PSYCHOSPIRITUAL ASPECTS OF PALLIATIVE CARE

Psychospiritual needs Psychological and spiritual needs are closely linked because of the way in which the spiritual dimension affects and is very much part of the physical, psychological and social aspects of our lives

Spirituality “A quality that goes beyond religious affiliation, that strives for inspiration, reverence, awe, meaning and purpose, even in those who do not believe in any God. The spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite and comes into focus when the person faces emotional stress, physical illness or death”

Spirituality (secular definition) Spirituality means making sense of the questions, ‘Who am I ?’ and ‘What am I ?’. Secular spirituality centres around the unifying force that integrates and transcends the physical, emotional and social dimensions and search for meaning of life. McGilloway (1985) suggests that this search provides a common bond between individuals and is an essential element for human relationships. In this, spirituality represents the very nature of men and women and their relationships with others. The secular approach to spirituality is about treating and being treated by others as someone of worth and with feelings. Doing so, acknowledges, implicitly or indirectly, person spirituality. Palliative Care, The Nursing Rolle edited by Jean Lugton and Margaret Kindlen

Assessment of spiritual needs Questions (open): Do you have a faith which sustains you? How important is this to you? Do you practice your faith in a group or community? Would you like to see someone who can help you talk through any faith and/or spiritual issues?

Further questions: What gives you hope and strength? Who/what is important to you? What do you understand about your illness? Is there anything you don’t understand? Are there any things you find difficult to talk about? Do you have any worries or concerns about the future?

Psychospiritual Needs For safety – feeling of security For understanding – opportunity to discuss the illness journey For self-esteem – involvement in decision-making; opportunity to give as well as receive To give love For self-worth – to know that one is loved and valued For purpose – to feel that one’s life still has meaning

To reconcile - opportunity for healing of damaged relationships; and to seek forgiveness For hope and creativity through realistic goals To find a meaning for life/death and to live in accordance with own value system (set of beliefs and hopes which motivate and direct a person) To search and question To be listened to – allowing expression of inner conflicts, fears, anger, anxiety To be answered with honesty and truthfulness

When these needs are not met, To have a guide, companion or friend ‘Food’ for the journey (Bible, prayers, poems, music, art) When these needs are not met, then our patients can become spiritually and/or psychologically distressed

Responding to Psychospiritual Needs Be there – stay there – get alongside, be present, even in silence Provide appropriate surroundings Listen– allow expression of feelings, including crying Give honest and truthful answers Involve the patient in decision-making Be non-judgmental Be a companion and friend

Include family and friends (within limits set by patient) Involve other professionals – be aware of how you can access spiritual help for the patient Be aware of the spiritual things the patient appreciates – flowers - fresh air - a type of music Allow the patient to give love and feel needed Value the patient for who they are, regardless of their beliefs, their status, their past life

“ Everything can be taken from man but one thing; the last of human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way…..man is not destroyed by suffering, he is destroyed by suffering without meaning” Frankle (1987)

Thank you for listening

References Lugton J.,Kindlen M. (1999) Palliative Care: The nursing role, Churchill Livingstone, Edinburgh McSherry W and Ross L. (2010) Spiritual assessment in healthcare practice. Wilcock P. (2013) Spiritual care of dying and bereaved people. Oxford textbook Palliative Medicine 2nd edn. P.977-990 (1998) Wright M.(2004) Hospice care and models of spirituality, European Journal of Palliative Care; 11(2)