Spirituality: Defining the Indefinable in Healthcare and Beyond
Kia ora/Hello,
This is our first blog for the project. We encourage you to comment freely! Throughout the three-year duration of the project, we will be writing blogs on different aspects, ranging from spiritual definitions (like the one below) to spiritual care and our findings. Our aim is to create a space for interested people to engage and further the ongoing national conversation on spiritual care in Aotearoa, New Zealand.
I am the co-lead in this project, see link for my background.
As a researcher specialising in the connection between spirituality and healthcare, I am often asked, "What do you mean by spirituality?" This seemingly simple question leads to a complex and multifaceted discussion. Indeed, spirituality is a concept that cannot be easily defined, as it is understood and experienced differently by each individual. However, there are common themes and elements in various definitions that can help us better grasp spirituality. In this blog, I explore some of the issues related to how we define and understand spirituality. We would love to hear your views so please add a comment below or register for one of our upcoming online meetings/hui!
Scientific research requires precise definitions, rigorous measurement, and empirical testing. We use these methods in our spiritual care research. However, there is no universally accepted 'gold standard' definition of spirituality. A 2021 review of spirituality definitions used in healthcare literature identified 24 spiritual dimensions discussed in 166 articles, with the most commonly mentioned ones being connection/relation, meaning/purpose, divine/god/higher power, transcendence/immaterial, others, beliefs, nature, and values.1 This highlights the multidimensional nature of the concept.
Expanding on these spiritual descriptors, spirituality often involves an examination of one's core beliefs and values, contributing to a sense of meaning and purpose in life. Many people describe spirituality as a feeling of connection with oneself, others, creativity, nature, or the sacred. It may also be connected to one's sense of identity and self-awareness. For some, spirituality is closely tied to religious practices and beliefs.
Although spirituality and religion have a historical connection, they are not necessarily interchangeable. An increasing number of people identify as spiritual but not religious, representing a wide spectrum from atheism to religious forms of spirituality. Some individuals may prefer terms like "existential" or "meaning-making" to describe their experiences, rather than using the word "spirituality."
One of the most commonly used definitions of spirituality in healthcare comes from an international consensus process led by palliative care professor Christina Puchalski. Forty researchers, spiritual care experts, and others from all over the world (see appendix for full list) met in person to talk about spiritual care, and definitions and came up with this definition:
Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices. (2)
Based on our study on spirituality at the end of life in Aotearoa, we published the following definition:
Spirituality means different things to different people. It may include (a search for): one’s ultimate beliefs and values; a sense of meaning and purpose in life; a sense of connectedness; identity and awareness; and for some people, religion. It may be understood at an individual or population level. (3)
Leader in end-of-life study and Māori researcher, Dr Tess Moeke-Maxwell suggests that for Māori, “spirituality is expressed through the concepts of ‘wairuatanga’ or ‘wairua’, which relate to the spiritual dimension of health and well-being and the interconnectedness of all aspects of life”. (4) See further discussion about wairuatanga on our website here.
Partly because of Māori, spirituality in Aotearoa is acknowledged in discussions about health, taught (briefly) in medical and nursing schools, and explored in State schools. The Te Whare Tapa Wha model (5), developed by Sir Professor Mason Durie, was introduced to the Health and Physical Education curriculum in 2000. This model represents a "whare" or house, with each side of the house representing a necessary component for our overall wellbeing or hauora. These components include physical, mental, social, and spiritual well-being, with the recent addition of the importance of the land, or "whenua."
The definitions of spirituality are often influenced by the perspectives of different disciplines and worldviews. Nursing and medicine, for example, may view spirituality in terms of its impact on health and well-being, including addressing spiritual distress. The connection between spirituality and psychological dimensions is also an area of interest. John Swinton and Stephen Pattison challenge the need for a definition, suggesting the “vagueness of the concept is its strength and value”, suggesting that the definition’s “value lies precisely in their contingent, evolutionary and contextual usage”. (6)
In Aotearoa New Zealand, there exists an intriguing paradox regarding spirituality. While many reject religion, with the fastest growing Census category being "none" (no religion), surveys indicate that many individuals engage in various forms of spirituality. (7) Spiritual responses are commonly observed during times of crisis, such as the Christchurch Mosque tragedy, and are deeply ingrained in Māori rituals like tangihanga (funeral ceremonies). Māori tikanga, te reo, and karakia are increasingly becoming a normal part of public ceremonies and events. The concept of the "human spirit" is also prominent in domains such as sports and the arts.
The study of spirituality remains a dynamic field with no single definition. Embracing its complexity and diversity can enhance our understanding and application of spiritual well-being in healthcare and beyond.
Our current research project seeks to understand how we can harness this complexity and diversity to deliver better care and outcomes when we and our loved ones engage with our healthcare system.
How do you define spirituality? What is most important to you?
Please share your thoughts in the Comment Box below!
References
1. de Brito Sena MA, Damiano RF, Lucchetti G, et al. Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework. Frontiers in psychology 2021;12:756080.
2. Puchalski CM, Vitillo R, Hull SK, et al. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med 2014;17(6):642-56. doi: 10.1089/jpm.2014.9427 [published Online First: 2014/05/21]
3. Egan R, MacLeod R, Jaye C, et al. What is spirituality? Evidence from a New Zealand hospice study. Mortality 2011;16(4):307-24. doi: 10.1080/13576275.2011.613267
4. Egan R, Cayley, S., Moeke Maxwell, T., Holmes, A., Waldegrave, C.,. Spirituality and Well-being: Discussion Paper 2013. Available from: http://spiritualityandwellbeing.files.wordpress.com/2013/09/spirituality-and-wellbeing-discussion-paper-2013-final.pdf.
5. Durie M. A Maori Perspective of Health. Soc Sci Med 1985;20(5):483-86.
6. Swinton J, Pattison S. Moving beyond clarity: towards a thin, vague, and useful understanding of spirituality in nursing care. Nurs Philos. 2010;11(4):226-37.
7. Wilberforce Foundation. Faith and Belief in New Zealand: Exploring the spiritual landscape in Aotearoa New Zealand. Auckland: https://faithandbeliefstudynz.org/, 2023.