The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

A Palliative Approach to Spirituality in Residential Aged Care

SUMMARY

This paper describes how a palliative approach to care is relevant in the context of residential aged care, with specific focus on the spiritual needs of residents. Three issues are described that make attention to spirituality in residential aged care particularly challenging: effects of cognitive changes, potential threats to dignity, and uncertainties about how to provide bereavement support to the range of people who experience loss in this care context. Reflections on how residential aged care staff might better assess the spiritual needs of residents are offered with suggestions from the literature about how to sensitively respond to these needs.     

Spirituality in the Treatment of Alcoholism: A Worldview Approach

To consider alcoholism an addiction with a spiritual dimension has historically posed a problem for the logical positivism and egalitarian orientations of most Western-trained therapists and academics. Many of these professionals argue that to define alcoholism as including a spiritual component invites nonscientific if not mystical approaches to treatment. For this reason, it has been difficult to legitimize a definition of alcoholism that considers spiritual components to etiology or treatment. In this article, the author suggests that issues of spirituality are an important focus in the treatment of alcohol dependence. To consider spirituality as representative of how one views the world and his or her role in creation may well relieve some of a professional counselor's apprehension about inserting a “theology” into treatment.     

How Separable Are Spirituality and Theology in Psychotherapy?

The authors respond to D. A. Helminiak's (2001) article “Treating Spiritual Issues in Secular Psychotherapy.” They focus particularly on Helminiak's argument for secular spirituality (whether spirituality can be independent of theology/religion) and his inherent biases in discussing the nature and existence of spirituality. The authors argue that all spiritual conceptions have theological implications—and thus a theology, broadly defined—and that theology, in this sense, pervades the theory and practice of all psychotherapists, whether or not they are religious.     

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.     

An examination of the new age movement: Who is involved and what constitutes its spirituality

Through substantial new quantitative research, I have found that participants of the New Age Movement are not young and not especially well‐off, but tend to be middle‐aged or older, and are represented throughout the entire economic spectrum. Moreover, their spirituality encompasses a wide variety of influences drawn from all religious traditions and spiritual concerns. While a great deal of social and spiritual common focus seems to exist in the Movement as a whole, my findings show that there is no one specific type of person who might be considered as being particularly active in the New Age. Furthermore, because of the wide variety of spiritual influences and the individual nature of participants’ spiritual quests, there does not appear to be a strong leaning to any one type of spirituality from which a more formalised New Age religious institution might arise. Through this new research, many claims about who is involved in the New Age Movement and what form their spirituality might take have been reviewed and I demonstrate that there are sizeable inaccuracies among the reports of some commentators.     

Caring for Creation and Striving for Climate Justice: Implications for mission and spirituality1

Presenting climate change as one of the most important challenges the world faces today, and one that already affects populations in the Pacific, in Africa, in the Caribbean and in Southeast Asia, the author links spirituality and mission with the advocacy work being carried on by the World Council of Churches on climate change issues. The article asserts that the ecumenical work on climate change is rooted in a biblical imperative. Two biblical insights, the wholeness of creation and the commitment for justice, are unfolded as guidelines for the ecumenical concern on climate change. The first one requests a renewed theology of creation that responds adequately to the accusation that Christianity is anthropocentric. In this theology, the trinitarian understanding of creation and the role of the Holy Spirit are highlighted. Together with theology, ethics is a core contribution churches make to the climate change debate. This ethical approach is based on the commitment for justice, biblically rooted, which pays special attention to the poor, the vulnerable ones. Main principles of climate justice from the UN Framework Convention on Climate Change are also analyzed. Finally, the spiritual dimension is presented following texts of Leonardo Boff and Larry Rasmussen, among others, as a specific contribution Christian churches make to climate change, ecology and environmental issues.     

ALL ANIMALS MATTER: MARC BEKOFF'S CONTRIBUTION TO CONSTRUCTIVE CHRISTIAN THEOLOGY

Abstract. Along with Jane Goodall, Mark Bekoff proposes that religion can join science in recognizing that animals have minds of their own; that humans can humbly imagine themselves inside these minds, all the while recognizing their independent integrity; and that, as creatures with psyches, animals deserve respect and care. In his various writings Bekoff offers many hints of what a theology of animal minds might look like and how it might be part of a more comprehensive theology of respect and care for the community of life. Process or Whiteheadian theology offers a way of appreciating Bekoff's insights, linking them with the ecojustice movement, showing how they can be linked with various themes in evolutionary biology, and developing a threefold approach to animal well‐being: cosmological, ethical, and spiritual. In so doing, process thought shows how the practice of science, particularly as expressed in cognitive theology, involves a marriage of empathy and observation, which represents science and spirituality at their best.     

