Spiritual CareSpiritual Careand Culture in HCSand Culture in HCSJiří Maxmilian ProkopJiří Maxmilian Prokop

jiri.prokopjiri.prokop@@kardia.czkardia.cz

What is Spirituality:What is Spirituality: The essence of spirituality is the search to know our true The essence of spirituality is the search to know our true

selves, to discover the real nature of consciousness. selves, to discover the real nature of consciousness. Moral aspect of life.Moral aspect of life. Having to do with deep, often religious, feelings and Having to do with deep, often religious, feelings and

beliefs, including a person’s sense of peace, purpose, beliefs, including a person’s sense of peace, purpose, connection to others and beliefs.connection to others and beliefs.

An inner sense of something greater than oneself. An inner sense of something greater than oneself. Recognition of a meaning to existence that transcends Recognition of a meaning to existence that transcends one's immediate circumstances.one's immediate circumstances.

Spirituality is the way you find meaning, hope, comfort Spirituality is the way you find meaning, hope, comfort and inner peace in your life. Many people find spirituality and inner peace in your life. Many people find spirituality through religion. Some find it through music, art or a through religion. Some find it through music, art or a connection with nature. Others find it in their values and connection with nature. Others find it in their values and principles.principles.

What is Religion?What is Religion? set of beliefs and practices, often centered upon specific set of beliefs and practices, often centered upon specific

supernatural and moral claims about reality, the cosmos, supernatural and moral claims about reality, the cosmos, and human nature, and often codified as prayer, ritual, and and human nature, and often codified as prayer, ritual, and religious law. religious law.

cultural traditions, writings, history, and mythology, as well cultural traditions, writings, history, and mythology, as well as personal faith and mystic experience. as personal faith and mystic experience.

a notion of the transcendent or numinous, often, but not a notion of the transcendent or numinous, often, but not always, in the form of theism always, in the form of theism

a cultural or behavioural aspect of ritual, liturgy and a cultural or behavioural aspect of ritual, liturgy and organized worship, often involving a priesthood, and organized worship, often involving a priesthood, and societal norms of morality (societal norms of morality (ethosethos) and virtue () and virtue (aretearete) )

a set of myths or sacred truths held in reverence or a set of myths or sacred truths held in reverence or believed by adherents believed by adherents

How is spirituality related to How is spirituality related to health? health?

No one really knows for sure No one really knows for sure The body, mind and spirit are connected. The body, mind and spirit are connected. Some research shows that things such as Some research shows that things such as

positive beliefs, comfort and strength gained positive beliefs, comfort and strength gained from religion, meditation and prayer can from religion, meditation and prayer can contribute to healing and a sense of well-being. contribute to healing and a sense of well-being.

Improving your spiritual health may not cure an Improving your spiritual health may not cure an illness, but it may help you feel better, prevent illness, but it may help you feel better, prevent some health problems and help you cope with some health problems and help you cope with illness, stress or death. illness, stress or death.

Human dimensionsHuman dimensions BBodyody MMindind People around mePeople around me SSpiritpirit

Connection Connection Total PainTotal Pain

(Saunders) (Saunders)

Culture Defined

• A system of shared symbols

• Provides security, integrity, belonging

• Constantly evolving

• A system of shared symbols

• Provides security, integrity, belonging

• Constantly evolving

66

Cultural Context

• Making meaning of illness

• Not limited to race or ethnicity

• Health disparities

• Making meaning of illness

• Not limited to race or ethnicity

• Health disparities

77

Cultural Competence

• Components• Importance of interdisciplinary

approach

• Components• Importance of interdisciplinary

approach

88

Cultural Assessment

• Cultural attributes• Variation within

groups

• Cultural attributes• Variation within

groups

99

Components within Culture

• Ethnicity • Race• Gender• Age• Religion and spirituality• Sexual orientation

• Ethnicity • Race• Gender• Age• Religion and spirituality• Sexual orientation

1010

Cultural Considerations of Communication

• Use of interpreters• Conversation style• Personal space• Eye contact

• Use of interpreters• Conversation style• Personal space• Eye contact

1111

Cultural Considerations of Communication (cont.)

