Spirituality and Purpose in Health Care Delivery

For more than a decade, researchers have been studying the degree to which patients reported receiving spiritual support from their medical team. While chaplaincy is well-established within health care institutions, these studies got me wondering about what is being done at a more grass-roots level to engage providers and front line staff in addressing patients’ spiritual and emotional needs.

I started by asking Larry Dossey, M.D., whose 1993 book Healing Words: The Power of Prayer and the Practice of Medicine made many of his medical colleagues call him a heretic for praying for his patients. Dossey points to the vast troves of data that demonstrate how thoughts and intentions can influence human biology; this could be called prayer, he says, but in a secular sense is considered healing thoughts, intentionality, love or compassion.

You don’t have to be a religious leader, says Dossey, to have a positive therapeutic effect on another person. This observation may sound simple but is important, according to Dossey, and often flies in the face of accepted neuroscience, which contends that your thoughts are confined to your own brain and body. The data show something different, insists Dossey: Consciousness is fundamental to the care process and can make a difference. He should know — he has authored more than 20 books on related topics.

This is delicate territory for caregivers, and one needs to tread carefully in a hospital setting. Nevertheless, hospitals of many kinds often don’t see spiritual care as out of the ordinary.

Promoting mindfulness

For example, at San Francisco-based Dignity Health, which operates hospitals and health care facilities in Arizona, California and Nevada, honoring the spiritual needs of patients and providers is very much steeped in the organization’s healing mission, given that it was founded by Catholic sisters, says Christina Fernandez, senior vice president for mission integration and spirituality. “Starting on the very first day of orientation, new employees are coached in our mission standards, one of which includes that we honor the spiritual life at work,” says Fernandez. They have three ways of talking about this.

“First is our relationships with each other, our selves and what we consider sacred,” says Fernandez. “Many things may come in the way of that during the day, but we have to recognize that when a patient enters the hospital, they are often in crisis and we need to ensure we are able to meet that need.

“Second, work has to have meaning, which is not hard to do in the health care field,” says Fernandez, “given we want people to get well and this work can be very rewarding.

“Finally,” she says, “we need time get in touch with ourselves, center ourselves and prepare for these challenges.” Dignity calls this moment a “reflective pause,” and has launched a systemwide Take 2 Minutes campaign to encourage all employees to explore the healing benefits of mindfulness. Anecdotal information is showing this initiative has been well received, and Dignity Health is planning to study its impact on patient and employee satisfaction.

Asking crucial questions

Lori Knutson R.N., administrative director for integrative health and medicine at Hackensack Meridian Health in New Jersey, has been developing its Five Pillars program — nutrition, activity, sleep, resilience and purpose — to help patients focus on their health and well-being goals. “Rather than focusing on the therapies we offer,” she says, “we want to understand what it means to the patient to be well, and we find that ‘purpose’ is key. What gives you meaning in life? How strong are your social connections? Where do you find strength and purpose? All these are crucial questions that can determine and impact other factors like nutrition, sleep or physical activity.”

Every patient is given a “meaning of life” survey to understand strengths and weaknesses in each of his or her five pillars. When a patient is admitted to the hospital, health coaches (trained nurses) go through the survey with the patient and offer support and direction as needed. Knutson says Hackensack Meridian has developed an algorithm with a risk stratification based on level of “purpose” and offers patients appropriate resources such as health coaching, reading materials, a referral to spiritual care or behavioral health at no charge. It is willing to bear the cost in hopes of better patient outcomes (the program is six months old), given current reimbursement models that include bundles of care.

Serving patient aspirations

In the same vein, the Veterans Health Administration is rolling out a new care model built around the patient rather than the disease or ailment. Emanating from the Office of Patient Centered Care and Cultural Transformation, and under the leadership of Tracy Gaudet, M.D., its executive director, 18 pilot sites throughout the VA health system have been funded to experiment with the care they want to provide and how. The intent is to re-orient care delivery toward developing a plan for each patient based on his or her own aspirations and desires. A variety of approaches are being studied to adapt the care model, including training primary care providers, developing health coaching skills, and offering yoga or meditation.

Ben Kligler, M.D., national director of the Integrative Health Coordinating Center, says that another key component of the program is a new cadre of “health partners” — veterans who are trained in listening and eliciting information in a nonclinical setting. Every new veteran entering the system, as well as existing patients, will be assigned a health partner to help him or her define aspirations and purpose in life. This approach, says Kligler, will allow the VA to better design care for each patient.

Making a difference

While completely reorienting your workplace culture may seem daunting, there are small steps your hospital or health system can take to get started:

  • Survey your providers and staff and elicit their interest, knowledge or skills.
  • Offer some basic training in screening and interviewing patients for their spiritual needs.
  • Create and allow space — both physical and mental — for staff to recharge and take time for themselves.

Demonstrating to your staff that your organization values and believes in honoring the spiritual needs of your patients, by starting with them, will create a workforce committed to your goals for healing and compassion.

Sita Ananth, M.H.A., is a Napa, Calif.–based consultant and writer specializing in wellness, community health and complementary medicine. She is also a regular contributor to H&HN’s website.

The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.

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