1. Spiritual Care Conference
Can Spiritual Care Support
Realistic Medicine in Practice?
Often a patient’s distress is created by the situation they may find themselves in, rather than by the symptoms of the illness
#spiritualcareconf
1/2/2019

2. Spiritual Care Conference
Can Spiritual Care Support Spiritual Care Support Realistic Medicine in Practice?
Often a patient’s distress is created by the situation they may find themselves in, rather than by the symptoms of the illness

3. Spiritual Care?
What do we mean we speak of ‘spirituality’?
1/2/2019

4. Psychodynamic Unity
Mind
Spirit
Body
1/2/2019

5. HDL (2002) 76 Spiritual Care in NHS Scotland
Acknowledged spiritual and religious changes eg belief without Belonging
Described relationship spiritual/religious
Involving all staff not just chaplains
A sensitive, non judgemental, person centred, culturally competent service
Accepting WHO description which integrates spirituality as part of health
1/2/2019

6. Contemporary Spiritual Care
It is widely recognised that the spiritual is a natural dimension of what it means to be human, which includes awareness of self, of relationships with others and with creation.
Spiritual care is not necessarily religious. Religious care should always be spiritual
1/2/2019

7. Contemporary Spiritual Care
Spiritual Care is usually provided in a one to one relationship, is completely person centred and makes no assumptions about personal conviction or life orientation.
Religious Care is provided in the context of shared religious beliefs, values, liturgies and lifestyle of a faith community.
1/2/2019

8. Among the basic spiritual needs that might be addressed within the normal, daily activity of healthcare are:
The need to give and receive love
The need to be understood
The need to be valued as a human being
The need for forgiveness, hope and trust
The need to explore beliefs and values
The need to express feelings honestly
The need to find meaning and purpose in life.
1/2/2019

9. Communication? Why is communication a barrier to realistic medicine?
1/2/2019

10. Background & context
Scotland-wide survey, focus groups and interviews
The majority of people in Scotland (70%) think that as a society we do not discuss death and dying enough (SPPC, 2003).
This cultural resistance can contribute to poor communication when planning of end of life care (Scottish Government, 2008).
1/2/2019

11. Background & context cont:
Living and Dying Well 2008
Short life Working Group 7 Report 2010
Stakeholder Group March 2011
CEL2011 Shaping Bereavement Care
Scottish Patient Safety Programme Fellowship “What matters to you”?
IHI Conversation Ready 2015
Strategic Framework for Action on Palliative and End of Life Care 2016
1/2/2019

12. Background & context cont:
Chief Medical Officer’s Reports 2016 – 2018
Realistic Medicine 2016
Realising Realistic Medicine 2017
Practising Realistic Medicine 2018
“Poor communication is the biggest source of complaints in the NHS, and she says there are too many examples of families being distraught at the overtreatment of loved ones at the end of life when they would have preferred less to be done”. (Catherine Calderwood, BMJ 2016;355:i5455 )
1/2/2019

13. 1998 Thesis: PALLIATIVE CARE : A THEOLOGICAL FOUNDATION
“... a “good death” can be achieved when the dying person is relieved not only of their physical pain but also of their emotional pain and relief of emotional pain is somewhat achievable through good honest and open communication ...”
George Beuken; Scottish Journal of Healthcare Chaplaincy Vol. .6 No
1/2/2019

14. Vision
Scotland should be a society in which dealing with death, dying, bereavement and loss in a healthy and constructive way is seen as part of ordinary life and where members of the public and health and social care professionals and volunteers have awareness of these issues and the many ways in which communities and individuals can support each other
1/2/2019

16. Conversations around Death & Dying
The Great Taboo
Conversations around Death & Dying

17. Fear
1/2/2019

18. The Scale of the Problem
Unnecessary harm is caused because people in Scotland are not open about death, dying and bereavement. For example:
People who are dying or bereaved can experience isolation because people don't know what to say or how to act towards them
People die without wills, leaving complicated situations for their families and friends.
Health care professionals struggle to have conversations with their patients about what care or treatments they want as they approach death. This makes it hard to plan the care that a person really wants
If the fact that someone is dying is not acknowledged then opportunities to resolve issues and say goodbye may be missed

19. 1/2/2019

20. Breaking the Taboo
How?
1/2/2019

21. A Framework for Improving End-of-Life Care: Five Conversation Ready Principles
Engage
Steward
Respect
Exemplify
Connect
02/01/2019

22. Exemplify
this work in our own lives, so that we fully understand the benefits and challenges
This principle embodies “walk the walk” and encourages all clinicians to “have the conversation” with their own families and loved ones about end-of-life care wishes.
Through IHI’s work, we gained increased confidence that this is an important starting point with organizations involved in Conversation Ready work — not just a “nice to have” but, in many cases, essential to achieving their aims.
02/01/2019

24. I didn't want that
Notice
Wonder
Realise
1/2/2019

25. Key Messages Being more open about death is a good thing
Death is normal
Thinking about death when you’re healthy means there is less to think about if you get sick
We can all help each other with death, dying and bereavement
Coming terms with your own mortality can help you to live life to the full
There are things individuals and communities can actively do to help friends through difficult times relating to death, dying and bereavement
Death is happening all around us, causing sadness and difficulties that people often don’t share
Death can be upsetting, and people need to take the time to grieve

26. Useful Resources
Good life, Good death, Good Grief
Dying Matters