Hospital-based spiritual care: what matters to patients?

Demographic changes in Australia have led to an increase in both religious diversity and the number of people who do not nominate a faith affiliation at hospital admission. Models of chaplaincy have shifted from clerical and largely male to an increasingly skilled and diverse spiritual care workforce appointed directly by health services. This study uses survey and in-depth interview methods at an inner-city Australian hospital to examine patient preferences for hospital chaplaincy provided by faith communities, and the importance of faith affiliation compared to other spiritual care provider characteristics. Survey results indicate that of 110 respondents, a high proportion (74%) prefer spiritual care to be provided by a person of the same faith. However, when considered relative to other characteristics, faith affiliation was not as important as kindness, listening skills and a non-judgmental attitude. Our findings have implications for workforce planning and educating. Further research in different settings and with different populations will make the findings more generalizable.

Understanding the outcomes of spiritual care as experienced by patients.

In moving toward professionalising spiritual care in the healthcare system, as an equal partner in whole person care, it has become increasingly important to develop an evidence base for spiritual care interventions, their value and longer-term outcomes for those receiving this care. This study utilised hard copy questionnaires across five Australian general hospitals to investigate patient reported outcomes of in-patient spiritual care. The survey included the Scottish Patient Reported Outcomes Measure (PROM), measures of patient experience and an open-ended question about experience of care. Data indicated a positive correlation between positive experience of spiritual care and a high score on PROM. Qualitative data elaborated on if and how the spiritual care received met patients' needs, the qualities they valued in the provider of this care and impacts of the care they experienced. Further development of the PROM in a variety of situations is however recommended.

Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study.

CONTEXT: Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging. OBJECTIVE: To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness. METHODS: Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description. RESULTS: 30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured. CONCLUSION: Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.

"Life Within the Person Comes to The Fore": Pastoral Workers' Practice Wisdom on Using Arts in Palliative Care.

BACKGROUND: Pastoral care (also chaplaincy, spiritual care) assists people to find meaning, personal resources, and connection with self, others, and/or a higher power. Although essential in palliative care, there remains limited examination of what pastoral workers do. This study examined how pastoral workers use and consider the usefulness of art-based modalities. METHODS: Qualitative research was used to examine the practice wisdom (tacit practice knowledge) of pastoral workers experienced in using visual arts and music in palliative care. Two focus groups were conducted. Thematic analysis was informed by grounded theory. RESULTS: Six pastoral workers shared information. Three themes emerged. First, pastoral workers use arts as "another tool" to extend scope of practice by assisting patients and families to symbolically and more deeply contemplate what they find "sacred." Second, pastoral workers' art affinities inform their aims, assessments, and interactions. Third, pastoral workers perceive that art-based modalities can validate, enlighten, and transform patients and families through enabling them to "multisensorially" (through many senses) feel recognized, accepted, empowered, and/or close to God. Key elements involved in the work's transformative effects include enabling beauty, ritual, and the sense of "home" being heard, and legacy creation. DISCUSSION AND CONCLUSION: Pastoral workers interpret that offering art-based modalities in palliative care can help patients and families to symbolically deal with painful memories and experiences, creatively engage with that deemed significant, and/or encounter a sense of transcendence. Training in generalist art-based care needs to be offered in pastoral education.

Capturing religious identity during hospital admission: a valid practice in our increasingly secular society?

Objective Most major Victorian hospitals include religious identity in routine admission demographic questions. However, approximately 20% of admissions do not have their religious identity recorded. At the Royal Melbourne Hospital this missing 20% was surveyed throughout 2014-15 for two reasons: (1) to enable patient care; and (2) to provide an insight into the significance of religious identity for patients. There is scarce literature on this subject, so the present mixed-methods study, including a qualitative component, will start to bridge the gap. Methods Mixed methods, cross-sectional survey. Results The quantitative component of the study found that religious identity was important for a significant proportion of our diverse population and that, in general, demographics were congruent with Australian Bureau of Statistics (ABS) census figures. The qualitative component also revealed significant complexity behind religious identity labels, which the census is unable to capture, providing an insight into the requirements of our growing multicultural population. Conclusions This study illustrates that religious identity is important for a majority of Royal Melbourne's culturally diverse inpatients. This data would seem to give the practice of collecting religious identity data on admission new credence, especially as our culturally and linguistically diverse populations increase. In order to understand these nuances and provide appropriate care, skilled spiritual screening and assessment would appear to be not optional, but rather necessary in our increasingly complex healthcare future. What is known about the topic? A search of the literature using related terms (religious, religion, spiritual identity, care) revealed that there is scarce literature on the subject of religious identity and its importance and meaning to patients. What does this paper add? This mixed methods study approaches the issue of the importance of religious identity from the patient perspective via a spiritual screening survey that included a qualitative component, so will begin to bridge a gap in knowledge. What are the implications for practitioners? Improved understanding of the complexity of the spiritual needs of our Victorian multicultural population and commensurate emphasis on the need for individual spiritual screening and assessment.