor analyzed and an instrument was developed which enables the practitioner to assess the type of spiritual functioning and fulfillment desired by older adults in long-term care settings.     

Integration of Spiritual Care in Hospital Care System in Iran

There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.

     

Attitudes Toward Spirituality and Spiritual Care among Iranian Nurses and Nursing Students: A Cross-Sectional Study

Addressing spiritual needs is taken into account as an integral part of holistic health care and also an important component of nursing practice. The aim of present study is to evaluate attitudes toward spirituality and spiritual care among nurses and nursing students at Semnan University of Medical Sciences in Iran. In this cross-sectional study, all nurses (n = 180) working in the teaching hospitals affiliated to Semnan University of Medical Sciences as well as senior nursing students (n = 50) selected by the census method. Finally, 168 individuals meeting the inclusion criteria were evaluated as the study sample. The data collection instrument was the Spirituality and Spiritual Care Rating Scale. The mean and standard deviation scores of attitudes toward spirituality and spiritual care among nurses and nursing students were 59 ± 10.9, and the scores obtained by the majority of study population (64.3%) ranged between 32 and 62 which were at a moderate and relatively desirable level. Nurses and nursing students working in aforementioned hospitals reported positive attitudes to spirituality and spiritual care. Given the importance of spiritual care and also the moderate level of spirituality and spiritual care among nurses and nursing students in this study, institutionalization of the concept of spirituality, provision of an appropriate context to deliver such care, and also implementation of interventions in order to improve spiritual care along with other nursing skills were assumed of utmost importance.     

Developing an adequate "pneumatraumatology": understanding the spiritual impacts of traumatic injury

Psychosocial interventions and systematic theology are primary resources for chaplains and congregational pastors who care for victims of physical trauma. Yet these resources may not be adequate to address the spiritual impacts of trauma. This article proposes a preliminary "pneumatraumatology," drawing on early Christian asceticism and Buddhist mysticism to describe one way of understanding the spiritual impacts of traumatic injury. It also suggests possible responses to these impacts informed by narrative/constructionist perspectives and Breggemann's understanding of the dimensions of spiritual transformation in the Hebrew Bible.     

Therapists' Use of Religious and Spiritual Interventions in Christian Counseling: A Preliminary Report

This study explored the use of religious and spiritual interventions in counseling by Christian therapists (N = 100). Use of religious and spiritual interventions correlated with personal religiousness and clinical training involving religious clients and religious and spiritual interventions. Course work involving either psychology or theology did not correlate with use of or self‐reported competency in using religious and spiritual interventions. Self‐reported competency was associated with personal religiousness; professional beliefs, attitudes, and values; personal experiences with counseling; and clinical training involving religious clients and religious and spiritual interventions. It is suggested that training programs incorporate clinical rotations, workshops, and supervision involving religious clients and religious and spiritual interventions to teach therapists to use religious and spiritual interventions in counseling.     

Cultivating Mindfulness Through The Practice Of Iaidō

Iaidō is a Japanese swordsmanship art that teaches the practitioner, iaidokan, a series of sword techniques known as kata. The number, and severity of [sword] techniques increases as the practitioner achieves higher grades (kyu and dan). To understand and conduct the [spiritual] core of iaidō, the iaidoka must learn how to be attentive and bodily and mindfully present when carrying out these [sword] techniques. In this respect, mindfulness training could be of great help by enhancing the ability of the iaidokan skills in this regard. Additionally, mindfulness training may be used to teach the practitioner of iaidō how to develop a being-mode. This article discusses, from both an outside-in perspective, as academic researcher and an inside-out perspective as a mindfulness and iaidō practitioner, the meaning of iaidō in terms of attention, [mindfulness] meditation and a being-mode. This discussion may prepare the way for a new and inspiring understanding of Asian spiritual practices in a Western guise.     

