The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

Global synergistic actions to improve brain health for human development.

The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.

O cuidado em saúde promovido pelas religiões afro-brasileiras / Health care promoted by afro-brazilian religions / El cuidado en salud promovido por las religiones afrobrasileñas

No decorrer da história, sempre foram infindáveis os casos em que os sujeitos recorriam a centros espíritas ou terreiros de religiões de matrizes africanas em decorrência de problemas como doenças, desempregos ou amores mal resolvidos, com o objetivo de saná-los. Por conta disso, este artigo visa apresentar os resultados da pesquisa relacionados ao objetivo de mapear os processos de cuidado em saúde ofertados em três terreiros de umbanda de uma cidade do litoral piauiense. Para isso, utilizamos o referencial da Análise Institucional "no papel". Os participantes foram três líderes de terreiros e os respectivos praticantes/consulentes dos seus estabelecimentos religiosos. Identificamos perspectivas de cuidado que se contrapunham às racionalidades biomédicas, positivistas e cartesianas, e faziam referência ao uso de plantas medicinais, ao recebimento de rezas e passes e à consulta oracular. A partir desses resultados, podemos perceber ser cada vez mais necessário, portanto, que os povos de terreiros protagonizem a construção, implementação e avaliação das políticas públicas que lhe sejam específicas.(AU)

In history, there have always been endless cases of people turning to spiritual centers or terreiros of religions of African matrices due to problems such as illnesses, unemployment, or unresolved love affairs. Therefore, this article aims to present the research results related to the objective of mapping the health care processes offered in three Umbanda terreiros of a city on the Piauí Coast. For this, we use the Institutional Analysis reference "on Paper." The participants were three leaders of terreiros and the respective practitioners/consultants of their religious establishments. We identified perspectives of care that contrasted with biomedical, positivist, and Cartesian rationalities and referred to the use of medicinal plants, the prescript of prayers and passes, and oracular consultation. From these results, we can see that it is increasingly necessary, therefore, that the peoples of the terreiros lead the construction, implementation, and evaluation of public policies that are specific to them.(AU)

A lo largo de la historia, siempre hubo casos en los cuales las personas buscan en los centros espíritas o terreros de religiones africanas la cura para sus problemas, como enfermedades, desempleo o amoríos mal resueltos. Por este motivo, este artículo pretende presentar los resultados de la investigación con el objetivo de mapear los procesos de cuidado en salud ofrecidos en tres terreros de umbanda de una ciudad del litoral de Piauí (Brasil). Para ello, se utiliza el referencial del Análisis Institucional "en el Papel". Los participantes fueron tres líderes de terreros y los respectivos practicantes / consultivos de los establecimientos religiosos que los mismos conducían. Se identificaron perspectivas de cuidado que se contraponían a las racionalidades biomédicas, positivistas y cartesianas, y hacían referencia al uso de plantas medicinales, al recibimiento de rezos y pases y a la consulta oracular. Los resultados permiten concluir que es cada vez más necesario que los pueblos de terreros sean agentes protagónicos de la construcción, implementación y evaluación de las políticas públicas destinadas específicamente para ellos.(AU)

A relação entre arte e vida em vigotski: uma análise conceitual / The relationship between art and life in vygotsky: a conceptual analysis / La relación entre arte y vida en vigotski: un análisis conceptual

Este trabalho teve como objetivo analisar a relação entre arte e vida segundo Vigotski. Para isso, foi realizada uma análise conceitual dos capítulos 1, 7, 9, 10 e 11 da Psicologia da Arte, do capítulo 13 da Psicologia Pedagógica e do texto O significado histórico da crise da Psicologia: Uma investigação metodológica. A pesquisa conceitual consiste na análise semântica dos principais conceitos de uma teoria com o intuito de elucidar seus sentidos ocultos ou confusos e desvendar possíveis contradições e ambiguidades no quadro teórico. Podemos observar que a arte é um fenômeno dialético tanto em sua criação como em seus efeitos. A influência da vida, isto é, da realidade sócio-histórica, na criação artística é indireta, pois ela é sempre mediada pelo psiquismo particular do artista. Já o efeito da arte sobre a vida possibilita que o ser humano se conscientize de sua realidade social e se engaje para mudá-la. A arte é, portanto, transformadora, pois reorganiza o psiquismo e possibilita uma mudança nas condições materiais dos seres humanos.(AU)

