Organizational-level principles and practices to support spiritual care


  • Holyoke P, Stephenson B. Organization-level principles and practices to support spiritual care at the end of life: a qualitative study. BMC Palliative Care 2017 16:24. Available here.

Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not.
 
This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations.
 
Nine Principles for organizational support for spiritual care emerged from the interviews. These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.
 
Click on any Principle for a link to a video.
 
Foundational principles that influence the organization of spiritual care 

1.Quality spiritual care incorporates the spiritual into every other aspect of hospice palliative care such that the spiritual is not merely a part or element of care, but rather a descriptor of the kind, nature and quality of all care.
2.More profoundly than in any other area of care, quality spiritual care is guided and directed by the dying person and the family.
3.Hospice palliative care is fundamentally a vocation, and the work is inherently spiritual.

Principles that enable a highquality approach to spiritual care by care providers
4.Quality spiritual care requires care providers to allow spiritual questions and issues to emerge.
5.Quality spiritual care entails the act of ‘witnessing'.
6.Quality spiritual care considers place as sacred.

Principles that enable the spiritual care practices of care providers
7.Quality spiritual care includes rituals and times dedicated to marking transitions and processing experiences.
8.Quality spiritual care involves creating and sustaining relationships beyond those typical between co‐workers.
9.Quality spiritual care emphasizes the role of volunteers, whose presence and work reinforces and ensures that hospice palliative care is grounded as vocational and spiritual.

Foundational Principle 1

Quality spiritual care incorporates the spiritual into every other aspect of hospice palliative care such that the spiritual is not merely a part or element of care, but rather a descriptor of the kind, nature and quality of all care.
 

 
The hospices we visited did not view spirituality and religious concerns as simply one element or component of overall palliative care; rather, spiritual care was embedded throughout the giving of all types of care.
 
Back To Top

Foundational Principle 2

More profoundly than in any other area of care, quality spiritual care is guided and directed by the dying person and the family.
 

 
Organizations seeking to support high quality spiritual care need to be vigilant about and attentive to health care providers desiring routinized ‘interventions’ and ‘best practices’ approaches to spiritual care. The practices of the hospice organizations in this study adopted, promoted, and enabled a more flexible, immediate, in-the-moment approach to listening and responding to spiritual needs.
 
Back To Top

Foundational Principle 3
Hospice palliative care is fundamentally a vocation, and the work is inherently spiritual.
 

 
For spirituality to permeate all aspects of palliative care, members of the care team will ideally go further than observing the norms of conduct and the rules of their profession or organization. In the hospices in this study, the care providers recognized their professional and organizational responsibilities, but they also conceived of their care work at least in part in spiritual or religious terms, and this perspective shapes their practice.
 
Back To Top

Enabling Principle 4

Quality spiritual care requires care providers to allow spiritual questions and issues to emerge.
 

 
The hospices in this study tend to model a course of action that is closer to ‘non-action’ (being present) than to deliberate, focused, interventionism (doing) for spiritual care, allowing spiritual questions and issues to emerge at the appropriate point in the hospice palliative care trajectory.
 
Back To Top

Enabling Principle 5

Quality spiritual care entails the act of ‘witnessing’
 

 
The fifth Principle, incorporating ‘witnessing,’ is consistent with the practice of allowing spiritual questions to emerge, and requires that the hospice palliative care organization enables care providers to be present at the time of death, to bring to a dying person and his or her family their wisdom of having witnessed death before, and to honour the life of the deceased person and mark the death on behalf of the wider community.
 
Back To Top

Enabling Principle 6

Quality spiritual care considers place as sacred.
 

 
In the hospices we visited, there was a concerted effort to create a special sense of place, based on a conviction that the place where one dies ought to be, in religious language, ‘sacred’ or ‘holy.’ Such a “place” is conducive to spiritual questions and issues emerging.
 
Back To Top

Enabling Principle 7

Quality spiritual care includes rituals and times dedicated to marking transitions and processing experiences.
 

 
The interviews in this study indicate rituals and routines provide a foundation and a constant reminder and a call to spiritual issues. The functions, effects and outcomes of ritualizing end of life care in these ways ensures there is a sense of community that enables spiritual care, created through traditions. It also ensures that the people who are dying – their lives and their deaths – are honoured, and that the hospice and the people caring in it, can, and do, maintain personal and collective and institutional relationships to the dead. Finally, the rituals develop a form of institutional memory that preserves the person, outside the push and pull of a more medicalized, secular sphere.
 
Back To Top

Enabling Principle 8

Quality spiritual care involves creating and sustaining relationships beyond those typical between coworkers.
 

 
Effective, respectful collaboration is a necessary condition for quality care; but the interviews revealed that there is something more than professional collaboration in high quality spiritual care. Organizations should nurture and encourage bonds of affection and sympathy among co-workers beyond those that generally form in other work environments. Interviewees consistently reached for the language of kinship (‘family,’ ‘marriage’), group solidarity (‘community’) and affective bonds (‘friends,’ ‘love’) in describing relationships to co-workers.
 
Back To Top

Enabling Principle 9

Quality spiritual care emphasizes the role of volunteers, whose presence and work reinforces and ensures that hospice palliative care is grounded as vocational and spiritual.
 

 
The interviews in this study support research arguing for the effectiveness of volunteer programs in end of life care, and the interviews suggested that a volunteer program is an essential element in creating quality spiritual care. The presence of volunteers provides a diffuse sense of the commitment demanded by hospice palliative work; their presence gives encouragement to paid staff and residents alike about the vocational and spiritual nature of hospice palliative care.
 
Back To Top
 

Connect with us