East of Ego: The Intersection of Narcissistic Personality and Buddhist Practice

This article explores the intersection of clinical narcissism and Buddhist meditation practice. Through the lens of Otto Kernberg and Heinz Kohut’s theories of narcissism, the article investigates the many facets of Eastern spiritual practice when undertaken by a narcissistic practitioner. In particular, questions are raised regarding the potential psychological dangers of pursuing meditation practice when suffering from clinical narcissism. Potential applications for a cross-pollination of psychoanalytic support and Buddhist practice are also considered for the narcissistic patient and/or spiritual practitioner.     

Is there a chaplain in your clinic?

As medical care continues to move outside the hospitals, clients with spiritual needs are more often to be found in clinics and doctors' offices than inpatient settings. Chaplains in partnership with physicians can contribute to healing in outpatient centers. A study of one group of clinic patients indicates that an outpatient setting may be a better place to address spiritual needs than a hospital setting. Pastoral interventions are acceptable to many clients, who according to statistics are already using alternative therapies to augment traditional medical care. Paul A. Mandziuk, M. Div., a priest of the Missionaries of La Salette, is a chaplain at Saint Louis University Health Sciences Center in St. Louis, MO, and serves on the leadership council of the National Association of Catholic Chaplains.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

A Role for Occupational Therapy in Foster Care

The purpose of this publication is threefold. First, it is an attempt to document the need for occupational therapy services within the foster care population. Second, it describes methods that can be used by occupational therapists to provide appropriate interventions to people affected by foster care. And third, it highlights the need for and identifies specific assessments that can be used to evaluate individuals affected by foster care and to measure the effectiveness of occupational therapy services delivered to foster care agencies.     

Issues relating to the use of forgiveness in counselling and psychotherapy

This paper explores forgiveness, which is a key component of spiritual pastoral care. Encouraging forgiveness is also one of the spiritual interventions most frequently used by psychotherapists. However, although forgiveness has been explored as an element in psychotherapy, the models generated have had little impact on research and practice. Recent research into forgiveness in therapy is considered, including several models put forward for its use. Some of the implications of the use of forgiveness in therapeutic practice are examined and guidelines for the use of forgiveness in psychotherapy are put forward based on the work of the Forgiveness Project at the University of Manchester.     

Apparitions and possessions as boundary objects: an exploration into some tensions between mental health care and pastoral care

Apparitions and possessions can be taken as genuine spiritual events or as symptoms of psychopathology. We focus upon occasions when the two seemingly conflicting “interpretations” co-exist in order to explore these phenomena as kinds of boundary objects—polymorphous realities stable and graspable enough, yet belonging to different worlds at once. Related diagnostic knowledge is often uncertain and always incomplete. Yet it enables authoritative and effective professional interventions. We conclude by discussing the relevance of such a view for contemporary efforts to validate patients’ spiritual experiences within mental health care.     

Use of religious and spiritual interventions by trainees in APA-accredited Christian clinical psychology programs

Little is known about the effectiveness of Christian clinical programs accredited by the American Psychological Association in training students to use religious and spiritual interventions in therapy. We surveyed 162 student therapists from three such programs regarding their training experiences and use of religious and spiritual interventions. Self-reported competency and use of religious and spiritual interventions correlated with a number of training components. However, none of the training components predicted unique variance in regression equations above and beyond that of general professional training, personal religiousness, and intervention-specific training. Suggestions are offered regarding intervention-specific training in both Christian and secular programs, the role of personal therapy in training, and the development of guidelines for competency in using religious and spiritual interventions.     

Holistic Psychology: A Brief Primer

This article explicates the foundations, essential themes and healing principles of holistic psychology; an approach which provides a corrective for such trends in modern scientific psychology as disciplinary perspectives, the overemphasis on the economics and politics of professionalism. Holistic psychology emphasizes spiritual healing, multi-cultural counseling, community and ecological interventions. Its core pillars of practice and care stem from the spiritual and wisdom traditions widely applicable to combating illness, injustice, violence, materialism, and technocratic influences so prevalent in contemporary society. As a breath and/or spirit based healing practice, holistic psychology provides a foundational exercise for personal, social and cosmic transformation.     

Addressing the spiritual domain in a plural society: what is the best mode of integrating spiritual care into healthcare?