This study aims to analyze the relationship between art and life according to Vygotsky. Therefore, a conceptual analysis of chapters 1, 7, 9, 10, and 11 of Psychology of Art, chapter 13 of Educational Psychology and the text The Historical meaning of the Crisis of Psychology: A Methodological Investigation was carried out. Conceptual research consists of the semantic analysis of the main concepts of a theory to elucidate its hidden or confused meanings and to reveal possible contradictions and ambiguities in the theoretical framework. Results show that art is a dialectical phenomenon both in its creation and its effects. The influence of life, that is, of socio-historical reality, on artistic creation is indirect since it is always mediated by the artist's particular psyche. The effect of art on life, on the other hand, allows human beings to become aware of their social reality and engage to change it. Art is, therefore, transformative, as it reorganizes the psyche and enables a change in the material conditions of human beings.(AU)

Este proyecto tuve como objetivo analizar la relación entre el arte y la vida, según Vigotski. Para esto, fue realizado un análisis de los capítulos 1, 7, 9, 10 y 11 de Psicología del arte, del capítulo 13 de Psicología Pedagógica y del texto Él significado histórico de la crisis de la Psicología: una investigación metodológica. La pesquisa conceptual consiste en la analice semántica de los conceptos de una teoría, para aclarar sus significados ocultos o confusos y desvendar contradicciones y ambigüedades em el cuadro teórico. Pudimos observar que, el arte es un fenómeno dialéctico en su creación tanto como en sus efectos. La influencia de la vida, esto es, de la realidad socio-histórica, en la creación artística es indirecta, pues es mediada por el psiquismo particular de lo artista. Así, el efecto del arte sobre la vida habilita que lo ser humano adquiera conciencia de su realidad social y que se comprometa a cambiarla. El arte, consiguientemente, transformadora, pues reorganiza lo psiquismo y habilita un cambio en las condiciones materiales de los seres humanos.(AU)

Spirituality in Nursing and Health: A Historical Context, Challenges, and Way Forward.

This article aims to share the historical context of spirituality in nursing, meanings and expressions of spirituality, and different models of spirituality along with its significance in nursing education and practice. Several challenges and tools for the successful integration of spirituality in education and practice are also discussed.

Divinity in nursing: The complexities of adopting a spiritual basis for care.

In this paper, the historical alignment of nursing with divinity-based perspectives and modern New Age nursing theories are explored. The nature of divinity in nursing is examined, together with the complexities and issues that arise in adopting a spiritual basis for care. The work of the key theorists in this area (Rogers, Newman, Parse, Watson, Dossey) is reconsidered and fundamental epistemological problems inherent in this approach reviewed. Specific concerns with the interpretation of holistic care, adoption of doxastic logic, faith-based rationales, influence of Caucasian Judeo-Christian and New Age values, misappropriation of science, use of pseudoscience and development of divinity as social consumer product are discussed. Practical problems with using a spiritual basis in contemporary nursing practice are also explored and the alignment of divinity-based nursing theories with the modern antiscience movement is examined. Overall, the re-emergence of divinity-based nursing and spiritual basis for care may be problematic, and would seem to counter the development of an inclusive profession. Additionally, the alignment of nursing with antiscience movements rejecting biomedicine has significant public health implications. This is argued as a regressive step for the advancement of the profession.

Hospitalized Patients' Perspectives on Spiritual Assessment: A Mixed Methods Study.

BACKGROUND: Research shows that spirituality is important, but patients report that nurses rarely address spiritual issues, and research from the patient viewpoint is limited. AIM: The research objective was to gain knowledge about hospitalized patients' perspectives on spiritual assessment by nurses. METHOD: This is a mixed methods exploratory study reporting on quantitative/qualitative aspects of the patient perspective. Norwegian nurses in an acute care hospital distributed a 21-item spiritual assessment survey to patients they felt would not be burdened by completing it. Patients' demographic data were not identifiable, survey packets were returned anonymously via hospital mail by 157 hospitalized patients. Each survey item and several variables on the demographic sheet had space for comments. Quantitative analysis used SPSS 21, qualitative data were thematically analyzed. FINDINGS: Statistically significant correlations were found with all survey items. Hospitalized people reported high comfort with spiritual assessment by nurses. Qualitative findings revealed that patients had differing views on if, when, and how nurses should ask spiritual questions of them. CONCLUSIONS: It is important to identify patients' perspectives in order to provide patient-centered holistic care. Understanding patient views will enlighten nurses and may promote spiritual care and improve patient health outcomes.

