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      Spirituelle Kompetenz in Psychiatrie und Psychotherapie – Hindernisse und Erfolgsfaktoren Translated title: Spiritual competence in psychiatry and psychotherapy—Barriers and success factors

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          Abstract

          Hintergrund

          Ebenso wie die World Psychiatric Association (WPA) und andere nationale psychiatrische Fachgesellschaften hat auch die Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) ein Positionspapier zu Religiosität und Spiritualität (R/Sp) in Psychiatrie und Psychotherapie veröffentlicht, in dem sie Patientenzentrierung und spirituelle Kompetenz (SpK) der psychiatrischen Berufe fordert. Es ist bekannt, dass Kompetenzmangel das wichtigste Hindernis für die Implementierung von Spiritual Care (SpC) in die klinische Praxis darstellt.

          Fragestellung

          Ziel der vorliegenden Studie ist die praxisnahe Untersuchung der SpK in Psychiatrie und Psychotherapie. Wie schätzen psychiatrisch Tätige die SpK ihrer eigenen Berufsgruppe ein und welche Variablen beeinflussen dieses Urteil?

          Material und Methoden

          Insgesamt 391 psychiatrische Pflegekräfte, 75 Psychiater, 119 Therapeuten verschiedener Professionen und 62 andere ( = 647) aus Krankenhäusern in Deutschland und Österreich füllten den SpC Competency Questionnaire (SCCQ) aus.

          Ergebnisse

          Pflegekräfte, ältere und spirituell erfahrenere Personen schätzen die SpK der eigenen Berufsgruppe vergleichsweise höher ein und meinen seltener, diesbezüglich nicht zuständig zu sein. Pflegende nennen häufiger als andere Berufsgruppen das Fehlen geeigneter Räumlichkeiten als Hindernis für die Implementierung von SpC. Höhere Einschätzung der SpK der eigenen Berufsgruppe geht mit höheren Werten in den SCCQ-Faktoren „Selbsterfahrung und proaktive Öffnung“, „Team-Spirit“, „Wahrnehmungs‑/Dokumentationskompetenz“ einher.

          Diskussion

          Die Zuständigkeit der Gesundheitsberufe für SpC in Psychiatrie und Psychotherapie wird unter den deutschsprachigen psychiatrischen Berufsgruppen noch kontrovers diskutiert. Dies hängt mit mangelnder Kompetenz in diesem Feld zusammen.

          Translated abstract

          Background

          Just as the World Psychiatric Association (WPA) and other national psychiatric societies, the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has published a position statement about religiosity and spirituality in psychiatry and psychotherapy, in which it demands patient orientation and spiritual competency in psychiatric professions. Previous research has shown that lack of competency is the major barrier against implementing spiritual care into clinical practice.

          Objective

          The aim of this study was to examine spiritual care in psychiatry and psychotherapy. An evaluation of how health professionals in psychiatry gauge the spiritual care competency of their professional group and which variables influence this judgement.

          Material and methods

          A total of 391 psychiatric nursing personnel, 75 psychiatrists, 119 therapists from diverse professions and 62 others, i.e. 647 working in German and Austrian hospitals completed the German version of the spiritual care competency questionnaire (SCCQ).

          Results

          Nursing personnel, older and spiritually more experienced persons gauged the spiritual competency of their own professional group comparatively higher and judged less frequently that they have no responsibility in this field. Nursing personnel reported the lack of suitable rooms as a barrier against implementation of spiritual care more often than other professional groups. Judging the spiritual competency of one’s own professional group higher is associated with higher values in the SCCQ factors self-experience and proactive opening up, team spirit, perception and documentation competency.

          Conclusion

          The responsibility of healthcare professions for spiritual care in psychiatry and psychotherapy is still a controversial issue among German-speaking psychiatric professional groups. This is partially due to a lack of competency in this domain.

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          Most cited references30

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          The association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter.

