What is spirituality? Evidence from a New Zealand hospice study

Spirituality: A Key Component of the Salvation Army's Bridge Programme Model of Treatment in Aotearoa New Zealand

Spirituality is vital to The Salvation Army's Bridge model of treatment for alcohol and drug addiction. Spirituality is expressed through Recovery Church, prayer, spirituality lifters, the 12-step programme, and focuses on meaning and purpose. We recruited participants from several regional centers throughout Aotearoa New Zealand and evaluated spirituality using the WHOQol-SRPB and open-ended questions. Most participants held broad understandings of spirituality, only a minority equating it with religion. Participants who completed the Programme had statistically significant increases in spiritual wellbeing at end-of-treatment. These increases were maintained at a 3-month follow-up. Increases in spiritual wellbeing were associated with decreases in severity of alcohol and drug use.

Strengthening Community End-of-Life Care through Implementing Measurement-Based Palliative Care

The increasing demand for palliative care in New Zealand presents a potential threat to the quality of service delivery. One strategy to overcome this is through the implementation of valid and reliable patient-reported outcome measures. This mixed-methods study aimed to (1) implement measurement-based palliative care (MBPC) in a community palliative care service in Auckland, New Zealand; (2) evaluate the clinical utility of MBPC perceived by clinicians; (3) describe patient characteristics as measured by the Integrated Palliative Care Outcome Scale (IPOS), the Australasian Modified Karnofsky Performance Scale (AKPS), and Phase of Illness (POI); and (4) evaluate the internal consistency of the IPOS. Participants were over 18 years of age from a community outpatient palliative care service. In a phased approach to implementation, healthcare staff were educated on each instrument used for patient assessment. Uptake and internal consistency were evaluated through descriptive statistics. An interpretive descriptive methodology was used to explore the clinical utility of MBPC through semi-structured interviews with seven clinical staff members. Individual patient assessments (n = 1507) were undertaken predominantly on admission, with decreasing frequency as patients advanced through to the terminal phase of their care. Mean total IPOS scores were 17.97 (SD = 10.39, α = 0.78). The POI showed that 65% of patients were in the stable phase, 20% were in the unstable phase, 9% were in the deteriorating phase, and 2% were in the terminal phase. Clinicians reported that MBPC facilitated holistic and comprehensive assessments, as well as the development of a common interdisciplinary language. Clinicians expressed discomfort using the psychosocial and spiritual items. Measurement-based palliative care was only partially implemented but it was valued by staff and perceived to increase the quality of service delivery. Future research should determine the optimal timing of assessments, cultural responsivity for Māori and Pacific patients, and the role of MBPC in decision support for clinicians.

Exploring the place of spirituality in Canadian health promotion

The field of health promotion advocates a socioecological approach to health that addresses a variety of physical, social, environmental, political and cultural factors. Encouraging a holistic approach, health promotion examines many aspects of health and wellbeing, including physical, mental, sexual, community, social and ecological health. Despite this holism, there is a noticeable absence of discussion surrounding spirituality and spiritual health. This research study explored how leading scholars in Canadian health promotion understand the place of spirituality in health promotion. Using the fourth edition of Health Promotion in Canada (Rootman et al., 2017) as the sampling frame of recognized leaders in the field, 13 semi-structured qualitative interviews were conducted with authors from the book. This study is situated within a critical health promotion approach that utilizes methodologies aiming for social justice, equity and ecological sustainability. I argue that by avoiding spirituality within health promotion frameworks and education, the secularism of health promotion and its underlying values of Eurocentric knowledge production and science remain invisible and rarely critiqued. This study intends to open up possibilities for centering spiritual and non-Western epistemologies and ways of knowing that have been marginalized, such as Indigenous understandings of health and wellbeing. Restoring right relations with Indigenous peoples in Canada has taken on new urgency with the calls to action of the Truth & Reconciliation Commission report (NCTR, 2015). This is one important way that health promotion can fulfill its promise of being inclusive, relevant and effective for human and planetary wellbeing.

