Reflecting on Clinical Practice Spiritual Care for Healthcare Professionals

Reflecting on Clinical Practice

Gordon Tom, Kelly Ewan, David Mitchell

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315346427
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

In the past 10 years spirituality and spiritual care have been much debated in professional healthcare literature, highlighting the need for a recognised definition of spiritual care to enable appropriate assessment of, and response to, spiritual issues. This accessible and highly relevant book surveys the numerous statements, guidelines and standards highlighted by these discussions, and equips healthcare professionals with the knowledge, skills and competence to provide the essence of spiritual care within their professional practice. Practical and evidence-based, this manual proves that delivery of good, professional spiritual care can build on intuitive human skills, and can be taught, learned, assessed and quantified. It gives readers the opportunity to move on from uncertainties about their role in the delivery of spiritual care by allowing them to asses and improve their understanding, skills and clinical practice in this area of care. Spiritual Care for Healthcare Professionals clearly grounds spiritual care in clinical practice. It is highly recommended for supporting academic study and encouraging healthcare practitioners to reflect on their practice and develop skills in spiritual assessment and care. Aimed at all healthcare professionals, it can be used by individual practitioners for continuing professional development as well as by academic staff developing educational programmes.

CHAPTER 1

Self-awareness

Introduction

Definitions of spirituality often include words which, although recognisable, are difficult to pin down and open to a wide variety of interpretations – for example, a sense of meaning, purpose, value, being, relationship or transcendence. This chapter will seek to grasp this ethereal term ‘spirituality’ and ground it in such a way that healthcare professionals can understand it and use it to inform the provision of spiritual care for patients, family/carers, volunteers and colleagues.

Understanding Spirituality

The search for an inclusive definition of the term ‘spirituality’ is an elusive one. In practice, when writing on spirituality authors begin with their own definition of spirituality and develop their thinking from there. Traditional healthcare models suggest that a definition would be a good starting place. If, as a healthcare professional, you know what spirituality is, you can then develop a strategy to assess the spiritual needs of the individual and seek to address them. However, the authors take a different approach and believe that the search for a working definition of spirituality is a futile one. Spirituality is about people, and every person is different. The key to providing spiritual care is to understand what spirituality means to the person you are caring for.

Understanding spirituality is further complicated by the common misconception that spiritual care and religious care are one and the same thing. Many healthcare professionals say the word ‘spiritual’, but in their head are thinking ‘religion’. The secular agenda, on the other hand, tries to remove religion from spirituality. The authors believe that neither of these approaches is helpful. Religion may or may not be a part of a person’s spirituality, and the only way to find out is to engage with the individual. The disentangling of spirituality and religion is explored in detail in Chapter 6. In the present chapter the authors will prepare the reader by exploring and developing an inclusive understanding of spirituality.

To understand spirituality in a healthcare context and in practice it is necessary to begin with a process of self-awareness and ask the following questions.

What does spirituality mean for me?

What do I think and believe about the key issues of life, health, illness, dying and death?

Reflective Activity 1.1 will help you to tease out these questions and think through how you understand and interpret your spirituality.

Reflective Activity 1.1

What does spirituality mean for you or what makes life worth living?

One way to think about this is to ask yourself what gives you meaning or a sense of purpose in life (or what is most important to you in life). Try to think of four elements and place them in order of importance or significance for you:

1

2

3

4

To this list you can now add how or where you find inspiration, hope, joy and support to cope with life and living:

1

2

3

4

Does this reflect your sense of spirituality? If not, try to think what is missing.

Although there will inevitably be variations in the reader’s response to this activity, in the authors’ experience there are some common expressions that are prevalent on a human level, and in particular for healthcare professionals. When considering what gives you a sense of meaning and purpose, your answers might include family, friends, work, health, religion or faith. Although family and friends are consistently at the top of this list, healthcare professionals often rate work highly, and it features as an important part of their spirituality and who they are as a person. This is not surprising – if we value human relationships highly as part of who we are, then the caring professions bring us face to face with humanity when it is particularly vulnerable, and the desire to help others feeds our sense of meaning, purpose and relationship.

