Reflecting on Clinical Practice Spiritual Care for Healthcare
Professionals
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Spiritual Care
for Healthcare
Professionals
Reflecting on clinical practice
TOM GORDON
Chair
Chaplaincy Training Advisory Group, Scotland
EWAN KELLY
Programme Director
Spiritual Care and Healthcare Chaplaincy, NHS Education for Scotland
Senior Lecturer in Pastoral Theology, University of Edinburgh
and
DAVID MITCHELL
Programme Leader, Healthcare Chaplaincy
Lecturer in Palliative Care
University of Glasgow
Foreword by
STEPHEN THORNTON CBE
Chief Executive
The Health Foundation
Radcliffe Publishing
London • New York
Radcliffe Publishing Ltd
33–41 Dallington Street
London
EC1V 0BB
United Kingdom
www.radcliffepublishing.com
Electronic catalogue and worldwide online ordering facility.
” 2011 Tom Gordon, Ewan Kelly and David Mitchell
Tom Gordon, Ewan Kelly and David Mitchell have asserted their right under the Copyright,
Designs and Patents Act 1998 to be identified as the author of this work.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without the prior permission of the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN-13: 978 184619 455 9
Typeset by Phoenix Photosetting, Chatham, Kent
Contents
Foreword vi
About the authors viii
Acknowledgements ix
Introduction 1
The art of spiritual care
1 Self-awareness 5
2 Faith, belief and culture 12
3 Communication issues and skills 22
4 The healthcare team 33
5 Competence in spiritual care 44
Assessing and responding to spiritual needs
6 Disentangling spiritual and religious care 57
7 Spiritual assessment 70
8 Responding to spiritual and religious needs 79
Working with the complexities of spiritual care
9 Ethics and values in spiritual care practice 102
10 Loss, grief and bereavement 112
The personal impact of spiritual care
11 Nurturing our spiritual selves 125
12 The institution and staff support 139
The unique role of the chaplain
13 Chaplain to the institution 148
Index 157
Foreword
Here is a book that fills a gap for all those seeking to understand the spiritual
components of healthcare and how to meet them. Written for all healthcare
professionals, including chaplains and spiritual care workers, it offers insights
and practical advice aplenty.
This book does not pull its punches. ‘The core skills of a healthcare
chaplain,’ the authors write, ‘include enabling others to articulate their sense
of spirituality, acting as a resource for staff and volunteers in their assessment
and delivery of spiritual care. Encouraging healthcare professionals to develop
their self-awareness and competence with regard to spirituality and spiritual
care is an essential capability and competence for the chaplain.’ Just reading
Chapter 1 will be a real challenge for many.
It is said that times are tough for healthcare chaplains in the NHS today. I
think it was ever thus. As a young trainee administrator in the early 1980s, I
recall checking admission forms from the night before in an unnamed teaching
hospital somewhere in the north of England. As was so often the case, the
section marked ‘religion’ had been left blank, so I was instructed to write in ‘C
of E’. No shared decision making there, then! Indeed, there has never been a
golden age where the spiritual preferences and desires of patients, carers and
staff were taken seriously and given their due place. It was and will always be
counter-cultural to some extent.
What this book does is to provide practical help to those with a responsibility
to lead in this field. It starts powerfully by stating that the greatest difficulty is
overcoming the confusion between spiritual care and religion. ‘Many people
when saying the word “spiritual” are actually thinking “religion”,’ say the
authors. ‘Indeed, not that long ago a spiritual assessment on admission to a
hospital ward was a single question: “What religion are you?” Although religion
may feature in a person’s spirituality, it will be alongside a host of other aspects,
such as family, friends, work, health, love and leisure activities.’
The book then goes on to offer practical help and advice for occasions when
one would expect the spiritual components of care to be at their most intense:
loss, grief, bereavement, staff support, etc. And it does so by asking the reader,
chapter by chapter, to undertake a ‘reflective activity’, a technique that I am sure
has wider utility in all aspects of healthcare management and decision making.
