Term Paper on "Effectiveness of Spirituality for Palliative Care Patients"

Term Paper 5 pages (1927 words) Sources: 1+

[EXCERPT] . . . .

Spirituality for Palliative Care Patients

When speaking of the end of life, quantitative research is relatively easy to obtain. It is easy to find out how many people die, when, and from what causes. What is less accessible, however, is information regarding the nature of that death, whether it was a so-called 'good death,' or not. Recently, there has been increasing interest, according to Christina M. Puchalski, MD, an associate at the Center to Improve Care of the Dying, "in the spiritual aspects of palliative care" Puchalski designed a course in spirituality in end-of-life care in 1992, amid predictions by her superiors that it would not attracted students or attention. "Today there are 40 such courses in U.S. medical schools, and the number is expanding fast" (Puchalski, quoted by Burnside, 1998).

While Puchalski's program predates the millennium, it is still valid; it would be especially useful to know whether her recommendation that caregivers for the end of life take 'spiritual histories' has gained a following, and if so, how it is helping. While that would require a major study, a question that can be answered with current research is this: Has spiritual content become widespread in the delivery of palliative care at the end of life? And what are the more common parameters of that spiritual care?

Hypothesis: This paper will attempt to affirm the hypothesis that spirituality plays a major role in contemporary palliative care via a topical survey of recent nursing, other medical and sociology journals.

Literature Review

Meyer (2000) defined spiritual care as "the promotion of spiritual health and well being through assessment of spiritual need or distress, and providing culturally sensitive interactions to encourage the patient in their spiritual growth." She noted that while chaplains or other spiritual leaders can provide a valuable resource, there are times when the nurse is the only person available.

Although the basis of spirituality is the same across religions -- caring for the soul in relation to the person's concept of God -- Meyer notes that it would be valuable for a health practitioner involved in end-of-life care to be familiar with all the pathways commonly used to approach spirituality in various cultures with which the nurse may come into contact. For example, Meyer refers to the African-American expression of spirituality known as the "Gift of Joy" that is expressed in "movement, song, rhythm, feeling, color, sensation, exultation and thanksgiving" (2000). Also mentioned is the Eastern philosophies' path of engaging in "meditation or altered states associated with religious ecstasy and/or shamanic journeying" (2000). "Spiritual care for the Christian includes only those approaches that will deepen and enhance a person's relationship with God," and that include "worship, compassionate presence, prayer, Bible reading, music, love and support" (Meyer 2000).

Meyer notes that the International Council of Nurses (ICN) Code of Ethics states: "In providing care the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family, and community are respected" (ICN, 2000, quoted by Meyer, 2000). The American Holistic Nurses Association also defines holistic care as incorporating the "inter-relationships of the physical, psychological, social, and spiritual dimensions of the individual, recognizing that the whole is greater than the sum of its parts" (Meyer 2000).

Cohen and Koenig (2002) noted that:

Interest in religion and spirituality as a source of resilience in coping with serious physical illness has seen a dramatic increase in recent years. Health care professionals providing medical care to patients with serious illnesses should consider the roles that they can play in meeting patients' religious and spiritual needs. Compassionately addressing these issues may increase the health of patients and/or increase the comfort and meaning in the process of illness and the process of dying.

In addition, they noted that the issues had been "woefully underaddressed" by researchers, proposing that there were several areas of investigation still left untouched, despite abundant anecdotal evidence in the same areas. Those areas are: "the religious and spiritual needs of people of different religions, the positive and negative effects of religion and spirituality in palliative and end-of-life care, and the contributions that religious and spiritual institutions as well as health care professionals can make to such endeavors" (Cohen and Koenig 2002).

A rabbi, Sandy Bogin, attempted to divorce spirituality from a specific religion for the purpose of investigating the use of spirituality in end-of-life care. "Spirituality involves who we are and how we see the world...Spirituality speaks to our desire to make sense of our world and find our place in it" (Bogin 2000). When people are in a palliative care setting, however, they have ceased being judged, by and large, by their accomplishments; they often feel adrift, that they have lost the essence of who they are (Bogin 2000). Bogin speaks from experience, noting that often when 'terminal patients' express a wish to die right now, what they really mean is that they don't want to die alone.

For the health or spiritual practitioner, Bogin says, "It is important to maintain a sense of hope. Perhaps no longer a hope for recovery, but hope for a peaceful end to life -- and for those whose religious beliefs include it, a hope for peace in the world to come" (Bogin 2000).

While Bogin does not address the notion of a 'spiritual history' directly, Bogin does note that the end of life is partially concerned with finding meaning in life, especially in the face of sudden and intense suffering.

Listening to people's stories, helping them review their relationships and accomplishments, helps them discover that meaning. We know people can transcend pain when they feel life has been worth living" (Bogin 2000), which would constitute a particularly spiritual way to provide palliative care.

Koenig (2001), in defining spiritual care in medical practice, echoed Puchalski's practice of spiritual histories as a helpful guide to spiritual palliative care. He noted that 90% of Americans believe in some form of religion or spirituality, making medical acknowledgement of that fact all but mandatory, especially in end-of-life care. He advised that best practice might be seen as "taking a spiritual history the identifies religious or spiritual needs and then coordinates the resources needed to meet those needs." Despite writing several years after Puchalski, Koenig felt compelled to include the information that "Taking a spiritual history in a sensitive and appropriate manner is controversial, although most experts agree that proper timing and a patient-centered approach are essential elements for success...A religious or spiritual history is best obtained during a comprehensive medical evaluation, introduced naturally as part of the social history" (Koenig 2001).

Soggie (2003) noted that although some professionals are still dedicated to the separation of the physical and the spiritual, "Health care must also involve community and spirituality. Indeed, I argue that health care truly exists only when community and spirituality are allowed to flourish, for community and spirituality are the most fundamental modes of humanity in dealing with brokenness, pain, suffering, and death." Soggie's experience as a psychotherapist dealing with terminal patients gave him some insight; some he borrowed from the great psychologist Carl Jung, who pointed out that "the deepest and most human psychological function is spirituality" (Soggie 2003).

Cole (2001) also approached the spirituality of palliative care from a psychological point-of-view. Reporting on a September 2000 conference at the Johns Hopkins School of Nursing, Cole noted that "There seemed to be genuine interest by many nursing organizations to work closer together, and a willingness of other nurses to learn more about the advanced psychiatric nursing role related to end-of-life care."

Werner et al. (2004) examined the role of palliative care teams in decision-making regarding use of life-sustaining treatments (LSTs) with terminally ill patients, suggesting interdisciplinary teams to make such decisions. While not addressing the effectiveness of spirituality in palliative care, it is clear that any team holding the life-or-death decision would be well-served, in both a medical and legal sense, to be familiar with the spirituality of the patient and the effect of that spirituality on the course of the patient's palliative care. Davidson et al. (2003) also studied effects on care of nursing "lack of awareness of palliative care philosophies and resources, and called for nurses to "be equipped on both an intellectual and a practical level about the concept of palliative care" in non-malignant but terminal disease. Specifically, that report concluded that palliative care teams should:

Affirm life and regard dying as a normal process,

Neither hasten nor postpone death,

Provide relief from pain and other distressing symptoms,

Integrate the psychological and spiritual aspects of care,

Offer a support system to help patients live as actively as possible up to death, and Offer a support system to help patients' families cope during the patients' illness and the families' own bereavement" (Davison et al. 2003).

Mulvihill (2004) explored the success of one team approach at a Canadian hospital. The team linked together like service and disparate clinical functions, "with people dedicated to keeping patients alive and others helping… READ MORE

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