Spiritual Pain Screening in Critically Ill Patients
Allison Kestenbaum, MA, MPA, BCC-PCHAC, ACPE, Amy Bellingausen, MD, and Rev. Stephen Lewis, MA, MDiv, BCC, UC San Diego Health, La Jolla, CA
Patients recovering from critical illness are at risk not only for physical pain, but also for spiritual or non-physical distress as they are coming to terms with the life-threatening experience they have just been through and the challenges of gaining back their prior level of function. The frequency with which patients experience this spiritual pain as they leave the ICU (and return to the ICU recovery clinic [IRC]) is not known, nor has a non-chaplain screening program been described (to the authors’ knowledge).
METHODS
As part of a demonstration/process improvement project, the team implemented a routine evidence-based spiritual screening workflow for English and Spanish speaking patients at the time of ICU downgrade and again at their first IRC appointment. The following screening question was used: “Are you experiencing spiritual pain? Spiritual pain is pain deep in your soul/being that is not physical.” Patients were asked to rate spiritual pain 0 – 10 (0 being lowest, 10 highest). A rating of four or above triggered a chaplain referral, subsequently changed to two or above. Spiritual pain was then assessed again for patients seen in the IRC, with follow up as needed by a spiritual care intern. A Spanish Language Advisory Group provided input to the project team throughout the project period to enhance cultural sensitivity and to make observations related to data findings.
RESULTS
Patients were assessed for spiritual distress by nursing staff at the time of ICU discharge, with pain scores ranging from 0-10. Those with scores greater than 2 were referred for chaplain care. Patients were screened at the time of initial IRC visit by physicians and also reported spiritual pain scales ranging from 0-10, with in-clinic visits from a chaplain intern as available. Differences in screening rates and spiritual pain scores between English and Spanish speaking patients were observed.
CONCLUSIONS
Spiritual pain is not uncommon in critically ill patients at the time of discharge from the intensive care unit and may persist until well after discharge. Nurse-led screening is feasible, though it may require ongoing support to maintain high levels of data capture. The appropriateness of the spiritual pain screening in critical care environments is in question. The observed differences based on patients’ language raises important concerns related to health equity. The involvement of the Spanish Language Advisory Group was an important resource for study design, implementation, and observation of data, and revealed potential pathways forward to address disparities in screening and spiritual support.
METHODS
As part of a demonstration/process improvement project, the team implemented a routine evidence-based spiritual screening workflow for English and Spanish speaking patients at the time of ICU downgrade and again at their first IRC appointment. The following screening question was used: “Are you experiencing spiritual pain? Spiritual pain is pain deep in your soul/being that is not physical.” Patients were asked to rate spiritual pain 0 – 10 (0 being lowest, 10 highest). A rating of four or above triggered a chaplain referral, subsequently changed to two or above. Spiritual pain was then assessed again for patients seen in the IRC, with follow up as needed by a spiritual care intern. A Spanish Language Advisory Group provided input to the project team throughout the project period to enhance cultural sensitivity and to make observations related to data findings.
RESULTS
Patients were assessed for spiritual distress by nursing staff at the time of ICU discharge, with pain scores ranging from 0-10. Those with scores greater than 2 were referred for chaplain care. Patients were screened at the time of initial IRC visit by physicians and also reported spiritual pain scales ranging from 0-10, with in-clinic visits from a chaplain intern as available. Differences in screening rates and spiritual pain scores between English and Spanish speaking patients were observed.
CONCLUSIONS
Spiritual pain is not uncommon in critically ill patients at the time of discharge from the intensive care unit and may persist until well after discharge. Nurse-led screening is feasible, though it may require ongoing support to maintain high levels of data capture. The appropriateness of the spiritual pain screening in critical care environments is in question. The observed differences based on patients’ language raises important concerns related to health equity. The involvement of the Spanish Language Advisory Group was an important resource for study design, implementation, and observation of data, and revealed potential pathways forward to address disparities in screening and spiritual support.