BackgroundThough most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations.MethodsForty-six digitally-recorded interviews were conducted with bereaved family members, care providers and administrators associated with four hospice organizations in North America, representing Buddhist, Catholic, Jewish, and Salvation Army faith traditions. The interviews were analyzed iteratively using the constant comparison method within a grounded theory approach.ResultsNine Principles for organizational support for spiritual care emerged from the interviews. Three Principles identify where and how spiritual care fits with the other aspects of palliative care; three Principles guide the organizational approach to spiritual care, including considerations of assessment and of sacred places; and three Principles support the spiritual practice of care providers within the organizations. Organizational practices that illustrate each of the principles were provided by interviewees.ConclusionsThese Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-017-0197-9) contains supplementary material, which is available to authorized users.

Ritual is part of what it means to be human. It defines and enriches culture, but what is ritual? What are the various kinds of ritual? Is ritual tradition bound and conservative or innovative and transformational? Ritual: A Very Short Introduction describes a number of specific rites and explores ritual from theoretical and historical perspectives. It focuses on the places where ritual touches everyday life; shows how ritual is an important vehicle for group and identity formation; how it generates and transmits beliefs and values; how it can be used to exploit and oppress; and how it has served as a touchstone for thinking about cultural origins and historical change.

Throughout the 1970s and the 1980s, scholarly theories of ritual began incorporating the language of ‘action’, ‘performance’, and ‘practice’, partly as a corrective to perceived limitations to existing theory, which was dominated by structuralism and communicative models. Ritual, once conceived as staid and habitual—in the best case, expressive, communicative, and symbolic of already existing ideas, beliefs, and values—was approached freshly in terms of agency and efficacy. In early theory, ritual was said to function as a kind of social glue, binding individuals in groups and confirming social statuses and hierarchies. Performance and action-centred theories variously analyse the socially disruptive and transformative potentials of ritual, questions of aesthetics and embodiment, and the formal, invariant properties of ritual. ‘Action’ is a particularly difficult concept, as it is conceived and used in ritual theory in several different, sometimes antithetical ways.

In the lexicon of ritual theory, the notion of ritualization bears a heavy load. The concept aims to account for both the origins and functions of ritual (at both the biological and cultural levels), as well as inform reflection on the meaning and merit of ritual and even ritual theory. Broadly, ritualization refers to modifications in behaviours (or actions) that, when combined, stereotyped, formalized, and repeated eventuate in recognizable rites (or rituals). Ritualization is to ritual as a tree is to a house or a gear to a bike. Since ritualization is especially concerned with processes, the concept is important to discussions of the dynamics of ritual—its origins, changes, adaptations, and developments. Different theorists, however, use the concept in quite specific, sometimes antithetical, ways.

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