Being and feeling spiritually safe when receiving health and social care.
Paul Michael Keenan
MSc, MA, BSc, PGCE, DipRS, DipHE NP, RNID, RNT.
Historically, caring professions such as nursing and medicine are viewed as having a sound spiritual foundation. However, within contemporary peer-reviewed literature its importance to the patients/service-user is questioned (1,2). In recent years the author and his colleagues have also increasingly received requests from individuals, both students and professionals alike, to assist them in understanding why spirituality and religion are important in and central to many patients’/service-users’ everyday lives and how this may be professionally responded to. In the short paper that follows the author outlines some reasons why health and social care professionals need to respond to their patients’/service-users’ spiritual needs and concerns.
Vulnerability, risk and safety
In contemporary health and social care the concepts of vulnerability, risk and safety have received increased importance in various aspects of health and social policy. Such an emphasis has been driven by the goal of ensuring safe, quality care. Examples of relevant professional social policies include, in the UK: Good Medical Practice (3), the Code for nurses and midwives (4) and here in Ireland the Code of professional conduct and ethics (5). It may also be argued that the focuses of services in these areas are partly motivated by the fact that professionals practice within an increasing litigation culture (6).
Whatever our health or social profession we often work within inter-disciplinary and inter-agency frameworks where the holistic needs of our patients/service-users are the primary focus of care. According to the Irish Scope of nursing and midwifery practice framework (7), holistic care may be defined as the comprehensive assessment and management of the person’s ‘…social, emotional, cultural, spiritual, psychological and physical’ needs. In terms of vulnerability, risk and safety, it may be argued that each of these three concepts apply equally to the individual holistic domains just mentioned and the interactional nature of such domains with each other.
While rarely explicitly linked in peer-reviewed literature and social policy, spiritual vulnerability, at risk spiritually and spiritual safety are central areas of everyday patient/service-user experience and therefore, of concern to professional practice and research. Yet, it is acknowledged that health professionals may avoid responding to the patient’s spiritual needs and requests in this increasingly secular age. As a result professionals may omit essential care interventions. This raises important ethical issues for professionals such as religious discrimination and persecution (1,2).
One area were the spiritual concerns of the person is explicitly acknowledged is contained within Speciality training curriculum for palliative medicine (8). Section 6.2. Religion and Spirituality spells out the medical competency required: ‘To have the knowledge and skills to elicit spiritual concerns, recognise and respond to spiritual distress and demonstrate respect for differing religious beliefs and practice and accommodation of these in patient care.’ (8. page. 47).
However, proficiency in this professional competency equally applies to all aspects of care and other health and social care professionals. The religious person doesn’t just want their spiritual needs to be considered only when receiving palliative care. They may require their spiritual needs to be acknowledged and addressed when receiving care. Full stop.
Therefore if a patient/service-user is, believes they are (or are assessed by competent others to be) vulnerable, at risk, in distress or unsafe with regards to their spirituality within the physical and social care environment they are within, important concerns must be raised by patients/service-users and the profession caring for them.
While all this appears obvious to many professionals, there is a need to reinforce such basic foundations of care in a world where, it can be argued, aggressive, corrosive secularisation/agnosticism/atheism can and evidently does undermine and trivialize the spiritual needs of patients/service-users and the professional responses to such needs (1). This undermining of respect of the individual can damage care and the person spiritually.
While limited research exists within the health and social care literature, professionals may begin the initial person-focused assessment by asking the patient/service-user a few basic, questions to ascertain their beliefs:
- Describe your spiritual needs/concerns?
- How can your spiritual needs/concerns be best addressed by the care team?
- Do you feel spiritually vulnerable, at risk or unsafe? If so, please outline why you feel that way and describe how the care team may support you to be and feel spiritually safe in their care.
In addition the professional is called upon to develop knowledge of the belief systems, practices and pastoral supports within various religions; work within the multi-disciplinary teams with faith professionals and develop skills in recognising and effectively responding to spiritual distress or, were it is beyond their scope of practice, making appropriate referral (JRCPTB 2010).
Spiritual Safety can therefore be understood as ‘the extent to which the individual recipient of care is and feels secure to practice their faith, and also in the ways in which the health and social care professional acknowledges, understands, shows respect and responds effectively to the patient’s/ service user’s needs/concerns.’
It is imperative that individuals are, and feel, spiritually safe. While this may present many challenges for individual professionals, it is the responsibility of all health and social care professionals to promote and ensure appropriate evidence-based practice where, spirituality may be properly acknowledged, respected and enabled in ways which manage the patient’s spiritual risk and enhances spiritually safe, quality care (1,2).
The author states that an essential aspect of holistic care is the patient/service-user being and feeling spiritually safe. However, this is often ignored by professionals. By enhancing spiritual safety the professional can reduce the patient’s/service-user’s spiritual vulnerability, risk and distress. While additional research is required, health and social care professionals play a pivotal role in enabling the spirituality of people in care who are in need and seek spiritual space and support.
- Keenan P. & MacDermott C. Prayer and Religion—Irish nurses caring for an Intellectually Disabled child who has died. Religions. 2016, 7(12), 148; doi:10.3390/rel7120148.
- Timmins F. & McSherry W. Editorial – Spirituality: the Holy Grail of contemporary nursing practice. Journal of Nursing Management. 2012; 20: 951-957.
- General Medical Council. Good Medical Practice. London, UK: General Medical Council; 2013.
- Nursing and Midwifery Council. The Code for nurses and midwives. London, UK: NMC; 2015.
- Nursing and Midwifery Board of Ireland. Code of professional conduct and ethics. Dublin, Ireland: NMBI; 2014.
- Aldridge J. Risk assessment, risk management and safety planning. In Jukes M. & Aldridge J. Person-centred practices – a holistic and integrated approach. London, Quay Books; 2007, p. 281-298.
- NMBI (2015) Scope of nursing and midwifery practice framework. Available at: http://www.nmbi.ie/Standards-Guidance/Scope-of-Practice. Retrieved on 12th Dec. 2016.
- Joint Royal Colleges of Physicians Training Board Speciality training curriculum for palliative medicine. London, Joint Royal Colleges of Physicians Training Board: 2010.
Paul Michael Keenan MSc, MA, BSc, PGCE, DipRS, DipHE NP, RNID, RNT.
Assistant Professor – Intellectual Disability Nursing
School of Nursing
and Midwifery, Trinity College Dublin, University of Dublin.