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.

Professional development for spiritual care practitioners: a program review.

Professional development is a crucial aspect for further successful progression of an individual's skills and effective function in their role. It is also a compulsory part of registration for most professionals in the health care sector. This article reports on the evaluation of a monthly professional development program, specifically for spiritual care practitioners, offered over the period 2017-2019 by Spiritual Health Association (Victoria, Australia) and its partners. Many common themes such as motivation, culture, purpose and areas for improvement have been identified and are further examined. Recommendations such as greater emphasis on the professionalism in the sector, broader inclusions of sessions across culture and ethnicity and the development of cross disciplinary communication skills are made for the future of this program.

Statistical fit is like beauty: A rasch and factor analysis of the Scottish PROM.

Chaplains help people face some of the most complex, intractable and traumatic issues in their lives. Spiritual care works. Unfortunately, spiritual needs are rarely met in health and social care because a) spiritual distress is not recognised as such, and b) chaplain interventions are undervalued and misunderstood. The Scottish Patient Reported Outcome Measure (PROM) © was created to help provide evidence for the impact of chaplain interventions. The aim of this study was to establish whether the PROM could also be used to identify patients in need of chaplain interventions. To test this psychometrically, Rasch and Confirmatory Factor Analysis was conducted on an international dataset of post intervention PROMS from UK, Europe and Australia completed between 2018-2020 (n = 1117). The data fit the Rasch model, and the PROM demonstrated uni-dimensionality, construct validity and reliability, meaning PROM scores represent a coherent concept. Higher scores represented lower levels of spiritual distress, and the mean score was 12 out of 20. PROM score of 9 was one standard deviation below the norm, a metric routinely used to identify 'clinically important difference' in psychometric scales. A Scottish PROM© score of 9 and under could therefore identify people for whom chaplaincy may be beneficial. The clinical implications of this are considerable.

"We Need to Learn from What we Have Learned!": The Possible Impact of Covid-19 on the Education and Training of Chaplains.

The responses of chaplains providing care in health services during the Covid-19 pandemic showed that they both learned new skills and taught these to others while working in environments made unfamiliar by personal protective equipment and social distancing. This paper discusses the responses of the participants as they relate to education and training as well as suggesting new content and styles of education to meet the needs of chaplains in future similar events.

"Essential Not Optional": Spiritual Care in Australia during a Pandemic.

This paper focuses on the impact of COVID19 in Australia. Three areas were investigated: professionalism, contrasting hospital and aged care services and "business as usual"? Impact was low overall, the timing being pre-second wave impact. Two areas of weakness were highlighted: depleted spiritual care teams due to standing down non-professional staff and uncertainty about the role of Chaplains in the care of other staff. Further study of second wave impact is recommended.

What Spirituality Means for Patients and Families in Health Care.

This research focuses on the spiritual care experiences of patients and families at a hospital in Australia. Twenty-four patients and 10 family members were interviewed. Results indicate the importance of relatedness: being treated as a person, reminded of your capabilities and conversations about what matters. Maintaining contact with friends and family, sustaining religious and spiritual practices, music therapy and pet therapy were also significant and contact with the natural world and shared activities. The results indicate the importance of spirituality offered through pastoral care, and that all those involved in health care can contribute to the spiritually nurturing environment that reinforces healing.

Novel oral anticoagulant induced upper limb haematoma: A case report.

The development of novel oral anticoagulant agents (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban has given patients better treatment alternatives to aspirin, clopidogrel, heparin and warfarin, mainly for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF), prophylaxis/treatment of venous thromboembolism (VTE) and also for the secondary prophylaxis of acute coronary syndromes. These agents are gaining in popularity due to their more stable pharmacokinetic profile, fewer drug interactions, as well as eliminating the need for routine monitoring. NOAC induced haematomas of the upper limb are rare and there is no real consensus on management. We present a case of a 70-year-old male on rivaroxaban who developed a delayed onset intramuscular forearm haematoma after a simple fall onto his left arm. Simple elevation of the limb was successful in leading to resolution of symptoms. As these agents increase in popularity, clinicians need to be more aware of potential risks of treatment and subsequent management.

Frames for the Future: Developing Continuing Education & Professional Development Programs for Spiritual Care Practitioners: A Perspective from Victoria, Australia.

