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Spiritual Care

Key Messages

  • Spirituality contributes to quality of life and wellbeing [1] and has been associated with positive emotional and mental health [2,3] and the ability to cope in a time of stress. [2]
  • For many people, spirituality is important throughout life; for many older people, spiritual care is especially important at the end of life. [4,5]
  • Spiritual care is an important aspect of palliative care, holistic or inclusive care, dignity-conserving care, respectful and culturally-appropriate care, and compassionate care. [1,5-7] Spiritual care is also important for the person who is dying as well as family members and care providers. [8]
  • The Australian National Guidelines for Spiritual Care in Aged Care are available to guide care. [1]
  • Spiritual care can be provided by all members of an aged care or palliative care team [9] and is optimised if a whole-of-organisation approach is taken. [1,8,9]
  • Spirituality and religion appear to have positive effects on older adults with dementia. [2,9]

Background

Definitions of spirituality are debated in the literature and often described as making connections, searching for or giving meaning and purpose to life, and seeking transcendence. [1-5,7,9-11] A comprehensive definition is offered by Puchalski et al. [7] ‘‘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.” (p. 646) A person's spirituality may be independent of religious belief, affiliation or practice. [1-3,5,7,9-11]

Spiritual care is an important aspect of holistic and compassionate care. [1,5-7] Acknowledging and supporting a person’s spirituality has been shown to reduce the distress that many people experience when they are ill or dying. [4] Pastoral care and spiritual care can be considered to be synonymous. [5]


Evidence Summary

Spirituality - searching for purpose, meaning and connectedness - can occur in the absence of any religious affiliation or practice. [1-3] The experience of ill-health particularly at end-of-life can rekindle or intensify spiritual or religious awareness. Research suggests positive associations between spirituality and religion, emotional and mental health. [2-5] When approaching death, spiritual or religious belief may help with coping, finding meaning and purpose, and facilitate a renewed peace of mind in for the final days. [3]

The recognition that health professionals have a role in spiritual care is relatively recent. [1,3,5-7] The authors of the National Guidelines for Spiritual Care in Aged Care suggest this is best delivered through a whole-of-organisation approach. [1,5,9] The authors also highlight the importance of a spiritual assessment for all people receiving aged care: an initial spiritual screening and an in-depth spiritual assessment. [1] A recent qualitative study outlines nine principles for the organisational support for spiritual care at the end of life. [8] These principles may help guide secular health organisations implement comprehensive, high-quality spiritual care in palliative care. [8]

Due to the subjective nature of spirituality, it may resist quantifying. However, to overcome spiritual distress and promote spiritual wellbeing [12] the measurement of spirituality is essential in screening and assessment. [4,10,11,13] Instruments to measure spirituality have been researched in order to validate them in a palliative care context and to test their validity and their cross-cultural applicability. [4,10,11] The McGill Quality of Life Questionnaire (MQOL), the Measuring the Quality of Life of Seriously Ill Patients Questionnaire (QUAL-E), and the Palliative Outcome Scale (POS) are recommended as the most appropriate multidimensional measures containing spiritual items for use in multicultural palliative care populations. [11] The ConnecTo Tool is also recommended. [13]

Spirituality and religion appear to have positive effects on older adults with dementia. [2,9] Benefits are derived from the maintenance of social interactions, [2] the stimulation of neural pathways through prayer [2] and the comfort provided by familiar rituals. [9] Meaningful activities may help people come to terms with the diagnosis of dementia, the decline in function and capacity, and to facilitate their preparedness for death. [2]

Spiritual care is an important aspect of palliative care, holistic or inclusive care, dignity-conserving care, respectful and culturally-appropriate care, and compassionate care. [1,5-7] Spiritual care can be provided by all members of an aged care or palliative care team [9] and is optimised if a whole-of-organisation approach is taken. [1,8,9] Spiritual care includes sensitive and respectful interactions, empathetic communication, activities like story-telling, reminiscing, mindfulness and meditation, prayer, [9] therapeutic life review [14] or dignity therapy. [6]

Deathbed phenomena (DBP), usually characterised by visions, is an unusual and hard-to-explain end-of-life experience. Although it is not uncommon in the health care setting, DBP may not always be reported by the person or their carers. If such phenomena are recounted, health professionals may use this as an opportunity to discuss spiritual and existential concerns, which have the potential to offer hope, meaning and connection. [15]

 

Quality Statement

Overall, the quality of the reviews included in this summary was good, with most reviews considered to be of acceptable or of high quality.

