Older Hospitalized African Americans: A Model for Addressing Spiritual Needs
The use of spirituality among African Americans, and older African Americans in particular, to cope with stressful situations is almost universal. Yet, in spite of the importance of spirituality to African Americans, the extant research suggests that African Americans are less likely to be asked about their spiritual needs during hospitalization, relative to European Americans. In other words, racial disparities in health care may also include disparities in the administration of spiritual care in hospitals. To assist practitioners address the spiritual needs of older African Americans, this poster reports findings from a study designed to develop and test a model of spiritual care for use in hospitals. Toward this end, the study hypothesized that 1) addressing older African Americans’ spiritual needs will be directly related to higher levels of overall satisfaction with service provision and 2) that this relationship will be mediated by satisfaction with certain dimensions of service provision (e.g., physicians, the discharge process).
The study design was cross-sectional. The sample consisted of 2,227 African Americans, aged 65 and older, who were consecutively discharged over a 12 month period from hospitals across the United States. Approximately 61 percent (n = 1,357) of respondents were female. De-identified hospital inpatient satisfaction data were supplied by Press Ganey, the largest healthcare organization in the nation specializing in the measurement of patient satisfaction. Surveys are administered to former inpatients soon after discharge in the privacy of their homes. Cronbach’s alphas across measures were acceptable (α = ranged from .78 to .94). After imputing missing data with the EM (Expectation-Maximization) algorithm procedure, and transforming variables to improve their normality, structural equation modeling (SEM) was used to test the study hypotheses.
Consistent with the study’s first hypothesis—addressing older African Americans spiritual needs was associated with higher levels of overall satisfaction with service provision. The model fit the data well [χ2 = 85.840 (df = 12, p > .001), CFI = .990, RMSEA = .053 (90% CI, .042 - .063), and SRMR = .012]. Spiritual needs accounted for 32% of the variance in overall satisfaction.
Consistent with the study’s second hypothesis, the relationship between spiritual needs and overall satisfaction was fully mediated by five variables. The resulting model fit the data well [χ2 = 2048.115 (df = 346, p < .001), CFI = .967, RMSEA = .047 (90% CI, .045 - .049), and SRMR = .023] and accounted for 72% of the variance in overall satisfaction. In declining order of magnitude these mediators were satisfaction with: nursing staff, the discharge process, physicians, visitors, and room quality.
Conclusions and Implications:
The results shed light on the variables that may help reduce disparities in the administration of spiritual care among hospitalized African Americans. Specifically, the results underscore the importance of nursing staff, the discharge process, physicians, visitors, and room quality in addressing African Americans’ spiritual needs. By focusing on these variables, it may be possible to provide more effective, culturally relevant services to older African Americans.