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Making Health Care Whole

Integrating Spirituality into Patient Care

Christina Puchalski Betty Ferrell

In the last fifteen years, the field of palliative care has experienced a surge in interest in spirituality as an important aspect of caring for seriously ill and dying patients. While spirituality has been generally recognized as an essential dimension of palliative care, uniformity of spiritual care practice has been lacking across health care settings due to factors like varying understandings and definitions of spirituality, lack of resources and practical tools, and limited professional education and training in spiritual care.

In order to address these shortcomings, more than forty spiritual and palliative care experts gathered for a national conference to discuss guidelines for incorporating spirituality into palliative care. Their consensus findings form the basis of Making Health Care Whole. This important resource provides much-needed definitions and charts a common language for addressing spiritual care across the disciplines of medicine, nursing, social work, chaplaincy, psychology, and other groups. It presents models of spiritual care that are broad and inclusive, and provides tools for screening, assessment, care planning, and interventions. This book also advocates a team approach to spiritual care, and specifies the roles of each professional on the team.

Serving as both a scholarly review of the field as well as a practical resource with specific recommendations to improve spiritual care in clinical practice, Making Health Care Whole will benefit hospices and palliative care programs in hospitals, home care services, and long-term care services. It will also be a valuable addition to the curriculum at seminaries, schools of theology, and medical and nursing schools.

List of Figures / ix

List of Tables / xi  

Foreword by Rachel Naomi Remen, MD / xiii  

Preface / xxi  


1. Why Spirituality in Palliative Care / 3  

2. Guidelines/Preferred Practices for Spiritual Care / 17  

3. Spirituality: Defining the Concept / 21

4. Background: Historical Context of Spirituality in Palliative Care / 26

5. Professional Standards for Spiritual Care 33


6. Spiritual Care Models / 55

7. Spiritual History Taking and Assessment of Patients and Families / 74

8. The Spiritual Treatment or Care Plan / 103

9. Interprofessional Considerations: Roles and Team Functioning / 140

10. Training and Certification / 155

11. Personal and Professional Development / 165

12. Quality Improvement / 178

13. Conclusion / 181

Acknowledgments / 183

Appendix A: Definitions Related to Spiritual Care / 191

Appendix B: Sample Spiritual Histories and Assessments / 198

Appendix C: Examples of Spiritual Screening Questions That Can Be Integrated into Hospital Intake Forms / 206

Appendix D: Spirituality Cases / 207

Appendix E: Professional Chaplaincy / 220

Appendix F: Listing of Research Instruments / 224

Appendix G: Listing of Curricula in Spirituality and Health / 228

Appendix H: Spirituality Centers and Other Relevant Websites / 229

References / 233

Index / 255