Spirituality in Palliative Care
Computing, Health and Science
School of Nursing, Midwifery and Postgrad Medicine
Spirituality is a term that is widely used and included as on integral feature of health care in general and palliative care in particular. It is one of four dearly recognised areas of holistic palliative care: physical, psychological, social and spiritual. Despite its ready recognition it is a concept that has proved difficult to define, and most writing on spiritual care begins with the author's definition and understanding. This chapter seeks to explore spirituality and spiritual care us it relates to palliative nursing practice. In particular, it will examine spirituality in the context of having a sense of meaning and purpose in living and the factors that contribute to an individual's sense of meaning: hope, being there, and peace. It also questions whether the much sought after definition of spiritual care is actually needed- or is it more helpful to be open to a broad concept? Within palliative care, issues of spirituality come into sharp focus, especially in practice. How health-care professionals can respond to people struggling with the difficult ‘why’ questions, or a sense of hopelessness, will be discussed. The experience of spiritual pain will also be explored. Is pain the best word or is it better to speak of distress? In palliative care, spiritual care includes the patient’s family/carers; if one is distressed that affects the other, so the nurse’s role in supporting the family will be discussed. A crucial element of spiritual care is self-awareness and, before we set out to care for others, we need to think through what ourselves understand and believe about life, death, illness and the relationships. Further discussions will examine how nurses can use that understand1ng in a non-judgemental way to journey with others to where they are and what they believe in. We also need to be aware that we are part of a care team and be open to using the skills the team, as multiprofessional teamwork is a core element of palliative care. The need for greater understanding of each other's role in spiritual care and the skills that each professional brings are also important. Not least is an understanding of the contribution that can be made by the profession with specialist expertise in spiritual care- chaplaincy, a profession that is about much more than religion. Having explored the concept of spiritual care and the impact on patients, family carers and ourselves both as individuals and part of a team, we are naturally led to think about how we put it into practice. One aspect that will be considered is whether spirituality lends itself to the use of an assessment tool and, if so, how it should be used. Considering competence in spiritual care, would a competency framework offer a different approach to assessment? The chapter concludes with a discussion of some current and future challenges, which include the changing demographics of society, the challenge of caring for people with non-cancerous conditions, developing spiritual care practice, spirituality within research, and the ultimate challenge of understanding our own mortality.