Is Spirituality Being Considered in the Occupational Therapy - Essay Example

The concept of spirituality has been receiving increasing importance in the well being of a person. This includes a healthy body and the mind. Debates and discussions have taken place that integration of the mind, body and spirit is essential for a healthy life. Research reveals that spirituality is being extensively considered in the Occupational Therapy (OT) process. Different thinkers and practitioners have evolved their own thoughts and meanings of spirituality, and discussed how spirituality can be incorporated in the OT process. A critical review of selected papers published on the subject has brought to light certain facts. This paper will summarize the existing knowledge in the field while suggesting how the gap could be filled. Definition of spirituality The word ‘spirituality’ itself has been defined and interpreted in so many ways by different practitioners in the field. Thorough research has been undertaken on the meaning and application of spirituality and its implications in treatment. While none of the authors and practitioners have been able to give any specific definition of spirituality, all agree to the extent that spirituality leads one to search the meaning in life. Research also reveals that spirituality has a close link to the well being of an individual as Johnston and Mayers (2005) state that it is a life force and involves the integration of mind, body, and spirit. According to Egan and DeLaat, ‘Spirituality relates to our thoughts, feelings, and actions concerning the meaning that we make to our daily lives.’ (cited by Johnston & Mayers). Tse et al., (2003) also agree that spirituality relates to an individual’s sense of meaning and purpose of life. They further clarify that spirituality is an experience, which transcends a person beyond the mundane level. McColl (2000) defines spirituality as a ‘sensitivity to the presence of spirit’ (cited by Wilding, 2002). While most have considered spirituality above religion, some researchers have related it to religion stating that the tension between the two remains unresolved in occupational therapy (Unruh, 2000). ‘Spirituality’ and ‘religion’ are not considered interchangeable terms (Udell & Chandler, 2004). Individuals may not have religious beliefs or affiliations but still have spiritual dimensions. The Canadian Model of Occupational Performance also defines spirituality as a source of will and self-determination, sense of meaning, purpose and connectedness (cited by Beagan & Kumas-Tan, 2005). Unruh, according to Beagan and Kumas-Tan, notes that ‘Spirituality may give life meaning, but meaning can be found in many other ways that may have nothing to do with spirituality.’ Even though some difference of opinion on the definition of spirituality has been cited, largely, meaning, purpose and connectedness has been generally accepted. Beagan and Kumas-Tan confirm that ‘meaning in life’ is one of the most frequently used words in discussions of spirituality and occupational therapy. According to Bash (2005) the term spirituality cannot be defined. It has been misconceived and he suggests that it could be this reason due to which practitioners may be reluctant to address spirituality in their profession. Of course, Bash refers to nurses generally but it could be applicable to the occupational therapists as well. Bash feels the approach should be client and patient centered. Joyle (2002) also agrees with Bash that spirituality is an elusive concept and cannot be defined. Both however, concentrate on nursing and Coyles findings endorse a strong connection between spirituality and health. Connectedness to God or some higher power is known to provide hope, according to Joyle. Spiritual experiences have helped individuals cope with HIV who were besieged with fear of death, suffering, uncertainty and hopelessness. Spirituality and Occupational Therapy Rosenfeld (2001) refers to studies that indicate that spiritual beliefs and practices have a significant positive effect on recovery from physical and mental illnesses and addictions. The world across, therapists are recognizing the importance of spirituality in the well-being of an individual. Various foundations and associations have amply demonstrated that spirituality has an health-enhancing link to the healing process. Wilding emphasizes that historically, spirituality and occupation have been linked. He does so by quoting Adolf Meyer who has said that occupation speaks to the very soul of man, which in other words is spirituality. Wilding also quotes Peloquin, according to whom also spirituality is a key component of occupation and thus is highly relevant to occupational therapy practice. Unruh endorses that spirituality has gained importance in OT in the last five years. A report of NHS maintains that spirituality was essential for the provision of high quality care (Udell & Chandler, 2004). Nursing itself is moving towards holistic healing, with due consideration given to the mind, body and spirit, exhibiting the importance of spirituality in healing and rehabilitation. Belcham (2004) admits that unless spirituality of the individual is taken into account, holistic healing is not possible as spirituality pervades all aspects of a person with a direct impact on his or her occupation (Clark et al., cited by Belcham). Beagan and Kumas-Tan have done a thorough research on various studies to determine the acceptance level and the attitude of the therapists towards integrating spirituality in their practice. Sixty-three percent of the therapists surveyed in an American study were indecisive or disagreed that spirituality was within the scope of OT practice but a British survey found that 75% of the therapists considered spiritual issues within the scope of occupational therapy. In another Canadian and American survey, it was found that majority found spirituality appropriate, one third found religion to be appropriate in addressing treatment. Interventions used by therapists Research has also been conducted to determine what spiritual interventions do the therapists use in their practice. In most cases, OT therapists pray for the clients, which in a survey by Collins et al., was as much as 74% (cited by Zorzes). While it has been observed that the therapists pray for the clients or use spiritual language, very few help the clients to develop or grow spiritual. Nevertheless, Collins et al., (2001) did find changes taking place and research suggested higher occurrence of discussion and integration of spirituality into practice (cited by Johnston & Mayers). Various researches demonstrate disparities between what the therapists believe and in what they actually practice. While most agree on the positive effects of spirituality, very few use this as a tool for enhancing their practice. Johnston and Mayers, through their research, found that despite therapists demonstrating a positive attitude towards spirituality, only 36.6% found it appropriate to use in OT. Beagan and Kumas-Tan too found that the therapists do agree that connection with self and others is an aspect of spirituality but they never used this means as a focus of therapy. This has also been confirmed by Hoyland and Mayers (2005) who cite the findings of Engquist et al (1997) and Rose (1999) that only small number of therapists addressed spirituality is their assessment even though large numbers considered it to be an important component of rehabilitation. The therapists remain focused on the occupation and then function of the client, says Belcham. A questionnaire study of British therapists found that 75% agreed that their role included spirituality but only 18% addressed spirituality consistently within their assessment (Rose cited by Belcham). A study of eight therapists by Egan and Swedersky (2003) however suggests that they were consciously discussing issues related to religion, suffering, and is general aiding the client (Johnston & Mayers). The gap persists in what ought to be done. Therapists’ attitude and understanding Research suggests that the occupational therapists lack in knowledge and understanding of the subject. They are not aware how spirituality could be used to assist people towards better health. Because therapists lack knowledge, they do not feel comfortable in relying on spirituality to enhance the healing process. Zorzes (2004) confirms that very little is taught to the OT practitioners how to incorporate spirituality into their practice. Secondly, lack of scientific evidence that spirituality aids in well-being has been a reason why therapists have refrained from using spirituality as a tool in their practice. Unruh suggests spiritual matters may be considered subjective and personal, and not appropriate for resolution using an evidence-based framework. Most frequent reasons according to Farrar (2001), include lack of knowledge and training, client too young or incapable of conceiving spirituality, or the practitioners incompetent to address spirituality (cited by Johsnton & Mayers). Confusion over the definition of spirituality has also been cited as one of the reasons therapists keep away from addressing this in their practice. Research of various literatures suggests that occupational therapists in Canada, UK and the US, experience uncertainty, guilt and embarrassment in addressing spirituality in their practice (Beagan and Kumas-Tan, 2005). They also quote other studies, which indicate that therapists hesitate to use the language of spirituality. It is important to understand the client’s functioning in the context of his/her own life (Rosenfeld). The therapists believe in client-centered process and they believe in treating people with dignity, equality, and fairness. This according to Beagan and Kumas-Tan implies an indirect spiritual