1. Debbie Homewood

2. Goals My goals are to: provide a definition of spiritual care as part of palliative care dispel the major myths or misunderstandings about spiritual care explore a model for providing spiritual care.

3. Some Definitions SPIRIT: Your Essence, your core self, the non-material part of you that is who you truly are, your being. SPIRITUALITY: the way individuals seek, experience and express MEANING and PURPOSE, and the way they experience their CONNECTEDNESS to the moment, to self, to others, to nature, and to the significant, sacred or transcendent. Religion: a specific fundamental set of beliefs and practices generally agreed upon by a number of persons or sects: e.g. the Christian religion; the Buddhist faith tradition.

4. Characteristics of Spiritual Well-being: 1. The sense that life, including suffering and death, has meaning or purpose. 2. Connection with one’s deepest self and beliefs about, and faith in, what it means to be a human being including one’s spirit or non-material self. (not necessarily religious). 3. A sense of connectedness to others and to the world. 4. The experience of the transcendent, or something greater than one’s self, which can gives life purpose and meaning and helps one find peace.

5. Misconception The misconception: that spirituality means religion. We are all spiritual beings and we all have spiritual needs. This misconception is as strong and pervasive as the misconception that palliative care means end-of-life care.

6. Spiritual Needs in Palliative Care Illness disturbs more than relationships inside the human organism: it disrupts families, it affects workplaces, shatters preexisting patterns of coping, raises questions about one’s sense of self, life, meaning and purpose and one’s relationship with the significant or the sacred. When life-threatening illness strikes, it strikes each person in his or her totality.

7. Spiritual Needs in Palliative Care The client: 1. Displays fear and/or anxiety about suffering or about death. 2. Expresses feeling forgotten by God, disconnected from God, or punished by God, (or the spiritual being believed in by the client) causing fear, depression or anxiety. 3. Depression, related to illness, prognosis, unexplored grief. 4. Serious, inappropriate grief response, presenting as uncontrollable crying, inability to function, lack of will to live. 5. Breakdown of communication in family of client, or between caregivers and client, especially regarding suffering, care, EOL wishes and death.

8. Spiritual Needs in Palliative Care 6. Inability to express feelings about care, suffering, EOL wishes. 7. Fear or anxiety about diagnosis or treatment, even if not EOL. 8. Client agitated and unable to find peace in any way. 9. Denial of diagnosis or prognosis. 10. Family in denial of diagnosis or prognosis, causing client great distress and impeding decision-making and communication.

9. Why meet these needs? The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Hospice palliative care strives to help patients and families: address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears prepare for and manage self-determined life closure and the dying process cope with loss and grief during the illness and bereavement. All those who have gone before us, leading the way in palliative care,have clearly identified spiritual needs as a necessary and important part of palliative care. Research Dr. Gary Rodin Prayer Mindfulness

10. Research Improving the Quality of Spiritual Care as a Dimension of Palliative Care: the Report of the Consensus Conference, Journal of Palliative Medicine, Vol. 12, No. 12, 2009. Dr. Benjamin W. Corn, University of Tel Aviv Spiritual Oncology: the quest for a niche in an evidenced based world.

11. Definition of Spiritual Care Spiritual care, as part of palliative supportive care, means identifying and meeting the needs of our clients that have to do with their spirit, that are contributing significantly to their suffering physically, mentally, emotionally, psychologically and spiritually, and affecting their quality of living and dying. Healing, not curing

12. Model of Spiritual Care 1. Screening for spiritual needs. Tools are available for initial screening by any member of the health care team attending to a client. 2. Once spiritual needs are identified, a decision can be made about making a referral to the Spiritual Care Provider if it is deemed that a more detailed assessment and possible interventions are needed. 3. Spiritual Assessment, conducted by a trained, professional Spiritual Care Provider. 4. Development of a Care Plan. 5. Treatment with appropriate interventions. 6. Evaluation and ongoing assessment.

13. The Spiritual Care Provider Assesses the spiritual care needs of the client and family Evaluates spiritual distress Develops a care plan with appropriate interventions, including referrals to other professionals and personal and community resources Makes referrals to community colleagues or other professionals Provides spiritual and/or religious care as required Communicates with colleagues about spiritual needs and spiritual well-being of client Conducts ongoing assessment and evaluation

14. Spiritual Health Interventions Therapeutic Communication Techniques: including Compassionate presence, active listening, life review, eliciting the client’s story Therapy: including Meaning-oriented therapy, meditation techniques, dignity-conserving therapy, counselling, spiritual support, Self-care: including Journaling, yoga, meditation, mindfulness, religious practices and ritual, sacred reading, prayer

15. Spiritual Care Practices Meditation Guided Imagery Mindfulness Gratitude Art Music Nature Journaling Spiritual or religious counselling Worship Prayer Ritual Working with spiritual, sacred or religious texts

16. Conclusion Spiritual care is an integral part of hospice palliative care. We must strive to continue to find ways to meet the spiritual needs of our clients and their families and caregivers. We all have spiritual needs and we can all help meet the spiritual needs of those we serve.