Integrating Spiritual Care in Population Health and Care Management: Two Case Examples.

PURPOSE/OBJECTIVES: The purpose of this case study is to describe the movement of spiritual care into outpatient, managed care and population health settings, as it has evolved in a major not-for-profit health care system in the United States. The objective is to begin to establish the effectiveness of integrating spiritual care as a part of the interdisciplinary team (IDT) in these contexts. PRIMARY PRACTICE SETTINGS: The case study presents two practice settings: a remote patient monitoring program for patients with complex medical conditions, and integration into population health as a part of a Medicare Advantage Insurance program that is a cooperative venture between the health care system (Ascension) and an established insurance program (Centene). FINDINGS/CONCLUSIONS: The cases presented suggest that the integration of spiritual care into the outpatient, managed care and population health contexts has a threefold benefit: enhancing patient care, increasing the effectiveness of the IDT, and providing for the care and support of the members of the IDTs themselves. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The cases presented suggest inclusion of spiritual care in the care management/population health approach to patient care is viable and valuable both for the benefit of the patient and the functioning of the care team.

The Urgency of Spiritual Care: COVID-19 and the Critical Need for Whole-Person Palliation.

The coronavirus disease 2019 (COVID-19) crisis has amplified the importance of palliative care to countless patients suffering with and dying from this disease, as well as to their families, communities, and the worldwide cadre of overburdened health care workers. Particularly urgent is the need for spiritual care specialists and generalists to address spiritual suffering given the degree of isolation, loneliness, and vulnerability caused by this pandemic. Although spiritual care has long been recognized as one of the domains of quality palliative care, it is often not fully integrated into practice. All disciplines are ultimately responsible for ensuring that spiritual care is prioritized to improve quality of life and the experience of patients and families facing spiritual emergencies amid the complex life-and-death scenarios inherent to coronavirus disease 2019. Although the pandemic has revealed serious fault lines in many health care domains, it has also underscored the need to recommit to spiritual care as an essential component of whole-person palliative care.

From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study.

BACKGROUND: Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC. METHODS: This exploratory mixed-method study with a sequential quantitative-qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis. RESULTS: The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures. CONCLUSIONS: MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC.

Spiritual Care for Everyone? An Analysis of Personal and Organizational Differences in Perceptions of Religious Diversity among Spiritual Caregivers.

In multicultural and multifaith societies spiritual caregivers increasingly meet clients with diverse (non-)religious or spiritual orientations. We investigate how this religious and spiritual (R/S) diversity is dealt with by spiritual caregivers working in healthcare settings, the military, and prisons. Based on a survey among spiritual caregivers (n = 208) in a secularized, European country (The Netherlands), this study shows how spiritual caregivers' personal as well as organizational factors relate to attitudes to R/S diversity. Spiritual caregivers who draw from several religious traditions in their lives have more positive views on spiritual caregiving to patients with another R/S orientation than theirs than those drawing from none or a singular tradition. Furthermore, authorization by a religious or Humanistic institution seldom relates to how R/S diversity is perceived, but the position of spiritual caregivers within various organizational settings and the way in which spiritual caregivers work does.

Enhancing Spiritually Based Care Through Gratitude Practices: A Health-Care Improvement Project.

