The 3 H and BMSEST models for spirituality in multicultural whole-person medicine.
OBJECTIVE
The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine.


METHODS
The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refined.


RESULTS
The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.


CONCLUSIONS
Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.
Anandarajah
Gowri
G
Department of Family Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA. Gowri_Anandarajah@brown.edu
D018864:Cultural Diversity; D004501:Education, Medical; D006694:Holistic Health; D006801:Humans; D019222:Mind-Body Relations, Metaphysical; D008954:Models, Biological; D008960:Models, Psychological; D011603:Psychophysiology; D012068:Religion and Medicine; D029181:Spirituality
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