1. Spiritual Care and Culture in HCS Jiří Maxmilian Prokop jiri.prokop@kardia.cz

2. What is Spirituality:  The essence of spirituality is the search to know our true selves, to discover the real nature of consciousness.  Moral aspect of life.  Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others and beliefs.  An inner sense of something greater than oneself. Recognition of a meaning to existence that transcends one's immediate circumstances.  Spirituality is the way you find meaning, hope, comfort and inner peace in your life. Many people find spirituality through religion. Some find it through music, art or a connection with nature. Others find it in their values and principles.

3. What is Religion?  set of beliefs and practices, often centered upon specific supernatural and moral claims about reality, the cosmos, and human nature, and often codified as prayer, ritual, and religious law.  cultural traditions, writings, history, and mythology, as well as personal faith and mystic experience.  a notion of the transcendent or numinous, often, but not always, in the form of theism  a cultural or behavioural aspect of ritual, liturgy and organized worship, often involving a priesthood, and societal norms of morality (ethos) and virtue (arete)  a set of myths or sacred truths held in reverence or believed by adherents

4. How is spirituality related to health?  No one really knows for sure  No one really knows for sure  The body, mind and spirit are connected.  Some research shows that things such as positive beliefs, comfort and strength gained from religion, meditation and prayer can contribute to healing and a sense of well-being.  Improving your spiritual health may not cure an illness, but it may help you feel better, prevent some health problems and help you cope with illness, stress or death.

5. Human dimensions  Body  Mind  People around me  Spirit  Connection  Total Pain (Saunders)

6. Culture Defined A system of shared symbols Provides security, integrity, belonging Constantly evolving A system of shared symbols Provides security, integrity, belonging Constantly evolving 6

7. Cultural Context Making meaning of illness Not limited to race or ethnicity Health disparities Making meaning of illness Not limited to race or ethnicity Health disparities 7

8. Cultural Competence Components Importance of interdisciplinary approach Components Importance of interdisciplinary approach 8

9. Cultural Assessment Cultural attributes Variation within groups Cultural attributes Variation within groups 9

10. Components within Culture Ethnicity Race Gender Age Religion and spirituality Sexual orientation Ethnicity Race Gender Age Religion and spirituality Sexual orientation 10

11. Cultural Considerations of Communication Use of interpreters Conversation style Personal space Eye contact Use of interpreters Conversation style Personal space Eye contact 11

12. Cultural Considerations of Communication (cont.) Touch Time orientation View of healthcare professionals Learning styles Touch Time orientation View of healthcare professionals Learning styles 12

13. Role of the Family Who makes decisions? Who is included in discussions? Is full disclosure acceptable? Who makes decisions? Who is included in discussions? Is full disclosure acceptable? 13

14. Cultural Influences on Decision Making   Beliefs about autonomy and other values differ   Disclosure of diagnosis and prognosis   Ascertain desire for disclosure 14

15. Language Used at the End of Life "Discontinuation" "DNR" "Withdrawing/withholding" "Discontinuation" "DNR" "Withdrawing/withholding" 15

16. When Cultures Clash Clashes occur Assess your reactions Never lie Offer information Use interpreters Clashes occur Assess your reactions Never lie Offer information Use interpreters 16

17. What is Spiritual Care?  Spiritual Care is a special kind of care that connects to you as a whole person – mind, body and soul. Your spirituality is about who you are, what is important to you and what you believe as a person. Spirituality can mean you are involved in a faith tradition, but not always.  The primary mission of the Spiritual Care department is to provide emotional and spiritual support to patients, family and staff.

18. AREAS OF ACTIVITY OF CHAPLAINCY 1.to proclaim and defend the infinite value and dignity of every person. 2.to be a reminder of the existential and spiritual dimension of suffering, illness and death. 3.to provide a reminder of the healing, sustaining, guiding and reconciling power of religious faith. 4.to endeavour to see that the spiritual needs of people from different religious or cultural backgrounds are met, respecting everyone's beliefs. 5.to try to protect patients from unwelcome spiritual intrusion or proselytising.

19. 6. to provide supportive spiritual care through empathic listening, demonstrating an understanding of those in distress. 7. to provide religious worship, ritual, and sacrament according to one's religious tradition. 8. to serve as members of the multi-disciplinary health care team 9. to provide and participate in teaching programmes for health care professionals. 10. to act as mediator and reconciler and provide advocacy for those who need a voice in the health care system. 11. to support and participate in research programmes about spiritual care.

20. 12. to assess and evaluate the effectiveness of providing spiritual care. 13. to facilitate community awareness of the needs and demands of the people they serve, the carers and health care systems.

21. THEOLOGICAL, PASTORAL AND ETHICAL MATTERS Chaplaincy is a resource on theological, pastoral and ethical matters, being involved in programmes and discussions concerning: a.theological and pastoral issues. b.spiritual/existential needs and values. c.ethical (including biomedical) issues. d.the improvement of pastoral health care.

22. EDUCATION, FORMATION AND SUPERVISION Those working in chaplaincy receive professional training throughout their ministry at a level appropriate to their appointment. This process includes: a.theological and pastoral education and reflection. b.awareness of health care issues. c.practical/clinical supervision. d.spiritual guidance.

23. STANDARDS FOR HEALTH CARE CHAPLAINCY IN EUROPE  7th Consultation of the European Network of Health Care Chaplaincy, meeting at Turku, Finland 12-16 June 2002  40 representatives of churches and organisations  representing 21 European countries participated.

24. Chaplains can assist or perform a variety of religious rituals:  Communion (Catholic or Protestant)  Anointing (Catholic or Protestant)  Baptism or child dedication  Weddings  Funerals and memorial services  Other religions???

25. How can I improve my spiritual health?  Identify the things in your life that give you a sense of inner peace, comfort, strength, love and connection.  Set aside time every day to do the things that help you spiritually. These may include doing community service or volunteer work, praying, meditating, singing devotional songs, reading inspirational books, taking nature walks, having quiet time for thinking, doing yoga, playing a sport or attending religious services.

26. 10 Times to Call a Chaplain: 1.When you need to speak with someone about spiritual or emotional concerns. 2.When you feel the need for prayer or would like to receive a blessing or the sacraments. 3.When you need help finding or contacting spiritual resources in the community. Chaplains will call your faith community upon your request. 4.When there is a new diagnosis or a reoccurrence, especially of a serious or life-limiting illness. 5.Before surgery or other procedure that might create anxiety or fear. 6.When a difficult ethical decision needs to be discussed or advance directives need to be made (DNRs, living wills, etc.). 7.To be with family and friends during difficult times or if there is family conflict. 8.To struggle together with unanswerable questions like "Why is this happening to me?" or "Where is God?" 9.When a patient is facing death or to help with funeral arrangements. 10.When a staff member needs support.

27. Religions in 1950, 1991 and 2001

28. 2001, Czech republic

30. Thank´s