Course 2: Motivation for Spirituality in Health Care

The Neighborhood Christian Clinic Logo

Course 2:
Motivation for Spirituality in Health Care

Use the arrow keys , to navigate through the slides.

Press F11 or F for full screen and ESC to exit full screen.

If you have any questions, please contact [email protected].

Keyboard Shortcuts

Keyboard Shortcuts

Before getting started, take a moment to view the keyboard shortcuts that are available to you:

  • SPACE , : Next slide
  • P , : Previous slide
  • F11 or F : Full screen
  • ESC : Slide overview / Escape from full screen
  • Home : First slide
  • End : Last slide
  • alt + S : Speaker notes view
  • B , . : Pause (Blackout)
  • ? : Show keyboard shortcuts

Tell Us About Yourself

Tell Us About Yourself

Once complete, please proceed to the next slide.

Course Audio

Along with the visual content, this course contains additional audio content.

In order to listen to the content through speakers or headphones, please check your audio settings so that you receive all of the content for this course.

create

Be prepared to write down your response to various prompts throughout the course.

Click the next page arrow to continue.

Introduction

The Neighborhood Christian Clinic Logo

Whole Person Care Program

person

Course 1

Understanding Health & Healing

search

Course 2

Motivation for Spirituality in Health Care

extension

Course 3

Personal, Environmental, & Staff Preparation for Whole Person Care

check_circle

Course 4

Strategies for Spiritual Care in a Health Care Setting

stars

Course 5

Living & Maturing as a Christian Health Care Professional

library_books

Resources

Program Resources

Motivation for Spirituality in Health Care

Course 2

Motivation for Spirituality in Health Care

Course Outline

  1. Understanding the Concepts of Religion, Spirituality, and Worldview
  2. Scientific Evidence for the Effects of Spirituality on Health
  3. Accrediting and Professional Organizations' Positions on Spiritual Care
  4. Patient Desire for Spiritual Care
  5. Ethical Basis for Spiritual Care
  6. Biblical Motivation for Spirituality in Health Care
  7. Conclusion
  8. Survey

As you take this course…

As you take this course…

Think about how the data presented can be used to…

thought bubble icon

Impact your faith

thought bubble icon

Change your practice


thought bubble icon

And most importantly, affect your patients

Topic 1: Understanding of Religion, Spirituality, and Worldview

Topic 1

Understanding of Religion, Spirituality,
and Worldview

Religion

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

Spirituality

Various religious books

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

Worldview

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

– (Myers and Noebel 2015)

Worldview

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

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 Worldview: Not Spiritual, but Religion Is Part of Life

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

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

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

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

Self-Reflection

thought bubble icon

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?

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

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

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

positive correlation scatter plot

Effectiveness of Religious Interventions

Effectiveness of Religious Interventions

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

  • Meditation
  • Spiritual reflection, e.g. taking a spiritual history
  • Prayer

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

Positive Correlation Scatter Plot

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 as well as greater religiousness.

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, faster 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)

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 Studies: Self-Reflection

Research Studies:
Self-Reflection

thought bubble icon

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

Topic 3

Accrediting and Professional Organizations’ Positions on Spiritual Care

Accrediting and Professional Organizations’ Positions on Spiritual Care

Accrediting Organizations

the joint commission logo

The Joint Commission (Formerly JCAHO)

the joint commission logo

International Society for Quality in Health Care (ISQua)

the joint commission logo

National Quality Forum

The Joint Commission

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 logo

The Joint Commission (Minimum Requirement for Spiritual Assessment)

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)

the joint commission logo

International Society for Quality in Health Care

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)

the joint commission logo

National Quality Forum

National Quality Forum

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

– (ISQua Accreditation 2015)

the joint commission logo

Accrediting Organizations: Self-Reflection

Accrediting Organizations: Self-Reflection

thought bubble icon

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

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)

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)

aamc logo

American Association of Medical Colleges (AAMC)

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: Major Medical Schools’ Resources on Religion and Health Care” section at the end of this course.
aamc logo

Additional Resources from AAMC: Major Medical Schools’ Resources on Religion and Health Care

Additional Resources from AAMC:

Major Medical Schools’ Resources on Religion and Health Care

  • George Washington Institute for Spirituality and Health
  • The University of Pennsylvania Health System
  • University of Washington School of Medicine
  • Duke University: Center for Spirituality, Theology and Health

American College of Physicians (ACP)

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)

acp logo

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

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)

ana logo

American College of Critical Care Medicine (ACCCM)

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)

ACCCM logo

Other Organizations That Encourage Spiritual Care

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 “ADDITIONAL RESOURCES: Professional Organizations With Spiritual Care Provisions” at the end of this course.

