Spirituality and Holistic People Centred Healthcare

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Spirituality and holistic people centered health care (A description of the HospiVision model) Andre de la Porte (HospiVision CEO, Lecturer and research fellow at the Centre for Contextual Ministry at the University of Pretoria) 1. Introduction 1.1 South African health care scenario According to the World Health Organization (WHO, n.d.) a well-functioning health system responds in a

balanced way to a population’s needs and expectations by

improving the health status of individuals, families and communities

defending the population against what threatens its health

protecting people against the financial consequences of ill-health

providing equitable access to people-centred care

making it possible for people to participate in decisions affecting their health and health system.

For a healthcare system to render quality health services to all people, when and where they need

them, the following is required:

a robust financing mechanism

a well-trained and adequately paid workforce

reliable information on which to base decisions and policies

well maintained facilities and logistics to deliver quality medicines to individuals and

populations.

Healthcare includes preventative, curative and palliative services.

The public health sector is institutionally fragmented and characterized by the poor standard of

infrastructure, skills shortages, poor staff attitudes, low levels of patient satisfaction, incompetent

management, continuing human resources and financial crises, with starkly different health outcomes

for different socio-economic groups. It should be emphasized that there are also many dedicated

people working under exceptionally difficult conditions in public health services. Some notable

successes have also been achieved. This should be recognized, along with the failings of the public

system.

Against this background we ask two important questions:

What is the contribution of spirituality, spiritual and pastoral work and the Faith-Based

Community (FBC) and Faith-Based Organizations (FBO) to holistic people-centred healthcare in

South Africa?

How can spirituality be integrated in a multi-professional and multi-disciplinary approach to

health care within the South African context?

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1.2 Spirituality and health care A World Health Organisation report published in 1998 recognised that:

'Until recently the health professions have largely followed a medical model, which seeks to

treat patients by focusing on medicines and surgery, and gives less importance to beliefs and to

faith – in healing, in the physician and in the doctor–patient relationship. This reductionism or

mechanistic view of patients as being only a material body is no longer satisfactory. Patients and

physicians have begun to realise the value of elements such as faith, hope and compassion in

the healing process. The value of such ‘spiritual’ elements in health and quality of life has led to

research in this field in an attempt to move towards a more holistic view of health that includes

a non-material dimension (emphasising the seamless connections between mind and body) '.

The George Washington Institute for Spirituality and Health (GWish) was established in May 2001 as a

leading organization on education and clinical issues related to spirituality and health. The Mission of

GWish is to work towards ‘a more compassionate system of healthcare by restoring the heart and

humanity of medicine through research, education and policy work, focused on bringing increased

attention to the spiritual needs of patients, families and healthcare professionals’ (GWish, n.d.). In 2012

the director of GWish (Puchalski) was one of the editors of the Oxford Textbook on Spirituality in

Healthcare (Cobb, Puchalski & Rumbold, 2012). The textbook is wide ranging and addresses issues such

as personhood, belief, hope, meaning making, compassion, dignity, suffering and the role of culture. In

the practice section aspects relating to models of spiritual care, nursing, psychiatry, social work, care of

children and palliative care is discussed. The textbook also offers sections on research, policy and

education. Pellegrino (in Cobb et al. 2012) observes:

‘Experienced clinicians have long known that true healing extends beyond the artful use of

medical knowledge. They grasped intuitively that serious or fatal illness was an ontological

assault, an existential assault on the whole of the patient’s lived world. To heal, the physician

must recognize the starkness of the patient’s encounter with his own finitude, i.e. with his

mortality and inherent limitations. Healing of the psychosocial-biological is of itself insufficient

to repair existential disarray of the patient’s life without recognizing the spiritual origins of the

disarray’.

The Council for Health Service Accreditation in South Africa (www.cohsasa.org) was established in 1996

to assist healthcare facilities in developing countries to deliver quality healthcare to their clients through

sustained improvement, using internationally recognised standards and based on patient safety

principles and operational research. COHSASA is accredited by ISQua. The COHSASA Hospital Standards

(Version 6.6 - June 2010 through to July 2014) currently does not have a standard for spirituality. The

COHSASA Hospice Palliative Care Standards (1st edition - August 2010 through to July 2014.) includes a

standard for spiritual care which states:

‘7.3.1: The spiritual needs of patients and families are identified and addressed according to

their religious and cultural beliefs and values.

Intent of 7.3.1

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The spiritual care service is managed by a suitably trained/experienced co-ordinator in line with

the policies and procedures that guide the service. It provides spiritual counselling and

bereavement support to patients and families in line with organisational policies and

procedures, which take gender into account. An assessment of spiritual concerns includes, but is

not limited to meaning, purpose, beliefs, guilt, forgiveness and unfinished life tasks. Care reflects

respect for different religious and cultural beliefs and rituals.

