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Background: Integrating spiritual aspects into treatment plans can release essential resources for coping with chronic pain. However, some spiritual aspects may also induce distress and hinder the coping process. There is a lack of evidence regarding how to perform the clinical tasks of exploring spiritual aspects and of instruments assessing related competencies. Therefore, we developed a web-based learning module to provide education on the subject alongside corresponding assessment instruments. The module presents the InSpiRe (Integration of Spirituality and/or Religion in patient encounters) protocol. The instruments encompass cognitive, affective, and behavioral dimensions. Methods: This paper aims to determine (i) the learning effects associated with completing the web-based spiritual-care learning module and (ii) the reliability and validity of the instruments employed. To address these aims, we conducted a pre-test/post-test trial with N = 32 randomly selected fourth-year medical students. During the pre-test, we assessed the students' knowledge, attitudes, and self-efficacy regarding exploring spiritual aspects. For this purpose, we developed a short-answer knowledge test, an attitude questionnaire, and a self-efficacy scale. Additionally, the students explored spiritual aspects with a simulated patient portraying a person with chronic pain. Three trained raters evaluated the students' performances using a self-developed scale. In the intervention phase, the students completed the 45-minute learning module on a personal computer. The module presented InSpiRe-related content as text and step-by-step video demonstrations, including hints that denote critical actions. The subsequent post-test was identical to the pre-test. Results: The internal consistency was suitable for all respective instruments, and there was an indication of solid validity of the performance test. After completing the spiritual care learning module, the students showed statistically significant increases in knowledge scores and significant positive shifts in their attitudes and levels of self-efficacy regarding exploring spiritual aspects. They also attained significantly higher performance scores in the same regard. Conclusions: Completing the spiritual-care module is associated with meaningful learning effects on cognitive, affective, and behavioral dimensions related to exploring spiritual aspects, as demonstrated in the post-test conducted shortly after the intervention. Due to good reliability and validity scores, the self-developed instruments can be applied appropriately. [ABSTRACT FROM AUTHOR]

Abstract Background Integrating spiritual aspects into treatment plans can release essential resources for coping with chronic pain. However, some spiritual aspects may also induce distress and hinder the coping process. There is a lack of evidence regarding how to perform the clinical tasks of exploring spiritual aspects and of instruments assessing related competencies. Therefore, we developed a web-based learning module to provide education on the subject alongside corresponding assessment instruments. The module presents the InSpiRe (Integration of Spirituality and/or Religion in patient encounters) protocol. The instruments encompass cognitive, affective, and behavioral dimensions. Methods This paper aims to determine (i) the learning effects associated with completing the web-based spiritual-care learning module and (ii) the reliability and validity of the instruments employed. To address these aims, we conducted a pre-test/post-test trial with N = 32 randomly selected fourth-year medical students. During the pre-test, we assessed the students’ knowledge, attitudes, and self-efficacy regarding exploring spiritual aspects. For this purpose, we developed a short-answer knowledge test, an attitude questionnaire, and a self-efficacy scale. Additionally, the students explored spiritual aspects with a simulated patient portraying a person with chronic pain. Three trained raters evaluated the students’ performances using a self-developed scale. In the intervention phase, the students completed the 45-minute learning module on a personal computer. The module presented InSpiRe-related content as text and step-by-step video demonstrations, including hints that denote critical actions. The subsequent post-test was identical to the pre-test. Results The internal consistency was suitable for all respective instruments, and there was an indication of solid validity of the performance test. After completing the spiritual care learning module, the students showed statistically significant increases in knowledge scores and significant positive shifts in their attitudes and levels of self-efficacy regarding exploring spiritual aspects. They also attained significantly higher performance scores in the same regard. Conclusions Completing the spiritual-care module is associated with meaningful learning effects on cognitive, affective, and behavioral dimensions related to exploring spiritual aspects, as demonstrated in the post-test conducted shortly after the intervention. Due to good reliability and validity scores, the self-developed instruments can be applied appropriately.

Introduction: Chronic non-communicable diseases (NCDs) are the leading cause of mortality globally and in Thailand. They affect the physical, psychosocial, and spiritual dimensions. Spiritual distress impacts the spiritual health of patients with chronic illnesses. Materials and methods: This study surveyed spiritual distress among patients with chronic NCDs. The sample comprised 400 patients with chronic NCDs from 8 provinces of Thailand, selected using a multistage sampling technique. A Spiritual Distress Scale for Thai Patients with Chronic Non-Communicable Diseases (SDS-Thai-NCDs) was used for data collection. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were applied for data analysis. Results: Research findings revealed that the overall spiritual distress among participants was at a mild level (72.65±30.21). Moreover, individual dimensions of spiritual distress were at a mild level, including: 1) Physical expression (9.16±3.54) 2) Loss of relationships with oneself and others (18.36±8.56) 3) Loss of relationship with nature and a higher power (8.49±4.10) 4) Loss of self-esteem, meaning, and purpose of life (21.96±10.16), and 5) Loss of hope and inner strength (14.68±7.63). Conclusion: The overall and individual dimensions of spiritual distress among participants were at a mild level. This finding can be useful in providing spiritual care for patients with NCDs and in further studies on spiritual distress in other groups and research areas. [ABSTRACT FROM AUTHOR]

