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Journal of Palliative MedicineVol. 3, No. 1 Innovations in End-of-Life CareTaking a Spiritual History Allows Clinicians to Understand Patients More FullyDr. Christina Puchalski and Anna L. RomerDr. Christina Puchalski and Anna L. RomerPublished Online:19 Apr 2005https://doi.org/10.1089/jpm.2000.3.129AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byVerbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices4 January 2022 | BMC Palliative Care, Vol. 21, No. 1Implementation of an Educational Toolkit to Increase Nurse Competence in Spirituality and Spiritual Care of Oncology Patients8 November 2022 | Journal of Holistic Nursing, Vol. 5Posicionamento sobre a Saúde Cardiovascular nas Mulheres – 2022Arquivos Brasileiros de Cardiologia, Vol. 119, No. 5Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention15 October 2022 | Family Practice, Vol. 29Religious and spiritual journeys of LGBT older adults in rural Southern Appalachia25 October 2021 | Journal of Religion, Spirituality & Aging, Vol. 34, No. 4The CASH assessment tool: A window into existential suffering19 May 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 4Integrating religion/spirituality into professional social work practice27 July 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 4The Concept of Spirituality in the Health Sector: Contributions from the Study of Religion27 September 2022 | International Journal of Latin American Religions, Vol. 12Systematic review: The relationship between religion, spirituality and mental health in adolescents who identify as transgender13 September 2022 | Journal of Gay & Lesbian Mental Health, Vol. 26„Des Lebens Ruf an uns wird niemals enden“ – Sinnzentrierte Interventionen im Überblick30 August 2022 | Zeitschrift für Palliativmedizin, Vol. 23, No. 05Case discussion: The critically ill older adult in spiritual distressGeriatric Nursing, Vol. 47Australian Patient Preferences for the Introduction of Spirituality into their Healthcare Journey: A Mixed Methods Study3 August 2022 | Journal of Religion and Health, Vol. 27Religion, Spirituality, and Ethics in Psychiatric Practice30 March 2022 | Journal of Nervous & Mental Disease, Vol. 210, No. 8Spiritual distress in dialysis: A case report21 July 2022 | Progress in Palliative Care, Vol. 211Interprofessional communication training to address spiritual aspects of cancer care19 July 2022 | Journal of Health Care Chaplaincy, Vol. 29Spirituality in Serious Illness and HealthJAMA, Vol. 328, No. 2What is the role of spiritual care specialists in teaching generalist spiritual care? The perspectives of pastoral care staff in a large Catholic health and aged care organisation.5 July 2022 | Journal of Health Care Chaplaincy, Vol. 63Teaching spirituality to medical students: a systematic review17 June 2021 | Journal of Health Care Chaplaincy, Vol. 28, No. 3Biblical narratives and the planned change process in social work: assessment tool integration of faith and learning5 May 2022 | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 41, No. 3God, spirituality and religion in women dying from gynecological cancer19 July 2021 | Climacteric, Vol. 25, No. 3Palliative Professionals’ Views on the Importance of Religion, Belief, and Spiritual Identities toward the End of Life16 May 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 10“Spirituality is everybody’s business”: an exploration of the impact of spiritual care training upon the perceptions and practice of rehabilitation professionals25 September 2020 | Disability and Rehabilitation, Vol. 44, No. 8A quality improvement project to standardize chaplain documentation in the electronic medical record28 December 2020 | Journal of Health Care Chaplaincy, Vol. 28, No. 2Corrigendum: Spirituality/Religiosity as a Therapeutic Resource in Clinical Practice: Conception of Undergraduate Medical Students of the Paulista School of Medicine (Escola Paulista de Medicina) - Federal University of São Paulo (Universidade Federal de São Paulo)29 March 2022 | Frontiers in Psychology, Vol. 13AD-LAST! An interdisciplinary clinical workshop to improve cultural and spiritual awareness in advance care planning skills15 March 2022 | Palliative and Supportive Care, Vol. 55Hope pictured in drawings by patients newly diagnosed with advanced cancer11 March 2022 | Journal of Clinical Nursing, Vol. 298Addressing spiritual distress in pediatric oncology14 January 2022 | Pediatric Blood & Cancer, Vol. 69, No. 3Exploring the Meaning of Spirituality and Spiritual Care with Help From Viktor Frankl24 June 2021 | Journal of Holistic Nursing, Vol. 40, No. 1Standardized Spiritual Screening Increases Chaplain Referrals Through the EMR: A Nurse-Chaplain Collaboration for Holistic Acute Healthcare23 February 2022 | Journal of Holistic Nursing, Vol. 63Interplay between spirituality and religiosity on the physical and mental well-being of cancer survivors15 September 2021 | Supportive Care in Cancer, Vol. 30, No. 2Top Ten Tips Palliative Care Clinicians Should Know About Spirituality in Serious Illness Allison Kestenbaum, George Fitchett, Paul Galchutt, Dirk Labuschagne, Shelley E. 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Costa, and Jane Morris13 August 2021 | Journal of Palliative Medicine, Vol. 24, No. 9Posicionamento sobre Hipertensão Arterial e Espiritualidade – 20211 September 2021 | Arquivos Brasileiros de Cardiologia, Vol. 117, No. 3The Content, Teaching Methods and Effectiveness of Spiritual Care Training for Healthcare Professionals: A Mixed-Methods Systematic ReviewJournal of Pain and Symptom Management, Vol. 62, No. 3Religiosity and spirituality in psychiatry residency programs: why, what, and how to teach?1 August 2021 | Brazilian Journal of Psychiatry, Vol. 43, No. 4Editorial: children’s life, religiosity and spirituality matter: perspectives of special groups and their related adults16 July 2021 | International Journal of Children's Spirituality, Vol. 26, No. 3Development and protocol for a nurse-led telephonic palliative care programNursing Outlook, Vol. 69, No. 4Psychological Distress Among a Tunisian Community Sample During the COVID-19 Pandemic: Correlations with Religious Coping27 March 2021 | Journal of Religion and Health, Vol. 60, No. 3Optimism and social support as contributing