C Smith mscript 02142021 (1) (docx) - Course Sidekick (2024)

Abstract Hospice focuses on assisting patients at the end of life through patient-centric care that manages physical, psychosocial, and spiritual symptoms. Despite inclusion in the Palliative Care Guidelines, patients continue to report that the healthcare team frequently neglects spiritual needs. The purpose of this pilot project was to evaluate the implementation of an evidence-based spiritual care protocol on staff perspectives about spiritual care, the frequency of spiritual needs assessments, and the inclusion of spiritual interventions. The project utilized an evidence-based quality improvement design with two anticipated outcomes following protocol implementation: (a) increased spiritual needs assessment intervals and interventions (b) improved staff perspectives on spiritual care. The clinical protocol consisted of provider education, assessment guidelines, interventions, and documentation requirements. Descriptive statistics were used to compare baseline data to post-protocol implementation. The results focused on the differences in the pre-and post-implementation changes in providers' perspectives, spiritual needs assessment, and inclusion of spiritual interventions. The results revealed improvement in all areas evaluated, suggesting that implementing a spiritual care protocol improves end-of-life care and supports the recommendation for hospices to implement an evidence-based protocol that includes staff education to enhance holistic care. Key words: spiritual care; spirituality; spiritual distress; hospice care; spiritual care protocol

The need for nurses to provide holistic care that incorporates physical, psychological, and spiritual elements has been highlighted since Florence Nightingale1 . Before 1979, when the World Health Organization (WHO) introduced spiritual health as a fourth dimension of care, health was viewed only as physical, mental, or social2 . However, spiritual care (SC) has been a critical element of palliative and hospice care since the late 1960s3 . When patients' spiritual needs are addressed, they experience increased peacefulness, improved quality of life (QOL), and decreased aggressive medical care4-6. Despite this, a significant segment of patients reports their healthcare team showing little to no concern for their spiritual needs7,8. A primary focus of hospice is to improve the end of life (EOL) through patient-centered care that manages symptoms from all domains9. The literature documents that the provision of SC at the EOL should concentrate on the patient and their caregivers and is included in the Palliative Care Guidelines (PCG)5,10. Patients' spiritual needs evolve as the goals of care and clinical status change; therefore, evaluation of needs should occur not only on admission but regularly throughout EOL care5 . Despite the recognized need to include SC,the healthcare team most often neglects attention to spiritual needs citing inadequate training as the primary reason for avoidance by healthcare providers (HCPs)2,9,11,12 . The PCG suggests an interprofessional approach to care; therefore, every hospice team member should receive education on delivering elemental SC6. Evidence of the Problem In the United States (US), the Medicare Hospice Benefit provides coverage for the majority of hospice care13, with nearly 1.5 million beneficiaries enrolled in hospice in 2017. The National Institute for Health and Care Excellence (NICE) and the WHO identifies the provision of spiritual care as a critical component of palliative and EOL care14. Lazenby8relates The

National Consensus Project for Quality Palliative Care's (NCPQPC) identification of SC as a quality care standard and its inclusion as a critical component of palliative care (PC). At the national level, there is evidence of an increased emphasis in research on providing SC, which offers support to the benefits of attending to the spiritual needs at the EOL15 . While the importance of including SC in practice has gained national attention, there is scarce recent literature surrounding SC's provision in nursing in the US's southeast region. In rural North Carolina, nurse practitioners felt SC was an essential part of care but was not routinely incorporate into practice16. In South Carolina, most adults are of the Christian faith (78%); however, 3% of the population reports a non-Christian religion, and 19% report being not religious17. Creel18discovered alienation as an unexpected theme when looking at spiritual care for those without a religious affiliation. The alienation or inability to provide SC for patients with different beliefs led to the nurse's inadequacy in delivering holistic care18. During an interview with the Chief Nursing Officer (CNO) of a regional hospice, B. Leroy, the results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, mandated by the Centers for Medicare & Medicaid Services (CMS), were reviewed. There was a deficit in assessing patients' spiritual needs at the regional hospice within five days of admission. Further discussion exposed the lack of a spiritual care protocol (SCP) and the inconsistent provision of care at the hospice. With minimal to no involvement from nursing or social workers (SW), chaplains provide the bulk of SC based on the presumption that all patients are of the Christian faith. Beyond the assessment done at admission, the care team did not routinely or consistently re-assess spiritual needs. This revelation led to her acknowledging the need to develop and implement an evidence-based SCP that included a culturally sensitive interprofessional approach (B. Leroy, personal communication, June 4, 2019).

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