Purpose: People with primary malignant brain tumors experience serious health-related suffering caused by limited prognosis and high symptom burden. Consequently, neuro-oncological healthcare workers can be affected emotionally in a negative way. The aim of this study was to analyze the attitudes and behavior of nurses and physicians when confronted with spiritual distress in these patients. Methods: Neurospirit-DE is a qualitative vignette–based, multicenter, cross-sectional online survey that was conducted in Bavaria, Germany. Reflexive thematic analysis was used for data analysis. Results: A total of 143 nurses and physicians working in neurological and neurosurgical wards in 46 hospitals participated in the survey. The participants questioned if the ability to provide spiritual care can be learned or is a natural skill. Spiritual care as a responsibility of the whole team was highlighted, and the staff reflected on the appropriate way of involving spiritual care experts. The main limitations to spiritual care were a lack of time and not viewing spiritual engagement as part of the professional role. Some were able to personally benefit from spiritual conversations with patients, but many participants criticized the perceived emotional burden while expressing the imminent need for specific training and team reflection. Conclusions: Most neuro-oncological nurses and physicians perceive spiritual care as part of their duty and know how to alleviate the patient’s spiritual distress. Nonetheless, validation of spiritual assessment tools for neuro-oncology and standardized documentation of patients’ distress, shared interprofessional training, and reflection on the professional and personal challenges faced when confronted with spiritual care in neuro-oncology require further improvement and training. [ABSTRACT FROM AUTHOR]

Spiritual distress, hopelessness, and depression are concepts that are often used in palliative care. A simultaneous concept analysis (SCA) of these concepts is needed to clarify the terminology used in palliative care. Therefore, the aim of this study is to conduct a SCA of spiritual distress, hopelessness, and depression in palliative care. A SCA was performed using the methodology of Haase's model. A literature search was conducted in March 2020 and updated in April 2022 and April 2024. The search was performed on the following online databases: CINAHL with Full-Text, MEDLINE with Full-Text, MedicLatina, LILACS, SciELO, and PubMed. The search was achieved without restrictions on the date of publication. A total of 84 articles were included in this study. The results highlight that the three concepts are different but also share some overlapping points. Spiritual distress is embedded in the rupture of their spiritual/religious belief systems, a lack of meaning in life, and existential issues. Hopelessness is a sense of giving up and an inability to control and fix the patient's situation. Finally, depression is a state of sadness with a multi-impaired situation. In conclusion, refining the three concepts in palliative care is essential since it promotes clarification and enhances knowledge development towards intervention. [ABSTRACT FROM AUTHOR]

Despite recognition that spiritual concerns contribute to caregiver burden, little is known about spirituality, spiritual well-being, and spiritual distress in Parkinson's disease caregivers. In this scoping review of the literature through October 2022, we searched PubMed, PsychINFO, Embase, and CINAHL. From an initial pool of 328 studies, 14 were included. Caregiver factors (e.g., depression, age) and patient factors (e.g., faith, motor function) affected caregiver spirituality and spiritual well-being. Caregivers experienced loss of meaning, existential guilt, and loneliness, and coped through acquiescence, cultural beliefs, prayer, and gratitude. Future research should focus on the specific spiritual needs of Parkinson's disease caregivers and interventions to address them. [ABSTRACT FROM AUTHOR]

Spiritual care specialists on the palliative care team are uniquely trained in performing spiritual assessments, a skillset necessary for identifying and treating spiritual distress (SD). While the importance of addressing SD as part of whole-person care has been explored in patients with diagnoses such as cancer and heart failure, the prevalence and treatment of SD in patients with dyspnea are not present in the literature. Using valid and reliable measurement tools to assess SD in severe dyspnea could improve patient-centered care at end-of-life, referring patients to spiritual care specialists and incorporating identified needs into the overall care plan. This paper reviews three tools designed to measure SD in patients with dyspnea. One tool, the Spiritual Distress Scale, has the greatest specificity and lowest patient burden. Recommendations for future research include creating and validating a shorter version of the tool to further reduce the burden on dyspneic patients. [ABSTRACT FROM AUTHOR]

Abstract Aim The aim of this study was to identify the defining characteristics of spiritual distress (00066). Design This study was conducted by integrated review method using Broom method. Methods PubMed, ProQuest, Web of Science, Embase, Scopus, and Cochran Library, and Persian scientific databases were searched from January 2010 to December 2020. Results Twenty‐one article and 74 defining characteristics were identified. 33 of these defining characteristics was mentioned in NANDA. The criteria with the highest frequency and repetition in articles were lack of peace, lack of hope, change in anger behaviour, lack of meaning in life, change in fear and crying behaviour, Concern about belief and values system and/or God. Conclusion Some of the spiritual distress defining characteristics overlap with other nursing diagnoses, including anxiety and hopelessness. Clinical and content validation studies need to be conducted and the main criteria for diagnosing spiritual distress in different cultures and religions need to be identified.

