Anandarajah Gowri
Department of Family Medicine, The Warren Alpert Medical School of Brown University, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA.
Ann Fam Med. 2008 Sep-Oct;6(5):448-58. doi: 10.1370/afm.864.
The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 theoretical models that provide common ground for further exploration of the role of spirituality in medicine.
The 3 H model (head, heart, hands) and the BMSEST models (body, mind, spirit, environment, social, transcendent) evolved from the author's 12-year experience with curricula development regarding spirituality and medicine, 16-year experience as an attending family physician and educator, lived experience with both Hinduism and Christianity since childhood, and a lifetime study of the world's great spiritual traditions. The models were developed, tested with learners, and refined.
The 3 H model offers a multidimensional definition of spirituality, applicable across cultures and belief systems, that provides opportunities for a common vocabulary for spirituality. Therapeutic options, from general spiritual care (compassion, presence, and the healing relationship), to specialized spiritual care (eg, by clinical chaplains), to spiritual self-care are discussed. The BMSEST model provides a conceptual framework for the role of spirituality in the larger health care context, useful for patient care, education, and research. Interactions among the 6 BMSEST components, with references to ongoing research, are proposed.
Including spirituality in whole-person care is a way of furthering our understanding of the complexities of human health and well-being. The 3 H and BMSEST models suggest a multidimensional and multidisciplinary approach based on universal concepts and a foundation in both the art and science of medicine.
过去十年间，支持灵性在全人患者护理中作用的证据激增，促使人们提议转向生物心理社会灵性健康模式。然而，在当今多元文化社会中实现这一范式转变面临诸多挑战。本文介绍了两种理论模型，为进一步探索灵性在医学中的作用提供了共同基础。
3H模型（头脑、心灵、双手）和BMSEST模型（身体、心理、灵性、环境、社会、超验）源自作者在灵性与医学课程开发方面12年的经验、作为主治家庭医生和教育工作者16年的经验、自幼对印度教和基督教的亲身经历，以及对世界伟大灵性传统的毕生研究。这些模型经过开发、在学习者中进行测试并不断完善。
3H模型提供了一个多维的灵性定义，适用于各种文化和信仰体系，为灵性提供了通用词汇。文中讨论了从一般灵性护理（同情、陪伴和治疗关系）到专业灵性护理（如临床牧师提供的护理）再到灵性自我护理等治疗选择。BMSEST模型为灵性在更广泛的医疗保健背景中的作用提供了一个概念框架，对患者护理、教育和研究都很有用。文中提出了BMSEST模型六个组成部分之间的相互作用，并参考了正在进行的研究。
将灵性纳入全人护理是深化我们对人类健康和幸福复杂性理解的一种方式。3H模型和BMSEST模型提出了一种基于普遍概念以及医学艺术与科学基础的多维和多学科方法。
