Perspectives and experiences of spirituality, spiritual needs, and spiritual care among intensive care patients, family members , and clinicians : a grounded theory investigation in the Johor state of Malaysia

Abstract

The intensive care environment is intimidating, too focused on the disease management and causing stress to the patients and the family members. As more patients survive critical illnesses, experts began to shift treatment focus towards survivorships. Based on previous literatures, critically ill patients of the intensive care unit (ICU) need psycho-emotional and spiritual care. These cares are also vital for their family members as they are also under distress with their loved ones being ill. However, clinicians were reported to be unprepared to provide spiritual care in the ICU because of poor knowledge, attitude and communication skills leading to inconsistent practice. This study sought to develop a model of spiritual care to guide ICU clinicians in providing spiritual care to their patients and family members in the intensive care unit (ICU) by utilizing grounded theory methodology. Interview guides were developed for the data collection. The researcher also conducted participatory observation and used field notes while conducting fieldwork in three ICUs in Johor, Malaysia. The study was commenced in October 2019 until June 2020, starting with the exploration of the experience and the spiritual needs of patients admitted in the ICUs and their family members. Another focus of this study was to explore the perceptions of the ICU clinicians on spirituality and the spiritual care that they provide for the patients and their families. A panel of six experts were invited to establish the usability and applicability of the model. A total of 47 patients, family members, ICU nurses and physicians were interviewed. The interviews and field notes were recorded, anonymized, transcribed. Data analysis was performed using grounded theory analysis in Atlas.ti software. The findings indicated there are nine dimensions of spiritual needs of ICU patients and family members consolidated upon four concepts. These concepts later become the foundational parts in the lnte1faith Spiritual Care Model for ICU Patients and Their Family Members. There are also multiple barriers to spiritual care as discussed by the ICU clinicians; nurses and physicians in this study. Further involvement of ICU stakeholders, education, training and research are needed to apply this spiritual care model in the management of critically ill patients and the family members.