What I’ve learned about spirituality in healthcare: Part 9

Finding your place within the conversation

One of the biggest concerns health professionals express when discussing spirituality is uncertainty about boundaries.

What exactly is my role?

What if I say the wrong thing?

These are important questions, and they deserve thoughtful consideration. At the same time, it is worth acknowledging that spirituality and ethics in healthcare is a complex area. Entire books have been written on the topic, and every profession has its own ethical guidelines, standards and scope of practice considerations.

So rather than trying to provide a comprehensive discussion, I would like to share a simple illustration that I have found helpful.

For me, the health professional role involves these tasks:

The first is to observe and listen.

Patients and clients often communicate spiritual concerns indirectly through questions about meaning, identity, values, hope, suffering and connection. They may also talk about the people, places and practices that help them cope during difficult times. Our role is not necessarily to solve these concerns, but to notice them when they arise.

The second task is to incorporate those concerns into care where appropriate and with the person’s permission.

This may involve considering what matters most to the patient when setting goals or making decisions. It may involve supporting access to meaningful relationships, activities, cultural practices, faith communities or places that provide comfort and strength. Often, addressing spirituality is less about doing something additional and more about ensuring that care remains centred on the person.

The third task is to refer when needed. 

Health professionals are not expected to meet every spiritual need themselves. Chaplains, spiritual care practitioners, cultural support workers, community leaders and other members of the healthcare team may all have an important role to play. Part of good practice is recognising when someone else’s expertise may be beneficial.

One image I find helpful is to think about circles of relationship.

At the centre with the patient are a patient’s family members, close friends, and cultural and religious community. These relationships involve mutual sharing and personal intimacy. In this space, patients may want to discuss openly about their spiritual or religious concerns or needs. 

Further out is the spiritual expert relationship. This is a space of explicit consent for in-depth spiritual assessment, and support around spirituality within healthcare. This can be a great resource for patients to discuss their spiritual concerns with someone who is often outside of their community.

Further out is the health professional relationship. This space can be warm, trusting and deeply meaningful. However, there is a power imbalance within the relationship. Therefore, the patient’s story always remains at the centre. Their experience is the focus of the interaction. 

Further out again may be an area of no response to spiritual issues, where a patient’s spiritual questions are not held within a relationship. This is where spiritual stories or concerns are simply ignored. 

As health professionals, we are constantly trying to find our place within that middle space. To provide patients with a safe and holistic healthcare service.

The goal for a health professional relationship is for the patient’s story to have room to breathe. A relationship where people feel heard and supported, where spiritual issues are screened, and spiritual values are integrated within treatment as appropriate. 

Thinking about these different roles as circles of closeness may help us in understanding and respecting our different spaces. 

Your healthcare role is not to have all the answers. It is to respond with care.

Key quote and reference: 

“All health care providers recognise and respond to spiritual needs, provide spiritual support, [and provide] referral as required” (p. 5).

Holmes, C. (2018). Towards National Consensus: Spiritual Care in the Australian Healthcare Context. Religions, 9(12). doi:10.3390/rel9120379

I’m Heather So, and my work centres around making space for spirituality in healthcare conversations. I offer workshops and training for health professionals, talks for people navigating a healthcare journey, and I am the author of The Suffering of a Child, now available for purchase.

Feel free to get in touch with me.