Abstract
This research aims to describe the perspectives of health care professionals, patients, and family members regarding spiritual care options in intensive care units (ICUs). Participants were recruited consecutively from January to August 2019, during which time data collection was conducted. A total of 1211 Spanish-language questionnaires were collected from 41 ICUs in Spain and Latin America. Approximately 655 participants worked as ICU professionals (74.5% of these participants were women, and 47.5% were nurses). Additionally, 340 questionnaires were sent to patients' families, and patients completed 216 questionnaires; 59.7% of these participants were men, and their mean age was 59.4 years. Most (69.7%) of the critical care professionals considered this type of care to be a part of their profession, 50.1% did not feel competent to provide this type of care, and 83.4% felt that training in this area was necessary. Most families (71.7%) and patients (60.2%) felt that spiritual suffering occurred during their stay in the ICU. The results of this study suggest a perceived deficit in spiritual care in ICUs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abdul Halain, A., Tang, L. Y., Chong, M. C., Ibrahim, N. A., & Abdullah, K. L. (2022). Psychological distress among the family members of intensive care unit (ICU) patients: A scoping review. Journal of Clinical Nursing, 31(5–6), 497–507. https://doi.org/10.1111/jocn.15962
Balboni, M. J., Sullivan, A., Amobi, A., Phelps, A. C., Gorman, D. P., Zollfrank, A., Peteet, J. R., Prigerson, H. G., VanderWeele, T. J., & Balboni, T. A. (2013). Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. Journal of Clinical Oncology, 31(4), 461–467. https://doi.org/10.1200/JCO.2012.44.6443
Barbero Gutiérrez, J., & Obra, S. (2017). Manual para la atención psicosocial y espiritual a personas con enfermedades avanzadas: Intervención psicológica y espiritual. Obra Social La Caixa.
Benito, E., Oliver, A., Galiana, L., Barreto, P., Pascual, A., Gomis, C., & Barbero, J. (2014). Development and validation of a new tool for the assessment and spiritual care of palliative care patients. Journal of pain and symptom management, 47(6), 1008-10181.e1. https://doi.org/10.1016/j.jpainsymman.2013.06.018
Best, M., Aldridge, L., & Butow, P. (2015). Treatment of holistic suffering in cancer: A systematic literature review. Palliative Medicine, 29(10), 885–898. https://doi.org/10.1177/0269216315581538
Best, M. C., Jones, K., Washington, J., Sullivan, J., Kearney, M., & Puchalski, C. (2022). Evaluation of the interprofessional spiritual care education curriculum in Australia: Online. Palliative & Supportive Care. https://doi.org/10.1017/S1478951522000244
Białek, K., & Sadowski, M. (2021). Stress, anxiety, depression and basic hope in family members of patients hospitalised in intensive care units – Preliminary report. Anestezjologia Intensywna Terapia, 53(2), 134–140. https://doi.org/10.5114/ait.2021.105728
Boston, P. H., & Mount, B. M. (2006). The caregiver’s perspective on existential and spiritual distress in palliative care. Journal of Pain and Symtom Management, 32(1), 13–26. https://doi.org/10.1016/j.jpainsymman.2006.01.009
Canfield, C., Taylor, D., Nagy, K., Strauser, C., VanKerkhove, K., Wills, S., Sawicki, P., & Sorrell, J. (2016). Critical care nurses’ perceived need for guidance in addressing spirituality in critically ill patients. American Journal of Critical Care, 25(3), 206–211. https://doi.org/10.4037/ajcc2016276
Carrera, J. C. (2011). Los fundamentos de la Bioètica, de H. Tristram Engelhardt. Bioètica & Debat, 17(64), 12–16. https://raco.cat/index.php/BioeticaDebat_es/article/view/257100
Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1–2), 129–142. https://doi.org/10.1300/J132v08n01_18
de la Sociedad, G. D. E. (2011). Los cuidados espirituales, entraña de los cuidados paliativos. Medicina Paliativa, 18(1), 1–3.
Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., Carlsson, J., Dahlin-Ivanoff, S., Johansson, I.-L., & Kjellgren, K. (2011). Person-centered care—Ready for prime time. European Journal of Cardiovascular Nursing, 10(4), 248–251. https://doi.org/10.1016/j.ejcnurse.2011.06.008
Escudero, D., Vina, L., & Calleja, C. (2014). For an open-door, more comfortable and humane intensive care unit. It is time for change. Medicina Intensiva (English Edition), 38(6), 371–375. https://doi.org/10.1016/j.medine.2014.01.001
Galiana, L., Oliver, A., Gomis, C., Barbero, J., & Benito, E. (2014). Cuestionarios de evaluación e intervención espiritual en cuidados paliativos: Una revisión crítica. Medicina Paliativa, 21(2), 62–74. https://doi.org/10.1016/j.medipa.2013.02.003
Gómez-Carretero, P., Monsalve, V., Soriano, J. F., & De Andrés, J. (2007). Alteraciones emocionales y necesidades psicológicas de pacientes en una Unidad de Cuidados Intensivos. Medicina Intensiva, 31(6), 318–325. https://doi.org/10.1016/S0210-5691(07)74830-1
Gordon, B. S., Keogh, M., Davidson, Z., Griffiths, S., Sharma, V., Marin, D., Mayer, S. A., & Dangayach, N. S. (2018). Addressing spirituality during critical illness: A review of current literature. Journal of Critical Care, 45, 76–81. https://doi.org/10.1016/j.jcrc.2018.01.015
Gries, C. J., Randall Curtis, J., Wall, R. J., & Engelberg, R. A. (2008). Family member satisfaction with end-of-life decision making in the ICU. Chest, 133(3), 704–712. https://doi.org/10.1378/chest.07-1773
Hvidt, N. C., Nielsen, K. T., Kørup, A. K., Prinds, C., Hansen, D. G., Viftrup, D. T., Hvidt, E. A., Hammer, E. R., Falkø, E., & Locher, F. (2020). What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping. BMJ open, 10(12), e042142. https://doi.org/10.1136/bmjopen-2020-042142
Jim, H. S., Pustejovsky, J. E., Park, C. L., Danhauer, S. C., Sherman, A. C., Fitchett, G., Merluzzi, T. V., Munoz, A. R., George, L., & Snyder, M. A. (2015). Religion, spirituality, and physical health in cancer patients: A meta-analysis. Cancer, 121(21), 3760–3768. https://doi.org/10.1002/cncr.29353
Johnson, J. R., Engelberg, R. A., Nielsen, E. L., Kross, E. K., Smith, N. L., Hanada, J. C., & Doll O’Mahoney, S. K. (2014). The association of spiritual care providers’ activities with family members’ satisfaction with care after a death in the ICU. Critical Care Medicine, 42(9), 1991–2000. https://doi.org/10.1097/CCM.0000000000000412
Johnson, R., Wirpsa, M. J., Boyken, L., Sakumoto, M., Handzo, G., Kho, A., & Emanuel, L. (2016). Communicating chaplains’ care: Narrative documentation in a neuroscience-spine intensive care unit. Journal of Health Care Chaplaincy, 22(4), 133–150. https://doi.org/10.1080/08854726.2016.1154717
Kang, K.-A., Han, S.-J., Lim, Y.-S.M.S., & Kim, S.-J. (2019). Meaning-centered interventions for patients with advanced or terminal cancer a meta-analysis. Cancer Nursing, 42(4), 332–340. https://doi.org/10.1097/NCC.0000000000000628
Kellehear, A. (2000). Spirituality and palliative care: A model of needs. Palliative Medicine, 14(2), 149–155. https://doi.org/10.1191/026921600674786394
Kestenbaum, A., Shields, M., James, J., Hocker, W., Morgan, S., Karve, S., Rabow, M. W., & Dunn, L. B. (2017). What impact do chaplains have? A pilot study of spiritual AIM for advanced cancer patients in outpatient palliative care. Journal of Pain and Symptom Management, 54(5), 707–714. https://doi.org/10.1016/j.jpainsymman.2017.07.027
Laín Entralgo, P. (1978). Historia de la Medicina. Salvat.
