Modern hospitals are constantly evolving because of technological advances, budget constraints and social transformations; in these places, the encounter with people of different ethnicity and culture poses challenges of integration in the care and hospitality that can be offered. For years, the humanization of medical care in the most advanced healthcare settings has involved an integration of biological, psychological and social aspects. In this perspective, while religious choices are considered to be personal, spiritual needs are receiving increasing consideration in the context of advanced health care.
However, the need to ground health care practices on scientific evidence calls for and requires a more accurate understanding and knowledge of the contribution that spiritual care can provide within the hospital context, in particular in the treatment of serious diseases. Among other things, there is no unanimous consensus on how to conceive the concept of spirituality nor the differences between spirituality and religiosity. In recent decades, there have been important changes and evolutions in hospital care, moving towards the provision of services increasingly loaded with technology, and with an always greater demand to follow strict criteria of effectiveness and efficiency. Also the spiritual assistance offered to patients during hospital treatment has to face the need for a reorganization and adaptation of traditional practices in light of the changes of the modern hospital context, in order to perform its supporting activity for the benefit of patients. Until a very recent past, said spiritual assistance was almost entirely identified with the religious assistance offered by chaplains.
Modern perspectives recognize a central role to the subjectivity of patients within the treatment process, for example in the patient-centered medical model or in the use of narrative medicine. To give meaning to the events that happen to us is always a crucial step in the re-elaboration of them, and while biological explanations do offer, in fact, the rational basis for understanding the pathophysiological dynamics of diseases, there is also a psychological and spiritual level that is no less important for the subjective re-elaboration of life events.
Therefore, there is the need for a health care model that includes, in the context of treatment, the different biological objective factors as well as the psycho-social and even spiritual subjective ones, in order to ensure attention to the peculiarities of individual patients, with their resources and vulnerabilities, along the entire path of care.
With respect to the spiritual dimension, new evidences are increasingly emerging on how it can influence the ability to support the disease and how many patients show religious or spiritual needs and would like to dialogue on these aspects as an integral part of their health care processes.
Relevant spiritual issues include the search for meaning with respect to illness, feelings of guilt, conflict with one’s religious convictions, the search for hope in the adverse circumstances of illness. It is pretty intuitive to understand how the spiritual dimension refers to hope, understood not as mere optimism or even as illusion. The question regarding which tools are suitable both in order to detect the spiritual dimension and to help and sustain hope remains an open one.
Such attention to the spiritual dimension also affects members of the medical staff who are directly involved in helping and supporting sick people, as well as their family members. Burnout, as well as the effort to accompany them through difficult times of their existence, the moment of mourning, its re-elaboration, and so on: these are all situations that undermine the physical, psychic and spiritual balance of health care personnel, who ask for help and support in these areas.
Spiritual issues in the medical setting have received increasing consideration in the scientific literature in recent years, and various health organizations, such as the Joint Commission on Accreditation of Healthcare Organizations, have highlighted the need to take spiritual aspects into account within hospital medical care.
One of the risks in which the spiritual dimension can slip is to marginalized or ousted, and this is especially true nowadays, since the economic pressure does not seem to take into account an adequate attention to this specific area, contrary to what happens in the international scene.
An agenda of research objectives is underway for a rational planning of activities and as the basis for collaboration with national and international institutions and researchers.