Objective: Assess changes in symptoms of anxiety, depression, and psychosocial or spiritual distress before and after ketamine-assisted psychotherapy (KAP) in individuals with problematic substance use (PSU). Methods: A retrospective chart review was performed on participant data from two five-year prospective outcomes studies: the AIMS Medical Outcomes Study (AMOS) and the AIMS Cancer Outcomes Study (ACOS). The efficacy of KAP for anxiety, depression, and psychosocial or spiritual well being was assessed in patients with current, past, or high risk of substance use disorder. Validated psychometrics utilized were Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the National Institute of Health - Healing Experiences of All Life Stressors (NIH-HEALS) questionnaires. Results: Between November 1, 2020 and October 31, 2022, a total of 18 patients identified with problematic substance use completed at least one KAP session and at least one baseline and post-KAP metric questionnaire. The PSU subpopulation average score changes were as follows: GAD-7 (-6.71 ± 9.15, n = 14); PHQ-9 (-7.44 ± 5.42, n = 16); and NIH-HEALS (5.13 ± 13.64, n = 15). The average score changes for the KAP population of enrolled subjects were as follows: GAD-7 (-2.45 ± 6.01, n = 104); PHQ-9 (-3.02 ± 6.01, n = 111); and NIH-HEALS (2.93 ± 11.91, n = 86). A comparison of average score changes (p < 0.05) between the PSU subpopulation and KAP population were as follows: GAD-7 (0.0219, 95% C.I. 1.37-8.11); PHQ-9 (0.0062, 95% C.I. 1.28-7.56); and NIH-HEALS (0.5197, 95% C.I. 8.96-4.56). For patients with PSU, results demonstrate statistically significant improvements in anxiety and depression symptoms after at least one KAP session. Average NIHHEALS scores increased, though not by a statistically significant amount. Compared to the general population of enrolled KAP patients during this period, patients with PSU reported significantly greater average reductions in GAD-7 and PHQ-9 scores. Conclusion: Undergoing one to six ketamine-assisted psychotherapy (KAP) sessions was associated with improved anxiety and depression ratings in patients with problematic substance use. Two-thirds of participants also experienced improved psychosocial and spiritual well-being. The use of KAP may be important to consider as a therapy for reducing anxiety and depression symptoms in patients with problematic substance use. [ABSTRACT FROM AUTHOR]

Religion and spirituality (R/S) provide possibilities for healing, resilience, meaning making, and posttraumatic growth (PTG) in the aftermath of trauma. Still, R/S may also be the precursors and/or sources of harm, resulting in experiences of spiritual distress (SD). While extensive research has examined the positive mental health impacts of R/S, its potential harms are under-investigated. Addressing this gap, this article draws on findings from an interpretative phenomenological analysis (IPA) study with four women of evangelical Christian (EC) backgrounds who have experienced SD. The women's stories revealed SD as an isolating and profoundly tension-filled experience characterized by painful relational loss, fraught belonging, existential uncertainty, and acute spiritual pain. Several women used the term "trauma" to describe their experiences. This study evidences the tender and isolating complexity of SD. For the women, spirituality served as both a cause and a perpetuator of trauma, and as a vehicle for transcendent meaning making in response to wounding. Ultimately, spirituality is tangled in the women's distress while also playing a role in their posttraumatic growth. Implications include a call for increased awareness and advocacy regarding SD, as well as a trauma-informed, spiritually sensitive, curious posture from practitioners supporting clients with SD to foster posttraumatic growth. [ABSTRACT FROM AUTHOR]

The dialysis cohort in Australia, as in other parts of the world, is becoming increasingly elderly and frail. The incidence of dialysis withdrawal prior to death is also increasing, often driven by clinical deterioration and/or psychosocial factors. Despite expertise in the biomedical aspects of dialysis, nephrologists may feel less equipped to explore the existential and spiritual aspects influencing a patient's decision-making. We present the case of an elderly woman for whom dialysis became increasingly challenging and burdensome as her global condition deteriorated. Despite multiple discussions being held regarding elective cessation of dialysis the treating team was unable to progress to a decision to withdraw. Shortly before her death the patient revealed, for the first time, the key influences of her religious beliefs to the community-based palliative care team. She described a strong Catholic faith and although unafraid of death itself, she was fearful that her decision to stop dialysis would be akin to suicide and therefore a mortal sin. Her condition deteriorated before these concerns could be further explored and she died in the intensive care setting with a high level of intervention. All people have a spiritual dimension that may influence their attitudes towards death and medical decision-making. If not elucidated, it can create barriers to appropriate care, as in this patient. There are many approaches to exploring these domains including validated tools to support clinicians who have not received dedicated training. [ABSTRACT FROM AUTHOR]