Linda Ross, B. A., & Jacky Austin, M. B. E. (2015). Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: Implications for nurse managers. Journal of Nursing Management, 23(1), 87–95. https://doi.org/10.1111/jonm.12087
Nin Vaeza, N., Martin Delgado, M. C., & Heras La Calle, G. (2020). Humanizing intensive care: Toward a human-centered care ICU model. Critical Care Medicine, 48(3), 385–390. https://doi.org/10.1097/CCM.0000000000004191
Noome, M., Beneken Genaamd Kolmer, D. M., Van Leeuwen, E., & Dijkstra, B. M. (2017). The role of ICU nurses in the spiritual aspects of end-of-life care in the ICU: An explorative study. Scandinavian Journal of Caring Sciences, 31(2), 569–578. https://doi.org/10.1111/scs.12371
O’Brien, M. R., Kinloch, K., Groves, K. E., & Jack, B. A. (2019). Meeting patients’ spiritual needs during end-of-life care: A qualitative study of nurses’ and healthcare professionals’ perceptions of spiritual care training. Journal of Clinical Nursing, 28(1–2), 182–189. https://doi.org/10.1111/jocn.14648
Oh, P.-J., & Kim, S. H. (2014). The effects of spiritual interventions in patients with cancer: A meta-analysis. Oncology Nursing Forum, 41(5), 290–301. https://doi.org/10.1188/14.onf.e290-e301
Puchalski, C. M. (2006). A time for listening and caring: Spirituality and the care of the chronically ill and dying. https://doi.org/10.1093/acprof:oso/9780195146820.001.0001
Puchalski, C. M., Ferrell, B., Otis-Green, S., & Handzo, G. (2016). Overview of spirituality in palliative care. UpToDate, jun, 8. https://www.medilib.ir/uptodate/show/2198
Puchalski, C. M. (2002). Spirituality and end-of-life care: A time for listening and caring. Journal of Palliative Medicine, 5(2), 289–294. https://doi.org/10.1089/109662102753641287
Puchalski, C. M., Blatt, B., Kogan, M., & Butler, A. (2014a). Spirituality and health: The development of a field. Academic Medicine, 89(1), 10–16. https://doi.org/10.1097/ACM.0000000000000083
Puchalski, C. M., Ferrell, B. R., Borneman, T., DiFrances Remein, C., Haythorn, T., & Jacobs, C. (2022). Implementing quality improvement efforts in spiritual care: Outcomes from the interprofessional spiritual care education curriculum. Journal of Health Care Chaplaincy, 28(3), 431–442. https://doi.org/10.1080/08854726.2021.1917168
Puchalski, C. M., Ferrell, B., Virani, R., Otis-Green, S., Baird, P., Bull, J., Chochinov, H., Handzo, G., Nelson-Becker, H., & Prince-Paul, M. (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine, 12(10), 885–904. https://doi.org/10.1089/jpm.2009.0142
Puchalski, C. M., Jafari, N., Buller, H., Haythorn, T., Jacobs, C., & Ferrell, B. (2020). Interprofessional spiritual care education curriculum: A milestone toward the provision of spiritual care. Journal of Palliative Medicine, 23(6), 777–784. https://doi.org/10.1089/jpm.2019.0375
Puchalski, C. M., King, S. D., & Ferrell, B. R. (2018). Spiritual considerations. Hematology/oncology Clinics of North America, 32(3), 505–517. https://doi.org/10.1016/j.hoc.2018.01.011
Puchalski, C. M., Sbrana, A., Ferrell, B., Jafari, N., King, S., Balboni, T., Miccinesi, G., Vandenhoeck, A., Silbermann, M., & Balducci, L. (2019). Interprofessional spiritual care in oncology: A literature review. ESMO Open, 4(1), e000465. https://doi.org/10.1136/esmoopen-2018-000465
Puchalski, C. M., Vitillo, R., Hull, S. K., & Reller, N. (2014b). Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine, 17(6), 642–656. https://doi.org/10.1089/jpm.2014.9427
Ross, L., & Miles, J. (2020). Spirituality in heart failure: A review of the literature from 2014 to 2019 to identify spiritual care needs and spiritual interventions. Current Opinion in Supportive and Palliative Care, 14(1), 9–18. https://doi.org/10.1097/SPC.0000000000000475
Salas, C., & Taboada, P. (2019). Espiritualidad en Medicina: Análisis de la justificación ética en Puchalski. Revista Médica De Chile, 147(9), 1199–1205. https://doi.org/10.4067/s0034-98872019000901199
Sánchez, M. D., Bimbaum, N. C., Gutierrez, J. B., Bofill, C. G., Mora-Figueroa, P. B., & Oliver, E. B. (2016). ¿Cómo percibimos los Profesionales el Acompañamiento Espiritual en los Equipos de Cuidados Paliativos en España? Medicina Paliativa, 23(2), 63–71. https://doi.org/10.1016/j.medipa.2013.07.002
Selby, D., Seccaraccia, D., Huth, J., Kurppa, K., & Fitch, M. (2017). Patient versus health care provider perspectives on spirituality and spiritual care: The potential to miss the moment. Annals of Palliative Medicine, 6(2), 143–152. https://doi.org/10.21037/apm.2016.12.03
