Those who participated in our project on prayer in hospitals often spoke about the importance of being respectful of what the patient would desire, in relation to prayer. In our analyses, we interpreted this stance as being person-centred. As it turned out, person-centredness was the most referenced node in our NVivoTM qualitative data analysis software.
What did person-centredness entail? Chaplains and staff spoke about how they elicited what the patient and family held as dear, what their belief system was, and then (for the most part) prayed within that framework. Chaplains especially, but also staff, were cautious not to impose prayer, or impose prayer in a certain format.
Person-centred care (also referred to as patient-centered care) is a buzzword in healthcare today. In British Columbia, for example, it is one of eight strategic priorities named by the Ministry of Health. At its core is the commitment to recognizing the patient as a whole person, and as a full partner in their health and healthcare.
A criticism levied against this movement is that it is rooted in neoliberal philosophies of individualism. Such a critique prompts the question: How was an individualistic bent toward prayer and person-centredness displayed? In the case of prayer, the data comprised of examples of praying across social borders of difference, which could leave the participants (patients, family, staff) feeling pleased with how a health encounter went. For example, when a street-involved patient asked a chaplain to pray with them, there was an unexpected bond that formed between them. Not surprisingly, such encounters were perceived as meaningful, but in the big picture, had anything changed for this person? They would be discharged to their life of impoverishment, and continue to struggle with the many associated challenges.
We have been thinking about how one studies prayer through an equity lens – where those structures that result in social stratification and disadvantage are brought into the sphere of analysis. An equity-lens has raised questions such as:
- What social assumptions might be shaping how I anticipate prayer should happen? For example, a participant mentioned that they were at times caught by surprise as to who might pray, and what might be considered prayer. Would a sex worker pray? Would a drug dealer pray? Would a wealthy person pray?
- Who are disadvantaged in our city? Who are structurally vulnerable? In London, hospitals built prayer rooms for Muslims. In Vancouver, a chaplain was involved in supporting the services at a street clinic, and an All Nations Sacred Space was built in a hospital. These are examples where institutional efforts are made to make prayer accessible to those who might not resonate with existing, formalized services.
Returning to the idea of person-centredness, might a people-centred approach to prayer complement and extend a person-centred approach. With colleagues from Sweden, we recently wrote on the context of palliative care, how people-centred care can offset the individualistic bent of person-centred care (Öhlén et al., 2018). People-centred care focuses not just on the illnesses of individuals, but also the determinants of ill health that manifest at individual and population levels. Care is focused and organized out of needs and expectations of communities.
In the case of prayer and spiritual care, a re-orientation could occur to consider the needs and expectations of those most vulnerable and marginalized.
The theme of an upcoming conference in Vancouver (May 10 – 12, 2019) is that of Inspiring Person-centredness: A call to action. The conference is co-hosted by Providence Health (in their Spirituality and Healthcare: The Missing Ingredient conference series) and Trinity Western University (in our Faith and Nursing Symposium series). Please consider joining us! One of the featured panels will draw on the findings of this study. See: www.spiritualityconferenceprovidencehealth.org
Öhlén, J., Reimer-Kirkham, S., Astle, B., Håkanson, C., Lee, J., Eriksson, M., Sawatzky, R. (2017). Person-centred care dialectics in palliative care—Inquired in the context of palliative care. Nursing Philosophy, 18(4).