A Novel Picture Guide to Improve Spiritual Care and Reduce Anxiety in Mechanically Ventilated Adults in the Intensive Care Unit

Abstract

Rationale: Hospital chaplains provide spiritual care that helps patients facing serious illness cope with their symptoms and prognosis, yet because mechanically ventilated patients cannot speak, spiritual care of these patients has been limited.

Objectives: To determine the feasibility and measure the effects of chaplain-led picture-guided spiritual care for mechanically ventilated adults in the intensive care unit (ICU).

Methods: We conducted a quasi-experimental study at a tertiary care hospital between March 2014 and July 2015. Fifty mechanically ventilated adults in medical or surgical ICUs without delirium or dementia received spiritual care by a hospital chaplain using an illustrated communication card to assess their spiritual affiliations, emotions, and needs and were followed until hospital discharge. Feasibility was assessed as the proportion of participants able to identify spiritual affiliations, emotions, and needs using the card. Among the first 25 participants, we performed semistructured interviews with 8 ICU survivors to identify how spiritual care helped them. For the subsequent 25 participants, we measured anxiety (on 100-mm visual analog scales [VAS]) immediately before and after the first chaplain visit, and we performed semistructured interviews with 18 ICU survivors with added measurements of pain and stress (on ±100-mm VAS).

Measurements and main results: The mean (SD) age was 59 (±16) years, median mechanical ventilation days was 19.5 (interquartile range, 7-29 d), and 15 (30%) died in-hospital. Using the card, 50 (100%) identified a spiritual affiliation, 47 (94%) identified one or more emotions, 45 (90%) rated their spiritual pain, and 36 (72%) selected a chaplain intervention. Anxiety after the first visit decreased 31% (mean score change, -20; 95% confidence interval, -33 to -7). Among 28 ICU survivors, 26 (93%) remembered the intervention and underwent semistructured interviews, of whom 81% felt more capable of dealing with their hospitalization and 0% felt worse. The 18 ICU survivors who underwent additional VAS testing during semistructured follow-up interviews reported a 49-point reduction in stress (95% confidence interval, -72 to -24) and no significant change in physical pain that they attributed to picture-guided spiritual care.

Conclusions: Chaplain-led picture-guided spiritual care is feasible among mechanically ventilated adults and shows potential for reducing anxiety during and stress after an ICU admission.

Keywords: anxiety; critical care; mechanical ventilators; palliative care; spiritual therapies.

Figure 1.

Spiritual care communication card (English version). (A) Front side. Part 1: Spiritual/religious affiliation assessment. (B) Back side. Part 2: Feelings assessment; part 3: Spiritual pain assessment; part 4: Chaplain interventions assessment. The communication card is 11 × 17 inches and laminated. See Figure E1 in the online supplement for Spanish version.

Figure 2.

Study participants. PMV = prolonged mechanical ventilation; RASS = Richmond Agitation-Sedation Scale; VAS = visual analog scale.

Figure 3.

Anxiety was measured with 100-mm visual analog scale (VAS) immediately before and after the first time the participant received chaplain-led picture-guided spiritual care among the second half of participants (n = 25). Anxiety decreased from a mean (SD) VAS score of 64 (29) to 44 (28) (mean absolute reduction of 20 points; 95% confidence interval, −33 to −7; P = 0.002; mean relative reduction of 31%; 95% confidence interval, −48% to −15%; P = 0.001).