BACKGROUND: Addressing spirituality in health care is important as it improves health outcomes; however, several provider barriers exist to providing spiritually based care. Local problem: A chart audit at a multidisciplinary wellness center serving a population with chronic mental health problems identified a need to improve the number of spiritually based interventions provided to clients by the nurse practitioner. DESIGN: A quasi-experimental design and pre- and post-test questionnaire were used to measure outcomes including the number of spiritually based interventions and provider attitudes. INTERVENTION: Providers, including a nutritionist, exercise physiologist, pharmacist, acupuncturist, and nurse practitioner, participated in two, 1-hour interactive educational sessions on providing spiritually based care, emphasizing the use of gratitude practices. RESULTS: The mean number of spiritually based interventions charted per visit by the nurse practitioner increased from 0.4 pre-implementation to 1.1 post-implementation (rate ratio = 2.57, with 95% CI [1.75, 3.87]; p < .001). Descriptive statistics from all providers show improvements in attitudes and comfort level in addressing spiritually based care. Several intervention areas documented by the nurse practitioner decreased significantly, including mind/body, which may be related to the study, as many spiritually based interventions are also mind/body interventions. CONCLUSION: Interactive educational sessions on spirituality can improve a health-care team's attitudes, comfort level, and practice of providing spiritually based care. Generalizability is limited to the project site, but the process could be implemented in other facilities to determine if similar results can be achieved.

Incorporating living from the heart into medical education.

Medical training poses many challenges to trainees' wellbeing. To address the impact of learning in a high turnover, high volume, acute care setting in the General Internal Medicine Clinical Teaching Unit, the Chief Medical Resident, in this personal account, shares how she and the Spiritual Care Practitioner united to form an innovative partnership. The introduction of the skills of spiritual care practitioners, generally referred to patients and families, to support medical students and residents resulted in the co-development and co-implementation of a unique, reflective, one-hour session. The objective was to create a protected space and time to discuss the impact of training and clinical experiences on medical trainees' wellbeing, in the context of "living from the heart".

Underrecognition and Undertreatment of Pain and Behavioral Symptoms in End-Stage Dementia.

End-stage dementia, a terminal condition, is associated with a high prevalence of physical pain and behavioral symptoms. As these patients often have a decreased ability to express their symptoms, they are often underrecognized and undertreated. This article proposes opportunities to improve patient care. The article underscores the role of assessment scales to optimize behavioral management for patients with dementia and discusses the value of pain management to improve behavioral symptoms. Additionally, a collaborative interdisciplinary team, including palliative medicine, pharmacy services, and spiritual support can optimize patient care and develop a plan of care.

[Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making].

Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting.

Benzedeiras de Maruípe: uma prática de cuidado humano em extinção / Maruipe's faith healers: an endangered human care practice

Estudo realizado com benzedeiras de uma área de saúde do município de Vitória - ES, objetivando identificá-las, conhecer suas histórias de vida e o interesse das mesmas em articularem-se com os profissionais das unidades básicas de saúde locais. Por se tratar de uma região marcada pela violência advinda do tráfico de drogas, tornou-se impossível identificar o universo dessas mulheres, face à impossibilidade de acesso a alguns desses bairros; assim posto, nossa amostra ficou limitada a cinco benzedeiras. A coleta de material do estudo se deu através de entrevistas e observações registradas em um diário de campo. O material transcrito e os apontamentos do diário de campo possibilitaram a narrativa de inspiração cartográfica deste estudo. Essas benzedeiras são mulheres entre 64 a 88 anos de idade, residem em locais inóspitos e em moradias humildes. Algumas benzem apenas crianças, outras todos aqueles que as procuram, inclusive para benzimento de seus animais. Nenhuma delas cobra e tão pouco aceita agradecimento pela atenção prestada, pois segundo elas, o agradecimento deve ser dirigido a Deus. São mulheres humildes, todas moradoras antigas da área, ora reconhecidas como importantes pelo dom que têm, ora rechaçadas como demoníacas por grupos religiosos. No tocante a uma aproximação com as equipes locais de saúde, todas as benzedeiras se mostraram avessas à ideia, no entendimento de que tal aproximação significaria uma demanda de benzimentos aumentada e obrigatória, o que contraria a lógica da atenção prestada pelas mesmas, que só benzem de acordo com a conveniência: sentindo-se bem, praticam o benzimento; estando desvitalizadas, evitam benzer. Por se tratar de mulheres idosas, as benzedeiras encontram-se ameaçadas de extinção, visto que aprender o oficio não tem sido objeto de interesse das novas gerações.(AU)

