A Proposed study: Development of a core set of spiritual care competencies and associated key performance indicators for healthcare professions at end-of-life-care specific to intensive care

Abstract

Background: In the Intensive Care Unit (ICU) dignity is often sacrificed in pursuit of curative, aggressive (often fruitless) interventions. While these aggressive interventions are generally successful, there’s often a delay in the inevitable transition to End-of-Life-Care (EOLC), resulting in unnecessary, prolonged, inhumane, high cost, “medicalised torture”. When patients’ stay is long-term stress is experienced fraught with uncertainty and hopes alternating with despairs. While ICU for others is an experience of sudden onset of EOLC without the chance of saying goodbye. Edwards et al (2010) and Wall et al (2007) identified that spiritual distresses such as despair, guilt of letting go, anger, regrets, helplessness, questioning of worldviews/God and unresolved conflict with loved ones are often experienced in ICU. This can lead to intense stress, anxiety, depression, prolonged complicated grieving and posttraumatic stress disorder if left unsupported (Tyrie and Mosenthal, 2012). In a cross-sectional survey (n-144) of adult ICUs, 85% of the respondents identified that spirituality was important to them (Kweku et al. 2016). Spiritual Care (SC) is well-established as an important domain to End-Of-Life-Care (EOLC) in the palliative arena (Puckalshi and Ferrell, 2010), is currently being integrated into healthcare curriculums with 9 core competencies recently development (EPPIC, 2016), has increasing research interests in other healthcare areas with emerging evidence (using rigorous and varied methodologies) of positive outcomes such as SC’s effect on mental health, cardiovascular health, the immune system and significantly identification of the role SC can play in preventing illness and speeding recovery (Koenig, 2011). There are requirements for SC provision by the World Health Organisation (WHO) (2017), the National Institute for Health and Care Excellence (NICE) (2017), US Joint Commission (2016), UK‘s statutory regulator for the medical profession (General Medical Council, 2010) and Ireland’s Health Service Executive (2014). Yet there is a dearth of evidence related to SC at EOLC in ICU. While SC practices in ICU are either inconsistent or not addressed at all with protocols scarce. Questions remain as to the core competencies required for the specialist ICU environment and how ICU can assess and improve SC at EOLC.