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You can learn how to provide care for meaning

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Thanks to a new grant from ZonMw, the Knowledge Centre on Spiritual Care and Home-based Chaplaincy is receiving a further boost in what is now the third phase of this large-scale, national project. This time, the focus is on professional training. Gaby Jacobs, chair and professor of Spiritual Care at the University of Humanistic Studies, says: “It’s about a different way of providing care and, therefore, a different way of learning.”

For the past five years, within the Knowledge Centre numerous partners in the Netherlands from the fields of research, education and practice have been working together towards a single mission: to provide high-quality care that addresses questions of meaning in the home setting. This is important because an increasing number of people are living at home or receiving treatment at home, even when they are grappling with profound questions about life. Trainers, researchers and professionals from a wide range of organisations and sectors are working together with clients and volunteers to develop knowledge about this form of care.

The project began with a grant in 2021 from the ZonMw programme ‘Zingeving en geestelijke verzorging’, and has already been extended twice. In the first phase, professionals from various disciplines worked together in learning networks, for example on the theme of finding meaning in life with an intellectual disability or on living with chronic pain. A wide range of professional bodies were also involved, including GPs, practice assistants, physiotherapists and occupational therapists, carers and nurses, as well as volunteers and staff working in the social sector, youth care and mental health services. In addition, particular attention was paid to spiritual care in the home setting.

In this third phase, the emphasis is on professionalisation and training in the provision of care focused on meaning. To this end, eight organisations are collaborating (see below), supported by a broad network of professionals, researchers and organisations. The University of Humanistic Studies is the lead organisation.

Need

Why do professionals in primary care, social care and spiritual care consider attention to meaning so important? Chair Gaby Jacobs: “Meaning is an existential need; without it, we cannot exist. You try to make sense of the world, to have a purpose in life, and to be of value to others or to society. If that sense of meaning is lost, it can lead to health problems.”

“The vast majority of professionals we surveyed see it as their role to focus on helping patients find meaning. The extent to which they go in guiding people through these questions themselves varies from one professional group to another. For example, a mental health practice support worker does more in this area than a GP. Whilst some physiotherapists say, ‘Not my job’, the occupational therapist says, ‘That is indeed part of what we do.’”

“There is often a sense of uncertainty about how to go about this. How do I have that conversation about finding meaning, and with what tools and resources? There are differences here too. A mental health practice support worker or a social worker often has experience in responding to existential questions, but does not always link this to finding meaning. So there is implicit knowledge. There are also professionals who notice questions about meaning but do not know how to respond to them.”

Curricula

That is why, at this stage of the Knowledge Centre, there is a strong focus on professional development. This takes the form, amongst other things, of continuing professional development courses. The so called Centra voor Levensvragen (regional networks of professional spiritual counsellors) have developed the training course ‘Support with Life Questions’, which is now offered nationwide to, amongst others, mental health practice nurses, nurses and social workers. These professionals also reflect on their own practices within learning communities with spiritual counsellors, in which people with lived experience also participate.

The Knowledge Centre is investigating how the search for meaning fits – and can fit – into the curricula of a wide range of degree programmes, such as medicine, including the general practice programme, and healthcare and social care programmes at senior secondary vocational (MBO), higher professional (HBO) and university (WO) levels.

Such training is urgently needed for various reasons, according to Gaby. “It is often difficult for professionals to recognise questions relating to meaning. Usually, patients or clients present their question or complaint in a different way. They come in with symptoms of stress, fatigue or because their partner is worried. Often, people themselves are not particularly aware of the role of meaning in their issue or complaint, because they are not used to paying attention to it or putting it into words. People may also unconsciously ‘translate’ feelings of unease, aimlessness or restlessness into a physical or mental problem, because this is more in line with what the healthcare provider can offer.”

A different approach

Another reason why questions of meaning are not recognised lies with the care professional themselves: “They have learnt to ‘listen’ to problems in a certain way and to carry out assessments. Meaning cannot be measured, it cannot be detected in the body, nor can it be expressed as a value. It requires a different way of listening.”

Even if care professionals do recognise questions of meaning in the story told by the patient or client, it remains to be seen whether they actually act on this. “We know from the literature that care professionals often feel they need knowledge of philosophical and religious perspectives and traditions. They do not dare to ask about these if they feel that such perspectives differ from their own beliefs.”

Professionals report that they find it difficult to move beyond the physical or mental realm and to reflect on personal needs or questions regarding meaning, or to adopt a ‘listening attitude’. They lack the language and tools to address the issue of meaning.

“Learning to care for a sense of meaning is also a very personal process.”
Gaby Jacobs Profesor and chair of Knowledge Centre

Through training and continuing professional development programmes, the Knowledge Centre seeks to remove the barriers to probing further into identified questions of meaning. “The challenge is to help professionals develop an attitude that is, first and foremost, focused on connecting with where the client or patient is at that moment – the confusion, uncertainty and questions they are grappling with. You set aside solution-focused approaches and accept the other person’s situation as it is. This is only possible if the professional is mindful of their own outlook on life and search for meaning. Learning to care for a sense of meaning is therefore also a very personal process.”

Practical aspects

In practical terms, this means that the Knowledge Centre does not merely focus on the question of what knowledge should be included in the training programme. It also emphasises the use of various methods, such as discussion exercises, individual and group reflection, on-the-job coaching and drawing on patients’ experiences.

Gaby: “We have learnt that learning about meaning-centred care cannot take place in an instrumental way. In order to provide meaning-centred care, it is important for professionals to be aware of their own ‘being’ and their own values in their practice. This is often only a small part of the training of medical, healthcare and welfare professionals in the Netherlands.”

“Trainers are often inclined to ‘tackle’ the search for meaning in the same way as other training topics are addressed on a physical and psychological level: through the transfer of knowledge and practical exercises to develop skills. However, providing care centred on meaning requires existential and transdisciplinary learning. It involves professional development in which meaning, values and identity form a central part of the process, in dialogue with other professionals and with clients.”

Unlearning

“Care for meaning is about a different way of providing care and also about a different way of learning. In this context, collaboration with spiritual counsellors remains of great importance, as this professional group specialises in meaning.”

“Providing a sense of meaning represents a different way of looking at what it means to be human and offering support in that regard. Not all tragedy can or needs to be taken away. For professionals, this also provides some breathing space: you do not have to be the ‘all-knowing saviour’. This requires a different attitude, a different starting point as a care provider. Learning in this context also involves, to some extent, unlearning what has become standard practice in training programmes. It is about learning once again to be human alongside the other person. I call this ‘radical fellow-humanity’.”

In the coming period, the Knowledge Centre will continue to learn, research and share knowledge. “The coming years will be crucial for broadly integrating the care for meaning into training programmes – or at least for finding or creating the right opportunities to do so. We need everyone’s involvement in this: not just the professionals and trainers themselves, but also policymakers and ambassadors.”

Partners Knowledge Centre 3

The Knowledge Workshop is a collaboration between eight organisations, supported by a broad network of professionals, researchers and organisations.