This is a study of faith healers at one health administrative region of the municipality of Vitória - ES, aiming to identify them, to know their life stories and their interest in articulating with professionals at the local units of primary healthcare. Because it is a region marked by violence arising from drug trafficking, it has become impossible to identify the universe of those women, due to the lack of access to some of these neighborhoods; thus our sample was limited to five faith healers. Material was collected for the study through interviews and observations recorded in a field diary. The transcripts and notes from the diary allowed the narrative of cartographic inspiration for this study. These healers are women between 64-88 years of age, living in austere locations in humble dwellings. Some bless only children, others all those who seek them, including blessing their pets. None of them charges anything, and they do not accept thanks for the provided attention, because according to them the thanks should be directed to God. They are humble women, all old residents of the area, sometimes recognized as important for the gift they have, sometimes rejected as demonic by religious groups. Regarding an approach with local health teams, all the faith healers proved averse to the idea, understanding that such approach would mean an increased and binding demand for blessings, which contradicts the logic of care provided by them, which is only to bless according to convenience: they bless when feeling well, and avoid it when devitalized. Faith healing is endangered of extinction, because the healers are older women, and learning the craft has not been the subject of interest among the younger generations.(AU)

Churches as targets for cardiovascular disease prevention: comparison of genes, nutrition, exercise, wellness and spiritual growth (GoodNEWS) and Dallas County populations.

BACKGROUND: We compared cardiovascular (CV) risk factors (CVRFs) of community-based participatory research (CBPR) participants with the community population to better understand how CBPR participants relate to the population as a whole. METHODS: GoodNEWS participants in 20 African-American churches in Dallas, Texas were compared with age/sex-matched African-Americans in the Dallas Heart Study (DHS), a probability-based sample of Dallas County residents. DHS characteristics were sample-weight adjusted to represent the Dallas County population. RESULTS: Despite having more education (college education: 75 versus 51%, P< 0.0001), GoodNEWS participants were more obese (mean body mass index: 34 versus 31 kg/m(2), P< 0.001) and had more diabetes (23 versus 12%, P< 0.001) and hyperlipidemia (53 versus 14%, P< 0.001) compared with African-Americans in Dallas County. GoodNEWS participants had higher rates of treatment and control of most CVRFs (treated hyperlipidemia: 95 versus 64%, P< 0.001; controlled diabetes: 95 versus 21%, P< 0.001; controlled hypertension: 70 versus 52%, P= 0.003), were more physically active (233 versus 177 metabolic equivalent units-min/week, P< 0.0001) and less likely to smoke (10 versus 30%, P< 0.001). CONCLUSIONS: Compared with African-Americans in Dallas County, CBPR participants in church congregations were more educated, physically active and had more treatment and control of most CVRFs. Surprisingly, this motivated population had a greater obesity burden, identifying them as a prime target for CBPR-focused obesity treatment.

Evidence-based spiritual care: a literature review.

PURPOSE OF REVIEW: As spiritual care has increasingly been considered an integral component of a healthcare treatment plan, spiritual care practitioners have been encouraged to adopt an evidence-based orientation, just as evidence-based practice is encouraged in every other aspect of healthcare. Though the notion of 'evidence-based spiritual care' is still developing, increasingly research is conducted in order to provide an evidence base to the practice of spiritual care. This article reviews spirituality and spiritual care literature from June 2010 to December 2011 that employ empirical research methods. RECENT FINDINGS: The majority of patient-focused studies concentrate on oncology and palliative care patients. In the review period, studies of care giver perceptions and experience came from multiple disciplines, including medicine, nursing, and chaplaincy. A discrepancy exists between the provision of spiritual care and the theoretical commitment of practitioners to offer such care. Practitioners continue to view spiritual care as part of their role to a greater extent than they provide it. This is often attributed to the absence of consensus in the field regarding the definition of spirituality, a lack of clarity of disciplinary role, and inadequate education for nurses and doctors about spiritual care. Research has further indicated that care givers' explorations of their own spirituality correlate with the provision of spiritual care. Although historically spiritual care has been most integrated into the care of palliative and oncology patients, researchers are developing and testing spiritual care assessment tools with other medical populations. In addition, they are evaluating these tools in diverse religious, cultural and national contexts. SUMMARY: Conceptual analysis combined with empirical study of care giver understandings of spiritual care will assist in developing clarity and consensus about the definition of spirituality and spiritual care. Investigation and conceptualization of interdisciplinary roles and provision of spiritual care is needed for optimizing collaborative care. More knowledge is needed about how to effectively teach spiritual care.

