Definitions of Spirituality

Spirituality, in the University of Wisconsin Department of Family Medicine Curriculum, is simply defined as the constellation of practices that, as Roger Walsh puts it in Essential Spirituality, “awaken the heart and the mind.” It has also been described as that which “pertains to ultimate meaning and purpose in life” (Post, et al. Ann Intern Med 2000;132:578-83).

The key, however, is to define what spirituality means for yourself. As is noted in the self-care portion of these web pages, the goal here is to foster self-exploration, not to try to promote a specific belief system. For health providers it is important, whatever one’s beliefs, to know about research findings related to this topic.

Spirituality and Health

Ninety percent of Americans believe in God or a higher being. Eighty percent believe that faith can help with recovery from an illness. The Handbook of Religion and Health (Koenig, et al., 2001) noted that at that time 1200 different studies of religion and health existed at the time of writing their book, and there was a trend toward a positive relationship between the two. Williams sums the data up nicely in a 2007 issue of the Medical Journal of Australia. Religiosity can be linked to less depression, decreased mortality, and lower risk of self-injurious behavior, among many other benefits. Conversely, what are referred to as more ‘negative’ perspectives (e.g., “My illness is a punishment from God”) can correlated with decreased health.

A 2003 survey of 476 physicians found that most primary care providers, while respectful of the importance of patient beliefs, typically did not bring up spiritual issues, unless the patient requests that they do. (Monroe MH et al, Arch Intern Med. 2003;163:2751-6). Given that spirituality and religious concerns are issues that will inevitably arise in one’s healthcare practice, providers would be well served to consider some of the following questions:

  • What are my own beliefs?
    • Do I believe that faith can promote healing, and if so, how?
    • How do I explain illness?
    • How do these beliefs affect my approach to caring for people at the end of their lives?
  • Would I be willing to pray with patients if asked?
  • What resources can I or others in my practice setting offer to address peoples’ needs in this area?
  • How might this person’s beliefs be drawn from to facilitate their healing?
  • Is the care I am providing respectful of those beliefs?

http://www.heritage.org/research/religion/HL816.cfm offers a nice review of some of the data surrounding spirituality, prayer, and medicine, as discussed in a panel discussion featuring several authorities on the subject of health and spirituality.

For a nice summary of the literature on the link between spirituality and health, see also the following link: Post SG, Puchalski CM, Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 2000; 132: 578-583.

Taking a Spiritual History

JCAHO, the commission responsible for hospital accreditation, has set outrequirements that all patients received at least some form of spiritual assessment. A number of assessment tools have been created to guide providers in how to approach spiritual issues with patients.

One of the more commonly used is FICA, as outlined on the George Washington Institute for Spirituality and Health Web site. In this mnemonic, FICA stands for:

1. Faith and Belief. Questions include, “Do you consider yourself spiritual or religious?” or “Do you have spiritual beliefs that help you cope with stress?”

2. Importance. “What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health?”

3. Community. “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you?”

4. Address. How would you like me, your healthcare provider, to address these issues in your healthcare?”

Other instruments, including the SPIRIT, HOPE, Kuhn’s, Matthews, and Maugan’s Spiritual Assessments are all outlined here.

http://www.annals.org/cgi/reprint/132/7/578.pdf – is the link to the one by Post, mentioned in the first paragraph.

http://www.aafp.org/fpm/20010500/60spir.html – Spirituality and Your Practice. Family Practice Management May 2001. Nice article covering an array of topics. Offers links to pastoral care organizations.

http://www.heritage.org/Research/Religion/HL816.cfm – Is Prayer Good for Your Health? Panel discussion reviewing religiosity, prayer, and health in the research literature. (Heritage Foundation). Chart 4 summarizes some of the research.

http://www.aafp.org/afp/AFPprinter/20010101/89ph.html?print=yes – Spirituality and health patient handout from AFP.

http://www2.edc.org/lastacts/archives/archivesNov99/featureinn.asp – Interview with Christina Pulchaski about spiritual assessments in health care.

http://www.beliefnet.com/story/131/story_13132_1.html – Religion News Service article on docs taking spiritual histories.

http://courses.washington.edu/mhe518/Articles/soundingboard.pdf – From Sloane RP et al, Should physicians prescribe religious activities? NEJM 2000; 342:1913-6.

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“Nothing in life is more wonderful than faith – the one great moving force which we can neither weigh in the balance nor test in the crucible . . . Faith has always been an essential factor in the practice of medicine . . . Not a psychologist but an ordinary clinical physician concerned in making strong the weak in mind and body, the whole subject is of interest to me.”
-William Osler

“Doctors and clinicians are healers through the caring relationships they form with patients.16 Caring often requires calling on an individual’s inner strengths. These strengths, among others, include spiritual resources that support integration or wholeness of body, mind and spirit… Attending to the spiritual dimensions of the patient can provide the physician with a more in-depth understanding of the patient and his or her needs… Clinicians’ own religious or spiritual practices or non-practices may affect their ability to function effectively in this area of clinical practice. As doctors, we have been trained to be “objective” and to keep our own beliefs and practices separate, but over time we have strayed into keeping patients’ beliefs, spiritual/religious needs and supports separate from their care. Thus, we are potentially ignoring an important element that may be at the core of patients’ coping and support systems and may be integral to their wellbeing and recovery – which is what we have set out to achieve in the first place.”
-R D’Souza, in the Medical Journal of Australia 2007;186: S57-9.