factors to spirituality in Cancer patients3 January 2021 | Supportive Care in Cancer, Vol. 29, No. 6A mixed‐methods approach to comparing perceptions of cancer patients' and cancer care providers' religious and spiritual beliefs, behaviours, and attitudes23 December 2020 | European Journal of Cancer Care, Vol. 30, No. 3Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review28 May 2021 | BMJ Open, Vol. 11, No. 5Using Simulation to Prepare Students for Medical Mission TripsJournal of Christian Nursing, Vol. 38, No. 2Implementation of a Meaning-Centered Psychotherapy training (MCPT) program for oncology clinicians: a qualitative analysis of facilitators and barriers9 October 2019 | Translational Behavioral Medicine, Vol. 11, No. 1Medical student reflections: Chaplain shadowing as a model for compassionate care 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Maiko, Steven Ivy, Beth Newton Watson, Kianna Montz, and Alexia M. Torke27 March 2019 | Journal of Palliative Medicine, Vol. 22, No. 4Time to follow the evidence – Spiritual care in health careEthics, Medicine and Public Health, Vol. 9How and When Is Role Modeling Effective? The Influence of Mentee Professional Identity on Mentoring Dynamics and Personal Learning Outcomes18 April 2019 | Group & Organization Management, Vol. 44, No. 2Teenagers and Cannabis Use: Why It's a Problem and What Can Be Done About ItJournal of Psychosocial Nursing and Mental Health Services, Vol. 57, No. 3Haken und Ösen: Spiritualität in der klinischen PalliativversorgungWege zum Menschen, Vol. 71, No. 2Approaching Spirituality Using the Patient-Centered Clinical Method27 January 2018 | Journal of Religion and Health, Vol. 58, No. 1Medical Students’ (Dis)comfort with Assessing Religious and Spiritual Needs in a Standardized Patient Encounter10 October 2018 | Journal of Religion and Health, Vol. 58, No. 1Spirituality and Religiosity of Pharmacy Students1 February 2019 | American Journal of Pharmaceutical Education, Vol. 83, No. 1Interprofessional spiritual care in oncology: a literature review16 February 2019 | ESMO Open, Vol. 4, No. 1Physical, Psychological/Psychiatric, Social, and Spiritual Problems and Symptoms13 April 2019Spiritual Assessment in Healthcare: An Overview of Comprehensive, Sensitive Approaches to Spiritual Assessment for Use Within the Interdisciplinary Healthcare Team18 May 2019The Role of the Nurse in Providing Spiritual Care: A Case Study Approach to Exploring Specific Care Provision by Healthcare Workers in the Context of an Interdisciplinary Healthcare Team18 May 2019Teaching and Learning About Spirituality in Healthcare Practice Settings18 May 2019Religion and Spirituality Among Medical Students5 June 2019Spiritual Care: The Role of Health Care Chaplaincy4 September 2019End-of-life milieu of critically sick children admitted to a pediatric hospital: A comparative study of survivors versus nonsurvivorsIndian Journal of Palliative Care, Vol. 25, No. 4Incorporating and Teaching Spirituality into Medical Education: An Overview of the Field and Possible Educational Strategies4 September 2019Religion, Spirituality, and Stress6 March 2019Toward Comprehensive Medicine: Listening to Spiritual and Religious Needs of Patients26 April 2019 | Gerontology and Geriatric Medicine, Vol. 5Din ve Psikoloji Arasındaki Uçurum Gerçekten Ne Kadar Derin? Psikoterapilerdeki Dini İzler15 December 2018 | Cumhuriyet İlahiyat Dergisi, Vol. 22, No. 3Women's Perceptions of Using Short Films to Integrate Spirituality in TherapyJournal of Systemic Therapies, Vol. 37, No. 4Content Validation of Advanced Illness Criteria of a Palliative Care Screening Tool Lauren C. DiLello, Karen Mulvihill, Jennifer Delli Carpini, Riddhi Shah, Julia Hermanowski, and Damanjeet Chaubey29 October 2018 | Journal of Palliative Medicine, Vol. 21, No. 11Understanding, assessing, and in the spiritual of medical and October 2018 | Theology, Vol. 11, No. and of in Living with October 2018 | Journal of & Social Services, Vol. No. for the spirituality as October 2018 | Revista de Vol. 71, No. An of an aged psychiatry March 2018 | Psychiatry, Vol. 26, No. de de vida de de Vol. 25, No. support and with in Care in the Care A Narrative June | Journal of Care Medicine, Vol. No. Care in Cancer: in the of of Clinical Oncology Educational Vol. 3, No. religion/spirituality in clinical practice: A among social and and October | Journal of Clinical Psychology, Vol. 74, No. Spirituality in Care December | Journal of Religion and Health, Vol. 57, No. of to spiritual care at the of a phenomenological exploration from the of palliative care February 2018 | Journal for the Study of Spirituality, Vol. 8, No. Existential Distress in Pediatric Cancer December and Patient Spiritual in the through October of Spirituality in November Psychological/Psychiatric, Social, and Spiritual Problems and July and End-of-Life Care in Cancer in Oncology Nursing, Vol. No. Care in Hospice and Palliative Journal of Hospice and Palliative Care, Vol. 20, No. and Spirituality: Literature review and Journal of Counseling, Vol. 18, No. of the tool existential communication between and cancer August | European Journal of General Practice, Vol. 23, No. Education and of Christian Nursing, Vol. 34, No. Care Interventions in to and Therapy C. and D. September | Journal of Palliative Medicine, Vol. 20, No. in Patients with A Qualitative September | Journal of Research in Nursing and Vol. 14, No. theory on the and in an exploratory case study September | Vol. 69, No. of the of Spirituality and Palliative Care Research and of Pain and Symptom Management, Vol. No. of a spiritual care training program for staff on November | Palliative and Supportive Care, Vol. 15, No. 4Spiritual distress and spiritual care in advanced heart July | Reviews, Vol. and Spiritual Patient Simulation in Nursing, Vol. No. Vol. 42, No. 4The impact of a spiritual in patients with and and their support December | Vol. 26, No. 3The Importance of a Spiritual History in Healthcare Vol. No. About Substance Use DisordersJournal of Psychosocial Nursing and Mental Health Services, Vol. No. and Spiritual Beliefs of April | Journal of Religion and Health, Vol. No. Care Perceptions of and With of Hospice & Palliative Nursing, Vol. 19, No. in Substance Use What to Know to Practice30 November | in Mental