title: A health services framework of spiritual care.
abstract: OBJECTIVE
  To introduce a health services framework of spiritual care that addresses the empirical and applied issues surrounding spirituality and nursing practice.
  
  
  BACKGROUND
  Despite over 20 years of study, the concept of spirituality is still under development, which limits application to nursing practice.
  
  
  METHODS
  Three studies using a health services framework are reviewed: (1) a survey study of dying patients and family that describes the providers, types and outcomes of spiritual care; (2) an exploratory study of the process of spiritual care; and (3) a multi-level study of the structure and outcomes of spiritual care in long-term care facilities.
  
  
  RESULTS
  Spiritual care recipients identify family or friends (41%), clergy (17%) and health care providers (29%) as spiritual care providers. The most frequently reported type of spiritual care was help in coping with illness (87%). Just over half (55%) were satisfied with the care that they received. The processes of spiritual care involved: (1) presence, (2) opening eyes, and; (3) co-creating, which was a mutual and fluid activity between patients, family members and care providers. In long term care facilities, decedents who received spiritual care were perceived as receiving better overall care in the last month of life, when compared with those decedents who did not receive spiritual care.
  
  
  CONCLUSIONS
  A health services framework provides a holistic view of spiritual care, one that is consistent with integrated nursing models.
  
  
  CONCLUSIONS
  By focusing on the structure, process and outcome elements of spiritual care within organisational settings, nursing management can develop feasible approaches to implement, improve and evaluate the delivery of this unique type of care.
authors.affiliation: Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 28599-7595, USA. tim_daaleman@med.unc.edu
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Daaleman
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D010166:Palliative Care; D017060:Patient Satisfaction; D011787:Quality of Health Care; D029181:Spirituality; D014481:United States