Exploring the “New” Frontier of Spirituality in Health Care: Identifying the Dangers

Enthusiasm is growing in nursing and medicine for addressing spirituality and religious needs in patient care. We urge caution and stress the need for greater awareness of the dangers involved. The first danger is the lack of any attention given to how informed consent might be relevant to the topic of patient autonomy in spiritual health care decisions. The second danger is that the major health care providers, nursing and medicine, are not adequately educated to provide such care. The third danger is that we have not yet sufficiently clarified the roles of the various providers and as a consequence coordination of quality spiritual care is in jeopardy.     

Organizational social context and psychopathology of youth in residential care: The intervening role of youth–caregiver relationship quality

Drawing on an ecological approach with multiple informants, this study investigated the mediating role of youth–caregiver relationship quality in associations between different features of residential care settings' organizational social context and youth's psychopathology. Participants were 378 youth aged between 12 and 25 years old, and 54 caregivers aged between 24 and 57 years old, from 29 generalist residential youth care settings in Portugal. Given the hierarchical structure of data, analyses were performed using multilevel modeling. Results revealed that organizational social contexts characterized by higher levels of engagement, stress, and centralization, as perceived by the caregivers, were associated with lower levels of youth's externalizing problems (e.g., aggressive behavior and delinquency), reported by the caregivers, via better youth–caregiver relationship quality, perceived by the youth in care. These findings highlight the relevance of creating an organizational social context in residential care settings that supports caregivers in establishing high-quality relationships with the youth in care, thereby promoting their mental health. This study contributes to the clarification of conflicting findings in previous studies of this field, by offering further empirical investigation of these issues.     

Brief Report: Safe at Home Base: Working Parents' Reasons for Choice of Home-Based Child Care

The current generation of working parents faces new challenges to the traditional family model. Despite this, they select forms of home-based child care more than any other type of care. Prior data also reveal that parents who use home-based care, center-based care, and family day care all cite quality as the primary reason for their choice. Given the similarity of reason and the difference in care actually used, working parents who use home-based care were interviewed on additional reasons for their choice. These parents lacked confidence in center-based care and preferred their children to receive one-to-one attention. Age of child, cost of care, and availability of centers did not affect choice. These adults seem to be selecting home-based care in an attempt to provide care as close as possible to parental care. They are making a statement on the importance of the home environment even as their participation in the workplace increases.     

Attention-Deficit Hyperactivity Disorder: The Medicalization of Misbehavior

During the past decade, there has been an increase in the diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD). This syndrome, typically diagnosed in childhood, is characterized by inattention, hyperactive motor behavior, and distractibility. Current prevalence rates obtained in various countries generally exceed the 3–5% reported by DSM-IV. Reasons for increased ADHD prevalence include changes in diagnostic standards, overlap between ADHD and other externalizing disorders, nonspecific behavioral criteria, and the rapid effects of stimulant medication on cognitive functioning. However, social, cultural, and economic factors may also contribute to increased diagnosis. ADHD has become a common topic in the lay media. Popular discussions of ADHD may serve as a metaphoric expression of social anxieties, particularly with respect to children. At the same time, ADHD has rapidly become incorporated into a medical model, with emphasis on pharmacological treatment. Reductions in mental health and educational services, as well as economic pressures of managed care, may also contribute to medicalization of behavioral problems. Collaboration between psychologists and primary care physicians can lead to more accurate diagnosis and appropriate treatment of ADHD and related disorders.     

A Christian for the Christians, a Christian for the Muslims! An Attempt at an Argumentum ad Hominem

Schmidt and Egler's critique of Christianity's exclusivist claimto truth rests on two suppositions: (a) that inter-religiouspastoral care for dying patients requires a respect for theircultural backgrounds which necessitates accepting the equalvalidity of their respective (non-Christian) religions, and(b) that exclusivism is incompatible with the Christian love-of-neighborcommandment. In opposition to this critique, (a) the authors'own "pluralist" understanding of Christianity is refuted ontwo levels. First, it leads to inconsistencies in the authors'own (and very adequate) understanding of pastoral care, especiallywith regard to their notion of intolerance, and second, it isirreconcilable with explicit New and Old Testament claims toabsoluteness. In addition, (b) the authors' understanding ofthe way in which "exclusivism" justifies intolerance and missionaryviolence is shown to rest, first, on a secularized reductionof Christianity, i.e., of Christians' own "religious identity"as well as of the Christian way of "helping those in need,"and second, on a merely theoretical (rather than also practical)view of Christians' commitment to God. As a corollary to thatrefutation, a reconsideration of the truly Christian sourcesof obedience and charity is recommended.     

Message in a bottle: a comparative study of spiritual needs of children and young people in and out of hospital

Using the metaphor of a message in a bottle as a framework and sending an S.O.S. to adults, the question of what are the three biggest needs of children and young people was asked. Data consisting of 107 important needs of children and young people was collected from 36 children and young people both in and out of hospital: in hospital by chaplains and other health care professionals, and out of hospital by children and youth work undergraduate students. This was a convenience sample across the United Kingdom with the majority of respondents in the Midlands. The data were coded and then thematically analysed and separately compared to Maslow’s hierarchy of needs. Emotional needs was the largest theme for hospitalised children and young people and relationship needs for the non-hospitalised children and young people. For both groups Maslow’s level 3 need of belonging was the greatest averaging at just over half the needs shared. A discussion of the results of the analyses identifies some ways in which the needs of hospitalised children and young people may differ, identifying some implications for practice.     

Depth of Field: Using photographs and narratives to explore and reflect on ageing

The learning landscape of the higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practise in today’s complex healthcare systems, including responding to changing demographics of population ageing. In this educational case study, we will share how we (a group of education, medical and nursing academics) developed ‘Depth of Field: Exploring Ageing’ a digital, consumer-driven, interprofessional reflective learning resource that uses photographs, narrative and small-group work to strengthen reflective capacity in current and/or future health professionals.     

The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator (ICD) removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process.