Integrating Spiritual Care into Maternity Care at a University Teaching and Referral Hospital in Eldoret, Kenya
Challenges, Lessons and Way Forward
Spiritual needs of care seekers, families and caregivers are ignored in maternity care in health facilities in Kenya. The quality of care remains poor with unacceptable maternal and neonatal mortalities. The Clinical Pastoral Education (CPE) Project at the College of Health Sciences of Moi University Eldoret, Kenya, aimed to integrate spiritual care into maternity care at The Riley Mother and Baby Hospital of The Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, in order to provide holistic healthcare. In phase I, spiritual needs of mothers of neonates admitted to the Newborn Unit at the MTRH in Eldoret, Kenya, were assessed using a research protocol with modified North America validated tools (see Appendix) and unstructured interview guides. For phase II, hospital chaplains, trained using a Moi University post-graduate diploma curriculum for clinical pastoral education and care, were engaged as spiritual caregivers at the Hospital. In phase III, the same tools were used to re-assess spiritual needs after introducing spiritual care. This article presents challenges and progress made, lessons learnt from the CPE Project and knowledge gaps identified from the study. Baseline data showed lack of trained hospital chaplains and inadequate spiritual care at the Teaching and Referral hospital despite great need by patients, caregivers and families. Lack of precise definitions, theoretical and conceptual frameworks for spirituality in literature emerged as a challenge. The Kenya Chaplaincy Training Centre was initiated at the hospital to train hospital chaplains and healthcare providers who could provide spiritual care. A psychobiosocial conceptual framework, utility tools and a new theory for self-empowerment were proposed to address knowledge gaps in current literature.
Adanikin, A. I., U. Onwudiegwu and A. A. Akintayo (2014) “Reshaping Maternal Services in Nigeria: Any Need for Spiritual Care?” BMC Pregnancy and Childbirth 14: 196–96. https://doi.org/10.1186/1471-2393-14-196
AMPATH. Leading with Care. www.ampathkenya.org (accessed 8 May 2018).
Amuyunzu, M. K. (1994) “Willing the Spirits to Reveal Themselves: Rural Kenyan Mothers” Responsibility to Restore their Children’s Health”. Medical Anthropology Quarterly 12(4): 490–502. https://doi.org/10.1525/maq.1922.214.171.1240
—(1998) The Management of Illness in a Plural Health Care Setting: A Case Study of the Duruma of Coastal Kenya. Cambridge: University of Cambridge.
Benning, V. (1996) “In Virginia, a Shift from Dependency to Self-sufficiency”. Washington Post, B01.
Beyers, J. (2010) “What is Religion? An African Understanding”. HTS Theological Studies 66(1): 1–8. https://doi.org/10.4102/hts.v66i1.341
Bowser, D., and K. Hill (2010) Exploring Evidence for Disrespect and Abuse in Facility-based Childbirth. USAID-TRACTION Project, Harvard School of Public Health, University Research Co., LLC.
Callister, L. C., and I. Khalaf (2010) “Spirituality in Childbearing Women”. The Journal of Perinatal Education 19(2): 16. https://doi.org/10.1624/105812410X495514
Cottingham, J. (2005) The Spiritual Dimension: Religion, Philosophy and Human Value. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511614866
Covey, S. R. (2008) The 7 Habits of Highly Effective People Personal Workbook. New York: Simon & Schuster.
Crowther, S., and J. Hall (2015) “Spirituality and Spiritual Care in and Around Childbirth”. Women and Birth 28(2): 173–78. https://doi.org/10.1016/j.wombi.2015.01.001
Dent, J. A. (2014) “Using the SPICES Model to Develop Innovative Teaching Opportunities in Ambulatory Care Venues”. Korean Journal of Medical Education 26(1): 3–7. https://doi.org/10.3946/kjme.2014.26.1.3
Engel, G. L. (1977) “The Need for a New Medical Model: A Challenge for Biomedicine”. Science 196(4286): 129–36. https://doi.org/10.1126/science.847460
Evangelista, C. Braz., M. E. Limeira Lopes, S. F. G. da Costa, F. M. da Silva Abrão, P. S. de Souza Batista and R. C. de Oliveira (2016) “Spirituality in Patient Care Under Palliative Care: A Study with Nurses”. Escola Anna Nery 20(1): 176–82. https://doi.org/10.5935/1414-8145.20160023
Fetterman, D. M., S. J. Kaftarian and A. Wandersman (1996) Empowerment Evaluation: Knowledge and Tools for Self-assessment and Accountability. London: SAGE Publications.
Fisher, J. (2011) “The Four Domains Model: Connecting Spirituality, Health and Well-being”. Religions 2(1): 17–28. https://doi.org/10.3390/rel2010017
Garcia-Rill, E. (2015) Waking and the Reticular Activating System in Health and Disease. Amsterdam, London, Oxford: Academic Press, Elsevier.
George, L. K., D. B. Larson, H. G. Koenig and M. E. McCullough (2000) “Spirituality and Health: What We Know, What We Need to Know”. Journal of Social And Clinical Psychology 19(1): 102–116. https://doi.org/10.1521/jscp.2000.19.1.102
Kangethe, S., F. M. Nafukho and A. M. Mutema (2000) Innovative Techniques in the Training of Health Professionals: The case of Moi University, Faculty of Health Sciences, Kenya. Presented at the Academy of Human Resource Development International Research Conference. Raleigh Durham, NC, USA.
