"Spirituality Matters"

Reflections on a Chaplaincy Championed Spiritual Care Initiative in a New Zealand Cancer Ward


  • Sande Ramage MidCentral District Health Board, Palmerston North
  • Barry Keane MidCentral District Health Board, Palmerston North
  • Richard Egan University of Otago




Cancer, chaplaincy, chaplains, intervention, spiritual care, spirituality


This article describes the Spirituality Matters project, a multi-disciplinary quality improvement project conducted in an inpatient cancer treatment ward during the summer of 2014-2015 at Palmerston North Hospital, New Zealand. The project involved staff training, pre- and post-surveys of staff, trailing a spiritual screening tool, specially designed education material for patients and staff, and patient interviews. Key findings suggest that although 81% of staff indicated initially that they were confident about engaging with patient around spirituality, in reality many of them found the process very challenging. Difficulties with language, role definition, competing clinical priorities, and perceptions of chaplains as ‘religious’ were identified as significant barriers. Although the project aim, of improving spiritual care provision, was not sustained after its trial period, a number of important lessons were learnt. This included the challenges of driving change in a clinical setting; including methodology, resourcing, utilization of academic researchers and the need for resilience in the face of seemingly insurmountable obstacles. The project did raise the profile of the chaplain and the issue of how best to meet spiritual need.

Author Biographies

Sande Ramage, MidCentral District Health Board, Palmerston North

Sande Ramage is Spiritual Care Coordinator at MidCentral District Health Board at Palmerston North, New Zealand. She had experience in health promotion and change management before retraining as an Anglican priest and working as a chaplain in schools and the military. Her focus now is working in partnership with the health system as we unravel how to honour the spirituality of people not aligned with a particular group. She explores spirituality one word at a time on spiritedcrone.co.nz.

Barry Keane, MidCentral District Health Board, Palmerston North

Barry Keane is the Director of Nursing for Cancer Services and Co-Nurse Director for the Central Cancer Network. He has had a varied career in both hospital and community based clinical roles including director of clinical services in specialist palliative care (hospice) services. His focus is on how to integrate evidence based spiritual assessment and care into the multidisciplinary model of care. He is currently the chair of the MidCentral DHB Spiritual Care Advisory Group (SCAG), a driver for spiritual and compassionate care development work in the DHB.

Richard Egan, University of Otago

Richard Egan is a Senior Lecturer in the Cancer Society Social and Behavioural Research Unit, Department of Preventive & Social Medicine, Dunedin School of Medicine, New Zealand. He teaches health promotion and has a range of research interests, including spirituality in health, supportive cancer care and health promotion.


Balboni, T. A., M. E. Paulk, M. J. Balboni, A. C. Phelps, E. T. Loggers, A. A. Wright, S. D. Block, E. F. Lewis, J. R. Peteet and H. G. Prigerson (2010) “Provision of Spiritual Care to Patients With Advanced Cancer: Associations With Medical Care and Quality of Life Near Death”. Journal of Clinical Oncology 28: 445–52. https://doi.org/10.1200/JCO.2009.24.8005

Baldacchino D. R. (2011) “Teaching on Spiritual Care: The Perceived Impact on Qualified Nurses”. Nurse Education in Practice 11: 47–53. https://doi.org/10.1016/j.nepr.2010.06.008

Canfield, C., D. Taylor, K. Nagy, C. Strauser, K. Vankerkhove, S. Wills, P. Sawicki and J. Sorrell (2016) “Critical Care Nurses’ Perceived Need for Guidance in Addressing Spirituality in Critically Ill Patients”. American Journal of Critical Care 25: 206–11. https://doi.org/10.4037/ajcc2016276

Chan, M. F., L. Y. F. Chung, A. S.C. Lee, W. K. Wong, G. S. C. Lee, C. Y. Lau, W. Z. Lau, T. T. Hung, M. L. Liu and J. W. S. Ng (2006) “Investigating Spiritual Care Perceptions and Practice Patterns in Hong Kong nurses: Results of a Cluster Analysis”. Nurse Education Today 26: 139–50. https://doi.org/10.1016/j.nedt.2005.08.006

Chuengsatiansup, K. (2003) “Spirituality and Health: an Initial Proposal to Incorporate Spiritual Health in Health Impact Assessment”. Environmental Impact Assessment Review 23: 3–15. https://doi.org/10.1016/S0195-9255(02)00037-9

Cobb, M. (2007) “Change and Challenge: The Dynamic of Chaplaincy”. Scottish Journal of Healthcare Chaplaincy 10(1).

