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Spirituality: Spirituality in Patient Care

Spirituality: Spirituality in Patient Care There is much I like in this book. Harold Koenig, MD, in a short and eminently readable style, outlines how important spirituality can be in treating the whole person. He gives clear definitions of religious coping, spiritual assessment, transference and counter-transference, and boundaries to care. Dr Koenig has a deep respect for a person's religiosity and a belief, buttressed by rigorous research studies, that religion is good for your health. Koenig also has a deep respect for chaplains, whom he considers "experts" in spirituality. My disappointment with this book is that it appears to be based on the old physician-centered philosophy of care. The physician has the duty to take a spiritual history. He or she has the responsibility to identify "spiritual needs" and "orchestrate resources to meet those needs," including community clergy. Other caregivers are ancillary providers, to be called in as consultants whenever the physician has determined such to be appropriate and only after the physician has obtained "consent from the patient" to ask "a chaplain or pastoral counselor to see the patient." Koenig has a great section on the history of medicine. He remembers that, before the mid-19th century, "many of the physicians . . . were monks or priests, addressing physical and spiritual needs hand in hand." He notes, "The profession of nursing came directly out of the church," and even psychiatry got its start in the United States as "moral treatment . . . based on the idea that insanity was a disruption of both mind and spirit." It appears that Koenig might advocate a return to the time when clergy and physicians were one and the same. Concerning the physician's "asking about the patient's religious beliefs," he writes: In fact, the physician's medical authority may even begin to take on an aspect of spiritual authority. The doctor has now become both physician and priest, capable of fully utilizing not only the power of medical therapies but also the power of the patient's belief and trust. Koenig describes the doctor managing the patient's care even out into the community: "Physicians and healthcare systems need to consider linking with religious communities through ‘parish nurses' (or lay leaders) to more fully address the health needs of patients and families who care for them." A reader might ask, where is the multidisciplinary team? Where is patient-centered care, shared decision-making, and a total plan of care fashioned by a variety of disciplines in constant communication with the patient and each other? Must the physician be the only one to inquire into the social and spiritual history of the patient? Koenig writes that "delegating these questions to others [the nurse, social worker, or chaplain] is not sufficient." Koenig has high regard for chaplains, writing that "chaplains are the true experts in this area [spirituality] and should be fully utilized whenever possible." He believes that, "for all but the most simple of spiritual needs that arise during such assessments, referral to chaplains and pastoral counselors should be considered." But it appears that chaplains, nurses, and social workers are ancillary services. Yet, there is much in this book to admire. "Spiritual assessments" are reviewed on pages 89 through 94. They vary from short "spiritual screens" to extensive spiritual histories. A reader might ask, what benefits would accrue from having the physician, nurse, or social worker ask a few spiritual screen questions, then having the chaplain ("the expert") do the full spiritual assessment? Such an approach appears to be the direction that the Joint Commission on Accreditation of Health Care Facilities (JCAHO) is heading in its Long Term Care Standards. Those standards mandate that a registered nurse coordinate the completion of the patient's assessment carried out by "qualified individuals" within the organization, including chaplain, social worker, nurse, physician (Care of the Patient PE1.1). One of the areas to be assessed, according to those standards (PE2.1.5.1), is the "resident's spiritual status and needs, including spiritual orientation and the dying individual's concerns related to hope, despair, guilt, or forgiveness." JCAHO's substance abuse protocol suggests a similar interdisciplinary approach and includes spiritual assessment as an important part of the rehabilitation program. Dr Koenig vacillates over whether physicians should pray with patients. He raises the issue, gives some guidelines, but allows a lot of room for discussion. Dr Koenig should be commended for writing a concise yet meaty book on spirituality in patient care. I hope it is widely read and discussed. Even the book's flaws can be useful in raising the issue of spirituality and encouraging physicians and other care providers to find ways to relate the patient's spirituality to the holistic plan of care. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Spirituality: Spirituality in Patient Care