Health Nursing, Vol. 38, No. End-of-Life Care to Religious and Vol. No. of Social Education, Vol. 53, No. Nursing Care and of Christian Nursing, Vol. 34, No. 1The of taking a religious and spiritual July | Psychiatry, Vol. 24, No. religion and spirituality in Vol. No. the role of religious in the at the of of Vol. No. care spiritual March | Supportive Care in Cancer, Vol. 24, No. Spiritual Care and the Role of An Review of Literature and April | Journal of Religion and Health, Vol. No. of the Spiritual Needs of of with Is in the June | Journal of Palliative Medicine, Vol. 19, No. Impact of a Tool for Comprehensive Assessment of Palliative Care on Assessment at and of Pain and Symptom Management, Vol. No. from Healthcare Students to Understand Spiritual Assessment in Clinical Practice29 October | Journal of Religion and Health, Vol. No. Spirituality in January | Journal of Religion and Health, Vol. No. 3Development and of to Assess Nurse Provision of Spiritual August 2014 | Journal of Holistic Nursing, Vol. 34, No. and Validation of the Practice Assessment September 2014 | Research on Social Practice, Vol. 26, No. and the Medical A of July | Journal of Health Care Chaplaincy, Vol. 22, No. history taking in palliative care: A controlled September | Palliative Medicine, Vol. 30, No. Is Is Using A and the Life With American in Spiritual March | Journal of in Mental Health, Vol. 11, No. and spiritual in September | International Journal of and Mental Health, Vol. No. 1The of Hospital to and Patients’ Spiritual A May | Journal for the Study of Spirituality, Vol. No. 1The and to March End-of-Life Spiritual March in Holistic Patient Journal of Nursing, Vol. No. of spiritual assessment for older September 2014 | and Vol. No. und der der Care, Vol. No. Spirituality and A for Holistic January | Journal of Religion and Health, Vol. No. and Belief, in Care spiritual history tool by C. M. Puchalski as an for an interdisciplinary in January | Journal for of and Social Vol. 21, No. the of Spiritual A Pain and Palliative Care Service Quality of Pain and Symptom Management, Vol. No. of Spiritual Assessment in September | Vol. No. the of Christian Nursing, Vol. 32, No. 4Spiritual care: is the assessment tool for palliative Journal of Palliative Nursing, Vol. 21, No. und Spiritualität in der September | Vol. 60, No. of September of spirituality assessment in palliative care patients in November 2014 | Progress in Palliative Care, Vol. 23, No. 4The for Spiritual A Mixed-Methods July | Oncology Nursing Vol. 42, No. 4The Integration of Religion and Spirituality in Social Practice: A May | Social Vol. 60, No. 3The and Educational of a Spiritual Life Review for Patients with and June 2014 | Journal of Cancer Education, Vol. 30, No. in Geriatric Palliative in Geriatric Medicine, Vol. No. An for Spiritual Well-Being May | Journal of Religion & Spirituality in Social Work: Social Thought, Vol. 34, No. Spiritual Assessment March | Journal of Health Care Chaplaincy, Vol. 21, No. American on Mental Health, and Help April | and Vol. 60, No. of Christian Nursing, Vol. 32, No. the Spiritual Needs and of Oncology Patients in Nursing Practice, Vol. 29, No. Care Training to Healthcare Professionals: A Systematic April | Journal of Pastoral Care & Counseling: Advancing theory and professional practice through scholarly and reflective publications, Vol. 69, No. analysis of spiritual
•The National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity.•The report recommends that the systems that educate, pay and employ nurses: 1) permanently remove barriers to care; 2) value their contributions; 3) prepare nurses to tackle health equity; and 4) diversify the workforce. The need to fully support nurses is interwoven throughout the report.•All nurses should work in partnership with others to advance the nine major report recommendations. The National Academy of Medicine's long-anticipated report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, offers an aspirational vision: the achievement of health equity in the United States built on strengthened nursing capacity, diversity, and expertise (Wakefield, 2021Wakefield M. Federally qualified health centers and related primary care workforce issues.Jama. 2021; 325: 1145-1146Crossref PubMed Scopus (10) Google Scholar). Released in May 2021, the report arrives at a critical moment for the profession. Many nurses are burned out, exhausted, and have experienced moral injury from caring for an unrelenting stream of patients with COVID-19. The pandemic has laid bare and further exacerbated long-existing health inequities. School closings during the pandemic similarly exacerbated educational disparities, and poor treatment of Black, Indigenous, and other people of color by police spotlighted inequities in law enforcement. Collectively, these inequities have resulted in renewed calls to dismantle structural, cultural, and interpersonal racism, including within nursing. This new report provides a roadmap for how the nursing profession can contribute its expertise to create a fairer, more just and healthier world. The report is the second collaboration between the Robert Wood Johnson Foundation (RWJF) and the National Academy of Medicine (NAM) on the future of nursing. The first report, released in 2010, re-conceptualized the role of nurses in transforming the healthcare system (Shalala et al., 2011Shalala D. Bolton L.B. Bleich M.R. Brennan T. Campbell R. Devlin L. The future of nursing: Leading change, advancing health. 