CPG Guidance Spiritual Care

Spiritual Care

A guideline for health and social care professionals in the delivery of spiritual care

February 2017 (V1)

Version: 1.0 Author E-mail: [email protected] Approval/Ratification body IGC Date Reviewed/ratified: March 2017 Subsequent Review date: March 2019 Contents

of 10 1 Introduction

Spiritual care is an integral part of holistic care and encompasses the physical, psychological, emotional, and socio-economic aspects of a person.

In a Survey undertaken by the Department of Health (2012) Spiritual care is described as “a fundamental part of nursing currently much neglected through ignorance and misunderstanding”.

This guidance aims to explain the importance of the spirit in all aspects of care and helps guide practitioners to make sure these needs are met.

2 What is Spiritual Care

That care which recognises and responds to the needs 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 or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging human contact in compassionate relationship, and moves in whatever direction need requires’ (NHS Education for Scotland, 2009).

Spiritual care is not:

• Just about religious beliefs and practices

• About imposing your own beliefs and values on another

• Using your position to convert

• A specialist activity

• The sole responsibility of the chaplain.

of 10 3 Roles & Responsibilities

All care staff registered and non-registered who provide care for people, their families, and carers with life limiting conditions and those who are in their last phase of life have a responsibility to support individuals spiritual care needs.

The Nursing and Midwifery Council (2015) expects nurses to be able to:

“In partnership with the person, their carer’s and their families, makes a holistic, person centred and systematic assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk, and together, develops a comprehensive personalised plan of nursing care.”

Support from Chaplaincy are available as a resource when if staff are required to signpost to faith and belief group leaders, or are faced with particularly challenging questions and/or are struggling to sustain deeply significant conversations.

4 What is Spirituality?

Spirituality is deeply personal. It is about the essence of being human and is woven throughout every aspect of our lives. It includes the following dimensions:

 Meaning and purpose in one’s life

 Sources of hope, strength and comfort.

 Love and relationships, including our own self- worth.

 Forgiveness, including self-forgiveness.

 Creativity and self–expression

 Trust in individuals/ family/ friends/ carers/ society/ the world at large.

 Faith and Belief

Some people’s spirituality is understood and expressed through religious belief, which might include specific and distinct sacred texts, symbols, and rituals.

We all have a need to make sense of our lives, to discover ways of coping in the most difficult of times, to remain connected to those we love and to feel valued and seen for who we are. Because of this spirituality is a universal need.

of 10 Why Is It Important In Palliative and End of Life Care

 Spiritual care is an integral part of holistic palliative care and encompasses the physical, psychological, emotional, and socio-economic aspects of a person.

 For some, the diagnosis of a life limiting disease may be one of the first times someone has had to explicitly consider the meaning and purpose of their life. There may be uncertainty about the future, a perceived lack of control, and a profound awareness about their personal mortality that had not existed before. Previously held beliefs may not sustain or support them, and there are then considerable implications for suffering and distress which can fragment and influence all the other aspects of personhood.  However even in the face of serious illness, for some, spiritual well-being is present. Here a person’s spirituality, their core beliefs and values are found to sustain them, and this can lead to positive outcomes of self -growth, transformation, and inner peace. This may well include a reduced fear of the future and their own, or their loved ones, death. And, will influence practical aspects of care such as pain and symptom control.

Practising 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.

How Do We Care For The Spirit?

 Sometimes described as ‘skilled companionship’, it requires sensitive, compassionate attentive listening, by someone who is willing to be fully present as thoughts, ideas, fears and hopes emerge. It is not passive or casual. This can be extremely difficult when we feel helpless because we cannot fix things, or provide answers to the deep and profound questions raised.

of 10  By paying attention to the light/ sounds/ smell etc of the care environment

 At times it may require specific religious support, perhaps including sacred rites, and sacraments, and our role may be to identify this and help to contact the appropriate faith leader, pastoral or chaplaincy team.

Possible Expressions of Spiritual Distress

 Persistent unresponsive pain.  Agitation & restlessness  Sleep disturbances, nightmares.  Anxiety, including seeking constant reassurance.  Anger, at self, others, God.  Expressed feelings of abandonment and aloneness/ feelings of hopelessness  Tearfulness.  Asking searching questions “Why me”  Self blame  Desire to heal broken relationship

What is needed from me?

• Adopting a caring attitude and disposition.

• Recognising and responding appropriately to people’s needs.

• Using 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).

• Giving time to listen and attend to individual need.

• Being aware of when it is appropriate to refer to another source of support e.g. chaplain, counsellor, another staff member, family or friend.

What Tools Do We Need

 Communication skills: Open questions

of 10 Attentive, focused listening Picking up on cues Reflection and summarising Silence Touch

 Compassion and empathy

 To encourage reminiscence.

 To pay attention to the whole physical environment in which care takes place.

 Understanding that our presence is part of the therapeutic intervention.

 An awareness of faith traditions/ religions Are there specific end of life care needs or requests?

 Knowledge of how to access information relating to a particular faith tradition, their spiritual leaders and/ or the chaplaincy team.