Com o poder nas mãos: um estudo sobre johrei e reiki / Powerful hands: a study of johrei and reiki

Os movimentos contraculturais, desencadeados principalmente nos anos de 1960/70, ao questionarem a sociedade tecnocrata-capitalista e incentivarem uma maior politização da vida social, possibilitaram ampliação da abertura para debates e tensões que afetaram as instituições sociais vigentes, contestando paradigmas consagrados. Tal fato permitiu uma (re)valorização e, até mesmo, reapropriação (ou criação) de perspectivas holísticas em relação ao corpo e à saúde, e a inclusão de outras dimensões explicativas, além das oferecidas pela racionalidade biomédica. Com a maior aceitação das práticas alternativas ou complementares, abriu-se espaço para a retomada de antigos métodos de cura através das mãos, entre elas, as que não necessitam de toque direto entre \"curador\" e paciente, como reiki e o johrei da Igreja Messiânica Mundial. Este estudo teve como objetivo apreender e interpretar os significados de reiki e johrei, considerando os arcabouços técnicos e conceituais sobre os quais estão alicerçados. Assim como, compreender como elas afetam o comportamento de seus praticantes e suas relações sociais. Para interpretar tais significados e experiências foram adotados os referenciais da antropologia interpretativa de Clifford Geertz e o método etnográfico. A pesquisa realizou-se em dois campos distintos, um Núcleo de Reiki e a Igreja Messiânica Mundial, ambos em Ribeirão Preto,SP , no período de outubro de 2009 a janeiro de 2012. Participaram deste estudo 15 reikianos como sujeitos principais e 5 frequentadores da Núcleo, como sujeitos secundários; mais 14 messiânicos, sujeitos principais e 5 frequentadores da Igreja, como sujeitos secundários. Os dados foram coletados por meio de observação participante, entrevistas semiestruturadas e diário de campo. Os principais resultados indicam que a crença no poder curativo nessas energias, reiki e johrei, aparece como principal sustentação de sua eficácia. Tanto os ensinamentos da Igreja Messiânica, como os ensinamentos e teorias associados ao reiki, foram capazes de fornecer novos sentidos para questões ou problemas desses sujeitos, modificando comportamentos como humor, agressividade, tolerância e sociabilidade, possibilitando a emergência de uma \"identidade holística\" e a configuração de novas \"comunidades de encantamento\" em torno dessas duas práticas.(AU)

Countercultural movements, initiated mainly in the 60\'s and 70\'s, questioned the capitalist- technocratic society and encouraged greater politicization of social life, enabling the extension of the debates and tensions that affected the existing social institutions, refuting established paradigms. This fact allowed a (re)valuing and even reappropriation (or creation) of holistic perspectives regarding the body and health, and the inclusion of other explanatory dimensions, beyond the ones offered by biomedical rationality. With an increased acceptance of alternative or complementary practices, there was more space for the return of ancient healing methods through hands, among them, those that do not require direct touch between \"healer\" and patient, such as reiki and johrei, of the World Messianic Church. This study aimed to recognize and interpret the meanings of reiki and johrei, considering the technical and conceptual frameworks upon which they are based, as well as to understand how they affect the behavior of its practitioners and their social relations. In order to interpret these meanings and experiences, Clifford Geertz\'s interpretive anthropology and the ethnographic method were adopted as frameworks. The research was carried out in two sites, a Reiki Center and the World Messianic Church, both in Ribeirão Preto, state of São Paulo, Brazil, from October 2009 to January 2012. The study included 15 reiki practitioners as main subjects and 5 frequenters of the Center, as secondary subjects; 14 messianic as main subjects, and 5 frequenters of the Church, as secondary subjects. Data were collected through participant observation, semi-structured interviews and field diary. The main results indicate that belief in the healing power of these energies, reiki and johrei, is the main support of their effectiveness. Both the Messianic Church doctrine as well as the doctrine and theories associated with reiki, were able to provide new meanings to issues or problems of these subjects, modifying behaviors such as mood, aggressiveness, tolerance and sociability, allowing for the emergence of a \"holistic identity\" and the setting of new \"communities of enchantment\" regarding these two practices.(AU)

