When families face the possibility of a life threatening
illness, spiritual issues are frequently a major source of concern,
comfort and contemplation
Spirituality includes concepts that spring from organized
religion AND it includes existential questions that supersede
Kemp (1) states that spirituality consists of meaning, hope,
relatedness (to a superior being and/or to a religion or community of
faith), and forgiveness.
Spiritual care can be provided by pastoral care representatives
from the family's own faith tradition. However, existential questions
are frequently posed to lay members of the health care team who are intimately connected to the family. Health care workers and hospice volunteers can "give permission" to families to express spiritual concerns by indicating that they are comfortable with the topic.
Never assume that you know what a family's religious beliefs
are, even if they are a member of an organized religion.
Respect the fact that spiritual issues may not be a central
issue for the family. In the same vein, respect the fact that the
family may choose to cope in ways that we would not define as
Kemp suggests that certain feelings or behaviors may indicate
unmet spiritual needs. These include: expressions of depression, low
self-esteem or guilt. Loneliness, anger, bitterness, fear and unrelieved physical symptoms MAY indicate the presence of spiritual distress.
Dudley, Smith, and Millison (2) reported the results of a survey
of methods used by hospices to assess their clients' spiritual needs.
Most spiritual assessment forms ask about religious affiliation. Many
spiritual assessments include open-ended religious questions such as
"Do you see yourself as a religious person?" or "how do you practice
your religion?". Many spiritual assessments also include open-ended
questions of a more global nature that ask questions such as "how
have you coped with crises in the past" or "what has given you
strength in the past." Still others ask questions related to the
meaning that the person attributes to the illness experience.
If the family is affiliated with a particular faith tradition
or a particular clergy person, ask if they would like you to contact
that person for them.
Encourage exploration of spiritual issues by indicating that
you are comfortable talking about them. This can be done by
statements such as "Many of the families that I have worked with have struggled with questions such as 'Why Me?'"
Encourage referral to your agency's pastoral care person.
Ask if there are particular readings or music that help
generate a sense of peace or calm for the family.
Recognize that you do not have to have answers to spiritual
Your presence and your non-judgmental attitude can convey a
powerful acceptance to the person in spiritual torment.
1 Charles Kemp (1994) Spiritual care in terminal illness. The American Journal of Hospice & Palliative Care, September/
2 James R. Dudley, Cheryl Smith, and Martin B. Millison (1995) Unfinished business: Assessing the spiritual needs of hospice
clients. American Journal of Hospice & Palliative Care, March/April:30-37.
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