Eesti Kristlike Arstide Ühing

Anamnees: kuidas votta vaimulikku anamneesi?

Why take a spiritual history?

There is often a spiritual dimension to health and suffering. Healthcare workers need to be aware of the importance of this; awareness will lead to better care of individuals  as we identify their needs.

In the past religious faith has been ignored or felt to have a negative impact on health.

HOWEVER, research has shown overwhelmingly that the deeper the faith people have, the deeper their religious commitment, the more likely they are to have positive mental and physical health outcomes – current research indicates that faith has a positive impact on illness prevention, coping with illness, recovering from surgery, improving treatment outcomes.

Only a small percentage of trials have shown negative outcomes.

'Spirituality has been a relatively neglected area in training and research in healthcare. This is true despite the fact that belief systems have been found to influence clinical outcomes, illness prevention, coping, recovery, and how patients define their illness experience.' McBride, Fam Med 1998;30:122-6.

In an acute hospital study in London in 2001, it was found that 71% of patients have an important spiritual belief although many do not express it in a religious way. King M et al. Psychol Med 2001;31:1015-23.

Much evidence to show that frequent religious attendance can be associated with reduced morbidity and mortality (for example suicide risk drops, alcohol abuse risk and illicit drug use risk drop).

Most people don't mind discussing these issues. (with permission, sensitivity and respect) (nb ; unethical not to offer treatment if indicated and I can provide it; even more so with the cure for the sickness of the soul!)

A palliative care consultant in New South Wales has introduced spiritual history taking into the medical school curriculum.

 

What do we mean by 'spirituality'?

(what it is not? ; not the same as religion)

Spirituality is the 'dimension of a person that seeks to find meaning in his or her life.' (gwish)

Or from Latin 'spiritualitas' meaning 'breath'; broad term with various definitions related to issues of meaning, hope, purpose, relationships, seeking answers to universal questions of life and death. Involves one's search for meaning, one's faith system (which all of us have, including eg an atheist), one's relationship to a higher power or god.

(cancer-research.umaryland.edu/spirituality.htm)

Or 'spirituality has been defined as a quality that goes beyond religious affiliation, that strives for inspirations, awe, meaning and purpose even in those that do not believe in any god. It has been argued that all individuals have a unique personal spirituality, irrespective of religious orientation.' (Triple Helix summer 2003, 'Spirituality and Health.')

Religion can be part of spirituality but not the same. Religion from Latin 'religare', 'to bind together', it is a more structured belief system that addresses universal spiritual questions, group-based, rites and rituals can be concrete way of expressing spirituality.

 

What is a spiritual need?

'Spiritual needs are the needs and expectations which humans have to find meaning, purpose and value in their life. Such needs can be specifically religious but even people who have no religious faith or are not members of an organized religion have belief systems that give their lives meaning and purpose.' 'Spiritual care is about helping people whose sense of meaning, purpose and worth is challenged by illness.'

(Murray et al, Palliative Medicine 2004;18:39-45.)

 

When to take a spiritual history?

4 main times;

Major illness, terminal disease, dying

Peri-operative period

Health checks

Social crisis and times of loss (eg. Bereavement, loss of job).

 

How do we take a spiritual history?

Importance of sensitivity, especially if patient or relatives obviously distressed.

Practice! Like the rest of the medical history...

 

2 different models of taking a spiritual history;

  1. Belief/Practice/Community;

Belief –

Do you have a faith that helps you (in a time like this)?

Do you have a personal faith?

What is important to you?

Is faith in God important to you?

Practice –

How does it affect your life (at a time like this)?

How do your beliefs help you cope in difficult situations?

Have you ever prayed about your situation?

Community –

Do you belong to a faith community?

Who gives you support?

What keeps you going? (same as What helps you to persevere when things are difficult?)

 

FICA – Faith/Importance/Community/Address;

Faith –

Do you consider yourself spiritual or religious or both? (we might have to define what we mean!)

Do you have spiritual beliefs that help you cope with stress?

If answer to above is 'no', could ask What gives your life meaning?

Importance –

What importance does your faith or belief have in your life?

What influence do your beliefs have in how you take care of yourself?

How have your beliefs helped you to cope during this illness?

What role do your beliefs play in regaining your health?

Community –

Are you part of a spiritual or religious community?

Is this of support and how?

Is there a person or group of people you love or who are important to you?

Address –

How would you like me to address these issues in your healthcare?

 

What might be some characteristics of spiritual suffering or pain?

Many! May include constant and chronic pain, anxiety, depression, isolation, conflict, anger, hopelessness, feelings of failure, loss of meaning/hope, loss of identity (roles/activity/independence), fear/anger at God, 'Why me?' etc.

 

What are some barriers to taking a spiritual history?

Lack of confidence, insensitivity, not knowing what to ask, lack of time, lack of care for the patient or their family. (use some personal examples)

Also,?cues to spiritual need (SEE MURRAY ET AL).

Important to recognise that each of us have our own beliefs; good to think about what they are. Healthcare professionals must respect the right of the patient to hold their own views and to have information remain confidential. Patients must never be forced to do something or to engage in conversation about these issues against their wishes. However spirituality is part of who we are as humans and most people are happy to talk about their views. (comment about Christianity here; 1 Peter 3:15 and encouraging Christian students to use these opportunities)

personally It would be great if you could share some thoughts about the conflict respecting the patients spirituality/world view and the obligation we have to share our faith as the only truth. I think it is difficult to come to terms with this.


Work in small groups/pairs;

 

1)   Ask yourself what gives meaning to your life and why? Discuss your answers (for example; friends, career, family, 'higher power', nature, art, animals, music etc).

2)   Imagine one of you is the healthcare professional and the other a patient. Practice asking some questions. (perhaps you will feel more comfortable with your own words or questions.)

 

Lorna Nunn

Resources; www.gwish.org, Saline Solution, others referenced above

 
Oled sellel lehel: Avaleht Artiklid Kristlus Anamnees: kuidas votta vaimulikku anamneesi?