Improving Spiritual Support for Patients, Families, and Staff After 5pm
Crit Care Med. Author manuscript; available in PMC 2015 Sep 1.
Published in final edited form as:
PMCID: PMC4134753
NIHMSID: NIHMS607366
The association of spiritual care providers' activities with family members' satisfaction with intendance later a death in the ICU
Jeffrey R. Johnson
1Harborview Medical Center, Sectionalisation of Pulmonary and Disquisitional Care Medicine, Department of Medicine, Academy of Washington, Seattle, WA
Ruth A. Engelberg
1Harborview Medical Center, Partition of Pulmonary and Disquisitional Care Medicine, Department of Medicine, University of Washington, Seattle, WA
Elizabeth L. Nielsen
1Harborview Medical Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA
Erin K. Kross
1Harborview Medical Eye, Division of Pulmonary and Critical Intendance Medicine, Department of Medicine, University of Washington, Seattle, WA
Nicholas L. Smith
2Section of Epidemiology, Schoolhouse of Public Health, Academy of Washington, Seattle, WA
3Seattle Epidemiologic Inquiry and Information Middle, Role of Research & Development, Seattle, WA
4Group Wellness Research Institute, Group Health, Seattle, WA
Julie C. Hanada
vDepartment of Spiritual Intendance, Harborview Medical Center, Seattle, WA
Sean K Doll O'Mahoney
5Section of Spiritual Care, Harborview Medical Eye, Seattle, WA
J. Randall Curtis
1Harborview Medical Center, Division of Pulmonary and Critical Intendance Medicine, Department of Medicine, University of Washington, Seattle, WA
Abstract
Objective
Spiritual distress is common in the ICU, and spiritual care providers are often called upon to provide care for patients and their families. Our goal was to evaluate the activities spiritual intendance providers' conduct to support patients and families, and whether those activities are associated with family unit satisfaction with ICU care.
Blueprint
Prospective cohort study.
Setting
350-bed, 65-ICU bed tertiary care educational activity hospital.
Subjects
Spiritual care providers and family members of patients who died in the ICU or inside 30 hours of transfer from the ICU.
Measurements
Spiritual care providers completed surveys reporting their activities. Family members completed validated measures of satisfaction with care and satisfaction with spiritual care. Clustered regression was used to appraise the clan between activities completed by spiritual care providers and family ratings of intendance.
Results
Of 494 eligible patients, 275 family members completed surveys (response rate, 56%). 50-vii spiritual intendance providers received surveys relating to 268 patients, completing 285 surveys for 244 patients (response rate, 91%). Spiritual intendance providers commonly reported activities related to supporting religious and spiritual needs (>=90%) and providing support for family feelings (90%). Discussions nearly the patient's wishes for end-of-life care and a greater number of spiritual care activities performed were both associated with increased overall family unit satisfaction with ICU care (p<0.05). Discussions almost a patient'south stop-of-life wishes, preparation for a family conference, and total number of activities performed were associated with improved family unit satisfaction with decision-making in the ICU (p<0.05).
Conclusions
Spiritual intendance providers appoint in a variety of activities with families of ICU patients; several are associated with increased family satisfaction with ICU care in general and controlling in the ICU specifically. These findings provide insight into spiritual intendance provider activities and provide guidance for interventions to improve spiritual care delivered to families of critically sick patients.
Keywords: intensive intendance, critical intendance, spiritual care, terminate-of-life intendance, dying, death, palliative intendance
INTRODUCTION
An inclusive conceptualization of spirituality is based on an individual'due south search for significant and purpose in life.ane,2 For many patients facing serious affliction, spirituality plays a substantial part in coping with prognosis, symptoms, and dying.3–6 Despite this endorsement of spirituality's importance, patients study that their physicians often fail to talk with them about their spiritual needs.vii–10 Chiefly, when spiritual care needs are unmet, patients rate their care more than poorly11 and medical costs are increased.12 The Joint Commission has recognized the importance of supporting spiritual needs, including information technology every bit a component of their care standards, and attention to spiritual needs has been considered a moral obligation for healthcare institutions.13,14
The importance of spirituality to families has been similarly described.15 In a survey of principal care outpatients, interest in discussions of spirituality was greatest when anticipating or experiencing the loss of a loved one, suggesting that the death of a family member is a fourth dimension of substantial spiritual need for family unit members of critically ill patients.9,15 Under these circumstances, a hospital chaplain or spiritual care provider may provide welcomed care in the intensive care unit of measurement. Although a visit by a spiritual care provider has been associated with increased family satisfaction with spiritual care,sixteen little is known about the specific activities spiritual intendance providers offering and their associations with ratings of care from the perspective of family members of patients who dice in the ICU.
