Course 2:

Motivation for Spirituality in Health Care

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Whole Person Care Program

Course 1

Understanding Health & Healing

Course 2

Motivation for Spirituality in Health Care

Course 3

Personal, Environmental, & Staff Preparation for Whole Person Care

Course 4

Strategies for Spiritual Care in a Health Care Setting

Course 5

Living & Maturing as a Christian Health Care Professional

Resources

Program Resources

Course 2

Motivation for Spirituality in Health Care

Course Outline

Understanding the Concepts of Religion, Spirituality, and Worldview
Scientific Evidence for the Effects of Spirituality on Health
Accrediting and Professional Organizations' Positions on Spiritual Care
Patient Desire for Spiritual Care
Ethical Basis for Spiritual Care
Biblical Motivation for Spirituality in Health Care
Conclusion

As you take this course…

Think about how the data presented can be used to…

Impact your faith

Change your practice

And most importantly, affect your patients

Topic 1

Understanding of Religion, Spirituality,
and Worldview

Religion

Beliefs, practices, and rituals related to the transcendent.

Transcendent in Western religious traditions:

God, Allah, Jehovah, or a Higher Power

Transcendent in Eastern religious traditions:

Brahman, manifestations of Brahman, Buddha, Dao, or ultimate truth/reality, often involves the mystical or supernatural.

May be organized and community-centered or practiced privately.
Originates within an established tradition that arises out of a community with common beliefs, shared text (e.g., Bible, Koran), and practices.

– (Koenig, King, and Carson 2012)

Spirituality

Historically

Historically, spirituality was based on organized religion and connected to the supernatural.

Man praying at sunset mountains with raised hands

Currently

Seen as a search for the sacred (although the sacred can be viewed as either religious or secular)
Includes nonspecific personal beliefs
Can refer simply to good mental health or positive psychologic states

Worldview

Framework from which we view reality and make sense of life and the world.

– (Myers and Noebel 2015)

Worldview

“Whether we realize it or not, all of us possess a worldview.

It influences how we perceive ourselves, how we relate to others, how we adjust to adversity, and what we understand to be our purpose.

Our worldview informs our personal, social, spiritual, and political lives.

Our worldview influences our values, our ethics, and our capacity for happiness.

It influences our understanding of where we came from and who we are; and shapes our identity.

Our worldview tells more about us perhaps than any other aspect of our personal history.”

– (Nicholi 2002, 7)

Worldview

Origin

Where do I come from?

Morality

What is right and wrong?

Identity

Who am I?

Meaning

What is my purpose?

Destiny

Where am I going?

Worldview

Non-Religious or Non-Spiritual

Origin

I evolved from a primitive life form.
I have always existed.

Morality

I do whatever I think is right, no matter what the rules are. I decide what is right or wrong depending on the circumstances.

Identity

I am what I do.
I am what I own.
I am what I believe in.

Meaning

I live for myself, for my happiness, and for my own pleasure.

Destiny

I am going nowhere.
When I die, I cease to exist.

Worldview

Not Spiritual, but Religion Is Part of Life

Origin

I was created by a divine power.

Morality

I try to obey laws made by man.

Identity

My identity is what I make of myself.

Meaning

I am here to be happy and help others.

Destiny

Maybe there is a heaven or a hell; I just hope I am good enough to go to heaven.

Worldview

Deeply Religious or Deeply Spiritual

Origin

I was created by a divine power.

Morality

I do whatever is required according to the tenets of my religion.

Identity

My religion is my identity.

Meaning

My meaning is defined by my religious beliefs.

Destiny

How I live in this life will determine how I live after I die.

Worldview

Christ Follower With a Biblical Worldview

Origin

I was created by God in the image of God.

Morality

Right or wrong is defined by God, and never changing.

Identity

I am a child of God.
I am a servant of God.
My identity is in Christ.

Meaning

I live for God's glory.
God is my purpose.

Destiny

I am going to heaven to be in the presence of Jesus.

Self-Reflection

How would you answer those worldview questions about origin, meaning, morality, destiny, and identity?

How does understanding the concepts of religion, spirituality, and worldview help you?

Why is any of this important to you as a professional?

The research definition of religion or spirituality does not include positive psychological states, nonspecific personal beliefs, nor phenomenon unrelated to the transcendent.

Instead, religion or spirituality is rooted in an established religious tradition.

– (Koenig, King, and Carson 2012; Sheldrake, 2007)

Topic 2

Scientific Evidence for the Effects of Religion and Spirituality on Health

Assessment of Religious Involvement

Researchers assess religious involvement by measuring indices such as:

Attendance at religious services
Frequency of prayer
Frequency of studying sacred text
Volunteering with faith-based organizations

– (Koenig, King, and Carson 2012; Sheldrake, 2007)

Positive Correlation Scatter Plot

Effectiveness of Religious Interventions

Researchers assess the effectiveness on outcomes by using religious interventions, such as:

Meditation
Spiritual reflection
Prayer

– (Koenig, King, and Carson 2012; Sheldrake, 2007)

Positive Correlation Scatter Plot

Impact on Mental Health and Positive Well-Being

Research Studies of Religion and Spirituality

79%

Prior to 2000, 81 of 102 (79%) studies reported greater well-being, happiness, and life satisfaction among those who were more religious.