FOREWORD vii
But what marks out this book for me is Chapter 11: Nurturing our spiritual
selves. ‘How,’ ask the authors, ‘do we as healthcare professionals… process our
experiences of supporting distressed service users and the emotions, issues and
questions that are raised in us? Where is the balm in our lives to soothe and care
for our souls? How may we learn and grow in an understanding of ourselves
and our practice, as individuals and as teams working in relationship, from
reflecting on experience?’ So, if you want my advice, this is the place to start.
Stephen Thornton CBE
Chief Executive, The Health Foundation
Non Executive Director, Monitor
Expert Member, Department of Health National Quality Board
June 2011
About the authors
Tom Gordon is a Church of Scotland minister who for 15 years was a hospice
chaplain with Marie Curie Cancer Care (MCCC) in their Edinburgh hospice
and acted as adviser to MCCC in spiritual and religious care. He also served
for several years as President of the Association of Hospice and Palliative Care
Chaplains, and is currently chair of the Chaplaincy Training Advisory Group in
Scotland. He now devotes his time to writing and lecturing, as well as facilitating
the Acorns Bereavement Support Programmes in Edinburgh and the Lothians.
Ewan Kelly is a former junior doctor who has spent most of his working life
as a healthcare chaplain and a university teacher. His experience includes
chaplaincy both in two teaching hospitals and in an independent hospice. He
currently works with NHS Education for Scotland on the strategic development
of spiritual care and healthcare chaplaincy in NHS Scotland as Programme
Director for Chaplaincy and Spiritual Care. In addition, he has a part-time
position as Senior Lecturer in Pastoral Theology at the University of Edinburgh.
David Mitchell is the programme leader for healthcare chaplaincy and
university teacher in palliative care at the University of Glasgow. He is also
a parish minister in West Cowal, Argyll, distance learning tutor for Edith
Cowan University, Western Australia, and executive member of the UK Board
of Healthcare Chaplaincy. His previous experience includes time as a chaplain
and lecturer in palliative care with Marie Curie Cancer Care, as a consultant in
healthcare chaplaincy for NHS Education for Scotland, and as joint editor of
the Scottish Journal of Healthcare Chaplaincy.
Acknowledgements
The authors gratefully acknowledge the support and affirmation of many
colleagues who have been or are currently involved in healthcare chaplaincy
throughout the UK, as well as professional colleagues from many other
healthcare disciplines. These individuals have, specifically and unknowingly,
been a great asset during the conceptualisation and preparation of this book.
In particular, many thanks are due to Georgina Nelson and Mark Stobert for
generously giving their time and insight when reviewing the manuscript at draft
stage, to Gillian Nineham and Jamie Etherington at Radcliffe Publishing for
their unfailing encouragement and guidance, and to Stephen Thornton for his
willingness to write the Foreword and for the generosity of spirit contained in
his words.
We are also grateful to SPCK and Bloodaxe Books for permission to repro-
duce the poems by Kathy Galloway and Stewart Conn.
Introduction
Professional healthcare organisations and health departments regularly include
statements in their codes of conduct, professional guidelines, standards and
capability and competency frameworks that spiritual care is an integral part of
the practitioner’s professional role.1–5
The guidance for NHS staff in the publication Spiritual Care Matters
states:
Spiritual care in the NHS must be both inclusive and accepting of human differ-
ence. As we learn to listen better to the particular needs of different people, so
we equip ourselves for work that is more fulfilling and effective. The provision
of spiritual care by NHS staff is not yet another demand on their hard pressed
time. It is the essence of their work and it enables and promotes healing in the
fullest sense to all parties, both giver and receiver, of such care.6
This book has been written to tease out what these numerous statements,
guidelines and standards mean, and to equip healthcare professionals with
the knowledge, skills and competence to provide this ‘essence’ of spiritual care
within their professional practice. The book also aims to guide the reader in
exploring how spiritual care is fundamentally relational in nature and inherent
in the professional art of providing healthcare.