Our specific aims were 2-fold: Aim 1) to draw the frequency of specific activities performed by spiritual intendance providers for patients who somewhen died in the ICU and their family members; and Aim 2) to evaluate the associations between spiritual care providers' activities and family ratings of satisfaction with care. We hypothesized that specific activities performed by spiritual care providers would be associated with higher family satisfaction with ICU intendance in general and spiritual care specifically. The ultimate goal of this report is to provide insights and guidance for futurity interventions designed to improve spiritual care for family of critically ill patients.
MATERIALS AND METHODS
Design and sample
Data for this study were nerveless as role of a "before-subsequently" trial evaluating the event of a multidisciplinary quality improvement intervention to amend palliative and end-of-life care in the ICU.17 The intervention consisted of clinician education (due east.1000., provision of grand rounds, interactive workshops), local champions (e.k., identification and training of ICU clinician-leaders), bookish detailing (eastward.g. meeting one-on-i with ICU directors), audit and feedback (eastward.g., sharing of ICU-specific family satisfaction questionnaire information with clinicians, managers and administrators), and system support (e.g, provision of order forms, communication aids). The intervention activities were extended to all members of the interdisciplinary team (east.grand., physicians, nurses, spiritual care workers, social workers).
Betwixt August 2003 and October 2005, eligible patients were identified from a 350-bed Level 1 Trauma center with 65 ICU beds in Seattle, Washington, that has had a Department of Spiritual Intendance since 1978. At the time of this report, there were over fifty spiritual care providers involved with ICU patients and their families. The majority of these were interns in their first yr of Clinical Pastoral Education, a nationally accredited program of education for ministry. The Clinical Pastoral Educational activity Program is an accredited grade of pastoral education for seminarians, clergy, and laity that utilizes an action/reflection model of learning under supervision. Students develop both professional pastoral identity and pastoral expertise. An accredited unit includes a minimum of 300 hours of clinical practice and 100 hours of grouping learning and supervision. The core methodology of the program involves individualized learning contracts, clinical do, didactic resources, individual and group supervision, and reflection that integrate theory, do, and personal history.
Spiritual care providers routinely screened the ICUs Monday through Fri to place patients or families who might benefit from spiritual care and also accepted referrals from clinicians. Our electric current analysis includes patients who died before (n = 122) and later (due north = 122) the intervention and for whom we obtained spiritual care provider questionnaires.
Eligibility/Recruitment Procedures
Patients
Nosotros identified consecutive eligible patients from the infirmary admission, belch, and transfer logs. Patients over the historic period of 18 were eligible if they died in an ICU or within thirty hours of transfer from an ICU to another hospital location. We excluded patients with ICU stays shorter than 6 hours to ensure that spiritual care providers were likely to have had an opportunity to become involved in care.
Family members
Approximately i calendar month after a patient's death, family unit questionnaires were mailed to addresses obtained from the patient'southward medical record. Included in the packet were a cover letter of the alphabet, a consent course, a stamped render envelope, and a ten-dollar incentive payment. The cover letter asked that the family member or friend virtually involved in the patient'south care consummate the questionnaire. Reminders included a postcard sent at one week after the initial mailing to all potential subjects and a second packet sent to non-respondents at 4 to six weeks after the initial mailing.
