LiSHoRe – Summary of findings

This page contains a summary of the findings from the LiSHoRe Project (Listen, Share, Hold, Respond).

What is the LiSHoRe Project?

Work package A: Consultation Groups with ethnically diverse staff from ten different NHS Trusts in Manchester, Leicester, Coventry, Worcester and Oxford, exploring their psychospiritual experiences during the COVID-19 pandemic. We held 16 groups with 55 participants from a range of ethnicities, ages and pay bands.

Work package B: Delivery and evaluation of 14 of Recovery and Renewal (R&R) Days. These 24-hour “retreats” for 8-12 staff, are run by the Oxford Health Spiritual & Pastoral Care team and are designed to provide a safe space for giving voice to causes of stress/distress, as well as exploring psychospiritual coping, connection and communication.

Work package C: Delivery and evaluation of six national psychospiritual webinars; these are freely available.

Definition of Psychospirituality

Spiritual care can be understood as care which responds to people’s need to find meaning, purpose, relationship and hope, and may include transcendent understandings of the Divine or of ultimate meaning. At times of crisis, loss, uncertainty etc. such as during the pandemic, many of us seek to find meaning. Psychospiritual care is defined as psychologically-informed spiritual care.

What were the main findings?

The following themes were generated from the consultation group data:

• Meaning of spirituality

Spirituality was very important to participants, often being fundamental to who they were, and to their work in the NHS.

“I have the calling to become a nurse and it’s a devotion, it’s my spirituality giving the helping hand. That is the way I meet my spirituality, that is the way I fulfil it” (female, Black British African, 40 – 49, Christian).

• Spirituality in the NHS

Many participants perceived that spirituality was a little recognised area in the NHS. A few participants felt their spirituality was respected by colleagues and line managers, but most felt it needed better integration within the NHS.

“Whether the spiritual aspect plays any part at all in the NHS, I don’t think it [spirituality] does. I don’t think it’s [spirituality] given much value or recognition” (male, Black British African, 40 – 49, Christian).

Many staff felt inhibited about discussing their spirituality at work. For some – particularly Muslim staff – it felt taboo to discuss their spirituality, for fear it might cause tensions.

“[spirituality is] something that you are not allowed to share with anyone. You might maybe share with colleagues, depending with what relationship you’ve got”, (female, Black African British, 40 – 49, Christian).

• Spirituality and ethnicity

Participants sometimes felt their religion/spirituality was intrinsically linked to their ethnicity, often leading to discrimination and insensitivity.

“The prayer room, it’s actually an old toilet…See, I’m a bit fussy about where I pray. I like it to be vacuumed. I like it to be clean, to put my ‘musalla’ down and then to know that… Everybody thinks, oh well. The ‘musalla’s’ clean. Yes, but the bottom of it’s still filthy from what it’s touched…So I’ve never felt, unfortunately, that my religion has been given any…And I’m not asking for any preference, but I think when I heard it was a bathroom and that was where the toilet area was, I wasn’t going to be praying in that spot”, (male, Asian British Indian, 40 – 49, Muslim).

• Spirituality and the pandemic

Some participants felt their spirituality was negatively affected during the pandemic. Reasons for this included: spirituality being deprioritised; participants losing faith when confronted by loss; and not connecting with others due to a lack of face to face contact.

Some participants reported heightened spirituality during the pandemic. Reasons included: time at home provided space for spiritual practise; spiritual practise helped cope with the pandemic; reflecting on the impermanence of life; and increased appreciation for things normally taken for granted.

• Psychospiritual support

Most participants spoke of a desire for improved psychospiritual support at work. There was a widespread view that existing sources of psychospiritual support – such as provided throughout COVID-19 – often did not reflect diverse cultural and spiritual needs and tended to be Eurocentric. For example, many participants described how spirituality meant connection and shared compassion with others and would prefer groups to come together and share, rather than 1:1 therapy/mentoring or internally-focused mindfulness sessions.

“One of the things that we did within my team as a way of keeping an eye on people very, very closely was that we instituted [short] daily meetings […] So you get a snapshot, of how the person is, but then you also get [a snapshot] of how the group is thriving…If somebody is a bit quieter first thing in the morning, you can say to them, are you okay?” (female, Black British African, 40 – 49, Christian).

• Leadership

Participants reported wanting caring and compassionate leadership, and for line managers to talk to them as a whole person, rather than in a procedural way.

“I think that’s [compassionate leadership] a different type of leadership style that we’re not taught. We’re taught to be very dictatorial, we’re taught to be very hierarchical, and that’s how the NHS has been” (female, Asian British Indian, 40 – 49, non-practicing Sikh).

There was a strong view that managers and leaders often hesitate to have open conversations about psychospirituality or ethnicity for fear of “saying the wrong thing”. Managers were urged to overcome this and “have the difficult conversations.”

“At the same time the compassionate side of me is also thinking, well, whatever manager is in place, how difficult that might be because they might not understand certain things themselves or feel as if they can be open and honest without feeling their actions might be questioned. It’s a very difficult balance” (female, Mixed White and Black African, 30 – 39, Christian).

Experiences of discrimination

• Many participants described experiences of discrimination at work, including underestimation of their qualifications and not receiving promotions. Participants felt that during the pandemic, ethnically diverse staff worked longer hours than their White colleagues, were less likely to have PPE and initially had higher COVID-19 death rates.
• Many participants found it difficult to speak up about discrimination, in case their views were dismissed or not taken seriously.

“If you’ve come from a space of traumatic experiences…For just being of colour or from somewhere different it is so difficult to have the courage to keep standing up again and having your voice, trying to get your voice out there” (female, Mixed White and Black African, 30 – 39, Christian).

• A substantial number of participants described positive experiences within the NHS regarding cultural and religious sensitivity and felt supported with their religious or cultural practises as much as their White colleagues would be. Some had been mentored and supported to progress and move up NHS pay bands.

R&R Days

The R&R Days led to a reduction of approximately 30% in sickness absence in the six months following attendance. This data indicates the value of this approach in improving staff wellbeing, indirect impacts on patient care and ongoing costs to the Trust.

There were small improvements in all domains of the ProQOL and Spirituality and Inclusion questionnaires. Participant ratings and qualitative feedback were very positive.

“The R and R made me feel very aware of how i need to look after myself, and it made me feel very valued and worth something as a human being”

Webinars

Attendance at the webinars was not high but there was very positive feedback.

“Thank You incredible, compassionate and wise reflections!”

What are the key recommendations?

1. Reconsider current approaches to psychospiritual care for staff, such as providing groups where people can connect, rather than 1:1-type approaches. See Psychospiritual Toolkit.
2. Promote a compassionate approach from Line Managers that enables awareness and openness when discussing psychospiritual issues and staff support. This could be enabled via training and via dissemination of the study findings.
3. Further evaluate Recovery & Renewal Days as a potentially highly effective approach.
4. Encourage senior leaders and line managers to talk about psychospirituality and ethnicity openly, without being held back by fears around political correctness.
5. Host dissemination event to share findings about the importance of psychospirituality amongst the NHS workforce, particularly for those from ethnically diverse backgrounds.