Research conducted as part of a Masters’ qualification ‘Assessing the frequency of care plan...

Research conducted as part of a Masters’ qualification

‘Assessing the frequency of care plan attention to the expressed spiritual or religious needs of service users in a

Health and Social Care Trust: a descriptive study’

Julia Walsh

November 2011

Introduction

Part One - Questionnaire• A - Demographics• B - Spirituality and Spiritual Care Rating Scale• C - Care plans and Mental Health• D - Responsibility for Spiritual CarePart Two - Electronic Records• Demographics• Initial Assessments• Recent Care Plan• Advance StatementResults

Participants

All participants were service users in receipt of an adult mental health service from a health and social care trust, recruited via Care Coordinators and flyers.

Gender

Male 31

Female 40

Total 71

Educational Attainment

Primary School 18

Sec. School GCSE 17

Sec. School 'A' level 6

Coll./Uni. Degree 21

Post Graduate 5

Missing data 4

Total 71

Ethnicity

White British 42

BME 29

Total 71

Religious or Spiritual Group

• Christian 19• Muslim 25• Any Other Religion 3• Spiritual Group 1• Other 1• Not religious 22

Total 71

Comparing demographic information from Questionnaire and from Electronic record

Electronic recordNot Known 25Christian 21Muslim 19Other 4No Religion 2Spiritual Group 0Any other religion 0Total 71

Questionnaire019251221371

Religious/spiritual practice?

From questionnaireYes 43No 28Total 71

From electronic recordsYes 7No 64Total 71

Care Plans with or without reference to

spiritual/religious matters SCPA - no care plan 10SCPA - no mention of spiritual/religious issues17

SCPA - text re spiritual/religious issues 8CPA - no care plan 2CPA - cultural/religious needs prompt – Yes 14CPA - cultural/religious needs prompt – No 9CPA - prompt plus text 9CPA - no mention 2Total 71

Initial Assessments – references to spiritual/religious matters

None Found 52

Initial Assessment - no mention of spiritual/religious

issues 11

Initial Assessment

- text re spiritual/religious issue

8

Total 71

Advance Statement or Directive

None found 62

No mention of

spiritual/religious issues 7

Text re spiritual /religious

Issues 2

Total 71

Spirituality and Spiritual Care Rating Scale – 17 statements

I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital Chaplain or my own religious leader if requested

I believe Care Coordinators can provide spiritual care by showing kindness, concern and cheerfulness when giving care

I believe spirituality is concerned with a need to forgive and a need to be forgiven

I believe spirituality involves only going to Place of Worship (e.g. Church/Mosque)

I believe spirituality is not concerned with a belief and faith in a God or Supreme being

• Agree 53• Uncertain 16• Disagree 2


• Agree 62• Uncertain 7 • Disagree 2


• Agree 20 • Uncertain 22 • Disagree 29

I believe spirituality is about finding meaning in the good and bad events of life

I believe Care Coordinators can provide spiritual care by spending time with a service user giving support and reassurance especially in time of need

I believe Care Coordinators can provide spiritual care by enabling a service user to find meaning and purpose in their illness

I believe spirituality is about having a sense of hope in life

I believe spirituality is to do with the way one conducts one’s life here and now

• Agree 52 • Uncertain 14• Disagree 5 • Agree 56 • Uncertain 10 • Disagree 3




I believe Care Coordinators can provide spiritual care by listening to and allowing service users time to discuss and explore their fears, anxieties and troubles

I believe spirituality is a unifying force which enables one to be at peace with oneself and the world

I believe spirituality includes areas such as art, creativity and self expression

I believe Care Coordinators can provide spiritual care by having respect for privacy, dignity and religious and cultural beliefs of a service user

I believe spirituality involves personal friendships, relationships





• Agree 56 • Uncertain 12• Disagree 2

I believe spirituality does not apply to Atheists or Agnostics

I believe spirituality includes people’s morals

• Agree 18 • Uncertain 23• Disagree 29

• Agree 53• Uncertain 14

• Disagree 3

Care Plans and Spiritual Care – 8 statements

I believe my spirituality should be taken into account in any explanation of my mental well-being

I feel able to talk to my Care Coordinator about my spiritual beliefs and values

My Care Coordinator has talked to me about my spiritual beliefs

My Care Plan contains information about my spiritual needs and strengths





I have an Advance Directive with information about my spiritual care wishes should I become too unwell to give directions myself

I would like to understand my present ill-health in terms of spiritual beliefs

My spiritual beliefs are based on religious faith

I have consulted with a spiritual/religious leader about my present ill-health





Religious/Not Religious

Religious 49

Not religious 22

Total 71

Religious(49): Non-Religious(22) - 8 significantly different responses1. Statement 1 (Ba)‘I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital

Chaplain or my own religious leader if requested’• Religious respondents are more likely to agree or strongly agree with this statement,

non-religious are more likely to be uncertain.2. Statement 3 (Bc)‘I believe spirituality is concerned with a need to forgive and a need to be forgiven’• Religious respondents are more likely to agree or strongly agree with this statement,

non-religious less likely to strongly agree and more likely to be uncertain or disagree. 3. Statement 5 (Be)‘I believe spirituality is not concerned with a belief and faith in a God or Supreme being’• Religious respondents are much more likely to disagree or strongly disagree with this

statement, non-religious most likely to be uncertain.4. Statement 10 (Bj)‘I believe spirituality is to do with the way one conducts one’s life here and now’• Religious respondents are more likely to agree or strongly agree with this statement,

non-religious less likely to strongly agree and more likely to be uncertain or disagree.