This study aims to rethink the integration of spiritual care into healthcare in spiritually plural societies. Based on a systematic review of the theoretical literature, we analysed 74 studies and distinguish four positions regarding the integration of spiritual care into healthcare: generalist-particularists who see the spiritual domain as a field to be addressed by all professional caregivers and in which caregivers’ own spiritual orientations play a vital role; generalist-universalists who advocate for all caregivers to provide spiritual care regardless of their spiritual orientations; specialist-particularists who argue that experts should address the spiritual domain in light of their own spiritual orientations; and specialist-universalists who call for experts to provide spiritual care regardless of their spiritual orientations. We argue that these four positions give different weight to the professional, personal, and confessional roles of the spiritual caregiver. Acknowledging these positions is a prerequisite for future scenarios of integrating spiritual care into healthcare.     

Assessing Religion and Spirituality in Counseling: Some Reflections and Recommendations

In this article, the importance of conducting a religious and spiritual assessment in counseling is considered. Some essential dimensions of religion and spirituality to assess are described. The authors recommend assessment questions that can be asked during clinical interviews or included on written intake questionnaires. They also briefly describe a few standardized religious and spiritual assessment instruments. Finally, they offer suggestions for conducting spiritual assessments in school settings.     

Religious and spiritual struggle: prevalence and correlates among older adults with depression in the BRIGHTEN Program

Older adults (OA) are more religious and/or spiritual (R/S) than younger adults, but some experience R/S struggle which is associated with poorer quality of life. Little is known about R/S struggle in community dwelling OA. This study examines prevalence, correlates, the association with depression for R/S struggle, and a desire for spiritual care in community dwelling OA with depression. In a programme for integrating care for these OA, 188 participants provided demographic information along with the Geriatric Depression Scale and a tool screening for potential R/S struggle. Prevalence of potential R/S struggle was 50%. The younger OA and Caucasian individuals vs. Hispanic individuals were more likely to experience potential R/S struggle. A relationship of potential R/S struggle with depression persisted with the inclusion of controls. Of those with potential struggle, 52% wanted to see a chaplain. Screening for potential R/S struggle can play an important role in choosing specific interventions for OA with depression.     

Mindfulness,Mysticism, and Narrative Medicine

Mindfulness based interventions (MBIs) are rapidly emerging in health care settings for their role in reducing stress and improving physical and mental health. In such settings, the religious roots and affiliations of MBIs are downplayed, and the possibilities for developing spiritual, even mystical, states of consciousness are minimized. This article helps rebalance this trend by using the tools of medical humanities and narrative medicine to explore MBI as a bridge between medical and spiritual approaches to health related suffering. My narrative medicine method draws insights from the arts and humanities that are rarely used in standard clinical research but are increasingly common among medical humanities and narrative medicine scholars. The specific path I take will be to work through historical, linguistic, and philosophic dimensions of mindfulness and mysticism as relevant to illness, suffering, death, and dying. I close with two case examples in which mindfulness is used as an intentionally spiritual practice for health concerns.     

Being Mindful About the Use of Mindfulness in Clinical Contexts

Over the last 10 years, interest in the use and investigation of mindfulness-based interventions in clinical settings has expanded greatly. This commentary addresses key questions facing clinicians and researchers in order to undertake future work with rigor and care. We consider, in particular, questions regarding the definition of mindfulness, the context within which mindfulness has evolved over time, including its origins as a spiritual practice, and requirements for clinicians and researchers to deliver and study mindfulness-based interventions competently. We offer suggestions for clinical practice and research, including the expansion of mindfulness-based interventions to increasingly diverse populations.     

Is Evidence Based Spiritual Care an Oxymoron?

Evidence based spiritual care utilizes empirical evidence on spirituality in addressing the spiritual needs of patients. Objections to evidence based spiritual care include issues of methodology and ethics. Reasons favoring evidence based spiritual care stem from a view that it is not an oxymoron but a paradox. An example of evidence based spiritual care is described using cardiac patients in a CCU unit. Concluding remarks note that we are at the beginning and need a new scientific/theological paradigm that integrates not separates science and theology.