Meanings and Interpretations of Spirituality in Nursing and Health

Numerous spirituality models and tools have been developed in health education and research, but a gap still exists around the conceptual clarity and articulation of spirituality among nurses and healthcare providers. Nurses and healthcare providers still find it difficult to interpret and apply the concepts of spirituality in their practice settings. This paper provides a concept analysis of spirituality using the Walker and Avant method of conceptual analysis. Several databases including conceptual and empirical literature from various disciplines have been used. The defining attributes of spirituality included spirituality and religion as a separable or mutual construct, spirituality as a personal construct, wholeness and integration, meaning making and purpose, sense of connectedness and relationship, transcendence, inner source of power, energy, and strength. Major antecedents of spirituality found were faith, personal values, and belief systems, and life adversities. Consequences of spirituality included personal/spiritual growth and wellbeing, resilience, and religiousness. Spirituality is a unique and personal human experience, an individualised journey characterised by multiple experiential accounts such as meaning making, purpose, connectedness, wholeness and integration, energy, and transcendence. Spiritual experiences are often difficult to examine and measure using scientific tools and empirical language. Healthcare providers need to fully understand and apply spirituality and spiritual care aspects to provide holistic person-centred care.

Spirituality in nursing: A concept analysis

BACKGROUND

Spirituality has always been present in the history of nursing and continues to be a topic of nursing interest. Spirituality has ancient roots. The term 'spirituality' is interpreted as spirit and is translated as breath and soul, whereas spirituality (immateriality) is spiritual nature. Historically, the term spirituality is associated with the term religiosity, a definition that persists today, and often the two terms are used interchangeably. In the healthcare context, the construct is still.

OBJECTIVE

To clarify the concept of spirituality in nursing.

RESEARCH DESIGN

In this article spirituality was explored using Rodgers' evolutionary and inductive method of concept analysis.

PARTICIPANTS AND RESEARCH CONTEXT

For this analysis, a sample of 71 articles published in English, from 2008 to 2018 from PubMed/Medline, CINAHL Plus with full text, PsycINFO, SciELO databases were retrieved. It was also accomplished an empirical search of dictionaries and e-books.

ETHICAL CONSIDERATIONS

This study was conducted according to good scientific practice.

FINDINGS

It emerged that "spirituality" is a dynamic process and has a range of attributes. The cultural dimensions, the religious and spiritual traditions, the ethnic diversity and the influence of the historical and social contexts represent the societal and historical conditions ingrained in the Western thought that influence the emergence of spirituality as a concept. Antecedents, attributes and onsequences appeared to inform and strengthen one another over time. Spirituality is a significant concept for the discipline of nursing with profound consequences for caring patients and for work organizations.

Patients' and Caregivers' Contested Perspectives on Spiritual Care for Those Affected by Advanced Illnesses: A Qualitative Descriptive Study

CONTEXT

Spiritual care refers to practices and rituals addressing spiritual/religious concerns. It supports coping with loss and finding hope, meaning, and peace. Although integral to palliative care, its implementation is challenging.

OBJECTIVE

To understand an Australian cohort of patients' and caregivers' perspectives about experiencing and optimizing spiritual care in the context of advanced illness.

METHODS

Patients and caregivers of patients with ≤12 month prognosis were recruited from a broader spiritual study via criterion sampling and agreed to opt-in interviews. Participants from an Australian, metropolitan health service received a spiritual care definition and were interviewed. Transcripts were analyzed using qualitative description.

RESULTS

30 patients (17 male; mean age 70 years) and 10 caregivers (six male; mean age 58.9 years) participated. 27 identified as Christian, and 10 had no religion. Participants described multifaceted and contested beliefs about spirituality. Many queried the tangibility of spirituality, but all valued respectful staff who affirmed personhood, that is, each individual's worth, especially when care exceeded expectations. They also resonated with positive organizational and environmental tones that improved holistic well-being. Participants stressed the importance of the hospital's welcoming context and skilled care, which comforted and reassured.

CONCLUSION

Although many patients and caregivers did not resonate with the term "spiritual care," all described how the hospital's hospitality could affirm their values and strengthen coping. The phrase "spiritual care and hospitality" may optimally articulate and guide care in similar, pluralist inpatient palliative care contexts, recognizing that such care encompasses an interplay of generalist and specialist pastoral care staff and organizational and environmental qualities.

Patients' spirituality perspectives at the end of life: a qualitative evidence synthesis

BACKGROUND

Understanding patient perceptions of their spiritual needs when approaching the end of life is essential to support the delivery of patient-centred care.

AIM

To conduct a qualitative evidence synthesis on spirituality and spiritual care needs at the end of life in all healthcare settings from the patients' perspective.

