title: Spiritual needs and spiritual support preferences of people with end-stage heart failure and their carers: implications for nurse managers.
abstract: BACKGROUND
  Spiritual care is an important element of holistic care but has received little attention within palliative care in end-stage heart failure.
  
  
  OBJECTIVE
  To identify the spiritual needs and spiritual support preferences of end-stage heart failure patients/carers and to develop spiritual support guidelines locally.
  
  
  METHODS
  Semi-structured interviews (totalling 47) at 3-monthly intervals up to 1 year with 16 end-stage heart failure patients/carers. Focus group/consultation with stakeholders.
  
  
  RESULTS
  Participants were struggling with spiritual/existential concerns alongside the physical and emotional challenges of their illness. These related to: love/belonging; hope; coping; meaning/purpose; faith/belief; and the future. As a patient's condition deteriorated, the emphasis shifted from 'fighting' the illness to making the most of the time left. Spiritual concerns could have been addressed by: having someone to talk to; supporting carers; and staff showing sensitivity/taking care to foster hope. A spiritual support home visiting service would be valued.
  
  
  CONCLUSIONS
  Our sample experienced significant spiritual needs and would have welcomed spiritual care within the palliative care package.
  
  
  CONCLUSIONS
  Nurse managers could play a key role in developing this service and in leading further research to evaluate the provision of such a service in terms of its value to patients and other benefits including improved quality of life, spiritual wellbeing, reduced loneliness/isolation and a possible reduction in hospital admissions.
authors.affiliation: Department of Education and Service Delivery, Faculty of Health, Education, Psychology and Sport, University of South Wales, Pontypridd, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Ross
authors.forename: Jacky
authors.initials: J
authors.lastname: Austin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009718:Nurse Administrators / Q000193:education / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D029181:Spirituality; D013727:Terminal Care / Q000379:methods* / Q000523:psychology*
keywords: heart failure; palliative care; qualitative research; spiritual care; spiritual needs; spirituality