Additional Resources: Professional Organizations With Spiritual Care Provisions

Additional Resources:

Professional Organizations With Spiritual Care Provisions

  • (JAMA) Journal of the American Medical Association
  • (JAMA) Health and Spirituality
  • (AMA) Religion and Spirituality in Health Care Practice
  • (AAFP) American Academy of Family Physicians
  • (AFP) Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment

Professional and Educational Organizations: Self-Reflection

Professional and Educational Organizations: Self-Reflection

thought bubble icon

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?

Topic 3: Conclusion

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

Topic 4

Patient Desire for Spiritual Care

Do patients want spiritual care?

Belief in God

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)

Belief in God

(Percentage of Adults Who Say They Believe in God)

(Pew Research Center 2014)

Belief in God (Do You Believe in God?)

Belief in God

(Do You Believe in God?)

(Gallup 2017)

Patient Desire for Spiritual Care: Conclusion

Patient Desire for Spiritual Care: Conclusion

  • Most patients believe in God.

Acceptance of Spiritual Conversation

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)

  • arrow_right life-threatening illnesses
  • serious medical conditions arrow_left
  • arrow_right 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)

Patient Desire for Spiritual Care: Conclusion

Patient Desire for Spiritual Care: Conclusion

  • Most patients would accept a conversation about spirituality.

Spiritual Conversation Should Happen

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

Patient Desire for Spiritual Care: Conclusion

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

Prayer

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)

Patient Desire for Spiritual Care: Conclusion

Patient Desire for Spiritual Care: Conclusion

  • Most patients would like their physician to pray with them.

End-of-Life Issues

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)

Patient Desire for Spiritual Care: Conclusion

Patient Desire for Spiritual Care: Conclusion

  • Most patients facing end-of-life issues want to talk to their primary care doctor, more than a psychologist, psychiatrist, or social worker.

Patient-Centered Spiritual Care

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

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 primary care doctor, more than a psychologist, psychiatrist, or social worker.

Research Observations

Research Observations

thought bubble icon

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

Patient Moments

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

William – Patient Moments

(October 2016)

Topic 4: Self-Reflection

Self-Reflection

thought bubble icon

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?

Topic 4: Conclusion

CONCLUSION

Accreditors require spiritual care and patients want it.

Next: Ethical Boundaries and Freedoms when Providing Spiritual Care

Topic 5: Patient Desire for Spiritual Care

Topic 5

Ethical Basis for Spiritual Care

Key Ethical Principles

Key Ethical Principles

ethical puzzle

Autonomy: The Principle Defined

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
autonomy puzzle piece

Autonomy: Ethical Medical Decision-Making

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
autonomy puzzle piece

Autonomy: Spiritual Care

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.
autonomy puzzle piece

Note: Proselytizing Versus Spiritual Support

Note: Proselytizing Versus Spiritual Support

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

Note: Proselytizing Versus Spiritual Support

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?”

Autonomy: Self-Reflection

Self-Reflection

thought bubble icon

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?

autonomy puzzle piece

Key Ethical Principles

Key Ethical Principles

ethical puzzle

Beneficence: The Principle Defined

The Principle Defined

  • Do good
  • Use clinical skills to assist patients
beneficence puzzle piece

Beneficence: Ethical Medical Decision-Making

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
beneficence puzzle piece

Beneficence: Definition of Illness Revisited

Definition of Illness Revisited

  • Refers to “an unhealthy condition of body or mind”
  • Defined as 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)
beneficence puzzle piece

Beneficence: Dimensions of a Whole Person

Dimensions of a Whole Person

Beneficent care attends to all dimensions of a whole person:

Diagram of all dimensions of a whole person: Physical, Mental, Emotional, Social, and Spiritual
beneficence puzzle piece

Beneficence: Definition of Illness Revisited

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 puzzle piece

Beneficence: Negligence

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

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)

Beneficence: Self-Reflection

Self-Reflection

thought bubble icon

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?

beneficence puzzle piece

Key Ethical Principles

Key Ethical Principles

ethical puzzle

Justice: The Principle Defined

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.
justice puzzle piece

Justice: Christian Worldview

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.
justice puzzle piece

Justice: Self-Reflection

Self-Reflection

thought bubble icon

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?

justice puzzle piece

Key Ethical Principles

Key Ethical Principles

ethical puzzle

Nonmaleficence: The Principle Defined

The Principle Defined

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

Nonmaleficence: The Principle Defined

The Principle Defined

Primum Non Nocere

First, Do No Harm

Nonmaleficence puzzle piece

Nonmaleficence: Spiritual Care

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.

Nonmaleficence puzzle piece

Nonmaleficence: Unethical Spiritual Care

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
Nonmaleficence puzzle piece

Nonmaleficence: Self-Reflection

Self-Reflection

thought bubble icon

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?

Nonmaleficence puzzle piece

Key Ethical Principles: Summary

Key Ethical Principles

ethical puzzle

Key Ethical Principles: Summary

When properly provided, spiritual care is ethical:

  • Benevolence (“Net benefit”): it provides far greater benefit than the risk of harm
  • Autonomy: it empowers free decisions
  • Nonmaleficence: it takes care to avoid harm
  • Justice: it respects and validates each patient’s free decisions
ethical puzzle

Ethical Basis for Spiritual Care: Self-Reflection

Ethical Basis for Spiritual Care: Self-Reflection

thought bubble icon

How does your faith affect how you treat patients?

Ethical Basis for Spiritual Care: Additional Self-Reflection

Ethical Basis for Spiritual Care: Additional Self-Reflection

thought bubble icon

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?

Topic 5: What’s Next

What’s Next

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

What does the Bible say?

Topic 6: Biblical Motivation for Spiritual Care in Health Care

“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

Topic 6: Biblical Motivation Concepts

Biblical Motivation Concepts

Identity in Christ

Identity in Christ

Biblical call

Biblical call

Emotional and spiritual impact on overall health

Emotional and spiritual impact on overall health

Healing through spiritual care

Healing through spiritual care

Identity in Christ

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

Identity in Christ:
Self-Reflection

thought bubble icon

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

Identity in Christ: A Chosen People

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])

A Chosen People: Self-Reflection

A Chosen People:
Self-Reflection

thought bubble icon

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

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

Holy, Set Apart:
Self-Reflection

thought bubble icon

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

Identity in Christ: The Foundation for Actiont

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

The Foundation for Action:
Self-Reflection

thought bubble icon

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

Biblical Model to Combine Physical Healing With Spiritual Care

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

Biblical Model:
Self-Reflection

thought bubble icon

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

Impact on Overall Health: Emotional Condition

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

Emotional Condition:
Self-Reflection

thought bubble icon

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

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

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

Spiritual Condition:
Self-Reflection

thought bubble icon

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

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])

Impact on Overall Health: Common Misconception

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

External Spiritual Forces:
Self-Reflection
Self-Reflection

thought bubble icon

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

Healing Through Spiritual 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

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]).

Healing Through Spiritual Care: Mental and Emotional

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

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

Healing Through Spiritual Care:
Self-Reflection

thought bubble icon

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, Next Course, and Survey

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, Next Course, and Survey

Topic 7: Conclusion

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

Whole Person Care Program: Next Course

The Neighborhood Christian Clinic Logo

Whole Person Care Program

person

Course 1

Understanding Health & Healing

search

Course 2

Motivation for Spirituality in Health Care

extension

Course 3

Personal, Environmental, & Staff Preparation for Whole Person Care

check_circle

Course 4

Strategies for Spiritual Care in a Health Care Setting

stars

Course 5

Living & Maturing as a Christian Health Care Professional

library_books

Resources

Program Resources

End-of-Course-Survey

End-of-Course-Survey

Once complete, please proceed to the next slide.

