*2.1. Spirituality*

Approaching care practices in a hospice from a ritual perspective fits the holistic approach of palliative care itself. From its beginnings, palliative care applies a holistic approach of care, meaning that a patient is approached from physical, psychological, social and spiritual perspectives. This becomes clear in, among other things, the definition of palliative care by the World Health Organization (WHO):

"[ ... ] an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."1

It is mainly the spiritual dimension of palliative care that leads us to pay attention to rituals and ritualized care practices. With this approach we follow, among others, ritual studies scholar Ronald Grimes, who explicitly links spirituality to ritual. In relation to the second research question of this article, we use a definition of spirituality which is, on the one hand, closely linked to the context of the research (palliative care and hospice care), and on the other hand, open and broad to include both religious and non-religious views on dying and death. For these reasons, we use the European consensus definition that was developed in the context of palliative care. According to this definition, spirituality is:

"[ ... ] the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred." (Nolan et al. 2011, p. 88)

This broad definition addresses both the individual and relational aspects of spirituality. In this study, we take on a relational approach of spirituality by looking at spirituality as a dimension that occurs in contacts between healthcare professionals and patients. Within this care relationship, meaning-making practices take place both implicitly and explicitly. This means we can find the spiritual dimension in everyday care practices.