Disembodied Souls or Soul-Less Bodies: Spirituality as Fragmentation

SUMMARY

‘Soul’ and ‘body’ are two linguistic expressions of one and the same reality, the human being. In pastoral care, aged care, and palliative care the stated aim is always to care for the whole person. An increasing focus on ‘spirituality’ has also led to objectifying and measuring what is ultimately beyond calculation. To care for each person as an ‘ensouled body’ and ‘embodied soul’ is to acknowledge we are in the service of one another. In entering one another's stories, words like impose, define, and manage are replaced by trust, love, and faithfulness. Measurable outcomes are then replaced by risk, ambiguity, and mystery: the heart and soul and body of human care.     

Prevalence and Nature of Spiritual Distress Among Palliative Care Patients in India

In palliative care research, little attention has been paid to the empirical study of spirituality in patients in non-Western countries. This study describes the prevalence and nature of spiritual distress among Indian palliative care patients. Data from 300 adult cancer patients who had completed a questionnaire with 36 spirituality items were analyzed. Spirituality was shaped by the Indian religious and economic context. A latent class analysis resulted in three clusters: trustful patients (46.4 %), spiritually distressed patients (17.4 %), and patients clinging to divine support (36.2 %). After regression, the clusters were found to be associated with pain scores (p < .001), gender (p = .034), and educational level (p < .006). More than half of the patients would benefit from spiritual counselling. More research and education on spirituality in Indian palliative care is urgently required.     

The prophetic nature of pastoral counselling

The role of pastoral counselling is explored in the light of the increasing interest among secular therapists in spirituality and the escalation in the number of clients presenting themselves with spiritual issues. Definitions are offered of spirituality, sexuality and religion as well as of pastoral counselling itself. The development of pastoral counselling is contrasted with the upsurge of Christian counselling in the latter years of the 20th century.The central influence of Carl Rogers is examined and it is argued that his late embracing of the spiritual dimension makes him, once more, a potential source of inspiration for pastoral counsellors in the years ahead. The critical tasks of integrating science and religion and of communicating across inter-faith boundaries require both an emphasis on contemplative and mystical experience and a radically evolving theology. Rogers' 'person of tomorrow' is seen as a possible blueprint for the pastoral counsellor of the future who can be assured of a difficult path and much hostility and misunderstanding.     

Emerging Finnish Adults Coping with Cancer: Religious,Spiritual, and Secular Meanings of the Experience

The article presents empirical findings on religious, spiritual, and secular coping among emerging Finnish adults with cancer and seeks an understanding of the different meanings they constructed of their experience with cancer. Autobiographical interviews and life tree drawings of 16 emerging adults were analyzed utilizing a narrative approach. To gain a deeper understanding of the cancer-coping and meaning-making processes, the stories of Beth, Sophia, and Anna are explored in detail. An exploration of the meaning-making process of all the participants shows that over time many of the participants were able to find meaning in their cancer experience. Religious meaning was found when the disease was discovered as a calling from God, spiritual meaning was discovered within a buffered identity and important relationships, and secular meaning was found in the courage to make a career change. The theoretical discussion points out a gap between the disciplines of theology and psychology of religion. The gap is partly bridged by utilizing the concepts of lived religion and existentially oriented spirituality in the discussion of meaning-making theories.     

Therapeutic turn

This paper offers a systematic and critical exploration of contemporary theology of pastoral care in the Evangelical Lutheran Church of Finland in light of the history of the practice of care-giving and Western cultural change. Currently, pastoral care is characterized by a therapeutic approach that aims to offer sincere help for earthly suffering and to promote the good things that the individual chooses to reach for. This has been drastically different than historical models from Luther to the early twentieth century that were spiritual and paternalistic in nature. The therapeutic turn connects to the therapeutic culture that has set self-actualization as a central idea determining Western cultural ethos. The therapeutic approach calls into question how the spiritual task of the church is carried out. The prevailing pastoral-psychological theology of pastoral care proves to be problematic. The spiritual task of pastoral care should be based on the basic Lutheran theology of God as objective and not conditioned upon the human mind. Yet, the therapeutic aim should still be maintained as the basic approach of care.     