Introduction: Cancer patients are exposed to several types of treatments, including chemotherapy. In this context, patients experience several nursing diagnoses, including spiritual distress. The definition of the diagnosis of spiritual distress is grounded in lack of meaning and purpose in life, a sense of suffering, and a feeling of disconnected. Purpose: The aim of this study was to determine the prevalence, sensitivity, specificity, and predictors of the nursing diagnosis of spiritual distress of cancer patients undergoing chemotherapy. Designs The study used a longitudinal questionnaire design with quarterly data collection points over a 12‐month period. Participants were recruited through random sampling, in an outpatients' setting in one oncology day unit in Portugal. Findings The highest prevalence of spiritual distress was found at 3 months after patients started chemotherapy. The highest value of specificity was lack of meaning in life and express suffering, and the highest values of sensitivity concerned spiritual distress diagnosis. The predictors of spiritual distress were express suffering, alienation, questioning meaning in life, lack of serenity, questioning the meaning of suffering, hopelessness, and lack of meaning in life. Conclusions: Spiritual distress is a human response that is current in patients undergoing chemotherapy, and the highest prevalence seems to occur at 3 months after commencing chemotherapy. Express suffering and lack of meaning in life play the role not only of defining characteristics (DC) in this study, but also of predictors in the diagnosis of spiritual distress. Clinical Relevance: The identification of the prevalence, predictors, sensitivity, and specificity of the DC of the nursing diagnosis of spiritual distress in cancer patients undergoing chemotherapy may facilitate nurses' clinical reasoning and improve the planning of nursing care in clinical practice in order to improve spiritual well‐being in cancer patients. [ABSTRACT FROM AUTHOR]

This essay endeavors to understand the impact of COVID-19 hard lockdown restrictions on funeral gatherings from a Zimbabwean religious/spiritual perspective. For most Zimbabwean Christians and non-Christians, funeral rites of passage are at the apex of all religious activities and are revered in most social settings. The central questions to this study are: How have funeral gathering restrictions impacted on the religious/spiritual beliefs of many Zimbabwean immigrants living in South Africa, who were not able to attend funeral ceremonies back home in Zimbabwe? What religious/spiritual implications does it have to attend or not attend funeral ceremonies from a Zimbabwean religious perspective? These questions are raised because during the pandemic, most Zimbabweans who lived in South Africa were forbidden to go home to attend funeral ceremonies due to travelling restrictions between the two countries. This study found that most Zimbabwean immigrants who did not participate in funeral rites of passage due to COVID restrictions were left with spiritual distress after the pandemic. Data for this article were collected through interviews with individuals from Zimbabwe who are living in South Africa. Interviewees were selected using purposive sampling. Confidentiality, anonymity, and suppression of names are some of the ethical considerations maintained throughout this research.

We conducted a literature search to identify and compare definitions of the experiential dimension of spiritual pain. Key databases were searched, up to the year 2021 inclusive, for papers with a definition of "spiritual" or "existential" pain/distress in a clinical setting. Of 144 hits, seven papers provided theoretical definitions/descriptions; none incorporated clinical observations or underlying pathophysiological constructs. Based on these findings, we propose a new definition for "spiritual pain" as a "self-identified experience of personal discomfort, or actual or potential harm, triggered by a threat to a person's relationship with God or a higher power." Our updated definition can inform future studies in pain assessment and management. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to identify the defining characteristics of spiritual distress (00066). Design: This study was conducted by integrated review method using Broom method. Methods: PubMed, ProQuest, Web of Science, Embase, Scopus, and Cochran Library, and Persian scientific databases were searched from January 2010 to December 2020. Results: Twenty‐one article and 74 defining characteristics were identified. 33 of these defining characteristics was mentioned in NANDA. The criteria with the highest frequency and repetition in articles were lack of peace, lack of hope, change in anger behaviour, lack of meaning in life, change in fear and crying behaviour, Concern about belief and values system and/or God. Conclusion: Some of the spiritual distress defining characteristics overlap with other nursing diagnoses, including anxiety and hopelessness. Clinical and content validation studies need to be conducted and the main criteria for diagnosing spiritual distress in different cultures and religions need to be identified. [ABSTRACT FROM AUTHOR]

Spirituality is the deepest foundation of an individual, which can help a person achieve meaning in life and become resilience to face challenges in life. Whereas spiritual distress is a distraction of spirituality in a person who is struggling with inner difficulties due to unfulfilled needs. Spiritual distress can be divided into two sub-concepts, namely "spirit" and "distress". Both terms bring different and contradictions meanings. While the spiritual meaning itself is different for each individual. This article aims to examine the patient's perception of spiritual meaning which in turn leads to the problem of spiritual distress faced by them. Data collection for this study used open-ended interviews with 15 palliative patients until reaching saturation of data. The results of the interviews were transcribed and analysed using NVivo software version 11. The information from the study subjects was categorized under the themes of spiritual well-being and spiritual distress. In conclusion, the spiritual state experienced by palliative patients depend on their condition and understanding of the spiritual definition itself. These findings are important to facilitate the solution to the problem of spiritual distress through the intervention by applying the knowledge and skills of Islamic psychospiritual therapy. Further research needs to be carried out to help in overcome every theme of spiritual distress experienced by patients. [ABSTRACT FROM AUTHOR]