approach to treatment. While they do not name their work as spiritual, respect for clients’ personhood, attention to meaning, relationship and connection, and inclusivity, all these are different aspects of spirituality. Research by Hoyland and Mayers suggests that the therapists addressed the spiritual need of their clients as just another need, which should be attended to. This implies it was more as a duty than an intervention, which should be adopted. The responses also differed depending upon whether the occupational therapist worked in the general or the surgical ward. The occupational therapist needs to understand how the individual ascribes meaning to spirituality and this should be incorporated in a way that results in therapeutic benefit (Belcham). Kirsh et al., (2001) cite the results of a study by Enquist et al., which brought to light the fact that the academic studies did not prepare the occupational therapists to address the spiritual needs of the clients. Students face difficulty even to think of their own spirituality and they are certainly not prepared to aid others in this field. While most studies show that respondents understand the importance of spirituality in healing, very few practiced it. What needs to be addressed is to help the clients overcome the fear of death. This requires a deeper understanding on the part of the practitioner, only then will he/she will be able to instill confidence in the client. Merely praying for the clients is insufficient. Prayers immediately bring to mind a place of worship, which becomes associated with religion. Spirituality is above religion; it is to know the self. Suffering and pain are a part of spiritual crisis; sufferings lead one to development and growth. Johnston and Mayers also agree that consideration of spirituality in practice within the literature appeared to be primarily implicit. Concentration in therapy remained on clients’ wellbeing and ability to pursue meaningful occupations, rather than specifically addressing spirituality. Fearlessness, death, purpose of human life, introspection reflection on one’s life and events, cause and effect, are issues which have never been addressed by the therapists. While the practices and the use of spirituality by the therapists have been addressed in the various studies, the need and inclination of the clients towards spirituality has never been assessed (Johnston & Mayers). The therapists too only informally discussed such issues and were reluctant to devote time to discuss them formally. Researchers have recognized the need to provide the opportunity to clients to make sense of their life story (Hoyland & Mayers). They feel if the spiritual needs are not assessed, a significant part of people’s lives would remain neglected and their maximum potential would not be achieved. Confusion over the definition and connecting it with religion becomes reason enough not to use it in their practice. Spirituality should be clearly differentiated from religion and the clients helped to travel towards the self. This would be half the battle won and the clients would be able to feel a quantum relief. Their approach to the ailment and life could change drastically; they would be able to connect to the higher self, the Supreme power, which may be known by different names in different religions. Spirituality should not be limited to religious traditions and beliefs. Spirituality simply denotes being close to the spirit. Hence, any setting that brings an individual close to the spirit or the self should be encouraged like watching the sunset as Johnston and Mayers suggest. Rosenfeld (2000) has also made suggestions how spirituality could be fostered but Johnston and Mayers believe that these activities would only address the religious and cultural needs and not really take into account the therapeutic potential. Various suggestions have been made in the literature how spirituality could be awakened in a person. Motivating the client to accept the suffering, encouraging them to traverse towards the self, helping them to reflect on their life and relationships are some of the suggestion set forth by Rosenfeld. Zinnbauer & Pargament (2000) suggest that the clients spiritual orientation, not that of the therapist, must remain the focus (cited by Rosenfeld). Hoyland and Mayers cite Espeland who suggested that assessing spiritual needs should be a part of the occupational therapy’s role. Filling the gap, discussions and conclusion The literature review has revealed that most studies have dealt with the attitudes and practices of the therapists and none with the clients. While most of the literature suggest that giving spiritual care was part of the occupational therapy domain, not many have actually applied it in practice. All the therapists in the studies admit that holistic approach and spirituality should be incorporated, most have not been enthusiastic about it. The