Spirituality in Patient Care
Details and Description
Description
This book is intended as a guide for practicing physicians, medical students, and residents to help identify and address the spiritual needs of patients. Those who will benefit most will be physicians who wish to know how to integrate spirituality into clinical practice in an effective and sensitive manner. Other professionals, such as nurses and chaplains, may use this book as they interact with doctors, other health professionals, and hospital administrators.
Endorsements and Reviews
Reviews
Napra Review—Eastsound, WA
A handbook for physicians to address and assess spiritual issues in patient care.
Share Guide
Spirituality in Patient Care is intended as a guide for physicians, medical students, nurses, and health practitioners. As emerging research demonstrates the effect of one’s spiritual beliefs on a person’s health, it’s important to perform a spiritual profile on a patient in addition to physical and lifestyle assessments. This book is a valuable resource to anyone in the healthcare profession.
Journal of the American Medical Association
There is much I like in this book. Harold Koenig, MD, in a short and eminently readable style, outlines how important spirituality can be in treating the whole person. He gives clear definitions of religious coping, spiritual assessment, transference and counter-transference, and boundaries to care.
Dr. Koenig should be commended for writing a concise yet meaty book on spirituality patient care. I hope it is widely read and discussed. Even the book’s flaws can be useful in raising the issue of spirituality and encouraging physicians and other care providers to find ways to relate the patient’s spirituality to the holistic plan of care.
Annals of Pharmacotherapy, The—Cincinnati, OH
The concise, application-oriented organization and content of this book make it an ideal companion for daily rounds and frequent reference. It is a pocket guide, not so much a seminar text, and explicitly meant for practicing clinicians, especially physicians. Thanks to an extensive index to additional literature, it is a good starting point for further research and study. The price is affordable and appropriate.
Sacred Space
The book is packed full of useful facts and concludes with a useful section on resources, including popular and academic books, journals, and websites. All in all, a useful contribution to spirituality in medical care.
Theology Digest—St. Louis, MO
[P]manual for physicians, medical students, and residents, with applications for nurses, chaplain and students in a range of health professions.
Journal of Christian Nursing
Overall, this book probably does speak in terms that physicians will appreciate. It is short, to the point and written from a scientific perspective. While nurses will be disappointed that it does not provide enough depth, we should not expect physicians to be masters of what is uniquely nursing. Spiritual care in the health care setting is really the domain of nursing and the clergy.
Research News & Opportunities in Science and Theology
Spirituality in Patient Care is a brief volume by Research News Editor-in-Chief Harold Koenig. A guide for physicians, medical students, nurses, chaplains and administrators on how to perform spiritual profiles on patients as part of clinical practice, the book also serves as a valuable basic primer for anyone being introduced to the relatively recent evidence of the relevance of spirituality to health care.
Scientific and Medical Network, The—Gloucestershire, United Kingdom
Koenig is by any standards an in intellectual heavyweight and first author of the seminal textbook, Handbook of Religion and Health, published in 2001 by Oxford University Press (Koenig H, McCullough M. and Larson, D). Yet here he has favored us with a book small enough to fit into a large pocket, and one that is redolent with good, practical and commonsensical advice.
Koenig distils a vast amount of epidemiological and clinically based research correlating health and spirituality into this little book. He is so succinct and to the point that his outline summary cannot be bettered:
BVSReviews
Spirituality in Patient Care should be on every health care worker’s list for things to listen to. Even if you aren’t in the health care field, there is a lot of information and thoughts to ponder on spiritual care and nurturing.
Journal of Christian Nursing
Overall, this book probably does speak in terms that physicians will appreciate. It is short, to the point and written from a scientific perspective. While nurses will be disappointed that it does not provide enough depth, we should not expect physicians to be master of what is uniquely nursing. Spiritual care in the health care setting is really the domain of nursing and the clergy.
Journal to the National Medical Association
It is refreshing to read an excellent resource authored by a well-informed, well-read, committed, academician with ties to clinical medicine. Dr. Koenig’s book is small enough to read in two sessions, and packed with enough information to whet the appetite of any clinician irrespective of spiritual persuasion.
I was excited to review this book because I have been involved with this subject for the past 15 years, both as a Pastor, and in my private practice of Medicine. I was curious to see how he would capsulate what I had been practicing into a book of 110 pages. To say the least, I was not disappointed.
Dr. Koenig’s introduction is succinct wasting no time preparing the reader for the book’s contents. I have only one warning; if you read the introduction you will purchase the book. The Introduction is so well written that the reader is not left straddling the fence.
The Book is divided into seven chapters, namely:
1. Why include spirituality?
2. How to include spirituality
3. When to include spirituality
4. What might result?
5. Boundaries and barriers
6. When religion is harmful
7. Resources on spirituality and health
From the outset it is important to understand that this author comes from a background rich in this subject. He has authored many clinical studies and authored several textbooks, two this year alone.
The first chapter necessarily asks "why include spirituality?" Dr. Koenig’s answer is patient centered. He presents data supporting the positive health care outcomes of people as a result of their spirituality while supplying the necessary caution in one’s approach. I agree with his statement; "religious beliefs and practices, then, are used to regulate emotion during times of illness, change, and circumstances that are out of patients’ personal control." Dr. Koenig also gave a historical perspective in this chapter. He traced the development of health care institutions and professions relating to spirituality in medicine. As early as AD 370 a large hospital was set up in Turkey as a response to Matthew 25:36-40; the profession of nursing came from the Catholic church, first by the Daughters of Charity of St. Vincent de Paul, in 1617. A Lutheran Pastor set up a nursing school in France in 1830 and Florence Nightingale, after receiving a calling from God, sought and received training from the Daughters of Charity and the Protestant deaconesses for nursing training. She is credited with establishing the modern principles of nursing. Dr. Koenig continues by showing the progress made in Psychiatry as a result of recognizing the importance of spirituality in patient care. He concludes this chapter with both a summary statement and an introduction to his next chapter. "Addressing spiritual needs of patients is not new, either in the practice of medicine or in psychiatry. How one goes about doing that in this day and age is the subject of the next chapter."
