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Spirituality In Patient Care Why How When & What Full Text EPUB

The book 'Spirituality in Patient Care' by Harold G. Koenig serves as a guide for healthcare professionals on how to integrate spirituality into clinical practice. It discusses the importance of addressing patients' spiritual needs, the process of spiritual assessment, and the timing and expected outcomes of such practices. Additionally, it explores potential barriers and the negative effects of religion on health, providing resources for further learning on the topic.

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168 views

Spirituality In Patient Care Why How When & What Full Text EPUB

The book 'Spirituality in Patient Care' by Harold G. Koenig serves as a guide for healthcare professionals on how to integrate spirituality into clinical practice. It discusses the importance of addressing patients' spiritual needs, the process of spiritual assessment, and the timing and expected outcomes of such practices. Additionally, it explores potential barriers and the negative effects of religion on health, providing resources for further learning on the topic.

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© © All Rights Reserved
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Spirituality In Patient Care Why How When & What

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Harold G. Koenig, M.D.

SPIRITUALITY IN
PA T I E N T C A R E
Why, How, When, and What

TEMPLETON FOUNDATION PRESS


Philadelphia & London
Templeton Foundation Press
Five Radnor Corporate Center, Suite 120
100 Matsonford Road
Radnor, Pennsylvania 19087

© 2002 by Harold G. Koenig

All rights reserved. No part of this book may be used or repro-


duced, stored in a retrieval system, or transmitted in any form or
by any means, electronic, mechanical, photocopying, recording, or
otherwise, without the written permission of Templeton Founda-
tion Press.

Designed and typeset by Kachergis Book Design,


Pittsboro, North Carolina

Printed by Versa Press, East Peoria, Illinois

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA


Koenig, Harold George.
mmSpirituality in patient care : why, how, when, and what /
mHarold G. Koenig.
mmmp.mcm.
mmIncludes bibliographical references and index.
mmeISBN 1-932031-12-X
mm1. Medical care.m2. Spirituality.m3. Faith Healing—
mmethods.m4. Patient Care—methods.m5. Spirituality.mI. Title.
mR725.55 .K64 2002 2002018100
m615.8/52 21

Printed in the United States of America

01 02 03 04 05 06 07 10 9 8 7 6 5 4 3 2 1
W H E N TO I N C LU D E S P I R I T UA L I T Y v

To my daughter, Rebekah Marie Koenig


vi W H E N TO I N C LU D E S P I R I T UA L I T Y
CONTENTS

IN T R O D U C T I O N 1

1 . W H Y I N C LU D E S P I R I T U A L I T Y ? 5

2 . H O W TO I N C LU D E S P I R I T U A L I T Y 20

3 . W H E N TO I N C LU D E S P I R I T U A L I T Y 33

4 . W H AT M I G H T R E S U LT ? 45

5. BOUNDARIES AND BARRIERS 59

6. WHEN RELIGION IS HARMFUL 77

7 . R E S O U R C E S O N S P I R I T U A L I T Y A N D H E A LT H 88

NOTES 110

INDEX 121

vii
S P I R I T U A L I T Y I N PAT I E N T C A R E
INTRODUCTION

T his book provides a short course for health profession-


als interested in identifying and addressing the spiritu-
al needs of patients. It is intended as a guide for practicing
physicians, medical students, residents, and possibly stu-
dents in other health professions. The primary audience,
however, is physicians who wish to know how to inte-
grate spirituality into clinical practice in an effective, sen-
sitive, and sensible manner. Nurses and chaplains may
also find this small book useful as they interact with doc-
tors, other health professionals, and hospital administra-
tors. While several other guides exist on how to address
spiritual issues, none of these are readily portable for easy
use and rapid access.1,2,3
Is there a need for such a guide? Despite the fact that
nearly two-thirds of American medical schools in 2001
taught required or elective courses on religion, spirituali-
ty, and medicine, few doctors today address the spiritual
needs of patients. Even in strongly religious areas of the

1
2 INTRODUCTION

United States, less than one-third of physicians even inquire about


the patient’s religious denomination, and fewer than one in ten
routinely take a spiritual history.4 Many physicians say they feel
uncomfortable addressing religious issues or don’t have time to do
this. Others don’t see addressing spiritual issues as part of their job,
don’t understand why it should be, don’t know how or when to do
it, and can’t imagine what the results would be if they did. This is a
book about the why’s, how’s, when’s, and what’s of addressing
spiritual issues in patient care.

