Team Based Spirituality: Impact of a Spiritual Care Curriculum on Healthcare Team Member Spiritual Care Competency and Well-Being
Hannah Beaven, Indiana University School of Medicine, Csaba Szilagyi, Rush University College of Health Sciences, Anastasia Holman, DMin, MDiv, MBA, BCC, Indiana University School of Medicine, Indiana University Health, The Daniel F. Evans Center at Indiana University Health, Mona Raed, MD, Indiana University School of Medicine, The Daniel F. Evans Center at Indiana University Health,
Community Health Network, James Slaven, Indiana University Department of Biostatistics and Health Data Science, Emily Burke, Regenstrief Institute, Abimbola Akinrinmade, The Daniel F. Evans Center at Indiana University Health, Regenstrief Institute, Alexia Torke, Indiana University School of Medicine, The Daniel F. Evans Center at Indiana University Health, Regenstrief Institute, Shelley Varner Perez, Indiana University Health, The Daniel F. Evans Center at Indiana University Health, Gary Mann, Indiana University School of Medicine, Chaman Kumar, Indiana University School of Medicine, and Alex Lion, Indiana University School of Medicine, The Daniel F. Evans Center at Indiana University Health, Riley Hospital for Children at Indiana University Health
Background: Despite patient spirituality being important to illness-related coping, meaning-making, and distress, many healthcare professionals (HCPs) report feeling underprepared to address the spiritual needs and concerns of patients. Numerous spiritual care training programs for HCPs have been developed over the past two decades to address this gap in care. We evaluated the efficacy of one such program, Team Based Spirituality (TBS), at improving healthcare team (HCT) member spiritual well-being and spiritual care competency.
Curriculum Design: Uniquely, TBS leverages a collaborative discussion-based framework designed to foster a spirit of friendship and places curricular emphasis not only on the foundations of clinical spiritual care and interprofessional collaboration, but also on the notion of team members attending to the spiritual well-being of one another. At the core of the TBS curriculum is a hypothesis: that HCT members are spiritual beings who benefit from spiritual care and community just as much as patients, and that this need can be met at least in part by building a spiritually authentic and inclusive sense of community between team members at the same time as they are learning to create that space for patients. This concept of team-based spirituality is relevant not only to the goal of providing holistic care to patients, but also to the goal of buffering against occupational challenges within medicine such as higher rates of burnout, moral injury, and rapid technological change. When HCTs are equipped to recognize spiritual distress and leverage their intrinsic spiritual resources, team members are better positioned to care for the spiritual well-being of patients, themselves, and one another.
Methods: A pre-posttest, mixed methods design was used to assess the impact of the TBS curriculum on multidisciplinary HCT members from a single large statewide healthcare system. Survey instruments were administered pre-training, immediately post-training, and 3 months post-training. A custom 16-item Team Based Spirituality Index (TBSI) instrument was developed to evaluate changes in spiritual care abilities (“Spirituality in the Care of Others” and “Spirituality in the Professions” subscales) and the team spiritual environment (“Personal Spirituality at Work” and “Spirituality in Teams” subscales). The validated Mayo Well-Being Index (MWBI) was utilized to trend burnout levels. Finally, a modified version of the validated Transformational Learning Activities Survey (TLAS) was administered at 3 months post-training to assess participants’ self-reported belief change and experience with the curriculum. Score change from baseline on the TBSI and MWBI surveys was assessed using generalized linear mixed modeling, whereas responses on the TLAS were tabulated categorically.
Results: 108 participants were recruited from 9 hospitals and 6 outpatient clinics representing over 20 departments and 30 specialty areas. 94 participants completed the TBS training. All TBSI subscale scores were significantly higher immediately post-training compared to pre-training levels, although only the “Care” subscale remained significantly higher at 3 months post-training. Composite TBSI scores remained elevated from baseline both immediately post-training and 3-months post-training. No change from baseline was observed in MWBI scores at either post-training timepoint. Participants rated practical experience and verbal discussion as the most important components of the curriculum. 45.1% of TLAS respondents reported an experience of support from a colleague or leader as a result of their participation in TBS. The majority of TLAS participants (60.8%) selected at least one experience of transformational learning (i.e., belief questioning, change, or affirmation) when choosing from pre-defined descriptions, whereas 39.2% indicated no change. When asked to elaborate qualitatively on their experience of change within TBS, 23.5% of TLAS respondents described a shift in their beliefs or attitudes post-TBS, 19.6% described affirmation of their previously held beliefs or attitudes, and 56.9% reported no change.