Physician Wellness in Orthopedic Surgery: Challenges and Solutions.

The growing epidemic of physician burnout suggests that a change is needed. Physician wellness is an ever-growing consideration, especially in orthopedic surgery, where the challenges to wellness are significant. This review provides many common sense wellness principles and solutions in four main components of wellness (physical, mental, emotional, and spiritual) interwoven with current research on the topic. Although directed to orthopedic surgeons, this guide can be applied to all physicians, because they are based on common human principles of wellness. Wellness is not created overnight, so wellness practices that increase the likelihood of experiencing wellness are encouraged.

As representações sociais sobre o processo saúde-doença na visão espírita / The social representations on the health-disease process in spiritual vision / Las representaciones sociales sobre el procedimiento salud-enfermedad en la visión espirita

Objetivo: Identificar as Representações Sociais sobre o processo saúde-doença no Espiritismo. Método: Estudo descritivo com abordagem qualitativa. Utilizados na pesquisa conceitos das Representações Sociais de acordo com Serge Moscovici. A coleta dos dados ocorreu através de entrevista semi-estruturada e aplicação da técnica livre associação de palavras e observação Livre. Resultados: O espiritismo crê que conquistamos a saúde quando estamos harmonizados conosco e com as leis divinas. Qualquer descumprimento dessas leis divinas gera um desequilíbrio no ser humano. Conclusão: A Enfermagem necessita reconhecer essas Representações Sociais, visto que elas irão esclarecer aos profissionais as experiências de pacientes religiosos, o modo como assimilam seu estado patológico e isto é um desafio para articulação de estratégias de aproximação

Objective: To identify as Social Representatives about the health-disease process in Spiritism. Method: Descriptive study with qualitative approach. Users in the magazine concepts of the Social Representations according to Serge Moscovici. The data collection was performed through a semistructured interview and the application of free set of free words and observations. Results: Spiritualism believes that it has gained health when we are harmonized with the divine laws. Any breach of divine law creates an imbalance in the human being. Conclusion: The Disease Associated with Social Representations, with the aim of being more exposed to professionals such as patient experiences, the way they assimilate their pathological condition and is a challenge for the articulation of strategies of approximation

Objetivo: identificar como Representantes Sociales sobre el proceso saludenfermedad en el Espiritismo. Método: estudio descriptivo con enfoque cualitativo. Usuarios en la revista conceptos de las Representaciones Sociales de acuerdo con Serge Moscovici. La recolección de los datos fue realizada por medio de entrevista semiestructurada y la aplicación del conjunto libre de palabras y observaciones libres. Resultados: el espiritismo cree que ha conquistado la salud cuando estamos armonizados con las leyes divinas. Cualquier incumplimiento de leyes divinas genera un desequilibrio en el ser humano. Conclusión: la Enfermedad asociada a las Representaciones Sociales, con el objetivo de estar más expuestas a los profesionales como las experiencias de enfermos, el modo como asimilan su estado patológico y es un desafío para la articulación de estrategias de aproximación

Health Care Professionals' Reflections on Their Learning as Spiritual Generalists and Integration Into Practice.

INTRODUCTION: Meeting spiritual needs of patients is an important aspect of quality health care, but continuing professional development and training to provide spiritual care remains inadequate. The purpose was to identify participants' learning from simulation-based spiritual generalist workshops and application to practice. METHODS: Interdisciplinary participants completed self-report demographic questionnaires before the workshops and questionnaires after workshops that listed open-ended take-home learning. Responses were analyzed using qualitative content analysis. A subgroup was surveyed 3 to 9 months after training to examine whether and how participants had incorporated workshop learning into clinical work. RESULTS: Workshop participants 181/211 (85.8%) reported learning in four categories: core values and skills of spiritual generalists, understanding spirituality/religion and its role in health care, interfacing with chaplaincy, and interprofessional teamwork. Of the subsample, 73.5% (25/34) completed surveys 3 to 9 months after training. Of those, 25/25 (100%) reported drawing on what they learned in workshops, and 24/25 (96%) reported making clinical practice changes. DISCUSSION: One-day spiritual generalist simulation-based workshops can improve continuing professional development learning experiences to provide generalist level of spiritual care. Workshops offered valuable learning and resulted in applicable clinical skills across professional roles. At 3 to 9 months after training, participants reported improved spiritual screening, recognition of spiritual distress, and referral to chaplaincy.

