Are we clear about Spiritual Care for Children? Stephen Parkinson Psychotherapist True Colours Children s Health Trust
Overview What do we mean by Spiritual Care Psychosocial stages and spiritual development Case example FICA - spiritual assessment tool How do we care spiritually?
Introduction The spiritual care of a dying child and the family is a territory with no reliable map we sometimes use the need to tackle the practical needs of palliative care as an easy escape route from spiritual exploration. (Brother Francis. Oxford Textbook of Palliative care for Children)
Definitions A quality that goes beyond religious affiliation, that strives for inspirations, reverence, awe, meaning and purpose. Murray and Zentner (1989) Spiritual care in health is influenced by 3 perspectives: religious, scientific and existential Sawatzky & Pesut (2005)
Children can sense goodness, love, happiness, joy and pain, and this may be expressed through a laugh, a smile, or even verbally. It is more about connections with people, nature and transcendence than about intellectualizing and rationalizing McSherry and Jolley in Price and McNeilly s Palliative Care for Children and Families (2009)
the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred Association of American Medical Colleges (1999)
The most obvious way to provide spiritual care to a child is to provide spiritual care to the parents/family
Spirituality grows and is expressed from cultural contexts
Spiritual care of atheist families is underrepresented in the literature Sid takes his dog Murphy for a walk. Steps on Murphy s tail. Murphy apologizes, thinking he must have done something wrong. Sid realizes that Murphy totally misunderstands how the world works. Murphy doesn t realize that Sid is only a kid, not some sort of Super-Duper Boss and King / of Absolutely Everything. Sid figures out that when bad things happen, Murphy thinks it is because he has displeased his almighty master, and when good things happen, it s because he s been good. Sid is going to explain this mistake to Murphy that he s only a kid, that most things seem to happen for no particular reason, but just because.
Palliative Children Children s spiritual foundations can be significantly altered by the diagnosis of a chronic illness, leading to increased risk of psychiatric conditions, behaviour problems and spiritual distress... Religiosity and spirituality can have both positive and negative effects on well-being Drutchas and Anandarajah (2014) Spirituality and Coping with Chronic Disease in Pediatrics
Fowler Stage 0 Primal or Undifferentiated faith (birth - 2 years). With consistent care a sense of trust and safety about the universe and the divine can develop Stage 1 Intuitive-Projective faith (3 7 years) Exposure to the unconscious and relative fluidity of thought patterns. Religion learned through experiences, stories, images and contact with others Stage 2 Mythic-Literal faith (most school children) belief in justice and reciprocity of the universe. Deities mostly anthropomorphic, metaphors taken literally
In the Sky with God Peter. 5 years old. German heritage. Rural. Older sister died following chronic illness. Peter experienced profound distress at death of his sister. Anxious attachment symptoms could be observed when his parents became emotionally unavailable. He was also anxious when medical equipment was removed from the house. He missed the home care nurse terribly.
Psychodynamically Peter s developmental view of god is strongly informed by his parents, especially his father Erikson s stages indicate risk regarding first 3 stages: mistrust, doubt and guilt: Can I trust the world? Why? Was it my fault? Piaget: Preoperational/pre-logical magical thinking or association I will fly to heaven to visit her
Should we question spiritual beliefs? Example 1. My brother was sick and he died and he is in heaven with my grandma and he has lots of fun but he s not allowed to come and see me. Example 2. My brother died because he broke my game and I hated him and then he got sick and died, and it s my fault.
Meaning making Frankl: we can tolerate suffering if we can find meaning and purpose in it. A dying priest refused all offers of pain relief as he saw his pain and suffering as a process of grace and purification. A baby or young child does not have a capacity to make meaning, but still can suffer. Spiritual care for the priest involves not giving pain relief, spiritual care for the baby involves giving pain relief.
