Identify what spiritual needs are, and how to respond to spiritual and
emotional needs.
Recognize that one’s own spirituality might affect how one might relate
Have the ability to assist with the faith of others without proselytizing
Identify chaplain’s role as part of the health care team and in the spiritual
Definitions
1) Spirituality
relationships with a higher being, with self, and with the world around the
visible. The part that does not die but is immortal. Webster defines spirit as
“a life giving force” and as the “active presence of God in human life.”
the arts. All these factors can influence how patients and health care
professionals perceive health and illness and how they interact with one
another.
2) Religion
Religion is first and foremost a way of seeing. It can’t change the facts about
the world we live in, but it can change the ways we see those facts, and that in
Non-denominational
– Judaism
– Hinduism
– Buddhism
– Islam (Muslims)
Spirituality
Physical
Emotional
Social
Spiritual
Bio-Psycho-Social-Spiritual
Schools of Medicine have been slow to recognize & appropriate this model
patient care.
Chaplains and clergy have often assisted patients with the spiritual
people, and to give the person the opportunity to accept spiritual support.
hope or hopelessness, and fear of dying are all clues that a person is struggling
Those who participated in religious activities and said their beliefs were
important showed:
follow-up
if IL-6
disease
patients
• Personal Prayer is the most commonly used non-drug method for pain
management:
- Prayer 76%
- Relaxation 33%
- Touch 19%
- Massage 9%
Coping: Bereavement
religions commitment over the course of the year prior to their child’s
death
• When asked what helped them cope with their cancer, the patients
answered:
in their lives
89% Believing that you will be in the loving presence of God or a higher power
87% Believing that part of you will live on through your children and
descendants
85% Feeling that you are reconciled with those you have hurt or who have hurt
you
Americans have long recognized the healing power of faith and prayer.
82%: believe in the healing power of prayer
64%: feel MDs should pray with those patients who request it
63%: want MDs to discuss matters of faith.
Almost 99% of MDs say religious beliefs can make a positive contribution
to the healing process. Yet, until recently, most medical studies failed to
Faith was the forgotten factor that was relegated by healthcare providers to the
chaplain's office.
Clinical Questions
• Does spirituality play a role in end-of-life care? How?
• What is the role of the interdisciplinary team with respect to the needs of the
patient?
• How does paying attention to patients’ spiritual needs help with delivery of
compassionate care?
May feel themselves to be in the company of God who gives them peace
and comfort.
Spiritual Needs
• May be dynamic in patient understanding of illness
forgiveness.
The search for meaning is one of the primary motivators that keeps us
going. When a person comes to a place where his or her life makes no
If the person can find no help for meaning and purpose in the future, he
Victor Frankl
control.
Frankl maintains that the attitude we choose to take toward our life
The spiritual journey relates to our inner struggle to shape our attitude
higher power.
you have or who you are. This may be conditional love also,
Unconditional love
Important for the dying person because he or she is no longer in a
position to earn love. Therefore it is important to encourage and support
the person’s belief in and relationship to God who offers unconditional
love. Examples of how a person might experience this might be through
prayer, and the appropriate use of Scripture.
Resolves guilt
Restored relationships
“Beware lest anyone resist the grace of God and a root of bitterness spring up
affirming the value of the people with whom you speak and leaving the
If the patient expresses a need for assist with their spiritual situation, a
God?," "Who are We?," "Who is Jesus?," "What Did Jesus Do?," "What
Can We Not Do?," "What Do We Have to Do?," and "What Does God
them. Simply ask people to evaluate how their current belief system is
B. You may say no, because the nurse may be an atheist or non-
C. You may say no, that would be an unethical intrusion into the privacy
of the patient.
Define your own philosophy of life and death. What do you believe?
What does human life mean to you? What does death mean? Is there
2. Physical
3. Psychological
4. Decision making
5. Communication
6. Social
7. Spiritual
8. Practical
Faith
Spiritual assessment
Spiritual assessment should, at a minimum, determine the patient’s
patient.
care and services being provide, and will identify if further assessment
Spiritual Assessment
An integral part of a patient’s initial assessment should include data
opportunity to participate
Open ended questions that are specific regarding beliefs can be helpful.
Spiritual History
Taken at initial visit as part of the social history, and at follow-up visits as
appropriate
P Personal Spirituality
etc..)
much?
Questioning of faith
C- Community
A- Address
connection
O: Organized religion
LET GO
Spiritual History
F- Do you have a spiritual belief? Faith?Do you have spiritual beliefs that help
I - Are these beliefs important to you? How do they influence you in how you
A - How would you like your healthcare provider to address these issues with
you?
Prayer
Communion
Why? Many people have not recognized their own spiritual needs, and
discussed.
to his bowel movements or his or her sex life. Aren’t these private
matters as well?
Medical specialties
Psychology
Philosophy: bioethics
process.
Four resources
caring way.
your own religious beliefs about your concerns for the patient.
and others.
A meaningful life
“There is a time for everything, and a season for every activity under heaven:
“The uncertainty is not the dying, it’s the preparation. We need to know
how to deal with the inevitable deaths of loved ones and friends and patients.
Death is the last enemy, but one that need not be feared.
Conspiracy of silence
MD and patient each wait for the other to initiate discussion. Even
Avoidance: “I’m healthy. I’m busy. No time. My family will take care of
it.”
Be nonjudgmental
“Put your house in order because you are going to die; you will not recover.”
2 Kings 20:1
Any person on the team- doctor, nurse, social worker, may recommend
– Imminent death
Routinely when:
– Discussing prognosis
A Shift of focus:
to the psycho-social-spiritual
For many patients facing serious illness or the end of life, the focus
Levine)
Spiritual Issues
Suffering
Loss or Abandonment
Guilt or Shame
Trust
Reconciliation
Hope
• Do their beliefs help them cope with their anxiety about death and with their
independent?
person of worth?
Lifetime project
Unfinished business
Funeral plans
Financial plans
Loss of relationships
Being a burden
Physical suffering
Spiritual Coping
• Hope: for cure, for healing, for finishing important goals, for a peaceful death
• Sense of control
• Acceptance of situation
Community support
Sources of assistance
Church
Hospice
Social groups
their interactions with patients they must seek to understand the meaning of
the patients’ stories in the context of the patients’ beliefs and family and
cultural values…. They must continue to care for dying patients even when
Grief
• Does the health care provider listen to their beliefs, faith, pain, hope or
despair?
• Are patients able to express their spirituality through prayer, art, writing,
to others of God?
appropriate?
heart failure and coronary artery disease that cannot be revascularized. After
occurs:
Physician: “In your situation, CPR is very unlikely to succeed. What do you
Mr. R: “Well, I want you to do what you can. I trust that God will decide when
it’s my time.”
medical recommendations
General Recommendations
appropriate
• Awareness of your own spirituality will not only help you personally, but will
also overflow in your encounters with those for whom you care.
– Buddhism
– Christianity
– Hinduism
– Judaism
– Islam
– Atheism
That’s your homework. Thanks and may God bless your ministry in caring for
people.