Spiritual care at the end of life: whose job is it?

Interest in and recognition of the function of religious and spiritual coping in adjustment to serious illness has been growing. In particular, there has been increasing interest in the importance of understanding and valuing patients' individual spirituality as a function of providing appropriate support, particularly as part of nursing practice. This stems partly from the influence and application of palliative care principles in a range of care settings and not just hospices. Four decades of professional rhetoric have emphasised the importance of care for the 'whole' person in terms of spiritual as well as psychological, physical and social needs, without evaluating its impacts on patients or considering whether this approach is realistic in every case. Professional ideology within palliative care has been dominant in influencing a culture of openness between professional health workers and dying patients in their care, with attention to spiritual needs an increasing part of professionals' remit. New ways to both assess and address spiritual concerns as part of overall quality of life are being developed by health care practitioners as part of a package of support for people with critical and terminal illness (Randall and Downie, 2006; Watts, 2008). For this support to be meaningful, however, it is necessary to determine which dimensions of spirituality are relevant and the ways in which the human spirit can be celebrated in the face of life-threatening illness (Cobb and Legood, 2008). The ultimate value of such exploration is to make it possible for us to die the way we live (Hockey, 2002)

Spirituality in psychotherapy : a hidden dimension : an exploratory study

Many in the caring professions consider spirituality to be a fundamental dimension of human experience and identity. Consequently, some claim that this dimension cannot be ignored in disciplines such as psychotherapy that deals with the human being and with human experience. Moreover, the increase in secularisation and the emphasis on the subjective and the personal in people's experience of spirituality and religion, have led to an increased interest in psychotherapy, counselling and other forms of activities and professions that deal more closely with the personal and subjective. Other themes that connect spirituality and psychotherapy include: spirituality is related to a person's mental health; people make meaning which assumes that they are spiritual beings; and spirituality and psychotherapy both involve enlightenment and meaning-making. For some, spirituality is manifest in psychotherapy either because of spiritual concerns that are raised by clients in the psychotherapeutic process, as a resource, or as a form of pathology. For others, therapy is a spiritual encounter. The research is a qualitative exploratory study of the experience and perception of the spiritual dimension of psychotherapy of Maltese practitioners. The study was held with two groups of Maltese psychotherapists and clinical and counselling psychologists. Each group attended a series of four focus/study group sessions. Key areas explored include the participants' conception of spirituality and religion and their understanding and experience of the spiritual dimension in counselling and psychotherapy. Broadly, the study focused on the ways in which spirituality may become manifest' and express itself in the psychotherapeutic process, the roles and experiences of the therapist and the client regarding spirituality in counselling and psychotherapy and the identification of the factors that may contribute to the spiritual dimension of counselling and psychotherapy. The findings are presented as two main domains, that of 'understanding spirituality and religion in a postmodern context' and 'spirituality and psychotherapy'. The latter is divided into four themes that are facets of the domain 'spirituality and psychotherapy'. These are a) understanding spirituality and religion, b) the therapeutic relationship as sacred space, c) the being: it is who the therapist is that counts and d) applications in clinical practice. The findings are discussed in relation to the literature and to the Maltese context

Mental health practitioners’ understanding and experience of spirituality and religion : implications for practice

Recent years have seen increased interest in the relationship between spirituality, religion and psychotherapy. Spirituality and religion may provide a lens through which to view one’s relationships and experiences and may be crucial during moments of crises and times of transition. A person’s use of religion and spirituality may be positively linked to her or his functioning and mental health. However, the opposite is also true since clients’ spiritual problems may underlie the issues or concerns that they bring to therapy. Consequently, dealing with spirituality and religion seems an unavoidable reality for the psychotherapist to the extent that some practitioners now regard providing spiritually sensitive therapy as an ethical obligation, particularly within a multicultural context. However, there is no consensus as to a definition of spirituality. Studies have shown that spirituality is a very individual phenomenon and that a person’s definition of spirituality is linked to his or her understanding and experience of life and religion and is further influenced by her or his cultural context. The implication is that this is true to each person in the therapeutic encounter: the psychotherapist and the client. This paper discusses the findings of a study in Malta where the spiritual dimension of psychotherapy was explored from the practitioner’s perspective. The focus is on the mental health practitioners’ understanding and experience of spirituality and religion and the resultant implications for practice.peer-reviewe

Spiritual care at the end of life : whose job is it?