78%

And, since the year 2000, 175 of 224 (78%) studies reported the same positive results.

– (Koenig, King, and Carson 2012, 144)

Impact on Mental Health and Negative Well-Being

Research Studies of Religion and Spirituality

Those with greater degrees of religious or spiritual involvement or interventions had:

less depression, faster recovery and reduced symptoms
lower suicidal ideations, attempts, and completions
lower anxiety
protective effect against alcohol use and abuse
protective effect against drug abuse
protective effect for delinquency and crime
greater marital stability

– (Koenig, King, and Carson 2012, 172-271)

Research studies directly examined the evidence of religion and spirituality on negative well-being.
Sixty-one percent of studies find that greater religious or spiritual involvement is associated with less depression, faster recovery, or that religious or spiritual interventions reduce depressive symptoms faster compared to secular treatments or controls.
Seventy-five percent of studies show lower suicidal ideations, suicide attempts, and completed suicides among those who were more religious or spiritual.
Fifty-seven percent of the best designed studies report less anxiety among those who were more religious or spiritual. Seventy-one percent of the studies showed that religious and spiritual interventions lower anxiety.
Eighty-six percent report less alcohol use or abuse among those who were more religious or spiritual. Eighty-four percent reported less drug abuse among the more religious.
Seventy-nine percent report less delinquency and crime among those who were more religious or spiritual.
Eighty-seven percent of studies show that religious or spiritual involvement leads to greater marital stability, with less divorce and separation, less spousal abuse, and less infidelity.

Impact on Physical Health

Research Studies of Religion and Spirituality

Greater religious or spiritual involvement is associated with:

less coronary heart disease
lower blood pressure or less hypertension
less dementia
greater likelihood of healthy balanced immune system
may prevent cancer or improve outcomes
greater longevity
lower levels of pain and other somatic symptoms

– (Koenig, King, and Carson 2012, 339-530)

Research on the impact of religion and spirituality shows positive affects in many areas of physical health.
There was weak to moderate inverse relationship between religious or spiritual involvement and coronary heart disease.
Fifty-seven percent of 63 studies found that religious or spiritual involvement was related to lower blood pressure or less hypertension.
Religious or spiritual involvement was inversely related to 12 of 14 risk factors for dementia, and 57% of studies show less dementia in religious or spiritual persons.
Fifty-six percent of studies show that aspects of religion and spirituality are significantly and positively related to indicators of a healthy balanced immune system.
Sixty-five percent of the 20 highest quality studies show that religion and spirituality may help to prevent the development of cancer or improve prognosis.
Seventy-six percent of the 62 best quality studies show that greater religious or spiritual involvement predicts greater longevity.
Thirty-nine percent of the 22 studies show religious or spiritual involvement is related to lower levels of perceived pain and other somatic symptoms.
These studies show benefits of religious or spiritual involvement on physical health, but additional research is needed.

Research Studies:
Self-Reflection

How do the research studies add value to what you understand about the impact of religion and spirituality on health?

How will the findings impact your health care practice?

Topic 3

Accrediting and Professional Organizations’ Positions on Spiritual Care

Accrediting Organizations

The Joint Commission (Formerly JCAHO)

International Society for Quality in Health Care (ISQua)

National Quality Forum

The Joint Commission

Accredits and certifies more than 21,000 health care organizations and programs
Is the nation’s oldest and largest accrediting organization
Requires documentation of a spiritual assessment

– (Hodge 2006, 317)

The Joint Commission

(Minimum Requirement for Spiritual Assessment)

Exploration of three areas:

Denomination or faith tradition

Significant spiritual beliefs

Important spiritual practices

– (Hodge 2006, 318)

International Society for Quality in Health Care

Active in over 100 countries
Works to achieve excellence in health care delivery and quality of care
Develops principles for accrediting health care organizations, including The Joint Commission
Requires that spiritual preferences of patients are recognized
Guides organization to develop processes that provide patients with access to spiritual care

– (ISQua Accreditation 2015)

National Quality Forum

Provides the best evidence-based approaches to improving care
Mandates documentation of a discussion of spiritual/religious concerns

– (ISQua Accreditation 2015)

Accrediting Organizations: Self-Reflection

What are the practical implications in your health care profession that can be taken from these organizations?

