Spiritual care. Velindre Cancer Centre Chaplaincy Department

Spiritual care. Velindre Cancer Centre Chaplaincy Department

SPIRITUAL CARE REV.ERIC BURKE. World Health Organisation statement 1948 Health is a state of complete physical, Mental and spiritual well-being and Not merely the absence of disease or Infirmity. World Health Organisation statement 1990 The spiritual aspects of patient care are those aspects of human life relating to experiences that transcend sensory phenomena. They are not the same as religious experiences though for many people religion is an expression of their spirituality. The spiritual dimension of human life may be seen as holding together the physical, psychological and social components. It is often understood as being concerned with meaning and purpose, and for those nearing The end of life, is commonly associated with the need for forgiveness, reconciliation and affirmation of worth. INTRODUCTION. In modern nursing practice there is an ever growing awareness of the need and benefit of what has been termed holistic care, ie the need to treat the whole person which includes both the physical ailments of that person and also the spiritual distress and pain which can be generated in that person because of the physical illness. However difficult we may find spirituality to define, the word is assuming increasing importance in much recent literature, especially that produced by the hospice movement and those engaged in palliative medicine. The concept of Total Pain, as introduced by Dame Cicely Saunders includes the idea of spiritual pain and gives it due weight in patient care. In this respect there is a growing acceptance that we human beings are not just physical entities but consist of body, mind and spirit, three separate components, yet all contributing to the wholeness of a human being. Spiritual care is one of the more overlooked aspects of nursing care probably because it is so often ill-defined and misunderstood and yet as already mentioned, it is receiving increased attention from both healthcare providers and consumers alike, with the increasing recognition that patients who have received what can be termed as

good spiritual care within their nursing care have perceived their care to be of a much better quality and as having more influence on their well being and quality of life than those who did not have their spiritual needs addressed. The failure of many nurses to address the spiritual needs of their patients is largely due to the lack of information and guidelines for the practice of spiritual care. In practice however many nurses frequently deal with matters of spirituality without recognising or naming them as such. What is spirituality? Spirituality is hard to define precisely but it refers to attitudes, beliefs and practices which animate people s lives and provide a dimension of human experience having to do with identity, purpose and meaning. People develop their own spirituality over the course of a lifetime. In developed societies spirituality is typically expressed through formalised religion of one sort or another but it is important to realise that the concept of spirituality is much broader than religion and that religion is only one form of spiritual expression. While everyone has a spiritual dimension, in Britain today only a minority of people practice a formal religion, hence, although people commonly say I am not Religious, they do not say I am not spiritual. [Working party on the impact of hospice experience 1991 Pg 151-2] Unfortunately, many nurses believe that meeting a patient s spiritual needs means finding out if they have a religious affiliation and then arranging for the appropriate chaplain or minister of religion to visit them. What are Religious Needs? Many people express their spirituality in terms of religious belief and membership of a particular faith or religious movement be it Christian, Jewish, Muslim, Hindu or any other of the many world faiths and religions. We are living in a multi-cultural society so nurses must be prepared to meet patients from many different religious backgrounds. Many patients will have strong religious beliefs and will have certain needs that come with their religious faith. Others will hold a nominal religious affiliation and definite religious needs will not be high on their list of priorities. Taking the Christian patient as an example, there are a variety of religious needs that need to be met and the Christian patient could require some or all of the following :- Prayer, Holy Communion, Anointing, Confession, Absolution, Baptism, to be able to attend a religious service on a Sunday, to receive a blessing and at the time of death, to be commended into Gods care. It is also important to remember that within the umbrella of the term Christian there are many different denominations with many different beliefs and needs.

Most of the major world faiths have certain rituals surrounding death and the nurse or carer must be aware of these and be able to give the appropriate care or be able to call an appropriate person to carry out these rituals. What are Spiritual Needs? Every individual person is different and has his or her own spiritual dimension developed over a lifetime influenced by various events in their lives and containing a set of beliefs and values that are unique to that person. Because of this it is difficult to say what are the exact spiritual needs of any particular individual and all we can do is acknowledge that each person is at a different stage of development in their lives and that each stage brings with it different needs, sometimes these needs are openly expressed at other times they are hinted at by the way a patient acts. However the main spiritual needs of any individual are to be accepted and valued. There is also the need to make sense of what is happening in their lives and to find a meaning to what is happening. This search for meaning is often but not always done through and in the light of a persons religious beliefs so that there is often the need to explore the teachings of religion in relation to their particular life situation. This spiritual need to explore a particular life situation and make sense of it is perhaps the greatest need of all in a patient and to do this properly the patient needs to find somebody, be it a doctor, nurse, chaplain or anybody who can offer a safe unthreatening environment in which the exploration can be enabled to take place. This person needs to be a companion to the patient on their journey and be able to stay with the patient as they explore their situation without judgement or any desire to change or influence their path on this exploration. What is spiritual pain? The concept of Total Pain has within it the notion of Spiritual Pain. It recognises that spirituality is an integral part of life and must be acknowledged if we are to give optimum care. Spiritual pain must be addressed not simply because it has an effect on the physical aspects of suffering but also because of our commitment to the care of the whole person. Spiritual pain may be evident in a variety of ways. Many patients need help to face feelings of guilt or unworthiness that can truly be described as spiritual pain, sometimes amounting to deep anguish.it is often expressed as a feeling of meaninglessness, that neither the world nor oneself has any purpose or meaning. Guilt and anger are common elements of spiritual distress or pain, plus the feeling that control of ones destiny has been taken over by others and that there is no way to alter or change the course of events. The fear of death and the possibility of judgement after death are also great contributory factors to spiritual pain as is the presence of unresolved questions about the nature of life beyond physical existence.

