POSITION STATEMENTS

 

Occupational Therapy Association of South Africa (OTASA) Position Statement: Spirituality in occupational therapy

 

 

Approved by the OTASA Council June 2018

 

INTRODUCTION AND PURPOSE

Spirituality refers to a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and to experience relationship with self, family, community, nature and the significant or sacred. Spirituality is expressed through beliefs, values, traditions and practices^1:644. The World Health Organization regards spirituality as one of the dimensions of quality of life². Spiritual well-being can also be viewed as an important aspect of health³.

The purpose of this paper is to state the Occupational Therapy Association of South Africa's position on spirituality and how it relates to education, practice and scholarship in occupational therapy. In addition, the paper can assist occupational therapy students, practitioners, educators and researchers to navigate their roles in relation to spirituality within the diverse South African context.

 

STATEMENT OF POSITION

1. The Occupational Therapy Association of South Africa (OTASA) affirms the holistic approach in occupational therapy whereby attending to the mind, body and spirit all form part of a person- and people-centred health practice³ .

2. OTASA acknowledges that there is insufficient engagement with a diversity of perspectives and scholarship on spirituality in occupational therapy, and consequently, a gap in current conceptual frameworks that practitioners draw from to address spirituality in practice.

3. OTASA regards spirituality as a potential resource that can enhance human agency, potential, meaning, hopefulness, resilience and connectedness^2,3,4,5, at any point during a person's existence and at any age, as well as when persons are confronted with ill-health, disability and other human sufferings such as stress. Spirituality forms part of health promotion and public health.

4. OTASA affirms that practitioners, students and educators in occupational therapy should be knowledgeable regarding the assessment of persons' spirituality, including their needs, practice and worldview^{6,7,8,9,10,11} and be able to integrate this knowledge in clinical reasoning and reflection¹².

 

SIGNIFICANCE OF THE POSITION PAPER TO OCCUPATIONAL THERAPY

This position paper serves as an invitation to a diversity of occupational therapy scholarship and practice, which is positioned for impact in a pluralistic society such as South Africa, where individuals and communities of different religious traditions and belief systems co-exist within a constitutional democracy.

 

STATEMENT OF SIGNIFICANCE OF THE POSITION TO SOCIETY

This statement affirms the role occupational therapy can play as a resource for a country that has inherited colonialism and apartheid, to humanise and heal itself^13,14. The Constitution of the Republic of South Africa affirms the right everyone has to enjoy their culture, practice their religion and use their language as well as freedom of conscience, thought, opinion and association⁸.

 

POTENTIAL BARRIERS FOR THE POSITION STATEMENT

There are potential barriers to integration of spirituality in occupational therapy practice^7,9,12. These barriers include:

❖ Under-representation of spirituality within occupational therapy education.

❖ Limited integration of spirituality in occupational therapy practice.

❖ Practitioner personal disposition towards spirituality in relation to individuals, communities and society.

❖ Limited practice guidelines in health facilities.

 

STRATEGIES FOR IMPLEMENTATION OF THE POSITION STATEMENT

The following three strategies are presented to raise awareness about the importance of spirituality in occupational therapy at this time:

Education and Training

Occupational therapy education should promote the understanding of spirituality within the scope of the profession. This could be incorporated within occupational therapy modules across curricula through engaged teaching and learning, demonstrated cultural sensitivity, social interaction across diverse backgrounds, self-reflection, reflective and critical thinking, good communication skills, and active listening within the classroom⁶.

Continuous Professional Development programmes as part of Communities of Practice need to offer training on personal growth, cultural sensitivity and the how-to of incorporating spirituality into occupational therapy practice.

The Professional Board of Occupational Therapy, Medical Orthotics, Prosthetics and Arts Therapy should evaluate whether the Minimum Standards for the Training of Occupational Therapists cover the integration of spirituality as part of person-centred and holistic treatment approaches.

Practice

Given the diversity of cultures in the South African context, every effort must be made to understand spirituality from the perspective of the individual or community. A non-judgemental approach to individuals and communities is in itself inherently spiritual, as the right to have one's dignity respected is enshrined in the Constitution of the Republic of South Africa⁸.

Occupational therapists should consider spirituality as part of routine history assessment of individuals, families and communities. This would enable occupational therapists to have an understanding of how spirituality influences resilience and hope from the position of the individual, family or community¹¹. Practical spiritual needs as identified by those receiving services, for example access to scriptural texts, prayer beads or clothing, or time for prayer, should always be met.

