Spiritually Competent Practice in Health Care

John Wattis, Stephen Curran, Melanie Rogers

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781351743686
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This book will be of tremendous use to all healthcare professionals from physicians to nurses to social workers, rehabilitation therapists, and chaplains. The pathway taken here is a sensible and reasonable one, emphasizing a patient-centred approach that underscores the importance of spiritually competent care. The Editors do an excellent job of describing how to integrate spirituality into patient care for all of the different healthcare professionals. They also emphasize the importance of an evidence-based approach that is guided by research. This book provides superb guidelines that will be enormously helpful to every healthcare professional.

Harold G Koenig, M.D., Professor of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina

This practical guide tackles the important issues of spirituality in health care, emphasising the role of organisations in developing a culture of leadership and management that facilitates spiritual care. Spirituality is a central part of holistic care that addresses physical, mental, emotional and spiritual aspects of care in an integrated way.

The chapters are written by experts in their fields, pitched at the practitioner level rather than addressing 'spirituality' as a purely theoretical concept. Each one describes the realities of spiritually competent practice and show how it can be taught and put into practice in a variety of areas and settings, including

Undergraduate and Postgraduate education

Acute healthcare settings

Mental health

Primary care

End of Life Care

Creative organisations

Social services

Ideal for practitioners, educators, trainees and managers in nursing and healthcare, the book is also relevant reading for occupational therapists, physiotherapists, social workers and psychologists.

1 What Does Spirituality Mean for Patients, Practitioners and Health Care Organisations?

John Wattis, Stephen Curran and Melanie Rogers

‘Why me?’ asks the patient newly diagnosed with advanced cancer.

‘What did they die for?’ asks the mother of a soldier killed in the Afghan campaign, interviewed on the radio.

‘How can I look after her at home without any support?’ asks the husband of a woman being discharged from hospital with end-stage heart failure.

‘How can I carry on?’ asks the patient with severe depression.

Most of us will have heard questions like these in our daily work and sometimes from our friends and family. Where does the cancer patient find the meaning in what is happening to them?

How can bereaved people resolve their grief?

How can families cope when faced with the practical and emotional pressures of caring for their dying loved ones?

The answers are personal and they depend on many factors. Cancer sufferers may find strength from the compassion of those who care for them and even find personal meaning in facing suffering and death. The mother of the soldier, whilst sad that Afghanistan is still not stable and the Western intervention did not achieve all that it aimed for, nevertheless may have found some consolation in the fact that her son died for a purpose and for values that he and she both embraced. The husband of the woman with end-stage heart failure may find strength to cope from the kindness and practical help of friends, family and the community nursing/support team. The person with severe depression may initially need medication and even inpatient care if actively suicidal. In the recovery phase they may need to find hope and meaning through psychotherapy and connecting with other people. How people respond to such crises depends on their own starting points, their life circumstances and the support they receive from family, friends and professionals. This book is about how health and social care professionals can play their part in supporting patients and their relatives and carers as they face the challenge and distress of life-changing, sometimes life-threatening, illness.

The issues of meaning, purpose, hope, connectedness and values are at the core of our understanding of spirituality. Victor Frankl, an Austrian Jewish psychiatrist who survived three years in Nazi concentration camps, stressed the importance of the search for meaning in life (1). His pre-war work included successful initiatives in suicide prevention but he refined his ideas through observing how he and others dealt with the immense suffering in the concentration camps. According to Frankl, meaning could be found in three ways: through love, through dedication to a life’s work, and through how one coped with unavoidable suffering. He developed a form of existential therapy which he called logotherapy (1). For him, existential issues were related to God and spirituality (2).

Spiritual Care Competencies

Van Leeuwen and Cusveller (3) reviewed the nursing literature to produce a list of spiritual care competencies for undergraduate education of nurses. This in-depth review defined six competencies in three domains. The competencies were backed up by illustrative vignettes and descriptions of key behaviours. In Box 1.1 we have adapted these competencies to apply to all health and social care practitioners and clustered them in the three domains (again adapted) identified by the original authors. We believe these can be a basis for identifying shared competencies needed by all practitioners.

Providing good spiritual care is part of whole-person, or holistic, care. Useful though spiritual competencies are in defining educational objectives, they are not enough. Holistic, or whole-person, care addresses physical, mental, emotional and spiritual needs and involves more than just ‘possessing’ competencies. It is not just about the competencies but whether and how we apply them in practice. This, in turn, is influenced by the work environment which can facilitate or obstruct practitioners in providing quality care. Holistic care demands a person-centred approach. We need to see the person using the service as a whole person with a life story, a sense of meaning and purpose, emotions and thoughts embedded in a matrix of relationships and shared beliefs. They are not just a problem to be fixed. Too often the focus on technical and economic issues (including restrictions on available time) makes it exceedingly difficult for practitioners to deliver care which supports the person in all aspects of their need. This is to the detriment not only of the service user but also can result in a demoralized, dispirited ‘burnt out’ workforce.

Box 1.1 Spiritual Care Competencies*

Spiritual self-awareness and use of self

1. Spiritual self-awareness and sensitivity to the needs of patients with different beliefs and values, and cultural and religious background.