Spiritual care providers
Inside 48 hours of an eligible patient's death, a self-report questionnaire was distributed to spiritual care providers who had been identified as associated with that patient by nautical chart review. In some cases, this included more than one spiritual care provider. The questionnaire included items related to the quantity, types, and quality of spiritual care provided to the patient and family. To enhance response rates, ii additional reminders were provided (i.e., postcard reminder/thanks at 1 week to all providers, boosted questionnaire delivery at 3–4 weeks to non-respondents). Spiritual care providers were informed that questionnaire results were confidential and that results would not be presented in any style that immune individuals to be identified. The Institutional Review Board at the University of Washington approved all study procedures and materials.
Spiritual Care Measures
The spiritual care providers' questionnaire was initially developed by the Harborview/University of Washington End-of-Life Care Research Program for completion by nurses18,xix and was adapted for spiritual intendance providers with the input of supervisors from this department. Spiritual intendance providers answered xiv questions most specific activities that they or other department members may have conducted to support the families with whom they were working. A composite score was created equally the sum of all endorsed items for the activeness types included for assay. The survey likewise included demographic items to describe the characteristics of spiritual care providers (i.e., historic period, sex, race/ethnicity, educational activity, years of ICU experience). The spiritual care provider activities questionnaire is available online (http://depts.washington.edu/eolcare).
Family-assessed outcome measures
Families' satisfaction with care was assessed with the Family Satisfaction in the ICU (FS-ICU) questionnaire.twenty This questionnaire has been validated using a subset of 24 out of the 34 items that families completed.21 The validated scoring includes: one) a total score (FS-ICU) averaged beyond 24 items; 2) a Satisfaction with Care (FS-Care) subscale averaged across fourteen items; and 3) a Satisfaction with Decision-Making (FS-Conclusion-Making) score averaged across10 items.21 An additional question, "How well did the ICU staff encounter your spiritual/religious needs," is role of the longer FS-ICU questionnaire, but is non part of the 24 items that contribute to the FS-ICU total or subscale scores. For these analyses, it was evaluated every bit a separate outcome. Family members' demographic information was also collected and included age, sex, race/ethnicity, didactics level and relationship to patient.
Analysis
For the analyses of the self-reported spiritual intendance providers' activities, Aim i, nosotros used descriptive statistics (i.eastward., frequencies, means, standard deviations) based on the total sample of spiritual care provider questionnaires in which nosotros included more than one questionnaire per patient, if available.
For the analyses of associations between spiritual care providers' self-reported activities and family unit outcomes (Aim 2) nosotros used robust, clustered regression models that accommodated the skewed distributions of the satisfaction scales (FS-ICU total, FS-Care, FS-Decision-Making) and accounted for the correlated data that resulted from spiritual care providers providing surveys for multiple patients; these clustered models relaxed the assumption of independence in observations and provided advisable standard errors by which to test the proposed associations. For the single item assessing satisfaction with spiritual care services for which the assumption of equal intervals betwixt response options was less likely to be valid, nosotros used ordinal logistic regression.
For Aim two analyses, nosotros offset created a reduced sample of spiritual intendance provider questionnaires (n=244) in which each patient had merely ane spiritual care provider questionnaire. This was necessary in guild to avoid cross-clustering for 32 patients who had ii or more than spiritual care provider questionnaires. The selection of surveys to retain was guided by the post-obit principles, in the following order of priority: i) to maximize the number of spiritual care providers represented; 2) to retain surveys with the most complete data; and 3) to balance the number of surveys included per spiritual care provider. We then excluded activities that were very frequent (>=xc%) (i.e., actively addressed spiritual or religious needs, discussed spiritual or religious needs, discussed family members' feelings) or were likely to be relevant to only a subset of patients and families (i.eastward., addressing cultural needs, discussing intra-family disagreements) with the rationale that these activities were unlikely to provide sufficient variability to allow reliable regression analysis. This resulted in the retention of seven activities and a summary score of the full number of activities as predictor variables.