The Joint Commission

International Society for Quality in Health Care

National Quality Forum

Professional and Educational Organizations

Encourage provision of spiritual care

Encourage medical schools to train students to provide spiritual care

American Association of Medical Colleges (AAMC)

Guides the education of students at all 151 accredited U.S. and 17 Canadian medical schools.
Created the Medical School Objectives Project (MSOP) that advocates for the incorporation of spiritual assessment and care of patients, which includes the following:
- Spiritual history
- Patient’s spirituality and cultural beliefs
- Research data on spirituality
- Role of clergy and other spiritual leaders
- Understanding of student’s own spirituality

– (Behan et al. 2012)

See “Additional Resources from AAMC” in the “Resources” section in this Whole Person Care Program.

The Association of American Medical Colleges is a not-for-profit association that supports the entire spectrum of education, research, and patient care activities conducted by all 151 accredited U.S. and 17 Canadian medical schools.
The AAMC created the Medical School Objectives Project in 1998 to guide the education of medical students. The most recent version, MSOP III, continues to advocate for the incorporation of spiritual assessment and care of patients, which include the following:
The ability to elicit a spiritual history.
The ability to apply the understanding of a patient’s spirituality and cultural beliefs and behaviors to appropriate clinical contexts.
Knowledge of research data on the impact of spirituality on health and on health care outcomes.
An understanding of, and respect for, the role of clergy and other spiritual leaders, and culturally-based healers and care providers.
An understanding of their own spirituality and how it can be nurtured as part of their professional growth, promotion of their well-being, and the basis of their calling as a physician.
It is important to note that AAMC has published a document that provides a framework for approaching issues of spirituality in patient care settings. The document includes links to major medical schools' resources on religion and health care.
For these links, see the "Resources" section in this Whole Person Care Program.

American College of Physicians (ACP)

State in their ethics manual that high-quality, end-of-life care should incorporate spiritual support

– (Snyder and American College of Physicians Committee 2012)

American Nurses Association’s Standards of Clinical Nursing Practice (ANA)

Includes the spiritual dimension as a necessary component of the nursing assessment
Requires nurses to use teaching methods that collaborate with the patient’s values, beliefs, and spirituality

– (American Nurses Association 2015)

American College of Critical Care Medicine (ACCCM)

Issues guidelines regarding spiritual care
Recommends that spiritual needs are assessed by the health care team and incorporated into the plan of care
States that a patient’s request for prayer should be honored if the health care worker is willing

– (Davidson et al. 2007)

Other Organizations That Encourage Spiritual Care

(JAMA) Journal of the American Medical Association
(AAFP) American Academy of Family Physicians
(APA) American Psychiatric Association
(AACN) American Association of Colleges of Nursing
(AHA) American Hospital Association
(ABP) American Board of Pediatrics
(AACCN) American Association of Critical-Care Nurses

For more information, see the See “Additional Resources from AAMC” in the “Resources” section in this Whole Person Care Program.

Professional and Educational Organizations: Self-Reflection

What organizations would you look to for guidance regarding spiritual conversations with your patients?

What entity or agency do you believe prohibits spiritual conversations with your patients?

CONCLUSION

Contrary to what many health care professionals believe, major health care accrediting and professional organizations actually encourage spiritual assessments and spiritual care of patients.

So what do the patients want?

Topic 4

Patient Desire for Spiritual Care

Do patients want spiritual care?

Belief in God

Do patients believe in God?

Journal of Family Practice reported that 70% of patients surveyed believed in God.

- (King and Bushwick 1994)

Belief in God

(Percentage of Adults Who Say They Believe in God)

(Pew Research Center 2014)

Belief in God

(Do You Believe in God?)

(Gallup 2022)

Patient Desire for Spiritual Care: Conclusion

Most patients believe in God.

Acceptance of Spiritual Conversation

Do patients accept a conversation about spirituality with their doctor?

Majority of patients would welcome a conversation with their physician about faith.
Majority of patients say it is appropriate for the doctor to enquire about spiritual needs in some circumstances.
Majority of patients thought it was appropriate for doctors to ask in some circumstances and were interested in this type of care.

– (Kalb et al. 2003; McCord et al. 2004)

life-threatening illnesses
serious medical conditions
loss of loved ones

Acceptance of Spiritual Conversation

Do patients accept a conversation about spirituality with their doctor?

Majority of patients would welcome a conversation with their physician about faith.
Majority of patients say it is appropriate for the doctor to enquire about spiritual needs in some circumstances.
Majority of patients thought it was appropriate for doctors to ask in some circumstances and were interested in this type of care.

