The study population consisted of 17 health care providers and 10 patients. 6 patients were Muslim and 2 were Armenian, 1 was Jewish and 1 was Zoroastrian. The average work experience of health care providers was 15 years and the religion of all of them was Islam. Table 1 presents the demographic characteristics of the participants.
Table 1. The Demographic Characteristics of the Participants
Married
|
Age range
|
Gender
|
number
|
Participants
|
Male
|
Female
|
80%
|
23-68
|
50%
|
50%
|
10
|
Patient
|
100%
|
25-58
|
57%
|
43%
|
17
|
Health Team
|
A total of 10 interviews were conducted with the participants of the first group, and 18 interviews were performed with members of the healthcare team. five sub-themes including identification of spiritual needs, situation analysis to meet spiritual needs, expansion of spiritual care, spiritual promotion, and spiritual distress was extracted from 910 codes and were assigned into two themes of the process of spiritual care and the outcome of spiritual care.
Table 2 presents the categories, subcategories, and examples of participant quotations.
Category
|
Subcategories
|
Initial Categories
|
Examples of participant quotations
|
1. The process of satisfying the spiritual needs of the patient
|
1-1 Identify spiritual needs
|
· Assess spiritual needs
· Investigating the patient's attitude and behavior towards the disease
· Investigating the patient's spiritual problems
|
"The leukemia patient decided to separate two years ago after a fight with his wife. He has severe nosebleeds and is diagnosed with cancer a few days later. He felt that it had caused the disease, and no matter how much painkillers they took, the pain did not go away. We followed up and talked to his wife. We said that he might not be here for another month or two. Come and tell me I forgave and what happened, the patient's methadone dose dropped drastically and he said, I was fine at all. "Although he died two months later, he regained his composure, and as soon as the cause of his pain was discovered and the cause resolved, it was a spiritual work." [A spiritual counselor[
|
|
2-1 Situation analysis to meet spiritual needs |
o Analysis of community culture
o Evaluate patient self-care performance
o Investigating the underlying factors in meeting spiritual needs
· Investigate barriers to providing and receiving spiritual care
|
"Usually in Iranian patients, it is not the culture to open up spiritual issues. Aside from the issue of medicine and treatment, neither physicians nor patients and families were accustomed to side discussions. "It is the expertise and maturity and comprehensiveness of the physician and nurse that can give the patient the belief that the problem is not ineffective on physical symptoms." [An oncologist]
|
|
1-3 Expand spiritual care |
· Provide basic strategies for spiritual care
· Develop a structure for providing spiritual care
· Provide spiritual care content
|
"Patients expect us not to be indifferent in dealing with their spiritual issues, But we do not know to what extent we can encroach on the patient's beliefs. Is this correct at all? Does it matter to us at all? If someone wants to do this, colleagues will criticize him. Managers believe that you must take care of the problem that the patient has referred to. Solve other problems elsewhere. "Our task is to determine how this care should be done and who is responsible." [A cancer nurse]
|
2. Outcome of spiritual care
|
2-1 Spiritual promotion
|
· Increase resistance power
· Mood upgrade
· Create a sense of satisfaction
· Compatibility with the current situation
· Lower expectations
· Reducing mental illness
|
"I was a teacher and I live with the power of my mind. I emotionally separated myself from the problems of the disease. "I see cancer as part of strengthening myself, and this kind of thinking has made me able to endure and resist to be alive." [A patient with breast cancer]
|
|
Spiritual distress 2-2 |
· Spiritual turmoil
· Occurrence of internal conflicts
|
"... When a clergyman goes over the patient's head, he should not talk to the patient about death and the other world, etc., this will make the patient disappointed in everything. "Sometimes we see that with these actions, the patient loses the same spirituality he had and becomes angry with God" [a health psychologist]
|
Category 1: The process of meeting spiritual needs
To identify the spiritual needs of each patient, the needs must be met through a coherent process. Identifying spiritual needs, situation analysis to meet spiritual needs, and expanding spiritual care should be done step by step. Findings of this category showed that meeting spiritual needs requires cooperation between professional health care providers and receiving specialized training in this field.
According to health care providers, identifying spiritual needs leads to accurate and effective planning for providing spiritual care. For this purpose, it is necessary to examine the patient's spiritual needs, attitude, and behavior towards the disease and the patient's spiritual problems [Subcategory 1-1].
Examining and analyzing the existing conditions by recognizing and exploiting facilitating factors, awareness of negative interfering factors, and proper planning to eliminate those factors, can be effective in meeting the spiritual needs of patients. These factors can be the culture of the community, the practice of patient self-care, effective factors in meeting spiritual needs, and barriers to providing and receiving spiritual care[Subcategory 1-2].
The findings showed that despite the many obstacles, the provision of spiritual care can be facilitated by examining the above.
Because cancer patients need frequent hospitalizations, it is necessary to take a comprehensive look at their issues and problems to implement a series of operational strategies to establish, structure, and provide spiritual care, which, according to health care providers, unfortunately, the situation in this area. There is nothing desirable [Subcategory 1-3].
Category 2: Outcome of spiritual care
The purpose of providing spiritual care is to reduce the spiritual problems of patients by meeting their spiritual needs; Therefore, the evaluation of the provided spiritual care should be done for each patient and based on the measures taken based on the specific spiritual needs of each patient and based on the expected outcomes; But what became clear from the analysis of the content of the participants' speeches is that the result of spiritual care can be positive, in the direction of the patient's spiritual development, or in a negative way, and cause his mental illness. Findings of this category showed that evaluation of spiritual care helps health care providers in purposeful and effective planning.
The experiences of the participants showed that effective spiritual care leads to increasing the patient's ability to resist the problems caused by the disease, improving morale, creating a sense of satisfaction, adapting to the current situation, achieving peace of mind, and reducing expectations and mental illness. [Subcategory 2-1].
It is important to note that providing spiritual care based on the personal beliefs of health care providers leads to internal conflicts in the patient. Such inconsistencies in the provision of spiritual care cause spiritual turmoil in the patient [Subcategory 2-2].