Potential confounders included: family characteristics (i.e., age, sex, race/ethnicity, teaching level), patient characteristics (i.e, age, sexual activity, marital condition), and spiritual care provider characteristics (i.e., historic period, sexual activity, race/ethnicity, years of ICU experience). Years of ICU experience was categorized into <ane, 1–5, or >five years of ICU experience. An individualized adjusted model was generated for each activeness, result, and fix of covariates. Covariates were included in each adapted model if the change in the β-coefficient was greater than or equal to xx% after inclusion of the covariate, relative to the unadjusted model. We chose 20% considering of the relatively big number of models examined. Intervention status was included in all adjusted models. Due to the number of tests of association, the analyses were considered hypothesis generating and we selected a p value of <=0.05 to signify statistical significance without adjusting for multiple comparisons.
RESULTS
Sample
Patients
587 eligible patients were identified during the study period. Well-nigh patients were white (77%), male person (66%), and never married/partnered, widowed or divorced (57%). Hateful age at time of death was 62 years, and a third of deaths were due to trauma (33%); mean length of hospital stay and ICU stay were 9.three and 6.3 days, respectively. Patients with documented spiritual intendance visits had significantly longer ICU lengths of stay and lower educational achievement (p<0.05); they did not vary on any of the other measured variables (Tabular array 1).
Tabular array i
Patient Characteristics (n=587)
| Characteristic | All Patients (northward=587) | No spiritual care visit (northward=220) | Spiritual care visit (n=367) | P * |
|---|---|---|---|---|
| Female, % (n) | 33.9 (199) | 30.v (67) | 36.0 (132) | .172 |
| Not-Hispanic white, % (n) | 77.3 (454) | 79.1 (174) | 76.iii (280) | .433 |
| Marital status % (n) | .141 | |||
| Married/domestic partnership | 43. 1 (248) | 37.iii (81) | 46.six (167) | |
| Divorced/separated | 22.viii (131) | 25.8 (56) | twenty.9 (75) | |
| Never partnered | xviii.1 (104) | 18.4 (40) | 17.ix (64) | |
| Widowed | 16.0 (92) | eighteen.four (twoscore) | fourteen.v (52) | |
| Underlying cause of death, % (north) | .203 | |||
| Trauma | 32.9 (193) | 29.five (65) | 34.ix (128) | |
| Cancer | five.1 (30) | 5.5 (12) | 4.ix (18) | |
| Other status | 62 (364) | 65.0 (143) | lx.2 (221) | |
| Didactics, % (n) | .039 ** | |||
| <= Eighth form | nine.0 (50) | 8.7 (18) | 15.5 (32) | |
| Some loftier school | 12.1 (67) | ix.7 (20) | 13.5 (47) | |
| High school/GED | 39.ii (217) | 35.0 (72) | 41.7 (145) | |
| Some college | 22.2 (123) | 25.2 (52) | twenty.4 (71) | |
| College | 12.6 (70) | 16.0 (33) | 10.6 (37) | |
| Graduate school | four.nine (27) | five.iii (xi) | 4.6 (xvi) | |
| Age at expiry, mean (SD) years | 61.7 (17.6) | 63.5 (17.6) | 60.6 (17.5) | .054 |
| Length of concluding hospital stay, mean (SD) days | 9.3 (11.1) | 8.three (ix.8) | 9.9 (xi.7) | .071 |
| Length of final ICU stay, hateful (SD) days | 6.three (8.1) | five.3 (7.five) | vii.one (viii.4) | .007 |
Family respondents
494 family members were contacted to complete surveys; 275 returned a survey (56%; Figure one). The majority of family respondents were white (82%), female (66%) and had some post-high school instruction. Many (45%) were spouses of the patients. As with patients, the only statistically pregnant family characteristic that was associated with a documented spiritual care visit was a lower level of educational achievement (Table 2). There were 118 patients for whom a family member and a spiritual intendance provider completed a survey and for whom there was a spiritual care visit documented (north=64 pre-intervention; 54 post-intervention.)
Flow diagram for family unit members.