The authors expect this book to encourage healthcare professionals to be
open to the enormous breadth and diversity in individual spirituality, and how
this can enhance and develop healthcare practice. However, there are a num-
ber of overarching questions on which the authors have a clear response. For
example, who provides spiritual care? What is the relationship between spiritu-
ality and religion? What is the relationship between spirituality and humanism
or atheism?
WHO PROVIDES SPIRITUAL CARE?
The authors share the view expressed above, and consider that all healthcare
professionals have the potential to provide spiritual care and can do so as part
of their regular practice. However, as with all aspects of healthcare, spiritual
care can have a complexity that will require specialist knowledge, expertise
1
2 SPIRITUAL CARE FOR HEALTHCARE PROFESSIONALS
and experience to assess and meet the needs of patients and their carers,
and this expertise is provided by a healthcare chaplain or a specialist spiritual
care provider.
SPIRITUALITY AND RELIGION
The greatest difficulty in spiritual care is overcoming the confusion with religion.
Many people when saying the word ‘spiritual’ are actually thinking ‘religion.’
Indeed, not that long ago a spiritual assessment on admission to a hospital ward
consisted of a single question: ‘What religion are you?’ Although religion may
feature in a person’s spirituality, it will be alongside a host of other aspects, such
as family, friends, work, health, love and leisure activities.
The authors firmly believe that the only way to understand spirituality
and its relationship to religion is to start within ourselves. The first chapters
in this book aim to do just that. The reader is encouraged to work through a
process of self-awareness and then to integrate their experiences of faith, belief
and culture to form an understanding of their spirituality, and to appreciate
the diversity of spirituality. In Chapter 6, the complexities of the relationship
between spirituality and religion are explored by ‘disentangling spiritual and
religious care’.
SPIRITUALITY AND HUMANISM
Another common misconception is that spirituality is irrelevant to those who
adopt a secular, atheist or humanist perspective on life and living. All people,
regardless of their life stance, have an innate spirituality. Indeed most of the
recent developments in standards, guidelines and competences in spiritual
and religious care have been informed and embraced by representatives of the
humanist societies. There are also humanists employed and serving in NHS
chaplaincy services providing spiritual care. The authors’ view is that spirituality
is individual to each person and can include all religious faiths, belief groups
(such as humanists), and those of any life stance.
WHO IS THIS BOOK FOR?
First and foremost, this book is a practical guide for healthcare professionals of
all disciplines. It encourages the reader to reflect on their personal and profes-
sional experiences and perceptions of life, health, illness, dying and death. It
guides the reader through the core skills of spiritual care, and promotes recogni-
tion of their natural abilities and instincts. Both through experience and through
the use of case scenarios and reflective activities this book seeks to earth spiritual
care in day-to-day professional practice.
INTRODUCTION 3
The book has also been prepared as a core textbook and resource for fur-
ther education and higher education institutions. The content has its roots in
spiritual and religious care capability and competency frameworks that are
recognised by the UK Departments of Health, NHS education specialists and
healthcare chaplaincy organisations. As such it is a valuable resource for devel-
oping course materials and integrating spiritual care within new and existing
healthcare programmes at all levels. The book is structured to aid reflective
practice and to facilitate the development of self-awareness. It is not so much a
traditional textbook as an instructional guidebook. The underlying premise of
the book is the authors’ belief that a healthcare practitioner’s humanity, the self,
is the most effective therapeutic tool that they possess.
The book is also a resource for healthcare chaplains. At the end of each
chapter there is a section devoted to the complexity of the topic and the
specialist knowledge, skills and abilities required of the chaplain or spiritual
care lead.
USING THIS BOOK
The first chapters in this book lead us to explore the art of spiritual care by encour-
aging us to focus on our self-awareness of the core elements of spiritual care:
➤➤ how we understand spirituality (Chapter 1)
➤➤ how faith, belief and culture influence our spirituality (Chapter 2)
➤➤ how we can develop and use communication skills in spiritual care
(Chapter 3)
➤➤ how teamwork can support spiritual care (Chapter 4)
➤➤ how we can recognise and develop competence in spiritual care (Chapter 5).
