Guy Jobin

The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons

BackgroundAlthough spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically acceptable instrument to assess spiritual distress in hospitalized elderly patients.MethodsA three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT): 1) Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model) to define the different dimensions characterizing a patients spirituality and their corresponding needs; 2) Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs related to each of the defined dimensions; 3) Qualitative assessment of the instruments acceptability and face validity in hospital chaplains.ResultsFour dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups.ConclusionsThe SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patients plan of care.

When Is Knowledge Ripe for Primary Care? An Exploratory Study on the Meaning of Evidence

The objectives of this study were to explore the meaning of scientific evidence as it is understood by primary care physicians. Individual interviews were conducted with actors chosen for their roles in the production and use of knowledge: 22 family physicians, 13 specialist physicians, and 6 researchers. Two situations served as points of reference for these discussions: screening for genetic breast cancer and treatment of hypertension. The results suggest that there may be a misunderstanding between the producers of knowledge and primary care practitioners with respect to what constitutes “evidence”— knowledge ready for integration into the clinical practice of primary care. These potential differences go beyond the issues of how information is disseminated. Rather, many of the questions raised by family physicians concern how knowledge is developed. In the interests of fostering better dissemination of new knowledge and encouraging its adoption, new links should be created between knowledge “producers” and potential users.

Gaudium et spes est-il un classique ?

La reception du concile Vatican II porte notamment sur la normativite de certains textes du Concile. Dans ces lignes, il s’agit pour nous d’etudier la reprise de la Constitution Gaudium et spes par l’episcopat canadien et quebecois. L’analyse rhetorique permet deja de donner des cles de comprehension. Gaudium et spes est simultanement sources d’argumentation, justification de la prise de parole en public, voire modele de celle-ci. Quelques exemples precis illustrent notre propos : ethique sexuelle et familiale et ethique socio-economique. Un effacement de la reference a Gaudium et spes transparait aujourd’hui. Deux genres litteraires sont utilises : epidictique et demonstratif. Dans quelle mesure peut-on dire que Gaudium et spes est devenu un classique ?