DESIGN

Studies were included where they were primary qualitative studies exploring spirituality in patients with a life expectancy of 12 months or less in any setting. Two reviewers independently screened titles, extracted data and conducted methodological quality appraisal. A thematic synthesis was conducted. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to summarise the certainty of the evidence.

DATA SOURCES

Six databases (Medline, Embase, Cochrane, CINAHL, PsycINFO, Applied Social Science Index and Abstracts) were searched from inception up to January 2019.

RESULTS

Fifty papers (42 unique datasets), incorporating data from 710 patients were included. Studies recruited from a mix of inpatient, outpatient, hospice and community settings across 12 different countries. Three overarching themes were generated: the concept of spirituality, spiritual needs and distress, and spiritual care resources. Relationships were an intrinsic component of spirituality.

CONCLUSION

Meeting patients' spiritual needs is an integral part of end-of-life care. This work emphasises that supporting relationships should be a central focus of spiritual care for patients at the end of life.

PROSPERO REGISTRATION NUMBER

CRD42019122062.

Spirituality among family caregivers in palliative care: an integrative literature review

BACKGROUND

Family caregivers experience spiritual and existential concerns while caring for their terminally ill family members.

AIM

To evaluate and synthesise studies on spirituality among family caregivers in palliative care.

DESIGN

An integrative literature review of peer-reviewed articles published between 2000 and 2016.

SAMPLE

Participants were family caregivers (parents, spouses, relatives or friends) caring for an adult (age>18 years) family member with a terminal illness in a palliative care setting.

RESULTS

Data from 26 published research papers were systematically analysed. Five themes were identified regarding spirituality and family caregiving: a close and meaningful connection, spirituality as a way of coping, spiritual needs and expressions among family caregivers, spirituality to transcend fears, and spirituality in family caregivers' decision-making.

IMPLICATIONS FOR PRACTICE

Nurses are encouraged to explore the spirituality and spiritual experiences of family caregivers to support their spiritual wellbeing while caring for their terminally ill family members.

Spirituality in Aotearoa, New Zealand: Personal Reflections From a Spirituality in Health Care Researcher

Spirituality is about what is of utmost value; it is a values lens that asks "what really matters most to me, my family, our community, our country, and our world." This personal reflection comes from a New Zealand academic who works in the spirituality and health care research field. Although largely biographical, this reflection offers some insight into the New Zealand context and this emergent field.

What GPs mean by 'spirituality' and how they apply this concept with patients: a qualitative study

Background

Little is known about how the concept of spirituality is understood and applied by GPs.

Aim

To provide a detailed description of how GPs understand the concept of spirituality and apply this with patients.

Design & setting

Nineteen Scottish GPs were interviewed about their perceptions of the concept of spirituality and how they apply this in practice.

Method

An approach informed by grounded theory was used to identify and summarise common themes.

Results

Seven concepts concerning spirituality emerged, some of which are previously unrecognised. Four attitudes to spiritual care and four patterns of spiritual care were identified.

Conclusion

GPs have varying views on what spirituality is, and these relate partly to individual beliefs and experiences. These create considerable variation in the delivery of spiritual care.

Reflections: Spirituality and Cancer Researchers

Spirituality is increasingly acknowledged as an essential element to consider within care for cancer and other chronic health conditions. As our colleagues in frontline healthcare roles integrate these concepts into their professional practice, it seems timely for the cancer research community to reflect on the place of spirituality within our work. This reflections article discusses challenges and opportunities for researchers considering spirituality in their own work roles and within broader discussions about health needs, care and research agendas.

Receiving Spiritual Care: Experiences of Dying and Grieving Individuals

The study examines the perceptions of interfaith spiritual care, received through a volunteer hospice organization, by 10 individuals facing death and dying. Qualitative methodology based on the Interpretive Phenomenological Analysis was used to collect and analyze the data. Four superordinate themes reflected meanings ascribed to spirituality and spiritual care in facing end of life: Vital Role of Spirituality in the End-of-Life Care, Definitions and Parameters of Spirituality and Interfaith Spiritual Care, Distinct Aspects of Interfaith Spiritual Care, and Unmet Spiritual Needs. The results expand an understanding of the role of spirituality and spiritual care as part of the hospice and palliative care through attention to individual perceptions and experiences, as well as to ways to expand attention to spirituality within the hospice care.

