Providing Spiritual Care In a multi-faith, multicultural. environment

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1 Providing Spiritual Care In a multi-faith, multicultural environment In a multifaith - multicultural environment DrDr Stanley C. Macaden Honarary Palliative care Consultant, BBH National Coordinator, Palliative Care Programme of CMAI e.mail < stancmac@gmail.com> Stanley C. Macaden Ex Director, Bangalore Baptist Hospital

2 Bangalore Baptist Hospital (BBH)Est: 1973 Emergency Entrance Radiotherapy Unit

3 BBH Palliative care Started in 1995 Fully integrated service Part of services of the hospital For all patients Ca & Non Ca Out pt care, in pt care & home care Bereavement support

4 BBH model of palliative care - An integrated approach! Base Mission Hospital + Multi Disc PCT I P - Symptom control O P- Combined- -Terminal care - pall / onc cl - Respite care - support groups Day care / procedures <25kms Home care Multi-disc Multi-pronged + continuity of care Bereavement support Ca prev / behav change >25kms Local GP/hosp Remote supervised - - care

5 Three essential components of palliative care Symptom relief Aim Empowerment of person & family to harness their potential Teamwork and partnership Psychosocial & Spiritual support Communication

6 PHYSICAL Other symptoms Adverse effects of treatment Insomnia and chronic fatigue PSYCHOLOGICAL Anger at delays in diagnosis SOCIAL Worry about family and finances Anger at therapeutic failure TOTAL Loss of job, prestige and income Disfigurement PAIN Loss of social position Fear of pain and / or death Feelings of helplessness Feelings of abandonment and isolation SPIRITUAL Why has this happened to me? Why does God allow me to suffer like this? What s the point of it all? Is there any meaning or purpose in life? How can I be forgiven for past wrongdoing?

7 Spiritual Pain Why has this happened to me? Why does God allow me to suffer like this? What s the point of it all? Is there any meaning or purpose in life? How can I be forgiven for past wrongdoing?

8 From- Introducing Palliative Care Robert Twycross Total pain needs Total care (wholistic) Soma Psyche Social Spiritual

9 (EAPC) Task Force on spiritual care in palliative care (SCPC) Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred. EUROPEAN JOURNAL OF PALLIATIVE CARE, 2011; 18(2)

10 Spirituality Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions and practices. Puchalski, Christina M., et al. Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine 17.6 (2014):

11 Defn: of spirituality Pertaining to God - belief - understanding - relationship Awareness of the transcendent the beyond in our midst Awareness of something beyond intellectual knowledge or normal sensory experience

12 Concerned with - Meaning of being fully human whole Meaning and purpose in life Interconnectedness and harmony with other people, planet Earth & Universe Right relationship with God / power or force in the Universe which transcends the present context of reality

13 Religion Shared framework of theistic beliefs & rituals within which spirituality is expressed and nurtured and the meaning of life explored Religion & spirituality not same but often intermingled Impact of a person s religion is either life engaging or life escaping

14 Religion a subset of spirituality, encompassing a system of beliefs and practices observed by a community, supported by rituals that acknowledge, worship, communicate with, or approach the Sacred, the Divine, God (in Western cultures), or Ultimate Truth, Reality, or nirvana (in Eastern cultures). i, Christina M., et al. Improving the spiritual dimension of whole person care: Reaching national and international consensus. Journal of Palliative Medicine 17.6 (2014):

15 Religion & Spirituality Religion knowing about God Spirituality knowing God

16 Signs of spiritual distress Sense of hopelessness, helplessness, meaninglessness (withdrawn, suicidal) Vivid dreams, nightmares Intense suffering, isolation Remoteness of God Anger towards God why questions Undue stoicism Sense of guilt / shame Bitter & unforgiving of others

17 Multi-faith environment Believer - Belonging to a particular faith (Hindu, Muslim, Sikh, Christian, Buddhist, Jain, Jew) - submitted to God s will - stuck on miracles - Faith - established / Lost / increased - Some belief in a higher being no religion Atheist

18 An approach for Spiritual care Build a relationship of trust Asses spiritual needs Facilitate meeting them Spiritual dialogue Specific (focused) interventions

19 Build a relationship of trust Competence knowledge, skills, communication Character & compassion Truthfulness Prayer

20 Asses & meet spiritual needs Prayer Religious activities rituals Visitation Communication

21 Spiritual dialogue Relationships - with God - with family - with others - need to be forgiven / forgive Values - that are dear to you - that you want to pass on to your family/ friends

22 Spiritual dialogue Meaning - what gives you meaning & purpose in life? - share some meaningful moments in life Hope - what is your hope? - belief in afterlife? Peace - what gives you peace? - do you have peace?