Cobb, M., C. Puchalski, and B. Rumbold (2012) The Oxford Textbook of Spirituality in Healthcare. Oxford: Oxford University Press. https://doi.org/10.1093/med/9780199571390.001.0001

Corn, B. W., H. M. Chochinov and M. Vachon (2012) “Integrating Spiritual Care into the Practice of Oncology”. Current Opinion in Supportive and Palliative Care 6: 226–27. https://doi.org/10.1097/SPC.0b013e328353b8e6

El Nawawi, N. M., M. J. Balboni and T. A. Balboni (2012) “Palliative Care and Spiritual Care: the Crucial Role of Spiritual Care in the Care of Patients with Advanced Illness”. Current Opinion in Supportive and Palliative Care 6: 269–74. https://doi.org/10.1097/SPC.0b013e3283530d13

Epstein-Peterson, Z. D., A. J. Sullivan, A. C. Enzinger, K. M. Trevino, A. A. Zollfrank, M. J. Balboni, T. J. Vanderweele and T. A. Balboni (2015) “Examining Forms of Spiritual Care Provided in the Advanced Cancer Setting”. American Journal of Hospice and Palliative Medicine 32: 750–57. https://doi.org/10.1177/1049909114540318

Gardiner, S. A., and S. Ramage (2013) PN Hospital Chaplaincy Survey: Survey Findings February 2013. Palmerston North: MidCentral Health District Health Board.

Gillam, S., and A. N. Siriwardena (2013) “Frameworks for Improvement: Clinical Audit, the Plan-do-study-act Cycle and Significant Event Audit”. Quality in Primary Care 21: 123–30.

Handzo, G. F., M. Cobb, C. Holmes, E. Kelly and S. Sinclair (2014) “Outcomes for Professional Health Care Chaplaincy: an International Call to Action”. Journal of Health Care Chaplaincy 20: 43–53. https://doi.org/10.1080/08854726.2014.902713

Healthcare Chaplaincy Council of Victoria Inc. (2009) Spiritual Care in Australia: What Do We Know? An Overview of the Australian Research Literature. Melbourne: Healthcare Chaplaincy Council of Victoria Inc.

—(2011) Capabilities Framework for Pastoral Care & Chaplaincy. Melbourne: Healthcare Chaplaincy Council of Victoria Inc.

Jankowski, K. R. B., G. F. Handzo and K. J. Flannelly (2011) “Testing the Efficacy of Chaplaincy Care”. Journal of Health Care Chaplaincy 17: 100–125. https://doi.org/10.1080/08854726.2011.616166

Martinuz, M., A. -V. Dürst, M. Faouzi, D. Pétremand, V. Reichel, B. Ortega, G. Waeber and P. Vollenweider (2013) “Do You Want Some Spiritual Support? Different Rates of Positive Response to Chaplains’ versus Nurses’ Offer”. Journal of Pastoral Care and Counseling 67: 1–10. https://doi.org/10.1177/154230501306700403

McClung, E., D. H. Grossoehme and A. F. Jacobson (2006) “Collaborating with Chaplains to Meet Spiritual Needs”. Medsurg Nursing 15: 147–56.

McSherry, W. and S. Jamieson (2011) “An Online Survey of Nurses’ Perceptions of Spirituality and Spiritual Care”. Journal of Clinical Nursing 20: 1757–767. https://doi.org/10.1111/j.1365-2702.2010.03547.x

Ministry of Health (2010) Guidance for Improving Supportive Care for Adults with Cancer in New Zealand. Wellington: Ministry of Health.

Nakau, M., J. Imanishi, J. Imanishi, S. Watanabe, A. Imanishi, T. Baba, K. Hirai, T. Ito, W. Chiba and Y. Morimoto (2013) “Spiritual Care of Cancer Patients by Integrated Medicine in Urban Green Space: a Pilot Study”. Explore: The Journal of Science and Healing 9: 87–90. https://doi.org/10.1016/j.explore.2012.12.002

NHS Education Scotland (2007) Guidance on Capabilities and Competencies for Healthcare Chaplains/Spiritual Care Givers [Online]. Available at: https://tinyurl.com/091201competencies (accessed 14 December 2011).

—(2009) Spiritual Care Matters: An Introductory Resource for all NHS Scotland Staff. Edinburgh: NHS Education for Scotland.

