Caregiving for existential wellbeing : existential literacy. A clinical study in an anthroposophic healthcare context

• Background and context: The occurrence of existential caregiving as a natural element of healthcare is the focus of this research. According to the literature, there is a lack of understanding of this issue, from a theoretical as well as a clinical point of view. In this design ‘existential’ and ‘spiritual’ are seen as synonymous and without religious association. Existential questions are regarded as questions about life, death, meaning, love, vulnerability, responsibility and dependence. The context for the project is an integrated anthroposophic hospital that offers rehabilitation for patients with cancer.Aims and objectives: With the support of an anthroposophic and caring scientific view of human beings, and by using concrete examples, the aim is to develop and deepen an understanding of existential care for patients in life-decisive phases in the care and rehabilitation of cancer. Clinical application research was used in cooperation with academic researchers and clinically active colleagues. Eleven clinicians from varying professions and two researchers collaborated over the course of two years. The data used came from 65 case reports of significant care situations experienced by the team members. A joint interpretive qualitative analysis led to the formulation of the findings.Conclusions: Existential caregiving in practice requires an ‘existential literacy’, using the metaphor of human life as a text or a book whose contents are legible only for the one versed in the language. In order to gain a complete understanding of caregiving, an ability to read a suffering human’s language and decipher its meaning is essential. The patient’s narrative might open up a caregiver’s awareness in a single illuminating moment. An authentic and listening attitude together with an active restriction of one’s own suppositions increase the possibility of providing existential care. Compassion and professional judgement function as the caregiving compass and ‘lexica’ for existential care.Implications for practice:An understanding of existential caregiving moments implies a developed insight into and sensitivity for the patient’s signs and needsExistential caring moments have countless variations, while bodily and intimate situations are sometimes found to be an opening to spontaneous, trustful interactions. Such moments could be learning moments if reflected and sharedFor training in the ability to ‘read the patient’, clinical reflections in groups where existential literacy is collectively sought are an optionClinical application research can allow caring scientific theory and healthcare research to be implemented in practice immediately, which may enhance quality of care and ultimately benefit the patient

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