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PROFESSIONAL AND PRACTICAL APPLICATIONS
Today every agency, institution, and human service professional desiring to meet the full scope of human needs must give attention to spirituality. The next seven chapters provide examples of how this is being done in representative contexts, including health care, hospices, counseling, social work, and chaplaincies, each of which suggests possible replications and adaptations elsewhere.
On a more personal level, we shall see how āThe Canticle of Brother Sunā by St. Francis of Assisi can be a tool for meditation and self-refection to stimulate anyone's spiritual growth. Another effective tool is the spiritual life review, which can be used by individuals alone, in their activities as members of either religious or secular groups, or as a part of clinical services. It helps people deal realistically with spiritual issues related to their past, present, and future.
People from every walk of life will benefit from these chapters. They provide suggestions and hints on how to help others spiritually, resources to aid volunteer and professional service activities, and clues for cultivating one's personal spirituality.
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Chapter 7
Spiritual Care by Primary Health Care Providers
Allison E. Soerens
Over the past century, scientific and technological advances in the field of medicine have caused many health care providers to lose sight of the individual patients they are treating. In most cases, these professionals believe that health is merely the absence of disease. This simplistic view of health significantly impairs quality patient care by not recognizing that humans are multidimensional holistic beings. Borins (1984) asserts that the word āholisticā reemerged in the 1970s. It comes from the Greek word holos, meaning all encompassing. Those who view health as a positive sense of well-being or state of wholeness not only care for peoplesā physical needs, but for their psychological, emotional, social, and spiritual needs as well. Health care providers who genuinely provide holistic health care incorporate spiritual care into their practice. Understanding the essence of spirituality and the implications it has for an individual's health is critical to providing high-quality health care.
While some primary health care providers believe the notion that spirituality or religious involvement positively influences health and clinical outcomes is inconceivable, others are beginning to recognize the invaluable benefits of spiritual care on patientsā health. Both past and current research on the role of spirituality in health care has yielded supportive evidence of the positive influence of religion and spirituality on health. However, in the current fast-paced, cost-driven, high-tech health care environment, the significance of spirituality has been lost (Dyson, Cobb, and Forman, 1997). In addition, the lack of agreement on the definition and meaning of spirituality continues to impede progress in this area.
THE MEANING OF SPIRITUALITY
The definitions of spirituality are very diverse, yet arriving at a general consensus on the definition of spirituality is essential for research. Meaning and purpose in life, belief, and hope are universal hallmarks of human spirituality (Catterall et al., 1998). It is important to recognize that religious involvement is often a component of spirituality, but spirituality does not necessarily imply that a religious component is present. The ability to generalize research findings between these concepts is still being established. Catterall and colleagues (1998) define spirituality as āthe lived experiences that give meaning to life and deathā (p. 163). Lane (1987) further states, āThe human spirit is a fragile vessel holding the essence of who we areā (p. 332). Moberg (1997) supports this statement. He gives further insight into the meaning of spirituality by stating, āOne's spirit inevitably is implicated in everything we believe, do, and think, not in only a fraction of our behavior and thoughtsā (as quoted by Ellor, 1997, p. 2).
RESEARCH ON SPIRITUALITY AND HEALTH
Prior to discussing the positive influence spirituality has on health, it is important to note that critics in the mental health field such as Sigmund Freud, Albert Ellis, and Wendall Waters have boldly claimed that religiosity negatively influences health. However, religion is only one component of spirituality, and research in this area has not supported their negative claims. Their accusations appear to be mere opinions with little substantiating evidence. In fact, Koenig (1997) in response reviewed numerous research studies and found that they indicate the positive effect of religiosity on health. For example, he found that four out of ten patients admitted to a tertiary-care teaching hospital believed religion was the most important factor that enabled them to cope. In addition, individuals with a higher degree of spiritual well-being and religious involvement were less likely to be treated for depression, anxiety, and alcohol or drug abuse.
According to Levin, Larson, and Puchalski (1997), research has shown that spirituality positively influences a person's ability to cope, decision to participate in health promoting behaviors, degree of supportive networks, and overall sense of well-being. Spiritual well-being enhances one's inner strength (Burkhardt, 1989). According to Conco (1995), research supports the fact that those who are spiritually well have a higher sense of well-being than those who are not, regardless of the presence of acute or chronic illness. Studies have further shown that individuals who regularly nurture their spirituality through religious practices, compared to those who do not, have a lower incidence of high blood pressure, heightened ability to cope with depression, decreased use of hospital services, and healthier immune systems (Mitka, 1998).
Catterall and colleagues (1998) found that many patients cite spiritual care as a dimension that enhances their well-being. Conco (1995) conducted a qualitative research study to assess the nature of spiritual care patients received during hospitalization. She interviewed three men and seven women ranging from age thirty-five to eighty-six who had been hospitalized for varying illnesses. The participants identified spiritual caregivers as ministers, nurses, doctors, family, friends, and nonprofessional hospital personnel. They believed their ability to cope with illness and recover was directly influenced by spiritual care, and they identified decreased anxiety, increased comfort, hope, inner strength, acceptance, optimism, and well-being as positive outcomes of spiritual care. Research conducted by Clark and colleagues (1991) supports these findings. They found that the most significant contributions to recovery perceived by recently hospitalized patients were support and hope.