5 Spiritual Enquiry Questions In enabling spiritual care, there are many ways in which health professionals can help patients and their loved ones. No one assessment tool can be used in isolation and it is important that we use all of our skills to stay focused on the agenda of the patient and move at their pace. However below are some questions adapted from the HOPE assessment tool (Anandarajah G. & Hight E. 2001) which can provide a platform to begin a conversation.

of 10 H What are your sources of hope, meaning, strength, peace, love? What helps you most when things go wrong (such as when you are ill) ? What sustains you and keeps you going? Is there a person, or a number of people who enable you to feel safe and valued and where are those people in your life now? What are your biggest hopes and biggest fears? Have you had the opportunity to explore and try to make sense of what is happening to you? For some people their spiritual or religious beliefs act as a source of comfort. Would that be true for you?

O If spiritual or religious beliefs are important: Are you part of an organised community of people who share your beliefs and support you? How important is that to you? Why is it important? How has being ill affected how you participate in this community? How can we help you in continuing this support? Would you like to contact your faith leader, or someone who you might want to explore this with further?

P Do you have personal spiritual beliefs/ practices? What are they? What do you do that nourishes you, that you enjoy and allows you to forget yourself e.g. listening to music, being in nature, prayer, meditation, attending a place of worship, art, reading, creative hobbies, gardening. What are your important daily routines? How can we enable those things to continue in your present place of care?

E How do your beliefs/ life values affect the kind of care that you would like me/ us to provide (over the next few months/ days/ weeks?). Based upon your beliefs/ life values/ the things we have talked about, have you given any thought to how you would like your care to be at the end of your life? Are there any conflicts between your beliefs and your medical care, including end of life care? Who would you like to talk about that with?

Remember to allow space for silence and to clarify and summarise what you have heard

of 10 6 When Should We Consider Spiritual Care?

 Because of the very nature of spirituality, spiritual care is continuous and seamless with all other aspects of care and so it’s very important not to think of it as a task that needs completing at certain times. We should always be alert to the cues in conversation that indicate we are talking about deeper issues. Patients and carers may have times of both spiritual well- being and spiritual distress, it may not be a constant state of one or the other, and we need to be alert to this.

 Sometimes patients will begin conversations focusing on physical aspects of their illness, but most conversations will include reference to how or why decisions are made, or why events are experienced as they are. It is about being attentive to what is said and employing all our communication skills and resources.

 As part of an initial assessment. This opens the topic in the conversation and sets the scene that we are interested in both patient and carers. Not simply in relation to practical aspects of care, but that we recognise this equally important human dimension, and are willing to listen to, and to help explore, their deepest hopes and fears. It may also help to identify other sources of religious or cultural support needed.

 Any significant change in the patient’s condition might shift the perspective in relation to spirituality. As new stressors emerge, there may be a change in understanding, beliefs, including sources of hope and comfort for example.

 When the patient reaches the last days of their life to ensure any spiritual need is highlighted and addressed. This will include being attentive in the last days of life, at the time of death, and following the death. Any specific needs should be documented to help and inform other healthcare workers so that they are able to provide appropriate and compassionate care.

 When providing Bereavement Support.

“Our lives begin to end the day we become silent about the things that matter.”

Martin Luther King

of 10 7 References . Anandarajah G. & Hight E. (2001) Spirituality and Medical Practice: using the HOPE questions as a practical tool for spiritual assessment. American Family Physician, 63, 1. 81– 92. . Cassidy P. & Davies D. In: Doyle D, Hanks GW, Cherny N, Calman K (editors). The Oxford Textbook of Palliative Medicine. 3rd Edition. Oxford University Press 2004. pp951-957. . Cobb M. (2001) The Dying Soul. Spiritual Care at the End of Life. Open University Press. . Culliford L. (2011) The Psychology of Spirituality. Jessica Kingsley Publishers . Department of Health (2008) End of Life Care Strategy-Promoting High Quality Care for all Adults at the end of their Life. The Stationary Office. London. . Department of Health (2009) Religion or Belief. A practical guide for the NHS. The Stationary Office. London. . Department of Health (2010) Spiritual care at the End of Life a systematic review of the literature. . Marie Curie Cancer Care (2003) Spiritual and religious Care Competencies for Specialist Palliative Care. Marie Curie Cancer Care. London. . McSherry W. (2006) Making Sense of Spirituality in Nursing and Health care practice: An Interactive Approach. 2nd Edition. Jessica Kingsley Publishers. London. . Milligan s. (2011) Addressing the spiritual needs of people near the end of life. Nursing Standard 26, 4, pp 47-56 . National Institute for Health and Care Excellence ( 2004) Guidance on Cancer Services: Improving Supportive and Palliative Care for Adults with Cancer. The Manual. NICE. London. . Neuberger J. (2004) Caring for people of different faiths. 3rd Edition. Radcliffe medical Press. . Royal College of Nursing. (2011) Spirituality in Nursing: A pocket Guide. RCN London. . Thomas K. (2003) Caring for the Dying at Home. Companions on the journey. Radcliffe Publishing Ltd. . Stanworth R. (2004) Recognising spiritual needs in people who are dying. Oxford University Press.