significance of spirituality in management of patients in karachi, pakistan hena jawaid rija aziz...
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Significance of spirituality in management of patients in Karachi, Pakistan
HENA JAWAID RIJA AZIZMURAD MOOSA KHANAWAID
Points to emphasize !
Why spirituality?
Why now?
What is the significance in cultural and therapeutic aspects?
What are the global evidences?
Any local research ?
Objectives
To understand concept of spirituality
To know significance of spirituality in medicine
Can we devise bio-psycho-social and spiritual plan for patients’ management?
Health Of Mind And Body
Ancient Greek period focused body and mind using two approaches • Materialist - stating matter, or brain • Personalist - central in the person is the core called soul
Unity of soul and mind
Shaman was a religious figure as well as healer
Jesus was a healer of body and spirit
Separation !!
Religiosity - spiritual concerns
Physicians and scientists were dedicated to physical one
Christina M et al., 2001
A torn image of healing
Rene Descartes, 17th C.E, philosopher
believed in mechanical laws
little or no concern to meaning
Ideologies dealt with rupture of body and spirit
Droege TA et al., 1991
Vision of Machine
New dimensions like –
Neuro - anatomy
Neurophysiology
Micro-biology
Old belief of spiritual highness & intellectual well-being were overshadowed by molecular sciences
Freud et al., 1895
Materialist Approach Only
Our life stories, relationships, meanings & purpose of life
Simply treating a medical diagnosis
Approaching a patient with materialist approach only
Koenig H et al., 2000
Spiritus - the breath
Religion - external functions and apparent code of conduct
Spirituality - esoteric dimensions of personality
- life’s most vital issues and concerns
- spirituality is seen as subjective features of life
Simpson and Weiner, 1991
Emerging definition of health
Ahead of biological functioning, influenced by cultural, social, and philosophical factors, including purpose in life and the quality of
healthy personal relationships
Ryff and Singer 1998
America
Association between intrinsic spirituality and patient’s experience
Assessment of spirituality may be important for family physicians
McBride, J. L., et al. 1998
United kingdom
People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.
King, Michael, et al. 2013
Germany
Multi center cross sectional study 580 Patients The associations between spirituality/religiosity (S/R) ,
positive appraisals. and internal adaptive coping strategies indicate - utilization as an active coping process.
Büssing, A., et al. 2009
Iran
Positive religious coping was assessed to be more in use than negative one to cope up with life difficulties.
Aflakseir, A. et al, 2011
India
Reported improvement in objective clinical psychopathology following a visit or stay at Temple
Raguram, R. at al, 2002
Local FindingsKarachi
Qidwai, W. et al. "Belief in prayers and its role in healing among family practice patients visiting a teaching hospital in Karachi, Pakistan." Pak J Med Sci April-June 25.2 (2009): 182-189.
Qidwai, Waris, and Arsalan Tayyab. "Patients' views about physicians' spiritual role in medical practice." Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 14.8 (2004): 462-465.
Local FindingsLahore
Farooqi, Y. N. et al. "Perception of god among depressives and medical patients." American journal of pastoral counseling 2.4 (1999): 31-43.
Local FindingsKPK
Feder, Adriana, et al. "Coping and PTSD symptoms in Pakistani earthquake survivors: Purpose in life, religious coping and social support." Journal of affective disorders 147.1 (2013): 156-163.
Why Spirituality was Ignored?
(a) It is less central (Bergin, 1991; “Politics of the Professorate,” 1991; Shafranske, 1996)
(b) Outside the scope of scientific study (Thomson, 1996)
(c) Should necessarily move away during an age of rational enlightenment (Barbour, 1990; also see Hill et al., 2000).
Why Spirituality was Ignored?
Two basic assumptions have contributed to the neglect of research in this area:
(a) Spirituality cannot be studied scientifically
(b) neither it Should be studied scientifically
Developing Attention
In 1976, the American Psychological Association has established division 36 (Society for the Psychology of Religion and Spirituality) which is dedicated to the psychology of religion, aiming to promote the scientific study of religion and encourage its incorporation in applied settings.
In 1992, three medical schools offered courses on spirituality and health. In 2001, 75 of the 125 schools offered courses.
Developing Attention
The First International Congress on Religion and Mental Health held in Tehran, Islamic Republic of Iran, from 16-19 April 2001. With 242 papers and posters received and 158 selected for presentation
Between the years 2000 and 2002, more than 1,100 additional articles, studies, and reviews involving religion, spirituality, and mental health appeared in psychology literature, compared with 101 articles between 1980 and 1982, suggesting a remarkable increase in attention paid to this area by scientific community.
Journals
The journal of religion and health – 1961
The American journal of Islamic social sciences – 1973
The journal of psychology and Christianity - 1982
The journal of psychology and Judaism – 1990*
The Muslim psychologist – 1997
Study objectives
To determine the importance of spiritual need in treatment plan
to propose bio-psycho-social and spiritual model for evaluation of medical as well as psychiatric illnesses
What is different ?
Bilateral assessment
- Healthcare professionals
- Patients
Different specialties included
Structured assessment tools
Methodology
Written consent will be obtained
Patient will be interviewed from outpatient department of Neurology, Psychiatry, Oncology, Medicine, Family medicine and Rheumatology.
Follow-up patients
Data will be collected by 02 principal investigators
Inter-rater reliability will be established. Confidentiality will be maintained.
SCALES
Al-Yousefi, N. A. (2012). Observations of Muslim physicians regarding the influence of religion on health and their clinical approach. Journal of religion and health, 51(2), 269-280.
SCALES
Puchalski, C. M. (2001). Spirituality and health: the art of compassionate medicine. Hospital Physician, 37(3), 30-36.
SCALES
F—Faith and belief“Do you consider yourself spiritual or religious?” I—Importance“What importance does your faith or belief have in your life? C—Community“Are you a part of a spiritual or religious community? A—Address in care“How would you like me, your healthcare provider, to address these issues in your healthcare?”
Results
Patients view spirituality positively
Want their physicians to discuss spirituality
Strong belief in spirituality helped them cope
Spirituality plays an important part in patients’ illness and its prognosis
Discussion
The American Journal of Psychiatry editorial (Andreasen, 1996) wrote it like, ‘We must practice and preach the fact that psychiatrists are physicians to the soul as well as the body.’
Larson and Matthews (1997) are building hope that the “wall of separation” between medicine and religion will be broken, and emphasize that “future is going to be prayer and Prozac”.
Prayer And Prozac
World Health Organization (1998) quotes health as :
‘a state of complete physical, mental and social well-being, not merely the absence of disease’.
Larson and Matthews [61] are building hope that :
“wall of separation” between medicine and religion will be broken, and emphasize that “future is going to be prayer and Prozac”.