This article examines the educational issues in ongoing professional education for spiritual care practitioners. A meta-evaluation of registration and evaluation data over four years (between 2013 and 2016) of one such monthly program conducted by Spiritual Health Victoria (Australia) will be examined. Recommendations are made to support healthcare managers and spiritual care educators in designing and developing continuing education programs for spiritual care practitioners in a variety of other professional health and care contexts.

International Study of Chaplains' Attitudes About Research.

An online survey was conducted by twelve professional chaplain organizations to assess chaplains' attitudes about and involvement in research. A total of 2,092 chaplains from 23 countries responded to the survey. Over 80% thought research was definitely important and nearly 70% thought chaplains should definitely be research literate. Just over 40% said they regularly read research articles and almost 60% said they occasionally did. The respondents rated their own research literacy as 6.5 on a 0-10 scale. Significant positive inter-correlations were found among all four measures: importance of (a) research and (b) research literacy; (c) frequency of reading articles; and (d) research literacy rating. Approximately 35% were never involved, 37% had been involved, 17% were currently involved, and 11% expected to be involved in research. The last three groups were significantly more likely to think research and research literacy were important and to read research articles than chaplains who were never involved in research. Given chaplains' interest in research, actions should be undertaken to facilitate further research engagement.

The experience of family carers of people with dementia who are hospitalised.

Hospital admission of a person with dementia can have a significant impact on the family carer, who temporarily relinquishes caring to health professionals. A descriptive qualitative design using in-depth interviews with a conversational approach was used to elicit data. Adjusting to the change in the carer's role can be challenging and result in feelings of helplessness, loneliness, loss of control and being undervalued. Family support can assist with the transition but family conflict increases anxiety. Good communication between clinicians and the carer is vital. The carer should be included in decision-making as the 'expert' in the care of the person with dementia. This article discusses findings of a larger study specifically related to the emotional support required for the carers of people with dementia, who are admitted to hospital. The carer and the patient must be considered as a dyad in relation to discharge planning.

End-of-life care in an Australian rehabilitation facility for older people: staff focus groups.

A qualitative study of staff experiences of end-of-life care for older people in a subacute rehabilitation facility was undertaken using three focus groups with senior multidisciplinary staff (5), junior nurses (8), and junior allied health staff (7). Content analysis revealed four major themes: being a key contact person; the quality of end-of-life care; referring to off-site service providers; and differing perspectives. These data have implications for multidisciplinary practice including staff education and capacity to change focus of care in facilities for older people dedicated to rehabilitation rather than palliation or end-of-life care.

End-of-life care in a rehabilitation centre for older people in Australia.

AIM: To investigate processes at the end of life for patients who died in a subacute evaluation and management facility for older people. METHODS: A retrospective chart audit for patients (n = 55) who died in the previous 2 years was undertaken, recording a number of significant variables. RESULTS: Despite diagnosis of comorbid medical conditions, most participants were admitted for improved functioning or assessment for alternative accommodation. Consistent with this focus, the key contact person was most often an allied health team member. Not For Resuscitation order and/or power of attorney documents on admission were uncommon (<30%) as were referrals to palliative care specialist staff (13%), although an end-of-life discussion was recorded (90%) and often included as a new goal of care (71%). CONCLUSION: Factors likely to improve end-of-life care include advance care planning, earlier recognition of short prognosis and staff education.

Responding to the death of a resident in aged care facilities: perspectives of staff and residents.

A qualitative study using individual semistructured interviews was undertaken to explore the perceptions and experiences of 23 aged care residents with mild dementia concerning the deaths of coresidents. The views of 25 facility staff members were also explored. The study was based in 3 aged residential facilities in Victoria, Australia. Interview data indicated that residents and staff had differing views. Residents reported that the impact of the death of a coresident was much less than staff members thought. Residents generally wanted to be told about the death of someone they knew and considered attempts to hide the death and the removal of the body both unnecessary and disrespectful. Both groups agreed that the celebration of the life of a resident was important, although they differed in their preferences for the way this is done. These findings have implications for staff education and practice.

A case study approach to investigating end-of-life decision making in an acute health service.

