Role-models in health care: should spiritual care of the dying be the concern of health professionals?
AbstractThe domains of medicine and healthcare are replete with role models of all kinds – the caring nurse (usually a woman), the skilled surgeon (usually a man) and the expert physician are some examples that come to mind. Speaking to Goffman’s paradigm, these are ‘front stage’ role models; others located ‘back stage’ might include scientists and technologists, all working to advance health and defeat disease. This illustrates how the work of caring for health comprises a number of professional subcultures each with its own demarcation and jurisdiction of practice often defended in the pursuit of enhancing specialized knowledge and preserving disciplinary autonomy. Increasingly, however, we are seeing calls for greater cross-disciplinary collaboration amongst healthcare professionals to provide person-centred care as acknowledgement of the multiple impacts of ill health for individuals and families. This particularly has been the case in palliative care philosophy that seeks to offer integrated physical, psychosocial and spiritual care for those living with terminal illness. Although an established medical specialty, palliative care challenges the medical domain of cure, promoting holistic approaches to patient wellbeing. The emphasis within this model on spiritual aspects of care has raised challenges for clinicians primarily concerned with cure of physical and psychological malfunction. Spiritual care of dying people contributes to a relational model of illness and death. In contrast to the medical model, the relational model helps to put the dying person ‘back together again’ in their full context, embedding them in a personal and social history. Spiritual care is part, not only of hospice care, but also of general nursing practice that recognizes the importance of spirituality in patient health. Nursing, as a particular role model of professionalized care, has continued to struggle with the delivery of spiritual care with much literature devoted to considering enhancing understanding of the concept of spirituality and its application to nursing practice in ways meaningful to patients. Given the complexity of the existential realities confronting dying people for whom often the focus is on their families, unfinished business as well as a plethora of other ‘legacy’ concerns, is it now time to ask more fundamental questions about the appropriateness of health professionals’ involvement in the spiritual care of those facing death? A further question is whether palliative care that has received almost universal social approval, should be more discriminating in its ‘domains’ of practice. In responding to these questions, this paper will argue for a different approach based on a community role model that fosters development of skills of individuals and families in seeing death as a normal part of life and spiritual care of dying people as part of our humanity. The sociologist, Allan Kellehear, has long been advocating for a shift in approaches to delivering spiritual care away from traditional professional models. This paper will explore some of his ideas together with my own that centre on connectivity through storytelling, faith, reflection, mutual enrichment and spiritual care as something we give to each other and not something we rely on ‘professional others’ to take responsibility for. Whilst for many, spiritual care is principally a matter of religious faith, in an age of increasing secularism this issue has taken on new dimensions and possibilities.
TypeConference or Workshop Item
Watts, Jacqueline H. <http://oro.open.ac.uk/view/person/jhw57.html> (2014). Role-models in health care: should spiritual care of the dying be the concern of health professionals? In: 4th European Conference on Religion, Spirituality and Health: Integrating Religion/Spirituality into Clinical Practice: Focus on Health Care Professionals, 22-24 May 2014, Malta.