Selman, L. E., Brighton, L. J., Sinclair, S., Karvinen, I., Egan, R., Puchalski, C., the InSpirit Collaborative. (2018). Patients’ and caregivers’ needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries. Palliative Medicine, 32(1), 216–230. https://doi.org/10.1177/0269216317734954
Sherman, A. C., Merluzzi, T. V., Pustejovsky, J. E., Park, C. L., George, L., Fitchett, G., Jim, H. S., Munoz, A. R., Danhauer, S. C., & Snyder, M. A. (2015). A meta-analytic review of religious or spiritual involvement and social health among cancer patients. Cancer, 121(21), 3779–3788. https://doi.org/10.1002/cncr.29352
Sinclair, S., Hack, T. F., MacInnis, C. C., Jaggi, P., Boss, H., McClement, S., Sinnarajah, A., & Thompson, G. (2021). Development and validation of a patient-reported measure of compassion in healthcare: The sinclair compassion questionnaire (SCQ). BMJ Open, 11(6), e045988. https://doi.org/10.1136/bmjopen-2020-045988
Steinhauser, K. E., Fitchett, G., Handzo, G. F., Johnson, K. S., Koenig, H. G., Pargament, K. I., Puchalski, C. M., Sinclair, S., Taylor, E. J., & Balboni, T. A. (2017). State of the science of spirituality and palliative care research part I: Definitions, measurement, and outcomes. Journal of Pain and Symptom Management, 54(3), 428–440. https://doi.org/10.1016/j.jpainsymman.2017.07.028
Swinton, M., Giacomini, M., Toledo, F., Rose, T., Hand-Breckenridge, T., Boyle, A., Woods, A., Clarke, F., Shears, M., & Sheppard, R. (2017). Experiences and expressions of spirituality at the end of life in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 195(2), 198–204. https://doi.org/10.1164/rccm.201606-1102OC
Todres, L., Galvin, K. T., & Holloway, I. (2009). The humanization of healthcare: A value framework for qualitative research. International Journal of Qualitative Studies on Health and Well-Being, 4(2), 68–77. https://doi.org/10.1080/17482620802646204
Toombs, S. K. (2001). Handbook of phenomenology and medicine (Vol. 68). Springer Science & Business Media.
Walach, H. (2017). Secular spirituality–what it is. Why we need it. How to proceed. Journal for the Study of Spirituality, 7(1), 7–20. https://doi.org/10.1080/20440243.2017.1290028
Wall, R. J., Engelberg, R. A., Gries, C. J., Glavan, B., & Curtis, J. R. (2007). Spiritual care of families in the intensive care unit. Critical Care Medicine, 35(4), 1084–1090. https://doi.org/10.1097/01.CCM.0000259382.36414.06
Willemse, S., Smeets, W., Van Leeuwen, E., Janssen, L., & Foudraine, N. (2018). Spiritual care in the ICU: Perspectives of Dutch intensivists, ICU nurses, and spiritual caregivers. Journal of Religion and Health, 57(2), 583–595. https://doi.org/10.1007/s10943-017-0457-2
Willemse, S., Smeets, W., van Leeuwen, E., Nielen-Rosier, T., Janssen, L., & Foudraine, N. (2020). Spiritual care in the intensive care unit: An integrative literature research. Journal of Critical Care, 57, 55–78. https://doi.org/10.1016/j.jcrc.2020.01.026
Wilson, M. E., Beesley, S., Grow, A., Rubin, E., Hopkins, R. O., Hajizadeh, N., & Brown, S. M. (2019). Humanizing the intensive care unit. Critical Care, 23(1), 32. https://doi.org/10.1186/s13054-019-2327-7
Zhao, J., Gao, S., Wang, J., Liu, X., & Hao, Y. (2016). Differentiation between two healthcare concepts: Person-centered and patient-centered care. International Journal of Nursing Sciences, 3(4), 398–402. https://doi.org/10.1016/j.ijnss.2016.08.009
Acknowledgements
The authors thank all the ICU professionals, patients, and family members who participated in this study, who were certainly the inspiration for this work, and who have helped us improve as individuals, professionals, and caregivers.
Funding
The authors have not disclosed any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Consent to Participate
Informed consent was obtained from all individual participants included in this study.
Ethical Approval
This study has been reviewed and endorsed by the Committee on Ethics and Scientific Research (CEIC) of the Universidad Francisco de Vitoria in Madrid (05-16-2018/No 20/2018) following the ethical precepts formulated in the updated Declaration of Helsinki by the World Medical Association.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
García Torrejon, M.C., Heras de la Calle, G., Martin Delgado, M.C. et al. Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America. J Relig Health 62, 2391–2411 (2023). https://doi.org/10.1007/s10943-023-01746-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10943-023-01746-2