Deconstructing Deconstruction is not intended to and should not destroy the belief, but rather enrich understanding and provide choice as to the role the belief ought to play in the person s life. The meaning and influence of the belief can be transformed once a person understands its historical and social contexts Griffith and Griffith (2002) Encountering the sacred in Psychotherapy: How to talk with people about their spiritual lives
Assessment F. Faith, Belief, meaning Do you consider yourself spiritual or religious? Or Do you have Spiritual beliefs that support you during difficult times like this? I. Importance or Influence of religious and spiritual beliefs and practices. What importance does your faith have in your life? What role do your beliefs play in supporting you at this time? C. Community connections: Are you connected with a particular church or community? Is there a group of people who are important to you? A. Address/Action: How would you like me to respect or address these issues in your health care (your child s care). Is there something I can do to support your spiritual needs at this time?
How do we care spiritually Being open to cultural/religious difference Being experienced in exploring our own faith/spirituality, and our own psychology The quality and presence that we bring to the encounter
What does spiritual care look like? 1. Holding a patients hand 2. Listening 3. Laughter 4. Prayer 5. Being present with the patient (Grant. 2004) Show kindness, concern and cheerfulness (McSherry. 1998)
Nurse Spiritual Care Therapeutics Questionnaire (Sample) Helped a patient to have quiet time or space Listened to patient talk about spiritual concerns/insights Encouraged a patient to draw/write about spirituality After completing a task, remained present just to show caring Asked how you could support their spiritual practices Arranged for clergy/chaplain to visit Encouraged patient to talk about what gives life meaning Discussed patients spiritual care needs with colleagues Taylor (2008) What is Spiritual Care in Nursing?
Creating opportunities for the spiritual- connection with self and others Symbolic activities/creations/rituals Play Music Art Conversation Humour Get out into nature, or bring nature in to the child
Meeting with head and heart Patients/clients need to see our competency, but they also need to see that we care. This is conveyed verbally and nonverbally Words may be the prelude to an I Thou meeting, but do not define it. Some of the most healing encounters have occurred when my client s eyes and mine meet, in the absence of words Rich Hycner (1995) I Thou I It Martin Buber
Be clear in your professional role nurses offering guided spiritual imagery or helping patients think about the meaning of their dreams could bring harm. (Taylor (2008) Similar caveats for other health professionals Effectiveness of providing spiritual care is dependent on the response of the child and family Watch out for platitudes
Four quadrants? Biological: Treat symptoms of pain and agitation. Safe, therapeutic touch. Psychological: Listen. Sometimes explore. Convey understanding and caring. Social: Belonging to and with others, not being isolated. It is all about connection, and another word for connection is attachment. Perhaps the spiritual resides within and emerges from the bio/psycho/social in the same way culture, sexuality, gender do.
Bibliography Association of American Medical Colleges (1999) (Brother Francis. (2006) The Spiritual Life. Chapter 7, Oxford Textbook of Palliative care for Children. Drutchas and Anandarajah (2014) Spirituality and Coping with Chronic Disease in Pediatrics Erikson. E. (1963) Childhood and Society Fowler. J. Stages of Faith: The Psychology of Human Development and the Quest for Meaning (1981) ISBN 0-06-062866-9 Grant. 2004) Griffith and Griffith (2002) Encountering the sacred in Psychotherapy: How to talk with people about their spiritual lives Horwitz, Rivka (1978), Buber's way to "I and thou" an historical analysis and the first publication of Martin Buber's lectures "Religion als Gegenwart". McSherry and Jolley. (2009) in Price and McNeilly s Palliative Care for Children and Families McSherry and Smith (2007). How do Children express their spiritual needs? Paediatric Nursing 19(3):17-20 Murray and Zentner (1989) Nash, Darby, Nash (2015) Spiritual Care with sick Children and Young People. Jessica Kingsley publishers. Sawatzky & Pesut (2005) Taylor (2008) What is Spiritual Care in Nursing? Weingarten. G. Me and Dog (2014) Simon & Schuster Books for Young Readers