Course Certificate

Course Certificate

The Neighborhood Christian Clinic Logo

Enter your name the way you want it to appear on the certificate.

Thank you for completing Course 2: Motivation for Spirituality in Health Care of the Whole Person Care Program.

Additional Resources from AAMC: Major Medical Schools’ Resources on Religion and Health Care

Additional Resources from AAMC:

Major Medical Schools’ Resources on Religion and Health Care

  • George Washington Institute for Spirituality and Health
  • The University of Pennsylvania Health System
  • University of Washington School of Medicine
  • Duke University: Center for Spirituality, Theology and Health

Additional Resources: Professional Organizations With Spiritual Care Provisions

Additional Resources:

Professional Organizations With Spiritual Care Provisions

  • (JAMA) Journal of the American Medical Association
  • (JAMA) Health and Spirituality
  • (AMA) Religion and Spirituality in Health Care Practice
  • (AAFP) American Academy of Family Physicians
  • (AFP) Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment

Additional Resources: Professional Organizations With Spiritual Care Provisions

Additional Resources:

Professional Organizations With Spiritual Care Provisions

  • (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

Topic 1 References

Topic 1 References

  • Koenig, Harold G., Dana E. King, and Verna Benner Carson. 2012. Handbook of Religion and Health. 2nd ed. New York, NY: Oxford University Press. ISBN-13: 9780195335958
  • Myers, Jeff, and David A. Noebel. 2015. "Battle of Ideas." In Understanding the Times: A Survey of Competing Worldviews, 1-25. Manitou Springs, CO: Summit Ministries. ISBN-13: 9781434709585
  • Nicholi, Armand M., Jr. 2002. The Question of God: C. S. Lewis and Sigmund Freud Debate God, Love, Sex, and the Meaning of Life. New York, NY: Free Press. ISBN-13: 9780743202374

Topic 2 References

Topic 2 References

  • Koenig, Harold G., Dana E. King, and Verna Benner Carson. 2012. Handbook of Religion and Health. 2nd ed. New York, NY: Oxford University Press. ISBN-13: 9780195335958
  • Sheldrake, Philip. 2007. "Periods and Transitions." In A Brief History of Spirituality, 10-11. Malden, MA: Wiley-Blackwell. ISBN-13: 9781405117715

Topic 3 References (1 of 3)

Topic 3 References (1 of 3)

  • American Nurses Association. 2015. Nursing Scope and Standards of Practice. 3rd ed. Silver Spring, MD: American Nurses Association.
  • Behan, J., S. Carmichael, R. Edeen, D. Gerry, M. Hoover, M. Hughes, M. Kalashnikova, F. George Vento, and J. Wald. 2012. "Understanding the Role of Spirituality in Medicine - A Resource for Medical Students." AAMC – OSR Committee on Student Affairs. Accessed August 20, 2018. https://www.aamc.org/download/300720/data/osrspiritualityresources.
  • Davidson, Judy E., Karen Powers, Kamyar M. Hedayat, Mark Tieszen, Alexander A. Kon, Eric Shepard, Vicki Spuhler, I. David Todres, Mitchell Levy, Juliana Barr, Raj Ghandi, Gregory Hirsch, and Deborah Armstrong. 2007. "Clinical Practice Guidelines for Support of the Family in the Patient-Centered Intensive Care Unit: American College of Critical Care Medicine Task Force 2004–2005." Critical Care Medicine 35, no. 2 (February): 605-622.

Topic 3 References (2 of 3)

Topic 3 References (2 of 3)

  • Hodge, David R. 2006. "A Template for Spiritual Assessment: A Review of the JCAHO Requirements and Guidelines." Social Work 51, no. 4: 317-326. Accessed August 10, 2018. https://www.researchgate.net/publication/6645998_A_Template_for_Spiritual_Assessment_A_Review_of_the_JCAHO_Requirements_and_Guidelines_for_Implementation.
  • ISQua Accreditation. 2015. Guidelines and Principles for the Development of Health and Social Care Standards: 4th Edition Version 1.2, September 2015. Dublin, Ireland: International Society for Quality in Health Care. Accessed August 20, 2018. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=2ahUKEwi2-dnK6orjAhVmwVQKHVYVAQkQFjAAegQIARAC&url=https%3A%2F%2Fwww.isqua.org%2Fmedia%2Fattachments%2F2018%2F03%2F20%2Fguidelines_and_principles_for_the_development_of_health_and_social_care_standards__4th_edition_v1.2.pdf&usg=AOvVaw0Kkss6oUVZEsl7H4Z8FjL5

