Eckhard Frick sj

Psychiatrist and Psychoanalyst

Professorship of Spiritual Care
Spiritual empowerment of patients
and health professionals
PROFESSUR FR SPIRITUAL CARE
Spiritual empowerment of patients and health professionals
1. Describing the field of Spiritual Care
2. What do Health Professionals think
about spirituality?
3. Mastery or Mystery?
4. Consequences of research
5. A network of competencies
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www.spiritualcare.de
PROFESSUR FR SPIRITUAL CARE
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Helpful person
centred care
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Religion
Spirituality
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Religion
Spirituality
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Religion
Spirituality
Cicely Saunders at the end of her first year as a nurse.
Saunders C BMJ 1996;313:1599-1601
1996 by British Medical J ournal Publishing Group
total pain, which was presented as a complex of physical,
emotional, social, and spiritual elements
physical
psycho-
social
spiritual
SUFFERING
Cicely Saunders: total pain
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PROFESSUR FR SPIRITUAL CARE
Spiritual empowerment of patients and health professionals
1. Describing the field of Spiritual Care
2. What do Health Professionals think
about spirituality?
3. Mastery or Mystery?
4. Consequences of research
5. A network of competencies
11
www.spiritualcare.de
KLINIK UND POLIKLINIK FR PALLIATIVMEDIZIN
KLINIKUM DER UNIVERSITT MNCHEN

In general, is it appropriate
for a physician to discuss
religious/spiritual issues
when a patient brings them
up?
PROFESSUR FR SPIRITUAL CARE
37,9 39
53,8
48,3
57,9
46,2
6,9
3
0
without religion (n=29) catholic (n=133) others (n=13)
religious belonging
NERSH Salzburg p=.045
always appropriate usually appropriate usually inappropriate always inappropriate
www.spiritualcare.de
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In general, is it
appropriate for a
physician to discuss
religious/spiritual issues
when a patient brings
them up?
PROFESSUR FR SPIRITUAL CARE
In general, is it appropriate for a physician to discuss religious/spiritual
issues when a patient brings them up? (%)
7
10
4
44
45
50
39
37
36
DK Physicians US Physicians AU Physicians
Always Usually appropriate Usually inappropriate Always inappropriate
KLINIK UND POLIKLINIK FR PALLIATIVMEDIZIN
KLINIKUM DER UNIVERSITT MNCHEN

In general, is it appropriate or
inappropriate for a physician
to inquire about a patients
religion/spirituality?
PROFESSUR FR SPIRITUAL CARE
67,3
93
53
32,7
7
47
n=171 HP AU n=100 Psych US n=1144 MD US
NERSH Salzburg
always or usually appropriate
usually or always inappropriate
www.spiritualcare.de
16
In general, is it
appropriate or
inappropriate for a
physician to inquire
about a patients
religion/spirituality?
p<.0001
KLINIK UND POLIKLINIK FR PALLIATIVMEDIZIN
KLINIKUM DER UNIVERSITT MNCHEN

When, if ever, is it
appropriate for a physician to
pray with a patient?
17
PROFESSUR FR SPIRITUAL CARE
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n=170
29
61
11
12
80
9
17
83
never only when patient
asks for
when MD senses it
would be appropriate
% of professions NERSH Salzburg
MDs nurses others
When, if ever, is
it appropriate for
a physician to
pray with a
patient?
PROFESSUR FR SPIRITUAL CARE
When religious/spiritual issues come up in discussions with patients, how
often do you respond in the following ways? I pray with the patient (%)
95
47
71
4
34
25
1
15
4
DK Physicians US Physicians AU Physicians
never rarely sometimes often/always
Copyright American Psychiatric Association.
All rights reserved.
From: Religion, Spirituality, and Medicine: Psychiatrists and Other Physicians Differing Observations,
Interpretations, and Clinical Approaches
Am J Psychiatry. 2007;164(12):1825-1831. doi:10.1176/appi.ajp.2007.06122088
Copyright American Psychiatric Association.
All rights reserved.
From: Religion, Spirituality, and Medicine: Psychiatrists and Other Physicians Differing Observations,
Interpretations, and Clinical Approaches
Am J Psychiatry. 2007;164(12):1825-1831. doi:10.1176/appi.ajp.2007.06122088
Copyright American Psychiatric Association.
All rights reserved.
Copyright American Psychiatric Association.
All rights reserved.
Curlin et al. 2007
Psychiatrists are less religious than other
physicians. However, they
generally endorse positive influences of
religion/spirituality on health
are more likely than other physicians to
Copyright American Psychiatric Association.
All rights reserved.
they are more likely than other physicians
to
note that religion/spirituality
sometimes causes negative
emotions
encounter religion/spirituality issues
in clinical settings
addressing religion/spirituality
issues with patients
PROFESSUR FR SPIRITUAL CARE
Austria
Brazil
Congo
Denmark
Germany
India
Indonesia
USA
Network for Research in Spirituality and Health
J apan?
For more
information, see
www.nersh.org
Please join!
PROFESSUR FR SPIRITUAL CARE
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www.spiritualcare.de
Rank Order