Table two
Family Respondent Characteristics (north=275)
| Characteristic | All Family unit Respondents (n=275) | No documented spiritual care visit (due north=94) | Spiritual intendance visit documented (north=181) | P * |
|---|---|---|---|---|
| Female person, % (n) | 65.8 (179) | 67.7 (63) | 64.eight (116) | .682 |
| Non-Hispanic white, % (n) | 81.9 (222) | 84.8 (78) | 80.4 (144 | .380 |
| Historic period, mean (SD) years | 56.4 (thirteen.8) | 56.5 (12.8) | 56.3 (14.3) | .946 |
| Didactics, median | some mail-high school teaching | some mail service-high school education | .003 ** | |
| Relationship to patient, % (northward) | .081 | |||
| Spouse or partner | 44.9 (123) | 37.half dozen (35) | 48.6 (88) | |
| Child of patient | 26.6 (73) | 29.0 (27) | 25.4 (46) | |
| Parent of patient | ten.six (29) | 12.9 (12) | 9.4 (17) | |
| Sibling | 10.half dozen (29) | 10.8 (ten) | 10.5 (19) | |
| Other relative or shut friend | 5.5 (fifteen) | 7.five (vii) | 4.4 (8) | |
| Lived with patient, % (n) | 57.7 (157) | 51.6 (48) | lx.9 (109) | .142 |
| Years of association with patient, mean (SD) | 38.half-dozen (15.8) | 40.6 (14.nine) | 37.6 (sixteen.one) | .124 |
Spiritual care provider respondents
Three hundred and eighteen questionnaires representing 268 patients were sent to 57 spiritual care providers (Figure 2). Two hundred and xl-four patients had at to the lowest degree ane questionnaire returned from at least i of 49 spiritual intendance providers, yielding a patient-based response charge per unit of 91% (244/268) and a spiritual intendance provider participation charge per unit of 86% (49/57). The hateful number of surveys distributed to these 57 providers was 5.vi (median=2, range= 1–36). The mean number completed was 5.0 (median =two, range = 0–34). The majority of the spiritual intendance providers were female (sixty%) and not-Hispanic white (76%). Although more than half were serving as interns in the Spiritual Intendance department and had therefore had little prior feel equally spiritual care providers in the ICU (< 1 year, n= 40%), they represented an older group of individuals (mean historic period, 42) with significant advanced degree preparation (46%).
Flow diagram for spiritual care providers.
Aim 1: Frequency of spiritual care provider activities
On average, spiritual care providers reported engaging in a large number of activities with ICU patients' family unit members: 102 (39%) received x or more of the 14 potential activities. Only xiii families (5%) were provided none of the activities. The mean and median number of activities per patient in which spiritual intendance providers engaged was eight. Actively addressing (92%) and discussing (92%) spiritual or religious needs were mutual. Discussions related to family unit members' feelings (90%) and patient values (79%) were also mutual, every bit was reminiscing about the patient (80%). Discussions about (28%) and actively addressing cultural needs (27%) were less common, every bit were discussions regarding intra-family unit disagreements about plan of intendance (20%; Tabular array three).
Tabular array 3
Spiritual Care Providers' Cocky-Reported Activities*
| Activity | # Valid Responses | % Endorsed |
|---|---|---|
| Actively addressed spiritual/religious needs | 285 | 92.3 |
| Discussed spiritual/religious needs | 284 | 91.v |
| Discussed family unit members' feelings | 281 | ninety.4 |
| Reminisced nigh patient | 282 | 79.eight |
| Discussed patient's values | 281 | 79.4 |
| Supported family decisions regarding care | 282 | 73.8 |
| Encouraged talking to and touching the patient | 280 | 61.8 |
| Assured family that patient would exist kept comfy | 276 | 55.ane |
| Discussed patient's wishes for cease-of-life intendance | 282 | 45.four |
| Located individual identify for intra-family discussion | 279 | 31.9 |
| Discussed cultural needs | 285 | 28.4 |
| Prepared family unit for briefing | 281 | 27.0 |
| Actively addressed cultural needs | 281 | 26.7 |
| Discussed intra-family disagreements most plan of care | 281 | 20.three |
Aim two: Specific spiritual care provider activities and family outcomes
The specific activity, "discussed patient's wishes for end-of-life intendance", likewise as the total number of activities were significantly associated with both higher total FS-ICU and higher FS-Decision-Making scores. Higher FS-Decision-Making scores were besides significantly associated with the activity, "prepared the family for a family briefing". The particular, "reminisced with the family about the patient", was associated with higher families' assessment of satisfaction with having spiritual needs met in the ICU. None of the spiritual provider activities were associated with the FS-ICU-Intendance subscale (Table 4).
