title: Spiritual care: how to do it.
abstract: OBJECTIVE
  This study explores the provision of spiritual care by healthcare professionals working at the end of life.
  
  
  METHODS
  Qualitative-ethnographic inquiry.
  
  
  METHODS
  Phase 1: five Canadian sites; phase 2: a residential hospice in Alberta, Canada.
  
  
  METHODS
  Phase 1: six palliative care leaders; phase 2: 24 frontline palliative care clinicians.
  
  
  RESULTS
  Data were collected over a 12-month period with analysis of findings occurring concurrently. Using semistructured interviews and participant observation, 11 themes, organised under five overarching categories, emerged from the data. Five bedside skills were identified as essential to spiritual care: hearing, sight, speech, touch and presence. The integration of these bedside skills with the intrinsic qualities of healthcare professionals, including their values and spiritual beliefs, appeared to be essential to their application in spiritual care. Spiritual care primarily involved the tacit qualities of healthcare professionals and their effect on patient's spiritual well-being, rather than their explicit technical skill set or expert knowledge base.
  
  
  CONCLUSIONS
  Participants identified spiritual care as both a specialised care domain and as a philosophy of care that informs and is embedded within physical and psychosocial care. Hearing, sight, speech, touch and presence were identified as the means by which healthcare professionals impacted patients' spiritual well-being regardless of clinician's awareness or intent. An empirical framework is presented providing clinicians with a pragmatic way of incorporating spiritual care into clinical practice.
authors.affiliation: Alberta Health Services, Cancer Care, Spiritual Care Services, Tom Baker Cancer Centre, Calgary Alberta, Canada.
authors.forename: Shane
authors.initials: S
authors.lastname: Sinclair
authors.forename: Shelley Raffin
authors.initials: SR
authors.lastname: Bouchal
authors.forename: Harvey
authors.initials: H
authors.lastname: Chochinov
authors.forename: Neil
authors.initials: N
authors.lastname: Hagen
authors.forename: Susan
authors.initials: S
authors.lastname: McClement
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D017051:Hospice Care / Q000379:methods / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D036301:Qualitative Research; D012068:Religion and Medicine; D029181:Spirituality