How are spiritual issues raised? Spiritual issues do not need to be raised with a patient, rather they should be allowed to surface on there own. The greatest skill of a person who is attempting to give spiritual care is the ability to listen and to look for indications from the patient. Peter Speck gives a number of indications of spiritual distress which include a sense of meaninglessness/helplessness, intense suffering, a feeling of the remoteness of God [which may lead to breaks with religious/cultural ties], anger towards God/religion/clergy, a sense of guilt or shame and unresolved feelings about death. However, these indications may not be obvious if patients are not the objects of our full attention or if they sense some barrier in the relationship. Very often we will need to be on the alert to the half spoken questions, the if only or what if queries or the it makes you think type of statements. These statements may well be the tip of the iceberg and if handled sensitively may lead to the patient revealing to you their inner world of turmoil and spiritual pain. The patient may often raise questions directly to a nurse or carer which has nothing to do with the physical ailment but all to do with the onset of spiritual pain. These sort of questions are those like why? why me? what have I done to deserve this? what is happening to me? is there a God? Other expressions often voiced are I ve done nothing worthwhile with my life, Who will remember me when I ve gone? or Why should anyone care about me?. How is Spiritual Care given? Spiritual Care Spiritual care.[is] responding to the uniqueness of the individual : accepting their range of doubts, beliefs, and values just as they are. It means responding to the spoken or unspoken statements from the very core of that person as valid expressions of where they are and who they are. It is to be a facilitator in their search for identity on the journey of life and in the particular situation in which they find themselves. It is to respond without being prescriptive, judgemental or dogmatic and without preconditions; acknowledging that each will be at a different stage on that personal spiritual journey. [D. Stoter[1995] Spiritual aspects of healthcare. London-Mosby-Page 8] To the type of statements or questions indicated in the previous paragraph there are no direct answers that can be handed out in the way pills or medicine are given. A useful starting point is to begin by listening and receiving the questions and doubts as they are voiced by the patient, and allowing the patient to be who they are and as they are. This is the baseline from which to move forward, just to be alongside in a non-threatening, non-judgemental, non authoritarian relationship which is not invasive of a patient s personal world of belief.

When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone to cry. A person who is suffering does not want explanation: The person wants consolation. Not reason but reassurance [Rabbi Harold Kushner-Why do bad things happen to good people] There is no ideal person to give spiritual care and in most cases the patient his or herself will chose who they wish to trust and confide in. All hospitals and hospices will have a trained healthcare chaplain who can facilitate and coordinate this care It is most important to have a multi-professional approach to their care; for instance if a patient chooses to relate to a particular nurse and raises issues of faith or religion then the healthcare chaplain should not simply try to take over the situation but should offer his or her expertise and knowledge to the nurse to enable him or her to continue the care with more confidence. It should become a duel role of care. The most effective spiritual care is done by simply being there and available to the patient. The simple quiet presence of a nurse or chaplain can often do much to quiet the anxieties and fears of the patient. This presence communicates without words to the patient the feeling that he/she is valued, cared for and understood. The dying are essentially people on a journey. They are uprooted people, dispossessed, marginalised, travelling fearfully into the unknown Sometimes the movement is barely perceptible, like the moving floors at Heathrow, but sometimes the tracks hurtle through the night, throwing their bewildered occupants from side to side with all the terror of the line to Auschwitz. Above all, the dying are alone and they are afraid. So the spirituality of those who care for the dying must be the spirituality of the companion, of the friend who walks alongside, helping, sharing and sometimes just sitting, empty-handed, when he would rather run away. It is the spirituality of presence, of being alongside, watchful, available, of being there. What about the Carer? [Sheila Cassidy] To care for the spiritual needs of patients can be very demanding on the one who is meeting these needs. To effectively carry out spiritual care the nurse or carer must take care to examine their own spirituality. Many nurses have not considered their own spiritual dimensions or value systems. Having a clear knowledge of their own framework of beliefs may make it easier for them to avoid a judgemental attitude toward patients who happen to have beliefs that conflict with their own ideas about the meaning to life. Giving spiritual care can involve a caregiver in confronting their own demons and devils and it can be very demanding work not least because of the demands that this care giving can put on a carers already overcrowded work schedule. It is often a temptation to retreat or withdraw and ignore the patient s indications or spiritual pain. For the nurse or doctor this can be done by hiding behind their professional role and concentrating purely on the physical aspects of a patient s

illness. For a clergyman or chaplain the same principle exists, rather than face up to the exhausting and sometimes threatening demands of spiritual care he or she can retreat behind the dog collar and simply hand out religious things ie communion, prayer etc, whilst keeping a distance between him/herself and the patients spiritual pain. For those engaged in spiritual care it is important to look after their own needs. Nurse should get together frequently to share experiences and support one another. Debriefing sessions often offered by the chaplaincy department should become an important part of their work rota. Hot baths, aromatherapy, yoga, all these things can help a carer relax and wind down and prevent the pain of a suffering patient taking over their own lives. Remember the BT slogan It s good to talk.