OT Views of Spirituality
With the positive impact of spirituality on client outcomes, and the term comprehensively defined in the OTPF-4, it stands to reason that occupational therapy practitioners have a clear understanding of how to use spirituality in their practice. Additionally, we also understand how to determine the spiritual needs of our clients. However, Egan & Swedersky (2003) noted that occupational therapists do not have a clear understanding of their role with spirituality in clinical practice. Additionally, their qualitative study found personal, conceptual, and institutional barriers to the utilization of spirituality in occupational therapy practice (Egan & Swedersky, 2003).
Table 1. Personal, Conceptual, and Institutional Barriers to using spirituality in occupational therapy practice. (Egan & Swedersky, 2003).
| Factor | Barrier |
| Personal | Lack of training in addressing the spiritual needs of clients. Concern with being intrusive with focusing on spirituality during practice. |
| Conceptual | Difficulty with applying spirituality concepts across a variety of cultures. Making spiritual aspects of care meaningful to all clients when culture is a large aspect of spiritual practice. |
| Institutional | Spirituality is an abstract concept that is difficult to make concrete for other team members. The amount of time it takes to address the spiritual needs of clients with other intervention needs. |
Client’s View of Spirituality
While research on spirituality in the field has focused on the beliefs of occupational therapy practitioners, Milliken (2020) focused on clients’ beliefs on spirituality and the role of occupational therapy. Results found that clients were open to defining their views of spirituality. Additionally, clients defined the expression of spirituality with engagement in activities such as listening to music or singing songs. Clients also felt comfortable discussing their spirituality, respected boundaries when discussing spiritual needs, and once they understand the role of occupational therapy in addressing spirituality, were able to discuss ways occupational therapy could address spiritual needs. Collectively, these findings point to a role for occupational therapy practitioners using spirituality in their practice with a need of a process to follow to effectively address this client’s need during an intervention.
Implementing Spirituality into OT Practice
Before you begin with your client:
- Separate your value system on spirituality during client care.
- Understand the definition of spirituality from an OT perspective and the impact on client outcomes (see Spirituality and Occupational Therapy Practice—Part I: Why is Spirituality Important in Client Care?).
- A guiding occupational therapy framework that can guide an understanding of the role of occupational therapy with spirituality and the impact on engagement can be found in the OTPF-4.
- A theoretical model that can be used to understand the role of spirituality of the person on engagement can be found here: Canadian Model of Occupational Performance and Engagement (CMOP-E) | OT Theory
- Differentiate religion from spirituality to guide your focus during client care. Hemphill (2015) noted “Spirituality is definitely a part of religion, but religion may not be a part of spirituality. Spirituality contains the domains of religion, but a person can be spiritual without following religious ideology.” Additionally, information on religious alignment can be found in the patient’s charts. This information is required to be available per JHACO: Spiritual Beliefs and Preferences – Evaluating a Patient’s Spiritual Needs | Critical Access Hospital | Provision of Care Treatment and Services PC | The Joint Commission
- Understand the various religious holidays to provide context with the individual you are providing intervention. Multi-faith religious holiday calendars can be found here:
When you begin with your client:
Client Guidance. Understand the definition of spirituality from the client’s perspective. Let your client guide your understanding of their level of involvement and definition of spirituality. For some religion may be directly linked to their spirituality. Therefore, learning the tenets of their religion becomes important. Let the client guide you in that understanding over time. You will have several sessions to gradually and appropriately work spirituality into a session.
Questions to Guide Understanding of Client’s Spirituality. The most suitable time during client care to learn about spirituality would be during the evaluation when learning more about the client’s IADLs skills. Some of the following questions found below can be asked to begin the conversation.
Intervention. Using spirituality with your client can look different. Some options:
Addressing Physical and Spiritual Needs.
- Have the client transport themselves to the facility’s services to address mobility and allow client to engage in spiritual practices.
- Ask the client to sit at the edge of the bed to read a sacred text such at the Bible, Quran, or Torah. This activty can help to increase endurance, and balance while allowing the client to read scriptures that are important to them. This activity can be graded up or down in a variety of ways—increasing the time sitting at the edge of the bed to read or modifying the level of support of the seating surface to challenge balance.
- Writing or typing scriptures that inspire the person’s healing trajectory. This activity allows the client to work on fine motor and coordination tasks while providing motivation through scriptures.
- Develop a routine for the client that replicates what was done prior to their hospitalization. If the client read a sacred text daily in the morning, setup a phone or electronic device with an app that has the text to allow the person to access that text in their room while waiting for a.m. or p.m. care. This modification supports a new routine until the client has a greater level of independence.
Addressing Cognitive and Spiritual Needs
- Have the client work on memory with certain verses of a text. One option is to a take a specific verse or two for the client to memorize or approximate in some manner.
- Discuss with the client their spiritual routine and determine ways to modify this routine in their current medical setting. This is a good way to have the client be part of the goal development while providing opportunities to problem solve.
- Have the client write/type a scripture for the day of the week to help with orientation. At the end of the week, have them review what they wrote for that week or ask questions about which is their favorite and why.
- Provide the client with an app to see if they can follow 2-3 step direction to access the text. Some apps can be found here: The best religious apps
Use the Spiritual Team. Understand the spiritual team at your facility—chaplain, rabbi, social worker for resources, and local houses of worship for support as needed.
Atheism. As previously noted, JHACO focuses on religion as part of the client’s intake. Therefore, there should be information on whether the client follows a specific religion or does not in the chart. Some areas to find the information would be the social worker’s intake or the face sheet of the chart.
Spirituality goes beyond religion and underlies a belief system. Understanding the belief system of an individual that does not subscribe to a specific religion can help to guide interventions in ways that are similar to individuals with specific religious beliefs. These can include, What is important to the person? What routines allow the person to feel motivated and complete? What factors demotivate a client? These are all areas that can be supported to help center the client and motivate them to participate and feel satisfied in the intervention process.
Conclusion
While there are barriers to addressing spirituality in occupational therapy practice, there are opportunities to use this in practice to positively impact client outcomes. There does not need to be ambiguity about the role of spirituality in occupational therapy practice. From a client’s perspective, there can be an interest in addressing spiritual needs during occupational therapy practice with an inclination to include spiritual needs during an intervention.
From an occupational therapy practitioner’s perspective, overcoming barriers begins with using theories and frameworks to clearly define the role of occupational therapy with spirituality. Additionally, rethinking ways to incorporate spirituality into practice can address clinician, client, and institutional needs.
OT Research Corner 