Spiritual Needs and Overall Satisfaction with Service Provision: A Meditation Model for Older Hospitalized American Indians

Background and Purpose

The linkage between spirituality and health and wellness is widely acknowledged among American Indians (AI), and perhaps older AI in particular. Yet, in spite of the importance of spirituality to AI, a paucity of research exists on the process of addressing the spiritual needs of older hospitalized AI. This knowledge-gap is especially troublesome given the persistent health disparities that engender disproportionately high levels of hospitalization among members of this population. To assist practitioners address the spiritual needs of older AI, this presentation 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 AI’ 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., nursing staff, the discharge process, etc.).

Methods

The study design was cross-sectional. The sample consisted of 860 AI, aged 50 and older, who were consecutively discharged over a 12-month period from hospitals across the United States. Approximately 53 percent (n=454) 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. 

Results

Consistent with the study’s first hypothesis—addressing older AI’ spiritual needs was associated with higher levels of overall satisfaction with service provision. The model fit the data well [χ²=22.696 (df=14, p=.065), CFI=.997, RMSEA=.027 (90% CI, .000 - .046), and SRMR=.008]. Addressing spiritual needs satisfactorily accounted for 39% of the variance in overall satisfaction with service provision.

Consistent with the study’s second hypothesis, the relationship between spiritual needs and overall satisfaction was fully mediated by four variables. The resulting model fit the data well [χ²=724.711 (df=240, p< .001), CFI=.971, RMSEA=.048 (90% CI, .044 - .053), and SRMR=.022] and accounted for 79% of the variance in overall satisfaction. In declining order of magnitude the mediators were satisfaction with: nursing staff, the discharge process, physicians, and visitors.

Conclusions and Implications

The results shed light on the relationship between spiritual needs and overall satisfaction with service provision among older hospitalized AI. Specifically, the results underscore the importance of nursing staff, the discharge process, physicians, and visitors in satisfactorily addressing the spiritual needs of older AI. For instance, social workers and other discharge planners may play a critical role in facilitating linkages between AI and tribal support systems that help process the needs that emerged during hospitalization and enhance wellness. In sum, by focusing on these four mediators, it may be possible to provide more effective, culturally relevant services to older hospitalized AI.