Kimani Kellen N, Murray Scott A, Grant Liz
School of Public Health, University of Nairobi, Nairobi, Kenya.
Primary Palliative Care Research Group, The Usher Institute, University of Edinburgh, Edinburgh, UK.
BMJ Glob Health. 2016 Nov 18;1(3):e000077. doi: 10.1136/bmjgh-2016-000077. eCollection 2016.
Exploring patients' spiritual issues is vital for informing holistic care. The spiritual concerns of patients living and dying with advanced heart failure in sub-Saharan Africa remains unknown. Our aim was to describe spiritual issues in the context of the lived experiences of patients with heart failure in Kenya.
We purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in-depth interviews with patients at 0, 3 and 6 months after recruitment. We conducted bereavement interviews with their carers. Interviews were recorded, transcribed into English and analysed using a thematic approach, assisted by Nvivo software package.
Patients expressed traditional and Christian spiritual beliefs in response to their illness. At diagnosis, some patients felt their illness had occurred because they had wronged God, while others felt betrayed by God. Some expressed comfort from God and optimism believing that God was in control and would heal their illness. During acute episodes patients questioned whether witchcraft or curses caused their illness. Younger patients experienced more spiritual distress. Although church fellowship generally offered spiritual and social support, some patients felt let down by the church which they perceived to favour those who offered more tithes.
This is the first study to explore the spiritual issues of people living with advanced heart failure in Kenya. Understanding patients' spiritual concerns is important for developing evidence-based patient-centred holistic care to promote multidimensional well-being.
探究患者的精神问题对于提供全面护理至关重要。撒哈拉以南非洲地区晚期心力衰竭患者的生存和死亡时的精神问题仍不为人知。我们的目的是描述肯尼亚心力衰竭患者实际生活经历中的精神问题。
我们在肯尼亚一家农村地区医院有目的地招募了18名晚期心力衰竭患者。在招募后的0、3和6个月对患者进行了系列深入访谈。对他们的护理人员进行了丧亲访谈。访谈进行了录音，转录成英文，并在Nvivo软件包的辅助下采用主题分析法进行分析。
患者对自己的疾病表达了传统和基督教的精神信仰。在诊断时，一些患者觉得自己生病是因为得罪了上帝，而另一些患者则觉得被上帝背叛了。一些患者表示从上帝那里得到了安慰并持乐观态度，相信上帝掌控一切并会治愈他们的疾病。在急性发作期间，患者会质疑巫术或诅咒是否导致了他们的疾病。年轻患者经历了更多的精神痛苦。虽然教会团体通常提供精神和社会支持，但一些患者觉得教会让他们失望，他们认为教会偏袒那些奉献更多什一税的人。
这是第一项探究肯尼亚晚期心力衰竭患者精神问题的研究。了解患者的精神问题对于制定以患者为中心的循证全面护理以促进多维度健康至关重要。