10. The National Academy Press, Washington DC2011: 12956https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-healthGoogle Scholar). RWJF and AARP formed The Future of Nursing: Campaign for Action, a nationwide initiative to advance the report recommendations. Over the past decade, the nursing field strengthened nursing education, advanced practice, promoted leadership, and increased workforce diversity. In doing so, the nursing field has built – and is continuing to build – its capacity to provide high-quality care to more Americans. As nursing built its capacity and as the evidence increasingly linked inequities to poorer health status, it became clear that nurses could do more to build healthier communities and advance equity. Nurses are the most trusted profession and the first point of contact for most people seeking health care. They are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being (Pittman, 2019Pittman, P. (2019,. March 12). Activating nursing to address the unmet needs of the 21st century: Background paper for the NAM Committee on Nursing 2030.Robert Wood Johnson Foundation. Available at: https://publichealth.gwu.edu/sites/default/files/downloads/HPM/Activating%20Nursing %20To%20Address%20Unmet%20Needs%20In%20The %2021st%20Century.pdfGoogle Scholar). Their expertise could be better used to combat the many shortcomings of the U.S. health system. The United States spends $3.5 trillion each year on health care (CMS, 2020) more than any other country in the world but ranks last compared with other high-income countries on equity, access to care, health care outcomes, and administrative efficiency (Schneider et al., 2021Schneider, E. et al.,(2021, August)) Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. compared to other high-income countries (Commonwealth Fund). https://doi.org/10.26099/01dv-h208.Google Scholar). Life expectancy, infant mortality and maternal mortality are worse in the United States compared with other high-income nations. Disparities in health care access and outcomes related to race, income, geography and other social and environmental factors are also common. RWJF has long believed that nurses have enormous potential for tackling the shortcomings of health and health care in the United States and in 2019 asked the NAM to form a committee tasked with charting a path for the nursing profession to create a culture of health, reduce health disparities, and improve the health and well-being of the nation. As the committee was well into the process of reviewing evidence and preparing to write the report, the pandemic took hold across the country and shined a light on the nation's rampant health inequities. The committee delayed the report to incorporate the major lessons from the pandemic: its disproportionate and devastating toll on poor and marginalized populations that could largely be attributed to persistent health disparities; the need to fully support nurses; and better prepare the workforce for future disasters. Released in May 2021, the report called for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. The report recommends that the systems that educate, pay, and employ nurses: (1) permanently remove barriers to care; (2) value their contributions; (3) prepare nurses to tackle health equity; and (4) diversify the workforce. The report underscores that prioritizing nurse well-being is paramount to advancing the recommendations. In addition, the report calls on national nursing organizations to develop a shared agenda for addressing the social determinants of health and achieving health equity. Finally, the committee prioritized research needs to build the evidence base to support nurses in advancing health equity. Each of these areas is discussed below. Far too often in the United States, people do not see a health care provider when they need one. Nearly 30 million people are uninsured in the United States, and roughly 40 million have health plans that leave them potentially underinsured (Collins et al., August 2020Collins, Sara R., Gunja, Munira Z., & Aboulafia, Gabriella N. (2020). U.S. Health insurance coverage in 2020: A looming crisis in affordability — findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020.Commonwealth Fund. https://doi.org/10.26099/6aj3-n655.Google Scholar). In addition, timely access to health care is undermined due to the inability to pay; geographic inaccessibility to services and providers, particularly in rural and underserved urban areas; lack of health literacy; and fundamental mistrust of the health care system and providers. Research demonstrates that delays in obtaining care can lead people to experience worse symptoms and disease progression (Man et al., 2018Man R.X.G. Lack D.A. Wyatt C.E. Murray V. The effect of natural disasters on cancer care: A systematic review.The Lancet Oncology. 2018; 19: e482-e499https://doi.org/10.1016/S1470-2045(18)30412-1Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). Nurses can help to explicitly address these gaps in access to care. For example, about 70% to 80% of advanced-practice nurses work in primary care, including in pediatrics, adult practice, gerontology, and nurse midwifery. While the primary care nurse practitioner field has grown, the number of physicians entering primary care has stagnated or declined (Barnes et al., 2018Barnes H. Richards M.R. McHugh M.D. Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.Health Affairs. 2018; 37: 908-914https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (127) Google Scholar; Barnes et al., 2018Xue Y. Ye Y. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing outlook. 2016; 64: 71-85https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (117) Google Scholar). Care provided by nurse practitioners has been found to be comparable to the care provided by physicians, according to numerous studies (Perloff et al., 2019Perloff J. Clarke S. DesRoches C.M. O'Reilly-Jacob M. Buerhaus P. Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries.Medical Care Research and Review. 2019; 76: 597-626Crossref PubMed Scopus (24) Google Scholar; Yang et al., 2020Yang B.K. Johantgen M.E. Trinkoff A.M. Idzik S.R. Wince J. Tomlinson C. State Nurse Practitioner practice regulations and US health care delivery outcomes: A systematic review.Medical Care Research and Review. 2021; 78: 183-196https://doi.org/10.1177/1077558719901216Crossref PubMed Scopus (32) Google Scholar). They are less expensive to employ than physicians and are more likely to care for vulnerable populations, including those in rural areas (Perloff et al., 2016Perloff J. DesRoches C.M. Buerhaus P. Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.Health Services Research. 