Through each of these chapters we first look at ourselves and explore what we
think about spirituality, religion, life, health, illness, dying and death. From
this self-awareness we then move out to consider how our own understanding
of spirituality can support us in our personal and professional knowledge, skills
and actions. The process of self-awareness is then used to guide us to consider
how we might provide quality and informed spiritual care as part of our every-
day professional practice.
From this initial understanding of spiritual care the book then goes on to
add depth to spiritual care practice by encouraging the reader to consider the
core elements of spiritual care in more detail, and it adds increasing complexity
to enable healthcare professionals to appraise and develop their personal and
professional practice. This is approached through chapters that explore the more
complex aspects of providing spiritual care, namely:
➤➤ disentangling spiritual and religious care (Chapter 6)
➤➤ spiritual assessment (Chapter 7)
➤➤ responding to spiritual and religious needs (Chapter 8).
4 SPIRITUAL CARE FOR HEALTHCARE PROFESSIONALS
The complexity increases as we consider two areas where our self-awareness and
clinical experience are important factors that influence the following:
➤➤ ethics and spiritual care (Chapter 9)
➤➤ the impact of loss, grief and bereavement in spiritual care (Chapter 10).
Following this in-depth analysis of spiritual care practice, the reader is then
encouraged to consider how the work of spiritual care affects them personally,
to engage in reflection and to consider the implications and resources of provid-
ing spiritual care in a healthcare setting. This is achieved through two chapters
which address the following:
➤➤ processing our own spiritual journey (Chapter 11)
➤➤ the institution and staff support (Chapter 12).
The final chapter of the book reflects on the unique role of the chaplain in spiri-
tual care in a healthcare setting – as chaplain to the institution (Chapter 13). The
role demands the creative gift of recognising significant events in the life of the
institution and an ability to assess the spiritual needs of the institution. It also
involves an ability to develop trusted relationships with healthcare staff across
the institution and to work with others to mark or pastorally care for all those
affected by these events with confidence and understanding.
REFERENCES
1 Welsh Assembly Government. Standards for Spiritual Care Services in the NHS in Wales
in 2010. Cardiff: Welsh Assembly Government; 2010.
2 UK Board of Healthcare Chaplaincy. Standards for NHS Chaplaincy Services.
Cambridge: UK Board of Healthcare Chaplaincy; 2009.
3 Nursing and Midwifery Council. Code of Conduct. London: Nursing and Midwifery
Council; 2008.
4 NHS Education for Scotland. Spiritual Care Matters: an introductory resource for all NHS
Scotland staff. Edinburgh: NHS Education for Scotland; 2009.
5 National Institute for Clinical Excellence. Improving Supportive and Palliative Care for
Adults with Cancer. Manual. London: National Institute for Clinical Excellence; 2004.
6 NHS Education for Scotland. Spiritual Care Matters: an introductory resource for all NHS
Scotland staff, op. cit.
CHAPTER 1
Self-awareness
INTRODUCTION
Definitions of spirituality often include words which, although recognisable, are
difficult to pin down and open to a wide variety of interpretations – for example,
a sense of meaning, purpose, value, being, relationship or transcendence. This
chapter will seek to grasp this ethereal term ‘spirituality’ and ground it in such
a way that healthcare professionals can understand it and use it to inform the
provision of spiritual care for patients, family/carers, volunteers and colleagues.
UNDERSTANDING SPIRITUALITY
The search for an inclusive definition of the term ‘spirituality’ is an elusive one. In
practice, when writing on spirituality authors begin with their own definition of
spirituality and develop their thinking from there. Traditional healthcare mod-
els suggest that a definition would be a good starting place. If, as a healthcare
professional, you know what spirituality is, you can then develop a strategy to
assess the spiritual needs of the individual and seek to address them. However,
the authors take a different approach and believe that the search for a working
definition of spirituality is a futile one. Spirituality is about people, and every
person is different. The key to providing spiritual care is to understand what
spirituality means to the person you are caring for.
