Healthcare needs go beyond the physical

Opinion: Recent Census data highlights our increasingly secular and multi-faith context. More than half of Aotearoa New Zealand’s population does not identify with any particular faith tradition, and just 32 percent are Christian, down from 36.5 percent in 2018.
For people whose spirituality is not associated with a faith or belief community, their spiritual needs in healthcare settings may be overlooked or marginalised. Other studies suggest that up to 80 percent of us are not actively religious, yet many have spiritual needs, especially in times of serious illness or crisis.
A new multi-university project looking at spiritual care and wairuatanga in health care aims to understand better the landscape of spiritual expertise among chaplains and other spiritual care experts, our healthcare professionals, and look to understand what the general population needs to achieve spiritual wellbeing.
The evidence base is growing, and that evidence suggests that looking after spiritual wellbeing positively impacts the wellbeing of patients and their whānau. Research shows 69 percent of people have spiritual needs when they have a serious illness.
Meaning, purpose, and belief are essential when facing health and wellbeing challenges. Appropriate and timely spiritual care becomes critical in providing comfort, hope, and resilience to patients and whānau.
Spirituality is a multifaceted concept that includes and extends traditional religious beliefs, spanning a continuum from atheist to theist that acknowledges the plurality of spiritual experiences.
While everyone has their own unique understanding and experiences, there are commonalities. For example, spirituality may encompass our search for meaning and purpose in life, a sense of connectedness, and a framework of beliefs and values that guide our identity and awareness; for many, it is connected to the sacred, transcendent or something beyond.  The many cultures that make up the Aotearoa NZ landscape have their own unique spiritual worldviews.
Māori embrace an understanding of ‘wairua’ as fundamental to living as Māori, the essence of life that underpins health and wellbeing. Learning from te ao Māori and other ways of living in the world helps to understand the interconnectedness of the seen and unseen parts of our experiences of life.
We can improve healthcare by understanding that wellbeing is deeply connected to the physical, environmental, psychological, emotional, social, and spiritual domains.
While the medical system prioritises physical wellbeing, we know that high quality spiritual care can enhance our quality of life at all ages and settings, ultimately benefiting the wellbeing of patients, whānau, and communities.
The role of spirituality and wairuatanga is mentioned in several national health strategy documents, including Pae Tū Hauora Māori Strategy, Te Mana Ola Pacific Health Strategy, Te Tāhū Hauora Health Quality and Safety Commission, and Treasury documents (He Ara Waiora).
Research suggests that universal coverage of spiritual care is inconsistently integrated into healthcare practices, despite the best efforts of the limited number of healthcare chaplains and spiritual care providers within the healthcare system.
Whether healthcare is provided in hospital settings, aged care, or secondary services, positive integration of wairuatanga and spiritual care are key to maintaining positive outcomes. Healthcare is under significant pressure, and perhaps highlighting the spiritual side of caring could improve the environment for everyone involved.
The project team comprises 10 researchers across three universities, kaumātua and advisers, who guide learning about the current state of spiritual care in healthcare in this country. Integral to this learning is understanding people’s needs and aspirations to help create a plan to improve spiritual care for all those who use the health system.
We note that many New Zealanders are not registered in the health system due to access or cultural safety concerns, and this population may have their own spiritual or wairua-informed healthcare practices. Phase one of our study has included a range of meeting/hui about the project and hearing people’s views.
Early findings suggest a call for more spiritual care, better spiritual care training for healthcare professionals, the link to land and rivers for some Māori regarding their wairua, and some chaplains are calling for more integration into the system.
To foster a truly holistic and patient-centred healthcare experience, spiritual care delivery, practices, better integration of spiritual care roles in the health system, and policies need to be part of the healthcare landscape.
Investing in research that encompasses diverse perspectives, including Māori and Pasifika spiritualities, atheistic beliefs, and the broader spiritual plurality that exists in Aotearoa, will help us contribute to improving healthcare.  
This research will enable us to better understand how spirituality and spiritual care influence patient and whānau experiences, guide the development and improvement of practice and policies, and ensure that spiritual care is tailored to meet the increasingly diverse needs of our population.
Doing so will help us build a healthcare system that understands the interconnections between healing the body and nourishing the mind, spirit, soul, family, and society.
The Health Research Council-funded project is looking to hear from all interested parties, so please have your say or join one of our online hui.
Associate Professor Richard Egan and Mei-Ling Blank are based in the Department of Preventive and Social Medicine at the University of Otago.
Associate Professor Waikaremoana Waitoki is based in Te Pua Wānanga ki te Ao Faculty of Māori and Indigenous Studies at the University of Waikato.
Jacqueline Tuffnell is a NZ Healthcare Chaplains Association representative, PhD Candidate in Chaplaincy, University of Otago.