2. Spiritual issues addressed with patients in a caring and culturally sensitive manner.

Spirituality in practice

3. Collection of information about spirituality and identification of spiritual needs.

4. Discussion with people using the service and relevant team about how spiritual care provision, planning and reporting are carried out.

5. Provision and evaluation of spiritual care with people using the service and team members.

Quality assurance and improvement

6. Contribution to quality assurance and improvement of spiritual care within the organization.

*Adapted from van Leeuwen R, Cusveller B. Journal of Advanced Nursing. 2004; 48 (3): 234–246.

Spiritually Competent Practice

It is not easy to provide a good definition of spirituality. Later in this chapter we provide two examples, one brief and one meticulous in its detail. We could have provided many others from a variety of sources; however, we have found, as we have looked into this area, that it is much easier to describe spiritually competent practice than to define spirituality. This is the latest iteration of how we would describe it:

Spiritually competent practice involves compassionate engagement with the whole person as a unique human being, in ways which will provide them with a sense of meaning and purpose, where appropriate connecting or reconnecting with a community where they experience a sense of well-being, addressing suffering and developing coping strategies to improve their quality of life. This includes the practitioner accepting a person’s beliefs and values, whether they are religious in foundation or not, and practising with cultural competency.

This is based on a previously published description (4), in turn based on a description developed from observational research in occupational therapy by one of our colleagues and co-author of two chapters in this work, Janice Jones (Chapters 3 and 7). We originally modified the description to make it generally applicable to all health care disciplines. Later modifications include adding the adjective compassionate to emphasise the central role of compassion in spiritually competent practice.

We want to make an important distinction between competencies as the building blocks of what can be taught to students and assessed and competent practice which requires the presence of other factors to be fully realised. We can express this in the equation:

Spiritually competent practice = Spiritual competencies + (Compassionate motivation commitment) + Opportunity

Competencies have been discussed, and an idea of how these can be framed is given in Box 1.1. However, compassionate motivation and commitment in the practitioner is essential to apply these. This in turn can be supported or obstructed by the organisation, depending on how it treats its staff and whether it promotes systems of care that provide time for compassionate, committed, spiritually competent care.

Chapter 3 in this book takes a closer look at spiritually competent practice. Chapter 4 looks at how two practitioners conceptualise these issues and how spiritually competent practice relates to other concepts in health and social care.

Definitions of Spirituality and Religion and Their Limitations

Spirituality

Spirituality seems to be a ‘tricky’ or nebulous concept to define (5–7) and that is why we have chosen to focus instead on the more easily described area of spiritually competent practice. However, we do not want to duck the issue of defining spirituality completely. We first address it by looking at our own research into how health care educators define it. When, as part of a small study (8), a group of health care educators were asked to provide their own personal definitions of spirituality, several themes emerged:

• That self, person (or personhood) and being were central to understanding spirituality, both in the context of teaching and in the delivery of care.

• That spirituality gave a sense of direction, meaning and purpose to life.

• That spirituality (far from being ‘other-worldly’) was practical, affecting how people lived and acted towards other people and the outside world.

Spirituality was regarded as something that could not be seen or touched but nevertheless could be experienced. This led to a need to use different methods to teach about spirituality focused on experiential learning rather than traditional methods (8). This is discussed further in Chapter 5.

How do the issues our health care educators identified compare with conventional definitions, and how does spirituality in this context differ from religion? Hill and Pargament (9), having commented that religion and spirituality are related rather than independent concepts, characterise spirituality as the ‘search for the sacred’ but go on to assert that religion is also characterised by the same search. This reflects the North American tendency to see spirituality as less distinct from religion than is the case in the UK where Cook (10), after a careful examination of existing work, developed a definition which embraced both the secular and the sacred positions:

Spirituality is a distinctive, potentially creative and universal dimension of human experience arising both within the inner subjective experience of individuals and within communities, social groups and traditions. It may be experienced as a relationship with that which is intimately ‘inner’, immanent and personal within the self and others, and/or as a relationship with that which is wholly ‘other’, transcendent and beyond the self. It is experienced as being of fundamental or ultimate importance and is thus concerned with meaning and purpose in life, truth and values (10).

This definition embraces personhood and relationship, sense of direction, meaning and purpose. To some extent, the emphasis on the fundamental nature of spirituality also accords with our respondents identifyin...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Editors
• Contributors
• 1 What Does Spirituality Mean for Patients, Practitioners and Health Care Organisations?
• 2 Spirituality in Western Multicultural Societies
• 3 Spiritually Competent Practice in Health Care: What Is It and What Does It Look Like?
• 4 How Two Practitioners Conceptualise Spiritually Competent Practice
• 5 How Can Spirituality Be Integrated in Undergraduate and Postgraduate Education?
• 6 Supporting the Practitioner
• 7 Spirituality in Acute Health Care Settings
• 8 Spirituality and Mental Health
• 9 Spirituality in the Primary
• 10 Spiritual Teamwork within End of Life Care
• 11 Creative Organisations: Spirituality and Creativity in a Health Setting
• 12 Using Social Role Valorisation to Make Services Sensitive to Spiritual Need
• 13 A Vision for the Future
• Index