The Spirituality Index of Well-Being: A New Instrument for Health-Related Quality-of-Life Research

PURPOSE Despite considerable interest in examining spirituality in health-related quality-of-life studies, there is a paucity of instruments that measure this construct. The objective of this study was to test a valid and reliable measure of spirituality that would be useful in patient populations

Religion, Spirituality, and Health Status in Geriatric Outpatients

BACKGROUND Religion and spirituality remain important social and psychological factors in the lives of older adults, and there is continued interest in examining the effects of religion and spirituality on health status. The purpose of this study was to examine the interaction of religion and spirituality with self-reported health status in a community-dwelling geriatric population

The Medical Home: Locus of Physician Formation

Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of “placing patients within contexts over time” as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge’s emphasis on learning organizations— organizations where people are continually learning how to learn together—presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians

The Context of Religious and Spiritual Care at the End of Life in Long-term Care Facilities

Despite the increasing numbers of Americans who die in nursing homes (NHs) and residential care/assisted living (RC/AL) facilities, and the importance of religious and spiritual needs as one approaches death, little is known about how these needs are met for dying individuals in long-term care (LTC) institutional settings. This study compared receipt of religious and spiritual help in four types of LTC settings: NHs, smaller (<16 beds) RC/AL facilities, traditional RC/AL facilities, and new-model RC/AL facilities. Data were also available for religious affiliation of the facilities, size, and provision of religious and hospice services. Controlling for such factors, the importance of religion/spirituality to the decedent was the strongest predictor of the decedent's receipt of spiritual help. In addition, new-model RC/AL facilities were significantly more likely to provide help for religious and spiritual needs of decedent residents than other RC/AL types, but did not differ significantly from NHs

An Exploratory Study of Spiritual Care at the End of Life

PURPOSE Although spiritual care is a core element of palliative care, it remains unclear how this care is perceived and delivered at the end of life. We explored how clinicians and other health care workers understand and view spiritual care provided to dying patients and their family members

Een cultuurvergelijkend onderzoek naar behandelbesluiten van artsen met betrekking tot demente verpleeghuispatie¨nten met pneumonie

Uit dit kwalitatieve onderzoek op basis van interviews in Nederland en in North Carolina (VS) bleek dat medische beslissingen door de arts worden beïnvloed door contextuele verschillen in de opleiding van artsen en in de structuur van de gezondheidszorg in de Verenigde Staten en Nederland. De Nederlandse artsen die verpleeghuispatiënten met dementie en pneumonie behandelden, namen actief de primaire verantwoordelijkheid voor behandelbesluiten, terwijl de Amerikaanse artsen zich passiever opstelden en zich meer voegden naar de voorkeuren van de familie, zelfs wanneer zij deze medisch niet zinvol vonden. De Nederlandse artsen kenden hun patiënten goed; zij namen hun beslissingen op basis van wat zij als het meest in overeenstemming achtten met het belang van de patiënt, terwijl Amerikaanse artsen aangaven hun patiënten in het verpleeghuis niet erg goed te kennen, omdat zij slechts beperkt tijd hadden voor contact met hen. Bij verbetering van zorg voor wilsonbekwame patiënten met een beperkte kwaliteit van leven dient rekening te worden gehouden met deze contextuele factoren en met de processen die bepalen hoe artsen zorgvoorkeuren van patiënt en familie vaststellen en bespreken

Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

<p>Abstract</p> <p>Background</p> <p>Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.</p> <p>Methods</p> <p>Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff.</p> <p>Results</p> <p>The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.</p> <p>Conclusions</p> <p>Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.</p

Relationships between quality of life and family function in caregiver

<p>Abstract</p> <p>Background</p> <p>There are caregivers who see their quality of life (QoL) impaired due to the demands of their caregiving tasks, while others manage to adapt and overcome the crises successfully. The influence of the family function in the main caregiver's situation has not been the subject of much evaluation. The aim of this study is to analyse the relationship between the functionality of the family and the QoL of caregivers of dependent relatives.</p> <p>Methods</p> <p>We conducted a cross-sectional study including 153 caregivers. Setting: Two health centers in the city of Salamanca(Spain). Caregiver variables analysed: demographic characteristics, care recipient features; family functionality (Family APGAR-Q) and QoL (Ruiz-Baca-Q) perceived by the caregiver. Five multiple regressions are performed considering global QoL and each of the four QoL dimensions as dependent variables. The Canonical Correspondence Analysis (CCA) was used to study the influence of the family function questionnaire on QoL.</p> <p>Results</p> <p>Family function is the only one of the variables evaluated that presented an association both with global QoL and with each of the four individual dimensions (p < 0.05). Using the CCA, we found that the physical and mental well-being dimensions are the ones which present a closer relationship with family functionality, while social support is the quality dimension that is least influenced by the Family APGAR-Q.</p> <p>Conclusion</p> <p>We find an association between family functionality and the caregiver's QoL. This relation holds for both the global measure of QoL and each of its four individual dimensions.</p

The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective

Context: The Dreyfus model describes how individuals progress through various levels in their acquisition of skills and subsumes ideas with regard to how individuals learn. Such a model is being accepted almost without debate from physicians to explain the &#x2018;acquisition&#x2019; of clinical skills. Objectives: This paper reviews such a model, discusses several controversial points, clarifies what kind of knowledge the model is about, and examines its coherence in terms of problem-solving skills. Dreyfus&#x2019; main idea that intuition is a major aspect of expertise is also discussed in some detail. Relevant scientific evidence from cognitive science, psychology, and neuroscience is reviewed to accomplish these aims. Conclusions: Although the Dreyfus model may partially explain the &#x2018;acquisition&#x2019; of some skills, it is debatable if it can explain the acquisition of clinical skills. The complex nature of clinical problem-solving skills and the rich interplay between the implicit and explicit forms of knowledge must be taken into consideration when we want to explain &#x2018;acquisition&#x2019; of clinical skills. The idea that experts work from intuition, not from reason, should be evaluated carefully