What is esoteric healing?

Esoteric Healing is a type of energy healing that originated from the teachings of Djwhal Khul and Alice Bailey first published in the early 1950s. Esoteric Healing instructors and practitioners are located in more than 19 countries throughout the world. Nurses and nurse practitioners as well as other health professionals (e.g., psychologists and physicians) have integrated Esoteric Healing into their current practice and/or have a separate practice in Esoteric Healing. According to Dochterman and Bulechek, the nursing diagnosis "energy field, disturbed" is defined as a "disruption in the flow of energy surrounding a person's being." Esoteric Healing is proposed to assist a person in balancing her or his flow of energy. In this article, Esoteric Healing is defined, and the components of the energy field according to the teachings of Esoteric Healing are differentiated. The basic Esoteric Healing treatment procedure, treatment protocols, and indications for when Esoteric Healing may be an appropriate healing modality option are described. Finally, research on Esoteric Healing is addressed.

Cura Encantada: Medicina Tradicional e Biomedicina entre os Pankararu do Real Parque em São Paulo / Enchanted Healing: Traditional Medicine and Biomedicine between Pankararu of Real Parque in São Paulo

Esta dissertação busca se aproximar das concepções Pankararu de cura e suas relações com a biomedicina. Embora os Pankararu sejam originários da região do submédio São Francisco, no Estado de Pernambuco, depois de um intenso processo de migração, muitos deles passaram a residir na Favela do Real Parque, em São Paulo. Este estudo se concentra nos Pankararu do Real Parque. Este trabalho descreve partes da cosmologia Pankararu e suas formas tradicionais de cura, na busca de compreender a integração dessas práticas com o atendimento biomédico do Município de São Paulo. Descrevo então como ocorre essa integração, assinalando os conflitos e os processos de "tradução" e ressignificação de seus elementos rituais para o contexto urbano. O crescente número de etnias que vivem na metrópole suscita indagações quanto à transformação e readaptação de seus discursos. Esta etnografia pretende explicitar como é realizado esse movimento e as formas de afirmação identitária e de conquistas políticas, principalmente, no campo da saúde.(AU)

This essay seeks to approach the Pankararu concepts of healing and their relations with Biomedicine. Although Pankararu originate from the region of São Francisco submid, in the State of Pernambuco, after an intense process of migration, many ofthem took up residence in the shantytown of Real Parque, in São Paulo city. This study focuses on the Pankararu of Real Parque. This paper describes parts of the Pankararu cosmology and their traditional ways ofhealing, seeking to understand the integration of these practices with biomedical care in São Paulo city. I describe,then, how this integration occurs, pointing out the conflictsand the processes of "translation" and their redefinition of ritual elements to the urban context. The growing number of ethnic groups living in the metropolis raises questions aboutthe transformation and upgrading of their speech es. This ethnography aims to explainhow this movement takes place and the forms of identity affirmation and political achievements, especially in the health field.(AU)

Methodological complexities associated with systematic review of healing relationships.

