Recognising spiritual needs.

I would like to congratulate Molly Page for her excellent article on spiritual care ("How well do we care for people's spiritual needs? Kai Tiaki Nursing New Zealand, November 2005, p18-19). While not a new area, spiritual care has arguably been forgotten for some time. This appears to be changing. Spirituality is increasingly being recognised by way of the bio/psychosocial/spiritual and te whare tapa wha models in a number of the Ministries of Health and Education strategies.

We need an informed debate and approach to this emerging issue. Naturally care needs to be taken, as misinformation and the fact that spirituality is at the heart of what it is to be human make this area delicate, but critically important. Some argue that while Western nations are healthier and wealthier, there is a gap, a spiritual hunger or a lack of meaning and purpose that may be part of the cause of many of our illnesses.

As Page notes, definitions are important, as spirituality is often misunderstood as referring solely to organised religion. While spirituality encompasses religions, a broader understanding is developing. Internationally there is no single agreed definition. However, there are common elements; these include meaning and purpose, values and beliefs, identity, and, for some, a religious or God connection.

Spirituality is slowly finding a place within health care, particularly palliative care. In my research into spirituality in New Zealand's end-of-life cancer care, I am finding a growing body of evidence that suggests links between spiritual well-being and other health outcomes. Much of the research in this area comes out of the United States, where people's spiritual expression is mostly religious. In New Zealand, while many have a spiritual belief, few belong to churches. Thus, how we address spiritual care can be by no means homogenous across our patient populations. More local research is needed for our unique communities. How spiritual care is given is still developing worldwide. Infrastructures for secular spiritual care need to be considered, as approaches are developed to meet local needs. The Government's primary health care strategy calls for a proactive approach to holistic health. I look forward to positive approaches and professional development, particularly in spiritual care, as we move forward.

Richard Egan, PhD student, Dunedin