Elsevier

Journal of Critical Care

Volume 45, June 2018, Pages 76-81
Journal of Critical Care

Communication
Addressing spirituality during critical illness: A review of current literature

https://doi.org/10.1016/j.jcrc.2018.01.015Get rights and content

Highlights

  • Organizations emphasize spiritual support for ICU patients and their surrogates.

  • 69–94% of surrogate decision-makers report spirituality as important.

  • Chaplains are specialist and clinicians are generalist in regards to spiritual care.

  • Research is needed in addressing the spiritual needs of ICU patients and surrogates.

Abstract

Objectives

The purpose of this review is to provide an overview of research on spirituality and religiosity in the intensive care setting that has been published since the 2004–2005 American College of Critical Care Medicine (ACCM) Clinical Practice Guidelines for the Support of Family in the Patient-Centered Intensive Care Unit with an emphasis on its application beyond palliative and end-of-life care.

Materials and methods

ACCM 2004–2005 guidelines emphasized the importance of spiritual and religious support in the form of four specific recommendations: [1] assessment and incorporation of spiritual needs in ICU care plan; [2] spiritual care training for doctors and nurses; [3] physician review of interdisciplinary spiritual need assessments; and [4] honoring the requests of patients to pray with them. We reviewed 26 studies published from 2006 to 2016 and identified whether studies strengthened the grade of these recommendations. We further categorized findings of these studies to understand the roles of spirituality and religiosity in surrogate perceptions and decision-making and patient and family experience.

Conclusions

Spiritual care has an essential role in the treatment of critically ill patients and families. Current literature offers few insights to support clinicians in navigating this often-challenging aspect of patient care and more research is needed.

Introduction

In 2004, ACCM created a task force to develop Clinical Practice Guidelines for the Support of Family in the Patient-Centered ICU. The importance of spiritual and religious support was emphasized in the form of four specific recommendations: 1) assessment and incorporation of spiritual needs in the ICU care plan; 2) spiritual care training for doctors and nurses; 3) physician review of spiritual needs from interdisciplinary assessments; and 4) honoring the requests of patients to pray with them [1].

Physicians, nurses, social workers and hospital chaplains have increasingly acknowledged the roles of religion and spirituality in patients' lives. Various groups have recommended policies that address spiritual and religious support. The International Council of Nurses in its “Vision for the Future of Nursing,” specifically included spiritual needs in the definition of compassionate and ethical care [2]. The North American Nursing Diagnosis Association (NANDA) created two specific diagnoses related to spiritual care: spiritual distress and readiness for enhanced spiritual well-being [3]. In 1995, social workers' education and client diversity programs also incorporated religion and spirituality. The National Association of Social Workers includes spiritual support in their Standards for Cultural Competence in Social Work Practice [4]. Since the 1940s, hospital chaplaincy has created a “sacred space” for people of all faiths and cultural beliefs to help find meaning, hope, and connection in stressful moments and draw upon their own sources of inner strength.

In addition to the bedside team, Centers for Medicare and Medicaid (CMS - the largest healthcare payer in the United States) and the Joint Commission (the largest accrediting body) have both recognized the importance of spiritual and religious support. CMS requires a spiritual care assessment for all patients admitted into hospice or palliative care in order to receive reimbursement [5]. The Joint Commission has written extensively on how essential spiritual and religious care are for effective communication, cultural competence, and patient and family centered care [6].

There continues to be discordance between recommendations and clinical practice especially in the intensive care setting. The 2004–2005 ACCM Task Force recommendations for spiritual/religious support were based on research from outside the ICU and explicitly indicated the need for ICU-specific studies [1]. The purpose of this review is to explore emerging research on spirituality and religiosity in the intensive care setting that has been published since the 2004–2005 Task Force report, with an emphasis on its application beyond palliative and end-of-life care.

Section snippets

Methods

Articles were retrieved from PubMed and PsycInfo. MESH terms were: religion, critical care, critical care nursing, critical care outcome, critical illness. Search terms for Pubmed were: ‘spiritual*’, ‘religion*’, ‘faith’, ‘critical’, ‘intensive’, ‘aggressive’, ‘care’, ‘ill’, ‘illness’. Search terms for PsycInfo were: ‘spiritual’, ‘religion’, ‘critical care’ and ‘intensive care’. Our search was limited to articles published in core clinical journals from January 2006 to June 2016. Notably, while

Results

In this review, our objectives were to assess the ACCM clinical practice guidelines in relation to each of the four respective recommendations. Second, we explored research on emerging themes in spiritual and religious support. Two authors independently reviewed the abstracts from 175 articles that resulted from the original search. From this, 141 articles were excluded. Thirty-four articles underwent full text review and eight additional articles were excluded. There were 26 articles that met

Discussion

Since the release of the ACCM's 2004–2005 clinical practice guidelines, twenty-six articles have been published on spiritual and religious support for patient-centered ICUs. None of the studies that were reviewed directly measured patient's spirituality or religiosity in the intensive care setting, likely due to incapacity. All studies came from core clinical journals, and thus we would consider all the included studies to be of high quality in terms of peer review and impact. Of the studies

Conclusion

Spiritual care has an essential role in treating critically ill patients and families. Current literature suggests relatively few ways to address these needs. Additional research is needed to understand the impact of optimized methods of addressing spiritual and religious needs in intensive care settings.

Conflicts of interest

None of the authors have conflicts of interest or financial disclosures.

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