The care delivered in palliative and end-of-life care is comprehensive, individualistic and integral to all needs of the dying patient. The integral nature suggests a strong focus on spiritual care for those at the end of life find inner peace and comfort. This often includes a preference to die at home surrounded by family and friends. In a spiritual sense, this home environment might help define who they are and what makes them who they are. Such spiritual harmony is important where pathology is constantly eroding their core spiritual dimension, resulting in searching questions about meaning of life in light of their impending death.
The thought of death heightens our possibility of being nothing (non-existence), which can easily lead to death anxiety (Nyatanga, 2013), and later, spiritual disharmony. Many may find it hard to contemplate their non-existence and yet, terminal illness is a constant reminder of that possibility, which may in turn raise further spiritual despair. Of interest here is how people cope, and our focus is on how we attend to their spiritual needs to support them.
One important point to consider, which I have discussed elsewhere in previous writings (Nyatanga, 2013), is the intricate nature or close interplay between religion and culture. The point to re-emphasise is that even people who hold the same religious beliefs may engage in different practices as influenced or dictated by their cultural practices. The practical question for community nurses working in palliative care is whether we need to review spiritual needs and how we assess for such needs of dying patients. The accuracy of our assessments should then lead to the right services/support, at the right time by the right professionals wherever the patient is. There are two other important pre-requisites needed:
- Skilled communication
- Introspection of our own belief system and understanding its interplay with the beliefs of those we care for.
Introspection is an emic element worthy of reminding us so that we are truly there for the patients. This is an important quality and yet can be most elusive in us as we may want to judge others and make decisions prematurely. Sensitivity is key to our communication as we seek to understand their diverse views and beliefs, before offering any interventions. Sensitivity means establishing what type of spiritual support they already receive and whether additional support is required.
Communication skills tend to focus on some of the micro and minute aspects of our interactions with patients. For example, it is important to understand what language patients use (death/dying or euphemisms such as ‘they are going to heaven’), and what that means in terms of the impending possibility of them being nothing on this earth. Communication skills facilitate disclosure from patients so that we fully understand their spiritual wishes and concerns. It is important that we do not ‘rush’ into giving information and advice prematurely, as this will stop further disclosure. Therefore, the motto when caring for patients at the end of life has to be: ‘gather before you give’.
Conclusion
The importance of spiritual care has never been important at the end of life. While this writing is targeted at health care professionals and those in the community in particular, the success of such care requires the input of everyone concerned with caring; service providers and commissioners all play an important role too, albeit indirectly. For example, commissioners and managers should facilitate the training of all staff in spiritual understanding and how it links to loss, grief and bereavement, and death anxiety. For health care professionals, let us ensure our assessments of spiritual needs are both sensitive and meaningful and not just a tick box exercise. Finally, it is almost always important that we understand ourselves first before we try and help others with their spiritual harmony.