AIM: To identify end-of-life (EOL) decision making processes for patients with non-cancer illnesses in a major metropolitan hospital. METHODS: A retrospective review using a case study framework of 47 randomly selected patient records over a 6-month period explored issues in EOL care planning. RESULTS: Reviewed charts represented 53% of total deaths in the study period. All patients (aged 66-99) had co-morbid conditions. In 64%, the first record of EOL discussions occurred in the last 24h of life. Four case groups were identified, ranging from a clear plan developed with patient/family involvement and fully implemented, to no plan with minimal patient/family involvement in decision making. Factors related to clearer EOL care planning according to expressed patient wishes included multiple previous admissions, shorter hospitalisations at EOL, living with a relative and involvement of family in decisions about care. CONCLUSION: This study has shown that the development and effective implementation of EOL plans is associated with the active involvement of both family members and health professionals. It also draws attention to the risks of delaying EOL discussions until late in the illness trajectory or later in life as well as pointing to challenges in acting on EOL developed outside the hospital environment.

The evaluation of a triage tool for a community palliative care service provider.

INTRODUCTION: Triage, widely used by the military and emergency departments, has not been reported in community palliative care services. Policy designed to improve equitable provision of this care has led to the development of a triage tool. METHODS: Retrospective data were collected (50 percent of referrals, n = 204) and analyzed using the Wilcoxon signed-rank test to determine the accuracy of the tool in predicting patient status at the first visit. Semi-structured interviews (n = 7) with palliative care service staff added qualitative data. RESULTS: Although significant differences between triage scores compared to outcomes at first visit were observed, issues such as upgrading of triage category compared to priority score occurred in more than 30 percent of cases. When correction for this was made, the tool was found to be an accurate guide to patient needs. CONCLUSION: This tool, when used as intended, was effective in assessing the urgency of need, and it is potentially useful on a wider scale, subject to further evaluation.

The experience of palliative patients and their families of a family meeting utilised as an instrument for spiritual and psychosocial care: A qualitative study.

BACKGROUND: This study explores the experience of palliative patients and their family members of a family meeting model, utilised as an instrument for the provision of spiritual and psychosocial care. In doing so the study embraces a broad understanding of spirituality which may or may not include formal religious practice and a concept of psychosocial care that includes: social and emotional well-being, communication, self esteem, mental health and adaptation to illness. The meeting of spiritual and psychosocial needs is considered to be an important aspect of palliative care. METHODS: This qualitative study, philosophically underpinned by hermeneutic phenomenology, investigates the participatory experience of palliative care patients and their significant family members of such a family meeting. People registered with two large metropolitan palliative care services, who met selection criteria, were referred by medical staff. Twelve of the 66 referred took part in family meetings which also included significant others invited by the patient. A total of 36 family members participated. The number of participants of individual family meetings ranged from two to eleven. After the family meeting every participant was invited to take part in an individual in-depth interview about their experience of the meeting. Forty seven interviews were conducted. These were audio recorded and transcribed. RESULTS: Data analysis, utilising Ricoeur's theory of interpretation, revealed seven main themes: personal experience of the meeting, personal outcomes, observation of others' experience, observation of experience and outcomes for the family unit, meeting facilitation, how it could have been different and general applicability of the family meeting. Throughout these themes were numerous references to aspects of the web of relationships which describe the concept of spirituality as it is defined for the purpose of this study. CONCLUSIONS: The findings indicate the potential of the type of family meeting reported for use in the spiritual and psychosocial care of people receiving palliative care and their families. However further research is needed to explore its application to more culturally diverse groups and its longer term impact on family members.

End of life care--the importance of advance care planning.

BACKGROUND: Communication about end of life care may involve difficult conversations for patients, family members and health professionals. However, a lack of understanding of a person's wishes about their future care may result in a loss of dignity for the person, and additional distress for their family members and health professionals and burden to the healthcare system. OBJECTIVE: This article discusses the barriers to advance care planning and provides some guidance for the general practitioner in undertaking advance care planning with patients and their families. Tips for initiating end of life discussions with patients and families utilising the 'PREPARED' acronym, and ensuring appropriate care delivery are included. DISCUSSION: Involving patients and their family members in advance care planning may be challenging and time consuming for GPs. However, there are a number of resources to support this activity in relation to training, communication support and Medicare item funding.

Recruiting palliative patients for a large qualitative study: some ethical considerations and staff dilemmas.

This article reports on the processes of staff members in referring patients to a study that explored the experience of palliative patients, family members, and health professionals with the implementation of a family meeting model as an instrument of spiritual care. The reported qualitative study was undertaken in two large metropolitan Australian hospitals. Criteria other than those set by the study protocol were employed by staff members referring patients. These included subjective opinions of who was suitable to refer and perceptions of patients' attitudes to religion or spirituality. Such practices raise ethical issues and may compromise studies that have received ethics approval.