Criteria for 7.3.1

A chaplain or spiritual care coordinator, who is suitably qualified and experienced,

coordinates the spiritual care of patients and families.

Suitably trained spiritual counsellor/s are available to meet the spiritual needs of patients

and/or families when required.

Spiritual support team members have access to information about different religions and

cultural practices related to illness, death and bereavement.

The spiritual support team facilitates the religious or spiritual rituals important to the

patient and family, especially at the time of death.

Suitably trained spiritual counsellor/s contribute to the bereavement support of the family

and members of the care team are identified.

Spiritual support is documented in the patient’s record’.

In South Africa there is no statutory requirement or official system in place for accreditation and

certification of spiritual and pastoral workers in healthcare. Neetling (2003) has done a study regarding

the relevance of pastoral work in South Africa with specific reference to the Southern African

Association for Pastoral Work1 (SAAP; (http://www.saap.za.net/). Neetling (2003:82) concluded that

Pastoral Counselling is a possible national health resource for healthcare, cost effectiveness, spirituality,

social change, reconciliation and multi-cultural application. Currently spiritual care and counselling is

mainly provided by religious, faith-based and community based organizations

1.3 Non-profit environment The important role of FBCs and FBOs is already indicated in the Department of Social Development's

2011 report on the South African Non-Profit sector. Faith-based organisations are the third biggest

sector (12% = 8839 out of a total of 76175), after Social Services ( 34%) and Development and Housing

(21%). This is followed by the Health Sector (11% = 8723). The South African Government’s National

Strategic Plan on HIV, STIs and TB 2012-2016 (n.d.) recognises die important role of the Faith-Based

sector and the networks it provides. In the 2012 article on The Scale of Faith Based Organization

Participation in Health Service Delivery in Developing Countries, Kagawa, Anglemyer and Montagu has

1 SAAP has as focus both professional and lay pastoral workers. This includes pastors in hospitals, call centres,

private independent practitioners, family and marriage counsellors, pastoral work in congregations, pastoral work for Correctional Service, Police Force chaplains and SANDF chaplains. Lay counsellors doing preventative and supportive work are also part of this group. SAAP is affiliated with the International Council for Pastoral Care and Counselling, and The African Association for Pastoral Studies and Counselling. SAAP provides a forum and membership system for pastoral workers as well as an accreditation system.

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estimated that faith-based organizations play a substantial role in providing healthcare in developing

countries and in some cases provide up to 70% of all healthcare services.

1.4 The faith-based environment Magezi (2008) emphasizes the churches2 contribution to national health and wellbeing. The church is a

subsystem of the community and as such can influence the community and society (Magezi 2008:273).

As much as the church, a clinic or a hospital must also be considered as part of the community and the

church (FBCs and FBOs) can make an important contribution to the function and impact of these

facilities. The church also has access to and can offer physical and human recourses to the community,

part of which can be health related (Magezi 2008:274). The church provides social and community

cohesion and it leaders can play an important role in societal and moral transformation (Magezi

2008:274). Magezi (2012) pleads for the repositioning of churches from the periphery to the centre in

order to make a meaningful contribution to public healthcare and indicates three areas of participation:

increasing access to primary and preventive care, improving delivery and quality of healthcare and

improving patients’ self-management of their disease. FBOs and CBOs can also play an important role in

community healthcare and primary healthcare. De Gruchy (2007) has indicated the value that religion

can add to health in the following areas: religion offers presence; religion offers an integration of

tangible and intangible health promoting factors; religion offers relationships and networks; religion

offers an interpretive framework.

2. HospiVision: a brief historic overview3

The decision by Christian Doctors and Ministers to build a chapel in the Pretoria General Hospital during 1945

The inauguration of the chapel in 1956

The start of pastoral services

Drastic changes during 1996

The founding of HospiVision in 1999

Exceptional growth during 2005-2008 as a result of international funding

In the same period the Oasis, food garden and play centre was developed

A crisis time during 2010-2012

The emergence of a best practice model

3. The HospiVision model

3.1 Organizational identity

3.1.1 Vision: Touching lives. Giving hope. HospiVision touches the lives of sick and vulnerable people and those around them through spiritual and emotional care, counseling and physical support, and gives them hope through developmental empowering programmes.