2016; 51: 1407-1423Crossref PubMed Scopus (83) Google Scholar). However, the ability of nurses to expand access to care is limited by state and federal laws, institutional barriers, and restrictive health systems policies that prohibit them from working to the full extent of their education and training (Wakefield et al., 2021Wakefield M.K. Williams D.R. Le Menestrel S. Flaubert J.L. The future of nursing 2020-2030: Charting a path to health equity. National Press, Google Scholar). The report calls for and organizations to remove these and as well as restrictive policies and In during the and provided full practice to nurse is just about the effect of the to expand scope of practice during the pandemic et al., R. Impact of pandemic on from a national 2021; Full Text Full Text PDF PubMed Scopus Google Scholar; et al., 19: for nurse practitioners to healthcare and for full practice 2021; PubMed Scopus (24) Google in the found that with to from The of nurse practitioner to reduce from the and Scholar). 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With the global aging population on the rise, delivering high-quality care for older adults presents growing challenges. Assessing nursing students' attitudes toward aging and their gerontological competencies is essential for improving the future quality of care for older adults. This study aimed to evaluate the gerontological competencies of final-year nursing students and their attitudes toward positive and negative ageism. It also examined the relationship between these variables to identify factors influencing students' readiness to care for older adults. A cross-sectional descriptive design with a relational screening model was employed. The study sample consisted of 381 final-year nursing students. Data were collected using the Personal Information Form, the Gerontological Nursing Competence Scale, and the Positive and Negative Ageism Scale. The mean total scores were 165.62 ± 28.70 for the Gerontological Nursing Competence Scale, 44.33 ± 7.77 for the Positive Ageism Scale, and 36.90 ± 6.73 for the Negative Ageism Scale. A moderate, statistically significant positive correlation was observed between gerontological nursing competence and positive ageism (r = .508, p < 0.01). Multiple linear regression analysis indicated that positive ageism was the strongest predictor of competence, explaining 28.6% of the variance (β = .453, p < 0.001). Negative ageism and other demographic variables were not significant predictors. These findings highlight that nursing students' positive attitudes toward older adults are closely linked to their gerontological nursing competence. Integrating educational strategies that foster constructive perceptions of aging into nursing curricula may enhance students' professional preparedness and contribute to higher-quality care for the aging population.
Disgust sensitivity and ageism significantly affect nursing interns' motivation to work in gerontological nursing. However, the complex interactions between these factors remain underexplored. This study used network analysis to explore relationships among nursing interns' disgust sensitivity, ageism and motivation to pursue a career in gerontological nursing and to identify key nodes in this network. This study recruited 698 nursing interns. The Disgust Scale-Revised (DS-R), the Fraboni Scale of Ageism and the Gerontological Nursing Career Motivation Questionnaire were used as measures. Centrality and bridge centrality indices were used to identify central and bridge symptoms. Network stability was assessed using a case-dropping bootstrap procedure. The network comparison test was used to analyse differences in networks by gender and residence. Bayesian networks were used to investigate possible probabilistic connections among variables. Network analysis identified 'antilocution' (D5) as the most central node in the overall network, whereas 'expectation' (D7) had the highest bridge strength. Bayesian network analysis further revealed that 'avoidance' (D4) had the greatest probabilistic influence and was strongly linked to other nodes associated with ageism and disgust sensitivity. 'Practicality' (D9) and 'importance' (D10) also showed significant probabilistic associations within the motivation domain. The network structure proved stable and reliable, with no significant differences attributable to gender or to residence. This study highlights the complex relationships among disgust sensitivity, ageism and motivation for a career in gerontological nursing. It identifies 'antilocution' (D5) in ageism and 'expectation' (D7) in career motivation as central nodes, associated with negative attitudes and lower career identity. Additionally, 'avoidance' (D4) behaviour shows a probabilistic association with higher levels of disgust sensitivity and with ageism. These findings suggest targeted interventions to improve the well-being and career motivation of nursing interns in gerontological nursing.
The prevalence of frailty among older adults residing in nursing homes is high, indicating the importance of effective interventions to prevent and reduce frailty. One such intervention, VIVIFRAIL, is an exercise program that benefits older adults with frailty. The primary aim of this study was to evaluate the feasibility (recruitment, adherence, compliance, attrition, motivation and satisfaction) of the VIVIFRAIL program in an institutional setting. The secondary aim was to examine the efficacy of the VIVIFRAIL intervention in improved frailty status, reduced frailty prevalence and improving health indicators, activities of daily living (ADLs) and quality of life (QOL) in older adults. This study was a randomised-controlled, assessor-blinded, prospective trial conducted from July to September 2024 among older adults residing in nursing homes. A total of 80 participants were enrolled, and the study had recruitment, adherence and compliance rates of 100%. The attrition rate was 7.5%, and the motivation and satisfaction rates were 86% and 87%, respectively. Significant improvements were observed in frailty status (P = .002), physical performance (P = .001), cognitive function (P = .025), ADLs (P < .001) and QOL (P < .001). Bonferroni post-hoc analysis indicated significant differences across all time points for frailty status (P < .001). The VIVIFRAIL exercise program was determined to be feasible for older adults residing in nursing homes and significantly improved frailty status, health indicators, ADLs and QOL. These findings support the incorporation of structured exercise interventions as an essential component of routine care provided by health-care professionals in nursing home settings.