Topic 3 References (3 of 3)

Topic 3 References (3 of 3)

  • National Quality Forum. 2016. Palliative and End-of-Life Care 2015-2016: Technical Report. Accessed August 10, 2018. https://www.qualityforum.org/Projects/n-r/Palliative_and_End-of-Life_Care_Project_2015-2016/Final_Report.aspx.
  • Snyder, L., and American College of Physicians Committee. 2012. "ACP Ethics Manual, Sixth Edition: A Comprehensive Medical Ethics Resource." Annual Internal Medicine Journal 156: 73-104.

Topic 4 References (1 of 4)

Topic 4 References (1 of 4)

  • Best, M., P. Butow, and I. Olver. 2015. "Do Patients Want Doctors to Talk About Spirituality? A Systematic Literature Review." Patient Education and Counseling 98, no. 11 (November): 1320–1328.
  • Balboni, Michael J., Amenah Babar, Jennifer Dillinger, Andrea C. Phelps, Emily George, Susan D. Block, Lisa Kachnic, Jessica Hunt, John Peteet, Holly G. Prigerson, Tyler J. VanderWeele, and Tracy A. Balboni. 2011. "'It Depends': Viewpoints of Patients, Physicians, and Nurses on Patient-Practitioner Prayer in the Setting of Advanced Cancer." Journal of Pain and Symptom Management 41, no. 5 (May): 836-847.
  • Gallup. 2017. "Religion: Do You Believe in God?" Accessed March 6, 2018. http://news.gallup.com/poll/1690/Religion.aspx?version=print.
  • Highfield, M. F. 1992. "Spiritual Health of Oncology Patients: Nurse and Patient Perspectives." Cancer Nursing 15, no. 1 (February): 1-8.

Topic 4 References (2 of 4)

Topic 4 References (2 of 4)

  • Kalb, Claudia, Anne Underwood, Ellise Pierce, Joan Raymond, Jenny Hontz, Karen Springen, and Sarah Childress. 2003. "Faith and Healing." Newsweek 142, no. 19 (November): 44–56.
  • King, Dana E., and Bruce Bushwick. 1994. "Beliefs and Attitudes of Hospital Inpatients about Faith Healing and Prayer." Journal of Family Practice 39, no. 4 (October): 349-352.
  • Koenig, Harold G., Mona Smiley, and Jo Ann Ploch Gonzales. 1988. Religion, Health, and Aging. Westport, CT: Greenwood Press.
  • Kristeller, Jean L., Mark Rhodes, Larry D. Cripe, and Virgil Sheets. 2005. "Oncologist Assisted Spiritual Intervention Study (Oasis): Patient Acceptability and Initial Evidence of Effects." International Journal of Psychiatry in Medicine 35, no. 4: 329-347. Accessed August 20, 2018. http://www.indstate.edu/cas/sites/arts.indstate.edu/files/Psychology/OASIS_Paper.pdf

Topic 4 References (3 of 4)

Topic 4 References (3 of 4)

  • MacLean, Charles D., Beth Susi, Nancy Phifer, Linda Schultz, Deborah Bynum, Mark Franco, Andria Klioze, Michael Monroe, Joanne Garrett, and Sam Cykert. 2003. "Patient preference for Physician Discussion and Practice of Spirituality." Journal of General Internal Medicine 18, no. 1 (January): 38–43.
  • McNichol, T. 1996. "The New Faith in Medicine." USA Today, April 5-7.
  • McCord, Gary, Valerie J. Gilchrist, Steven D. Grossman, Bridget D. King, Kenelm F. McCormick, Allison M. Oprandi, Susan Labuda Schrop, Brian A. Selius, William D. Smucker, David L. Weldy, Melissa Amorn, Melissa A. Carter, Andrew J. Deak, Hebah Hefzy, and Mohit Srivastava. 2004. "Discussing Spirituality With Patients: A Rational and Ethical Approach." Annals of Family Medicine 2, no. 4 (July-August): 356-61.

