SpirOnto:
Semantically Enhanced
Patient Records for Reflective
Learning on Spiritual Care in
Palliative Care
ARTEL Workshop 2013, Paphos, Cyprus
Christine Kunzmann, Traugott Roser,
Andreas Schmidt, Tanja Stiehl

http://spironto.de 2Sep 2013
Motivation
 Palliative care is a multi-professional environment
 Doctors
 Nurses
 Chaplains/Spiritual caregivers
 Social workers
 Patient record as „boundary object“
 Information store and basis for decision making
 Foundation for reflection („Supervision“)
 Gaining evidence and insight into spirtual care

Reflective practice
 Demanding nature of child palliative care
 Regular reflective practice in informal group sessions
 Narratives about individual patients
 Development of a deep and rich understanding of their
work
 At longer time intervals: institutionalized supervision
http://spironto.de 3Sep 2013

Spiritual care
http://spironto.de 4Sep 2013
 Culturally sensitive spiritual care is as important as medical
and care in palliative situation
 Currently, however, spiritual care is not seen as a systematic
approach with observable effects (as medicine or care)
 For a basis for a systematic approach, an concept network
(„ontology“) was created which was derived from existing
documentation
 Facilitates finding gaps and possibilities for action beyond
one‘s own profession

Ontology development
 Ontology developed based on 143 existing patient
records (on paper, years 2004-2009)
 Qualitative analysis
 Formative evaluation of the resulting ontology with staff
members with various backgrounds
http://spironto.de 5Sep 2013

Full ontology
http://spironto.de 6Sep 2013

Ontology
 Facts about a patient or its social environment,
demographics, disease/care status, cultural background
 Observations that led to the identification of the facts
(timestamp and a possibly rich description)
 Spiritual concepts that interpret facts, such as eternity
and finiteness, eternal love, guilt, purity, powerlessness
vs. almightiness, or autonomy
 context-dependent interpretations
 Spiritual interventions are possible spiritual care
activities, e.g., support, meaningful silence, pastoral
interviews, practical consultancy, or rituals.
http://spironto.de 7Sep 2013

http://spironto.de 8

http://spironto.de 9Sep 2013

The System
 Phased development
 Summer 2013: First initial prototype developed for
Windows Notebooks and Tablets
 Intended as a proof of concept for getting feedback
 Testing planned
 Further development and larger scale evaluation planned
for 2014
http://spironto.de 10Sep 2013

http://spironto.de 11Sep 2013

http://spironto.de 12Sep 2013

Screenshot
http://spironto.de 13Sep 2013

Conclusions
 Spiritual care is often belittled as lacking evidence of its
effectiveness
 Development of the ontology has already shown that
spiritual care follows a systematic approach.
 made visible through the general structure of the ontology:
observations/facts, spiritual concepts as
interpretations, and spiritual care interventions.
 Workshops with physicians, social workers, and carers: can
act as a boundary object between the disciplines and can
create awareness about spiritual care and its relevance
 First prototype with editing capabilities about to be
tested, analysis and visualization planned for 2014
 Also applicable in related fields, such as elderly care, or
care for handicapped people
http://spironto.de 14Sep 2013

Team
 Christine Kunzmann, Pontydysgu, UK
kontakt@christine-kunzmann.de
 Traugott Roser, University of Münster, Germany
traugott.roser@uni-muenster.de
 Andreas P. Schmidt, Karlsruhe University of Applied
Sciences, Germany
andreas_peter.schmidt@hs-karlsruhe.de
 Tanja Stiehl, Center of Pediatric Palliative Care, LMU
Munich, Germany
tanja.stiehl@med.uni-muenchen.de
http://spironto.de 15Sep 2013