The ideology and organization of spiritual care: three approaches.

The development of holistic, multidisciplinary care of the terminally ill has prompted discussion of what spiritual care might mean, but how can this be done in what is largely a secular context? This paper analyses the three options. (1) The idea of the hospice as a religious community enables total care to be given, but conflict can develop as such institutions expand and take on less devout staff. (2) An organizationally less problematic approach, fitting a widespread understanding of religion, is that only some people are religious and they may be referred by staff to the chaplain--but this undermines the goal of holistic care. (3) Recent discussion of spiritual needs, however, argues that everyone has a spiritual dimension, entailing a search for meaning. All staff can help in this area, so this approach is welcomed by nurses seeking to practice holistically and also by chaplains seeking to expand their domain, but it also has certain costs. The article concludes by raising some problems that may emerge if this third approach becomes institutionalized.