Transcript Clinical Review - Advancing Expert Care

Clinical Review for the Generalist
Hospice and Palliative Nurse
Spiritual Care
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Objectives
1. Identify the components of spirituality
and its prevalence
2. Discuss the impact of spiritual distress
3. Discuss assessment of spirituality
4. Discuss spiritual interventions for
patients and their families
5. Identify patient and family spiritual
education
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National Consensus Project
for Quality Palliative Care
National Consensus Project for Quality
Palliative Care - Guideline 3.2.
 Spiritual and existential dimensions are
assessed and responded to based on the best
available evidence, which is skillfully and
systemically applied.
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Spirituality
 Personalized system of beliefs through
which one understands meaning and
purpose in life
 Involves harmonious relationships
 Over 91% of Americans state they believe
on God (Gallop, 2011)
Studies have indicated the strong desire of patients with
serious illness and end-of life concerns to have spirituality
included in their care
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Religion
 More structured belief system
 Organized effort involving ritual and
devotion to manifest spirituality
 Formal expression of one’s spirituality
 Most religions expect general adherence to
a particular body of beliefs (doctrines)
regarding one’s relationship with God (by
whatever name)
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Faith
 Acceptance of something without proof,
for example: God
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Spirituality
Prevalence
 Important to terminally ill
 Determinant of quality of life
 Spiritual distress
 Religious practices used as coping strategies
 Affects patient’s journeys
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Spiritual Distress
 Difficulty in finding meaning
 Alienation from religious community
 Lack of access
 Need to reconcile with God, others or self
 Spiritual beliefs opposed
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Suffering
 Associated with threats to intactness
 Impacts human dimensions
 Highly personal experience
 Pain may increase suffering
 Better endured with meaningful perspective
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Suffering
 Occurs if patient in crisis
 Chronic suffering
 Multiple types simultaneously or at
different times
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Factors Influencing Suffering
 Meaning of illness and symptoms
 Invalidation or discounting of symptoms
 Life experiences, past regrets
 Cultural and religious background
 Role changes
 Unfinished business
 Fears (known / unknown)
 Patient / family exhaustion
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Assessment
 Tools vary based on discipline
 Identify aspects of individual’s spirituality
 Upon admission and routine reassessment
 Trustful nurse-patient relationship
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Assessment
 Ask open-ended questions with observations
 About spiritual and religious beliefs
 What spirituality is for them
 What are their spiritual goals
 Listen
 Observe the physical environment
 Questions may be personal or sensitive
 Adapt questions to patient’s language of
responses
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Assessment Tools
 Dossey’s Spiritual Assessment Tool
 Meaning and purpose
 Inner strengths
 Interconnections
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Assessment Tools
FICA Spiritual Assessment Tool
 Assists patients to identify sources of
meaning and purpose in their lives
Faith/Beliefs
 Importance/Influence
 Community
 Address care issues

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Assessment Tools
HOPE Assessment Tool
 Hope
 Organized religion
 Personal spirituality
 Effects of care and decisions
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Assessment Tools
SPIRIT Assessment Tool
 Spiritual belief system
 Personal spirituality
 Integration
 Rituals/restrictions
 Implications
 Terminal event planning
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Diverse Spiritual/Religious Views
 Ask patients/families about their beliefs
 Explore beliefs
 Acknowledge meaning
 Don’t assume all people of a preference
hold identical beliefs
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Differences Regarding
Death and Dying
 Biological and social death
 Impending death
 Preparation for death
 Role of family
 Rituals
 Death seen as a process
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Traditions and Rituals
 Reduces fear and
anxiety
 Converts unknown
into known
 Brings relief
 Channels emotions
 Affirms the group
 Provides safety valve
 Ways of expressing
unpleasant emotions
 Confirms sense of
belonging
 Affirms group
cohesiveness
 Protects
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Spirituality Interventions
 Goals
 Be present in the face of suffering