To develop and evaluate the usability of clinical-decision support systems (CDSS) tailored for skilled nursing facilities (SNFs), incorporating standardized nursing languages to support optimal nursing care. The current study used a user-centered design, with four participants from a single SNF. Large language modeling was used to train and test CDSS using a total of 130 Generative Pretrained Transformer 4.0-generated scenarios of simulated SNF residents. System usability was evaluated using the System Usability Scale (SUS); Usefulness, Satisfaction, and Ease-of-Use (USE) questionnaire; and heuristic evaluation. Mean SUS score was 60 (SD = 3.65). Mean USE score was 6.62 (SD = 0.55), with the ease of learning subdomain rated highly. We identified usability issues through heuristic evaluation with nursing faculty experts, receiving overall positive feedback. CDSS has the potential to significantly enhance care quality, marking a pivotal advancement in the application of health care technology to support nursing professionals.
Rapid population aging has intensified the complexity of gerontological nursing care, highlighting the need for educational approaches that foster empathy and reduce ageist attitudes among nursing students. Narrative medicine has been proposed as a humanistic pedagogy to enhance perspective-taking; however, its integration within structured instructional models in nursing education remains underexplored. This study aimed to describe within-cohort changes in empathy and ageist attitudes among undergraduate nursing students following participation in a narrative-medicine module structured using the BOPPPS instructional framework, and to examine the association between these two constructs. A quasi-experimental, one-group pretest-post test design was employed in a compulsory undergraduate nursing course. A total of 120 nursing students participated. Empathy was measured using the Jefferson Scale of Empathy-Health Professions Student version, and ageism was assessed using the Chinese version of the Fraboni Scale of Ageism. Paired-samples t tests were used to examine pre-post changes, and correlation and exploratory regression analyses were conducted to summarize associations between empathy and ageism. Mean empathy scores increased from pre-test to post-test (mean difference = 0.45, 95% CI [0.33, 0.57]; t = 7.18, p < 0.001), while mean ageism scores decreased (mean difference = - 0.40, 95% CI [- 0.53, - 0.27]; t = - 6.02, p < 0.001), reflecting small-to-moderate effect sizes. Post-intervention empathy was moderately and negatively associated with ageism (r = - 0.42, p < 0.001). Exploratory regression analysis indicated that empathy accounted for a modest proportion of variance in ageist attitudes (B = - 0.34, p < 0.001). These findings describe modest within-cohort changes and associations observed following a narrative-based instructional module delivered within a structured teaching framework. Given the one-group pre-post design and the compulsory course context, results should be interpreted cautiously due to predictable threats to internal validity, including testing and maturation effects. The proposed CARE-AGE framework is therefore presented as an evidence-informed conceptual curriculum model rather than a validated intervention. The study contributes descriptive insight into how theory-guided narrative pedagogy may be situated within gerontological nursing education.
The new Universal Health Insurance (UHI) reforms aim to improve equity and quality of healthcare delivery; however, their sustainability depends on engagement and retention of the nursing workforce. Psychological empowerment has been identified as a key factor influencing nurses' attitudes and work-related behaviors, yet the evidence on how it relates to job embeddedness among nurses working in the early phase of UHI implementation in Egypt remains underexplored. This study aimed to assess the association between psychological empowerment and job embeddedness among nurses under the umbrella of the new Universal Health Insurance in Egypt. A descriptive cross-sectional design was employed from August 2025 to November 2025. A total of 213 nurses working at Aswan Specialized Hospital, affiliated with the UHI system in Upper Egypt, were recruited. Data were collected using a demographic questionnaire, and psychological empowerment was measured using the Psychological Empowerment Scale, and job embeddedness was assessed using the Global Job Embeddedness Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical linear regression were used for data analysis. Among 213 nurses, the mean score of psychological empowerment was reported at high overall levels of 5.75 (SD = 0.77), particularly in the dimensions of competence and meaning, alongside moderately high levels of job embeddedness, with a mean score of 4.76 (SD = 0.89). Psychological empowerment showed a significant positive correlation with job embeddedness (r = 0.512, p < 0.001). In hierarchical regression analysis adjusting for demographic and professional covariates, psychological empowerment emerged as a strong and independent predictor of job embeddedness (β = 0.55, 95% CI: 0.398-0.701, p < 0.001), explaining an additional 16.5% of the variance after controlling for covariates (ΔR2 = 0.165). In adjusted analyses, the covariates were not independently associated with job embeddedness. Psychological empowerment was positively associated with nurses' job embeddedness in the UHI implementation setting. Higher levels of empowerment-related factors were positively associated with greater embeddedness, suggesting their relevance to workforce engagement and retention during health system reform. Our study findings highlight that psychological empowerment plays a crucial role in fostering nurses' job embeddedness, which is critical for sustaining workforce retention and stability. Enhancing supportive leadership and nurses' involvement in decision-making is critical, especially during the early phase implementation of the universal health insurance system reform.
To clarify how Ikigai and closely related meaning constructs are described in literature relevant to older people in Korea and to propose a provisional, context-informed conceptual framework for gerontological nursing. Ikigai, often glossed as "a life worth living," has been associated with well-being in later life, yet its meaning and operationalisation vary across settings. Greater conceptual clarity is needed to support culturally responsive nursing assessment and care planning. Rodgers' evolutionary method of concept analysis (Rodgers, 2000) was used to examine contemporary scholarly use of Ikigai and related concepts in 13 peer-reviewed studies (published 2002-2024; searched January 2000-June 2025), of which 10 were conducted outside Korea and three in Korea. Data were analysed to identify defining attributes, antecedent contexts, consequences and related concepts. Six defining attributes were identified: psychological equanimity, purposefulness in life, self-worth and personal value, social connectedness, cultural belonging, and reflective wisdom and self-integration. Four antecedent contexts were identified: family and intergenerational change, cultural and value transformation, health and functional challenges, and existential and social disconnection. Four consequence domains were identified: emotional stability and psychological balance, active health orientation and functional preservation, life fulfilment and satisfaction, and community integration and social engagement. In literature relevant to older people in Korea, Ikigai was not presented simply as a list of valued sources, but was provisionally interpreted as a process through which relational sources such as family roles, intergenerational continuity and everyday responsibilities may be internalised as an enduring sense of life's worth. Ikigai may be understood as a dynamic and context-dependent meaning process in later life that includes both valued sources of worth and a sense of life's worth. This review offers a provisional conceptual framework for gerontological nursing and supports further qualitative and measurement research in Korea. This framework can support gerontological nurses in assessing meaning, dignity, purpose and relational continuity alongside physical and functional indicators. Nurses may use open-ended questions and observable indicators to identify valued roles, relationships and routines that sustain older people's sense that life is worth living. Meaning-centred and culturally responsive care planning may help support participation, autonomy and continuity during later-life transitions.