profession of occupational therapy continues to seek a comprehensive definition of spirituality. This is the reason why it has been difficult to apply it in practice. The literature and the studies do not give an idea about the age group of the therapists, which can help to highlight the causes of reluctance on the part of the therapists. Fresh young graduates may have reluctance specially if they have not been exposed to such practices during field work. Suggestions have been made how spirituality could be incorporated into OT. It has to be a conscious effort to include spirituality and address spiritual issues in the context of the client’s life to supplement the healing process. Barriers to using have been identified. Clients needs have seldom been addressed. While all agree that spirituality is an essential part of OT opinions vary on the definition of spirituality and the relationship of spirituality and practice in OT. What are lacking are the interventions and a deeper understanding. Practitioners need to reflect on the methods of intervention. Perhaps at the undergraduate level, this needs to be addressed with much care and attention. At the student level itself they must develop confidence in practicing spirituality during their field experience. This would help them overcome the embarrassment and guilt in practice. Three most important issues that need attention include field experience in addressing spirituality at the undergraduate level, personal spiritual growth, and insight of the therapists, and more research on the client needs. Unless a therapist has learnt how to reflect and address his or her own spiritual needs, he is not competent to evoke this attitude in others. Self-introspection would make them overcome guilt and embarrassment they face now. Researchers mostly agree that spiritual and healing have a deep connection. What lacks is the addressing of such issues for therapeutic benefits. Studies and researches have provided enough knowledge on spirituality in the context of occupational therapy but remedies and suggestions have not been forthcoming in equal measure. Practice with spirituality has to be embedded as a part of the undergraduate course leaving no provision for the therapist to have any doubts. Qualitative and quantitative measurement of spiritual interventions could encourage more therapists to use spirituality in their practice. Re-examination of spiritual and occupation is essential. While spirituality has been discussed in most of the researches and literature, studies have been conducted, but in practice, it has only been used informally. While therapists appear to acknowledge the positive effects of using spirituality, they do not apply it in their practice. Hence, it can be concluded that spirituality is not practiced in occupational therapy, as it is believed to be. References: Bash, A. (2005), Commentary on McSherry W, Cash K & Ross L (2004) Meaning of spirituality: implications for nursing practice, Journal of Clinical Nursing, Volume 14, Number 10, November 2005, pp. 1268-1269(2) Beagan, B. & Kumas-Tan, Z. (2005), British Journal of Occupational Therapy Volume 68, Number 1, January 2005, pp. 17-24(8) Belcham, C. (2004), Spirituality in Occupational Therapy: Theory in Practice? British Journal of Occupational Therapy January Volume 67, Number 1, 1 January 2004, pp. 39-46(8) Coyle, J. (2002), Spirituality and health: towards a framework for exploring the relationship between spirituality and health, Journal of Advanced Nursing, Volume 37, Number 6, March 2002, pp. 589-597(9) Hoyland, M. & Mayers, C. (2005), Is Meeting Spiritual Need within the Occupational Therapy Domain? British Journal of Occupational Therapy, Volume 68, Number 4, April 2005, pp. 177-180(4) Johnston, D. & Mayers, C. (2005), British Journal of Occupational Therapy Volume 68, Number 9, September 2005, pp. 386-392(7) Kirsh et al., (2001), Developing awareness of spirituality in occupational therapy students, Occupation Therapy International, Occupational Therapy International. London: 2001. Vol. 8, Iss. 2; p. 119 (7 pages) Rosenfeld, M. S. (2001), Spirituality, Motivation and Performance, 25 Aug 2006 Tse et al., (2005), Exploration of Australian and New Zealand indigenous people’s spirituality and mental health, Australian Occupational Therapy Journal (2005) 52, 181–187 Udell, L. & Chandler, C. (2000), The Role of the Occupational Therapist in addressing the Spiritual Needs of Clients, British Journal of Occupational Therapy October 2000 63(10) Unruh, A. M. (2000), Application of evidence-based decision-making to the spirituality construct: Definitions and outcome measures, Wilding, C. (2002), Where angels fear to tread: Is spirituality relevant to occupational therapy practice? Australian Occupational Therapy Journal (2002) 49, 44–47 Zorzes, J. (2004), How Are Occupational Therapists Addressing Spirituality in Their Practice? 25 Aug 2006 Read More