A Social Work Perspective on Spirituality with
Palliative Clients
by Bobbi Preston, BSW, MSW Candidate
Sole Charge SW Clinical Practice Leader with FHA and member of
Social Workers in Health
Over the last year, Paula Annis and I had the inspiring opportunity
and experience of completing social work in health research toward
completing an MSW at UBC. Paula is a Psychiatric SW and ASTAT
Counsellor employed with the FHA. The preliminary results of our
research, entitled “Social Work Perspectives on Spirituality
with Palliative Clients: A Qualitative Study”, were presented
last spring 2005 at the BC Hospice Palliative Care Association
Conference in Richmond and in a Poster Presentation at the Canadian
Association of Psychosocial Oncology Conference in Victoria.
Research studies indicate that spirituality is a very important
consideration in palliative care and may be important to a dying
person’s quality of life and ability to cope with dying.
Especially absent from the literature was the social work perspective
of spirituality as it relates to palliative care. Yet contrary
to the medical model, the field of social work has historically
used an holistic approach, focusing on human needs and conditions
beyond the physical. We proposed that social workers may have
an important perspective to offer on spirituality that is not
reflected in existing literature. Furthermore, since social workers
are employed in practically every health care setting, including
those that provide palliative care, they may offer unique and
valuable insights that are currently lacking yet need to be incorporated
into the study of spirituality and palliative care.
We embarked on a journey to capture perspectives of social workers
on spirituality and their understanding or experiences of their
role in addressing spiritual needs of palliative clients. We had
an overwhelming response of interest in the topic, as well as
validation of the need for research in this domain. Our focus
group thoughtfully and articulately shared their remarkable experiences
and insights.
The social work participants reiterated previous findings, as
well as clearly highlighted interesting distinctions. Previous
studies indicated confusion around the terms religion and spirituality,
as well as confusion due to the lack of a singular universal definition,
believing this is an obstacle toward assessing and addressing
spirituality. Our most significant finding was that these social
workers clearly differentiate between the terms and assume the
potential for addressing issues related to spirituality irrespective
of whether the person is religious or not.
The shared perspective was that spirituality encompasses connectedness
to relationships, life events, humanity and nature, a source of
power greater than oneself, a search for meaning, purpose and
peace as well as synchronicity and a perception of orchestrated
meaning on a higher level. The participants’ definition
of spirituality was very broad. Further, they welcomed the challenges
that were presented by the ambiguous and undefined nature of facilitating
the exploration of spirituality. They recognized that it is a
process and a journey and they felt privileged to be a part of
it.
The group unanimously assumed a spiritual essence in the whole
person aware this may not reflect the experiences of their clients.
They respected that clients may not be open to addressing a spiritual
dimension. Moreover, they were at ease tailoring their interventions
to reflect the unique meaning that spirituality has played in
their clients’ lives and dying processes. They appreciated
that each person experiences spirituality in their own way.
“…we tend to get more involved with …spirituality
when people are struggling with it and trying to figure out the
connection – that’s when it comes to be expressed
– when it’s being questioned.”
Rather than a static or a one-way interview, the group demonstrated
an approach to spirituality and assessment that is a dynamic,
evolving, and, sometimes, intimate process of exploration. They
demonstrated that they do address and assess spirituality with
palliative clients. The themes that emerged were spiritual awareness,
the therapeutic use of self in providing a safe environment for
exploration, client centredness, creativity, resourcefulness,
and flexibility. They expressed openness to ongoing learning and
critical thinking around spirituality and the human experience.
For the most part, the literature reflects that healthcare professionals
experience discomfort in these domains. These social workers demonstrated
they possess a comfort level with spirituality, unknowns, silence,
suffering, and dying.
In sum, we were able to conclude that the social work focus
group identified spirituality as an essential consideration for
many of their palliative clients and that it is an inherent component
of social work practice. The group also affirmed that the interdisciplinary
team shares responsibility in providing spiritual care.
We were privileged to be part of this study and grateful for
the expertise and commitment of our participant social workers.
We wanted to share the discussion with you to encourage further
discussion, as well as further research.