JAMA , Volume 288 (12) – Sep 25, 2002

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Publisher
American Medical Association
Copyright
Copyright © 2002 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.288.12.1530-JBK0925-3-1
Publisher site
See Article on Publisher Site

Abstract

There is much I like in this book. Harold Koenig, MD, in a short and eminently readable style, outlines how important spirituality can be in treating the whole person. He gives clear definitions of religious coping, spiritual assessment, transference and counter-transference, and boundaries to care. Dr Koenig has a deep respect for a person's religiosity and a belief, buttressed by rigorous research studies, that religion is good for your health. Koenig also has a deep respect for chaplains, whom he considers "experts" in spirituality. My disappointment with this book is that it appears to be based on the old physician-centered philosophy of care. The physician has the duty to take a spiritual history. He or she has the responsibility to identify "spiritual needs" and "orchestrate resources to meet those needs," including community clergy. Other caregivers are ancillary providers, to be called in as consultants whenever the physician has determined such to be appropriate and only after the physician has obtained "consent from the patient" to ask "a chaplain or pastoral counselor to see the patient." Koenig has a great section on the history of medicine. He remembers that, before the mid-19th century, "many of the physicians . . . were monks or priests, addressing physical and spiritual needs hand in hand." He notes, "The profession of nursing came directly out of the church," and even psychiatry got its start in the United States as "moral treatment . . . based on the idea that insanity was a disruption of both mind and spirit." It appears that Koenig might advocate a return to the time when clergy and physicians were one and the same. Concerning the physician's "asking about the patient's religious beliefs," he writes: In fact, the physician's medical authority may even begin to take on an aspect of spiritual authority. The doctor has now become both physician and priest, capable of fully utilizing not only the power of medical therapies but also the power of the patient's belief and trust. Koenig describes the doctor managing the patient's care even out into the community: "Physicians and healthcare systems need to consider linking with religious communities through ‘parish nurses' (or lay leaders) to more fully address the health needs of patients and families who care for them." A reader might ask, where is the multidisciplinary team? Where is patient-centered care, shared decision-making, and a total plan of care fashioned by a variety of disciplines in constant communication with the patient and each other? Must the physician be the only one to inquire into the social and spiritual history of the patient? Koenig writes that "delegating these questions to others [the nurse, social worker, or chaplain] is not sufficient." Koenig has high regard for chaplains, writing that "chaplains are the true experts in this area [spirituality] and should be fully utilized whenever possible." He believes that, "for all but the most simple of spiritual needs that arise during such assessments, referral to chaplains and pastoral counselors should be considered." But it appears that chaplains, nurses, and social workers are ancillary services. Yet, there is much in this book to admire. "Spiritual assessments" are reviewed on pages 89 through 94. They vary from short "spiritual screens" to extensive spiritual histories. A reader might ask, what benefits would accrue from having the physician, nurse, or social worker ask a few spiritual screen questions, then having the chaplain ("the expert") do the full spiritual assessment? Such an approach appears to be the direction that the Joint Commission on Accreditation of Health Care Facilities (JCAHO) is heading in its Long Term Care Standards. Those standards mandate that a registered nurse coordinate the completion of the patient's assessment carried out by "qualified individuals" within the organization, including chaplain, social worker, nurse, physician (Care of the Patient PE1.1). One of the areas to be assessed, according to those standards (PE2.1.5.1), is the "resident's spiritual status and needs, including spiritual orientation and the dying individual's concerns related to hope, despair, guilt, or forgiveness." JCAHO's substance abuse protocol suggests a similar interdisciplinary approach and includes spiritual assessment as an important part of the rehabilitation program. Dr Koenig vacillates over whether physicians should pray with patients. He raises the issue, gives some guidelines, but allows a lot of room for discussion. Dr Koenig should be commended for writing a concise yet meaty book on spirituality in patient care. I hope it is widely read and discussed. Even the book's flaws can be useful in raising the issue of spirituality and encouraging physicians and other care providers to find ways to relate the patient's spirituality to the holistic plan of care.

Journal

JAMAAmerican Medical Association

Published: Sep 25, 2002

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