A groundbreaking study from researchers at Trinity Western University (TWU) and Providence Health Care has illuminated the transformative potential of art-based spiritual care (ABSC) in addressing health inequities across Canada's diverse healthcare landscape. Published in the Journal of Religion and Health, the philosophical analysis underscores how integrating artistic expression into spiritual support can foster inclusive healing, particularly for marginalized communities facing structural barriers.

Lead author Dr. Kendra L. Rieger, an Associate Professor in TWU's School of Nursing, along with colleagues Sheryl Reimer-Kirkham, Myron A. Penner, Alysha McFadden, and Anne Tuppurainen from Providence Health Care, conducted a scoping review to map the evidence on ABSC. Their work reveals art as a 'spiritual language' that transcends verbal barriers, enabling patients with pain, distress, language challenges, or physical limitations to express profound spiritual needs. This approach aligns with British Columbia's Ministry of Health framework recognizing spiritual health as essential to whole-person care.

What is Art-Based Spiritual Care?

Art-based spiritual care refers to the intentional use of creative mediums—such as drawing, painting, music, storytelling, or digital art—in spiritual health encounters within healthcare settings. Unlike traditional verbal counseling, ABSC leverages art's non-verbal power to facilitate meaning-making, emotional release, and relational connection. The process typically unfolds in three steps: (1) invitation to create freely with supplied materials like those in Providence's Art Cart Initiative; (2) reflective dialogue on the artwork's spiritual significance; and (3) integration into holistic care plans. This method draws from historical precedents, including Indigenous storytelling circles using medicine wheels and palliative mandala creation for end-of-life reflection.

In Canadian contexts, ABSC responds to growing religious diversity—Statistics Canada reports 0.2% of the population follows traditional Indigenous spirituality, with rising 'spiritual but not religious' identifications. For structurally vulnerable groups, art bypasses cultural mismatches in chaplaincy, promoting equity by honoring diverse expressions of spirituality.

Philosophical Foundations: Intersecting Art, Spirituality, and Health

The study's core philosophical inquiry explores why art and spirituality converge for equitable health promotion. Historically, art has been theorized as a divine conduit—from Renaissance religious iconography to modern expressive therapies. Rieger et al. argue that art embodies transcendent qualities, evoking awe and purpose amid illness. Yet, without equity lenses, ABSC risks reifying inequities; for instance, Eurocentric art forms may alienate Indigenous or 2SLGBTQ+ patients. The authors advocate decolonizing practices, drawing on Truth and Reconciliation Commission calls for culturally safe care.

Key to their framework is intersectionality—coined by Kimberlé Crenshaw—examining how race, Indigeneity, gender, and migration status intersect with spiritual access. Trauma- and violence-informed care (TVIC) further ensures sensitivity to historical harms, like residential school legacies affecting Indigenous spiritual expression.

Health Equity Challenges in Canadian Healthcare

Canada grapples with stark health disparities: Public Health Agency data shows Indigenous peoples experience 2-3 times higher chronic disease rates, while 2SLGBTQ+ individuals face elevated mental health burdens due to discrimination. Spiritual care, often under-resourced, exacerbates these; only 20-30% of hospitals have dedicated chaplains trained in diversity. ABSC addresses this by offering low-barrier entry— no artistic skill required—making it viable for dementia patients, non-verbal individuals, or those from language-minority groups comprising 22% of Canada's population.

At Providence Health Care, Vancouver's largest Catholic health network serving 200,000+ patients annually, the Art Cart—a mobile trolley with supplies—has demonstrated cross-cultural acceptance. Patients create mandalas or collages, sparking discussions on purpose and hope, reducing isolation.

Case Studies from Providence and TWU Collaborations

The Art Cart Initiative exemplifies ABSC in action. One case involved an elderly immigrant patient unable to speak English; through collage-making, she depicted family memories, unveiling spiritual distress tied to displacement. Staff reported reduced burnout from co-creating, with Dr. Tuppurainen noting, “Art is cross-culturally accepted... you can speak through art.”

• Palliative Care: Music and visual arts aid end-of-life meaning-making, aligning with Canadian Association for Spiritual Care standards.
• Indigenous Wellness: Collaborations with Elders incorporate smudging and beading, decolonizing spiritual support.
• 2SLGBTQ+ Inclusion: Expressive arts affirm gender-diverse identities, countering erasure in faith-based settings.

TWU's Arts for Equity program, funded by Health Research BC, extends this via Rieger's leadership, piloting initiatives at BC sites.

Implications for Nursing Education in Canadian Universities

TWU's School of Nursing integrates ABSC into curricula like NURS 510 Foundations of Nursing Knowledge, training students in equity-oriented practices. As Canada's first explicitly Christian nursing program emphasizing holistic care, TWU models covenantal caring—self-aware responsiveness to patients' beliefs. Other universities, like UBC and McMaster, could adopt similar modules amid CIHR's push for interdisciplinary spiritual health research.Read the full study here.

CIHR grants (e.g., applId=484236) fund TWU-led pilots implementing ABSC at three BC sites, evaluating outcomes for diverse patients.

Challenges and Barriers to Scaling ABSC

Despite promise, challenges persist: scope-of-practice limits for chaplains, funding shortages (spiritual care budgets <1% of hospital totals), and Eurocentric biases. Standardization lacks, with calls for practitioner guides. Staff training in intersectionality is crucial to avoid cultural appropriation.

Future Directions and Research Outlook

Ongoing TWU-PHC collaborations, backed by CIHR, aim for a practitioner's guide and RCTs on ABSC outcomes. As Canada's population diversifies—projected 30% visible minorities by 2041—ABSC could redefine spiritual care, advancing health equity through respectful partnerships. Nursing programs nationwide stand to benefit, equipping graduates for inclusive practice.

Dr. Francis Maza of PHC affirms, “Spiritual health is a lived reality at the bedside,” positioning ABSC as vital for whole-person healing.

Stakeholder Perspectives: From Patients to Policymakers

Patients report enhanced wellbeing; one oncology participant via participatory art described newfound hope. Educators like Rieger emphasize anti-racist arts training for students responding to MMIWG reports. Policymakers, via BC's spiritual health framework, endorse expansion, potentially influencing national standards.

Actionable Insights for Healthcare Providers

• Stock Art Carts with diverse materials (beads, paints, instruments).
• Train in TVIC and OCAP® principles for Indigenous data sovereignty.
• Partner with universities for student placements in ABSC.
• Evaluate via patient feedback and equity metrics.

By embedding ABSC, Canadian universities and hospitals can pioneer equitable spiritual care, bridging gaps for tomorrow's diverse society.

Photo by Belinda Fewings on Unsplash