Brooke (1987) states that it is the spiritual dimension that enables older adults to find meaning in their lives and cope with age-related problems. Berggren-Thomas and Griggs (1995) found that one way older adults nurture their spirituality is through church attendance. They determined that the benefits of church attendance include social interaction, emotional support, enhanced self-esteem, and spiritual growth. The studies in Seeber (1990) also support the notion that spiritual well-being is critical to successful aging.
Conversely, Kazanjian (1997) found that patients who perceive themselves as alone and helpless respond to age-related problems and serious and terminal health conditions with confusion and despair. In addition, Mor, McHorney, and Sherwood (1986) found that bereaved individuals seek medical care more frequently, but are no more likely to be hospitalized. They suggest that this health-seeking behavior is an attempt to gain social support. Perhaps this hypothesis can be expanded to state that these individuals are seeking spiritual support. Dyson, Cobb, and Forman (1997) suggest that in order to be truly happy and at peace one must have a sense of purpose and meaning in one's life. Illness, suffering, and death challenge personal meaning. Health care providers who care for their patientsā spirituality assist them in developing effective coping skills and finding meaning in their life experiences.
This body of research illustrates the positive links between spirituality and health. Furthermore, it supports the hypothesis that the integration of spiritual care into therapy by primary health care providers enhances the quality of care patients receive. However, despite the vast body of evidence supporting the correlation between spirituality and positive health outcomes, spiritual care is still an underutilized therapy modality by health care providers.
CURRENT PRACTICE
The nursing community has been known for its commitment to providing holistic patient care, of which spiritual care is a necessary component. David B. Larson, MD, president of the National Institute for Health Care Research, believes that physicians are ready to integrate spiritual care into their practices, providing there is adequate scientific research to support its use (Mitka, 1998). Primary health care providers are in an excellent position to integrate the spiritual with the physical and psychosocial, providing true holistic care. For many individuals, religious beliefs and practices are an essential component of their spirituality.
Maugans and Wadland (1991) interviewed 115 physicians in primary health care and 135 patients whom they cared for, to investigate the perceived role of religion in health care. They found that actual inquiry regarding the religious beliefs and practices of a patient was infrequent. The most reported opportunity to address these issues by both patients and physicians was in the context of a serious or life-threatening event. However, 30 percent of both groups also recognized health care maintenance visits as an acceptable time to assess religiosity. Two barriers to providing spiritual care identified by this study were a lack of formal training and a belief that it is primarily the patient's responsibility to address religious issues. However, over 40 percent of the patients welcomed physician inquiry about spiritual and religious matters. Greene and colleagues (1987) support this finding. They concluded that patients do respond favorably to physician-initiated inquiries regarding spiritual well-being.
BELIEFS ABOUT PROVIDING SPIRITUAL CARE
The author conducted an exploratory, qualitative, research study to assess primary health care provider studentsā attitudes and beliefs regarding spiritual care. A seven-item interview guide with open-ended questions concerning spiritual care was designed for this purpose. The following questions were utilized during the interview process:
How do you define spirituality?
Do you feel you have sufficient skills and knowledge to nurture patientsā spirituality?
Have you received any formal training on spiritual care? If so, was it through a required or elective class?
How can a primary health care provider give spiritual care to patients?
How often do you participate in this type of care?
What are the barriers, if any, to providing spiritual care?
Do you believe spirituality has a role in the delivery of health care by primary care providers? Explain your answer.
A convenience sample of ten nurse practitioner and medical students were interviewed. Confidentiality of the respondents was assured. Consent was implied by completion of the interview.
Participants defined spirituality as a person's connection to a purpose or calling; faith in a higher being; sense of purpose in life, meaning, value, and direction; an inner connection with one's soul; a relationship with God; and a belief system that helps a person find one's inner self. When asked if they had received any formal training on spiritual care, 50 percent responded āno,ā while only 10 percent stated they had received education regarding spiritual care through a required course. Furthermore, 60 percent of the respondents stated that they did not feel they had sufficient skills and knowledge to nurture a patient's spirituality. However, they unanimously believed spirituality had a role in the delivery of health care by primary health care providers. In addition, they identified a variety of interventions that primary care providers can implement to enhance their patientsā spirituality. These included listening, being present, giving positive feedback, offering a supportive attitude, facilitating expression, exploring spiritual resources, being aware of one's own spirituality, providing holistic assessment, conveying an interest and willingness to discuss spiritual matters, offering support of religious personnel, and praying with patients. Barriers to giving spiritual care were perceived as a lack of time, limited knowledge base, lack of rapport, environmental constraints, and patientsā unwillingness to discuss spiritual matters.
Due to small size, the findings of the study cannot be generalized to a larger population, although they have several implications. This study implies that there is a lack of education regarding spiritual care of patients in academic health care study. As is evident here and in Chapter 4, research supports the positive effects of spirituality on health. Clearly, it is an integral part of holistic health care. Future investigation of primary health care provider curricula is necessary. In addition, although half of the respondents did not believe they were equipped to provide spiritual care, all were able to identify spiritual care interventions. This suggests that, although advanced course work, seminars, and workshops heighten an individual's knowledge and ability to give spiritual care, many individuals, as spiritual beings, intuitively know how to nurture the spiritual realm. Finally, time was the most frequent...