Norwood, F. (2006) “The Ambivalent Chaplain: Negotiating Structural and Ideological Difference on the Margins of Modern-Day Hospital Medicine”. Medical Anthropology 25: 1–29. https://doi.org/10.1080/01459740500488502

Otis-Green, S., B. Ferrell, T. Borneman, C. Pulchalski, G. Uman and A. Garcia (2012) “Integrating Spiritual Care within Palliative Care: an Overview of Nine Demonstration Projects”. Journal of Palliative Medicine 15: 154–62. https://doi.org/10.1089/jpm.2011.0211

Pearce, M. J., A. D. Coan, J. E. Herndon, H. G. Koenig and A. P. Abernethy (2012) “Unmet Spiritual Care Needs Impact Emotional and Spiritual Well-being in Advanced Cancer Patients”. Supportive Care in Cancer 20: 2269–276. https://doi.org/10.1007/s00520-011-1335-1

Puchalski, C. M. (2006a) “Spiritual Assessment in Clinical Practice”. Psychiatric Annals 36: 150–55.

—(2012) “Spirituality in the Cancer Trajectory”. Annals of Oncology 23: 49–55. https://doi.org/10.1093/annonc/mds088

Puchalski, C. M., ed. (2006b) A Time for Listening and Caring: Spirituality and the Care of the Chronically Ill and Dying. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195146820.001.0001

Puchalski, C., B. Ferrell, R. Vitani, S. Otis-Green, P. Baird, J. Bull, H. Chochinov, G. Handzo, H. Nelson-Becker, M. Prince-Paul, K. Pugliese and D. Sulmasy (2009) “Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference”. Journal of Palliative Medicine 12: 885–904. https://doi.org/10.1089/jpm.2009.0142

Puchalski, C. M., R. Vitillo, S. K. Hull and N. Reller (2014) “Improving the Spiritual Dimension of Whole Person Care: Reaching National and International Consensus”. Journal of Palliative Medicine 17: 642–56. https://doi.org/10.1089/jpm.2014.9427

Rumbold, B. (2013) “Spiritual Assessment and Health Care Chaplaincy”. Christian Bioethics 19: 251–69. https://doi.org/10.1093/cb/cbt027

Salsman, J. M., G. Fitchett, T. V. Merluzzi, A. C. Sherman and C. L. Park (2015) “Religion, Spirituality, and Health Outcomes in Cancer: A Case for a Meta?analytic Investigation”. Cancer 121(21): 3754–59.

Salsman, J. M., J. E. Pustejovsky, H. S. Jim, A. R. Munoz, T. V. Merluzzi, L. George, C. L. Park, S. C. Danhauer, A. C. Sherman, M. A. Snyder and G. Fitchett (2015) “A Meta-analytic Approach to Examining the Correlation between Religion/Spirituality and Mental Health in Cancer”. Cancer 121(21): 3769–778. https://doi.org/10.1002/cncr.29350

Sinclair, S., M. Mysak and N. A. Hagen (2009) “What Are the Core Elements of Oncology Spiritual Care Programs?” Palliative and Supportive Care 7: 415–22. https://doi.org/10.1017/S1478951509990423

Snowden, A., I. Telfer, E. R. Kelly, H. Mowat, S. Bunniss, N. Howard, & M. A. Snowden (2012) Healthcare Chaplaincy: the Lothian Patient Reported Outcome Measure (PROM). The Construction of a Measure of the Impact of Specialist Spiritual Care Provision. Retrieved from http://www.mendeley.com/profiles/austyn-snowden/.

Statistics New Zealand (2013) 2013 Census Usually Resident Population Counts. Wellington: Statistics New Zealand.

Statistics NZ (2013) “QuickStats About Culture and Identity”. 2013 Census. Retrieved from https://tinyurl.com/yan4fbcg (accessed 10 December 2018).

Todd, N. (2007) “New Zealand as a Multireligious Society: Recent Census Figures and Some Relevant Implications”. Aotearoa Ethnic Network Journal 2.

Wright, M. C. (2001) “Chaplaincy in Hospice and Hospital: Findings from a Survey in England and Wales”. Palliative Medicine 15: 229–42. https://doi.org/10.1191/026921601678576211



How to Cite

Ramage, S., Keane, B., & Egan, R. (2018). "Spirituality Matters": Reflections on a Chaplaincy Championed Spiritual Care Initiative in a New Zealand Cancer Ward. Health and Social Care Chaplaincy, 6(1), 62-81. https://doi.org/10.1558/hscc.32493




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