5. Statement 18 (Ca)‘I believe my spirituality should be taken into account in any explanation of my

mental well-being’• Religious respondents are much more likely to agree or strongly agree

with this statement, non-religious more likely to be uncertain or disagree.6. Statement 21 (Cd)‘My Care Plan contains information about my spiritual needs and strengths’Religious respondents were more likely to agree, strongly agree or be

uncertain about this statement, non-religious more likely to disagree.7. Statement 24 (Cg)‘My spiritual beliefs are based on religious faith’• Religious respondents are much more likely to agree or strongly agree

with this statement, non-religious to disagree or strongly disagree.8. Statement 25 (Ch)‘I have consulted with a spiritual/religious leader about my present ill-health’• Religious respondents were more likely to agree and strongly agree with

this statement, non-religious to disagree or strongly disagree.

Muslim/Christian

Christian 19

Muslim 25

Total 44

Data removed 27

Total 71

Muslim(25): Christian(19) - 5 significantly different responses1. Statement 1 (Ba)‘I believe Care Coordinators can provide spiritual care by arranging a visit by the hospital Chaplain or

my own religious leader if requested’ • The Muslim group were more uncertain about Care Coordinators ability to arrange a religious

visit. 2. Statement 4 (Bd)‘I believe spirituality involves only going to a Place of Worship (e.g. Church/Mosque)’• Christian respondents were more likely to strongly disagree; Muslim respondents more likely to

disagree or be uncertain.3.Statement 13 (Bm)‘I believe spirituality includes areas such as art, creativity and self expression’ • Muslim respondents were much more uncertain about this broader ‘existential’ definition of

spirituality, Christians were more likely to agree and strongly agree.4. Statement 15 (Bo)‘I believe spirituality involves personal friendships, relationships’• Muslim respondents were more uncertain about whether spirituality involved relationships. All the

Christian respondents agreed or agreed strongly with the statement. 5. Part D (D9) – Who do you believe should be responsible for providing Spiritual Care?‘Should a combination of all be responsible for providing Spiritual Care?’• Christian respondents were more likely to say ‘Yes’ to this question (1=’Yes’, 2=’No’).

White British(42): BME(29) - 6 significantly different responses1. Statement 3 (Bc)‘I believe spirituality is concerned with a need to forgive and a need to

be forgiven’• White British respondents are more likely to agree with the

statement, BME respondents are more likely to strongly agree.2. Statement 4 (Bd)‘I believe spirituality involves only going to a Place of Worship (e.g.

Church/Mosque’• White British respondents are more likely to disagree and strongly

disagree with this statement, BME respondents are more likely to be uncertain or disagree.

3. Statement 13 (Bm)‘I believe spirituality includes areas such as art, creativity and self

expression’• White British respondents are more likely to agree or agree strongly

with this statement, BME respondents more likely to be uncertain.

4. Statement 16 (Bp)‘I believe spirituality does not apply to Atheists or Agnostics’• White British respondents are more likely to disagree with this

statement; BME respondents are more likely to be uncertain.5. Statement 24 (Cg)‘My spiritual beliefs are based on religious faith’• White British respondents are more likely to be uncertain or

disagree with this statement; BME respondents are more likely to agree or strongly agree.

6. Statement 29 (D4) Who do you believe should be responsible for providing Spiritual Care?

‘Should Service Users be responsible for providing Spiritual Care?’

• White British respondents are more likely to agree that Service Users should be responsible for providing spiritual care; BME respondents more likely to disagree.

Male (31): Female(40) - 2 significantly different responses1. Statement 23 (Cf)‘I would like to understand my present ill-health in terms of

spiritual beliefs’• Women are more likely to agree and strongly agree with

this statement; men are more likely to disagree.2. Statement 31 (D6) Who do you believe should be

responsible for providing Spiritual Care?‘Should Service User’s Family and Friends be responsible

for providing Spiritual Care?’• Women are more likely to agree with this statement; men

more likely to disagree.

Summary of findings

• Participants think about and define ‘spirituality’ in different ways

• Participants were most likely to agree about the importance of ‘spiritual care’

• The area of most disagreement was whether ‘spirituality’ was a religious concept

• Care Coordinators do not routinely include any exploration of ‘spirituality’ in assessments or care plans

• Care Coordinators have not checked information held in ‘demographics’ for accuracy

Some recommendations

• Organisational agreement of what ‘spirituality’ and ‘spiritual care’ means

• Guidance for staff to be available at induction and included in the training for Care Coordinators

• Audit of demographic information on religion• More discussion about what spirituality means

for the non-religious• Clarity about how their spiritual needs/strengths

are assessed and documented in care plans

‘One size does not fit all’

• This research provides further evidence of the lack of attention paid to service users’ spiritual and religious needs

• Training needs are highlighted in this research

• Training, as in ‘cultural capability’ model, must include examining the attitudes, beliefs and values of staff

Research conducted as part of a Masters’ qualification ‘Assessing the frequency of care plan...

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