The United Nations Convention on the Rights of Persons with Disabilities together with the Constitution of the Republic of South Africa can be used to guide occupational therapy practice that promotes attention to persons' spiritual life.

A multi-disciplinary team approach should be regarded as an asset for incorporating spirituality and addressing persons' spiritual needs^10,11,12. This approach can enhance the relationship between institution-based practitioners and traditional healers, members of faith-based organisations and the clergy in order to promote holistic quality of life, health and well-being.

Research

A diversity of perspectives in researching the potential relevance and impact of spirituality on occupational engagement and participation is important, in order to support contextually relevant occupational therapy practice.

 

CONCLUSION

The aim of the position statement is to raise awareness about the significance of spirituality in occupational therapy education, practice and research. It is believed that addressing the spiritual needs of individuals, groups and communities appropriately and adequately, falls within the scope of practice for occupational therapy, and has the potential to enhance persons' quality of life, health and well-being.

 

REFERENCES

1. Puchalski C, Vittillo R Hull S, Reller R Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine. 2014; 17(6): 642-656.         [ Links ]

2. WHOQOL SRPB Group. A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Social Science & Medicine. 2006: 1486-1497.         [ Links ]

3. Ramugondo EL. Human occupation and health. In SA Dsouza, R Galvaan & EL Ramugondo (Eds.), Concepts in occupational therapy: Understanding Southern perspectives. Karnataka: Manipal University Press, 2017.         [ Links ]

4. Ramugondo EL. Unlocking spirituality: Play as a health promoting occupation in the context of HIV/AIDS. In F Kronenberg (Ed.), Occupational therapy without borders: Learning from the spirit of survivors. New York, NY: Elsevier/Churchill Livingstone, 2005: 313-325.         [ Links ]

5. Ramugondo EL. Meaning and purpose in human occupation. In SA Dsouza, R Galvaan & EL Ramugondo (Eds.), Concepts in occupational therapy: Understanding Southern perspectives. Karnataka: Manipal University Press, 2017.         [ Links ]

6. Mthembu TG, Wegner L, Roman NV Teaching spirituality and spiritual care in health sciences education. A systematic review. African Journal of Physical Activity and Health Sciences, 2016; 22(41): 1036-1057.         [ Links ]

7. Mthembu TG, Roman NV WegnerL. A cross-sectional descriptive study of occupational therapy students' perceptions and attitudes towards spirituality and spiritual care in occupational therapy education. Journal of Religion and Health. 2016; 55(5): 1529-1549. doi:10.1007/s10943-015-0125-3.         [ Links ]

8. Republic of South Africa. The Constitution of the Republic of South Africa, 1996.         [ Links ]

9. Mthembu TG, Wegner L, Roman NV Barriers to Integration of Spirituality and Spiritual Care in Occupational Therapy Education in a South African context. Journal of Spirituality in Mental Health 2017; 19(1): 61-79. http://dx.doi.org/10.1080/19349637.2016.1206843.         [ Links ]

10. Mthembu TG, Wegner L, Roman NV Exploring occupational therapy students' perceptions regarding spirituality in occupational therapy groups: A qualitative study. Occupational Therapy in Mental Health 2017. http://dx.doi.org/10.1080/0164212X.2016.1245595.         [ Links ]

11. Mthembu TG, Wegner L, Roman NV Spirituality in the Occupational Therapy Community Fieldwork Process: A qualitative study in the South African context. South African Journal of Occupational Therapy. 2017; 47(1): 16-23.         [ Links ]

12. Hess K, Ramugondo E L. Clinical reasoning used by occupational therapists to determine the nature of spiritual occupations in relation to psychiatric pathology. British Journal for Occupational Therapy 2014; 77 (5): 234-242. DOI: 10.4276/030802214X139 90455043449.         [ Links ]

13. Guajardo A, Kronenberg F Ramugondo EL. Southern occupational therapies: Emerging identities, epistemologies and practices. South African Journal of Occupational Therapy. 2015; 45(1): 3-10, http://dx.doi.org/10.17159/2310-3833/2015/v45n1a2.         [ Links ]

14. Kronenberg F, Kathard H, Laliberte Rudman D, Ramugondo EL. Can Post-Apartheid South Africa be enabled to humanise and heal itself? South African Journal of Occupational Therapy 2015; 45(1): 20-26. http://dx.doi.org/10.17159/2310-3833/2015/v45no1a4.         [ Links ]

 

 

Contributing Authors

Nazeemah Soomar

Thuli Mthembu

Elelwani Ramugondo