• Touch• Time orientation• View of healthcare professionals• Learning styles

• Touch• Time orientation• View of healthcare professionals• Learning styles

1212

Role of the Family

• Who makes decisions?• Who is included in discussions?• Is full disclosure acceptable?

• Who makes decisions?• Who is included in discussions?• Is full disclosure acceptable?

1313

Cultural Influences on Decision Making

Beliefs about autonomy and other values differ

Disclosure of diagnosis and prognosis Ascertain desire for disclosure

1414

Language Used at the End of Life

• "Discontinuation"• "DNR"• "Withdrawing/withholding"

• "Discontinuation"• "DNR"• "Withdrawing/withholding"

1515

When Cultures Clash

• Clashes occur• Assess your

reactions• Never lie• Offer information• Use interpreters

• Clashes occur• Assess your

reactions• Never lie• Offer information• Use interpreters

1616

What is Spiritual Care?What is Spiritual Care? Spiritual Care is a special kind of care that Spiritual Care is a special kind of care that

connects to you as a whole person – mind,connects to you as a whole person – mind, body and soul. Your spirituality is about who body and soul. Your spirituality is about who you are, what is important to you and what you are, what is important to you and what you believe as a person. Spirituality can you believe as a person. Spirituality can mean you are involved in a faith tradition, mean you are involved in a faith tradition, but not always.but not always.

The primary mission of the Spiritual Care The primary mission of the Spiritual Care department is to provide emotional and department is to provide emotional and spiritual support to patients, family and staff.spiritual support to patients, family and staff.

AREAS OF ACTIVITY OF AREAS OF ACTIVITY OF CHAPLAINCYCHAPLAINCY

1.1. to proclaim and defend the infinite value and dignity of to proclaim and defend the infinite value and dignity of every person.every person.

2.2. to be a reminder of the existential and spiritual dimension to be a reminder of the existential and spiritual dimension of suffering, illness and death.of suffering, illness and death.

3.3. to provide a reminder of the healing, sustaining, guiding to provide a reminder of the healing, sustaining, guiding and reconciling power of religious faith.and reconciling power of religious faith.

4.4. to endeavour to see that the spiritual needs of people to endeavour to see that the spiritual needs of people from different religious or cultural backgrounds are met, from different religious or cultural backgrounds are met, respecting everyone's beliefs.respecting everyone's beliefs.

5.5. to try to protect patients from unwelcome spiritual to try to protect patients from unwelcome spiritual intrusion or proselytising.intrusion or proselytising.

6. to provide supportive spiritual care through empathic 6. to provide supportive spiritual care through empathic listening, demonstrating an understanding of those in listening, demonstrating an understanding of those in distress.distress.

7. to provide religious worship, ritual, and sacrament 7. to provide religious worship, ritual, and sacrament according to one's religious tradition.according to one's religious tradition.

8. to serve as members of the multi-disciplinary health care 8. to serve as members of the multi-disciplinary health care teamteam

9. to provide and participate in teaching programmes for 9. to provide and participate in teaching programmes for health care professionals.health care professionals.

10. to act as mediator and reconciler and provide 10. to act as mediator and reconciler and provide advocacy for those who need a voice in the health care advocacy for those who need a voice in the health care system.system.

11. to support and participate in research programmes 11. to support and participate in research programmes about spiritual care.about spiritual care.

12. to assess and evaluate the effectiveness of 12. to assess and evaluate the effectiveness of providing spiritual care.providing spiritual care.

13. to facilitate community awareness of the 13. to facilitate community awareness of the needs and demands of the people they serve, needs and demands of the people they serve, the carers and health care systems. the carers and health care systems.

THEOLOGICAL, PASTORAL AND THEOLOGICAL, PASTORAL AND ETHICAL MATTERSETHICAL MATTERS Chaplaincy is a resource on theological, Chaplaincy is a resource on theological,

pastoral and ethical matters, being involved pastoral and ethical matters, being involved in programmes and discussions concerning:in programmes and discussions concerning:

a.a. theological and pastoral issues.theological and pastoral issues.

b.b. spiritual/existential needs and values.spiritual/existential needs and values.

c.c. ethical (including biomedical) issues.ethical (including biomedical) issues.

d.d. the improvement of pastoral health care.the improvement of pastoral health care.

