Based on her work as a non-religious healthcare chaplain, Madeleine Parkes discusses the role and purpose of spirituality in healthcare.
Since its inception in 1948, the NHS healthcare system in Britain has funded the provision of chaplains, or professional spiritual care givers, in part to ensure patient’s rights under the Human Rights Act (Article 9) and the 2006 Equality Act are met. The NHS is also interested in how a patient’s spirituality is helpful to healing and wellbeing. As a non-religious healthcare chaplain myself whose main responsibility is the provision of spiritual care to non-religious patients, I have faced some challenges when discussing and implementing secular spiritual care in a hospital environment. In the recent blog, Watts argues that scholars of spirituality must make a distinction between the study for spirituality (understanding spirituality’s practical application) and the study of spirituality (describing spirituality in a specific context). One of the challenges I face as a non-religious chaplain is managing both of these approaches to studying spirituality in a secular and medical based institution.
Many people have needs beyond the physical but these do not necessarily have to be religious; they can be existential, concerning life’s ‘big questions’, such as ‘who am I with this diagnosis?’ and ‘what might happen when I die?’ These are legitimate questions patients may have to face, but of course, the answers to these questions heavily depend on the context in which they are asked. For example, a culturally Jewish teenager learning of his cancer diagnosis may have different non-physical needs to an atheist grandmother diagnosed with dementia. Whilst ‘spirituality’ is the term used frequently in healthcare policy and practice to describe the existential quest many human beings embark upon, whether this is partly through religious faith or not, it becomes essential for chaplains to have comprehensive, empirically ground understanding of this term in order to provide sufficient care.
Although defining spirituality exists in many scholarly debates[i], there are only the beginnings about its specific definition (study of) and application (study for) in UK healthcare contexts.[ii] The first comprehensive overview of healthcare in the UK discusses spirituality theoretically in various healthcare contexts but not in depth with empirical evidence. This immediately presents those of us engaged in both research and delivery of spiritual care in healthcare a dilemma, as neither the study of spirituality (definitions) or for spirituality (application) appear to be well developed.
Many scholars in this field have suggested that ‘meaning making’ is central to the definition of spirituality, which any of us who have suffered from an illness, disability or bereavement may be familiar with.[iii] When our lives are shaken by the crisis of an illness the metanarratives we have relied upon to give our lives meaning up to that point may no longer feel helpful or adequate.
During my work as a non-religious hospital chaplain, I have seen time and time again people searching for a new lens of meaning making, a new meta-narrative to subscribe to, in the face of illness, disability or death. What this looks like could be considered the patient’s spirituality. A person’s spirituality, particularly when it is not tied to a religious framework, is usually very personal, subjective and may change many times.[iv] This makes it a difficult concept to define and study from an academic or scientific perspective. In a hospital environment providing good quality research is important in order to justify the offer of an intervention or service. Any medical intervention requires evidence before a hospital will adopt the procedure, and the same requirements are being introduced for all hospital services including spiritual care and chaplaincy. This brings us to a crucial difficulty – how to measure and evaluate an intervention that, by its very nature, is subjective and highly individual.
In my experience, it is not always helpful for chaplains to over-complicate or over-think the definition of spirituality, especially when the primary concern is the practical application for the patient’s wellbeing. Yet as professional spiritual care givers we should be engaged in research into the definition of spirituality, and be able to understand how it applies to a patient and their spiritual and existential struggles. Unfortunately, the resources to conduct this research are limited. For example, the primary goal of the three chaplaincy teams I have worked in was to meet the practical and immediate needs of the patient in the hospital, which takes up considerable time and resource, and the drive to conduct research was a lower priority.
My role as a chaplain is to facilitate the patient to find answers to questions about meaning-making, to enable them to begin a quest or a search for a new lens or metanarrative through which their current situation can be viewed. Due to the subjective nature of one’s spirituality, it is difficult to measure how effective the “spiritual care intervention” I provide is, unlike for example measuring symptom relief when a patient is prescribed medication. Again the study for spirituality and healthcare is difficult as measuring a spiritual care intervention in a meaningful and quantifiable way is problematic. Harold et al. document the relationship between religious practice and health outcomes, although it does not measure non-religious or spiritual practices. There have been some small steps towards conducting quantitative research into the effects of spirituality for patients in specific healthcare contexts.[v] But more needs to be done.
Healthcare chaplains, traditionally representative of a specific religious faith but also highly trained in pastoral care and wider spiritual wellbeing, are well-versed and well-placed to help with a search for spirituality if needed by patients and their families. Increasingly there are more non-religious, humanist or spiritual-not-religious care givers being employed to help non-religious patients along their journey. However, this provision of care also needs to be supported by carefully defined and planned research in order to better understand the role of secular spirituality in healthcare contexts. Both the study for and of spirituality is much needed.
[i] See, for example, King, Ursula. 2009. The Search for Spirituality, London: Canterbury Press Norwich; Tacey, David. 2003. The Spirituality Revolution, Sydney: Harper Collins Publishers.
[ii] For such pioneer studies, see Swinton, John. 2001. Spirituality and Mental Health Care, London: Jessica Kingsley Publishers; Darby, Kathryn, Paul Nash & Sally Nash. 2015. Spiritual Care with Sick Children and Young People, London: Jessica Kingsley Publishers.
[iii] See, for example, Pargament, Kenneth. 2001. The Psychology of Religion and Coping, New York: Guilford Press; Puchalski, C. M. 2002. “Spirituality and end-of-life care: A time for listening and caring”. Journal of Palliative Medicine, 5 (2), 289-294.
[iv] Hay, David. 2006. Something There: The Biology of the Human Spirit, London: Darton, Longman and Todd.
[v] For example, Barber, Joanna, Madeleine Parkes, Helen Parsons & Christopher Cook, 2012 “Importance of spiritual wellbeing in assessment of recovery: The Service user Recovery Evaluation (SeRvE) scale.” The Psychiatrist 36, 444-450.
Madeleine Parkes is a first-year PhD student at Aberdeen University and a part-time hospital chaplain who specialises in spiritual care for non-religious patients. Her PhD is a qualitative study that seeks to understand how hospital chaplains address the needs of non-religious patients.