– (Kalb et al. 2003; McCord et al. 2004; Best, Butow, and Olver 2015)

Do patients accept a conversation about spirituality with their doctor?
In Newsweek's 2003 poll, 72% of Americans say they would welcome a conversation with their physician about faith.
In the 2004 study "Discussing Spirituality With Patients: A Rational and Ethical Approach," of the 1,413 adults who were asked to respond, 921 completed questionnaires. Eighty-three percent of respondents wanted physicians to ask about spiritual beliefs in at least some circumstances.
For at least 70% of those respondents, they wanted spiritual discussion with their physician when they were dealing with:
• a life-threatening illness,
• a serious medical condition, and
• the loss of a loved one
In 2015, the journal Patient Education and Counseling published a systematic literature review. These studies took place over the course of 23 years with 12,327 patients.
In 38 of the studies, patients were asked if they wanted their doctors to ask them about religious or spiritual matters.
More than half the studies, 30 out of 38, addressing this question reported that a majority of patients thought it was appropriate for a doctor to enquire about religious or spiritual needs in at least some circumstances.
And, all of these studies had some patients interested in this type of care.

Patient Desire for Spiritual Care: Conclusion

Most patients would accept a conversation about spirituality.

Spiritual Conversation Should Happen

Do patients think doctors should talk to them about their faith?

Majority of patients believe doctors should discuss spiritual faith with their patients.
Majority of patients felt that physicians should be aware of their religious or spiritual beliefs.
Majority of patients thought it was appropriate for a doctor to enquire about religious or spiritual needs.

– (McNichol 1996, 4-5; MacLean et al. 2003; Best, Butow, and Olver 2015)

Patient Desire for Spiritual Care: Conclusion

Most patients think doctors should talk to them about their faith.

Prayer

Do patients want their physician to pray with them?

Majority of geriatric patients indicated would like their physician to pray with them.
Majority of patients felt that in certain circumstances they would like their physicians to pray with them.
Half of dying patients wanted they physicians to pray with them.
Majority of advanced cancer patients view practitioner-initiated prayer as spiritually supportive.

– (Koenig, Smiley, and Gonzales 1988; Oyama and Koenig 1998; MacLean, et al. 2003; Balboni et al. 2011)

Do patients want their physician to pray with them?
In 1988, Koenig, Smiley, and Gonzales reported that 72 geriatric medical patients and senior center participants were asked how they would feel about their physician praying with them during times of extreme physical or emotional distress. 51% indicated, "Yes, very much," and 27% indicated "Yes, somewhat."
In 1998, Oyama and Koenig surveyed 380 family medicine outpatients. Sixty-seven percent of patients felt that in certain circumstances they would like their physicians to pray with them.
In 2003, the Journal of General Internal Medicine reported that acceptance of prayer with their physician depended on the acuity of the visit. If patients were dying, 50 % wanted their physician to pray with them.
In 2011, the Journal of Pain and Symptom Management reported that 80% of advanced cancer patients viewed practitioner-initiated prayer as spiritually supportive.

Patient Desire for Spiritual Care: Conclusion

In certain circumstances, most patients would like their physician to pray with them.

End-of-Life Issues

Do patients facing end-of-life issues want to talk to their primary care doctor?

Patients would rather receive spiritual care from their primary care doctor than a psychologist, psychiatrist, or a social worker.
Majority of dying patients would want their physician to know their beliefs.
Most patients considered attention to spiritual concerns an important part of cancer care by physicians and nurses.

– (Highfield 1992; MacLean et al. 2003; Vallurupalli et al. 2012)

Do patients facing end-of-life issues want to talk to their health care provider about spiritual matters?
In 1992, the Cancer Nursing journal did a small study of cancer patients and nurses in religiously affiliated hospitals; the response was that patients would rather receive spiritual care from a physician rather than a psychologist, psychiatrist, or a social worker.
A 2003 study published in Journal of General Internal Medicine, "Patient Preference for Physician Discussion and Practice of Spirituality," reported that 70% of dying patients would want their physician to know their beliefs.
In the 2012 Journal of Supportive Oncology article "The Role of Spirituality and Religious Coping in the Quality of Life of Patients with Advanced Cancer Receiving Palliative Radiation Therapy," at least 85% of patients considered attention to spiritual concerns an important part of cancer care by physicians and nurses.

Patient Desire for Spiritual Care: Conclusion

Most patients facing end-of-life issues want to talk to their health care providers about spiritual matters.

Patient-Centered Spiritual Care

Overall, would patients accept patient centered spiritual care?

Majority of patients felt a brief inquiry of spiritual and religious concerns was "somewhat" useful to "very" useful.
Factors that fostered spiritual conversations included:
- The patients’ acceptance of their diagnosis
- A trusting relationship
- A respect for the patients’ beliefs.

– (Kristeller et al. 2005; Vermandere et al. 2012)

Patient Desire for Spiritual Care: Conclusions

Overall, there is greater acceptance of spiritual care when offered in a patient-centered manner:

Most patients believe in God.
Most patients would accept a conversation about spirituality.
Most patients think doctors should talk to them about their faith.
Most patients would like their physician to pray with them.
Most patients facing end-of-life issues want to talk to their health care providers about spiritual matters.

Research Observations

What trends do you see over the past decades?

In the future, do you anticipate patients being receptive to spiritual care?

Since spiritual care is what most patients want, should it be offered?

