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Chapter 218. Psychosocial, Cultural, and Spiritual Aspects

Stephanie Grossman, MD, FHM, FAACP; Farnaz Arabshahi, RN, FNP; Debbie Gunter, RN, FNP, ACHP; Gwendolynn Harrell, RN, CHPN; Shella Patel, ANP, BSN, MSN; Sandra Schaap, MDiv; Tammie E. Quest, MD

  1. What steps are most likely to relieve caregiver distress?

  2. What steps are most likely to address a patient's anger?

  3. What questions have been found to be moderately effective in screening for health care literacy?

  4. What is the FICA Spiritual History Tool?

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Case 218-1

A 62-year-old woman who is regaining function after a recent stroke was observed to be crying at each clinical visit.

Psychosocial aspects of care influence patient outcomes, compliance, and decision making. Patients experience illness within the context of their cultural and spiritual experience and do so surrounded by a network of family and caregivers. This chapter will identify and discuss the assessment and management of cultural, spiritual, and family caregiver aspects of care.

Emotional Distress

Response to emotional distress is an important aspect of forging the therapeutic relationship. Patient encounters may reveal intense emotions such as fear, anger, sadness, and hopelessness, especially when patients face unexpected serious or life-threatening illness. The patient may already be experiencing significant life stressors prior to hospitalization, such as divorce, death or illness of a close relative, financial worry, difficulty with family relationships, or substance use or abuse. The patient may have undiagnosed or undertreated psychological or behavioral issues including anxiety or depression. When presented with empathetic opportunities, physicians often shift their focus to biomedical explanations. Responding to emotional distress with a supportive approach can help promote an atmosphere of trust, improved patient satisfaction, and better patient outcomes (Table 218-1).

Table 218-1 Responding to a Patient's Emotional Distress
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Table 218-1 Responding to a Patient's Emotional Distress

  1. Listen to the patient

    • No interruptions

  2. Listen to yourself.

    • Read your own feelings but do not act on your emotions quickly
    • Allow your emotions to cue more discovery about the patient

  3. Reflect thoughts, feelings, and behavior

    • Reflection means restating what a patient has said using their own words and phrases

  4. Affirmation and respect

    • Thank the patient for risking the sharing of emotions

  5. Empathic curiosity

    • Don't be afraid to ask for more information about the emotions (eg, Can you share with me more about your sadness)

  6. Summarize and paraphrase

    • Restate the patient's story in your own words; in contrast to reflection, paraphrase and summary involves

  7. Make a plan

    • May involve changes in how you and the patient communicate
    • Set expectations for next steps
    • Offer follow-up
    • Create a time period for returning

Data from Ambuel B, Responding to Patient Emotion, 2nd Edition. Fast Facts and Concepts. August 2005; 29. Available at: http://www.eperc.mcw.edu/fastfact/ff_029.htm.)

When clinicians encounter anger, they should determine whether the source of the anger is internalized (eg, related to fear, loss of control, being a burden, or a result of anticipatory grief of life goals not accomplished) or externalized (eg, directed at others including health care providers). Personal feelings of guilt or fear may ...

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