Nearly 60 people from diverse backgrounds and cultures — doctors, nurses, researchers, chaplains, social workers, or counselors and educators — gathered on the George Washington University’s Foggy Bottom campus this summer. Some, like Richard Bauer, a Roman-Catholic priest and social worker, traveled from Africa. Others traveled from Australia, Europe, India, Japan Canada, and parts of the United States. But they all had one thing in common: their interest in spirituality; specifically, its role in health care.
All were taking part in the seventh annual Spirituality and Health Summer Institute hosted by the GW Institute for Spirituality and Health (GWish), established in 2001 as the first university-chartered institute supporting spirituality in health care. This year’s institute, like prior ones, focused on “whole-person” care, which means attending to all aspects of the person — the psychosocial spiritual as well as the physical. It means honoring the dignity of each person clinicians serve and providing compassionate and relationship based care..
So what exactly is spirituality, and what does it have to do with health care? Broadly defined, spirituality is people’s inner resources, the ones that help them cope with difficult situations, like a diagnosis of cancer or diabetes, or the effects of childbirth or aging, explains Christina Puchalski, M.D. ’94, RESD ’97, professor of medicine at the George Washington University School of Medicine and Health Sciences (SMHS) and the founder and director of GWish.
Spirituality is about what matters most to the person — It encompasses secular, cultural, religious, philosophical and personal beliefs, values, and practices. Spirituality is how belief connects to the significant or sacred in their lives Puchalski notes.
“When you ask patients about their spiritual needs, they just get it,” says Rev. George Handzo, BCC, the Summer Institute’s Co-Director. Conversely, health-care providers often aren’t aware of its importance and benefits — to both patients and providers.
Over the three-day institute, more than a dozen speakers addressed evidence for spiritual care and compassionate presence, offered examples of tools to bring spirituality to the forefront of clinical care, and outlined the roles of members of the interdisciplinary team. The experiential learning event included large- and small-group case-based discussions and treatment/care plan development by interdisciplinary teams. Using standardized patient scenarios, participants were able to practice talking with the patients about the their spiritual, psychosocial and physical needs. In doing so, participants learn to listen more carefully to their patients and to work as a team to create whole-person treatment plans.
Participant Richard Bauer knows firsthand what spirituality means to patients. Bauer, who has lived in Africa for the past 20 years and now lives in Namibia, came to this year’s conference to learn more about spirituality and medicine after meeting Puchalski at the 2012 International AIDS Conference in D.C. Bauer has worked in HIV-care support and has studied how spirituality can help patients get the care they need. For example, he says caring for the whole-person greatly improves treatment adherence rates and, in turn, quality and length of life.
Unknown to many clinicians, considering their patients’ spirituality can benefit not only the patient, but also the clinician as well, says native Washingtonian Kenneth Pargament, Ph.D., professor of psychology at Bowling Green State University, and one of the Summer Institute’s speakers. An awareness of spirituality in medicine can make clinicians aware of their own spiritual life, giving them the ability to practice compassionate listening and caring, he says.
Studies show that when people verbalize their worries and someone is listening, their stress levels decline, but the listener’s stress level rises, according to Pargament. Such is the case in the clinician-patient relationship. When clinicians focus on the spirituality of their work, he adds, their stress level was reduced and they were “healed by the spiritual character of the helping relationship.” So, if clinicians learn to see their work as a calling, one in spiritually deeper terms — they report lower stress levels, more job satisfaction, and less burnout.
“Spirituality is a relational process,” Pargament says. “It’s often spoken about in terms of the individual, but it’s about interconnectedness. I’m going to suggest that there’s something in relationships with our patients, with our families, with each other, that’s healing, that sustains us if we’re mindful of it.”
Such mindfulness can lead to what Pargament terms “sacred moments.” Sacred moments can be thought of as spiritual “tipping points,” in which something profound, uplifting, or even mysterious, takes place between clinicians and patients, something that “cuts beneath the superficial to get to some reality of life,” says Pargament. “We see each other beyond our roles as clinician and patient.”
Clinicians, warns Pargament, cannot create sacred moments, they can only cultivate them. “Be interested in your patient, be humble and share your humanness, and be mindful that any moment may be a sacred moment,” he says. “It may be a look, a pat on the back, or holding a hand, but it can be transformational for both the patient and the clinician.”
Caring for the whole person can serve as a gateway to patient disclosure, and consequently better care, adds Harvey Chochinov, M.D., Ph.D., Distinguished Professor of Psychiatry at the University of Manitoba, and another Summer Institute speaker. “When patients feel that caring is present, they’re much more likely to fully disclose things that they want and need, and what their goals are.”
Take, for example, pain management and the will to live. “Pain and the will to live dance an intimate dance,” says Chochinov. When clinicians meet someone’s psychosocial or spiritual needs, the subjective experience of pain can diminish as will to live increases, he says. “Good pain management can have profound spiritual implications, shaping how they experience what’s happening to them as they approach the end of life.”
Likewise, dignity is vital to whole person care, especially at the end of life, says Chochinov. When patients in palliative care were asked what dignity is, they said it was to be seen, to be acknowledged, and to be honored and respected. “Patients who feel that their dignity has been compromised at the end of life are much more likely to report that life is no longer worth living, losing the will to live,” adds Chochinov.
“If we’re really going to do this work right, we have to start understanding what’s happening inside of our head and our own heart, because we also are a player at the bedside, and the drama unfolding before us.”
All the speakers and the participant are part of a “silent revolution” as then Assistant Secretary of Health Howard Koh noted two years ago at the 5th annual summer institute. Since then a Global Network in Spirituality and Health was formed (GNSAH) with close to 200 members from around the world and growing, noted Najmeh Jafari a post doc at GWish who is on the leadership committee of GNSAH. During the presentation at this summer institute, participants were getting on iPads to sign up to join the movement to create spiritually centered compassionate health systems. “The glue that hold us together is compassion, love and a powerful passion to try,“ noted Puchalski in a Global Health conference in 2011. Now, according to Puchalski, it’s a reality with GNSAH and with the increased global attendance at the Summer Institute. “We are creating a movement of like-minded clinicians, academics, researchers, policy makers, and others who can work together to more fully integrate spiritual care, including training, service delivery and standards into health systems.”