Chapter two addresses the issue of information gathering. Dr. Koenig introduces several tools to assist the Physician. With each segment he discusses the importance of recognizing two issues, namely: the patient’s sensitivity to the issue, and the physician’s comfort zone. The tools serve as a method to carefully weave between the two, enabling the Physician to obtain the history necessary to improve the care of the patient. The Koenig, as well as all Physicians, recognize that patient’s private lives are being invaded and perhaps limits are in order; however, certain patient’s health outcomes are improved when the physician has knowledge of their spirituality. Dr. Koenig makes it clear that spiritual inventories must be individualized to patient condition and the depth of that inventory may vary from patient to patient.
Recognizing the truth of the last statement the next chapter offers several caveats that address the statement, when to include spirituality. This chapter offers some useful tools that will assist the physician in initiating a spiritual history. For the physician who wants to be sensitive to the patient’s needs, without appearing "too religious," this chapter offers help. Dr. Koenig lists the various points in the patient encounter where a history can be obtained without appearing to be intrusive. Within the social history of a new patient encounter, upon hospital admission, during a health maintenance visit, within a hospice setting, are but a few places where this can be done. For the Physician concerned with praying with patients and for the one that routinely prays with patients this chapter discusses both the advantages and pitfalls of prayer. Physicians are result conscious and it is this motivation that drives decisions in therapeutic intervention.
This next chapter discusses the results of spiritual intervention. The results of studies that deal with patient coping, compliance, and doctor-patient relationship are presented. I was impressed with these statements:
"By asking about the patient’s religious beliefs in a respectful manner, the doctor indicates a desire to understand an important part of who that person is. If the physician then supports and encourages those beliefs, the patient’s trust in the doctor may be amplified. If the physician goes so far as to actually pray with the patient, then this will confirm even more that the physician can be trusted."
Though this statement is a realistic outcome of such activity Dr. Koenig states that caution must be made to avoid patient transference from a Physician-Patient relation to a Physician-Priest, Patient relationship. There is only one situation where a Physician-Priest, Patient relationship may be construed as acceptable. I Pastor a Baptist Church within the city where I practice and several of my members have chosen me as their primary physician. These patients call me Pastor whether it is in the church or within the office setting. In my office setting I represent their Physician-Pastor and in the church, Pastor. This unique circumstance is the only one that I can site where transference has not occurred; the relationship is already multifaceted.
Dr. Koenig discusses the negative consequences of spiritual intervention, summarizing them in six bulleted points and presenting four legal case examples.
At this point I wrote another note in the margin. "I have discovered that the physician must get to know the patient first. A Physician -Patient rapport must be firmly established before initiating more probing interventions. As physicians we invade people’s private lives enough. It is easy to treat the biological aspects but tricky to get at the rest. Some patient’s complain that we do not treat the whole patient; some like distance. The art is to distinguish between the two!"
To distinguish between the two is to recognize those boundaries and barriers to the process. This represents the purpose of chapter five. Dr. Koenig presents the text of Hippocrates’ original oath, its amended version published in the New England Journal of Medicine, the oath of Moses Maimonides, and of Pelligrino. Each of these oaths represent the same principle; "do no harm" to the patient. This chapter not only offers extensive explanations into those boundaries and barriers that should be respected and broached with caution, but also discusses methods by which the physician can overcome those barriers that impede initiating a discussion into the spiritual aspects of patient care. This chapter peaked my curiosity. I really wonder whether medical students are being taught this aspect of patient care and if so actually using it. A survey given to medical students each year of their schooling, through graduation, and if possible residency, would prove to be a very interesting barometer of physician comfort in this area. As physicians we are taught to know our limits and not intervene where limited. Dr. Koenig’s recognition of this fact is the background for the information presented in the next chapter.
Both sides of the argument are presented well. There are legitimate concerns that intervention may introduce harm and there are concerns that the lack of intervention may affect patient health outcome. As an academician Dr. Koenig recognizes the need for further, evidence-based research in this area.
After reading this chapter I left with the realization that no randomized, placebo-controlled study exists that evaluates the health status outcome of a large group of patients in a community based setting where the intervention was spiritual and the placebo was usual care. The chapter gives anecdotal information and the sources of negative outcomes came from the media. I recognize that many studies have been done in a variety of physical and psychiatric states; however it was not the purpose of this chapter to introduce. It is my point of view that this chapter served as an excellent spot to introduce the information. The lack of it’s introduction indicates to this reader that research in this area would answer the question, When is religion harmful?
If the reader has read the first six chapters he is hooked. Chapter seven will be a welcomed delight. This chapter is pregnant with the synopsis of several spiritual history taking tools. He summarizes the top research studies that address spiritual intervention in mental, physical and social health. Next Dr. Koenig gives an annotated bibliography of the major academic and nonacademic books on the subject and concludes with websites where further information can be obtained. The last section of the book lists the reference citations for each chapter heading.
Summary
This book represents an excellent summary and springboard for any person interested in the subject. In a matter of just a very few hours a wealth of information can be gleaned from the book and the resources listed and summarized will only peak the interest of the more interested. I highly recommend this book as reading for all physicians and would certainly recommend it as part of any course on medical ethics and/or required reading for any medical student.
Translations
Portuguese (SA)