Abstract:
Spiritual care of patients is considered a fundamental component of quality, compassionate
health care. In the African context spirituality is seen as a vital component of whole-person
care (Louw, 2014; De la Porte, 2016). However, a practical and ethical framework has not
been available by which to integrate spiritual aspects into the consultation between patient
and practitioner. The development of a framework in this study expands on the
recommendations made by the authors of the standards for spiritual care (Puchalski, Vitillo,
Hull & Reller, 2014). This accounts for the structure, process and outcome elements of
spiritual care within health service design (Daaleman, 2012). The framework is the product of
this study, rooted in the perspectives of various role-players in spiritual care.
This qualitative study used a case study design that accounted for the perspectives of three
kinds of role-players within health care, viz. spiritual health care scholars, health practitioners
and patients, sampled purposefully from private practice, Daspoort Clinic and the University
of Pretoria High Performance Centre in South Africa respectively. Practical guidance items
extracted from literature were drafted into an initial framework. They were then subjected
to a process of development, revision and refinement through participant contributions
through individual interviews and a focus group. Structural coding was used in the analysis as
to yield various iterations of the practical and ethical framework presented in its final format
in this thesis.
The framework describes eight principles for quality spiritual care, with specific quality
requirements for each principle. It makes recommendations on how to implement the
principles. The framework also describes possible catalysts and impediments to quality
spiritual care. Findings are also presented on how the framework was derived from the
contributions of the various participants. From the health experts, the benefits and ways of
incorporating spirituality were underscored and taken up in the framework. Patients
contributed to the framework mainly by underscoring the importance of a suitable attitude
of the practitioner and a sincere person-to-person engagement. The inter-disciplinary team
underscored the importance of incorporating spiritual rituals and accounting for their
potential complications.
The framework may be used to inform and guide individual practice, inter-disciplinary health
management and policy development. In research, the framework may be developed further
to address what the ethical boundaries would be for introducing spiritual rituals within the
health context, anticipating that such will need to be context-sensitive and responsive.