Table 4
Results of multivariate regression analyses*, testing associations between spiritual care provider's activities and family unit members' ratings of satisfaction
Linear regression used for FS-ICU, FS-Intendance, and FS-Controlling. Ordered logistic regression used for Spiritual care needs met.
| FS-ICU Total Score | Spiritual intendance needs met in ICU (single particular) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N (116) | β (SE) | t | p | 95% CI | Due north (106) | β (SE) | z | p | 95% CI | |
| Spiritual Intendance Provider's Activities | ||||||||||
| Reminisced most the patient | 114 | 5.036 (2.636) | one.91 | 0.065 | −0.334, ten.406 | 105 | .8216 (0.386) | ii.thirteen | 0.033 | 0.065, i.578 |
| Discussed patient's values | 114 | four.585 (ii.869) | 1.60 | 0.120 | −1.260, ten.429 | 105 | 0.616 (0.390) | 1.58 | 0.114 | −0.148, one.380 |
| Supported decisions regarding intendance | 114 | five.133 (iii.068) | one.67 | 0.104 | −1.116, 11.382 | 103 | 0.418 (0.379) | 01.ten | 0.270 | −0.325, 1.162 |
| Encouraged talking to and touching patient | 111 | −2.281 (iii.231) | −0.71 | 0.486 | −8.879, 4.317 | 97 | −0.438 (0.437) | −ane.00 | 0.316 | −1.294, 0.418 |
| Bodacious family unit that patient would be comfy | 111 | four.041 (2.689) | 1.50 | 0.143 | −ane.436, 9.518 | 96 | 0.143 (0.352) | 0.41 | 0.684 | −0.546, 0.833 |
| Discussed patient's wishes for end-of-life care | 114 | 7.598 (2.566) | two.96 | 0.006 | 2.371, 12.824 | 100 | 0.844 (0.441) | 1.91 | 0.056 | −0.021, 1.709 |
| Prepared the family for conference | 112 | 5.165 (2.788) | i.85 | 0.073 | −0.521, 10.850 | 96 | 0.868 (0.473) | 1.84 | 0.066 | −0.059, 1.796 |
| Total number of activities performed | 116 | ane.231 (.592) | 2.08 | 0.046 | 0.024, two.437 | 106 | 0.139 (0.073) | 1.90 | 0.058 | −0.005, 0.282 |
| FS-ICU: Care domain | FS-ICU: Decision-making domain | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| N (117) | β (SE) | t | p | 95% CI | N (116) | β (SE) | t | p | 95% CI | |
| Spiritual Care Provider's Activities | ||||||||||
| Reminisced near the patient | 115 | iv.381 (2.944) | one.49 | 0.147 | −1.616, 10.378 | 111 | 3.648 (3.443) | 1.06 | 0.298 | −3.383, ten.680 |
| Discussed patient's values | 115 | 6.180 (three.444) | i.79 | 0.082 | −0.834, thirteen.195 | 111 | 3.102 (3.665) | 0.85 | 0.404 | −4.382, x.586 |
| Supported decisions regarding care | 111 | 4.586 (two.992) | 1.53 | 0.136 | −one.524, 10.696 | 114 | 6.298 (iv.174) | 1.51 | 0.141 | −2.203, fourteen.800 |
| Encouraged talking to and touching patient | 108 | −1.857 (2.718) | −0.68 | 0.500 | −7.408, 3.694 | 108 | −4.964 (4.002) | −1.24 | 0.224 | −13.137, 3.210 |
| Assured family unit that patient would be comfy | 108 | three.157 (2.756) | ane.fifteen | 0.261 | −2.471, 8.785 | 111 | four.654 (3.600) | one.29 | 0.205 | −two.678, xi.987 |
| Discussed patient's wishes for end-of-life care | 114 | 4.113 (2.338) | ane.76 | 0.088 | −0.649, 8.875 | 114 | eleven.723 (3.323) | 3.53 | 0.001 | 4.955, xviii.492 |
| Prepared the family for conference | 108 | 2.973 (ii.864) | 1.04 | 0.308 | −ii.885, 8.831 | 112 | 7.630 (two.282) | 2.32 | 0.027 | 0.936, 14.323 |
| Full number of activities performed | 117 | 1.047 (0.573) | i.83 | 0.077 | −0.120, two.213 | 116 | 1.575 (0.762) | two.07 | 0.047 | 0.022, 3.128 |
Discussion
Our study of spiritual care providers is the first study to demonstrate the number and variety of activities that they report completing while providing back up for families of critically ill patients. The family-completed questionnaires suggest several of these activities are associated with higher family satisfaction with care. In our sample, we establish that both families' and patients' education levels were related to provision of spiritual care, with those with less educational activity beingness more likely to have had a documented spiritual care visit. Two big studies, one nationally representative and one in the South, found that individuals with less education are more likely to self-designate as religious,22,23 and therefore our findings may represent appropriate targeting of spiritual intendance for those who desire it.