Understanding spirituality is further complicated by the common miscon-
ception that spiritual care and religious care are one and the same thing. Many
healthcare professionals say the word ‘spiritual’, but in their head are thinking
‘religion’. The secular agenda, on the other hand, tries to remove religion from
spirituality. The authors believe that neither of these approaches is helpful.
Religion may or may not be a part of a person’s spirituality, and the only way to
find out is to engage with the individual. The disentangling of spirituality and
religion is explored in detail in Chapter 6. In the present chapter the authors
will prepare the reader by exploring and developing an inclusive understanding
of spirituality.
To understand spirituality in a healthcare context and in practice it is neces-
sary to begin with a process of self-awareness and ask the following questions.
5
6 SPIRITUAL CARE FOR HEALTHCARE PROFESSIONALS
➤➤ What does spirituality mean for me?
➤➤ What do I think and believe about the key issues of life, health, illness, dying
and death?
Reflective Activity 1.1 will help you to tease out these questions and think
through how you understand and interpret your spirituality.
Reflective Activity 1.1
What does spirituality mean for you or what makes life worth living?
One way to think about this is to ask yourself what gives you meaning or a sense of purpose
in life (or what is most important to you in life). Try to think of four elements and place them in
order of importance or significance for you:
1
2
3
4
To this list you can now add how or where you find inspiration, hope, joy and support to cope
with life and living:
1
2
3
4
Does this reflect your sense of spirituality? If not, try to think what is missing.
Although there will inevitably be variations in the reader’s response to this
activity, in the authors’ experience there are some common expressions that are
prevalent on a human level, and in particular for healthcare professionals. When
considering what gives you a sense of meaning and purpose, your answers might
include family, friends, work, health, religion or faith. Although family and
friends are consistently at the top of this list, healthcare professionals often rate
work highly, and it features as an important part of their spirituality and who
they are as a person. This is not surprising – if we value human relationships
highly as part of who we are, then the caring professions bring us face to face
with humanity when it is particularly vulnerable, and the desire to help others
feeds our sense of meaning, purpose and relationship.
When we think more widely about how or where we find inspiration, hope,
support and coping strategies, the list is much longer and more varied, and
can include walking, music, gardening, socialising, sport, art, religion and faith,
SELF-AWARENESS 7
and meditation, for example. It is when we move beyond our sense of meaning
and purpose to consider what sustains and inspires us in spirit that we truly
enter the domain of how individual spirituality really is. Some may find their
support in solitude and doing something different, others find that immersing
themselves with healthy people is a good way to cope, while yet others may use
both, depending on where they are and how they are feeling. There is no right
or wrong way in spirituality. Rather it is a continuing journey of experience and
development as well as re-connecting with previously utilised coping mecha-
nisms which were found to be helpful.
UNDERSTANDING LIFE, HEALTH, ILLNESS, DYING AND DEATH
If spirituality is an individual and fluid concept that we journey through, then it
follows that our lived experience will have an influence on our sense of spiritual-
ity, and our life experiences will have the potential to colour our understanding.
Healthcare professionals often find themselves working at the challenging
interface between the human experience and its transitions through life, health,
illness, dying and death.
To engage with and understand spirituality, it is also important for indi-
viduals to reflect on their own perceptions and attitudes to the challenges and
vulnerabilities in life, living and dying. For example, when does life begin? What
does it mean to say that you are healthy? What is quality of life? What is a good
death?
Reflective Activity 1.2 will help you to explore what you think and believe
about some of the key issues of life, health, illness, dying and death.
Reflective Activity 1.2
This activity will use your experiences both as a person and as a healthcare professional to
help you to consider your beliefs about life, health, illness, dying and death.
