Creating a culture of spiritual care

A general manager asked one of my chaplaincy colleagues about her vision for integrating pastoral care into their facility.  This inquiry is such a brilliant, open-ended question that opens up so many avenues.  Where might we begin?

In healthcare, it has been a long-standing tradition for the chaplain to take care of the spiritual and eternal needs of the patient’s soul while the doctor took care of the patient’s physical needs.  During the twentieth century, there was a complete separation of the roles of faith and medicine.   Physician Paul Tournier challenged this view of separation.  In his private practice, he forged a new type of medicine, which he called “the medicine of the person. ” The medicine of the person integrated both physical and spiritual health.  In the 1960s, palliative care was developed, and with it came a new idea of spiritual care or general pastoral care in medicine. This was an alternative to the traditional model of religious care, which was based solely on a person’s faith and denomination.

Tournier’s influence made its way into the medical systems through various avenues, of which palliative care was at the forefront.  Cicely Saunders, the doctor who founded the modern concept of palliative care, talked about the idea of “total pain” and the need to address a patient’s medical, psychological, social, and spiritual needs all at once.  Saunders herself was an evangelical Christian who recognised that everyone has a spiritual nature – each patient and every member of staff.  In her hospital, a chapel for Christian worship, was available for quite reflection for all, and spiritual care of a general nature was the role of every staff member and no patient should have their spiritual needs go unmet.

Fig 1. Generalist-Specialist x Broad-Narrow Spiritual Care Matrix

Saunders’ biopsychosocial-spiritual framework gave rise to the current generalist–specialist spiritual care model.  In this model, all staff are responsible for spiritual care at a general level which is expressed through holistic care, and concern for aspects of the patient’s well-being including their spiritual/religious dimension which is usually expressed through compassionate presence.  Compassionate presence is the ability of all staff members to be deeply present to the patients in their whole being with a concern about their whole life –­ family, faith, losses, griefs, hopes and cares.

In Saunders’ model spiritual care is integrated into the facility.  All staff receive training in primary spiritual care which includes training in understanding what might be necessary to the patients beyond their medical care, being a safe self-aware person, who is comfortable in their own skin and religious and spiritual beliefs who is able to create space for other to speak about the things pressing most closely on their heart.  Such a system might also include volunteers and pastoral carers who have been trained in general spiritual care and who have time to visit with patients hearing their perspectives.

In the generalist–specialist model, there are also specialist spiritual care practitioners who may be trained narrowly within one religious tradition and others who have been trained more broadly in aspects of personal formation, within which there are levels of expertise: foundational, advanced and expert.  The spiritual care practitioners who work to help scaffold people through times of change and spiritual adjustment have trained to a professional level.  Various training pathways exist in fields of spiritual direction, pastoral counselling, clinical pastoral education, and philosophical therapies that work with people’s reality.  These spiritual care practitioners provide spiritual care to a wide range of patients across the service, including patients who might describe themselves as spiritual but not religious and others who consider themselves to be neither religious nor spiritual.  In this system, there are also specific religious visitors who visit people of their own denomination or religion, who visit and pray, conduct rituals, offer blessings, or read sacred texts.  The distinctions here, are often described as ward-based visiting and faith-based visiting.  A comprehensive spiritual care service provides both.

The research team stressed the importance of adequate spiritual care training for all staff (including any volunteers and pastoral carers in a facility who have contact with patients with serious and life-limiting illnesses), as well as referral channels and access to specialist-level trained religious and spiritual care practitioners.

A multidisciplinary team of medical and spiritual care researchers recently conducted a meta-analysis scanning thousands of academic papers that focused on spirituality and medicine.  They then focused in on 371 papers concerning spirituality in serious illness and health and identified implications for patient care and health outcomes.  The team made three significant findings: (1) spiritual care needs to be incorporated into care for patients with serious illness; (2) spiritual care education needs to be integrated into the training of interdisciplinary teams caring for persons with serious illness; and (3) include speciality spiritual care practitioners in the care of patients with serious illness.

The research team stressed the importance of adequate spiritual care training for all staff (including any volunteers and pastoral carers in a facility who have contact with patients with serious and life-limiting illnesses), as well as referral channels and access to specialist-level trained religious and spiritual care practitioners.

In order to more fully appreciate the finding of this review, it might help to think of spiritual care in its broadest sense, as a 2×2 matrix where spiritual care is offered both at generalist and specialist levels through both broad and narrow expressions of spiritual and religious care, where all quadrants are needed to meet the ongoing spiritual needs of patients.  There is also overlap where narrow religious care often incorporates broad general spiritual care, and many specialist religious practitioners are also certified in broad specialist spiritual care. It is also possible that people hold different positions in the matrix depending on the role a carer is performing at a particular time for example, a nurse who may also be trained in a specific religious tradition who might also provided narrow-generalist care if needed.  

A vital function of an integrated matrix for a health facility would be to describe the scope of spiritual practice for each section, which clearly outlines the skills and capabilities, as well as the limitations of practice for each quadrant of the matrix.

Fig 1. Generalist-Specialist x Broad-Narrow Spiritual Care Matrix is drawn from my research in The Nature of Religious and Spiritual Needs in Palliative Care Patients, Carers, and Families and How They Can Be Addressed from a Specialist Spiritual Care Perspective