Spirituality and end of life

Transcription

1 Spirituality and end of life Dr. Wilf McSherry Professor in Nursing

2 Objectives Demonstrate why spiritual care is important at the end of life Highlight the importance of being aware of our own spirituality and how this may impact upon the provision of spiritual care at the end of life Offer some simple strategies and approaches to support the assessment and delivery of spiritual care at the end of life

3 One Chance To Get It Right Priority 5 (pg. 24) An individual plan of care, which includes food and drink, symptom control and psychological, social and spiritual support, is agreed, co-ordinated and delivered with compassion.

4 National care of the dying audit for hospitals, England (2014 Pg. 52) Discussions regarding the patient s spiritual needs were held with patients who were capable of participating in such discussions (52%, n=3,391): Yes 21% (715) No 79% (2,676)

5 New Nursing and Midwifery Council (NMC) Code There is no mention of the word spiritual Discrepancies between Code of practice and other documents such as Guidance for pre-registration nursing programmes

6 Competences All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. Nursing and Midwifery Council (2010 p 45) Standards for pre-registration nursing programmes NMC London.

7 Spirituality and nursing Strongly Disagree Disagree Uncertain Agree Strongly Agree

8 Spirituality and quality of care Strongly Disagree Disagree Uncertain Agree Strongly Agree

9 RCN (2011) Spirituality is about: Hope and strength Trust Meaning and purpose Forgiveness Belief and faith in self, others and for some this includes a belief in a deity/higher power Peoples values Love and relationships Morality Creativity and self expression

10 McSherry (2009) Definition of Spirituality Spirituality is universal, deeply personal and individual; it goes beyond formal notions of ritual or religious practice to encompass the unique capacity of each individual. It is at the core and essence of who we are, that spark which permeates the entire fabric of the person and demands that we are all worthy of dignity and respect. It transcends intellectual capability, elevating the status of all of humanity... McSherry, W. Smith, J (2012 p 118) Spiritual Care In McSherry, W., McSherry, R., Watson, R. (Eds) (2012) Care in Nursing Principles values and skills Oxford University Press, Oxford

11 A scenario Question to consider as I am reading: What is the model of care evident in the scenario Piles, C Providing spiritual care Nurse Educator 15 (1) 36 41

12 Medical Model? TRAUMA NURSING CARE MANIKIN, Clinical Training Model, medical model,anatomical model Training-Model-medical-model-anatomical-model.html

13 Assessing and providing spiritual care The practice of spiritual care is about meeting people at the point of deepest need. It is about not just doing to but being with them. It is about our attitudes, behaviours and our personal qualities i.e. how we are with people. It is about treating spiritual needs with the same level of attention as physical needs. RCN (2011) RCN/NCPC Conference

14 Reflections from a Sideward Question to consider as I am reading: What is the model of care evident in this situation McSherry, W. (1996) Reflections from a Sideward. Nursing Times 92 (33) p29, 31

15 Me and my context What we assess, and what we deliver ALWAYS depends on me and my context Do I feel comfortable going deep - or do I refer on? Is specialist input required (e.g. Chaplain, own minister) Can I make the time needed? What level of communication is there (family or patient) etc? RCN/NCPC Conference

16 Patient led and expressed need It also ALWAYS depends on the patient and/or family What do they understand by spiritual or religious care? Do they have a spiritual/belief framework? Do they want anything explicitly labelled as spiritual care? What do they want- and can I (we) do it or get it? There is always complexity for example, when family and patient are in a different spiritual place - but that s what makes this challenging and interesting! RCN/NCPC Conference

17 We get treatment in the hospital and care in the hospice

18 Treatment Scientific Proficient Technical Competence Detached Robotic Cold

19 Care Warm Time Presence Valued Accepted Recognise the person

20 Hard and Soft Nurse Hard Proficient Technical Competence Detached Robotic Cold Soft Warm Time Presence Valued Accepted Recognise the person

21 Harvey Chochinov, O.M, M.D., PhD, FRCPC University of Manitoba Director, Manitoba Palliative Care Research Unit Cancer Care Manitoba Chochinov, H, M. (2007) Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. British Medical Journal 335,

22 Dignity conserving care at the end of life A D B C

23 Conclusion Spirituality reminds us to focus our attention on the individual the person, not just the medical condition at the end of life Nurses and all health and social care professional can play a key role in the assessment and provision of spiritual care at the end of life There is a need for us all to have an awareness of our own spirituality and how this may impact on the delivery of spiritual care at the end of life