title: Situated clinical encounters in the negotiation of religious and spiritual plurality: a critical ethnography.
abstract: BACKGROUND
  Despite increasingly diverse, globalized societies, little attention has been paid to the influence of religious and spiritual diversity on clinical encounters within healthcare.
  
  
  OBJECTIVE
  The purpose of the study was to analyze the negotiation of religious and spiritual plurality in clinical encounters, and the social, gendered, cultural, historical, economic and political contexts that shape that negotiation.
  
  
  METHODS
  Qualitative: critical ethnography.
  
  
  METHODS
  The study was conducted in Western Canada between 2006 and 2009. Data collection occurred on palliative, hospice, medical and renal in-patient units at two tertiary level hospitals and seven community hospitals.
  
  
  METHODS
  Participants were recruited through purposive sampling and snowball technique. Twenty healthcare professionals, seventeen spiritual care providers, sixteen patients and families and twelve administrators, representing diverse ethnicities and religious affiliations, took part in the study.
  
  
  METHODS
  Data collection included 65 in-depth interviews and over 150h of participant observation.
  
  
  RESULTS
  Clinical encounters between care providers and recipients were shaped by how individual identities in relation to religion and spirituality were constructed. Importantly, these identities did not occur in isolation from other lines of social classification such as gender, race, and class. Negotiating difference was a process of seeing spirituality as a point of connection, eliciting the meaning systems of patients and creating safe spaces for the expression of that meaning.
  
  
  CONCLUSIONS
  The complexity of religious and spiritual identity construction and negotiation raises important questions about language and about professional competence and boundaries in clinical encounters where religion and spirituality are relevant concerns.
authors.affiliation: University of British Columbia, Okanagan, FIN 344, 3333 University Way, Kelowna, BC, Canada V1V 1V7. barb.pesut@ubc.ca
authors.forename: Barbara
authors.initials: B
authors.lastname: Pesut
authors.forename: Sheryl
authors.initials: S
authors.lastname: Reimer-Kirkham
mesh_terms: D000884:Anthropology, Cultural; D002170:Canada; D006801:Humans; D017008:Negotiating; D011369:Professional-Patient Relations; D012067:Religion