Patients and families facing serious and life-threatening illnesses are at risk for spiritual distress. Screening for spiritual distress is an efficient way of identifying issues. The State of Spirituality scale takes a unique, multidimensional approach to spirituality screening. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ² (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ² (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ² (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ² (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease. [ABSTRACT FROM AUTHOR]

Background: Spiritual care is a critical component of hospice and palliative medicine; however, physicians frequently lack the necessary competencies to adequately address patients' spiritual needs. This study aims to examine the spiritual care competencies of physicians as reflected in their care notes, thereby providing insights into their approaches for managing spiritual distress. Methods: A narrative inquiry approach was employed to qualitatively analyze interaction notes from 30 palliative care patients experiencing spiritual distress. Data were collected from a medical university professor's care notes between April 2019 and February 2024. Results: The most common form of spiritual distress observed was reluctance to leave life, followed by loss of dignity. Physicians demonstrated expertise in holistic care, addressing physical, psychological, and spiritual needs with a comprehensive approach. Their demeanor reflects acceptance of mortality and acknowledgment of the limitations of medical care, helping foster gratitude and contentment in patients. Effective communication was pivotal, involving the conveyance of information, empathetic engagement, and active listening. Compassionate interactions emphasized the importance of spiritual care in patient-centered care delivery. Conclusions: Spiritual care competencies are essential for improving patient outcomes and advancing comprehensive palliative care. Future efforts should integrate these competencies into communication training within medical education to more effectively enhance health care providers' competencies., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract Background Existential distress is a significant source of suffering for patients facing life-threatening illness. Psychedelic-Assisted Therapies (PAT) are novel treatments that have shown promise in treating existential distress, but openness to providing PAT may be limited by stigma surrounding psychedelics and the paucity of education regarding their medical use. How PAT might be integrated into existing treatments for existential distress within palliative care remains underexplored. Methods The present study aimed to elucidate the attitudes of palliative care clinicians regarding treatments for existential distress, including PAT. We recruited palliative care physicians, advanced practice nurses, and spiritual and psychological care providers from multiple US sites using purposive and snowball sampling methods. Attitudes toward PAT were unknown prior to study involvement. Semi-structured interviews targeted at current approaches to existential distress and attitudes toward PAT were analyzed for thematic content. Results Nineteen respondents (seven physicians, four advanced practice nurses, four chaplains, three social workers, and one psychologist) were interviewed. Identified themes were 1) Existential distress is a common experience that is frequently insufficiently treated within the current treatment framework; 2) Palliative care providers ultimately see existential distress as a psychosocial-spiritual problem that evades medicalized approaches; 3) Palliative care providers believe PAT hold promise for treating existential distress but that a stronger evidence base is needed; 4) Because PAT do not currently fit existing models of existential distress treatment, barriers remain. Conclusions PAT is seen as a potentially powerful tool to treat refractory existential distress. Larger clinical trials and educational outreach are needed to clarify treatment targets and address safety concerns. Further work to adapt PAT to palliative care settings should emphasize collaboration with spiritual care as well as mental health providers and seek to address unresolved concerns about equitable access.

Religion and spirituality (R/S) provide possibilities for healing, resilience, meaning making, and posttraumatic growth (PTG) in the aftermath of trauma. Still, R/S may also be the precursors and/or sources of harm, resulting in experiences of spiritual distress (SD). While extensive research has examined the positive mental health impacts of R/S, its potential harms are under-investigated. Addressing this gap, this article draws on findings from an interpretative phenomenological analysis (IPA) study with four women of evangelical Christian (EC) backgrounds who have experienced SD. The women’s stories revealed SD as an isolating and profoundly tension-filled experience characterized by painful relational loss, fraught belonging, existential uncertainty, and acute spiritual pain. Several women used the term “trauma” to describe their experiences. This study evidences the tender and isolating complexity of SD. For the women, spirituality served as both a cause and a perpetuator of trauma, and as a vehicle for transcendent meaning making in response to wounding. Ultimately, spirituality is tangled in the women’s distress while also playing a role in their posttraumatic growth. Implications include a call for increased awareness and advocacy regarding SD, as well as a trauma-informed, spiritually sensitive, curious posture from practitioners supporting clients with SD to foster posttraumatic growth.