 

Page created 11 October 2017
 

  • References

  • About PubMed Search

  1. Meaningful Ageing Australia. National Guidelines for Spiritual Care in Aged Care [Internet]. 2016 Aug [cited 2017 Oct 11].
  2. Agli O, Bailly N, Ferrand C. Spirituality and religion in older adults with dementia: a systematic review. Int Psychogeriatr. 2015 May;27(5):715-25. doi: 10.1017/S1041610214001665. Epub 2014 Aug 26.
  3. Candy B, Jones L, Varagunam M, Speck P, Tookman A, King M. Spiritual and religious interventions for well-being of adults in the terminal phase of disease. Cochrane Database Syst Rev. 2012 May 16;(5):CD007544. doi: 10.1002/14651858.CD007544.pub2.
  4. Gijsberts MJ, Echteld MA, van der Steen JT, Muller MT, Otten RH, Ribbe MW, et al. Spirituality at the end of life: conceptualization of measurable aspects-a systematic review. J Palliat Med. 2011 Jul;14(7):852-63. doi: 10.1089/jpm.2010.0356. Epub 2011 May 25.
  5. Doyle C, Capon H. National Guidelines for Spiritual Care in Aged Care; Background and Literature Review (1.18MB pdf). Parkville (VIC): Meaningful Ageing Australia; 2016.
  6. Fitchett G, Emanuel L, Handzo G, Boyken L, Wilkie DJ. Care of the human spirit and the role of dignity therapy: a systematic review of dignity therapy research. BMC Palliat Care. 2015 Mar 21;14:8. doi: 10.1186/s12904-015-0007-1. eCollection 2015.
  7. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014 Jun;17(6):642-56. doi: 10.1089/jpm.2014.9427. Epub 2014 May 19.
  8. Holyoke P, Stephenson B. Organization-level principles and practices to support spiritual care at the end of life: a qualitative study. BMC Palliat Care. 2017 Apr 11;16(1):24. doi: 10.1186/s12904-017-0197-9.
  9. Jackson D, Doyle C, Capon H, Pringle E. Spirituality, spiritual need, and spiritual care in aged care: What the literature says. J Relig Spiritual Aging. 2016;28(4):281-95.
  10. Selman L, Harding R, Gysels M, Speck P, Higginson IJ. The measurement of spirituality in palliative care and the content of tools validated cross-culturally: a systematic review. J Pain Symptom Manage. 2011 Apr;41(4):728-53.
  11. Selman L, Siegert R, Harding R, Gysels M, Speck P, Higginson IJ. A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations. J Pain Symptom Manage. 2011 Oct;42(4):604-22.
  12. Harrington A. The importance of spiritual assessment when caring for older adults. Ageing Soc. 2014 Jan;36(1):1-16.
  13. Meaningful Ageing Australia. ConnecTo. 2017 [cited 2017 Oct 12].
  14. Keall RM, Clayton JM, Butow PN. Therapeutic life review in palliative care: a systematic review of quantitative evaluations. J Pain Symptom Manage. 2015 Apr;49(4):747-61.
  15. Devery K, Rawlings D, Tieman J, Damarell R. Deathbed phenomena reported by patients in palliative care: clinical opportunities and responses. Int J Palliat Nurs. 2015 Mar;21(3):117-25.

Definition

Spiritual care involves assisting residents to articulate those things that are important to them personally. Spiritual care involves sensitive listening, rather than providing answers. It is not necessary for the aged care team to share the same spiritual beliefs as the resident in order to understand the resident’s spiritual needs, nor is the aim of spiritual care for members of the aged care team to impose their own views.

Search strategy

(“Spirituality“ [Mesh] OR Spiritual*[tiab] OR faith[tiab] OR chaplain*[tiab] OR chapel[tiab] OR clergy[tiab] OR pray*[tiab] OR pastoral[tiab] OR religiosity[tiab])