Nurse
Barriers, n
(%)
Physician
Barriers, n
(%)
P-
values
#1 Not enough time 79 (71) 142 (73) 0.39
#2
Lack of private space to discuss these matters
with my patients
83 (74) 76 (39) <0.001
#3 I have not received adequate training 67 (60) 121 (62) 0.94
#4
I believe that spiritual care is better done by
others on the health care team
35 (31) 120 (62) <0.001
#5 I am worried that patients will feel uncomfortable 50 (45) 86 (44) 0.12
#6
I feel uncomfortable engaging these issues with
patients whose religious/spiritual beliefs may
differ from my own
37 (33) 94 (48) 0.04
#7
I am personally uncomfortable discussing
spiritual issues
37 (33) 91 (47) 0.03
#8
I do not believe it is my professional role to
engage patient spirituality
26 (23) 87 (45) <0.001
#9
I am worried that the power inequity between
patient and (nurse/doctor) makes spiritual care
inappropriate
27 (24) 84 (43) <0.001

Barriers to spiritual care (Balboni et al. J Pain Sympt Manage 2014)
PROFESSUR FR SPIRITUAL CARE
Barriers that predicted less frequent SC
included
inadequate training
(nurses: odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.12-
0.73, P = 0.01; physicians: OR = 0.49, 95% CI = 0.25-0.95, P = 0.04)
not my professional role
(nurses: OR = 0.21, 95% CI = 0.07-0.61, P = 0.004; physicians: OR =
0.35, 95% CI = 0.17-0.72, P = 0.004)
power inequity with patient
(nurses: OR = 0.33, 95% CI = 0.12-0.87, P = 0.03; physicians: OR =
0.41, 95% CI = 0.21-0.78, P = 0.007)
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PROFESSUR FR SPIRITUAL CARE
Fostering implementation of Spiritual Care
by :
adequate training
Integrating a basic spiritual
competency into health
professionals practice
Empowering patients and families
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PROFESSUR FR SPIRITUAL CARE
Approaching the Japanese situation
76% do not believe in any religion
94% have a deep feeling of reverence towards their
ancestors
56% sense something in nature that surpasses the
power of human beings
While keeping a distance from any specific group,
Japanese people tend to consider it important to have
a deep respect for deities or powers that are beyond
human understanding
Nagase Int Journal Appl Sociol 2012
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PROFESSUR FR SPIRITUAL CARE
Nagase Int Journal Appl Sociol 2012
There only exists a tacit acceptance
of the notion of spiritual well-being
within the conceptual dimensions of
health in the field of nursing and
welfare in Japan
30
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PROFESSUR FR SPIRITUAL CARE
Spirituality
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reisei
Divine nature