Strengthening the spiritual domain in palliative care through a listening consultation service by spiritual caregivers in Dutch PaTz-groups: an evaluation study.

BACKGROUND: Palliative care should be holistic, but spiritual issues are often overlooked. General practitioners and nurses working together in PaTz-groups (palliative home care groups) consider spiritual issues in palliative care to be relevant, but experience barriers in addressing spiritual issues and finding spiritual caregivers. This study evaluates the feasibility and perceived added value of a listening consultation service by spiritual caregivers in primary palliative care. METHODS: From December 2018 until September 2019, we piloted a listening consultation service in which spiritual caregivers joined 3 PaTz-groups whose members referred patients or their relatives with spiritual care needs to them. Evaluation occurred through (i) monitoring of the implementation, (ii) in-depth interviews with patients (n = 5) and involved spiritual caregivers (n = 5), (iii) short group interviews in 3 PaTz-groups (17 GPs, 10 nurses and 3 palliative consultants), and (iv) questionnaires filled out by the GP after each referral, and by the spiritual caregiver after each consultation. Data was analysed thematically and descriptively. RESULTS: Consultations mostly took place on appointment at the patients home instead of originally intended walk-in consultation hours. Consultations were most often with relatives (72%), followed by patients and relatives together (17%) and patients (11%). Relatives also had more consecutive consultations (mean 4.1 compared to 2.2 for patients). Consultations were on existential and relational issues, loss, grief and identity were main themes. Start-up of the referrals took more time and effort than expected. In time, several GPs of each PaTz-group referred patients to the spiritual caregiver. In general, consultations and joint PaTz-meetings were experienced as of added value. All patients and relatives as well as several GPs and nurses experienced more attention for and awareness of the spiritual domain. Patients and relatives particularly valued professional support of spiritual caregivers, as well as recognition of grief as an normal aspect of life. CONCLUSIONS: If sufficient effort is given to implementation, listening consultation services can be a good method for PaTz-groups to find and cooperate with spiritual caregivers, as well as for integrating spiritual care in primary palliative care. This may strengthen care in the spiritual domain, especially for relatives who are mourning.

O potencial consolador das cartas psicografadas na saúde emocional de enlutados / The consoling potential of psychographed letters in the emotional health of bereaved people

Resumo A pesquisa objetivou conhecer o estado emocional de pessoas em luto complicado que receberem cartas escritas por médiuns, cuja emissão foi atribuída a seus entes falecidos. Trata-se de estudo qualitativo com abordagem quantitativa, realizado com 48 voluntários em três cenários, sendo um virtual e dois presenciais. Estes responderam a formulários estruturados compostos por nove perguntas que definiram o perfil dos participantes; e a 17 perguntas sobre o luto, elaboradas conforme critérios do Diagnostic and Statistical Manual of Mental Disorder (DSM-5), que verificou os sentimentos antes e depois da comunicação mediúnica. Concluímos que as mensagens contribuíram para melhorar a saúde emocional das pessoas provenientes dos cenários presenciais, interferindo positivamente na qualidade de vida, validando o conceito de "Cartas Consoladoras".

Abstract The research aimed to know the emotional state of people in complicated mourning who receive letters written by mediums, whose emission was attributed to their deceased ones. This is a qualitative study with a quantitative approach, carried out with 48 volunteers in three scenarios - one virtual and two in person. These responded to structured forms composed of nine questions that defined the profile of the participants; and 17 questions about grief, elaborated according to the criteria of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5), which verified feelings before and after mediumistic communication. We conclude that the messages contributed to improve the emotional health of people from face-to-face settings, positively interfering in the quality of life, validating the concept of "Consoling Letters".

The Relationship between Spiritual Intelligence and Resiliency of Rehabilitation Staff.

