Along with sexuality, many healthcare providers avoid approaching the topic of spirituality with their patients. Unfortunately, the reductionistic approach in Western medicine, which focuses primarily on the physical symptoms of illness, denies the importance of treating the “whole” person, including psycho-spiritual aspects of healing. Many factors are responsible for the lack of providing spiritual care, including discomfort among healthcare providers, uncertainty about the role of spirituality and religion in practice, medical institutions ill-prepared to address psycho-spiritual issues, lack of time, and Western cultural values.
Spiritual care as defined in the literature is “recognizing, respecting, and meeting patients’ spiritual needs” (Baldacchino, 2015). Implementing spiritual care can be accomplished through facilitating religious/spiritual participation, supporting, and showing empathy by listening and talking, promoting a sense of well-being by helping to find meaning and purpose in patients’ illness and life, and referring to chaplains and pastors.
According to a Pew Research survey conducted in 2017, an increase in 27% of adults identify as “spiritual but not religious.” More than half (59%) of Americans report feeling a deep sense of peace and well-being. This change has occurred among men and women, whites, blacks, Hispanics, different ages, political party affiliation, and educational levels. Furthermore, 48% of identity is religious and spiritual, while 6% say they are religious but not spiritual. Additionally, 18% say they are neither religious nor spiritual.
What is spirituality?
A universal definition of spirituality is simultaneously complex and elusive; we can define spirituality as a sense of connection to something bigger than ourselves, typically searching for meaning and purpose in life. Many people describe a spiritual experience as sacred, transcendent, or a deep sense of connectedness. A further perspective views spirituality as a continuous journey for discovery and self-realization. Christina Puchalski, MD, asserts, “spirituality is the aspect of humanity that refers to the way individuals express meaning and purpose and experience their connectedness to the moment, to self, to others, to nature, and the significant and sacred.” Although religion and spirituality overlap, they are not the same. Spirituality is a broader concept encompassing the search for meaning, value, and connection. In contrast, religion involves an organized belief system promoted and maintained through institutions, including rules of behavior, practices, rituals, and traditions.
Neurobiological spiritual home
Neuroscientists from Yale and Columbia Universities scanning brains among diverse subjects found a “neurobiological home” for spirituality. Experiencing something greater than ourselves, whether it involves communion with God, nature, or humanity, is in a specific part of our brain, the parietal cortex. Decreased activity in the parietal cortex may indicate that individuals lose some sense of self while connecting with something greater during spiritual experiences. The experience of “oneness” with others, rooted in most religions, can foster compassion and kindness. Furthermore, researchers discovered that spiritual experiences involve significant changes in perception, moderating the effects of stress on mental health.
Unlock unlimited CE with Elite Nursing Passport Membership.
Spirituality, resilience and recovery
Spirituality in promoting mental health is strongly associated with resilience, the ability to overcome adversity. Moreover, a World Health Organization (WHO) study that spirituality and religion (S/R) are strongly positively related to quality of life for people across 18 countries (Cook & White, 2018). Studies indicate that religion and spirituality are protective factors against depression and assists in recovery. Substantial evidence suggests positive associations between spirituality and longevity, reduced substance misuse, quicker healing after surgery, cancer recovery, and chronic pain management. Spirituality may also play a role in neuroplasticity, the ability of the brain to mitigate the negative consequences of trauma, thereby, strengthening resilience.
Furthermore, S/R plays a significant role in individuals’ understanding and making sense of their suffering. Many individuals interpret their illness from a spiritual perspective. In turn this spiritual perspective enables individuals to find hope, peace, comfort, strength, acceptance, and connection. Adapting to chronic illness requires an individual to find meaning, purpose, and a new identity. Spirituality can act as a vehicle during this challenging adaptation process. Furthermore, spiritual practices can bridge an individual’s former occupational identity to an evolving identity. The continuity of spiritual practices helps ground an individual during periods of chaos and uncertainty.
On a community level, diverse religious, spiritual, and cultural practices can promote human kindness, compassion, and relationships through moral and spiritual consciousness fostering social participation, harmony, and a sense of belonging. Among many religions, occupations such as meditation, prayer, singing, chanting, charity, and social action offer meaning, purpose, and connection. However, certain religious beliefs ascribing poor health to adverse actions in a previous life, often impede acceptance and adaptation to illness. Feelings of guilt and self-blame can also arise when individuals encounter illness.
Barriers to integrating spirituality in healthcare
Findings from studies (McLean et al., 2003) suggest that one-third of patients feel that their physicians should be aware of their religious and spiritual beliefs. Nevertheless, doctors rarely discuss S/R beliefs with their patients. The reasons for avoiding discussions revolving around S/R include:
- Fear of projecting their belief system onto patients.
- Lack of time and training.
- Lack of physicians own religious and spiritual beliefs.
- Uncertainty about patients who feel comfortable/uncomfortable discussing the topic.
- The assumption that those in need will seek spiritual counseling.
Given competing issues (depression, suicide ideation, domestic violence, substance misuse, etc.), demands on time during an office visit to address S/R beliefs are often not prioritized.