Koenig, H. G. (2007) “Religion, Spirituality and Medicine in Australia: Research and Clinical Practice”. Medical Journal of Australia 186(10): S45. https://doi.org/10.5694/j.1326-5377.2007.tb01039.x
—(2012) “Religion, Spirituality, and Health: The Research and Clinical Implications”. ISRN Psychiatry Volume 2012. Article ID 278730, https://www.hindawi.com/journals/isrn/2012/278730/
—(2015) “Religion, Spirituality, and Health: A Review and Update”. Advances in Mind-body Medicine 29(3): 19–26.
Koenig , H. G., D. B. Larson and S. S. Larson (2001) “Religion and Coping with Serious Medical Illness”. Annals of Pharmacotherapy 35(3): 352–59. https://doi.org/10.1345/aph.10215
Kwarteng, G. (2015) “Religious Beliefs, Spirituality and Health: Implications for Maternal and Child Mortality in Ghana”. Spirituality and Health 1(2): 11–15.
Leibson Hawkins, R. (2005) “From Self-sufficiency to Personal and Family Sustainability: A New Paradigm for Social Policy”. J. Soc. & Soc. Welfare 32: 77.
Levin, J. S., and H. Y. Vanderpool (1989) “Is Religion Therapeutically Significant for Hypertension?” Soc Sci Med 29(1): 69–78. https://doi.org/10.1016/0277-9536(89)90129-9
Mbiti, J. S. (1990) African Religions & Philosophy. Nairobi, London: Heinemann.
Miller, S., and J. M. Belizán (2016) “The True Cost of Maternal Death: Individual Tragedy Impacts Family, Community and Nations”. Reproductive Health 12(1): 1. https://doi.org/10.1186/s12978-015-0046-3
Moloney, S. (2007) “Dancing with the Wind: A Methodological Approach to Researching Women’s Spirituality Around Menstruation and Birth”. International Journal of Qualitative Methods 6(1): 114–25. https://doi.org/10.1177/160940690700600102
Pesut, B., S. Reimer-Kirkham, R. Sawatzky, G. Woodland and P. Peverall (2012) “Hospitable Hospitals in a Diverse Society: From Chaplains to Spiritual Care Providers”. Journal of Religion and Health 51(3): 825–36. https://doi.org/10.1007/s10943-010-9392-1
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(6): 642–56. https://doi.org/10.1089/jpm.2014.9427
Rudolfsson, G., I. Berggren and A. B. da Silva (2014) “Experiences of Spirituality and Spiritual Values in the Context of Nursing – An Integrative Review”. The Open Nursing Journal 8: 64–70. https://doi.org/10.2174/1874434601408010064
Scrivens M (2017) “Spiritual Expectations and Experience of Women with Newborns.” Toronto Journal of Theology 33(2): 329-331. https://doi.org/10.3138/tjt.33.2.329
Selman, L., R. Harding, M. Gysels, P. Speck and I. J. Higginson (2011) “The Measurement of Spirituality in Palliative Care and the Content of Tools Validated Cross-culturally: A Systematic Review”. Journal of Pain And Symptom Management 41(4): 728–53. https://doi.org/10.1016/j.jpainsymman.2010.06.023
Solanka, O, A., L. Bola, A. Oladosu, A. Akinlo and S. O. Olanisebe (2015) “Religion as a Social Determinant of Maternal Health Care Service Utilisation in Nigeria”. African Population Studies 29(2): 1868–881. https://doi.org/10.11564/29-2-761
Speck, P. (2004) “Spiritual Care in Health Care”. Scottish Journal of Healthcare Chaplaincy 7(1): 21–25. https://doi.org/10.1558/hscc.v7i1.21
Starkshald, B. (1994) “Self-confidence and Personal Motivation”. The Quarterly Journal of Economics 117(3): 871–915. https://doi.org/10.1162/003355302760193913
Tanyi, R. A. (2002) “Towards Clarification of the Meaning of Spirituality”. Journal of Advanced Nursing 39(5): 500–509. https://doi.org/10.1046/j.1365-2648.2002.02315.x
Tiew, L. H., D. K. Creedy and M. F. Chan (2013) “Student Nurses” Perspectives of Spirituality and Spiritual Care”. Nurse Education Today 33(6): 574–79. https://doi.org/10.1016/j.nedt.2012.06.007
Timmins, F., and S. Caldeira (2017) “Understanding Spirituality and Spiritual Care in Nursing”. Nursing Standard 31(22): 50–57. htps://doi.org/10.7748/ns.2017.e10311
van Meurs, J., W. Smeets, K. C. Vissers, M. Groot and Y. Engels (2018) “Nurses Exploring the Spirituality of Their Patients with Cancer: Participant Observation on a Medical Oncology Ward”. Cancer Nursing 41: E39–45. https://doi.org/10.1097/NCC.0000000000000526
Weaver, A. J., K. J. Flannelly and C. Liu (2008) “Chaplaincy Research: its Value, Its Quality, and its Future”. J Health Care Chaplain 14(1): 3–19.
Weckowicz, T. (1998) Ludwig von Bertalanffy (1901–1972): A Pioneer of General Systems Theory. CSR Working Paper N. 89-92. Edmonton, Canada University of Alberta, Center for System Research. https://doi.org/10.1080/08854720802053796
WHO (1948) Preamble to the Constitution of the World Health Organization as Adopted by the International Health Conference. Official Records of the World Health Organization, no. 2: 100).
—(2012) UNFPA, The World Bank. Trends in Maternal Mortality: 1990 to 2010. WHO, UNICEF: UNFPA, and The World Bank Estimates.