For some patients, spiritual practice involves religious rituals or religious services. Other patients who self-identify as spiritual but not religious find meaning through meditation, quiet reflection, and connecting with nature (Burton, 2017). At Advocate Aurora Health, our commitment to diversity and inclusion honors the beliefs of all people. For us, respecting spiritual beliefs is an essential part of what it means to provide the best whole-person care, and that respect involves communication, collaboration, compassion, and creativity.
Recently, at Advocate Aurora Health, we began a “We Ask Because We Care” campaign to capture REAL (race, ethnicity, and language) information from our patients at the start. We train our registration staff to explain to patients that we ask for this information so that we can meet their specific needs and provide the safest and best care. We also use this opportunity to ask about religious or spiritual beliefs to provide the most personal and culturally sensitive care.
Board-certified chaplains at our sites of care often take the lead in recognizing a patient’s spiritual beliefs and practices and then communicating them and their implications to others on the care team. However, each of our caregivers is also encouraged to ask clarifying questions of the patient and family and to avoid assumptions. For example:
•What in your spiritual life is most important to you during your hospitalization?
•How can we best honor your beliefs and practices to help you in the healing process?
To integrate the information into the patient’s care plan, caregivers share what they learn with the rest of the care team in chart notes and conversations.
Collaboration between care providers and community faith organizations is important in respecting patients’ spiritual beliefs. For example, after leaders from the Orthodox Jewish community contacted us with ideas to make a hospital more welcoming to Orthodox Jewish patients, we organized a meeting of hospital leaders, spiritual care providers, and representatives from several Orthodox Jewish congregations. This conversation led to initiatives including a kosher hospitality suite near the hospital to provide both kosher food and Sabbath (holy day) accommodations that enable families whose loved ones are seriously ill to stay near the hospital and maintain Sabbath practices.
Respecting spiritual beliefs and religious practices is especially important at the time of death. Once, when working with a Muslim family whose loved one was dying, the chaplain recalled that the Muslim tradition includes certain rituals for care of the deceased’s body, with burial occurring within 24 hours of death. The chaplain and family explored options for direct removal of the body and worked with nursing and administrative staff to honor these practices. The family felt respected in this process and expressed gratitude for the dignity shown to their loved one.
During the course of treatment for an aggressive cancer, a patient shared with the chaplain his commitment to his American Indian heritage as well as his life as a devout Christian. In the last hours of life, his family gathered around his bed for a traditional Christian rite (Commendation of the Dying) led by his pastor, combined with traditional American Indian chants, blessings, and a cleansing with sage led by a tribal leader. The spiritual care team worked with the nursing team and physicians to make this happen in ways that exemplified respect and compassion.
Patients and families frequently request prayers with the care team prior to surgeries or other procedures. Although they may feel like an inconvenience to clinicians who are busy and eager to proceed with the case, it is respectful to honor these requests. Not only will the team gain the patient’s and family’s trust by doing so, but the patient also will enter into the procedure more confident and calm.
Recently, a patient’s son brought a bishop from Africa to a meeting to discuss the care goals for his mother. Also present at the meeting were the patient’s geriatrician (an Egyptian-born Coptic Christian), her oncologist (an American-born Catholic), and the chaplain (an African-American mainline Protestant). The son asked the bishop to lead the group in prayer before the meeting. The bishop did so, and then sang sacred music from the patient’s faith tradition. The others in the room remained respectful and silent as the previously unresponsive patient opened her eyes and focused intently on the music. The family and their faith leader later expressed gratitude for the compassion shown by the members of the care team during this very meaningful time.
The increasing diversity of Advocate Aurora Health’s patient communities and of the staff who care for them has prompted us to modify and adjust our policies and practices regularly to ensure that we provide the best care possible. In the past, when we cared for parents experiencing a stillbirth or fetal demise, the nursing staff—usually following their own religious traditions—asked the parents if they would like their child to be baptized. In cultural sensitivity education and seminars for nursing and spiritual care staffs, we have rephrased the question: “Would you like a blessing or a baptism for your baby?” This approach prompts the family to share what is most meaningful to them in keeping with their own beliefs (which might not include baptism), while providing spiritual care for the staff as well.
In another case, the paternal grandmother of a seriously ill baby in the neonatal intensive care unit demanded that the chaplain baptize her grandchild. In talking about it with the baby’s mother (also hospitalized), the chaplain learned that she was not Christian and was uncomfortable with the idea of baptism. She told the chaplain that her preference for the child was a ritual with candles, a bowl of water, incense, and salt. The chaplain worked with members of the care team to provide materials that met hospital safety standards, including a votive candle, a dish of sterile water, essential oil, and salt. A nurse and the chaplain placed the elements on top of the incubator while the chaplain and family together offered the blessing the mother had chosen. She deeply appreciated the opportunity to care for her child in ways that were consistent with her beliefs and tradition. This example also served as a learning opportunity for the care team about the importance of finding appropriate ways to express unfamiliar spiritual practices.
There are times when the intention of honoring and respecting diverse beliefs points to the need for new policies. In our emergency departments, we experienced a growing number of Jehovah’s Witnesses patients who needed blood transfusions but refused them. To address the question of how to honor the patient’s beliefs over the physician’s need to treat, we brought together staff from various disciplines to develop thoughtful, compassionate procedures that educate both the healthcare team and the family about options that respect the patient’s spiritual beliefs.
As technology’s role in healthcare continues to grow, we are finding ways to use it in the spiritual care space, too. For example, a behavioral health patient expressed unhappiness with his life and with living in general. However, as the chaplain learned, he loved listening to the music of a particular artist who “spoke to his spirit.” The chaplain found the artist’s music on YouTube and played it through the television in the patient’s room. The patient’s ability to connect with this spiritual need advanced his well-being, which improved his mood and his interactions with the rest of the care team.
Technology can also be helpful when meeting spiritual care needs from a distance. Although we have a team of chaplains who collaborate with leaders from a variety of faith groups in our communities to meet the diverse needs of our patients, sometimes the appropriate care provider is not available. To address such situations, we are piloting “telechaplaincy” visits with iPads so that we can bring spiritual care to the patient in the time of greatest need.
Healthcare providers are serving a growing diversity of patients today and must be open to different practices to meet their spiritual care needs while providing the best whole-person care. Informed and respectful patient communication, collaboration between healthcare providers and local faith organizations, compassion during especially difficult times, and creativity in exploring new ways to provide sensitive care can greatly support patients as well as care teams.