Spiritual Needs in Health Care Settings: A Qualitative Meta-Synthesis of Clients' Perspectives

As observers have noted, clients' spiritual needs have become a "core health concept" (Shih, Wang, Hsiao, Tseng, & Chu, 2008). Social work practitioners, as key players in the provision of health care services, are often called on to address clients' spiritual needs (Anderson, Anderson, & Felsenthal, 1993; Davidson, Boyer, Casey, Matzel, & Walden, 2008; Flannelly, Galek, & Handzo, 2005; Fletcher, 2004; Sheridan, 2009). NASW's (2001) Standards for Cultural Competence in Social Work Practice enjoin practitioners to provide services that are responsive to clients' spiritual beliefs and values, a point echoed by the NASW (2008) Code of Ethics standards that address religion. Taking clients' spiritual needs into account is an integral component of holistic service provision that directly facilitates positive health outcomes. Spiritual needs often emerge in the context of receiving health or behavioral health services (Nelson-Becker, Nakashima, & Canda, 2007). As clients wrestle with challenges, spirituality often becomes more salient (Koenig, 2007; Pargament, 1997). Spiritual assets may be operationalized to help clients understand, cope with, or otherwise deal with the stressors they encounter on admission to the health care system (Pargament & Raiva, 2007; Saleebey, 2006). Research suggests that spiritual needs are common in health care settings (Flannelly et al., 2005). The prevalence of spiritual needs has been explored in a variety of settings, including residential substance abuse treatment programs (Carroll, McGinley, & Mack, 2000), emergency departments (Jang et al., 2004), hospitals (Reed, 1991), pediatric units (Feudtner, Haney, & Dimmers, 2003), psychiatric wards (Fitchett, Burton, & Sivan, 1997), rehabilitation units (Anderson et al., 1993), cancer clinics (Balboni et al., 2007), hospices (Hampton, Hollis, Lloyd,Taylor, & McMillan, 2007; Hermann, 2007), and various outpatient settings (Astrow, Wexler, Texeira, He, & Sulmasy, 2007; D'Souza, 2002; Moadel et al., 1999; Warner-Robbins & Christiana, 1989). Although prevalence rates vary from setting to setting, typically the majority of respondents report the presence of spiritual or religious needs. For example, Fitchett et al. (1997) examined the presence of religious needs among a sample of medical/surgical patients (N = 50) with a wide variety of admitting diagnoses. Just over three-quarters reported having three or more specific religious needs during hospitalization. This same body of research suggests that many clients want health care professionals to address their spiritual needs (Koslander & Arvidsson, 2007). Although not every client believes that spiritual concerns should be discussed in health care settings, most clients appear to believe that such discussion is appropriate (Arnold, Avants, Margolin, & Marcotte, 2002; Dermatis, Guschwan, Galanter, & Bunt, 2004; Larimore, Parker, & Crowther, 2002; Mathai & North, 2003; Rose, Westefeld, & Ansley, 2001, 2008; Solhkhah, Galanter, Dermatis, Daly, & Bunt, 2009). For instance, among clients (N = 79) receiving psychiatric services, D'Souza (2002) found that 69 percent felt that practitioners should consider clients' spiritual needs in treatment. Failure to adequately address spiritual needs can directly affect an array of health-related outcomes (Balboni et al., 2007; Hermann, 2007; Koenig, 2007; Koenig, McCullough, & Larson, 2001). For example, Astrow et al. (2007) examined the relationship between addressing spiritual needs and overall perceptions of care among a sample of outpatients (N = 369) receiving treatment at a cancer center in New York City. The authors found that clients who reported their spiritual needs were not adequately addressed reported significantly lower levels of global satisfaction with the care they received. The importance of this finding is accentuated by the fact that global measures of client satisfaction are typically understood as a proxy for the quality of care clients receive in health care settings (Jackson, Chamberlin, & Kroenke, 2001; Press, 2002; Shea et al. …