2 I prefer the use of the terms FBC and FBO as opposed to ‘church’.

3 See Annexure A for the historic overview

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3.1.2 Mission HospiVision facilitates the establishment of sustainable integrated support and developmental programmes that reach out to and are in service of the sick, the vulnerable and the disadvantaged, their families and those who care for them. 3.1.3 Values HospiVision is committed to spiritual values such as respect, responsibility, integrity, love, fairness and service. Ownership by the community, church, family and individual involved, is encouraged. HospiVision promotes a culture of lifelong learning and development.

3.2 Guiding principles 3.2.1 A holistic people-centred approach

A Bio-psychosocial and spiritual approach

A re-visioning of the understanding of “Bio” to include all aspects of the person’s physical life

From “person-centered” to “people-centered” (Ubuntu and Batho Pele) 3.2.1 A Faith-based approach

Creating a context and community to search for meaning

3.2.3 Contextually relevant programmes

South African realities

Diverse health care contexts 3.2.4 Collaborative partnerships

Hospital

Other organizations

Donors

Community

Volunteers

Training institutions and universities 3.2.5 Multi and inter-disciplinary approach

This conference is an embodiment of such an approach

3.2.6 Creative communication and resource mobilization

Adapting in the fast changing world of communication

The quest for sustainability

3.2.7 Organizational support and development

Governance, management and administrative systems

Monitoring, evaluation and reporting

Partnership development and management

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3.3 Programmes

Hospi-Care (Touching lives) o Spiritual and emotional support, care and counselling to patients, their families and

caregivers.

o Employee assistance programmes

o Trauma support and counselling

o Hospi-Kids: care and support to sick, orphaned and vulnerable children, in particular

those infected or affected by HIV & AIDS in the family and/or living with a life-

threatening illness (e.g. cancer)

o Counselling centre: trauma counselling, bereavement support and professional

health care related counselling services

Hospi-Help (Giving hope) o Physical and nutritional support o Skills training and socio-economic development programmes for people living with

HIV and AIDS, chronic illness and disability

o Community support and engagement

o Volunteer recruitment, selection, training and mentoring

o Accredited training for volunteer and professional caregivers, companies, as well as

community and faith based leaders

o Marketing, communication and resource mobilization o Radio pulpi

4 Interlude: a Practical Theological reflection

Practical theology is a theological theory of action which includes a hermeneutical, strategic and

empirical reflection on the intention and meaning of human actions as expression of the praxis of God,

as it takes place in faithful daily living, the practice of ministry and the transformation of society.

Osmer (2011) identifies at least four meta-theoretical issues that practical theologians must deal with

either explicitly or implicitly:

Theological rationale: An account of the substantive theological convictions that explain why a

practical theologian works in certain ways. It often grounds other methodological commitments

or guides the way a practical theologian works on a particular issue. Practical theology is first

and foremost a ‘theological’ theory.

‘The theory–praxis relationship: Drawing on philosophy, social theory, and/or theology to make

decisions about the nature of praxis or practice and theory’s relationship to it.

Sources of justification: The way in which a practical theologian draws on and weights the

traditional sources of theological truth – Scripture, tradition, reason and experience.

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Models of cross-disciplinary work: The task of bringing two or more fields into conversation with

one another. It includes the selection of dialogue partners and the way in which they are related

to theology.

Based on the hermeneutical circle Osmer (2008) has identified the following four tasks that

contemporary practical theology attends to:

Descriptive-empirical: What is going on? Gathering information to better understand particular

episodes, situations, or contexts.

Interpretive: Why is this going on? Entering into a dialogue with the social sciences to interpret

and explain why certain actions and patterns are taking place.

Normative: What ought to be going on? Raising normative questions from the perspectives of

theology, ethics and other fields.

Pragmatic: How might we respond? Forming an action plan and undertaking specific responses

that seek to shape the episode, situation, or context in desirable directions.

Addressing spirituality in healthcare offers unique opportunities for practical theology and pastoral care.

Firstly, it is immediately relevant to individuals and communities and to the South African society and

addresses core issues which also relates to other problems such as poverty, HIV and AIDS, crime and

violence. Secondly it is an area where true inter- and cross-disciplinary work can take place as it involves

health, psycho-social , developmental and theological sciences. Thirdly, everybody involved will be

engaged in some way on a personal level, because spirituality touches the core of our humanity.

5 Developing a best practice model

The model as it is presented here has developed organically over a number of years and will continue to evolve

In most of our projects and programmes we started with one component of the model (usually the emotional and spiritual care and counselling component) and added other components over time

Tshwane Rehabilitation Hospital represent the first time that we attempt to implement all aspects of the model in a structured process

Discussions started on 28 May 2014 this year.

What we represent here is the result of the implementation process over the past 5 months

Osmer’s four tasks represents a good framework for the development of a best practice model

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