1. Principles and good practice in paediatric spiritual care
Rev Paul Nash
&
Rev Kathryn Darby
Chaplains
Birmingham Children’s Hospital

2. In this session Highlight principles of spiritual care – 12
Begin to describe our approach
Share – what’s been a very positive journey for us

3. Defining spirituality
Connectedness
To the world
ourselves, others
the transcendent – beyond ourselves
Sense of the sacred – awe and mystery
Meaning and purpose

4. Spirituality
What gives you life? What energises you? What gives you strength?

5. Principles and practices of spiritual care for sick children
Participation, empowerment and autonomy
Empowering patients to choose, ask, understand
Child centred; child led
ongoing consent
a creative outcome can instil a positive sense of accomplishment and pride.

6. Principles and practices of spiritual care for sick children
2. Create spaces for spiritual care to occur and relationships to develop
attitude of openness and acceptance
active listening, rapport
relationship with the patient and family
a shared activity can be the means of creating a safe space – child free to speak
openings and closings are vital
Appropriate space - e.g. intensity of the contact; the physical and emotional space between the chaplain and the child; the pace, length of time spent, read the signs
*Openings and closings: particularly if a child has been open about difficult feelings and experiences, and if the session is likely a “one-off” encounter. For instance, reflecting back on the session with the child can be a way to find appropriate closure.

7. Principles and practices of spiritual care for sick children
Spiritual care occurs within the context of relationship
Developing rapport and trust
How to demonstrate love and care
Respecting their personal space
Active listening

8. Building relationship

9. Principles and practices of spiritual care for sick children
Spiritual care happens in the context of family - often with family present
Parents spend long periods of time at the bedside
Relieve stress and pressure – bring something new into the space - change the dynamic
They may welcome the opportunity to go for a short break, get some fresh air, have a shower, gain some adult time, make a telephone call. In these ways, by providing space for them and security in knowing their child is well supervised, spiritual care for parents is indirectly given.

10. Hope Blanket

12. Celebrating with the family

13. Principles and practices of spiritual care for sick children
5. We need to connect and build on existing spirituality and if appropriate faith
some people an act of spiritual care will have more meaning if it is an act of religious care.
Prayer may be an integral part of this connecting
Religious care: E.g praying in Arabic; bible stories
Another way of reflecting on existing spirituality and faith is identifying … child at the door waiting for his parents – made a ball out of magic clay – seen him kicking a ball the other day
prayer may be an integral element of this connecting;
In many cases, children welcome being prayed for but also need the space to articulate their own prayer, to express and share the treasure within themselves.
Vocabulary for faith – Liz’s story

14. Candle for Nanny

15. Principles and practices of spiritual care for sick children
5. We need to connect and build on existing spirituality and, if appropriate, faith
Finding a vocabulary for faith
Religious care: E.g praying in Arabic; bible stories
Another way of reflecting on existing spirituality and faith is identifying … child at the door waiting for his parents – made a ball out of magic clay – seen him kicking a ball the other day
prayer may be an integral element of this connecting;
In many cases, children welcome being prayed for but also need the space to articulate their own prayer, to express and share the treasure within themselves.
Vocabulary for faith – Liz’s story

16. Liz’s story of an encounter with “Rosie”
“She then chose a clear glass pebble. She said it made her think of the sea and we spoke of how love is like the waves of the sea that never stop rolling in …. She held the glass pebble and said:
I’m not really a religious person but I feel as if this is speaking to me.”

17. Principles and practices of spiritual care for sick children
Developmental and learning context is important to understand in choosing activities, resources and language
Taking time to ask – what is appropriate
Different ways of learning – e.g. visual, auditory, kinaesthetic
Being inventive and creative

18. Principles and practices of spiritual care for sick children
3) Offering “episodes of spiritual care” reflects the often integrated nature of assessment and intervention and the element of reciprocity
using the terms assessment and intervention fits well within a hospital environment and other staff readily comprehend them but they do not fully represent what happened.
In essence what is more accurate is that staff offered an episode of spiritual care
assessment and intervention are integrated
person centred in their approach
Relational exchange
*person centred - guided by and responsive to the child’s direction, and willing to take new and unplanned routes.