Nosotros found that the total number of activities performed was associated with college scores on the FS-ICU, a general and validated measure of satisfaction with care in the ICU. This is consequent with prior studies in which the provision of spiritual support was associated with higher quality-of-life scores near the fourth dimension of death.ten,24 One novel characteristic of our written report is that it relates to care provided to families of patients who died in the ICU; almost prior studies of spiritual care have been conducted among outpatients in oncology or palliative intendance clinics.25 The finding that lxx% of principal care patients would like to discuss spiritual matters with their healthcare team if their family member were to die indicates that spiritual care is needed in support of families of patients at loftier take a chance of expiry.15
In a prospective multisite study, cancer patients whose religious and spiritual care needs were poorly met by clinic staff were more probable to die in an ICU, indicating that attention to spiritual care may bear upon choices for intensive care at the end of life24. Nosotros detected a pregnant clan between the occurrence of discussions of patients' wishes for stop-of-life intendance and college overall assessments of the ICU experience. Information technology may be the case that, for family members, the opportunity to give voice to the patient's wishes and have this best-selling by a spiritual care provider provides some back up. Similarly, the association between reminiscing near the patient and satisfaction with spiritual care supports the importance of patient-focused and family-centered approaches in which the patient is seen equally an important and unique person with individual values, beliefs and history. For family members, the opportunity for a spiritual intendance provider to larn nigh their loved one as an private may be of particular value.
The FS-ICU is equanimous of two subscales, one representing satisfaction with the means in which care has been delivered, and the other measuring satisfaction with the ways in which intendance decisions were made.21 In contrast to the decision-making subscale and the total score, the FS-Care subscale was not significantly associated with spiritual care provider activities. This may be due, in part, to the kinds of items that are part of the FS-Care subscale; many assess the quality of intendance received from doctors and nurses and these may non be influenced past the activities that spiritual intendance providers are able to provide. Notwithstanding, the significant associations between spiritual care activities and higher satisfaction with ICU decision-making may suggest that i important function of spiritual care relates to comfort with and conviction in difficult decisions. This finding also supports the hypothesis that family members' experience of decision-making depends on factors beyond the provision of information, besides including spiritual and emotional back up.26–28 This hypothesis is consistent with prior studies, including one in which discussions of spiritual needs during family unit conferences were associated with greater satisfaction with decision-making.29 Similarly, in a report of 48 family unit members of patients who had died in an ICU, 23 (48%) respondents spontaneously mentioned spirituality as reassuring at the time of terminate-of-life decision-making.30
Surrogate decision-making by family members may play an of import role in the psychological distress experienced by family members subsequently a patient dies in the ICU. For example, family members who adopt passive decision-making roles exhibit greater degrees of depression and anxiety,31 and those whose desired controlling function is discordant from bodily decision-making role bear a greater burden of future depression and PTSD.32 The majority of patients who die in the ICU exercise and then after a conclusion to withhold or withdraw life-sustaining therapy33 and this decision-making comes with a heavy emotional and psychological cost.34 Our findings, too as those of others,29,30 propose that expert spiritual care may be i important opportunity to support family members through this decision-making process.