Patient Moments

Listen to what a patient has to say about spiritual care.

William – Patient Moments

_{(October 2016)}

Self-Reflection

What is your experience as a patient?

What do you do in your own practice?

What should you do in your own practice?

Is there a patient that you are currently caring for that would benefit from a spiritual conversation?

CONCLUSION

Accreditors require spiritual care and patients want it.

Next: Ethical Boundaries and Freedoms when Providing Spiritual Care

Topic 5

Ethical Basis for Spiritual Care

Key Ethical Principles

The Principle Defined

Dictates that all care is patient centered
Requires respect for each person’s capacity to make decisions
Requires the right to be held accountable for these decisions

Ethical Medical Decision-Making

To make free choices, a patient needs

Adequate, accurate, and complete information
To feel respected as the decision-maker
Opportunity to deliberate, to make wise decisions
Opportunity to accept or reject care
Spiritual resources to help with identified issues

Spiritual Care

A health care professional …

Must follow the patient’s expressed wishes regarding spiritual care.
Unless permitted, neither prescribes spiritual practices nor urges the patient to relinquish religious beliefs or practices.
Seeks to understand the patient’s spirituality, even if it is not a shared belief.
Performs a spiritual assessment in an impartial manner.
Practices spiritual care with professionalism.

Note: Proselytizing Versus Spiritual Support

So, how does a health care professional provide spiritual care without proselytizing?

Note: Proselytizing Versus Spiritual Support

Proselytizing

Intent to convert, or attempts to convert, someone from one religion, belief, or opinion to another

“You really need to do what I do for spiritual support!”

Spiritual Support

Patient-centered care; responding to the patient’s need and providing assistance

“May I share my personal source of spiritual support?”

Well, what is proselytizing? Is providing spiritual support proselytizing?
Proselytizing in health care is when a professional enters the exam room with the intent to convert, or attempts to convert, someone from one religion, belief, or opinion to another.

Providing spiritual support is different because it is patient centered. In the process of providing patient-centered care that is autonomous, the health care professional is to determine all the needs of the patient, which includes spiritual needs.
If the patient presents a spiritual need, the professional can ask the patient where he or she gets support. If the patient does not have a support system, the professional can ask for permission to share his or her source of personal spiritual support. This conversation may lead to prayer, referring the patient to a spiritual care giver, or sharing the gospel.
This is not proselytizing, because the health care professional is responding to the patient's need and providing assistance with permission.

Self-Reflection

Key questions for the health care professionals to answer for themselves:

Based on the principle of autonomy, can you share Jesus with patients?

What burdens or concerns you most about the principle of autonomy and sharing your faith?

Key Ethical Principles

The Principle Defined

Do good
Use clinical skills to assist patients

Ethical Medical Decision-Making

Ways to accomplish beneficence

Advocate for the patient’s health
Research what is best for the patient’s health
Teach and counsel the patient in what will improve his or her health
Provide therapies to improve health

Definition of Illness

Refers to “an unhealthy condition of body or mind”

Produces multidimensional brokenness that impacts a person as a whole.

Beneficent care requires treating the patient as a whole.

– (Merriam-Webster Dictionary 2019; Elder ca. 1995, 5)

Dimensions of a Whole Person

Beneficent care attends to all dimensions of a whole person:

Definition of Illness Revisited

Research shows the positive impact of religion and spirituality on health.

Beneficent care should include an assessment of spirituality and spiritual needs.

Beneficence: Negligence

In contrast, if a patient presents a need, it is negligent for the health care professional not to respond to the need nor refer to another professional who can.

Negligent

“I can’t help you.”

Not Negligent

“I can’t help you, but I will refer you to someone who can.”

– (Pearce et al. 2012)

Beneficence: Negligence

Likewise, unmet spiritual needs can impact physical and emotional well-being.

Negligent

“I can’t help you with your spiritual concerns!”

Not Negligent

“How can I help you with your spiritual concerns?
May I refer you to a chaplain?”

– (Pearce et al. 2012)

Self-Reflection

Key questions for the health care professionals to answer for themselves:

Based on the principle of beneficence, what concerns you about providing spiritual care?

If the principle of beneficence urges us to do good for patients, why aren’t health care professionals willing to address spiritual needs?

Key Ethical Principles

The Principle Defined

Requires that health care professionals provide equally competent care to each patient.
Respects the rights and the autonomy of all people.

What is provided to one patient should be offered to all patients, which includes spiritual care.

Christian Worldview

Each person is

Created in the image of God
Has inherent value regardless of age, social status, economic status, or potential to contribute to society

This worldview places great importance on human dignity and human value, which in turn sets a high standard for justice.

Self-Reflection

Key questions for the health care professionals to answer for themselves:

Based on the principle of justice, what concerns you about providing spiritual care?

What do you believe gives patients value to you? How does this affect your practice?