Conclusions: TBS is an effective spiritual care curriculum for increasing HCT member experience of team support and producing sustained improvements in spiritual care competency. Future study directions include investigating the effect of changes to the curriculum delivery style and evaluating strategies to sustain improvements to the team environment. Additional study of the impact on wellness may be warranted with a more sensitive measure of spiritual well-being given self-reported improvements in vocational wellness by some participants despite the quantitative lack of impact on burnout scores.
Curriculum Design: Uniquely, TBS leverages a collaborative discussion-based framework designed to foster a spirit of friendship and places curricular emphasis not only on the foundations of clinical spiritual care and interprofessional collaboration, but also on the notion of team members attending to the spiritual well-being of one another. At the core of the TBS curriculum is a hypothesis: that HCT members are spiritual beings who benefit from spiritual care and community just as much as patients, and that this need can be met at least in part by building a spiritually authentic and inclusive sense of community between team members at the same time as they are learning to create that space for patients. This concept of team-based spirituality is relevant not only to the goal of providing holistic care to patients, but also to the goal of buffering against occupational challenges within medicine such as higher rates of burnout, moral injury, and rapid technological change. When HCTs are equipped to recognize spiritual distress and leverage their intrinsic spiritual resources, team members are better positioned to care for the spiritual well-being of patients, themselves, and one another.
Methods: A pre-posttest, mixed methods design was used to assess the impact of the TBS curriculum on multidisciplinary HCT members from a single large statewide healthcare system. Survey instruments were administered pre-training, immediately post-training, and 3 months post-training. A custom 16-item Team Based Spirituality Index (TBSI) instrument was developed to evaluate changes in spiritual care abilities (“Spirituality in the Care of Others” and “Spirituality in the Professions” subscales) and the team spiritual environment (“Personal Spirituality at Work” and “Spirituality in Teams” subscales). The validated Mayo Well-Being Index (MWBI) was utilized to trend burnout levels. Finally, a modified version of the validated Transformational Learning Activities Survey (TLAS) was administered at 3 months post-training to assess participants’ self-reported belief change and experience with the curriculum. Score change from baseline on the TBSI and MWBI surveys was assessed using generalized linear mixed modeling, whereas responses on the TLAS were tabulated categorically.
Results: 108 participants were recruited from 9 hospitals and 6 outpatient clinics representing over 20 departments and 30 specialty areas. 94 participants completed the TBS training. All TBSI subscale scores were significantly higher immediately post-training compared to pre-training levels, although only the “Care” subscale remained significantly higher at 3 months post-training. Composite TBSI scores remained elevated from baseline both immediately post-training and 3-months post-training. No change from baseline was observed in MWBI scores at either post-training timepoint. Participants rated practical experience and verbal discussion as the most important components of the curriculum. 45.1% of TLAS respondents reported an experience of support from a colleague or leader as a result of their participation in TBS. The majority of TLAS participants (60.8%) selected at least one experience of transformational learning (i.e., belief questioning, change, or affirmation) when choosing from pre-defined descriptions, whereas 39.2% indicated no change. When asked to elaborate qualitatively on their experience of change within TBS, 23.5% of TLAS respondents described a shift in their beliefs or attitudes post-TBS, 19.6% described affirmation of their previously held beliefs or attitudes, and 56.9% reported no change.
Conclusions: TBS is an effective spiritual care curriculum for increasing HCT member experience of team support and producing sustained improvements in spiritual care competency. Future study directions include investigating the effect of changes to the curriculum delivery style and evaluating strategies to sustain improvements to the team environment. Additional study of the impact on wellness may be warranted with a more sensitive measure of spiritual well-being given self-reported improvements in vocational wellness by some participants despite the quantitative lack of impact on burnout scores.