Background: As thousands of patients, often with complex care needs, were hospitalized due to the coronavirus disease 2019 (COVID-19) pandemic, demand for palliative care was magnified. Part of hospitals' palliative care teams, palliative chaplains delivered emotional support while specializing in the religious, spiritual, and the existential aspects of care. With COVID-19 containment measures increasing isolation and disrupting supportive family connections, the emotional and spiritual well-being of the patients and families were unclear. Objectives: Through the unique perspectives and insights of inpatient palliative care chaplains, we sought to qualitatively capture their perceptions and the patient–family experience as the pandemic emerged. Setting/Subjects: This investigation was based in the United States. Design: Individual semistructured telephone interviews (n = 10) were conducted between April 22 and May 6, 2020. Through thematic analysis, analyses progressed through initial coding sessions, refining a codebook, identifying representative quotes, and recognizing themes. Results: Five themes were identified and described through the coding process and recognizing representative quotes: (1) visitor restrictions—patients, (2) visitor restrictions—families, (3) religious struggle, (4) spiritual distress, and (5) decision making. Conclusions: Inpatient palliative care chaplains were active interprofessional partners caring for patients and families as the uncertainty of the pandemic unfolded. The crises of this pandemic magnified chaplain specialization as they attended to emotional, spiritual, and religious suffering and as well as complex decision making with patients and their family members. [ABSTRACT FROM AUTHOR]

Cognitively enhanced people will have mental and possibly spiritual health needs that merit therapeutic and spiritual care response. This article addresses people who, although significantly enhanced, overlap with ordinary or "normal" (i.e., non-enhanced) people such that their status as humans is not questioned. Effective therapeutic and spiritual care approaches for these cognitively enhanced individuals will have a strong cognitive component. Cognitive therapy, originated by Aaron Beck, is an example of a therapeutic model that could prove useful with people cognitively enhanced. Four relevant elements of the cognitive therapy modality are explored: a developed cognitive structure, little consideration to unconscious factors, minimum attention to family of origin, and collaboration. Two psychological challenges with religious dimensions and import, which could be faced by individuals as a consequence of their cognitive enhancements, are concerns about physicality and fitting into community with ordinary humans and other enhanced humans. [ABSTRACT FROM AUTHOR]

The Interprofessional Spiritual Care Curriculum (ISPEC) was created to train interdisciplinary health care teams to recognize and address the spiritual needs of seriously or chronically ill patients. The curriculum, in a train-the-trainer format, employs didactic presentations, discussions, lab sessions, skill demonstrations, and video clips. In course applications, participants were required to submit goals to achieve and demonstrate institutional support. For the first ISPEC course, in July 2018, 48 clinician-chaplain teams attended. Following the 2½ day course, participants had access to online training modules for 1-year, ISPEC faculty mentoring support, and regular conference calls on goal implementation progress. Participants reported recognizing the importance of providing spiritual care and a new understanding of how collaborating as interprofessional teams enabled them to integrate this care into their home institution settings. In a mixed-methods evaluation survey completed 12 months after the ISPEC course, participants reported on the percentage of their goals completed, number and types of professionals they had educated in spiritual care, and personal confidence regarding spiritual care leadership skills. This data can serve as a model to guide other organizations striving to improve spiritual care, practiced collaboratively by clinicians and chaplains, as an essential aspect of overall QI efforts in palliative care. [ABSTRACT FROM AUTHOR]

ContextSpiritual care is integral to quality palliative care. Although chaplains are uniquely trained to provide spiritual care, studies evaluating chaplains' work in palliative care are scarce.ObjectivesThe goals of this pre-post study, conducted among patients with advanced cancer receiving outpatient palliative care, were to evaluate the feasibility and acceptability of chaplain-delivered spiritual care, utilizing the Spiritual Assessment and Intervention Model ("Spiritual AIM"), and to gather pilot data on Spiritual AIM's effects on spiritual well-being, religious and cancer-specific coping, and physical and psychological symptoms.MethodsPatients with advanced cancer (N = 31) who were receiving outpatient palliative care were assigned based on chaplains' and patients' outpatient schedules, to one of three professional chaplains for three individual Spiritual AIM sessions, conducted over the course of approximately six to eight weeks. Patients completed the following measures at baseline and post-intervention: Edmonton Symptom Assessment Scale, Steinhauser Spirituality, Brief RCOPE, Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-12), Mini-Mental Adjustment to Cancer (Mini-MAC), Patient Dignity Inventory, Center for Epidemiological Studies-Depression (10 items), and Spielberger State Anxiety Inventory.ResultsFrom baseline to post-Spiritual AIM, significant increases were found on the FACIT-Sp-12 Faith subscale, the Mini-MAC Fighting Spirit subscale, and Mini-MAC Adaptive Coping factor. Two trends were observed, i.e., an increase in Positive religious coping on the Brief RCOPE and an increase in Fatalism (a subscale of the Mini-MAC).ConclusionSpiritual AIM, a brief chaplain-led intervention, holds potential to address spiritual needs and religious and general coping in patients with serious illnesses.

ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

ABSTRACT Introduction: The prevalence of cases of HIV infection in the group of adolescents “Men Sex Men (MSM) in Indonesia has continued to increase from 2015 to 2019. The problem of decreasing physical health, feeling depressed, social stigma, stress and inconsistent behavior with religious values will create prolonged distress that hinders the quality of life. Objectives: The purpose of this study was to identify spiritual distress in adolescents infected with HIV with MSM. Methods: This study was conducted with a cross-sectional approach to 84 young people living with HIV/AIDS. The sample selection technique used snowball sampling with a Spiritual questionnaire. Data analysis was conducted by using frequency distribution and Lambda test processed using a computer system. Results: The results showed that 56% were in a state of spirituality with no disturbance, 38.1% were in moderate spiritual distress, and 6% were severe spiritual distress. The SSI score mean of respondents was 16.3 ± SD 4.9. There was a correlation between the length of diagnosis and the incidence of spiritual distress with a p-value of 0.000 and a value of r = 0.459. Spiritual distress tended to occur a lot in the early days of being diagnosed with HIV. There was no correlation between age and the incidence of spiritual distress (p = 0.097). Discussion: This study showed that spiritual care support for adolescents MSM would help overcome existential problems related to HIV. ABSTRAKPendahuluan : Prevalensi kasus infeksi HIV pada kelompok remaja dengan Lelaki seks sesama Lelaki (LSL) di Indonesia terus mengalami peningkatan dari tahun 2015 – 2019. Permasalahan penurunan kesehatan fisik, perasaan tertekan, stress stigma sosial serta pertentangan perilaku dengan nilai- nilai agama akan menjadikan distress berkepanjangan yang menghambat peningkatan kualitas hidupnya. Tujuan : Tujuan penelitian ini adalah untuk mengidentifikasi distress spiritual pada Remaja terinfeksi HIV dengan LSL. Metode : Penelitian ini dilakukan dengan pendekatan cross sectional terhadap 84 remaja ODHA LSL. Tehnik pemilihan sampel menggunakan snowball sampling dengan kuesioner Spiritual Scale Injury. Analisis data menggunakan distribusi frekuensi dan Uji lambda yang diolah menggunakan sistem komputer. Hasil: Hasil penelitian menunjukkan 56 % berada pada kondisi spiritualitas tidak ada gangguan, 38,1 % menunjukkan distress spiritual sedang dan 6 % menunjukkan distress spiritual berat. Rata-rata skor SSI responden mean 16,3 ± SD 4.9. Terdapat korelasi antara lama terdiagnosa dengan kejadian distress spiritual dengan nilai p 0,000 dan nilai r = 0,459. Distress spiritual cenderung banyak terjadi pada awal awal terdiagnosa HIV. Tidak ada korelasi antara usia dengan kejadian distress spiritual (p=0,097). Diskusi : Penelitian ini menunjukkan bahwa dukungan spiritual care pada remaja LSL akan membantu mengatasi masalah eksistensial berkaitan dengan HIV.

Spirituality is considered a protective factor against negative health outcomes and risk behaviors among people living with HIV. To limit the spread of HIV infection among young men who have sex with men, knowledge of spirituality is needed in healthcare services. This study aimed to explore spirituality among young men who have sex with men living with HIV and 20 to 24 years old in Thailand. This qualitative descriptive study was conducted with 10 participants employing in-depth interviews at a tertiary hospital in lower northern Thailand January-August 2017. The data were analyzed by using qualitative content analysis. The rich findings provide insights into the spiritual dimension from a Thai Buddhist perspective among young men who have sex with men living with HIV for promoting health and changing their risky behaviors. Four main themes arose from data analysis: 1) experiencing spiritual distress following HIV diagnosis (fear of stigmatization, self-loathing, and hopelessness); 2) accepting the truth of having HIV (acknowledging previous misbehaviors, disclosing their HIV status, and seeking ways to remain healthy); 3) increasing good karma to prolong life (refraining from transmitting HIV to others and avoiding drinking alcohol to reduce risk behaviors); and 4) gaining spiritual well-being to live with HIV (having a spiritual anchor, having life goals, living with hope, and living in the moment). These findings contribute to the development of models or interventions to support young men who have sex with men living with HIV to reduce risk behaviors and promote spiritual well-being by using the religious teaching and religious practices as a guideline. [ABSTRACT FROM AUTHOR]

Background: Literature on the spirituality of cancer patients has been mainly focused on the experiences of western patients. Few studies explore the experience of Asian cancer patients, while no spiritual study on cancer patients has been conducted in Vietnam. Purpose: The purpose of this study was to survey the spiritual distress of cancer patients at two general hospitals in northern Vietnam. Methods: This was a quantitative survey with a cross-sectional design. This study used purposive sampling with a fitting the inclusion criteria, alongside the Spiritual Distress Scale-Vietnam version (SDS-V). The data was collected by an investigator in two general hospitals in northern Vietnam. The study received approval from two research councils. Results: The results demonstrated that the demographics of cancer patients in the study reflected the national data of Vietnam. Regarding the four exploratory dimensions, more than 50% of cancer patients expressed feeling hardship and sorrow, most did not feel loneliness, most patients reported a good relationship with others and God, while the majority of were afraid to discuss death. Conclusions: Due to impact of aging and poverty on the sample patients, further studies into the interconnectivity between economics and the spiritual health status of patients is recommended. Additionally, since the 132 Vietnamese cancer patients reported a positive relationship with others and God, healthcare professionals should study effective strategies to apply the above strengths in easing hardships for future cancer patients. [ABSTRACT FROM AUTHOR]

