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1. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?

Author

Lau C, Stilos K, Nowell A, Lau F, Moore J, and Wynnychuk L

Subjects
Aged, Critical Care methods, Female, Humans, Male, Middle Aged, Patient Care Team organization & administration, Professional-Patient Relations, Retrospective Studies, Tertiary Healthcare, Organizational Innovation, Palliative Care methods, Patient Comfort methods, Spirituality, Terminal Care methods
Abstract

Background: Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital., Objective: We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not., Methods: A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016., Results: Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients., Conclusions: Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.

Published
2018
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2. What is Truth? The Spiritual Quest of Forensic Psychiatry.

Author

Norko MA

Subjects
Empathy, Humans, Professional Role, Social Justice, Forensic Psychiatry, Philosophy, Medical, Spirituality
Abstract

The search for truth is a foundational aim and value of forensic psychiatry. It is also a deeply spiritual exercise. It must, therefore, be possible to describe a spirituality of forensic psychiatry, which I attempt to begin in this article. This exploration opens with a discussion of spirituality and its contexts. I then examine the nature of vocation in its application to medicine, psychiatry and the law. This proceeds to a close evaluation of the attitudes and activities that I will argue occupy the groundwork of forensic practice and form pathways to truth: presence, empathy, compassion, and centering. I then examine some of the forces that harm the expression of truth in the courtroom, and the means for healing those injuries. Concern for the common good, an integral part of my own spirituality, arises repeatedly in this discussion. I conclude with thoughts on the search for truth, in our work and in ourselves, and an invitation to colleagues to imagine forensic psychiatry as a spiritual practice. My hope is that this endeavor will stimulate reflection among forensic clinicians and encourage further inquiry and explication., (© 2018 American Academy of Psychiatry and the Law.)

Published
2018

3. Eremitism in China

Author

J. Paper

Subjects
media_common.quotation_subject, Geography, Planning and Development, Buddhism, Gender studies, Development, Christianity, Chinese culture, Religious experience, Spirituality, Elite, Sociology, Asceticism, China, media_common
Abstract

The ascetic-eremitic life typical of the elite spirituality of Buddhism and pre-Protestant Christianity was not a part of Chinese culture prior to the introduction of Buddhism, and it has been viewed askance from the standpoint of normative Chinese values to the present. On the other hand, an unusual non-ascetic eremitism has a history in China that precedes Buddhism. The equivalent of the eremitic life in China into the present, for the elite, of course, was to refuse to hold governmental office or to be forced into retirement. This was a lifestyle understood as a religious one often related to ecstatic religious experience as well as maintaining the highest ethical values. There was no asceticism involved indeed, such a life was often one devoted to aesthetic pursuits- except the poverty that may follow from being unemployed.

Published
1999

4. The Post-Contact Origin of an American Indian High God: The Suppression of Feminine Spirituality

Author

Jordan Paper

Subjects
Fallacy, Religion in India, Omnipotence, media_common.quotation_subject, Philosophy, General Medicine, Christianity, Monotheism, Spirituality, Ideology, Evolutionism, Religious studies, Theology, media_common
Abstract

T HE QUESTION OF whether or not there was an aboriginal high god in the Americas has continuously reflected European ideological concerns. The late nineteenth century theories propounding an evolution of religion, with Christianity placed at the pinnacle of human development, were countered by Andrew Lang followed by Father Wilhelm Schmidt who, in his Ursprung der Gottesidee (1912), proposed a naive and pure monotheism at the very beginning of human culture. Each side utilized American Indian examples to bolster its argument. Those sympathetic with Native Americans tended to reflect Schmidt's views and assume a "primitive" monotheism as the basis of American Indian religions. American students of Native American cultures tended to avoid the controversy and concentrate on specific ethnological instances, usually finding the high god a reflection of missionary influence. W. J. McGee (1897: 182) early on pointed to "the popular fallacy concerning the aboriginal 'Great Spirit' " as an "erroneous interpretation" of the Siouan term wakanda: "Among these tribes the creation and control of the world and the things thereof are ascribed to 'wakan-da', just as among the Algonquin tribes omnipotence was assigned to 'ma-ni-do'; yet inquiry shows that wakanda assumes various forms, and is rather a quality than a definite quantity". (McGee's linguistic analysis is to be distinguished from simplistic evolutionist positions; e.g., William Jones [1905]). Alanson Skinner (1913: 79) thought in reference to the Algonkin Menomini, "Probably the sun was originally the head of the Powers above and Mati Haiwit ik [Great Spirit] is but a modern development of the old idea, through missionary influence." Frank Speck (1977/1935: 28-29) developed the same understanding in regard to the Algonkin Montagnais-Naskapi beliefs: "To the influence of missionary priests, I am now inclined to believe, may be attributed the concept of an anthropomorphic supreme deity-the historic and often discussed Tcetcimantti, 'Great Power,' commonly interpreted as 'Great Spirit.' " (Paul Radin, the eminent scholar of Amerindian religion

Published
1983