19. Principles and practices of spiritual care for sick children
7. Metaphor is a significant tool for spiritual care
Metaphors: butterfly image, hearts, child held in God’s hand, growing trees, animals, glass pebbles,
Metaphors can open up a new spiritual language. E.g. the language of colours representing feelings

20. Principles and practices of spiritual care for sick children
8) Spiritual care occurs within and by a community and can offer windows of normalization
Hospital is a new community - help patients attain this sense of community
Windows of normalization: opportunities for child/family to do “normal” things together.
Children care about other children
Community - Finding opportunities for patients to be together – Hope Blanket; Easter Garden
Normalising opportunities – restore a sense of perspective and balance – not always absorbed with anxiety
children care about other children - witness and identify with the pain, discomfort, experiences of others near them. How can they be helped to process this experience and express their feelings? Also connect with others
Giving back to others can be a source of pride and pleasure and is an essentially humanising activity on the pathway to recovery.
Sometimes an initial tentative approach leads the chaplain and others into a place of community and cohesion.
For instance, the chaplain describes the moment of grace with Katy - becoming aware of being in the midst of a community of people, almost ordinary in its character, with people swooning over a new baby brother, chatter, the flow of conversation and interactions and movement of cleaners and visiting staff, coming in and out of the room, Katy at the centre of the scene; neighbouring child joining in
Introducing sensory boxes to two neighbouring 15 year olds, Lara and Becky; although they did not speak directly to each other, they were companionably alongside one another.

21. Community

22. Making a comfort box

23. Community Spirit

24. Principles and practices of spiritual care for sick children
9. Meaning making helps children and young people articulate, identify and understand their spiritual needs
connects with what is already there as well as new activities
marking significant moments
avoid loading the child with our expectations and assumptions
building - enabling the child to share new thoughts or connections they have made.
Marking sig moments– e.g. prayer of blessing before an operation or celebrating a milestone
help the child to notice the positive, life enhancing parts of their experience, which are also present but may be overshadowed by the challenges - Examen.
Avoid our own expectations (e.g. lament – song of praise)

25. “Remembering” Postcard

26. Principles and practices of spiritual care for sick children

27. Principles and practices of spiritual care for sick children
10. Identity may have a heightened significance in sickness
coming to terms with a new identity- includes being sick
positive identity: helping children to see they are valuable, precious and special
Names are highly important
During illness, we might expect difficult feelings to emerge
Identity as sick person – child in TCT – want to go back to school; see friends; also top of class
Positive identity: helping them to see who they are and how valuable, precious and special they are within this new context.
*remembering names, calling people by their preferred names and exploring the significance of a name are all vital.
Names: recently, family from Romania. Chaplain learned that everyone was calling him by one name, but not his preferred name. Very little English
Difficult emotions -in children and within ourselves as care givers. Effective spiritual care will not shy away from these aspects of identity – handling difficult material requires sensitivity and ongoing self reflection and development as a practitioner.

28. Identity may have a heightened significance in sickness

29. Principles and practices of spiritual care for sick children
11. Concrete/visible expressions and reminders of spiritual care are important
Leaving something behind
a wide range of postcards
Communicate care for the object made
The activities, and objects made, are a gift
Most of all, we offer the gift of our own care
that acts as a reminder or an opportunity for ongoing reflection is one of the things that emerges most strongly from the project. (e.g. prayer card; bracelet patient wears all the time; symbolic blanket)
and how we have made someone feel and the most valuable tool in spiritual care is a loving person who treats the patient as if they are special, precious and to be respected.

30. Sun catcher

31. Principles and practices of spiritual care for sick children
12. Offering “episodes of spiritual care” reflects the often integrated nature of assessment and intervention and the element of reciprocity
Both patient and chaplain - changed by each other
identify activities that are deeply satisfying.
person leading the activity is a vital part of the episode becoming spiritual care
Changed: genuine expressions of love and care between chaplain and child/young person.
We need to continue to develop activities and are beginning to identify those which may be simple yet not simplistic having an ageless quality
which has training implications.

32. Conclusion Improved patient experience.
change within ourselves as practitioners.
energy and enthusiasm, discovery and surprise shared within the team indicated a shift in awareness and practice
bringing resources to the bedside leads to a more child-centred and child-directed contact
the intended hope is a change in multi-disciplinary practice, not just in Chaplaincy.

33. Episode of spiritual care

34. Principles and practices of spiritual care for sick children
Participation, empowerment and autonomy are core underpinning values.
We need to create spaces for spiritual care to occur
Spiritual care occurs within the context of relationship
Spiritual care happens in the context of family ; often family is present
We need to connect and build on existing spirituality and if appropriate faith
Developmental and learning context is important to understand in choosing activities, resources and language
Metaphor is a significant tool for spiritual care
Spiritual care occurs within and by a community and can offer windows of normalization
Meaning making helps children and young people articulate, identify and understand their spiritual needs
Identity may have a heightened significance in sickness
Concrete and visible expressions and reminders of spiritual care important
Offering “episodes of spiritual care” reflects the often integrated nature of assessment and intervention