spiritual care

Intervention, Ethical Decision-Making, and Spiritual Care By Keith A. Evans Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices. (Puchalski, Vitillo, Hull, & Reller, 2014, p. 646) Essential Questions

• How does spirituality affect advance care planning? • What are the similarities and differences between hospice and palliative care? • How would a nurse explain the Christian principle(s) for administering spiritual care to

patients? Why is this worldview important to the nurse and patient? • How would a nurse complete a spiritual care intervention with a patient? What type of

open-ended questions should be asked?

Introduction All human beings seem to be born with an intrinsic desire for meaning, transcendence, purpose, and belonging. This desire is what drives all of human life from beginning to end. Any and every worldview is essentially an attempt to decipher and live out one’s ultimate meaning and purpose. Four fundamental points follow from this observation. First, all human beings desire to discover what their ultimate meaning and purpose might be. An easy way of beginning to decipher where one derives his or her ultimate purpose is to simply notice the things that one considers to be priorities in everyday life. For some, it is to make as much money as possible or to further one’s career at the cost of all else. For others, it may be family or the pursuit of comfort. Ultimate purpose is linked to what a person considers to be the most valuable and to be sought after above all else. The term worship, often relegated to only describe religious practices, can actually describe all of human behavior because worth-ship, the root word from which the term worship comes, refers to ascribing ultimate value and meaning to something or someone. In short, whether religious or not, people can view that human beings are worshipers by nature.

Secondly, every person has a spiritual nature, whether he or she realizes it or not. Spirituality is informed and developed within the context of a person’s worldview. A person’s spirituality is reliant upon his or her faith, lack of faith, theological interpretations, and even how they view the origins of creation and humanity. What they value above all else is once again dependent upon what is truly real and what it means to live fully as a human being. A person’s worldview shapes his or her inner life and character, such that it is not purely an academic or intellectual question but will involve his or her emotions, thoughts, feelings, desires, and will. In the same way that all

 

 

people have a worldview, all people will have or express a particular kind of spirituality, even if it is not always recognizably religious.

Thirdly, a person’s worldview and, in turn, what they come to worship shapes, informs, and transforms them spiritually. It is not a question of whether or not they will be spiritually formed because all are being formed or developing internally in one way or another, rather the question is what exactly are they being formed into? Dallas Willard (2002) addresses this idea as follows:

We may be sure of this: the formation, and later transformation of the inner life of [human beings], from which our outer existence flows, is an inescapable human problem. Spiritual formation, without regard to any specifically religious context or tradition, is the process by which the human spirit or will is given a definite “form” or character. It is a process that happens to everyone. The most despicable as well as the most admirable or persons have had a spiritual formation. Terrorists as well as saints are the outcome of spiritual formation. Their spirits have been formed. Period. (p. 19) Finally, given the first two points above, the importance of a person’s spirituality and inner workings must be considered. That is, what considerations each individual has internally, what one values, especially when it comes to serious matters he or she may have not been exposed to or confronted with. When people have to face fears and unknown questions, people then rely on their real person deep down inside, their human spirit. This is where an understanding of the importance of the concept of spirituality and how it relates to patient care begins. It is a serious mistake to think of spiritual care as simply a last-ditch effort to provide emotional comfort to patients after all other medical treatments have failed. Nor is it accurate to relegate spiritual care to the realm of simply facilitating the performance of religious rituals and rites, void of compassion and empathy. As a matter of fact, if human beings are spiritual in nature, spiritual care truly encompasses all care, medical or otherwise. When a health care provider does his or her job with skill, competence, and understanding, most people will be shaped by gratitude, joy, and trust. On the other hand, if a patient’s experience with a health care provider is characterized by indifference, belittling, or even technical negligence, such a patient’s inner world will likely develop an aversion to and distrust of health care providers. Equally disturbing is the damage caused to what a Christian worldview would call the soul, the inner being that experiences real emotional wounding. This means that helpful interventions and ethical decision-making flow out of a person’s spirituality and not the other way around. The core of a person’s being, what he or she values pours into these important decisions.

Puchalski et al.’s (2014) comprehensive definition of spirituality reveals the complex nuances of humanity’s spiritual nature. This definition can be well supported by diverse faith and spiritual traditions, but also by Christian beliefs and biblical principles. If a person believes he or she was created by God, then this person must assume that his or her spirituality was given by God to be used for God-glorifying purposes (Psalm 29:2; 1 Corinthians 10:31). The quality of a Christian’s spiritual experiences is connected to the depth of his or her relationship with an interactive, redemptive, and holy God who gives peace, joy, and deep life satisfaction when one’s life and faith beliefs are aligned with godly principles of living and purpose (Colossians 2:6; 3:1–17; Ephesians 2:4–10; Galatians 5:16–25; Philippians 2:13; 4:13).

This chapter will review the key role that personal beliefs play in informing ethical and end-of- life-decisions. In the next section, a Christian theological basis for spiritual care will be