“God loves me no matter how I am”: a phenomenological analysis of the religious and spiritual experiences of HIV-infected African-American women with depression

Depression is associated with increased HIV morbidity and mortality, particularly among African-American women (AAW) in the United States. The purpose of this qualitative study was to explore religious practices, spiritual beliefs, and experiences among AAW with co-occurring HIV infection and depression. A transcendental phenomenological study design was used to explore the experiences of AAW's religion and spirituality after an HIV diagnosis and living with depression. The four themes that were identified included: Religious Conflict and Return to Religious Practices; Religious Fortitude Broken and Feeling Judged; Spiritual Connection is More Powerful than Attending Church Services; and Spiritual Healing and Re-Connecting with Spirituality. These findings suggest that the distinction between internal and external manifestations of spirituality is important and that given the current religious climate, interventions that focus on supporting internal spiritual practice may be a more important and effective approach for AAW with co-occurring HIV infection and depression.     

The Spiritual Transcendence Index: An Item Response Theory Analysis

ABSTRACT

In an attempt to measure understudied dimensions of spirituality, recent efforts have focused on the transcendent dimension of spirituality. The Spiritual Transcendence Index (STI) was developed to assess a perceived experience of the sacred that affects one’s ability to transcend life’s difficulties. The main focus of the current study was to investigate the psychometric properties of the STI by utilizing the microscopic item-level examination tools unique in item response theory (IRT), as well as its scale-level exploration devices for psychometric properties of an assessment measure. IRT analyses were conducted to investigate the STI’s psychometric properties across samples (N = 712) including how well the measure assesses the latent construct, spiritual transcendence, from the low to high range of the construct. The findings confirm that the 8-item index is a single factor that assesses the latent construct, spiritual transcendence. Instead of the original 6-category version, these findings support a 4-category response version; the 3 categories of disagreement may be collapsed into a single category. These findings not only inform the refinement of the STI but also highlight an important psychometric approach for the refinement of spirituality/religiousness measures, especially those with ceiling effects.     

Holistic Human Development

One of the tenets of holism is that the whole is greater than the sum of its parts. Applying this theorem epistemologically, we could say that a holistic view is greater than the sum of the specialized views that contribute to it. Within the framework of three divergent worldviews (mechanistic, organismic and contextual) as originally proposed by Pepper (World hypotheses: A study in evidence, University of California Press, Los Angeles, 1961), holism as both a philosophical position and a practical approach to research is applied to the study of adult human development. Because spiritual development has received less scholarly attention than biological, cognitive, or emotional functioning, topics such as meditation research, non-religious spirituality, and the concept of soul are covered to promote a balanced developmental perspective. Historical and philosophical factors leading to holism are described, a sampling of interdisciplinary dialogue between psychology and theology is presented, and conclusions regarding the need for holistic thinking and the relationship between religion and spirituality are offered.     

Rethinking the Human Being in Light of Evolutionary Biology

Abstract : For the sake of its own enrichment and relevance, Christian anthropology today must be informed by what we are learning from the biosciences, including the theory of biological evolution. The two quite different paradigms of theology and biology should be seen as complementary to each other, with theology recognizing the biological foundation of human nature. This necessitates a repudiation of the traditional body/soul dualism and re‐conceptualizing the concept of soul as a metaphorical expression rather than a spiritual entity. It affirms the spiritual dimension of human life that relates us to God and neighbor. Biblical scholarship affirms this psychosomatic, holistic view of the human being.     

Toward New Directions for Ministry in Aging:

The church has a leadreship role in the field of aging in providing its own definitions, utilizing its own resources, and functioning with the spiritual orientation toward person-centered growth of the aging. While psycho-social theories of aging have shaped the church's role in the past, the church should avoid ageism, broadly define aging, and reinterpret its functions. The themes of religiosity, religion, theology, spirituality, and ministry are discussed. The developmental and wholistic goal of the church's involvement in aging is spiritual well-being. Solid theological basis and acerful spiritual focus lead to sound ministry. Development of the concept of spiritual aging is proposed.     

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.