This research aims to determine the relationship between spiritual intelligence and resiliency of rehabilitation staff. The reliable and validated spiritual intelligence and CD-RISC resiliency and demographic scales were used to collect data. There is a significant relationship between spiritual intelligence and the resiliency of rehabilitation staff (r = 0.38). Results showed that by increasing spiritual intelligence, resilience could increase.

Reconciling as a Primary Pastoral Act of Spiritual Care.

Hiltner's shepherding perspective offered a primary reference point for pastoral theologians. This paper examines how the reconciling function of that perspective guides the care proceeding from it for Black persons experiencing medical crises. I analyze connections in the work of Archie Smith with Black persons involved in the healthcare system to show how Black persons draw upon spiritual resources and other resources implicit to the Black community itself in order to reconcile lived experiences with sickness.

Nurse care for the hospitalized elderly's spiritual dimension.

OBJECTIVE: to analyze the nurse care for the spiritual hospitalized elderly's dimension. METHOD: a qualitative study, based on Jean Watson's Theory of Human Caring. The study included 17 nurses working in a geriatric center in Salvador City, Bahia State, Brazil. The collection of testimonies occurred between January and April of 2018, through an interview. RESULTS: spiritual care were dialogue, encouragement and respect for religious activities, embracement, empathy. One of the obstacles to providing this care was the lack of preparation in accessing the elderly's spiritual dimension. FINAL CONSIDERATIONS: spirituality is a dimension of human and holistic nursing care. Caring for the spirit contributes to foster transpersonal care. The difficulty may be in the lack of nurses' preparation. It is necessary that they cultivate and live their own spirituality, transmitting the understanding in each care relationship.

Spirituality and religiosity for the transcendence of the elderly being.

OBJECTIVE: to understand the life experiences that favor transcendence of the elderly being. METHOD: a qualitative phenomenological hermeneutic study, in two groups of elderly coexistence. The selection of participants was by intentional sampling: 11 elderly, achieving theoretical saturation. Data collection was carried out through a phenomenological interview with a detonating question. Ethical principles of the General Health Law in health research were fulfilled. Analysis with Heideggerian hermeneutic circle was performed. RESULTS: unity of meaning on the consciousness of a higher power for transcendence is highlighted, where spirituality and religiosity are resources of the elderly for strength, feel protected, overcome difficult situations and reach fullness; both favor the understanding of their historicity by manifesting enlightenment. FINAL CONSIDERATIONS: transcendence of the elderly being is favored with spirituality and the experiences of their daily life are imbued with a spiritual and religious relationship that give meaning to their existence.

Vínculos entre homeopatia e espiritismo no Rio Grande do Sul na passagem para o século XX / Ties between homeopathy and Spiritism in Rio Grande do Sul at the turn of the twentieth century

Resumo A prática da homeopatia teve importante desenvolvimento no Brasil na passagem para o século XX. Especialmente do Rio Grande do Sul, estado na região Sul do Brasil, homeopatas conseguiram introduzir suas práticas vinculando-se a uma perspectiva científica que organizou uma proposta de curso superior, mas também a um movimento religioso que divulgava o uso da homeopatia por meio de receituário recebido por médiuns. Esses dois movimentos possuíam adeptos que atuavam em frentes diversas, oferecendo os medicamentos homeopáticos gratuitamente ou divulgando suas ideias em periódicos e outros meios. O artigo analisa esses contextos de interação dos homeopatas e de práticos espíritas na primeira metade do século XX, procurando entender como essas perspectivas se aproximaram e permitiram permanências.

Abstract The practice of homeopathy developed significantly in Brazil at the turn of the twentieth century. Especially in Rio Grande do Sul, the southernmost state in Brazil, homeopaths were able to introduce their practices by linking them to a scientific perspective that organized a plan for advanced training as well as to a religious movement which disseminated the use of homeopathy through prescriptions received by mediums. These two movements had supporters who worked on several fronts, offering homeopathic medicines for free or spreading their ideas in magazines and other vehicles. The article analyzes these contexts in which homeopaths and Spiritist practices interacted during the first half of the twentieth century in an attempt to understand how these perspectives approached each other and permitted continuity.

Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.

Training for awareness of one's own spirituality: A key factor in overcoming barriers to the provision of spiritual care to advanced cancer patients by doctors and nurses.

OBJECTIVE: When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with "unrealized potential" for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it. METHOD: We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.ResultWe had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How "developed" a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.Significance of resultsDespite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.