Spirituality, health, and medical care of adults.Among the more impressive discoveries in spirituality and health research in the last two decades has been finding that certain aspects of spirituality are consistently associated with lower morbidity and mortality Morbidity and Mortality can refer to:
Taking a Spiritual History is the first step, and is especially important in inpatient care inpatient care Managed care Services delivered to a Pt who needs physician care for > 24 hrs in a hospital , care of the dying, and care of people with serious and/or chronic illness. (1) It is important to try to understand the patients' spiritual and religious views toward health, because such views may have a substantial impact on treatment choices, attitudes, coping, and even future health. There are many methods for taking a spiritual history, including semistructured, open-ended questioning, and more structured methods. The method currently taught at our institution is the HOPE method, first described by Anandarajah in 2001. The HOPE questions can be viewed on the web at www.aafp.org/afp/20010101/81.html and have been validated in the medical school teaching environment. (2)
This approach also leads naturally into the next area to address: Care. Caring for the patient may seem natural, and may not be connected to spirituality in everyone's mind. However, if one defines spirituality as the search for purpose and meaning in life, then compassion and care for patients relates directly to the caregiver's spirituality and feeds appropriately into the needs of patients. In patients who are dying, in whom there is little hope of medical cure, compassionate care becomes paramount and sometimes is the sole comfort that clinicians can provide. To be present in the patient's suffering, treating them as a person and being human with them on hospital rounds every day, is extremely important and is part of the essence of spiritual care. Too often there is a temptation to "skip" dying patients on morning rounds ("We can't do anything for her, so why are we rounding on this patient?") or to misinterpret mis·in·ter·pret
tr.v. mis·in·ter·pret·ed, mis·in·ter·pret·ing, mis·in·ter·prets
1. To interpret inaccurately.
2. To explain inaccurately. do-not-resuscitate (DNR See dynamic noise reduction and domain name resolver. ) with do-not-treat. Compassion and care are related to positive health outcomes and are essential to understanding the spiritual care of adults. (3)
The next element of Spiritual-CPR is Prayer. A sensitive, patient-centered approach that respects everyone is suggested. (4) In certain instances, such as terminal illness, loss of a loved one, presurgery, or other times of emotional upset and distress, the clinician may be asked by the patient to participate in prayer. Patient-centered prayer is a very natural by-product by·prod·uct or by-prod·uct
1. Something produced in the making of something else.
2. A secondary result; a side effect.
1. of creating an environment of permissiveness for discussion of spiritual issues. If one succeeds in creating such an environment, one will begin to receive requests for prayer from patients. The clinician does not need to feel obligated ob·li·gate
tr.v. ob·li·gat·ed, ob·li·gat·ing, ob·li·gates
1. To bind, compel, or constrain by a social, legal, or moral tie. See Synonyms at force.
2. To cause to be grateful or indebted; oblige. to lead prayer, but listening while the patient prays is a reasonable and doable task for most physicians. The level of reassurance with which this act can provide patients is incalculable in·cal·cu·la·ble
a. Impossible to calculate: a mass of incalculable figures.
b. Too great to be calculated or reckoned: incalculable wealth. . It speaks to our humanity and our willingness to meet them half-way in their hour of need. The doctor-patient relationship doctor-patient relationship,
n in-teraction between a physician and a patient. is almost always strengthened by such interaction. Physician-initiated proselytizing and coercion are unacceptable. However, participating in prayer when suggested by the patient or when there is known congruence con·gru·ence
a. Agreement, harmony, conformity, or correspondence.
b. An instance of this: "What an extraordinary congruence of genius and era" of beliefs, is not only acceptable, but is also likely to be beneficial in creating a healing environment healing environment,
n any circumstances that promote recovery from people in the direction of wholeness and healing. . (5)
The third element of Spiritual-CPR is Resources. If one determines the need for psychological counseling in a patient, one naturally and automatically refers them to a psychologist or psychiatrist for further care. When one determines that a patient has spiritual conflicts, need for spiritual comfort, or need for prayer and support, then one should just as automatically seek the help of a chaplain or counseling minister. For inpatients, chaplains are required to be available, thus one should have little trouble requesting assistance. For outpatients, many resources are available. Psychologists and family therapists are now integrating spiritual care into their counseling practice, and advertising these services. In addition, many clergy have advanced degrees in psychology and counseling. Pastoral counseling Pastoral counseling is a branch of counseling in which ordained ministers, rabbis, priests and others provide therapy services. Practitioners in the United States are subject to the standards of the American Association of Pastoral Counseling and many are either licensed as a LPC is a growing area of psychotherapy that uses spiritual resources as well as psychological understanding for healing and growth. Pastoral counselors are certified mental health professionals who also have had in-depth religious training. The American Association American Association refers to one of the following professional baseball leagues:
AAPC American Association of Political Consultants
AAPC Avis d'Appel Public à la Concurrence (France) ) sets professional standards and certifies pastoral counselors. The organization is nonsectarian and respects the spiritual commitments and religious traditions of those who seek assistance without imposing counselor beliefs onto the client.
Spiritual-CPR can help you to help your patients and can assist you in addressing the spiritual aspects of medical care in adults.
1. Anandarajah G, Hight hight
Named or called.
[Middle English, past participle of highten, hihten, to call, be called, from hehte, hight, past tense of hoten E. Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician 2001;63:81-88.
2. King DE, Blue A, Mallin R, et al. Implementation and assessment of a spiritual history taking curriculum in the first year of medical school. Teach Learn Med 2004;16:64-68.
3. Steffen PR, Masters KS. Does compassion mediate the intrinsic religion-health relationship? Ann Behav Med 2005;30:217-224.
4. Koenig HG. The Healing Power of Faith. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of , Simon and Shuster, 1999.
5. McDonough-Means SI, Kreitzer MJ, Bell IR.. Fostering a healing presence and investigating its mediators. J Altern Complement Med 2004;10 (Suppl l):S25-41.
Curiosity is one of the permanent and certain characteristics of a vigorous mind. --Samuel Johnson
Dana E. King, MD, MS
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The Medical University of South Carolina , Charleston, SC.
Reprint requests to Dana E. King, MD, MS, Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29464. Email: email@example.com