EDUCATION, FORMATION EDUCATION, FORMATION AND SUPERVISIONAND SUPERVISION

Those working in chaplaincy receive professional Those working in chaplaincy receive professional training throughout their ministry at a level training throughout their ministry at a level appropriate to their appointment. This process appropriate to their appointment. This process includes:includes:

a.a. theological and pastoral education and reflection.theological and pastoral education and reflection.b.b. awareness of health care issues.awareness of health care issues.c.c. practical/clinical supervision.practical/clinical supervision.d.d. spiritual guidance.spiritual guidance.

STANDARDS FOR HEALTH CARE STANDARDS FOR HEALTH CARE CHAPLAINCY CHAPLAINCY IN EUROPEIN EUROPE

7th Consultation of the European 7th Consultation of the European Network of Health Care Chaplaincy, Network of Health Care Chaplaincy, meeting at Turku, Finland 12-16 June meeting at Turku, Finland 12-16 June 20022002

40 representatives of churches and 40 representatives of churches and organisationsorganisations

representing 21 European countries representing 21 European countries participated. participated.

Chaplains can assist or Chaplains can assist or perform a variety of perform a variety of religious rituals:religious rituals:

Communion (Catholic or Protestant) Communion (Catholic or Protestant) Anointing (Catholic or Protestant) Anointing (Catholic or Protestant) Baptism or child dedication Baptism or child dedication Weddings Weddings Funerals and memorial services Funerals and memorial services

Other religions???Other religions???

How can I improve my How can I improve my spiritual health?spiritual health?

Identify the things in your life that give you a sense of Identify the things in your life that give you a sense of inner peace, comfort, strength, love and connection. inner peace, comfort, strength, love and connection.

Set aside time every day to do the things that help Set aside time every day to do the things that help you spiritually. These may include doing community you spiritually. These may include doing community service or volunteer work, praying, meditating, service or volunteer work, praying, meditating, singing devotional songs, reading inspirational singing devotional songs, reading inspirational books, taking nature walks, having quiet time for books, taking nature walks, having quiet time for thinking, doing yoga, playing a sport or attending thinking, doing yoga, playing a sport or attending religious services. religious services.

10 Times to Call a Chaplain:10 Times to Call a Chaplain:1.1. When you need to speak with someone about spiritual or When you need to speak with someone about spiritual or

emotional concerns. emotional concerns. 2.2. When you feel the need for prayer or would like to receive a When you feel the need for prayer or would like to receive a

blessing or the sacraments. blessing or the sacraments. 3.3. When you need help finding or contacting spiritual resources in When you need help finding or contacting spiritual resources in

the community. Chaplains will call your faith community upon your the community. Chaplains will call your faith community upon your request. request.

4.4. When there is a new diagnosis or a reoccurrence, especially of a When there is a new diagnosis or a reoccurrence, especially of a serious or life-limiting illness. serious or life-limiting illness.

5.5. Before surgery or other procedure that might create anxiety or Before surgery or other procedure that might create anxiety or fear. fear.

6.6. When a difficult ethical decision needs to be discussed or When a difficult ethical decision needs to be discussed or advance directives need to be made (DNRs, living wills, etc.).advance directives need to be made (DNRs, living wills, etc.).

7.7. To be with family and friends during difficult times or if there is To be with family and friends during difficult times or if there is family conflict. family conflict.

8.8. To struggle together with unanswerable questions like "Why is To struggle together with unanswerable questions like "Why is this happening to me?" or "Where is God?" this happening to me?" or "Where is God?"

9.9. When a patient is facing death or to help with funeral When a patient is facing death or to help with funeral arrangements .arrangements .

10.10. When a staff member needs support. When a staff member needs support.

Religions in 1950, 1991 and 2001Religions in 1950, 1991 and 2001

2001, Czech 2001, Czech republicrepublic

Thank´sThank´s