Authors (including presenting author) :
Leung WY(1)
Affiliation :
Palliative Care Unit, M&G, Ruttonjee & Tang Shiu Kin Hospital
Introduction :
In palliative care (PC) unit of Ruttonjee and Tang Shiu Kin Hospitals (RTSKH); the patients are having life-threatening illness. They are facing different physical-psychosocial and spiritual problems. The vision for Hospital Authority PC Service is to support terminal illness patients with holistic palliative care so as to improve quality of life till the end-of-their life journey (Hospital Authority, 2017). With regards to World Health Organization, spiritual care of the patient at the end-of-life is a core element (WHO, 2018). Spirituality is an important dimension to enhance medical outcome in life-threatening illness patients (Balboni et al., 2013). Delivering spiritual care to patients is necessary in nursing; it is an important to enhance medical outcome in life-threatening illness patients (Minton et al., 2018)
Our patients suffering from life threatening illness may experience different spiritual disturbance such as depression; worries; fear loss of control and death. Nevertheless, their spiritual stress is difficult to be addressed because they may not be willing or ready to tell in-depth feelings and thought; not open to talk death and not willing to share family problem that probably due to conservative character of Chinese; limited privacy provided and preservation of self-image and dignity.
In our current practice, there is limited assessment to patient’s spiritual status and without formal systemic spiritual assessment tool to evaluate patients’ spiritual stress. Patients’ spiritual problem is easily being overlooked. In view of lacking evidence based structure spiritual assessment tool for identifying patients spiritual distress in our palliative care unit which may lead to indistinctive intervention provided; a program of enhancing spiritual care to patients at the end-of-life was proposed and formulated.
Objectives :
1. Introduce spiritual assessment in the daily nursing practice.
2. Propose & implement care interventions to address patient care needs at the end-of-life.
Methodology :
(1) Analyze
- Identified the problem of spiritual care in current palliative care nursing practice. An Ishikawa diagram was used to find out the root causes of incomplete spiritual care to patient at the end-of-life.
(2) Develop
- An enhancement project action plan was developed.
(3) Action
3.1 Studied the research papers related to spiritual care to patient at the end-of-life; spiritual assessment tool and interventions.
The articles published from 2011 to 2018 with inclusion criteria related to spiritual assessment and nursing intervention regarding spiritual care in the data base of CINAHL, MEDLINE and hand searched from Goggle were identified under the process of literature search. The summary of literature review is listed below.
(Importance of spiritual care to patient in end-of-life)
*Understand the meaning of spirituality is needed
*Meeting individuals’ spiritual needs has been found to improve quality of life and the ability to cope with ill health
*Delivering spiritual care is necessary nursing role
(Spiritual Assessment)
*Lack of formal questioning that powerless nurse to identify spiritual needs
*A systemic spiritual assessment tool helps nurses to evaluate patient spiritual distress comprehensively avoid overlook
*It cover structure & words that nurse to address and document patient spiritual need easily
*HOPE tool is highly praised among 25 common spiritual assessment tools
(All-around intervention)
*Religious support: helps patient and family to get connection to higher power via religious rituals
*Compassion care: e.g. active listening, trust relationship, respect, protect patient dignity, bring peace & hope to patient
*Empathetic communication: enter deeper conversation, give connection to patient
*Empathetic life review: recognized as evidence-base intervention
*Respect transcendence phenomena : bring peace & comfort to patient and family
3.2 The HOPE systemic assessment tool was selected for our daily practice
3.3 Pilot the assessment tool & Implement care for patients with spiritual disturbance in end-of-life
3.4 Develop One-page profile of spiritual care preference to patients to address their spiritual needs
3.5 Conduct staff sharing session about the modified spiritual care practice
3.6 Training to PC volunteers of spiritual care to patient in end-of-life
3.7 Perform patient satisfaction survey on spiritual care by Palliative Care team
Result & Outcome :
Patient satisfaction evaluation was done on Aug 2018; the survey was conducted to ten patients who received the modified spiritual assessment and spiritual care intervention. The result was 30% agree and 70% of patients totally agree PC nurse can help relieve their spiritual disturbance; they satisfied our PC service because their condition and disease progress can update to them; PC nurses willing to listen their problems and concerns with empathy showed.
