Palmer Jennifer A, Hilgeman Michelle, Balboni Tracy, Paasche-Orlow Sara, Sullivan Jennifer L
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.
Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Gerontologist. 2022 Apr 20;62(4):556-567. doi: 10.1093/geront/gnab134.
Spiritual care aims to counter negative outcomes from spiritual distress and is beneficial to persons living with dementia. Such care needs dementia-appropriate customization. We explored the salient spiritual needs in dementia to inform future intervention development. Health care providers are well situated to observe the nature of spiritual needs across and within medical conditions.
We conducted semistructured qualitative interviews with providers. We sampled purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains). Our interview guide inquired about, for example, the nature of spiritual needs in dementia and stakeholders' roles in addressing them. Inductive/deductive thematic analysis was employed.
24 providers participated. The thematic structure consisted of 2 themes: (a) spiritual experience in dementia differs from that in other medical conditions (subthemes: fear, profound loss of self, progressive and incurable nature, and impacted ability to access faith) and (b) the need for spiritual intervention at the mild stage of dementia (subthemes: awareness in mild dementia and its influence on spiritual distress, and a window of opportunity).
We learned about the potential "what" of spiritual needs and "who" and "when" of implementing spiritual care. Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss of self early in symptom progression, and stakeholder training. Researchers should study additionally the "how" of dementia-appropriate spiritual care. Conjointly, these efforts could promote spiritual well-being in persons living with dementia worldwide.
精神关怀旨在应对精神困扰带来的负面后果，对痴呆症患者有益。此类关怀需要针对痴呆症进行适当调整。我们探究了痴呆症患者突出的精神需求，以为未来干预措施的开发提供依据。医疗保健提供者处于有利位置，能够观察不同医疗状况下及同一医疗状况内精神需求的本质。
我们对医疗保健提供者进行了半结构化定性访谈。我们按学科（牧师、护理人员、社会工作者、活动专业人员）和宗教传统（针对牧师）进行了目的抽样。我们的访谈指南询问了诸如痴呆症患者精神需求的本质以及利益相关者在满足这些需求方面的作用等问题。采用了归纳/演绎主题分析法。
24名医疗保健提供者参与了访谈。主题结构包括两个主题：（a）痴呆症患者的精神体验与其他医疗状况下的不同（子主题：恐惧、自我的深刻丧失、病情进展且无法治愈的本质以及获取信仰能力受到影响），以及（b）痴呆症轻度阶段对精神干预的需求（子主题：轻度痴呆症中的意识及其对精神困扰的影响，以及一个机会之窗）。
我们了解了精神需求可能“是什么”以及实施精神关怀的“谁”和“何时”。启示包括需要针对痴呆症的精神评估工具、在症状进展早期针对恐惧和自我丧失的干预措施以及利益相关者培训。研究人员应进一步研究针对痴呆症的精神关怀的“如何做”。综合起来，这些努力可以促进全球痴呆症患者的精神健康。