In light of your worldview, are there patients that are difficult for you to provide care for?

Key Ethical Principles

The Principle Defined

Asserts an obligation to not inflict harm intentionally
Should act in ways that do not cause avoidable or intentional harm

The Principle Defined

Primum Non Nocere

First, Do No Harm

Spiritual Care

As with any tool used by a health care professional, there are ways in which spiritual care can be misused.

Providing spiritual care would violate the principle of nonmaleficence if it caused harm.

Unethical Spiritual Care

Denying autonomy, causing harm, or neglecting other beneficent care:

Pressuring a patient to decide according to your personal beliefs
Focusing exclusively on spiritual care
Sharing religious beliefs without permission
Suggesting that receipt of further medical care is dependent on listening to a spiritual presentation
Advising spiritual practices that decrease coping and increase burdens
Denying a patient’s right to refuse spiritual care

Self-Reflection

Key questions for the health care professionals to answer for themselves:

Based on the principle of nonmaleficence, what concerns you about providing spiritual care?

How can you prevent taking unfair advantage of your position as a health care professional when you provide spiritual care?

Key Ethical Principles

Key Ethical Principles: Summary

When properly provided, spiritual care is ethical:

Benevolence: focused on the patient’s good
Autonomy: it empowers free decisions
Nonmaleficence: it takes care to avoid harm
Justice: it respects and validates each patient’s free decisions

Ethical Basis for Spiritual Care: Self-Reflection

How does your faith affect how you treat patients?

Ethical Basis for Spiritual Care: Additional Self-Reflection

How do the principles of ethics affect how you treat patients?

How do the principles of ethics and your faith align with or support one another?

What does spiritual care look like in your practice?

What are the ways that you can improve spiritual care for your patients?

What has been your spiritual care experience as a patient?

What’s Next

Now we know that accreditors require spiritual care, patients want it, and providing it is ethical.

What does the Bible say?

“Tell them the kingdom is here. Bring health to the sick. Raise the dead. Touch the untouchables. Kick out the demons. You have been generously treated so live generously.”

– (Matt. 10: 7-8 [MSG])

Topic 6

Biblical Motivation for
Spiritual Care in Health Care

Biblical Motivation Concepts

Identity in Christ

Biblical call

Emotional and spiritual impact on overall health

Healing through spiritual care

Identity in Christ

Who we are in Christ determines what we do.
We are Christians who are health care professionals.
We no longer live, but Christ lives in us
(Gal. 2:20).
We are His adopted sons for the praise of His glory (Eph. 1:5)!

“The Spirit you received does not make you slaves, so that you live in fear again; rather, the Spirit you received brought about your adoption to sonship…”

– (Rom. 8:15 [NIV])

Identity in Christ:
Self-Reflection

If your identity is in Christ, how does this impact how you will provide health care?

Identity in Christ:
A Chosen People

God’s people have been given a collective identity and purpose (1 Pet. 2:9).
Being chosen should be an opportunity for service.
Israel was chosen to bring His redemptive purpose to the world (Isa. 42:6).
Jesus told the disciples that He chose them and appointed them (John 15:16).
God chose His people from all nations
(Gal. 3:26-29).

“For he chose us in him before the creation of the world to be holy and blameless in his sight. In him we were also chosen.”

– (Eph. 1:4, 11a [NIV])

God’s people, Christians, have been given a collective identity and purpose, as a chosen people.
In first Peter it says, "… you are a chosen people, a royal priesthood, a holy nation, God’s special possession, that you may declare the praises of him who called you out of darkness into his wonderful light."
We as Christians are a chosen people.
Therefore, being chosen should not be a source of pride, but an opportunity for service.
Israel was chosen to bring His redemptive purpose to the world.
Jesus told the disciples that He chose them and appointed them.
God chose His people from all nations. Hear what Paul has to say to the Galatians, "So, in Christ Jesus you are all children of God through faith, for all of you who were baptized into Christ have clothed yourselves with Christ. There is neither Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus. If you belong to Christ, then you are Abraham’s seed, and heirs according to the promise."

"For he chose us in him before the creation of the world to be holy and blameless in his sight. In him we were also chosen."

A Chosen People:
Self-Reflection

If your identity is in Christ and you are chosen by God, how does this impact how you will provide health care?

Identity in Christ:
Holy, Set Apart

Holiness IS NOT external holiness or self-focused.
Holiness IS living with a constant awareness that we have been set apart for a holy purpose.
Paul was a servant of Christ Jesus, set apart for the gospel (Rom. 1:1).

“Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price.”

– (1 Cor. 6:19-20 [NIV])

Holy, Set Apart:
Self-Reflection

If you are holy, set apart, how does this impact how you will provide health care?

Identity in Christ:
The Foundation for Action

Our identity in Christ is the foundation for what we do.

