Spirituality and Healthcare

religion

a specific set of organized beliefs and practices, usually shared by a community or group

spirituality

more of an individual practice and has to do with having a sense of peace, connectedness, meaning, and purpose

faith

an inner attitude, conviction, or trust relating human beings to a supreme God or to an ultimate source of meaning

denomination

a generic term for a distinct religious body identified by traits such as a common name, structure, leadership, and doctrine

spirituality touches upon a person's sense of:

- the meaning of human life...what makes human life worthwhile or valuable...what constitutes a "good" life, a "meaningful" life, or a "valuable" life

- his or her relationship with self, with the rest of the world around us, with other people, with the transcendent

- what matter or endures in life...what brings joy, happiness, satisfaction, fulfillment...what brings sadness....

- the experience of suffering and loss, what those mean, and how to live with them...

- grappling with the inevitability of death, and what that means for the one who dies and for those around them

illness can bring about "spiritual distress"

a "state of suffering related to the impaired ability to experience meaning in life through connections with self, others, nature, the world or a power greater than oneself"

spiritual distress

- can impair health

- more likely to correlate with perception of pain

- more likely to correlate with depression

- higher suicide risk

- higher levels of anxiety

- higher resting heart rates

- greater psychological distress

- diminished levels of well-being

indicators of possible spiritual distress

- anxiety or fear about an uncertain future related to illness or injury; self or family member

- anguish with sudden death; grief; loss

- anxiety about dying

- desire for reconciliation with God, loved ones or within oneself

- despair or hopelessness

- conflicted belief system

- why me?

- how will I care for my family?

- who am I now? what is my value now?

spiritual consolation correlates with:

- enhanced ability to deal with treatment challenges

- increased optimism about future prognosis

- greater sense of engagement in care plan

- lower incidence of depression and anxiety

- lower resting heart rates

- greater psychological equanimity

- increased levels of well-being

indicators of spiritual consolation:

- increased meaning

- increased peace with self, God, others

- closeness, intimacy

- community and belonging

- sense of self-determination

- respect for dignity of human person

- forgiveness and reconciliation

- thoughtful, reflective preparation for death

JCAHO's suggestions for exploration:

- who or what provides the patient with strength and hope?

- does the patient use prayer in their life?

- how does the patient express their spirituality?

- how would the patient describe their philosophy of life?

- what type of spiritual/ religious support does the patient desire?

- what is the name of the patient's clergy, ministers, chaplains, pastors, rabbi?

- what does suffering mean to the patient?

- what does dying mean to the patient?

- what are the patient's spiritual goals?

- is there a role of the church/synagogue in the patient's life?

- how does faith help the patient cope with illness?

- how does the patient keep going day after day?

- what helps the patient get through this health care experience?

- how has illness affected the patient and his/her family?

AMA draft: spirituality in medical education and practice

our AMA strongly encourages the inclusion of spiritual health in curricula in medical school, graduate medical education, and continuing physician professional development as an integral part of whole person care. curricula should include:

1. assessing spiritual health as part of the history and physical

2. addressing treatment of spiritual distress by the clinician, with appropriate referral to spiritual care professionals

3. acknowledging patients' spiritual resources

4. developing compassionate listening skills

5. ensuring ongoing follow up of patient's spiritual health by clinicians as appropriate

6. understanding ethical guidelines on communication with patients on spiritual issues

7. self-reflection on one's own spirituality within professional development courses, especially as related to their vocation and wellbeing

examples of situations:

- end-of-life care

- hospice

- palliative care

- refusal to accept vaccines

- other medication conversations about patient goals talking with patient/family about death yours?

how do I talk to patients about these kind of things?

Two "Spiritual Assessment" Tools:

FICA Inventory

HOPE Inventory

- remember that these are starting point for your reflection about your own approach

The FICA Spiritual Assessment Tool:

F: Faith and beliefs

I: Importance and influence

C: Community

A: Address

F - Faith and Belief

"Do you consider yourself spiritual or religious?" or "Is spirituality something important to you?" or "Do you have spiritual beliefs that help you cope with stress and difficult times?""What gives your life meaning?"

I - Importance

"What importance does your spirituality have in your life? Has your spirituality influenced how you take care of yourself and your health? Does your spirituality influence you in your health care decision making (e.g., advance directives, treatment, etc.)?"

C - Community

Are you part of a spiritual or religious community?

A - Address in Care

How would you like me to address these issues in your health care?

The HOPE Spiritual Assessment Tool:

H—Spiritual Resources

O—Organized religion

P—Personal spirituality/Practices

E—Effects on medical care and end-of-life issues

H - Spiritual Resources

What are your sources of hope or comfort? What helps you during difficult times?

O - Organized Religion

- Are you a member of an organized religion?

- What religious practices are important to you?

P - Personal Spirituality

Describe the beliefs and practices of your religion that you personally accept.

Describe those beliefs and practices that you do not accept or follow.

In what ways is your spirituality/religion meaningful for you?

How is your spirituality/religion important to you in daily life?

E - Effects on Care

- is there any conflict between your effects on care beliefs and the care you will be receiving?

- do you hold beliefs or follow practices that you believe may affect your care?

- do you wish to consult with a religious or spiritual leader when you are ill or making decisions about your healthcare?

"Compassionate Presence" skills:

- letting go of your own agenda and pre-set ideas

- not the time to "re-make" the patient's spirituality

- bringing a non-judgemental attitude of openness, deep respect, and humility

- listening: silence is okay

- being fully present to patient: "I'm here for you"

- pay full attention to them, not allowing distractions

- allow for warmth in the relationship

how does this relate to pharmacy practice, what should I do?

- what is is that makes a person valuable?

- what are some assumptions that are part of my spirituality or religion that might shape the way I see my patients and my approach to treating them?

- how do I understand death?

- how can I become more comfortable talking with my patients about their spirituality and beliefs?

- will I pray for my patients?

- what if a patient asks me to pray with her or him?

- do I see my role as a pharmacist as a career...a vocation...a sacred calling?

- how can I nurture a deeper sense of, and appreciation for, what it means to be human?

- can I allow my patients to teach me more about my own humanity?

- what else?