23 Specific interventions only with permission Share your personal feelings, stories, testimony to bring glory to God Share Scripture verses as appropriate Pray with their permission

24 Tools for Spiritual Care 1. History & needs assessment SPIRIT: FICA: FAITH: HOPE: FACT: SNAP: 2. Evaluation Quality indicators Quality of Spiritual Care scale (QSC) Evidence-based quality indicators for Spiritual Care:

25 Tools for Spiritual Care 1. History & needs assessment SPIRIT (T. A. Maugans, The SPIRITual history, Archives of Family Medicine 5 (1997): 11-16; B. Ambuel and D. E. Weissman, Discussing spiritual issues and maintaining hope, in eds., D. E. Weissman and B. Ambuel, Improving End-of-life Care: A Resource Guide for Physician Education, 2nd ed. (Milwaukee, WI: Medical College of Wisconsin, 1999) FICA (C. M. Puchalski and A. L. Romer, Taking a spiritual history allows clinicians to understand patients more fully, Journal of Palliative Medicine 3 (2000): )

26 Tools for Spiritual Care 1. History & needs assessment HOPE (G. Anandarajah and E. Hight, Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment, American Family Practice 63 (2001): ) FAITH (D. E. King, Spirituality and medicine, in eds. M. B. Mengel, W. L. Holleman and S. A. Fields, Fundamentals of Clinical Practice: A Text Book on the Patient, Doctor and Society (New York, NY: Plenum, 2002): )

27 Tools for Spiritual Care 1. History & needs assessment FACT (LaRocca-Pitts, A Chaplain s Tool for Assessing Spiritual Needs in an Acute Care Setting Chaplaincy Today e-journal of the Association of Professional Chaplains Volume 28 Number 1 Spring/Summer 2012 (AJPCH 2009) SNAP (The Spiritual Needs Assessment for Patients) Rashmi K. Sharma, Alan B. Astrow, MD, Kenneth Texeira, PhD, Daniel P. Sulmasy, MD, PhD

28 Tools for Spiritual Care Evaluation Quality Indicators Quality of Spiritual Care scale (QSC) - a scale measuring quality of spiritual care at end of life that was tested on family members of deceased long-term care residents Evidence-based quality indicators for Spiritual Care: Healthcare Chaplaincy Network ( )

29 FICA: Spiritual Assessment Spiritual History-Christina M Puchalski F Faith, Belief, Meaning I Importance and Influence C Community A Address / Action in Care (

30 Spiritual care: Quality Indicators (18) 1. Structural indicators Process indicators Outcomes - 6

31 Important Listen to their experience Share your experience in love (not forcing) Never argue, force or compel Sometimes being there more important than doing or talking Providing neat answers unlikely to be helpful Encourage finding own answers meaning in their suffering

32 Remember God s Spirit ministers to the spirit of the person We are only instruments in His hands What we may see - is acceptance - submission - peace

33 Counseling

34 Prayer

35 Comments by families Godly, compassionate, timely, excellent, Angelic support Team gave courage to my mother and helped me handle the situation Team became like our family members Never seen such caring health professionals We pray for strength to the team to take care of more people

37 Best poster award-14 th International IAPC Conf TATA MH Mumbai Feb 2007

38 Feed back to Question - Was our spiritual support through discussion and prayer - comforting? (76%) - acceptable? (24%) - upsetting? ( 0%) - unacceptable? (0%)

39 Conclusion Spiritual care must be provided Can be done sensitively Must be done in love We can never fully understand a person s spiritual pain We are only partners with God in His healing ministry Does help in accepting the situation and in obtaining peace.

40 Our motivation & guidance Lord Jesus said in His sermon on the mount (Matthew 5:13,14) You are the salt of the earth You are the light of the world Light to expel the darkness of death by the light of the world - - JESUS! By lifting up JESUS! By giving them JESUS! Jesus love compels us to be competent, compassionate and committed in serving the suffering and dying and allowing them to die peacefully with dignity and HOPE

41 Thank You

43 Definitions Transcendence: exceeding/surpassing usual limits : extending or lying beyond the limits of ordinary experience (MW) Existence or experience beyond the normal or physical level.(ox) Existential: relating to, or affirming existence (living) (MW)

WHOLE HEALTH: CHANGE THE CONVERSATION. Spiritual Assessment Tools Clinical Tool

WHOLE HEALTH: CHANGE THE CONVERSATION Advancing Skills in the Delivery of Personalized, Proactive, Patient-Driven Care Spiritual Assessment Tools Clinical Tool This document has been written for clinicians.