To make disciples (Matt. 28:19)
To go and bear fruit (John 15:16)
To be a witness (Acts 1:8)
To do good works that God prepared beforehand (Eph. 2:10)
To be prepared to give an answer for the hope that we have (1 Pet. 3:15)

…To declare the praises of Him who called you out of darkness into wonderful light.

– (1 Pet. 2:9)

The Foundation for Action:
Self-Reflection

How can this foundation for action manifest itself in your health care practice?

Biblical Model to Combine Physical Healing With Spiritual Care

Jesus sent the twelve disciples out to preach the Kingdom of God and to heal the sick
(Luke 9:1-6).
A paralyzed man was presented to Jesus who healed him both spiritually and physically
(Mark 2:1-14).
Jesus healed the disabled man at the pool and subsequently gave spiritual counsel to stop sinning
(John 5:1-15).

Biblical Model:
Self-Reflection

What personally stops you from following Jesus’s commission to both heal the sick and share the gospel?

Impact on Overall Health: Emotional Condition

The intensity of David’s emotional suffering affected the health of his eyesight.
“My eyes grow weak with sorrow; they fail because of all my foes.”
(Ps. 6:7 [NIV])
Solomon learned that when he was in emotional distress his bones ached.
“A heart at peace gives life to the body, but envy rots the bones.”
(Prov. 14:30 [NIV])

Emotional Condition:
Self-Reflection

How could an emotional assessment have affected his or her care?

Are there other examples you can think of?

Impact on Overall Health: Spiritual Condition

A right relationship with God and righteous living positively impacts physical health.

“Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight. Do not be wise in your own eyes; fear the Lord and shun evil. This will bring health to your body and nourishment to your bones.”

(Prov. 3:5-8 [NIV])

Impact on Overall Health: Spiritual Condition

Conversely, there are biblical examples of how physical symptoms arise from sin.

Body aches, festering wounds, searing pain, palpitations, failing strength, poor eye sight (Ps. 38: 3, 5, 7, 10)

“When I kept silent, my bones wasted away…my strength was sapped…Then I acknowledged my sin to you, and you forgave the guilt of my sin.”

(Ps. 32:3-5 [NIV])

“There is no health in my bones because of my sin.”

– (Ps. 38: 1 [ESV])

Spiritual Condition:
Self-Reflection

How could a spiritual assessment have affected his or her care?

Are there other examples you can think of?

Impact on Overall Health: External Spiritual Forces

Job was blameless and upright, but God permitted Satan to inflict him with suffering
(Job 2:7 [NIV]).
Demon possession affected a man’s mental health and consequently physical health
(Mark 5: 2-5 [NIV]).
Woman was crippled by an evil spirit, which caused her to be bent over and disabled
(Luke 13:10-11 [NIV]).

“I was given a thorn in my flesh, a messenger of Satan, to torment me. Three times I pleaded with the Lord to take it away from me. But he said to me, ‘My grace is sufficient for you, for my power is made perfect in weakness.’ ” …

(2 Cor. 12:7-9 [NIV])

External spiritual forces can also impact overall health. Here are a few examples:
Consider Job. He was blameless and upright, but God permitted Satan to inflict him with suffering.
We read in Job, "So Satan went out from the presence of the Lord and afflicted Job with painful sores from the soles of his feet to the crown of his head."
Also, demon possession affected a man’s mental health and, consequently, his physical health.
We read in Mark 5, "When Jesus got out of the boat, a man with an impure spirit came from the tombs to meet him. This man lived in the tombs, and no one could bind him anymore, not even with a chain. For he had often been chained hand and foot, but he tore the chains apart and broke the irons on his feet. No one was strong enough to subdue him. Night and day among the tombs and in the hills he would cry out and cut himself with stones."
Another example is when a woman was crippled by an evil spirit, which caused her to be bent over and disabled.
In Luke we read, "On a Sabbath Jesus was teaching in one of the synagogues, and a woman was there who had been crippled by a spirit for eighteen years. She was bent over and could not straighten up at all."
And finally, the Apostle Paul’s health was affected by a messenger from Satan.
He reflected, "I was given a thorn in my flesh, a messenger of Satan, to torment me. Three times I pleaded with the Lord to take it away from me. But he said to me, 'My grace is sufficient for you, for my power is made perfect in weakness.'"

Impact on Overall Health: Common Misconception

It is very important to note that if someone is sick, it does not necessarily mean that person has sinned and now is being punished.

This is a common misunderstanding, even among Christians. The disciples of Jesus had an incorrect understanding of this concept as well:

“As he went along, he saw a man blind from birth. His disciples asked him, ‘Rabbi, who sinned, this man or his parents, that he was born blind?’ ‘Neither this man nor his parents sinned,’ said Jesus, ‘but this happened so that the works of God might be displayed in him.’”

(John 9:1-3 [NIV])

External Spiritual Forces:
Self-Reflection
Self-Reflection

How will knowing that external spiritual forces can impact your patient’s health affect how you provide care?