Hospital Social Work and Spirituality: Views of Medical Social Workers

This article is based on a study of 1,389 medical social workers in 108 hospitals across 12 countries, on their views on spirituality and spiritually sensitive interventions in hospital settings. Results of the logistic regression analyses and structural equation models showed that medical social workers from European countries, United States of America, Canada, and Australia, those had undergone spiritual training, and those who had higher self-reported spiritual experiences scale scores were more likely to have the view that spirituality in hospital settings is for facilitating integral healing and wellness of patients and were more likely to prefer spiritual packages of New Age movements as the form of spiritual program, understand spiritual assessment as assessing the patients' spiritual starting point, to then build on further interventions and were likely to attest the understanding of spiritual techniques as mindfulness techniques. Finally they were also likely to understand the spiritual goals of intervention in a holistic way, that is, as that of integral healing, growth of consciousness and promoting overall well-being of patients vis-à-vis only coping and coming to terms with health adversities. Results of the structural equation models also showed covariances between religion, spirituality training, and scores on the self-reported spiritual experiences scale, having thus a set of compounding effects on social workers' views on spiritual interventions in hospitals. The implications of the results for health care social work practice and curriculum are discussed.

Spiritual beliefs, practices, and needs at the end of life: Results from a New Zealand national hospice study

OBJECTIVE

International studies have shown that patients want their spiritual needs attended to at the end of life. The present authors developed a project to investigate people's understanding of spirituality and spiritual care practices in New Zealand (NZ) hospices.

METHOD

A mixed-methods approach included 52 semistructured interviews and a survey of 642 patients, family members, and staff from 25 (78%) of NZ's hospices. We employed a generic qualitative design and analysis to capture the experiences and understandings of participants' spirituality and spiritual care, while a cross-sectional survey yielded population level information.

RESULTS

Our findings suggest that spirituality is broadly understood and considered important for all three of the populations studied. The patient and family populations had high spiritual needs that included a search for (1) meaning, (2) peace of mind, and (3) a degree of certainty in an uncertain world. The healthcare professionals in the hospices surveyed seldom explicitly met the needs of patients and families. Staff had spiritual needs, but organizational support was sometimes lacking in attending to these needs.

SIGNIFICANCE OF RESULTS

As a result of our study, which was the first nationwide study in NZ to examine spirituality in hospice care, Hospice New Zealand has developed a spirituality professional development program. Given that spirituality was found to be important to the majority of our participants, it is hoped that the adoption of such an approach will impact on spiritual care for patients and families in NZ hospices.

Spirituality in Renal Supportive Care: A Thematic Review

Chronic kidney disease is marked by a reduced life expectancy and a high symptom burden. For those who reach end-stage renal disease, the prognosis is poor, and this combined with the growing prevalence of the disease necessitates supportive and palliative care programmes that will address people's psychosocial, cultural and spiritual needs. While there is variation between countries, research reveals that many renal specialist nurses and doctors are reluctant to address spirituality, initiate end-of-life conversations or implement conservative treatment plans early. Yet, other studies indicate that the provision of palliative care services, which includes the spiritual dimension, can reduce symptom burden, assist patients in making advanced directives/plans and improve health-related quality of life. This review brings together the current literature related to renal supportive care and spirituality under the following sections and themes. The introduction and background sections situate spirituality in both healthcare generally and chronic kidney disease. Gaps in the provision of chronic kidney disease spiritual care are then considered, followed by a discussion of the palliative care model related to chronic kidney disease and spirituality. Chronic kidney disease spiritual needs and care approaches are discussed with reference to advanced care planning, hope, grief and relationships. A particular focus on quality of life is developed, with spirituality named as a key dimension. Finally, further challenges, such as culture, training and limitations, are explicated.

Promoting spiritual care for older people in New Zealand: the Selwyn Centre for Ageing and Spirituality

Purpose

– The purpose of this paper is to describe the development of a centre to promote the spiritual care of older people in New Zealand.

Design/methodology/approach

– The spiritual scene in New Zealand is described and “spirituality” defined. The history of the Selwyn Centre for Ageing and Spirituality (SCAS) is illustrated by case studies in three areas: research, education and advocacy, noting challenges in providing spiritual care to older people.

Findings

– The number of New Zealanders claiming a religious affiliation is dropping but spirituality is of interest and relevance to many people. The acknowledgement of Maori spirituality has affected government policy. The SCAS has supported research and provided education throughout the country. Advocacy is difficult where care focuses on the physical and funding for frail older people is limited.

