Discomfort in Addressing Spiritual Needs: A Hospital-Wide Exploration into the Hole in Holistic Care

Abstract

Throughout its history, the nursing profession has claimed to provide holistic patient care, which is defined as bio-psycho-socio-spiritual care. However, many nurses do not feel comfortable with the “spiritual” element of care and are uncertain about their professional role in the assessment and delivery of spiritual care. Discomfort and avoidance of attending to the spiritual needs of human beings creates “a hole” in holistic patient care. This case study examined a specific healthcare organization in its entirety to identify professional roles, processes, communication, and language of spiritual care when addressing spiritual distress in dying patients and their families. The study included examination of organizational procedures and the designated and perceived roles of key professionals in defining, identifying, and addressing spiritual distress of dying patients and their families within the single hospital. Strengths and gaps were determined by comparing the findings against a proposed conceptual framework developed from a synthesis of existing practice models for spiritual assessment and care of dying patients and families experiencing spiritual distress. The major gaps or problem areas that were identified included: (a) Lack of an organizational structure for spiritual assessment, planning, and implementation of spiritual care, or communication of the spiritual care plan among healthcare professionals, (b) Screening questions that do not identify with spiritual distress, (c) No clear delineation of roles and responsibilities related to spiritual care, leading to tension between some disciplines, and (d) No healthcare provider education or training on understanding spirituality, assessing spiritual needs, and responding to spiritual distress.