Healing Through Spiritual Care

Health care professionals:

Should be doing more than fixing broken cells.
Are in a unique position to provide spiritual care.

Scripture provides abundant examples of how the health of the whole person can improve through spiritual care.

Healing Through Spiritual Care: Physical

Fear of the LORD and rejecting evil will bring health and nourishment (Prov. 3:7-8 [NIV]).
Faith in the name of Jesus completely healed a man (Acts 3:16 [NIV]).
A woman was there who had been crippled, straightened up (Luke 13:10-13 [NIV]).

The following are examples of physical healing through spiritual care:
In Proverbs 3 it says, “Do not be wise in your own eyes; fear the LORD and shun evil. This will bring health to your body and nourishment to your bones.”
Peter proclaims in Acts 3, “By faith in the name of Jesus, this man whom you see and know was made strong. It is Jesus’ name and the faith that comes through him that has completely healed him, as you can all see.”
Luke writes, "On a Sabbath Jesus was teaching in one of the synagogues, and a woman was there who had been crippled by a spirit for eighteen years. She was bent over and could not straighten up at all. When Jesus saw her, he called her forward and said to her, 'Woman, you are set free from your infirmity.' Then he put his hands on her, and immediately she straightened up and praised God."

Healing Through Spiritual Care: Mental and Emotional

“For God has not given us a spirit of fear, but of power and of love and of a sound mind.”

- (2 Tim. 1:7 [NKJV])

“You will keep in perfect peace those whose minds are steadfast, because they trust in you.”

- (Isa. 26:3 [NIV])

Healing Through Spiritual Care: Spiritual

“For this people’s heart has become calloused; they hardly hear with their ears, and they have closed their eyes. Otherwise they might see with their eyes, hear with their ears, understand with their hearts and turn, and I would heal them.”

- (Matt. 13:15 [NIV])

Healing Through Spiritual Care:
Self-Reflection

In what ways have you seen healing of the whole person occur through spiritual care?

A focus on spiritual health does not minimize the importance of efforts to maintain good physical health.

Topic 7: Conclusion

Now that you have completed this course, let’s reflect on the things that motivate us to provide spiritual care:

There is scientific evidence for the positive health benefits of spirituality.
Secular organizations require it.
Most patients want it.
It's ethical, when provided in a patient-centered manner.

And above all, the Bible compels it.

Topic 7: Conclusion

"How do I provide spiritual care for my patients?"

References can be found in the “Resources” for this Whole Person Care Program.

Thank you!

Please click the next page arrow to complete the end-of course survey and receive your certificate!

Course 2: Motivation for Spirituality in Health Care

Course 2: Motivation for Spirituality in Health Care

Keyboard Shortcuts

Keyboard Shortcuts

Course Instructions

Introduction

Whole Person Care Program

Course 1

Course 2

Course 3

Course 4

Course 5

Resources

Motivation for Spirituality in Health Care

Course 2

Motivation for Spirituality in Health Care

As you take this course…

As you take this course…

Impact your faith

Change your practice

And most importantly, affect your patients

Topic 1: Understanding of Religion, Spirituality, and Worldview

Topic 1 Understanding of Religion, Spirituality, and Worldview

Religion

Religion

– (Koenig, King, and Carson 2012)

Spirituality

Spirituality

Historically

Currently

Worldview

Worldview

– (Myers and Noebel 2015)

Worldview

Worldview

– (Nicholi 2002, 7)

Worldview

Worldview

Origin

Morality

Identity

Meaning

Destiny

Worldview Worldview: Not Spiritual, but Religion Is Part of Life

Worldview

Non-Religious or Non-Spiritual

Origin

Morality

Identity

Meaning

Destiny

Worldview: Not Spiritual, but Religion Is Part of Life

Worldview

Not Spiritual, but Religion Is Part of Life

Origin

Morality

Identity

Meaning

Destiny

Worldview: Deeply Religious or Deeply Spiritual

Worldview

Deeply Religious or Deeply Spiritual

Origin

Morality

Identity

Meaning

Destiny

Worldview: Christ Follower With a Biblical Worldview

Worldview

Christ Follower With a Biblical Worldview

Origin

Morality

Identity

Meaning

Destiny

Self-Reflection

Self-Reflection

Topic 2: Scientific Evidence for the Effects of Religion and Spirituality on Health

– (Koenig, King, and Carson 2012; Sheldrake, 2007)

Topic 2 Scientific Evidence for the Effects of Religion and Spirituality on Health

Course 2:

Motivation for Spirituality in Health Care

Topic 1

Understanding of Religion, Spirituality,
and Worldview

Topic 2

Scientific Evidence for the Effects of Religion and Spirituality on Health

Research Studies:
Self-Reflection

Topic 3

Accrediting and Professional Organizations’ Positions on Spiritual Care

Topic 4

Patient Desire for Spiritual Care

Do patients want spiritual care?