This investigation scrutinises the psychometric qualities of the Arabic version of the Older People's Quality of Life-Brief (OPQOL-brief) scale in a sample of Arabic-speaking older adults to support culturally appropriate assessment of lived experience and person-centred care in later life and to strengthen gerontological nursing assessment and evaluation across settings. A cross sectional study included 539 Arabic-speaking older Egyptians (50.3% women; 60.7% aged 65-75). Forward-backward translation and cultural adaptation procedures support linguistic and cultural equivalence. Data collection uses a mixed-mode approach (face-to-face and online) to support inclusive participation; procedures were standardised across modes to minimise measurement differences. The scale yielded a three-factor structure reflecting the multidimensional nature of quality of life in older adults. Internal consistency was high for the total score (Cronbach's alpha and McDonald's omega = 0.92). Measurement properties did not differ significantly by gender, supporting cross-gender interpretability. Concurrent validity showed a strong positive correlation between Arabic OPQOL-brief and resilience scores (r = 0.60, p < 0.001), supporting its relevance to nursing care planning and outcome monitoring. Psychometric testing in this study includes factor structure, internal consistency reliability, concurrent validity and measurement invariance. This research closes a gap in the literature and supports the Arabic OPQOL-brief as a robust tool for assessing quality of life in Arabic-speaking older adults. The new scale can help support nurse-led person-centred assessment, care coordination and evaluation of interventions.
To examine the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and depressive symptoms among rural older adults in South Korea and explore implications for gerontological nursing. The current cross-sectional study used 2022 national survey data from 456 rural adults aged ≥65 years. Depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), and vitamin D status (<20 ng/mL vs. ≥20 ng/mL) were analyzed using adjusted logistic and linear regression. Vitamin D deficiency was significantly associated with greater odds of depressive symptoms (odds ratio = 2.59, p < .001), and lower serum 25(OH)D3 levels were independently associated with higher PHQ-9 scores (β = -0.177, p < .001). Female sex was also a significant predictor. Vitamin D deficiency may be a modifiable factor in depression screening. Including vitamin D assessment in gerontological nursing practice may support early identification and prevention in rural older adults.
This study aimed to translate and validate the Arabic PSI-20, examine its psychometric properties, test measurement invariance across key subgroups and establish an optimal cut-off score. Problem-solving ability (PSA) is a core cognitive competence underpinning nursing students' academic success, clinical reasoning and professional readiness. Although the Problem-Solving Inventory-20 (PSI-20) is widely used internationally, no validated Arabic version is available for Arabic-speaking nursing students. A two-phase methodological and cross-sectional validation study. Faculty of Nursing, Mansoura University, Egypt, during the 2024-2025 academic year. A total of 633 undergraduate nursing students participated in Phase Two. Phase One followed Beaton's cross-cultural adaptation framework. Phase Two involved psychometric evaluation using confirmatory factor analysis (CFA), assessment of convergent and discriminant validity, internal consistency, test-retest reliability, receiver operating characteristic (ROC) curve analysis and multi-group measurement invariance across gender, GPA, family structure, living arrangements, sleep regularity and ChatGPT use. The Arabic PSI-20 demonstrated excellent internal consistency (Cronbach's α = 0.956) and strong construct validity. CFA supported the original three-factor structure (CFI = 0.979, RMSEA = 0.055). Measurement invariance was confirmed across most subgroups, with partial invariance across ChatGPT-use categories. PSA was positively associated with self-directed learning and negatively associated with academic stress. ROC analysis identified an optimal cut-off score of ≥ 57 for detecting low PSA (AUC = 0.799). The Arabic PSI-20 is a valid and reliable instrument for evaluating PSA.
This pilot randomized controlled trial evaluated whether a Gagné's model-based interactive desktop simulation program could reduce ageism and improve nursing students' attitudes toward older adult care. Hundred and twenty nursing students were randomized to an intervention group (n = 60) receiving eight sessions combining Gagné's instructional events, desktop simulations, case discussions, and structured reflection, or a control group (n = 60) receiving no intervention. Groups were comparable at baseline across all outcome measures (WEPS, FSA, PCOP-SV; all p > 0.05). Post-intervention, the intervention group demonstrated significantly greater improvement in willingness to work with older adults (WEPS), reduced ageist attitudes (FSA), and more positive perspectives on caring for older patients (PCOP-SV), with statistically significant group-by-time interactions across all three outcomes sustained at follow-up. A simulation-enhanced instructional program based on Gagné's model shows promise for improving attitudinal outcomes in gerontological nursing education. Findings are preliminary and should be interpreted cautiously given the pilot design and complete-case analysis. Trial Registration: ClinicalTrials.gov identifier: NCT0613947.
