Understandings and perceptions of spirituality held by multidisciplinary professionals involved in a community based palliative care organization: Implications for professional practice.
As a universal human experience, spirituality is innate to humanity. Nevertheless, the attempt to define spirituality within health care has led to a range of diverse and often nebulous definitions. Holistic practice within palliative care includes the physical, psychological, social, and spiritual aspects of human beings, all of which can facilitate pain for the terminally ill. Commonly, spiritual pain is inadequately addressed within palliative care. This is due to spirituality not being identified or performed by multidisciplinary professionals, who feel untrained and inadequate for the task due to a lack of education or professional development in the area of spirituality. As a part of holistic practice these professionals are called to provide basic spiritual care and make timely spiritual referrals within their everyday practice. A lexicon of spirituality was required to bring appropriate language for the identification and provision of basic spiritual care and judicious referrals to spiritual professionals. As more terminally ill people indicate a desire to die at home, true holistic palliative care that is community based is becoming crucial. For this research study a small community based palliative care organization, Ballarat Hospice Care Incorporated, was chosen to be the case study. Understandings and perceptions of spirituality and spiritual care were developed and articulated through extended focus groups and semi structured individual interviews with members of the multidisciplinary team. The employment of a hermeneutic phenomenological theoretical perspective allowed the essence of the experience of spirituality at BHCI to emerge and be given language by those who worked there. van Manen's four fundamental lifeworld existentials of lived space, lived time, lived other, and lived body were used as guides to reflection and interpretation of the textual conversations. Consequently, the definitional framework applied in this research study was of spirituality as connectedness with Self, with Other, with the world, and with mystery/transcendence, not static, but constantly evolving towards ultimate unity. Correspondingly, it also was useful to apply the concept of disconnectedness which identified experiences of possible spiritual pain and despair. This spirituality schema brings common language to what had previously been seen as an ill defined concept. The connectedness and disconnectedness framework is accessible and can be practically employed to assist the multidisciplinary team in defining and identifying spirituality and spiritual care. Importantly, it is inclusive of all people regardless of belief, values, and personal meanings.