Development and test of a complex intervention: "promoting spiritual coping” of family caregivers of an adult relative with severe mental illness

Background Severe mental illness is characterized by severe changes in functionality interfering with daily life activities. The home-dwelling person with severe mental illness often needs support from family members who assume the role of caregivers. The performance of the role of family caregiver often leads to a burden, with an impact on physical and mental health. As so, the caregiver develops coping strategies to deal with stressful situations. Among these, spiritual coping strategies are often used, which involve the relationship with oneself, others, and/or the transcendent/God or nature and may include religious or spiritual practices. These strategies are related to improvement in physical and mental well-being. The specialist nurse in mental and psychiatric health has competencies, such as the systemic assessment and intervention based on the biological, psychological, social, cultural, and spiritual dimensions aiming at the promotion of well-being and mental health. The main goal of this study was to develop and test the intervention “promoting spiritual coping” in the family caregivers of home-dwelling people with mental illness. Materials and methods A mixed-method study with a sequential exploratory design was conducted, using the development and feasibility/pilot phases of the Medical Research Council’s framework. The development stage included a systematic literature review according to Joanna Briggs Institute guidelines; two focus groups with caregivers and experts; and an online modifed e-Delphi. The test phase consisted of a pilot test with ten family caregivers of home-dwelling people with a mental illness accompanied by the community mental health structures of health units in the Lisbon region. The outcomes included spiritual coping, quality of life, and the burden of the family caregiver. Results A protocol for the intervention was developed and tested with a group of ten family caregivers. A three-session intervention was implemented. The outcomes were assessed pre and post-intervention. Signifcant changes were observed in the outcomes and the family caregivers mentioned that it was helpful to discuss issues regarding spirituality and religiosity. Conclusion The intervention "promoting spiritual coping" was developed and tested, considered appropriate for family caregivers of people with mental illness, to be applied in psychotherapeutic context by mental health nurses.