Creating Healing Environments

Health Progress, May/Jun 2006 by Puchalski, Christina M, McSkimming, Sylvia

Today's health care system is in crisis. Due to increasing insurance limitations on reimbursements and rising malpractice costs, physicians are pushed to see more patients each day and to shorten the length of their visits. Some hospitals attempt to contain costs by cutting their nursing staffs. Many social work departments are also short-staffed because of rising health care costs. Although many social workers and nurses would like to spend more time on direct patient care, they are forced by staffing issues to use it on documentation, such as discharge planning. Physicians also know that excellent patient-centered care requires time, but many find that they do not have that time.

Many health care professionals note that their own spirituality supports them in finding meaning in their profession. In addressing patients' spirituality, such caregivers realize, they also trigger questions in themselves about their own spirituality. Given the current stresses in the health care system, caregivers find it a challenge to tap into their own spirituality in a way that nurtures their clinical practice. Consequently, physician and other clinician burnout is often high.

Spirituality is the source of life's meaning. It is the individual's continuous search for meaning and transcendence in life, especially during times of illness and pain. For some people, spirituality includes religious practices; for others, it may include nature, art, music, family, or community. Spirituality is the lifeline that sustains people through stress and challenging times, an essential aspect of one's humanness.

Today, however, health care providers are illequipped to care for the spiritual dimension in patients. Many patients complain about the increasingly impersonal approach they encounter in hospitals and other health care organizations. And, ironically, they often experience this sense of alienation at precisely the time when they most need human interaction and spiritual support. People facing challenges in their health and well-being often turn inward to reflect on the meaning of their illnesses and their lives and to search for purpose and hope. This search for meaning and purpose is integral to each individual and influences the impact of illness on the patient and his or her family.

The U.S. health care system itself is frequently perceived as lacking in personalized and compassionate health care services. One often hears medical students say that, although they are learning important values and practices, they find that the organizations in which they will practice-hospitals, nursing homes, outpatient offices, and others-do not reflect the material taught concerning the importance of spirituality to good health.

Care providers who lcam more about the spiritual lives of their patients find they are able to provide more personalized care while, at the same time, nurturing their own spiritual awareness and growth.

In 2004 two organisations, the George Washington Institute tor Spirituality and Health, Washington, DC, and the Supportive Care Coalition: Pursuing Excellence in Palliative Care, Portland, OR (formerly Supportive Care of the Dying: A Coalition for Compassionate Care ), collaborated in developing a solution to the depersonalization of health care. To this end, they created the "Hospital-Rased Spirituality Initiative: Creating Healing Environments," an innovative demonstration project designed to test ways of restoring heart and humanity to health care by reintegrating an awareness of spirituality and spiritual care into the role of each care provider.

THE INITIATIVE'S GOALS

Specifically, the initiative was intended to achieve two objectives: First, to develop and test strategies that encourage ownership of the professional responsibility to attend to spiritual concerns among caregivers; and, second, to better understand the organisational values and infrastructure that support increasing the spiritual care that caregivers provide. Integral to this process was developing programs that address caregivers' own spirituality, as well as that of patients. The goals were to:

* Develop a process that is reproducible, effective, and respectful of available resources within the hospital system

* Foster awareness of personal spirituality in direct caregivers and indirect care providers as an aspect of their professional lives

* Foster development of enhanced individual competencies for delivering patient-centered, interdisciplinary, spiritual care

* Develop structured patient spiritual assessment and a model of integrating patients' spiritual values into treatment plans

* Develop and test strategies for applying those competencies in the work environment in which care is delivered for people with progressive chronic or life-threatening illness and injury

* Develop and provide peer mentoring and coaching so that participants can "model, teach, and encourage" others in developing skills that facilitate the provision of "fully present" care (that is, attending to the patient's psychosocial and spiritual dimensions as well as the physical dimension, the goal being to develop a earing, supportive, trusting relationship with him or her)