BACKGROUND/CONTEXT: There is growing recognition within the field of medicine that healing and healing relationships are important and that developing evidence-based medicine approaches to healing should be an important aspect of this emerging field, including the use of systematic reviews. Health care leaders charged with developing healing initiatives in hospitals often are frustrated in their attempts to find rigorous reviews of the literature to support their programs. OBJECTIVE: The objective of this project was to conduct a systematic review that asked, "What is the return on investment to hospitals that implement programs aimed at enhancing healing relationships?" METHODS: A comprehensive literature search using several electronic databases was conducted to locate studies that evaluated hospital-based programs involving "healing relationships." All studies found were evaluated as to their relevance to the study and screened for methodological quality. RESULTS: Research investigators found broad heterogeneity across the 80 included studies with regard to stated aims, target populations, outcomes measured, measurement tools employed, and evaluation methods used. Only 10 articles were categorized as being methodologically strong. CONCLUSIONS: Results of the systematic review highlighted challenges in synthesizing knowledge about healing that included absence of widely accepted definitions and language around "healing", locating literature published across many different disciplines, and absence of standards for conducting rigorous program evaluations in hospitals. A less formal qualitative review of included studies also revealed themes in the literature that provide clues about the professional, social, cultural, and historical influences that have helped to shape the evidence base to date.

A cura pela fé: crenças, saberes, práticas e poderes no mundo rural do nordeste brasileiro / Faith healing: beliefs, knowledge, practices and powers in the rural Northeast of Brazil

Esta tese busca analisar a cura religiosa no catolicismo popular e contemporâneo, entre as populações rurais do interior da Paraíba, do Nordeste brasileiro. O estudo investiga a cura ministrada por vários curadores, os tipos de curadores populares, as práticas de devoção pessoal e as experiências em perspectivas holísticas no universo religioso da cura. Constata-se que as ações dos agentes de cura não são excludentes entre si. Elas se associam e até certo ponto se complementam de acordo com a situação e o público atendido, configurando ações em torno de um hibridismo religioso-cultural. Na análise, o trabalho confere especial relevância às expressões simbólicas distintas, à ressignificação de valores culturais e a dádivas e reciprocidades que se constituem no âmbito da cura. Neste sentido, discute a cura em perspectiva que vai além da cura de um mal físico e focaliza os elementos que sugerem a cura psíquica, introduzindo-se assim para os propósitos deste estudo, o conceito denominado de cura social. A cura social se expressa a partir de particularidades culturais, políticas, econômicas e sociais que o processo de cura envolve e revela. Ganham destaque alguns aspectos considerados relevantes nas diferentes trajetórias pessoais dos curadores e suas repercussões na aquisição e no desempenho para com o Dom da cura. A cura religiosa é entendida como algo que ultrapassa classes e categorias sociais; a cura está ao alcance de qualquer indivíduo que nela confira fé. O estudo foi desenvolvido com base em princípios metodológicos etnográficos, apoiados pela observação participante, seguida por entrevistas semi-estruturadas, por conversas informais e por demais contatos com pessoas dos dois segmentos 'curadores'; e 'curados';. A pesquisa permitiu revelar de modo abrangente as concepções do publico na região pesquisada em relação ao conceito de cura e doença, bem como verificar a relevância social das experiências de cura.(AU)

The forgotten heart of care: a model of spiritual care in the National Health Service.

Answering the spiritual as well as religious needs of patients has for years been seen as the province of the hospital chaplain, because spirituality has been regarded as the province of religion. As chaplains in the NHS we hope in this paper to raise awareness of the importance of spiritual care in the health service as a whole. Although there seems to be a large amount of interest in this area there are few tangible means of identifying and assessing spiritual need. Within the limits of this paper we aim to define spiritual care, to outline how we can identify spiritual distress, and suggest ways of evaluating spiritual care. Although we realise the difficulty of the task, we wish to 'Transcend vagueness and come to a more comfortable understanding of spirituality.' (Price et al 1995)