Interest in and recognition of the function of religious and spiritual coping in adjustment to serious illness has been growing. In particular, there has been increasing interest in the importance of understanding and valuing patients' individual spirituality as a function of providing appropriate support, particularly as part of nursing practice. This stems partly from the influence and application of palliative care principles in a range of care settings and not just hospices. Four decades of professional rhetoric have emphasised the importance of care for the 'whole' person in terms of spiritual as well as psychological, physical and social needs, without evaluating its impacts on patients or considering whether this approach is realistic in every case. Professional ideology within palliative care has been dominant in influencing a culture of openness between professional health workers and dying patients in their care, with attention to spiritual needs an increasing part of professionals' remit. New ways to both assess and address spiritual concerns as part of overall quality of life are being developed by health care practitioners as part of a package of support for people with critical and terminal illness (Randall and Downie, 2006; Watts, 2008). For this support to be meaningful, however, it is necessary to determine which dimensions of spirituality are relevant and the ways in which the human spirit can be celebrated in the face of life-threatening illness (Cobb and Legood, 2008). The ultimate value of such exploration is to make it possible for us to die the way we live (Hockey, 2002).peer-reviewe

Intersectional reflections on the impact of COVID-19 across the life course

The occurrence and development of COVID-19 was unexpected. During these last two years social distancing and lockdown measures, vaccination programmes, and dealing with virus variants have led to a climate of fear and uncertainty. The first COVID-19 case in Malta was recorded on 7th March 2020. Since then, Malta has experienced four transitions as far as the containment and spread of COVID-19 is concerned and is currently going through a fourth transition characterised by an efficient vaccination programme that has put both the number of COVID cases and COVID-related deaths to record lows. Drawing on presentations during a Faculty for Social Wellbeing seminar in 2022, this paper presents a number of reflections on how the experience of the COVID-19 pandemic was not a homogenous one. The pandemic impacted persons differently depending on their positioning in the life course as well as in the social structure. For instance, being pregnant and giving birth during a pandemic was accompanied by considerable uncertainty. Also, ascertaining that persons with disability and older persons continue to exercise their human rights emerged as a crucial challenge. The pandemic has therefore not been experienced by everyone equally and in the same way, with some age groups and vulnerable groups being rendered increasingly voiceless. Governments are presently endeavouring to jump start the economy and yet there is an embedded feeling that the new ‘normal’ will be nothing like the past. How will we return to ‘normality’, if ever, and what are the changes we envisage? These were among the questions that were asked during the annual seminar and that have informed this paper.peer-reviewe

A blood atlas of COVID-19 defines hallmarks of disease severity and specificity.

Treatment of severe COVID-19 is currently limited by clinical heterogeneity and incomplete description of specific immune biomarkers. We present here a comprehensive multi-omic blood atlas for patients with varying COVID-19 severity in an integrated comparison with influenza and sepsis patients versus healthy volunteers. We identify immune signatures and correlates of host response. Hallmarks of disease severity involved cells, their inflammatory mediators and networks, including progenitor cells and specific myeloid and lymphocyte subsets, features of the immune repertoire, acute phase response, metabolism, and coagulation. Persisting immune activation involving AP-1/p38MAPK was a specific feature of COVID-19. The plasma proteome enabled sub-phenotyping into patient clusters, predictive of severity and outcome. Systems-based integrative analyses including tensor and matrix decomposition of all modalities revealed feature groupings linked with severity and specificity compared to influenza and sepsis. Our approach and blood atlas will support future drug development, clinical trial design, and personalized medicine approaches for COVID-19

Methodological innovation in the use of focus groups in qualitative health related research

Focus groups are “ideal for exploring people’s talk, experiences, opinions, beliefs, wishes and concerns” (Kitzinger, 2005: 57) and are increasingly used in a wide range of qualitative research. The dynamics of the focus group method centre on participants providing an audience for each other that encourages a greater variety of communication. Focus groups are not a natural event (Kitzinger, 2004); they are social process involving issues of trust, meaning and interpretation as well as relations of power between group members and between the researcher/facilitator and the group. These concerns informed the design of a series of focus groups undertaken to explore the spiritual dimension of psychotherapy with a group of psychotherapists. The requirement for an evolutionary process rather than a single focus group resulted in the development of a FOST group method. This group method is a blend of a focus group and a study approach. This paper discusses the context and practice of this method that is a spiral and evolutionary process of personal reflection and group interaction over a period of time. Details of different techniques used to stimulate discussion and debate as opposed to consensus seen as one of the limitations of focus groups, will be outlined. Also discussed are ethical considerations relating to potential vulnerability of participants in sharing ideas about spirituality that is both a theoretically complex and deeply personal topic

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)