          Controversy exists regarding whether and how physicians should address religion/spirituality (R/S) with patients. This study examines the relationship between physicians' religious characteristics and their attitudes and self-reported behaviors regarding R/S in the clinical encounter. A cross-sectional mailed survey of a stratified random sample of 2000 practicing U.S. physicians from all specialties. Main criterion variables were self-reported practices of R/S inquiry, dialogue regarding R/S issues, and prayer with patients. Main predictor variables were intrinsic religiosity, spirituality, and religious affiliation. Response rate was 63%. Almost all physicians (91%) say it is appropriate to discuss R/S issues if the patient brings them up, and 73% say that when R/S issues comes up they often or always encourage patients' own R/S beliefs and practices. Doctors are more divided about when it is appropriate for physicians to inquire regarding R/S (45% believe it is usually or always inappropriate), talk about their own religious beliefs or experiences (14% say never, 43% say only when the patient asks), and pray with patients (17% say never, 53% say only when the patient asks). Physicians who identify themselves as more religious and more spiritual, particularly those who are Protestants, are significantly more likely to endorse and report each of the different ways of addressing R/S in the clinical encounter. Differences in physicians' religious and spiritual characteristics are associated with differing attitudes and behaviors regarding R/S in the clinical encounter. Discussions of the appropriateness of addressing R/S matters in the clinical encounter will need to grapple with these deeply rooted differences among physicians.
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            Religion, spirituality, and medicine: psychiatrists' and other physicians' differing observations, interpretations, and clinical approaches.

            This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting.
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              Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training.

              To determine factors contributing to the infrequent provision of spiritual care (SC) by nurses and physicians caring for patients at the end of life (EOL). This is a survey-based, multisite study conducted from March 2006 through January 2009. All eligible patients with advanced cancer receiving palliative radiation therapy and oncology physician and nurses at four Boston academic centers were approached for study participation; 75 patients (response rate = 73%) and 339 nurses and physicians (response rate = 63%) participated. The survey assessed practical and operational dimensions of SC, including eight SC examples. Outcomes assessed five factors hypothesized to contribute to SC infrequency. Most patients with advanced cancer had never received any form of spiritual care from their oncology nurses or physicians (87% and 94%, respectively; P for difference = .043). Majorities of patients indicated that SC is an important component of cancer care from nurses and physicians (86% and 87%, respectively; P = .1). Most nurses and physicians thought that SC should at least occasionally be provided (87% and 80%, respectively; P = .16). Majorities of patients, nurses, and physicians endorsed the appropriateness of eight examples of SC (averages, 78%, 93%, and 87%, respectively; P = .01). In adjusted analyses, the strongest predictor of SC provision by nurses and physicians was reception of SC training (odds ratio [OR] = 11.20, 95% CI, 1.24 to 101; and OR = 7.22, 95% CI, 1.91 to 27.30, respectively). Most nurses and physicians had not received SC training (88% and 86%, respectively; P = .83). Patients, nurses, and physicians view SC as an important, appropriate, and beneficial component of EOL care. SC infrequency may be primarily due to lack of training, suggesting that SC training is critical to meeting national EOL care guidelines.
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                Author and article information

                Contributors
                eckhard.frick@tum.de
                Journal
                Nervenarzt
                Nervenarzt
                Der Nervenarzt
                Springer Medizin (Heidelberg )
                0028-2804
                1433-0407
                10 August 2020
                10 August 2020
                2021
                : 92
                : 5
                : 479-486
                Affiliations
                [1 ]GRID grid.6936.a, ISNI 0000000123222966, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, , Technische Universität München, ; Ismaninger Str. 22, 81675 München, Deutschland
                [2 ]kbo-Isar-Amper-Klinikum gGmbH, Akademisches Lehrkrankenhaus der LMU München, Vockestraße 72, 85540 Haar bei München, Deutschland
                [3 ]Landesklinikum Amstetten-Mauer, Hausmeninger Str. 221, 3362 Mauer, Österreich
                [4 ]Klinik Chiemseewinkel, Römerstraße 17, Seeon-Seebruck, 83358 Deutschland
                [5 ]GRID grid.412581.b, ISNI 0000 0000 9024 6397, Professur für Lebensqualität, Spiritualität und Coping, , Universität Witten/Herdecke, ; Alfred-Herrhausen-Str. 50, Witten, 58448 Deutschland
                Article
                975
                10.1007/s00115-020-00975-0
                8087556
                32776233
                05f4ce17-7dc5-4199-8c42-222133a97a1e
                © The Author(s) 2020

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                History
                Funding
                Funded by: Klinikum rechts der Isar der Technischen Universität München (8934)
                Categories
                Originalien
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                Neurology
                kompetenz,spiritual care,psychiatrie,psychotherapie,implementierung,competency,psychiatry,psychotherapy,implementation

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