Caring for Spiritual Needs

Liza Waller Chaplain

2014

Learning Outcomes

• To identify what we mean by spiritual care and why it’s important in palliative care

• To understand differences between ‘spiritual’ and ‘religious’ needs

• To gain understanding of spiritual assessment

• To gain understanding of spiritual well being and spiritual distress

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What is spiritual care

‘I want someone who will have time for me, to listen to me, who will not judge me, who will take what I feel seriously’

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Being there and being human

‘Sometimes I feel like shouting at a nurse or a doctor, you know... ‘Don’t just stand there , do something!’ I feel so helpless.

But then most of the time I feel like shouting instead ‘Don’t do something just stand/stay there!’ There aren’t any rule books for that but I think the strategy is to be human’.

(Talking about Spirituality in Health Care Practice Gillian White)

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Listening listening listening

Listening to patient’s stories and narratives – life stories – helping them to piece together the fragments and find the meaningful threads that have been in their lives. What have been the significant moments? turning points? What have been the values they have lived by? What helped them get through hard times? How do they make sense now of what is happening to them?

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Why is spiritual care important ?

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Dame Cicely Saunders

‘Spiritual Care is our attempt to help the person find acceptance and prepare for death’ ‘You matter because you are you, and you matter to the end of your life.’

‘We will do all we can not only to help you die peacefully, but also to live until you die.’

Essential element of healthcare

‘Spirituality is an essential element of healthcare because spirituality is the essence of our humanity. It is that part of people that seeks healing, meaning, and groundedness in the midst of suffering or illness.‘ (McSherry 2010)

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Professional responsibility

• ‘NHS staff will respect your privacy and

dignity. They will be sensitive to, and respect your religious, spiritual and cultural needs at all times’ (‘Your guide to the NHS, Dpt of Health 2001)

• ‘Spiritual Care is our attempt to help the person find acceptance and prepare for death’ (Cicely Saunders ‘Total Pain’)

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• ‘Everyone is a spiritual being regardless of faith and religious affiliation’ (Wright 2002)

• ‘Palliative care should ... integrate the psychological and spiritual aspects of patient care’ (WHO 2002)

• ‘The responsibility of the whole team....’(NICE

2004)

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What is spirituality?

What does it mean to you? ‘In order for staff to meet the

spiritual needs of others they need to be aware of their own spirituality’

(Wright 2002)

The nature of truth

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A definition of spirituality

Spirituality can be defined as that which gives ultimate or transcendent meaning in life – could be nature, energy, belief, family, community - may include religious belief relationship with a notion of ‘god’, and may not.

(Puchalski 1999)

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• ‘Spirituality is about the heart. Whatever and whoever most matters to me in my heart is what I call of deep spiritual importance’

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Differences • Spirituality

• Individual

• Personally defined

• Subjective

• Emotionally orientated

• Inward vv outward focus

• No doctrine

Handbook of Religion and Health 2001

• Religion

• Organised collective system of faith and beleifs

• Community focussed

• Cumulative traditions

• Prescribed rules and rituals

• Observable Objective

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Speck 1998

• Spirituality ‘A search for existential meaning within an individual life experience, with reference to a higher power beyond the self which may not necessarily be called God’

• Religion ‘A particular system of faith and worship expressive of an underlying spirituality and interpretive of the named religious understanding of God’

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More definitions

Spiritual: - spiritual ‘breath of life’ - what makes us feel alive the search for existential meaning within a life experience with reference to a power other than self which may or may not be called God (e.g. higher power, force energy, etc.), unique and Individual.

Religious - involves system of rules and beliefs, customs, practices. A particular system of faith and worship expressive of an underlying spirituality and interpretive of the named religion’s understanding of ‘God’

Philosophical – e.g. Existentialism, humanism, atheism

Where the search for existential meaning excludes any reference to a power other than the person him/herself. (Cobb and Robshaw1998)

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Cobb and Redshaw 1998

Spiritual

Philosophical

Religious

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‘The importance of both spirituality and religion is that they provide a context in which people can make sense of their lives, explain and cope with their experiences and find and maintain and sense of hope, inner harmony and peacefulness in the midst of the existential challenges of life’ (Dept of Health paper 2011)

Spiritual Assessment

Enquiry into religious belief

.

In depth spiritual

experience

Spiritual wellbeing Spiritual distress

Wellbeing and/or distress

• connection belonging peace harmony acceptance pleasure joy integratation wholeness

• disconnection disHarmony – disEase meaninglessness despair anger agitation loneliness inner conflicts guilt fear

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Caring for your

Spiritual Well Being

How to assess

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Building Spiritual strengths Puchalski Handzo Wintz& Bull 2009

• Gratitude

• Hope

• Ability to forgive

• Connection to self/transcendent/God

• Support from spiritual/religious community

• Peace/serenity/acceptance

• Surrender

• Love

• Forgiveness of self

• Satisfying philosophy of life

• Joy

• Courage

• Prayer/meditation

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Enablers to Providing Spiritual Care

• Active listening

• Sense of hope

• Awareness of own spirituality

• Maintaining the patient’s dignity and humanity

• Promoting quiet time

• Allowing space

• Being there

• Recognising the human dimension between the patient and carer

Barriers to Providing Spiritual Care

• Lack of knowledge • Lack of confidence • Lack of time • Lack of privacy • Lack of continuity • Difficulty assessing spiritual need • Inappropriate environment • Staff unaware of own spirituality • Lack of formal preparation in nurse education

Spiritual Care Communication skills

• Compassionate presence

• Reflective listening, query about important life events

• Support of patient’s sources of spiritual strengths

• Open ended questions to elicit feelings

• Gentle inquiry about spiritual beliefs, values, practices

• istening to patient’s narrative and life story

• Follow up - referral

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What’s needed is… • Relationship

• Being there

• Space and time

• Connection

• Trust

• Sensitivity

• Respect

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Helpful reading

• Ed: Cobb M & Robshaw V 1998 The Spiritual Challenge of Healthcare Churchhill Livingstone

• Cobb M 2001 The Dying Soul. Spiritual Care at the End of Life Open Univ Press

• Frankl. V (1959) 2004 Man’s Search for Meaning Rider

• Kushner .H. 2001 When bad things happen to good people. Shocken Books

• Ed : McSherry.W and Ross L 2010 Spiritual Assessment in Healthcare Practice M&K publishing

• Neuberger J 2004 Caring for Dying people of Different Faiths Radcliffe Medical Press

• Ed: Orchard H 2001 Spirituality in Health Care Contexts Jessica Kingsley

• Puchalski C.M and Ferrell B 2010 Making Healthcare Whole Templeton Press

• White G 2006 Talking about Spirituality in Health Care Practice Jessica Kingsley

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