Health
Try writing a short statement about what ‘being healthy’ means to you. Consider the physical,
psychological, social and spiritual factors that influence your thinking.
Illness
Reflect on an illness that you have experienced, no matter how minor.
• What was the impact of your experience on your understanding of ‘being healthy’?
• From your experiences as a healthcare professional, are there any particular illnesses that
you fear for yourself? Can you articulate what it is that you fear?
Life and death
While we have no say in how we come into life, we can think about how it might end.
• Think about what kind of death you envisage as a good death for yourself. For example,
would it be sudden or with time to say goodbye? Would you die in your sleep or fighting to
the last?
(continued)
8 SPIRITUAL CARE FOR HEALTHCARE PROFESSIONALS
• If you died in any of these ways, what might be the effect on your loved ones?
• Have your views changed over time? If so, what influenced this change?
Having reflected on your awareness of life, health, illness, dying and death, you
can revisit Reflective Activity 1.1 and consider whether there are any additions
or changes that you would like to make with regard to what spirituality means
to you.
SEXUALITY AND SEXUAL PRACTICE
Why include a section on sexuality alongside self-awareness in spiritual care?
The link between spirituality and sexuality is a direct rather than tenuous one.
If we consider that human relationships are important factors in our sense of
spirituality and who we are as a person (see Reflective Activity 1.1), then it fol-
lows that anything which affects those relationships affects our spirituality.
Illness, treatments and drugs can all affect our sense of self, our body image and
our relationships. In a very real sense the physical, psychological, social and
spiritual dimensions of our being come together in our sexuality and our sense
and expression of self.
In the authors’ experience, the same wariness and fears that healthcare profes-
sionals have about approaching spiritual care exist around sexuality and sexual
practice. For example, it is the patient’s private life, the issues can be embarrass-
ing to talk about, and there is a perceived potential for causing offence. These are
legitimate fears. However, they can be overcome with self-awareness, practice
and developing experience.
As with spiritual care, a useful way of approaching this issue is to explore our
self-awareness – to reflect on our own thoughts and feelings about the issues of
sexuality and sexual practice. From this base as healthcare professionals we may
become more confident and willing to engage with patients and their family/carers.
The activities in this section will guide us in reflecting on our intimate rela-
tionships, how they might be affected by illness, and the implications that this
may have for our sexuality.
Reflective Activity 1.3
Reflect on a significant relationship in your life in which your sexuality is a significant factor.
Think through the different components of the relationship and how important they are to you
– for example, body image, emotions, physical contact.
After being diagnosed with an illness that you are unfamiliar with, you are being advised to
undertake a course of treatment which you are told may have ‘significant side-effects’. How
would you respond to a healthcare professional asking you the following question?
SELF-AWARENESS 9
‘When given this diagnosis, patients often have concerns or questions about their sexuality. Is
there anything you would like to ask?’
• Would you want to engage in the conversation to find out more?
• Would you simply answer ‘no’ and close the conversation?
There is no right or wrong answer to Reflective Activity 1.3. It is your choice that
matters. However, if the healthcare professional does not ask the question you
won’t have the choice. Reflective Activity 1.4 will help you to take your thinking
further and challenge the depth of your awareness and experiences.
Reflective Activity 1.4
This activity will help you to explore what information you would want to know if you were a
patient about to undergo treatment that could affect your sexuality or sexual practice.
Tick the relevant boxes if you would want to know the information if you might experience any
of the following:
☐☐Loss of libido
☐☐Dryness or pain during sex
☐☐Incontinence
☐☐Infertility
☐☐Impotence
Are there any other areas you would add to this list?
You can also consider the following:
• Would you still want to know this information if the effects were likely to be temporary
rather than permanent?
• Would your views change depending on whether or not you were in a relationship? Would
you want your spouse or partner to be included in the information giving?
• Would your views have been the same if you were younger or older than you are now?
As an example of how self-awareness can influence thinking and practice,
Reflective Activity 1.5 will encourage you to take your awareness of your
own thinking and needs and use this to consider your workplace practices
and procedures.