Family members of patients admitted to the intensive care unit (ICU) experience multidimensional distress. Many clinicians lack an understanding of spiritual health practitioners' role and approaches to providing spiritual support. Through semi-structured interviews and focus groups with 10 spiritual health practitioners, we explored how spiritual health practitioners support families of patients in the ICU to better understand their scope of practice and role within an interdisciplinary critical care team. Spiritual health practitioners' work was described through clinical roles (family support, clinician support, bridging family members and clinicians), activities (companioning, counseling, facilitating difficult conversations, addressing individual needs), tensions (within and between roles and activities, navigating between hope and anticipated clinical trajectory, balancing supportive care and workload) and foundational principles (holistic perspective, resilience). A more comprehensive understanding of these roles and skills may enable clinicians to better integrate spiritual health practitioners into the fabric of care for patients, families, and clinicians themselves. [ABSTRACT FROM AUTHOR]

Chaplains are charged with the essential task of reflecting on their experiences and developing their insights into formats that can be shared with others. This brief report summarizes the spiritual distress and coping of four participants in the Hear My Voice pilot study for patients with advanced diseases, and includes questions for reflection on spiritual care and further research. It emphasizes the importance of taking time to listen deeply to one's experiences and the work of others to gain insight and perspective, contribute to the knowledge of others in writing, teaching and research, and advance best practices in spiritual care. [ABSTRACT FROM AUTHOR]

Background: Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested. Aim: The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy. Design: Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions. Participants: Twenty-five outpatients (M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited. Results: Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1—12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress (r =.46), greater spiritual distress (r =.44), and lower quality of life (r = -.56). Conclusion: Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives. [ABSTRACT FROM AUTHOR]

Objectives: Spirituality has an impact on the quality of life of palliative care patients and it influences the way in which they experience their disease. Spiritual distress is a common issue among palliative care patients in India that is best assessed through a tool specifically designed for them. This study presents the findings of a psychometric assessment of SpiDiscI: a 16-item spiritual distress scale for Hindi speaking palliative care patients in India. Materials and Methods: This study used a non-experimental cross-sectional sample survey design. 400 cancer patients undergoing pain treatment at the pain and palliative care unit of a tertiary cancer hospital in New Delhi enrolled in the study and completed the study's questionnaire. The questionnaire contained a section on demographic information, a numerical rating scale (NRS) for pain, SpiDiscI, FACIT-Sp-12, and WHOQOL-BREF. A subset of 50 patients with stable pain completed SpiDiscI a 2nd time 2 weeks after the first administration of the scale to assess test-retest reliability. Results: The scale's internal consistency is very good (Cronbach's Alpha 0.85). Spiritual distress scores ranged from 0 to 93.8 (mean 37.1, SD 23.6). Significant negative correlations between SpiDiScI and both FACIT-Sp-12 (R = --0.16, P = 0.001) and WHOQOL-BREF (R = -0.27, P < 0.001) confirmed convergent validity. There was no significant association with NRS pain scores (R = 0.06, P = 0.224). The highly significant association (R = 0.75, P < 0.001) of the scores on assessments 2 weeks apart confirmed test-retest reliability. Conclusion: SpiDiScI is a reliable and valid measure to assess spiritual distress in research among Hindi speaking palliative care patients in India. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore how nurses' religious beliefs affect their ability to forgive themselves and others. Design: A descriptive correlational study was conducted. Methods: The data were collected using an online survey via Qualtrics using three validated tools Enright Forgiveness Inventory - 30 (to measure forgiveness of others), Enright Self-Forgiveness Inventory (to measure forgiveness of self), and Duke University Religious Index (to measure religiosity). Findings: Forgiveness of others was associated with both non-organized religious activities and intrinsic religiosity. After controlling for other variables, non-organized religious activities continued to predict forgiveness of others but organized religious activities negatively predicted forgiveness of others. Self-forgiveness was not associated with any of the religiosity indicators, and in the regression model, the seriousness of self-offense alone uniquely explained self-forgiveness. Conclusion: Stressed nurses become distracted, may miss effective job performance, and patient care may suffer. Emotional and spiritual health and better patient outcomes can be attributed to the nurse forgiving others and the self. Nurses must be self-aware to develop forgiveness strategies for their well-being and provide effective care. Faculty should teach "person-centered" care and educate students to forgive others and themselves for effective patient care.