Advance care planning (ACP) can help prepare for future losses and decisions to be taken. However, relatives of persons with dementia may wait for healthcare professionals to initiate ACP... Show moreAdvance care planning (ACP) can help prepare for future losses and decisions to be taken. However, relatives of persons with dementia may wait for healthcare professionals to initiate ACP conversations which may not adequately address their individual information needs. To evaluate inducing and enhancing conversations about meaning and loss, we conducted an ethnographic study on nurse-led ACP conversations using a question prompt list (QPL) on six dementia wards of a nursing home in the Netherlands from January to September 2021. Staff received training in using the QPL, with information and sample questions to inspire relatives to ask their questions, in particular on meaning and loss. Thematic analysis was applied to transcribed interviews and memos of observations. Nursing staff in particular was concerned about having to be available to answer questions continuously. Relatives used the study as an opportunity to get in touch with professionals, and they saw the QPL as an acknowledgement of their needs. There was a mismatch in that staff wished to discuss care goals and complete a care plan, but the relatives wanted to (first) address practical matters. A QPL can be helpful to conversations about meaning and loss, but nursing staff need dedicated time and substantial training. Joint agenda setting before the conversation may help resolve a mismatch in the preferred topics and timing of conversations. Show less
Gijsberts, M.J.H.E.; Steen, J.T. van der; Hertogh, C.M.P.M.; Deliens, L. 2020
ObjectiveTo examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors... Show moreObjectiveTo examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors associated with spiritual care provision.MethodsA cross-sectional survey was sent to a representative sample of 642 elderly care physicians requesting information about their last patient who died and the spiritual care they provided. We compared their general perception of spiritual care with spiritual and other items abstracted from the literature and variables associated with the physicians' provision of spiritual care. Self-reported reasons for providing spiritual care were analysed with qualitative content analysis.ResultsThe response rate was 47.2%. Almost half (48.4%) provided spiritual end-of-life care to the last resident they cared for. Half (51.8%) identified all 15 spiritual items, but 95.4% also included psychosocial items in their perception of spirituality and 49.1% included other items. Physicians who included more non-spiritual items reported more often that they provided spiritual care, as did more religious physicians and those with additional training in palliative care. Reasons for providing spiritual care included a request by the resident or the relatives, resident's religiousness, fear of dying and involvement of a healthcare chaplain.ConclusionMost physicians perceived spirituality as a broad concept and this increased self-reported spiritual caregiving. Religious physicians and those trained in palliative care may experience fewer barriers to providing spiritual care. Additional training in reflecting upon the physician's own perception of spirituality and training in multidisciplinary spiritual caregiving may contribute to the quality of end-of-life care for nursing home residents. Show less
The main aim of the present study is to investigate when “loss of self” results in scaredness or anxiety during or after an out-of body-experience (OBE). An OBE is an intense form of (bodily) self... Show moreThe main aim of the present study is to investigate when “loss of self” results in scaredness or anxiety during or after an out-of body-experience (OBE). An OBE is an intense form of (bodily) self loss in which people have the impression that their self is located outside their body. In a sample of respondents reporting to have had an OBE (n = 171), anxiety and different conceptualizations of “self loss” were assessed. In addition, questions were asked about meaning making processes after the OBE. Results show that there was no relationship between anxiety and self loss with a relational component (i.e., mystical experiences, positive spiritual experiences). However, there was significantly more anxiety in respondents who (1) (have) experience(d) ego loss/deconstruction, (2) have difficulties to (re)turn their attention to an internal bodily state (low mindfulness) and/or (3) experience a lack of self-concept clarity. Respondents who did not succeed in making sense of their OBE experience more anxiety, more ego loss/deconstruction, lower mindfulness and higher self-unclarity. Finally, the article examines how respondents explain their OBE (by using, for instance, medical, spiritual or psychological explanations) and how and why respondents do (not) succeed in making sense of the OBE. Show less
