Spiritual care at End of Life

SPIRITUAL CARE AT END

OF LIFE

Uniting Mission: Pastoral and Spiritual Care SeriesRev Jorge RebolledoHead of Mission Education

Restoration & Transformation

• Restoration: strategies associated with “rituals of modern medicine”

• Transformation: strategies associated with ritual practices of traditional and spiritual healers and faith communities who acknowledge human limits and mortality

Two distinct “ritual” strategies that organise and interpret the

experience of dying

Restoration & Transformation

• Restoration: strategies associated with “rituals of modern medicine”

• Transformation: strategies associated with ritual practices of traditional and spiritual healers and faith communities who acknowledge human limits and mortality

What is Spirituality?

That which lies at the core of each person's being, an essential

dimensionwhich brings meaning to life. It is

acknowledged that spirituality is not only

constituted by religious practices, but must be understood more broadly

asrelationship with God, however God or ultimate meaning is perceived by theperson, and in relationship with other

people.(MacKinlay, 2006: 14)

What is Spiritual Care?

• What do you think it is?

• Definition

• What have you experienced?

• Uniting and Spiritual Care• Who does it?

What is Spiritual Care?

• What do you think it is?

• Definition

• What have you experienced?

• Uniting and Spiritual Care• Who does it?

That care which recognises and responds to theneeds of the human spirit when faced with

trauma,ill health or sadness and can include the need

for meaning, for self worth, to express oneself,

for faith support, perhaps for rites or prayer orsacrament, or simply for a sensitive listener.

Spiritual care begins with encouraging humancontact in compassionate relationship, and moves

in whatever direction need requires’

What is Spiritual Care?

• What do you think it is?

• Definition

• What have you experienced?

• Uniting and Spiritual Care• Who does it?

What is Spiritual Care?

• What do you think it is?

• Definition

• What have you experienced?

• Uniting and Spiritual Care• Who does it?

Spiritual Care 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.

Spiritual Care is not…

…just about religious beliefs and practices

…about imposing your own beliefs and values

…using your position to convert

…a specialist activity

…the sole responsibility of the chaplain.

Who does Spiritual Care?

• What do you think it is?

• Definition

• What have you experienced?

• Uniting and Spiritual Care• Who does it?

Spiritual DistressSigns of Spiritual distress

The following is not an exhaustive list but does show some common symptoms: 

• tearfulness or weeping• withdrawal or lack of interest• restlessness or being unable to settle• complaining• anger• sudden religious leanings or abandonment of previously held beliefs• fear (of being alone or falling asleep and so on).

Potential TriggersThese may differ across specific clinical specialties but more generally these may include:

• after a trauma (such as an accident or assault)• when bad news is broken• when a lengthy stay is envisaged• when a situation becomes life-threatening or terminal• when a bereavement is being experienced• when a patient is isolated and receiving no visitors• when a patient is a long way from home• when undergoing a crisis (in personal or home situations as well as in health)• when treatment is being withdrawn• on a significant anniversary.

What to do?

What do you think you should do if you see signs of Spiritual Distress in a resident or

colleague?

What can I do as a Nurse?

• Adopt a caring attitude and disposition

• Recognise and respond appropriately to people’s needs

• Use observation to identify clues that may be indicative of underlying spiritual need e.g. peoples’ disposition (sad/withdrawn), personal artefacts (photographs, religious/ meditational books and symbols)

• Give time to listen and attend to individual need

• Be aware of when it is appropriate to refer to the Chaplain or other form of support

Guidelines for Spiritual Care by Non-Chaplain Staff

• Listen more than talk • Practice being present • Avoid judgment of beliefs, practices, or emotional responses • Refrain from proselytising or imposing your own beliefs • Avoid discussion of religious doctrine, dogma, and complicated theological questions • Avoid religious clichés • Respect patient and family spiritual framework and practices • Coordinate and collaborate as a member of the

interdisciplinary team • Refer to Chaplain

SPIRITUAL CARE AT END OF LIFE

Basic Skills and Techniques

“do you have a way of making sense of the things that happen to you?”

“what sources of support/help do you look to when life is difficult?”

“would you like to see someone who can help you?”

“would you like to see someone who can help you talk or think through the impact of this illness/life event?

(You don’t have to be religious to talk to them)”

Just as you would assess your patients’ physicalneeds, an initial assessment of their spiritual

concerns is also important.

You may findquestions such as these helpful:

Empathetic Presence• Just be there

• Listen more than talk

• Use Active Listening techniques to show empathy etc.

• What does an empathetic presence do?

Recall an experience from your own personal or professional life when you were unable to help someone feel better, take away

their pain, or “fix” a problematic situation.

An exercise in empathetic presence

How did you feel? How did you cope with these feelings?

How did you respond to the person who was suffering?

Reflect for a moment:

• Are you a problem solver, seeking solutions and offering advise?

• What does it mean for you as a nurse, doctor, social worker, etc. to be powerless?

• Do you feel a sense of failure in this situation?

Normalisation of Experience

• What is normalisation?

• Normalisation builds trust

• Normalisation calms fears

• Normalisation helps coping

Ways of Normalising Experience

A resident is highly anxious about their future ability to cope with symptoms and with the task of saying goodbye to loved ones

Method one: “Of course you are anxious”

“It makes sense to me” “After all, you’ve never gone

through this before and it is a lot to take on at once”

Method two:

Tell the person that many of your patients were also anxious at

first but, with a little assistance, these

persons grew more trusting in how they would cope with the

future

Where do I go when I am feeling out of my depth?

• the Chaplaincy team (who are there for staff and patients of all faiths and no faith)•another colleague, someone you trust (mentor or preceptor) • psychosocial team (e.g. social worker, counsellor, psychologist)• your own faith groups and/or other support networks.