The qualitative development of a practical and ethical framework for the integration of spiritual aspects into the health practitioner’s consultation

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.