 Unmet spiritual needs
 Indirect expressions of spiritual needs
 Nurses can be catalyst for spiritual
reconciliation
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Meaning
 Reason and purpose
 Life review
 Integrate the sacred as defined and
accepted by the individual
 Examination of patient’s life
 Ongoing
 Explore an aspect of their life
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Meaning
 Explore meaning of life, death and illness
 Readings reflective of patient’s beliefs
 Finding meaning in process of dying
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Hope
 Expectation of a good
 Universal themes
 Framed within context of limited physical
existence
 Questions that facilitate expressions
 Great hopes
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Relatedness
 Relationship to higher power
 Previously suppressed feelings may present
again
 Reconnection or reconciliation
 Existential and/or spiritual isolation
 Patient’s faith history
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Forgiveness or Acceptance
 By a higher power
 Of self
 Life review
 Universality of regret and guilt
 Not all guilt is related to patient’s own doing
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Transcendence
 Beyond self and suffering
 Finding meaning in serious or life-
threatening illness
 Outcome of spiritual needs
 Beyond human intervention
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Spiritual Care Advisor (SCA)
 Make referral beyond scope of practice
 Team should be well-versed in spiritual
care issues
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Consider SCA Referral
 Patient/family request
 Seek support
 Spiritual distress identified
 Unable to identify source of suffering
 Patient is nonverbal or comatose
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Patient and Family Education
 Encourage patient to verbalize concerns
 Review past spiritual coping strategies
 Explore new spiritual coping strategies
 Encourage family to verbalize fears without
judgment
 Encourage exploration of unresolved issues
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Conclusion
 Terminally ill consider spirituality to be one of the
most important dimensions of their lives.
 ASK patients about their spiritual goals.
 Complete regular and ongoing spiritual
assessment.
 LISTEN to the words the patient saying. Assess
physical environment for objects that reflect
individual meaning.
 Referrals to professional with specialized
knowledge as appropriate.
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References
1. Supiano KP, Altilio T, Indelicato RA, Eighmy JB, Nahman
EJ. Care of the patient and family. In: Berry PH, ed. Core
Curriculum for the Generalist Hospice and Palliative Care
Nurse. 3rd. Dubuque, IA: Kendall/Hunt; 202010: 141-161.
2. Baird P. Spiritual care interventions. In: Ferrell BR, Coyle N,
eds. Textbook of Palliative Nursing. 3rd ed. New York, NY:
Oxford; 2010: 663-671.
3. Taylor EJ. Spiritual assessment. In: Ferrell BR Coyle N, eds.
Textbook of Palliative Nursing. 3rd ed. New York, NY:
Oxford; 2010: 647-661.
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References
4. The Gallup Organization. More Than 9 in 10 Americans
Continue to Believe in God. Available at
http://www.gallup.com/poll/147887/Americans-ContinueBelieve-God.aspx. Accessed: December 12, 2011.
5.
Albaugh JA. Spirituality and life threatening illness: a
phenomenological study. Oncology Nursing Forum.
2003;30(4):593-598.
6.
Potter M. Loss, suffering, bereavement, and grief. In: Matzo
M, Sherman D, eds. Palliative Care Nursing: Quality Care
to the End of Life. New York, NY: Springer; 2001: 275-325.
7. Cassel E. The Nature of Suffering and the Goals of Medicine.
New York, NY: Oxford University Press; 1991.
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References
8. Dossey B. Holistic modalities and healing moments.
American Journal of Nursing. 1998;98:44-47.
9. Puchalski CM. Spiritual assessment tool. Innovations in
End-of-Life Care. 1999;1(6): Available at
www.edu.org/lastacts/assesstool.asp.
10. Story PS, Knight C, Schonwetter R. Hospice/Palliative
Care Training for Physicians: Pocket Guide to
Hospice/Palliative Medicine. Glenview, IL: American
Academy of Hospice and Palliative Medicine: 2003.
11.Oosterwal G. Caring for People from Different Cultures at
the End of Life. Symposia conducted at: The Meeting of
Supportive Care of the Dying: A coalition for
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Compassionate Care; January 21, 2003; San Antonio, TX.
Additional References
 Perley MJ, Psychosocial Emotional and Spiritual Issues.
In: Perley MJ, Dahlin C, ed. Core Curriculum for the
Advanced Practice Hospice and Palliative Care Nurse.
Pittsburgh, PA: Hospice and Palliative Nurses Association;
2007: 417-437.
 National Consensus Project for Quality Palliative Care
(2009). Clinical Practice Guidelines for quality palliative
care, 2nd ed. Available at
www.nationalconsensusproject.org. Accessed October 8,
2009.
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