Spiritual Care in a Healthcare Context Presented by Rev Neil Hepworth, Chaplain with particular responsibilities for the Medical Division, Critical Care & Palliative Care

Why do we need to know about Spiritual Care? NHS Policy (e.g. Nice per cancer/palliative care 2004, EOLC Strategy 2008) Integral to health & wellbeing Central to good medical and nursing care. An aspect of ‘Holistic’ or ‘total person’ care Physical symptoms can be caused by emotional or spiritual distress or be the cause of it- humans beings are complex and health is as much about how we think and feel as the state of our flesh and bones! psychologica l Spiritual Social Physical

Quote “He may cry for rest, peace and dignity, but he will get infusions, transfusions, a heart machine, or a tracheotomy…He may want one single person to stop for one single minute so he can ask one single question- but he will get a dozen people around the clock, all busily preoccupied with his heart rate, pulse, electrocardiogram or pulmonary functions, his secretions or excretions but not with him as a human being” (Kubler-Ross, 1969, edition 1997, On Death and Dying, New York, Scribner, p22, italic emphasis mine).

What is Spirit uality ? ‘Spirit’-Human spirit &/or Divine Spirit Connecting with the ‘other’ and/or being aware of the bigger world around us. Human desire & quest for meaning The essence of who I am- my unique identity Shaped by our experience & context May be expressed & nurtured in various ways Beyond the physical, mental, emotional yet encompasses all of them Integral to a Religion or faith structure for many people but not all

Context of being ill When we are healthy we take life’s pursuit for granted Health problems can threaten our ‘peace’. It can lead to ‘existential’ questioning It can arouse strong emotions It may affect self-esteem

Basic Spiritual Care: Something we are all responsible for! Prior things to remember: A duty to be aware of patient’s religion, spiritual & cultural needs. Inform patients about the chaplaincy and how to access them It is about the patient’s spirituality and not our own

Basic Spiritual Care: Something we are all responsible for! (Ingredients of care) Empathy Emotional support Listen to spiritual concerns “As patients may express their needs only once, it is important for those assessing need to be highly attuned to the spiritual dimension of patient care” (NICE, 2004,Supportive & Palliative Care Services for Adults with Cancer, p96, section 7.7).

Basic Spiritual Care: Something we are all responsible for! (Ingredients of care continued ) Reminiscence Encouragement & Hope *Affirming a positive outlook is not to be confused with prohibiting any expression of negative and low feelings!!! Nor is it giving false reassurance!

Basic Spiritual Care: Something we are all responsible for! (Summary ) Basic Spiritual care is really nothing more and nothing less than good humane care. “we are people first and professionals second…it is the people part of us that is required most in our offering of spiritual care” (Tom Gordon, A Need for living, 2001, page 41).

Basic Spiritual Care: Something we are all responsible for! Some final things to remember: Refer if necessary to a ‘specialist’ Look after yourself

Specialist Spiritual Care: Something Chaplains and staff with particular experience and training should do. All that was said under basic spiritual care plus: Use of reminiscence for spiritual assessment and targeted support Theological and philosophical explorations around existential issues Religious support

A definition of ‘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 without being prescriptive, judgemental or dogmatic and without preconditions, acknowledging that each will be at a different stage on that personal spiritual journey.” ( Stoter, D., 1995, Spiritual Aspects of Health Care. London: Mosby, page 8)

Quote from End of Life Strategy “Facing death and the associated pain of loss and separation is hard to bear for all those concerned. Each person is part of a family or community unit and has emotional, social and spiritual needs, as well as physical and practical needs. Every person is unique and should be treated with dignity and respect. They should be able to express their hopes and expectations of what has deepest meaning for them. In essence, this is a recognition of the spiritual dimension of each person.” (,Dept of Health, 2008, End of Life Care Strategy, p76, 3.99)

How can spiritual support be given? Give time & presence Listen Encourage them to talk about their lives- especially achievements, sources of hope, concerns/regrets/disappointments By being accepting- ie non-judgmental By not pushing your own belief or unbelief but focusing on the patient’s agenda and their beliefs/values Refer to a chaplain

Trigger questions for Spiritual support? When you lay in the long evenings what do you find yourself thinking about? What things/activities/people are important to you? How do you see the future? Do you consider yourself a spiritual person? Is there anything on your mind? Does anything help you cope with all this?

Any questions or things you want to say? Thank you for listening- and remember I am here to support you as well as the patients! Contacting a Chaplain: Office tel If Urgent ring switchboard and ask for the on-call chaplain- a 24/7 provision.