The Age-Friendly Health Systems (AFHS) is a national initiative that ensures evidence-based care for older adults. To facilitate implementation, direct care providers created a questionnaire for older adults to complete before a clinic visit. The current mixed methods study evaluated the questionnaire's acceptability using the Theoretical Framework of Acceptability and explored provider perceptions of the questionnaire. In 2022, the questionnaire was sent to 1,100 retail health clinics. After 4 weeks of use, an online survey was sent to 3,300 direct care providers (e.g., nurse practitioners, physician assistants) at these clinics. Higher-than-average acceptability of the questionnaire in most of the Theoretical Framework of Acceptability domains was reported and self-reported implementation, completion, and documentation of all AFHS 4Ms improved. In open-ended responses, direct care providers described how the questionnaire was user-friendly and improved clinic visit efficiency. Direct care provider innovations help overcome real-world challenges, improving the effective implementation and delivery of evidence-based practices in a retail health clinic setting.
Communicating bereavement to older adults with dementia presents ethical and emotional challenges, particularly in Japanese long-term care environments, where family-centred decision-making and cultural norms shape caregiving practices. Despite the increasing demand, bereavement support remains insufficiently structured. This study aimed to clarify how nurses and care workers recognise and respond to the disclosure of a loved one's death to older adults with dementia and to examine current practices and preferences regarding bereavement support in Japanese long-term care settings. A questionnaire survey was administered to 217 formal caregivers with dementia care experience. The survey explored participants' recognition of bereavement disclosure, professional attributes, and preferences for support resources, such as manuals and training. Statistical analyses included Mann-Whitney U and Chi-square tests. Caregivers showed diverse recognition of bereavement disclosures. Care workers were more likely to avoid informing patients than were nurses, citing concerns such as emotional distress and family consultations. Recognition was associated with professional experience and the number of bereavement cases encountered. Most facilities lack standardised support manuals, and many caregivers express a strong need for structured resources and training. Cultural values and institutional norms influenced support preferences. Recognition of bereavement disclosure among caregivers varies and is shaped by professional roles, experience, and cultural contexts. To enhance dementia care, it is essential to develop ethically sensitive and culturally appropriate support models that reflect caregivers' perspectives and practical needs, including standardised tools and interdisciplinary collaboration.
To estimate prevalence and identify determinants of metabolic syndrome (MetS) in Korean older adults (≥65 years), with actionable implications for gerontological nursing. We analyzed 2023 Korea National Health and Nutrition Examination Survey (KNHANES) data. Of 6,929 respondents, 1,641 adults aged ≥65 years with complete data were included. MetS followed ATP III criteria adapted for Korean cutoffs. Independent variables spanned sociodemographic (age, sex, education, income, residence), behavioral (smoking, alcohol use, physical activity, sleep), and biological factors (25(OH)D₃, BMI). Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% CIs (α=.05). MetS prevalence was approximately 42%. Higher odds were observed for age ≥72 years (aOR=1.27, 95% CI 1.00-1.62, p=.047) and BMI ≥25 kg/m² (aOR=6.92, 95% CI 5.51-8.69, p<.001). Lower odds were seen for male sex (aOR=0.74, 95% CI 0.58-0.95, p=.020), meeting WHO physical activity recommendations (aOR=0.70, 95% CI 0.52-0.95, p=.021), sleep ≥7 h/night (aOR=0.73, 95% CI 0.59-0.92, p=.007), and serum 25(OH)D₃ ≥20 ng/mL (aOR=0.68, 95% CI 0.53-0.87, p=.002). Income, education, residence, smoking, and alcohol were not significant. MetS is common among Korean older adults, with obesity the dominant risk factor and modifiable behaviors (physical activity, sleep, vitamin D) showing protective associations. Gerontological nursing should prioritize: (1) nurse-led screening (waist circumference, blood pressure, glucose, lipids); (2) brief counseling on WHO-aligned activity, sleep hygiene, weight management, and vitamin D optimization; and (3) scalable referral pathways-including rural adaptations-to reduce disparities and support healthy aging.
Dietary supplements are commonly used by older adults for concerns such as memory loss or to slow the progression of Alzheimer's disease. However, these agents are not regulated by the U.S. Food and Drug Administration. Furthermore, there are limited long-term studies evaluating safety and efficacy, especially in older adults. The intent of the current article is to review the recent literature on commonly used dietary supplements in older adults to reduce the risk of cognitive decline and dementia. Systematic reviews and/or meta-analyses published within the past 10 years were reviewed to provide recommendations on the use of dietary supplements for brain health. There is limited evidence supporting the efficacy of commonly used dietary supplements but there are germane safety concerns that need to be considered by the interprofessional team. Future research should prioritize standardized dosing, diverse older adult populations, and long-term outcomes focusing on efficacy and safety.
Effective preoperative education is a core nursing responsibility in orthopaedic care and may influence postoperative recovery following total knee arthroplasty (TKA). This study examined the effects of a nurse-led, technology-supported preoperative education and self-care promotion program on patient knowledge and rehabilitation outcomes after TKA. A quasi-experimental, two-group repeated-measures design was conducted among 60 patients undergoing TKA between January and August 2025. The intervention group received a nurse-led educational program delivered via the Line OA platform, incorporating e-book materials, instructional videos, and individualized nursing guidance. The control group received routine nursing care. Data were collected at pre-admission, admission, discharge, and at 2 and 6 weeks postoperatively. Outcomes included TKA-related knowledge and knee range of motion (ROM). Patients in the intervention group demonstrated significantly higher knowledge scores across all postoperative time points compared with the control group (p < 0.05). Knee flexion ROM showed a significant improvement over time in the intervention group, indicating enhanced functional recovery. A nurse-led, technology-supported preoperative education program improves patient knowledge and supports early postoperative rehabilitation following TKA. Integrating digital education into routine orthopaedic nursing practice may enhance patient engagement and recovery outcomes.