Why? Why address spirituality in patient care? Why identify


spiritual needs? Why should this be a routine part of health care?
In chapter 1, I examine five reasons why physicians ought to con-
sider this: (1) religious beliefs and spiritual needs are common
among medical patients and serve a distinct function; (2) religious
beliefs influence medical decision making; (3) there is a relation-
ship between religion and both mental and physical health; (4)
many patients would like their doctors to address these issues; and
(5) there is a historical precedent for doing so. These five reasons
also underscore a need for physician training in this area.

How? How does a physician identify and address spiritual needs?


In chapter 2, I describe the process of spiritual assessment, e.g.,
how to take a spiritual history and instruments for doing so. Next, I
examine the role of the physician as orchestrator of resources, sup-
porter of patients’ spiritual beliefs, and participant in spiritual ac-
tivities with patients (such as prayer). I also discuss here the im-
portance of physicians and healthcare systems linking together
with religious organizations (through parish nurses or lay leaders)
to address the present and future health needs of communities.
INTRODUCTION 3

When? In chapter 3, I address a number of important issues with


regard to the timing of spiritual assessment and support. When does
one take a spiritual history during the course of medical evalua-
tion—as part of the chief complaint, history of the present illness,
family history, social history, physical exam, or wrap-up? Are cer-
tain kinds of patients more appropriate than others (for example,
a teenager in for a wart removal, a pregnant woman being seen
for a prenatal exam, an older person in for a health maintenance
visit, or someone being admitted to a hospital, nursing home, or
hospice)? How often should a spiritual history be done: once and
never repeated, every visit, only at selected times? When does a
physician provide spiritual support and what kinds of support are
permissible? What about praying with patients? Is this ever ac-
ceptable.

What? What results can be expected from addressing patients’


spiritual needs? I discuss in chapter 4 the impact that spiritual as-
sessment can have on the patient’s ability to cope with illness, on
the doctor-patient relationship, patient compliance, and more
broadly, on the course of medical illness and response to treat-
ment. Some of the practical benefits of communicating with, refer-
ring to, and interacting with clergy in hospital and community set-
tings are illustrated.

Boundaries and Barriers. In chapter 5 I explore limitations in the


role that physicians can play in this area. Are there ethical bound-
aries that should not be crossed? Does medical specialty make a
difference? Are there gray areas that must be addressed on a case-
by-case basis? What kinds of problems can arise when physicians
attempt to address spiritual needs of patients? How can these prob-
lems be avoided? Are there other pitfalls and dangers to be aware
4 INTRODUCTION

of when addressing spiritual issues? What are some of the resis-


tances, fears, and concerns of health professionals that prevent
them from addressing religious or spiritual issues, and how valid
are these concerns?

When Religion Is Harmful. Here I examine the negative effects that


religion may exert on health. Are there times when spiritual beliefs
can actually interfere with medical care, lead to health problems,
or worsen disease outcomes? What are some examples and how
often does this occur? How can clinicians handle these cases in a
sensitive, thoughtful, and effective manner? Can physician inquiry
about spiritual issues cause harm?

Further Resources. In the final chapter, I provide resources that cli-


nicians can turn to for more information about spirituality and
health. First, different assessment tools for taking a spiritual history
are described and discussed. Second, ten key original research
studies on spirituality and mental health, ten on physical health,
and ten on social health are presented and briefly summarized.
Third, I review academic texts on religion and health, and also
summarize popular books on the topic. Finally, websites, newspa-
pers, and popular magazines where health professionals can obtain
up-to-date information about spirituality and health are described.
Although this little book will not provide the physician with
everything he or she will ever need to know about competently ad-
dressing religious or spiritual issues in patient care, it is a good start
and will point to key resources to develop further skills in this area.
CHAPTER 1

W H Y I N C LU D E S P I R I T U A L I T Y ?

W hy include spirituality in patient care? Why would a


physician address spiritual needs or support a pa-
tient’s religious beliefs? Physicians need to be able to an-
swer these questions clearly and unambiguously before
deciding to tackle spiritual issues with patients. Here are
five reasons physicians should do so:

• Many patients are religious, and religious beliefs help


them to cope.
• Religious beliefs influence medical decisions, espe-
cially when patients are seriously ill.
• Religious beliefs and activities are related to better
health and quality of life.
• Many patients would like physicians to address their
spiritual needs.
• Physicians addressing spiritual needs is not new, but
rooted in the long historical relationship between religion,
medicine, and healthcare.

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