Research limitations/implications

– While the importance of good spiritual care for older people is clear, this is not easy to achieve. However, an organisation like SCAS has brought the issue to national awareness and made some contribution to increased understanding and improved practice.

Practical implications

– As the population ages and expressions of spirituality diversify, a deeper understanding of spirituality beyond Christian religion is required.

Social implications

– While the SCAS focuses on older people, it has formed a nexus of people more widely interested in spirituality at all ages, in different cultures and throughout the country.

Originality/value

– This is the first description of a New Zealand organisation specifically addressing the spiritual care of older people.

Spiritual care and kidney disease in NZ: a qualitative study with New Zealand renal specialists

AIM

People with chronic kidney disease have a shortened life expectancy and carry a high symptom burden. Research suggests that attending to renal patients' spiritual needs may contribute to an improvement in their quality of life. The aim of this qualitative study was to investigate the provision of spiritual care in New Zealand renal units from the perspective of specialists.

METHODS

The study followed a generic qualitative approach and included semi-structured interviews with specialists recruited from New Zealand's ten renal centres.

RESULTS

Five specialist doctors and nine specialist nurses were recruited for interviews. Understandings of spirituality were broad, with most participants having an inclusive understanding. Patients' spiritual needs were generally acknowledged and respected though formal spiritual assessments were not done. Consideration of death was discussed as an often-unexamined need. The dominant position was that the specialists did not provide explicit spiritual care of patients but there was some ad hoc provision offered through pre-dialysis educators, family meetings, Māori liaison staff members and the efforts of individuals. Chaplains were well used in some services. Participants had received no pre and little in-service training or education in spiritual care. Suggestions for improvements included in-service training, better utilization of chaplaincy services and training in advance care planning.

CONCLUSION

Most participants indicated they would attempt to provide some form of spiritual care, either directly or by referring the patient to appropriate services. However, participants generally demonstrated a lack of confidence in addressing a patient's spiritual needs.

Spirituality: what is its role in pain medicine?

BACKGROUND

For many years, spirituality has been regarded as an integral aspect of patient care in fields closely allied to pain medicine such as palliative and supportive care. Despite this, it has received relatively little attention within the field of pain medicine itself. Reasons for this may include a lack of understanding of what spirituality means, doubtfulness of its relevance, an uncertainty about how it may be addressed, or a lack of awareness of how addressing spirituality may be of benefit.

METHODS

A review of the literature was conducted to determine the changing conceptual frameworks that have been applied to pain medicine, the emergence of the biopsychospiritual approach and what that means as well as evidence for the benefits of incorporation of this approach for the management of pain.

RESULTS

Although the concept of spirituality is broad, there is now greater consensus on what is meant by this term. Many authors and consensus panels have explored the concept and formulated a conceptual framework and an approach that is inclusive, accessible, relevant, and applicable to people with a wide range of health conditions. In addition, there is accumulating evidence that interventions that address the issue of spirituality have benefits for physical and emotional health.

CONCLUSIONS

Given the firm place that spirituality now holds within other fields and the mounting evidence for its relevance and benefit for people with pain, there is increasing evidence to support the inclusion of spiritual factors as an important component in the assessment and treatment of pain.

The spiritual environment in New Zealand hospice care: identifying organisational commitment to spiritual care

OBJECTIVES

Spiritual matters naturally arise in many people who have either a serious illness or are nearing end-of-life. The literature shows many examples of spiritual assessments, interventions and care; however, there is a lack of focus on organisational support for spiritual care. We aimed to ascertain the structural and operational capacity of New Zealand's hospices to attend to the spiritual needs and concerns of patients, families and staff.

METHODS

As part of a larger study, a mail out cross-sectional survey was distributed to 25 New Zealand hospices and asked details from staff about facilities, practices and organisational aspects of spiritual care. Data were collated by creating a 'hospice setting spiritual score' based on an aggregate of eight items from the survey.

RESULTS

There was a 66% response rate. Summary scores ranged from 2 to 7 indicating that while sites delivered a range of spiritual services, all could improve the level of spiritual care they provide. The two most common items missing were 'spiritual professional development' and 'formal spiritual assessment.'

CONCLUSIONS

This simple setting spiritual score provides a snapshot of a hospice's commitment to spiritual care. It could be used as a preliminary auditing tool to assist hospices in identifying organisational and operational aspects that could be improved to enhance spiritual care delivery.

