Providing care to patients in critical care units generates stress. Helping the critical care nurse manage this stress can lead to better patient experiences and higher nursing retention. While providing holistic care to patients produces better outcomes, addressing the holistic needs of the caregiver must also be considered. Included in the holistic needs of the nurse is their spiritual well-being. A study that measures spiritual well-being, stress, and nursing retention is the focus of this review.

Preliminary bone scans have been performed on all patients with early breast cancer. The incidence of positive scans has been recorded and several factors determining scan status have been enumerated. Particular attention has been focused on the natrual history of scan positive and scan negative patients. Eighteen per cent of stage I and 41 per cent of stage II cancers had positive bone scans. Scan results were correlated with age, menopausal status, tumour position, tumour size and histological node status. Postmenopausal patients were found to have a significantly increased risk of being scan positive (P less than 0-01). Follow-up studies have confirmed that the lesions demonstrated by scanning actually represent metastatic foci. At 18 months 85-7 per cent of scan positive patients had evidence of disseminated disease compared with only 11-4 per cent of scan negative patients (P less than 0-01). Clinically overt advanced disease evolves from positive scan lesions. It is clear that a significant percentage of patients felt to have early breast cancer already have widely disseminated disease at the initial presentation. The biological significance of bone scan lesions makes a sensitive screening test for dissemination an essential part of the preliminary assessment of patients with breast cancer. Bone scans provide an excellent prognostic index at a patient's initial assessment.

The use of a concise standardized spiritual screening process to identify spiritual practices and needs of patients is essential for holistic nursing care. This interprofessional initiative resulted in the development of a spiritual screening tool that substantially increased Pastoral Services referrals to the patients who needed them and represents a significant opportunity in the delivery of holistic nursing care. Acute care settings may benefit from the adoption of a standardized chaplain referral process housed in the EMR and completed on the frontlines by trusted nursing staff providing patient and family centered care. This standardized spiritual screening process not only triggered essential services of Pastoral Services, but also helped identify and address important spiritual needs of hospitalized patients. The ability to design a tool responsive to the evolving, spiritual needs of patients can be challenging. Through collaboration with chaplains, nurses can be instrumental in creating instruments informed by available evidence in the empirical literature. Furthermore, engaging patients as a source of data during instrument design helps to ensure the content validity and practical usefulness of an instrument. Healthcare organizations might choose to implement and further evaluate/refine the new Spiritual Screening Tool and referral process developed as a result of this initiative.