Although the Occupational Therapy Practice Framework (OTPF-4) includes spirituality and religious expression as an occupation, many occupational therapy practitioners remain uncertain about the role of spirituality in practice. Many occupational therapy practitioners recognize the value of spirituality in their personal and work lives and identify the importance of spirituality in health and well-being for their patients/clients. Nevertheless, occupational therapy practitioners avoid the subject. In addition to the lack of understanding about the role of S/R, occupational therapy practitioners report inadequate skills in addressing the topic, fear offending their patients, projecting their own beliefs, perceive limits regarding S/R issues, and are uncertain about obtaining reimbursement for incorporating S/R into their practice.
The results of a study (Egan & Swedersky, 2003) exploring spirituality in occupational therapy practice identified four themes including:
- Dealing with religious concerns – Awareness of and acceptance of diverse religious and secular beliefs. Furthermore, appreciation and respect for the diversity of views resulted in a hesitancy to address S/R concerns for fear of imposing personal beliefs on patients.
- Addressing suffering – Therapists reported this as a moral responsibility and necessary before patients could progress in their rehabilitation.
- Encouraging the self – Getting to patients uniqueness and understanding their values to foster meaningful occupations for promoting health and well-being.
- Therapist development – Therapists gained personal spiritual insights through therapeutic interactions with patients.
Incorporating spirituality into practice
Initiating a spiritual assessment can be the first step for integrating spiritual care into practice. The HOPE assessment involves five questions addressing core aspects of spirituality within the medical environment. This assessment can facilitate a meaningful discussion with diverse populations whose spirituality does not affect traditional religious practice. It also allows for those whose religion, God, or prayer is essential and can volunteer this information.
The HOPE Spiritual Assessment includes the following five questions:
H: Sources of hope, meaning, comfort, strength, peace, love, and connection. This question can facilitate a discussion about internal support and what sustains an individual to keep going in the face of adversity.
O: Organized religion. This question involves information about membership in a religious community and its role in health, resilience, and connection.
P: Personal spirituality and practices. This question involves belief in God or a higher power and meaningful spiritual practices.
E: Effect of medical care and end-of-life issues. This question involves possible conflicts about S/R beliefs and medical care/decisions, the impact of illness on spiritual participation, and access to S/R resources (chaplain or community spiritual leader).
Preventative healthcare and spirituality
For patients who do not identify as “religious,” clinicians can educate patients about complementary and integrative health approaches such as meditation, yoga, tai chi, listening to sacred music, and spending time in nature, to name a few. Many of these approaches are preventative and cost-effective. Throughout the world, these non-traditional approaches are the mainstay of healthcare. Cultural competence is needed to ensure that these complementary approaches are congruent and consistent with a patient’s values and belief system. Many hospitals offer complementary and integrative health approaches that alleviate pain associated with illness and provide psycho-spiritual benefits.
Spirituality and religion play a vital role in health promotion, prevention, recovery, and adaptation to chronic illness. Spirituality and religion provide resources for coping, finding meaning and purpose in suffering, and life fulfillment. Our current healthcare landscape focusing on productivity, symptom management, efficiency, and profit often results in diminished humanistic care.
The client/patient-centered and holistic movement can hopefully redress the dissatisfaction with care often experienced by patients/clients when meeting their psycho-spiritual needs. Furthermore, medical education is remiss in preparing physicians, nurses, therapists, and other ancillary staff in embedding spiritual care into practice. While defining spirituality tends to be a cumbersome task, its role as a protective factor is potent and essential.
- American Occupational Therapy Association (2020). Occupational Therapy Framework Domain & Process- Fourth Edition. American Journal of Occupational Therapy,74, 7412410010. doi: 10.5014/ajot.2020.74S2001
- Baldacchino, D. (2015). Spiritual Care Education of Health Care Professionals. Religions, 6, 594–613. doi: 10.3390/rel6020594
- Cook, C.H. & White, N.H. (2018). Resilience and the role of spirituality. Oxford textbook of public mental health. Oxford: Oxford University Press, 513-520. Retrieved from https://dro.dur.ac.uk/27794/2/27794.pdf
- Egan, M. & Swedersky, J. (2003). Spirituality as Experienced by Occupational Therapists in Practice. American Journal of Occupational Therapy, 57, 525-533. doi: 10.5014/ajot.57.5.525
- Gowri, A. & Hight, E. (2001). Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment. Am Fam Physician, 63(1),81-89. Retrieved from https://www.aafp.org/afp/2001/0101/p81.html
- Lipka, M. & Gecewicz, C. (2017). More Americans now say they’re spiritual but not religious. Pew Research Center. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/
- MacLean, C.D., Susi, B., Phifer, N., Schultz, L. et al. (2003). Patient Preference for Physician Discussion and Practice of Spirituality: Results from a Multicenter Patient Survey. J Gen Intern Med.18(1): 38–43. doi: 10.1046/j.1525-1497.2003.20403.x PMCID: PMC1494799
- Miller, L., Balodis, I.M., McClintock, C.H. et al. (2019). Neural Correlates of Personalized Spiritual Experiences, Cerebral Cortex, 29, (6), 2331–2338. doi: 10.1093/cercor/bhy102
- Puchalski, C.M., Blatt, B., Kogan, M. Butler, A. (2014). Spirituality and Health: The Development of a Field. Academic Medicine, 89(1), 10-16. doi: 10.1097/ACM.0000000000000083