When we think more widely about how or where we find inspiration, hope, support and coping strategies, the list is much longer and more varied, and can include walking, music, gardening, socialising, sport, art, religion and faith, and meditation, for example. It is when we move beyond our sense of meaning and purpose to consider what sustains and inspires us in spirit that we truly enter the domain of how individual spirituality really is. Some may find their support in solitude and doing something different, others find that immersing themselves with healthy people is a good way to cope, while yet others may use both, depending on where they are and how they are feeling. There is no right or wrong way in spirituality. Rather it is a continuing journey of experience and development as well as re-connecting with previously utilised coping mechanisms which were found to be helpful.

Understanding Life, Health, Illness, Dying and Death

If spirituality is an individual and fluid concept that we journey through, then it follows that our lived experience will have an influence on our sense of spirituality, and our life experiences will have the potential to colour our understanding. Healthcare professionals often find themselves working at the challenging interface between the human experience and its transitions through life, health, illness, dying and death.

To engage with and understand spirituality, it is also important for individuals to reflect on their own perceptions and attitudes to the challenges and vulnerabilities in life, living and dying. For example, when does life begin? What does it mean to say that you are healthy? What is quality of life? What is a good death?

Reflective Activity 1.2 will help you to explore what you think and believe about some of the key issues of life, health, illness, dying and death.

Reflective Activity 1.2

This activity will use your experiences both as a person and as a healthcare professional to help you to consider your beliefs about life, health, illness, dying and death.

Health

Try writing a short statement about what ‘being healthy’ means to you. Consider the physical, psychological, social and spiritual factors that influence your thinking.

Illness

Reflect on an illness that you have experienced, no matter how minor.

• What was the impact of your experience on your understanding of ‘being healthy’?
• From your experiences as a healthcare professional, are there any particular illnesses that you fear for yourself? Can you articulate what it is that you fear?

Life and death

While we have no say in how we come into life, we can think about how it might end.

• Think about what kind of death you envisage as a good death for yourself. For example, would it be sudden or with time to say goodbye? Would you die in your sleep or fighting to the last?
• If you died in any of these ways, what might be the effect on your loved ones?
• Have your views changed over time? If so, what influenced this change?

Having reflected on your awareness of life, health, illness, dying and death, you can revisit Reflective Activity 1.1 and consider whether there are any additions or changes that you would like to make with regard to what spirituality means to you.

Sexuality and Sexual Practice

Why include a section on sexuality alongside self-awareness in spiritual care? The link between spirituality and sexuality is a direct rather than tenuous one. If we consider that human relationships are important factors in our sense of spirituality and who we are as a person (see Reflective Activity 1.1), then it follows that anything which affects those relationships affects our spirituality. Illness, treatments and drugs can all affect our sense of self, our body image and our relationships. In a very real sense the physical, psychological, social and spiritual dimensions of our being come together in our sexuality and our sense and expression of self.

In the authors’ experience, the same wariness and fears that healthcare professionals have about approaching spiritual care exist around sexuality and sexual practice. For example, it is the patient’s private life, the issues can be embarrassing to talk about, and there is a perceived potential for causing offence. These are legitimate fears. However, they can be overcome with self-awareness, practice and developing experience.

As with spiritual care, a useful way of approaching this issue is to explore our self-awareness – to reflect on our own thoughts and feelings about the issues of sexuality and sexual practice. From this base as healthcare professionals we may become more confident and willing to engage with patients and their family/carers.

The activities in this section will guide us in reflecting on our intimate relationships, how they might be affected by illness, and the implications that this may have for our sexuality.

Reflective Activity 1.3

Reflect on a significant relationsh...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Foreword
• About the authors
• Acknowledgements
• Introduction
• 1 Self-awareness
• 2 Faith, belief and culture
• 3 Communication issues and skills
• 4 The healthcare team
• 5 Competence in spiritual care
• 6 Disentangling spiritual and religious care
• 7 Spiritual assessment
• 8 Responding to spiritual and religious needs
• 9 Ethics and values in spiritual care practice
• 10 Loss, grief and bereavement
• 11 Nurturing our spiritual selves
• 12 The institution and staff support
• 13 Chaplain to the institution
• Index