Professional Documents
Culture Documents
(National Center of Continuing Education, Inc. Death and Dying, pg. 23)
MSOP Report III regarding spirituality
Spirituality is recognized as a factor that contributes to
health in many persons. The concept of spirituality is
found in all cultures and societies. It is expressed in
an individuals search for ultimate meaning through
participation in religion and / or belief in God, family,
naturalism, rationalism, humanism and the arts. All
these factors can influence how patients and health
care professionals perceive health and illness and
how they interact with one another.
Christina Puchalski MD
Bio-Psycho-Social-Spiritual
Schools of Medicine have been slow to
recognize & appropriate this model of
whole person care.
The Nursing profession has long
recognized the spiritual aspects of patient
care.
Chaplains and clergy have often assisted
patients with the spiritual aspects of illness
and the search for meaning & purpose.
George H. Grant,M.Div., PhC.
Spiritual care defined
Spiritual care is recognizing and responding to
the multifaceted expressions of spirituality we
encounter in our patients and their families. The
purpose is to determine the nature of a persons
relationship to God and other people, and to
give the person the opportunity to accept
spiritual support. Themes such as the search for
meaning, feelings of connection or isolation,
hope or hopelessness, and fear of dying are all
clues that a person is struggling with spiritual
issues.
Christina Puchalski MD
Gallup survey key findings
Reassurances that gave comfort
89% Believing that you will be in the loving
presence of God or a higher power
87% Believing that death is not the end but a
passage
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
George H. Gallup International Institute.
Spiritual Belief and the Dying Process:
Christina Puchalski MD A Report on a National Survey, 1997.
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.
CMDS
Fortunately, there is change.
Scientists are realizing what people
already know, that a personal
spiritual relationship helps us make
sense out of illness. It gives hope. It
changes health-related behavior
and thus reduces the risk of
disease.
But faith has an even greater
impact. Studies have revealed that
faith improves the immune system,
enhances healing, reduces
complications during major
illnesses and much more.
CMDS
Clinical Questions
Does spirituality play a role in end-of-life care?
How?
Should nurses address spirituality with their
patients and 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?
Where does spirituality fit?
Patients may have
coping mechanisms
related to their belief
May be supported by
a community of caring
others.
May feel themselves
to be in the company
of God who gives
them peace and
comfort.
George H. Grant,M.Div., PhC.
Spiritual Needs
EPEC- AMA
Approach to
spiritual assessment
Suspect spiritual pain
Establish a conducive
atmosphere
Express interest, ask specific
questions
Listen for broader meanings
Be aware of your own beliefs
and biases
EPEC- AMA
A Spiritual Inventory might
include questions about:
The patients perception of what is going on.
What gives meaning and purpose to life?
How, or whether belief and faith enter in.
Love: By whom do you feel loved-accepted?
Forgiveness--need it? Do you need to grant it to
others?
Prayer--What do you pray for?
Quiet and meditation--What helps get you on
center?
George H. Grant,M.Div., PhC.
Spiritual assessment
Meaning, value personal, of the illness
burden, control, independence, dignity
Faith
Religious life, spiritual life
Identify areas of spiritual crises. Would
pastoral intervention be needed or desired
their own pastor or the hospital or
hospice chaplain?
EPEC- AMA
Spiritual assessment
Spiritual assessment should, at a
minimum, determine the patients
denomination, beliefs, and what spiritual
practices are important to the patient.
This information assists in determining the
impact of spirituality, on the care and
services being provide, and will identify if
further assessment or services are
needed.
Christina Puchalski MD
Taking a spiritual history. . .
S Spiritual Belief System
P Personal Spirituality
I Integration in a Spiritual Community
R Ritualized Practices and Restrictions
I Implications for Health Care
T Terminal Events Planning (advance
directives, DNR wishes, DPOA etc..)
SPIRIT
FICA (Pulchalski 1999)
LET GO (Storey and Knight 1997)
Nurses and MDs should know the patients
personal values and wishes. The patients
religion is specified in the medical record.
Francis Peabody
FICA assessment tool
Christina Puchalski MD
The HOPE Questions
H: Sources of hope, meaning,
comfort, strength, peace, love
and connection
O: Organized religion
P: Personal spirituality and
practices
E: Effects on medical care and
end-of-life issues
LET GO
A meaningful life
A peaceful, dignified death
There is a time for everything, and a
season for every activity under
heaven: a time to be born and a
time to die.
Ecclesiastes 3:1-2
Questions asked by dying and
chronically ill patients
Why is this happening to me now?
What will happen to me after I die?
Will my family survive my loss?
Will I be missed? Will I be
remembered?
Is there a God? If so, will He be there
for me?
Will I have time to finish my lifes work?
Christina Puchalski MD
The uncertainty is not the dying, its 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.
2 Kings 20:1
End-of life discussions-how
Suffering
Meaning and Purpose
Loss or Abandonment
Guilt or Shame
Trust
Reconciliation
Hope
Christina Puchalski MD
Spiritual Identifiers in Dying Patients
Is there purpose or value to their life?
Are they able to transcend their suffering?
Are they at peace with themselves and
others?
Are they hopeful, or are they despairing?
What nourishes their personal sense of value:
prayer, religious commitment, personal faith,
relationship with others?
Do their beliefs help them cope with their
anxiety about death and with their pain, and
do they aid them in attaining peace?
Patients raise spiritual questions
Who am I, now that I am sick or dying?
What is the meaning of my life when I am no
longer productive and independent?
Where am I connected to others who value me
and see me as a person of worth?
What is my relationship to God and am I going to
Heaven?
What do I now value most in the time that is left
to me?
Christina Puchalski MD
Spiritual Care for the dying
Practice of compassionate presence
Listening to patients fears, hopes, pain, dreams
Obtaining a spiritual history
Attentiveness to all dimensions of the patient and
patients family: body, mind and spirit
Incorporation of spiritual practices as appropriate
Involve chaplains as members of the
interdisciplinary healthcare team
Christina Puchalski MD
Community support
Sources of assistance
Church
Disease support groups
Hospice
Social groups
Friends, neighbors, and employment
peers
Nurses must be compassionate and
empathic in caring for patients In all
of 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
disease-specific therapy is no longer
available or desired.
MSOP Report I,
Christina Puchalski MD Association of American Medical colleges, 1998
Grief
An emotion or complex of emotions we
experience when we lose someone or
something we value.
Christina Puchalski MD
Religious Beliefs Related to
Health Care
What are the health related beliefs of
these major religions?
Buddhism
Christianity
Hinduism
Judaism
Islam
Atheism
Thats your homework. Thanks and may God
bless your ministry in caring for people.