10 SPIRITUAL CARE FOR HEALTHCARE PROFESSIONALS
Reflective Activity 1.5
This activity will help you to consider your workplace setting and the implications of the care
that you offer to patients and their spouses/partners for their sexuality or sexual practice.
List the treatments, drugs or elements of care that you normally provide to patients that could
have an impact on their sexuality or sexual practice.
1
2
3
4
Consider the following questions:
• Is there a local protocol in place with regard to who informs the patient of the risks and/or
side-effects?
• Is the information given to everyone, or are some individuals excluded because of their
age or any other factor?
• Is this something that you feel your department does well?
• Are there ways in which it could be improved?
In considering our own sense of spirituality, our sense of sexuality and our
understanding of life, health, dying and death, we have hopefully gained some
self-awareness of where we are and what we understand about ourselves. From
this base we are now better prepared to study spiritual care in depth and to
journey with others. The remaining chapters of this book will guide us through
that process, adding depth to our understanding of spiritual care and helping
us to think through the knowledge skills and experiences that are needed to
practise and provide spiritual care.
CHAPLAIN OR SPIRITUAL CARE PROFESSIONAL
As a chaplain or spiritual care professional we are expected to have an advanced
self-awareness of our own spirituality, and an understanding of the broad and
individual range of expressions of spirituality that are possible and unique to
each person. Although we are not expected to have the answer to practical ques-
tions about sexuality and treatment side-effects, we do need an understanding
of the depth and importance of these issues to individuals if we are to provide
spiritual care in complex pastoral encounters. This understanding should also
extend to those whom we would refer on when these questions arise.
The core skills of a healthcare chaplain include enabling others to articulate
their sense of spirituality, and acting as a resource for staff and volunteers in their
assessment and delivery of spiritual care. Encouraging healthcare profession-
als to develop their self-awareness and competence with regard to spirituality
and spiritual care is an essential capability and competence for the chaplain.1,2
SELF-AWARENESS 11
Reflective Activity 1.6 will help you to consider practical ways in which you can
encourage and support healthcare professionals in their spiritual understanding
and self-awareness.
Reflective Activity 1.6
You have been asked to present a teaching session on spirituality and spiritual care for
healthcare professionals in training (or an induction session for new staff). From your
experience of the healthcare literature on spirituality and spiritual care, and reflection on your
own spirituality and practice of spiritual care:
• Identify the key concepts of spirituality.
• Prepare your introduction for the session.
• Develop an activity that would encourage those whom you are teaching to reflect on what
spirituality is to them and begin the process of self-awareness.
One approach to this activity would be to take the key concepts of spirituality
that you identified in Reflective Activity 1.6 and create your own understand-
ing and working definition of spirituality. However, an alternative would be
simply to list them and then introduce your activity. A balance has to be found
between giving enough information to start people thinking, and giving too
much information which then steers their thinking in a particular way. You may
find it helpful to take Reflective Activity 1.1 above and adapt it as an introduc-
tory activity using your own words and style. Given the similarity of the ways
in which spirituality and sexuality can be approached or avoided by healthcare
professionals, it may add depth to your session if you include a brief comment
or activity on sexuality.
At the end of each chapter you will find a section for the chaplain or spiritual
care professional. These sections should enable you to develop and add depth
to your personal understanding and self-awareness of spirituality.
FURTHER READING
Browse the shelves of the professional journals in your local healthcare library
for articles on spirituality or spiritual care, or conduct a literature search using
the term ‘spiritual’ to see how the authors’ understanding of spirituality agrees
or differs.
REFERENCES
1 UK Board of Healthcare Chaplaincy. Spiritual and Religious Care Capabilities
and Competences for Healthcare Chaplains. Cambridge: UK Board of Healthcare
Chaplaincy; 2009.
