1. What is Spirituality? Does everyone have a spiritual side? Alison Peers - End of Life Care Facilitator

2. Spirituality Body of evidence: spirituality, including religion, is an important coping resource for many of those approaching the end of life Holloway et al (2011)

3. Spirituality- definition Support that seeks to “help people approaching the end of life and those close to them including their relatives, carers and friends to:

4. Spirituality- definition Explore how they might understand, make sense of or find meaning in what is happening to them Identify sources of strength they can draw on, and Decide whether those sources are helpful during this period in their lives.” National Council for Palliative Care

5. Spiritual issues Why has this happened to me? Does God exist, why has he allowed this? Am I being punished? Who or what has caused my suffering? What meaning does my life have? What will happen when I die?

6. Spirituality May struggle with: Guilt Anger Despair May search for: Forgiveness Peace Hope

7. Spiritual Pain Unaddressed issues: May lead to spiritual pain Consider asking: What is most important/meaningful to you? What helps you through difficult times? Do you have a faith which helps you make sense of life? Do you ever pray?

8. Spiritual Pain “bitter anger at the unfairness of what is happening (at the end of life) and above all a desolate feeling of meaninglessness. Here lies, I believe, the essence of spiritual pain”. Saunders (1988:29)

9. Holisitic Care Physical Psychological/emotional Social Cultural Spiritual

10. Spiritual Care Whose role is it?

11. HOPE Assessing Spiritual Needs

12. HOPE Hope – what are the sources of hope, meaning, peace Organised religion – what is its role for that person Problems/issues/questions they are facing Effect on care - how

13. Spiritual support Asking a chaplain or counsellor to see them Finding a faith leader from their own religion to visit Arranging for them to go to their place of worship Providing a place where they can reflect/pray

14. Spiritual support Listening, being there Pray with them Providing things such as a Bible, Koran Reading scriptures to them Arranging for certain rituals to be carried out, e.g., Holy Communion Playing music which they find helpful Reading, e.g., poem

15. Agree/Disagree Every person is a spiritual being Spirituality has nothing to do with formal religion I would be willing to share my own beliefs with someone who is dying I would feel comfortable praying with a patient I would never take a patient to church I am afraid of dying There is always a purpose in suffering A person must make peace with God before death Prayer always gets results Forgiveness is important before death I learn about spirituality from my patients My faith helps me give palliative care Only faith makes sense of death It is essential to refer to a person’s faith advisor for spiritual support

16. What have you learnt? What will you change?

18. Care of Significant Others

19. How do we involve families and friends in: The Care? The Discussions?

20. Specific Wishes Clothes, makeup, hair, photos, music Family, friends present, not alone Quiet environment, dignity, privacy Personal care Pain relief, e.g., timing of Toileting, pads, commode, urinals, catheter, convene Diet and fluids Mouthcare, Toiletries Spiritual care, religious needs - anticipate

21. Supporting families & friends Accomodation Transport Meals Washing facilities Emotional support Time Respect and dignity