Spiritual well-being of people with psychiatric disabilities: the role of religious attendance, social network size and sense of control.

The influence of psychiatric symptoms, religious attendance, social network size, and sense of control on spiritual well-being were investigated in a cross-sectional study using the Spirituality Index of Well-being. Forty-seven participants with psychiatric disabilities from six consumer-run organizations participated. A factor analysis result revealed two domains of spiritual well-being for people with psychiatric disabilities: self-perceptions regarding making sense of life (developing life purpose) and self-efficacy in obtaining life goals. Based on our regression analyses, religious attendance, expanding social network size, and having a sense of control over important areas of life may enhance spiritual well-being in spite of severity of psychiatric symptoms. Supporting mental health consumers who hope to be fully integrated into social and spiritual communities is important. Given the increased attention to consumers' internal spiritual experiences in a recovery process, this study adds to knowledge about spirituality in the mental health field.

The repeated appeal to return home in older adults with dementia: developing a model for practice.

Dementia care has been trapped in a "trial and error" type of practice due to difficulty understanding the needs of older adults with severe dementia. Behavioral and Psychological Signs and Symptoms of Dementia (BPSD) can be quite difficult for residential staff. However, some experienced care workers succeed in establishing effective relationships. The goal of this study was to: 1) develop a process to identify needs behind BPSD; 2) find solutions using a team approach; and 3) apply the results to educate new workers. The KJ method was employed to reach decision-making about best practices in residential dementia care. This qualitative method is used to organize group data collected in the field and is based on understanding complex situations. A group process of 12 Japanese care workers experienced in understanding and responding to the "repeated appeal to return home" of residents in nursing care facilities is highlighted along with an illustrative case example. The workgroup met over two years. The study revealed five steps in understanding the needs behind the appeal, which include: (1) Listen to the voice and go with the flow of the behavior; (2) Learn about the inner experience; (3) Learn about the contextual environment of "here and now" situations; (4) Reflect on the care environment; and (5) Find the keyword. This needs identification process has application to other cultural contexts. The implications of this study for practitioners who work with people with dementia in residential settings will be discussed.

Evaluating hospice services for improvement: a manageable approach.

Over the past thirty years, hospice services across the United States have been established as a viable alternative for terminally ill patients. As expected, during this period of stabilization, hospice service leaders have invested the majority of their energy in securing funding, developing coalitions, and developing/implementing services. All of this work has occurred to support the primary aim of symptom control for patients through use of pharmacotherapy, as well as provision of ancillary services by interdisciplinary teams consisting of nurses, social workers, pastoral care staff, occupational therapists, and others. Little attention has been given to assessing the effectiveness of this range of services in a holistic way. This paper presents a model of evaluation that is both manageable to implement and suitable to the political environments where hospice providers reside. The article demonstrates an approach that is collaborative and directs the evaluative process towards the improvement of services.

Voices of resilience: older adults in hospice care.

Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.