2 The Scottish Government. Chief Executive Letter (2008) 49 – Spiritual Care. Edinburgh:
The Scottish Government Healthcare Policy and Strategy Directorate; 2008.
CHAPTER 2
Faith, belief and culture
INTRODUCTION
In healthcare, the quality strategy of advanced care planning encourages us to
adopt a person-centred approach to care.1 If healthcare is to focus on the indi-
vidual, then by its very nature that should include our individual faith, beliefs
and culture, whatever they might be – religious, secular or a blend of both.
There is a small but vocal voice of opinion that states faith and belief should be
separated from the institutions and services of state such as the National Health
Service (NHS).2 The authors believe that this view misunderstands the inherent
influence of faith, belief and culture in all human beings.
In considering the value and influence of faith, belief and culture, the authors
support the following inclusive definitions of the NHS and the UK Board of
Healthcare Chaplaincy (UKBHC).3–6
➤➤ Faith community: a recognisable group who share a belief system and usually
undertake religious practices such as prayer, scripture reading, meditation and
communal acts of worship.
➤➤ Belief group: any group which has a cohesive system of values or beliefs, but which
does not classify itself as a faith community.
These definitions acknowledge and distinguish the religious and humanist per-
spectives, yet enable them to stand alongside each other and work together.
Indeed many of the national guidelines, standards and documents have been
positively influenced by the inclusion of the Humanist Society as a recognised
belief group.
It is also worth noting the definition of what is meant by an ‘individual’, as
this demonstrates the inclusive nature of this topic and the focus of this book.
➤➤ Individual: any person … including: patients, service users, clients, relatives,
carers, and NHS staff, or groups thereof.
This chapter will enable the reader to explore the influence of faith, belief and
culture in our personal and professional life. As in Chapter 1, self-awareness is
the key, and reflecting on our own understanding and experiences will earth our
understanding and the influence of faith, belief and culture in those we seek to
12
FAITH, BELIEF AND CULTURE 13
care for. A person-centred approach to care rather than an in-depth study of the
various world religions and belief systems is the way to best practice.
THE MEANING OF HEALTH
The German theologian, Paul Tillich, emphasises in the human condition the
deep longing for being ‘whole, not yet split, not disrupted, not disintegrated,
and therefore healthy and sane’.7
Healthcare is thus fundamentally an activity that enables people to re-estab-
lish a whole that was broken. In many instances this means making new or
broader connections to a reality that may have to include illness and suffering,
the success or failure of treatment, and even dying, death and bereavement.
To be healthy, therefore, is to be completely related or (inter)connected to the
psyche, society, the cosmos, and the reality that we face.
Within this context of a return to wholeness, some will process their desire
for healing through religious beliefs or practices. Religion, in its best sense,
means ‘to be connected’, arising as it does from the Latin word religare, mean-
ing ‘to bind together into one bundle or sheaf’. Not surprisingly, therefore, the
influence of faith, belief and culture remains important for many people as
professional and personal frameworks seek to provide environments in which
broken people find that they can be ‘bound together’ again, and reconnected to
the things that matter to them.
PERSON-CENTRED APPROACH
A person-centred approach, while it is the ideal in healthcare, becomes essential
when we seek to include faith, belief and culture in our assessment and care. The
following section on faith, belief and culture will consider the complexity of car-
ing for individuals who may self-identify and say that they adhere to a particular
religion or belief group, yet in life and living show considerable variety in their
beliefs and practices.
The only way to truly understand an individual’s beliefs and practices,
and what impact these may have on care for that patient and their carers, is
to conduct an individual assessment. This is explored further in Chapter 6, on
disentangling spiritual and religious care.
FAITH AND BELIEF
Each religion has its own clearly defined set of beliefs and practices that differ
from each other and distinguish the different world religions. However, within
each of these distinguishing religious labels, such as Buddhism, Christianity,
Islam, Judaism and Sikhism, are a host of different denominations, schools
or branches. Each of these branches will differ in their interpretation of the
main principles, beliefs and practices of their religion. Furthermore, within