Topic 4 References (4 of 4)

Topic 4 References (4 of 4)

  • Oyama, Oliver, and Harold G. Koenig, 1998. "Religious Beliefs and Practices in Family Medicine." Archives of Family Medicine 7, no. 5 (September): 431-435.
  • Pew Research Center. 2014. "Belief in God: % of Adults Who Say They…." Accessed March 6, 2018. https://www.pewforum.org/religious-landscape-study/belief-in-god/.
  • Vallurupalli, M., K. Lauderdale, M. J. Balboni, A. C. Phelps, S. D. Block, A. K. Ng, L. A. Kachnic, T. J. Vanderweele, and T. A. Balboni. 2012. "The Role of Spirituality and Religious Coping in the Quality of Life of Patients With Advanced Cancer Receiving Palliative Radiation Therapy." Journal of Supportive Oncology 10, no. 2: 81-87.
  • Vermandere, Mieke, Yoo-Na Choi, Heleen De Brabandere, Ruth Decouttere, Evelien De Meyere, Elien Gheysens, Brecht Nickmans, Melanie Schoutteten, Lynn Seghers, Joachim Truijens, Stien Vandenberghe, Sofie Van de Wiele, Laure-Anne Van Oevelen, and Bert Aertgeerts. 2012. "GPs' Views Concerning Spirituality and the Use of the FICA Tool in Palliative Care in Flanders: A Qualitative Study." British Journal of General Practice 62, no. 603 (Oct.): e718–e725.

Topic 5 References

Topic 5 References

  • Elder, Harvey. ca. 1995. "Whole Patient Care Includes Spiritual Care." Paper presented at METS Conferences.
  • Merriam-Webster Dictionary, s.v. "illness". Accessed September 10, 2019, https://www.merriam-webster.com/dictionary/illness.
  • Pearce, Michelle J., April D. Coan, James E. Herndon, Harold G. Koenig, and Amy P. Abernethy. 2012. "Unmet Spiritual Care Needs Impact Emotional and Spiritual Well-Being in Advanced Cancer Patients." Support Care Cancer 20, no. 10 (October):2269-76.

Additional Resources References (1 of 2)

Additional Resources References (1 of 2)

  • American Association of Colleges of Nursing. 2008. The Essentials of Baccalaureate Education for Professional Nursing Practice. Washington, DC: American Association of Colleges of Nursing.
  • Anandarajah, Gowri, and Ellen Hight. 2001. "Spirituality and Medical Practice: Using the HOPE Questions as a Practical Tool for Spiritual Assessment." American Family Physician 63, no. 1: 81-89.
  • Ehman, John E. 2012. “Religious Diversity: Practical Points for Health Care Providers."
  • Fournier, A. L. 2017. "Creating a Sacred Space in the Intensive Care Unit at the End-of-Life." Dimensions of Critical Care Nursing 36, no. 2 (March/April): 110-115. doi: 10.1097/DCC.0000000000000231.

Additional Resources References (2 of 2)

Additional Resources References (2 of 2)

  • Marwick, C. 1995. "Should Physicians Prescribe Prayer for Health? Spiritual Aspects of Well-Being Considered." JAMA 273, no. 20: 1561-1562.
  • McCormick, T. 2014. “Spirituality and Medicine.” UW Medicine.
  • Pargament, Kenneth I., ed. 2013. APA Handbook of Psychology, Religion, and Spirituality. Washington, DC: American Psychiatric Association. ISBN-13: 9781433810770.
  • Saguil, Aaron, and Karen Phelps. 2012. "The Spiritual Assessment." American Family Physician 86, no. 6: 546-550.
  • Vanderweele, Tyler J., Tracy A. Balboni, and Howard Koh. 2017. "Health and Spirituality." JAMA 318, no. 6: 519-520.
  • Zaidi, Danish, ed. "Religion and Spirituality in Health Care Practice." Special issue, AMA Journal of Ethics 20, no. 7 (July 2018).