Our study has several limitations. Get-go, information technology was conducted in a single center, and the results may not generalize to all ICU patients and families. Washington Land has a less religious population than many other areas of the USA35 and the impact of spiritual intendance may vary regionally. Furthermore, at the time our study was conducted, a big chaplaincy training plan was in place. This resulted in, on boilerplate, less experienced spiritual care providers than may do in other ICUs, equally well as provision of spiritual care to a big proportion of families. Despite the limitation of a single-center study, our findings provide insights into the potential office of spiritual intendance. Second, this is an observational study, and as such causation cannot be inferred. Furthermore, spiritual care provider questionnaire items such as "actively addressed cultural needs" and "discussed intra-family disagreements" cannot exist fairly addressed in an observational study, since such needs were non prospectively assessed and would only exist "addressed" for cultural minorities or families with conflict. Third, we do not know how the furnishings of activities may have varied depending on families' spiritual needs, every bit nosotros do non have indications of whether the spiritual care providers' visits were requested and by whom they were requested. Although the spiritual care provider program is designed to meet the spiritual needs of a various community, offering culturally-sensitive emotional and spiritual support to patients, families and staff, regardless of religious, faith or spiritual tradition, families may have been reluctant to engage or take spiritual care providers' services if they felt that their own religious traditions may non be addressed. In addition, nosotros have no information on interactions with spiritual care practitioners who were not affiliated with the infirmary, such as those representing the patients' usual church building, synagogue, or mosque. Finally, due to the number of comparisons we conducted, our findings must be considered exploratory and time to come studies are needed to confirm them.
Our findings suggest that spiritual care providers' conversations with families about the patient as an individual, with specific reference to his or her wishes for end-of-life care, may be particularly useful for families. Spiritual care providers' activities were most strongly associated with satisfaction with families' conclusion-making in the ICU, which may point improved condolement with hard decisions when family members feel supported past a spiritual care provider. Our results provide some management for time to come studies testing interventions to ameliorate spiritual care for family unit of critically ill patients; they as well suggest that interventions designed to improve the delivery of spiritual care in the ICU may be associated with improvements in family unit members' satisfaction with decision-making.
Acknowledgments
Footnotes
Conflict of interest: The authors have no fiscal conflict of interest
Copyright form disclosures: Dr. Curtis received back up for article research from NIH. His institution received grant support from NIH, Robert Wood Johnson Foundation, and PCORI. Dr. Johnson received support for article research from NIH. His establishment received grant support from National Institutes of Wellness. Dr. Engelberg received support for article research from NIH. His institution received grant support from National Institutes of Health and Patient Centered Outcomes Inquiry Plant (PCORI). Dr. Nielsen received back up for article research from NIH. Her institution received grant support from National Institutes of Wellness. Dr. Kross received back up for commodity research from NIH. Her institution received grant support from National Institutes of Health - K23 honor. Dr. Smith received support for article research from NIH. Dr. Hanada received support for article research from NIH. Her institution received grant support from National Institutes of Health. Dr. O'Mahoney received support for article research from NIH, is employed by Harborview Medical Center, received support for development of educational presentations from University of Washington (stipend for contribution to a presentation on what chaplains demand to know about mental illness in 2010), and received support for travel from the Association for Clinical Pastoral Education (ACPE Acquaintance Supervisor). His institution received grant support from National Institutes of Health.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134753/
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