Improving the spiritual dimension of whole person care: reaching national and international consensus

Two conferences, Creating More Compassionate Systems of Care (November 2012) and On Improving the Spiritual Dimension of Whole Person Care: The Transformational Role of Compassion, Love and Forgiveness in Health Care (January 2013), were convened with the goals of reaching consensus on approaches to the integration of spirituality into health care structures at all levels and development of strategies to create more compassionate systems of care. The conferences built on the work of a 2009 consensus conference, Improving the Quality of Spiritual Care as a Dimension of Palliative Care. Conference organizers in 2012 and 2013 aimed to identify consensus-derived care standards and recommendations for implementing them by building and expanding on the 2009 conference model of interprofessional spiritual care and its recommendations for palliative care. The 2013 conference built on the 2012 conference to produce a set of standards and recommended strategies for integrating spiritual care across the entire health care continuum, not just palliative care. Deliberations were based on evidence that spiritual care is a fundamental component of high-quality compassionate health care and it is most effective when it is recognized and reflected in the attitudes and actions of both patients and health care providers.

Exploring occupation roles of hospice family caregivers from Māori, Chinese and Tongan ethnic backgrounds living in New Zealand

A major challenge to occupational therapists working in palliative care is determining the best ways to help family caregivers who are caring for family members. The purpose of this study was to explore palliative caregiver occupations among Māori, Chinese and Tongan ethnicities. Six informants participated, one woman and one man from each ethnic group. In each of their homes, informants were asked to discuss what it was like caring for their dying family member. The occupational themes resulting from these interviews were food preparation, spirituality and family gathering. Therapists need to be aware of the differences in how people care for family members within their ethnicity. Implications are that occupational therapists can help families identify activities important to them within the main occupational themes: different types of foods and their preparations, various ways to express spirituality and how families gather together members of their extended family. Further, clinicians need to take on the role of a "not-knowing" but curious health-care provider in order to meet the needs of caregivers. The limitation was the small number of participants who all lived in one geographic area. Future studies should include a wider group of ethnicities.

How spirituality is understood and taught in New Zealand medical schools

Objectives:

The objective of this research was to explore how spirituality is currently understood and taught in New Zealand Medical Schools.

Methods:

A mixed methods study was carried out involving interviews (n = 14) and a survey (n = 73). The first stage of the study involved recorded semi-structured interviews of people involved in curriculum development from the Dunedin School of Medicine (n = 14); which then informed a cross-sectional self-reported electronic survey (n = 73).

Results:

The results indicate that spirituality is regarded by many involved in medical education in New Zealand as an important part of healthcare that may be taught in medical schools, but also that there is little consensus among this group as to what the topic is about.

Significance of results:

These findings provide a basis for further discussion about including spirituality in medical curricula, and in particular indicate a need to develop a shared understanding of what ‘spirituality’ means and how it can be taught appropriately. As a highly secular country, these New Zealand findings are significant for medical education in other secular Western countries. Addressing spirituality with patients has been shown to positively impact a range of health outcomes, but how spirituality is taught in medical schools is still developing across the globe.

A belief in the soul may contribute to the stress experienced in the dissecting room

The aim of this research was to explore whether medical students believe in a soul and how this may affect their dissecting experience. Three questionnaires were delivered electronically to the 2011 cohort of second-year medical students over a 2-year period. At the University of Otago, students enter medicine via three categories: Health Sciences First Year (following 1 year of university); postgraduate (following a Bachelors or higher degree); and 'other' category entry (Allied Health Professional or 3 years after a Bachelors degree). The entry category, age, ethnicity and gender of the students were collected; 51.6% of the students believed in the concept of a soul. On a scale of 1-5, students ranked the importance of religion/spirituality as 2.69. Those who believed in a soul were more likely to have a religious/spiritual component to their life and be males or 'other' category entrants. However, there were many students who believed in the soul who did not have a religious/spiritual association, suggesting that this belief extends beyond religion. Those who believed in a soul had significantly higher anticipatory stress and experienced higher levels of stress during dissection. A higher proportion of students in the 'other' category entrants believed in the concept of the soul and also had significantly higher levels of stress during dissection. Our data suggest that a belief in a soul may affect students' experiences in dissecting. Incorporating the teaching of humanities with anatomy may help medical students as they assimilate both the biomedical and philosophical aspects of dissection.