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Spirituality In Patient Care

Why How When & What

Spirituality In Patient Care
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US$ 6.99 (+ tax)

This book is intended as a guide for practicing physicians, medical students, and residents to help identify and address the spiritual needs of patients. Those who will benefit most will be physicians who wish to know how to integrate spirituality into clinical practice in an effective and sensitive manner. Other professionals, such as nurses and chaplains, may use this book as they interact with doctors, other health professionals, and hospital administrators.

Templeton Foundation Press; January 2008
128 pages; ISBN 9781599470207
Read online, or download in secure PDF format or MobiPocket
Excerpt
This book provides a short course for health professionals interested in identifying and addressing the spiritual needs of patients. It is intended as a guide for practicing physicians, medical students, residents, and possibly students in other health professions. The primary audience, however, is physicians who wish to know how to integrate spirituality into clinical practice in an effective, sensitive, and sensible manner. Nurses and chaplains may also find this small book useful as they interact with doctors, other health professionals, and hospital administrators. While several other guides exist on how to address spiritual issues, none of these are readily portable for easy use and rapid access.1,2,3 Is there a need for such a guide? Despite the fact that nearly two-thirds of American medical schools in 2001 taught required or elective courses on religion, spirituality, and medicine, few doctors today address the spiritual needs of patients. Even in strongly religious areas of the United States, less than one-third of physicians even inquire about the patient’s religious denomination, and fewer than one in ten routinely take a spiritual history.4 Many physicians say they feel uncomfortable addressing religious issues or don’t have time to do this. Others don’t see addressing spiritual issues as part of their job, don’t understand why it should be, don’t know how or when to do it, and can’t imagine what the results would be if they did. This is a book about the why’s, how’s, when’s, and what’s of addressing spiritual issues in patient care. Why? Why address spirituality in patient care? Why identify spiritual needs? Why should this be a routine part of health care? In chapter 1, I examine five reasons why physicians ought to consider this: (1) religious beliefs and spiritual needs are common among medical patients and serve a distinct function; (2) religious beliefs influence medical decision making; (3) there is a relationship between religion and both mental and physical health; (4) many patients would like their doctors to address these issues; and (5) there is a historical precedent for doing so. These five reasons also underscore a need for physician training in this area. How? How does a physician identify and address spiritual needs? In chapter 2, I describe the process of spiritual assessment, e.g., how to take a spiritual history and instruments for doing so. Next, I examine the role of the physician as orchestrator of resources, supporter of patients’ spiritual beliefs, and participant in spiritual activities with patients (such as prayer). I also discuss here the importance of physicians and healthcare systems linking together with religious organizations (through parish nurses or lay leaders) to address the present and future health needs of communities. When? In chapter 3, I address a number of important issues with regard to the timing of spiritual assessment and support. When does one take a spiritual history during the course of medical evaluation as part of the chief complaint, history of the present illness, family history, social history, physical exam, or wrap-up? Are certain kinds of patients more appropriate than others (for example, a teenager in for a wart removal, a pregnant woman being seen for a prenatal exam, an older person in for a health maintenance visit, or someone being admitted to a hospital, nursing home, or hospice)? How often should a spiritual history be done: once and never repeated, every visit, only at selected times? When does a physician provide spiritual support and what kinds of support are permissible? What about praying with patients? Is this ever acceptable. What? What results can be expected from addressing patients’ spiritual needs? I discuss in chapter 4 the impact that spiritual assessment can have on the patient’s ability to cope with illness, on the doctor-patient relationship, patient compliance, and more broadly, on the course of medical illness and response to treatment. Some of the practical benefits of communicating with, referring to, and interacting with clergy in hospital and community settings are illustrated. In chapter 5 I explore limitations in the role that physicians can play in this area. Are there ethical boundaries that should not be crossed? Does medical specialty make a difference? Are there gray areas that must be addressed on a caseby-case basis? What kinds of problems can arise when physicians attempt to address spiritual needs of patients? How can these problems be avoided? Are there other pitfalls and dangers to be aware of when addressing spiritual issues? What are some of the resistances, fears, and concerns of health professionals that prevent them from addressing religious or spiritual issues, and how valid are these concerns? When Religion Is Harmful. Here I examine the negative effects that religion may exert on health. Are there times when spiritual beliefs can actually interfere with medical care, lead to health problems, or worsen disease outcomes? What are some examples and how often does this occur? How can clinicians handle these cases in a sensitive, thoughtful, and effective manner? Can physician inquiry about spiritual issues cause harm? Further Resources. In the final chapter, I provide resources that clinicians can turn to for more information about spirituality and health. First, different assessment tools for taking a spiritual history are described and discussed. Second, ten key original research studies on spirituality and mental health, ten on physical health, and ten on social health are presented and briefly summarized. Third, I review academic texts on religion and health, and also summarize popular books on the topic. Finally, websites, newspapers, and popular magazines where health professionals can obtain up-to-date information about spirituality and health are described. Although this little book will not provide the physician with everything he or she will ever need to know about competently addressing religious or spiritual issues in patient care, it is a good start and will point to key resources to develop further skills in this area.