shinnen
conviction

shinko
belief

shky

mushky
(mu, "zero") + (shu, "sect") + (ky, "suffix for doctrine")
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PROFESSUR FR SPIRITUAL CARE
Spiritual empowerment of patients and health professionals
1. Describing the field of Spiritual Care
2. What do Health Professionals think
about spirituality?
3. Mastery or Mystery?
4. Consequences of research
5. A network of competencies
33
www.spiritualcare.de
PROFESSUR FR SPIRITUAL CARE
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PROFESSUR FR SPIRITUAL CARE
Medical dichotomy
T. A. Hutchinson (Ed.), Whole Person Care (pp. 31-43): Springer New York.
PROFESSUR FR SPIRITUAL CARE
T. A. Hutchinson (Ed.), Whole Person Care (pp. 31-43): Springer New York.
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heal iyasu
Patient
disease
Asklepios
Hippocrates
PROFESSUR FR SPIRITUAL CARE
Mystery # riddle (enigma)
Mystery does not mean "riddle"; it rather denotes a room, a
surplus in sense, which rather embraces and seizes us than that
we grasp it or even can embrace it
Paradoxical empowerment: by opening up to the mystery, you
will be delivered from
fantasies of almightiness
fantasies of helplessness
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PROFESSUR FR SPIRITUAL CARE
spiritual pain is actually the
result of the breaking of two
illusions: first, I am in control of
my own being;
and second, I am in control of the
relationships around me.
PROFESSUR FR SPIRITUAL CARE
Loss of control in collective or individual
disasters opens a new horizon, a spiritual
horizon, for:
patients (spiritual coping, re-
discovering meaning)
health professionals (accepting that
healing iyasu is more than
curing naosu)
self-care
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PROFESSUR FR SPIRITUAL CARE
Spiritual empowerment of patients and health professionals
1. Describing the field of Spiritual Care
2. What do Health Professionals think
about spirituality?
3. Mastery or Mystery?
4. Consequences of research
5. A network of competencies
41
www.spiritualcare.de
PROFESSUR FR SPIRITUAL CARE
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Hanson et al.: Providers and types of spiritual care during
serious illness (J Pall Med 2008)
41%
29%
17%
6%
7%
Family/Friends
Health profs
chaplains
God/Higher Power
others
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Huguelet et al. (2011): A randomized trial of spiritual assessment of
outpatients with schizophrenia: patients' and clinicians' experience.
Psychiatric Services 62:79-86
RCT: proactively taking a spiritual history vs. reacting
to the patients desire
Prospective longitudinal design (2 measures)
Assessment training for psychiatrists
PROFESSUR FR SPIRITUAL CARE
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Do the patients wish to speak with their psychiatrist about religion
and spirituality?
PROFESSUR FR SPIRITUAL CARE
DSM V Code V62.89 Religious or Spiritual Problem
This category can be used when the focus of
clinical attention is a religious or spiritual
problem. Examples include distressing
experiences that involve loss or questioning of
faith, problems associated with conversion to a
new faith, or questioning of spiritual values that
may not necessarily be related to an organized
church or religious institution.
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PROFESSUR FR SPIRITUAL CARE
Do the patients wish to speak with their psychiatrist about religion and
spirituality?
0
5
10
15
20
25
30
35
t1 t2
Agree a lot or totally (%)
SpirHistory no SpirHistory
*
*
47
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Balboni, Balboni et al.: Cancer 2011: Support of cancer
patients spiritual needs and associations with medical care
costs at the end of life
339 Pat. suffering from advanced cancer
prospective, multi-centre study
Patients satisfied with spiritual care vs. not
satisfied patients
Comparison of costs for ICU,ventilation, etc.
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Balboni, Balboni et al.: Cancer 2011
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Balboni, Balboni et al.: Cancer 2011
PROFESSUR FR SPIRITUAL CARE
Spiritual empowerment of patients and health professionals
1. Describing the field of Spiritual Care
2. What do Health Professionals think
about spirituality?
3. Mastery or Mystery?
4. Consequences of research
5. A network of competencies
51
www.spiritualcare.de
PROFESSUR FR SPIRITUAL CARE
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www.spiritualcare.de
Spiritual Care is an overlap of health-care professions...
medicine
social work
chaplaincy
psychotherapy
nursing
Spiritual Care
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Personal
history
training
Attitudes
Skills
knowledge
... and of several contexts:
team (if available)
Institution
(public or private)
ethics & law
linguistic, inter-religious, and socio-cultural background
PROFESSUR FR SPIRITUAL CARE
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