What does the international research suggest?
In the last 20 years there has been a steady growth of cross-disciplinary peer reviewed publications showing the value, importance and contribution of spirituality in health (Whitford & Olver, 2012; Williams, 2006), education (Fraser, 2004), business (Lips-Wiersma & Mills, 2002) and social work (Sullivan, 2009).
Spirituality is increasingly understood as having an important impact on our health and well-being (Puchalski, 2012). This evidence has informed policy, such as the Scottish National Health Service, who note “spiritual care in the NHS must be both inclusive and accepting of human difference” (NHS Education Scotland, 2009). The NHS suggest four reasons that spirituality needs to be considered: it is ethical, it is mandated as part of their regulatory framework, it is financially sensible as there will be better outcomes for patients and happier staff, and clinically it improves outcomes (NHS Education Scotland, 2009).
The evidence, while not without problems (Sloan et al., 2000), is such that 75 % US medical schools now teach compulsory courses on spiritual care (Puchalski, 2006) and in education spirituality is part of the compulsory State school curricula in New Zealand (Ministry of Education., 1999). A senior Māori academic suggests “Taha wairua is generally felt by Māori to be the most essential requirement for health” (Durie, 1998, p. 72). Valentine’s (2009) research endorses this:
“Through wairua Māori identity is expressed, relationships are forged, balance is maintained, restrictions and safety are adhered to, healing is transmitted, and the connection between te ao wairua and te ao Māori are maintained. These aspects of Māori reality are inclusive and interconnected (p.iii).”
There is also some evidence that suggests people want their spiritual needs met by healthcare providers. In a Scottish qualitative study, Murray et al. (2004) interviewed 40 patients with terminal illness and their carers every three months over a year, resulting in 149 interviews. They concluded that “Spiritual concerns were important for many patients … both early and later in the illness progression.” (Murray, Kendall, Boyd, Worth, & Benton, 2004). In a US quantitative study, 921 participants were asked when it was appropriate for doctors to ask about spirituality, found 83% wanted “physicians to ask about beliefs in at least some circumstances.” (McCord et aI., 2004). A recent mixed methods New Zealand study of those affected by terminal illness showed 69% of participants wanted spiritual care (Egan et aI., 2010). Tacey calls this a “client led recovery of spirituality” (Tacey, 2003).
From the 1990s forward a growing body of research began to suggest a positive relationships between religiosity/spirituality and various health outcomes (Berry, 2005; Sinclair, Pereira, & Raffin, 2006). Some of the most convincing studies have come out of those focus on quality of life (QOL). A large Australian quantitative study (n=999) showed the importance of spiritual well-being to overall quality of life among cancer patients, suggesting spirituality was “a significant, unique contributor to QOL beyond the core domains of physical, social/family, and emotional wellbeing” (Whitford & Olver, 2012).
Qualitative studies, some argue the best method to examine spirituality, are almost unanimous confirming the “fundamental importance of spirituality at the end of life” (Williams, 2006). There are some negative aspects related to spirituality and health however, these are mostly related to negative religious coping styles, for instance feeling guilt and subsequent punishment from God in the form of ill-health (Hills, Paice, Cameron, & Shott, 2005; Holmes 2011).
In 2010 Perkins identified a total of 239 published papers, books, chapters, theses and conference presentations on spirituality authored by New Zealanders. The themes were:
- education/youth (27 papers)
- gender/sexuality (8)
- Māori/other cultures (54)
- disability/ageing (21)
- religion in New Zealand (21)
- nature/art/alternative spirituality (16)
- health, particularly palliative care and mental health (46)
- business/law/government, including policy documents (46)
Although this is unlikely to be a complete list it shows the breadth of interest in spirituality. Further, the Health Research Council has funded 5 projects incorporating spirituality (mainly related to Māori and Pacific issues) since the year 2000. (Personal Communication, Dr. Katie Evans 25.7.2011).
The weight of evidence is growing to show the importance of spirituality in society. This include healthcare, the community, the workplace and as a protective factor against a range of life challenges. It is also a central component of quality of life and resilience. Despite these development, spirituality is still the ‘forgotten factor’ in most of New Zealand contexts, with some exceptions such as hospice care (Egan, et al. 2011) and some Māori and Pacifica approaches (Durie 1998; Capstick, Norris et al. 2009).
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