Spiritual Awareness & the Interdisciplinary Team-an article from Medscape

[Guest guest]

Spiritual Awareness & the Interdisciplinary Team

Kevin Quiles, M. Div

 

 

Definition of Spirituality

Spirituality is often defined by images of an individual off in the corner with religious materials to offer anyone who wishes to receive some basic support. Patients and families are often categorized in limited, stereotypical terms when it comes to their religion. By the time we unconsciously add our own preconceived ideas about family dynamics and faith, the interdisciplinary team may feel they have a good understanding of patient and family. However, various presenters at the 6th Annual Clinical Team Conference of the National Hospice and Palliative Care Organization pointed out that the medical model today must broaden its understanding of how to incorporate spirituality into the palliative care and hospice model. Furthermore, each professional discipline is an active participant in the spiritual care of the patient and family. One recurrent theme of various presenters was the art of self-awareness.

To help reach a greater understanding of how patients and their families express spirituality, members of the team should ask, "What is spirituality to me?" The question has a personal history with each of us. This includes the definition of our families, our upbringing, our moral and emotional development, and our religious background.

When and how were emotions expressed? How were you taught to view people from other faith groups? What were accepted ways of expression? Who taught you about love? What gave you a sense of meaning? What made you afraid? These questions and others can be asked in the present tense as well, since spirituality is a constantly moving presence. The process of self-reflection or self-inquiry can lead to a better understanding of how we function with and around our patients and families.

In "Discerning the Path -- Diversity Within Culture and Spirit," Carlyle Coash, MA,[1] HospiceCare of Boulder and Broomfield Counties, Lafayette, Colorado, pointed out that asking oneself a series of personal questions daily in moments of reflection can promote a greater sensitivity toward the unique spirituality of those under hospice care. The nurse will gain an understanding of how she functions with her patients and families when she remains mindful of the personal and interpersonal stories that shape her values, her understanding of the meaning of life and death, and her relationships. The medical director will have an understanding of her direction in group discussions as she develops a higher insight into the aspects of her biography that have shaped her thinking and her perceptions about health, family, and faith.

As each professional discipline of the hospice team reflects on his or her life's story, each will gain further awareness of a unique definition of spirituality. When a nurse has an awareness of his definition of home, he will be able to see his definition as only one of many possible definitions of home. When a medical director has a clear picture of what brings him meaning and purpose in life, he will discover how different that perspective can be from that of the person next door.

Spirituality vs Religion

The development of spiritual self awareness will lead each member of the team to discover that religion is actually derived from spiritual experiences, and therefore not the origin of spirituality. Dina Carroll, MDiv,[2] Hospice and Palliative Care of Louisville, Louisville, Kentucky, presented "Honoring or Imposing? Interdisciplinary Spiritual Care." People often attempt to discover who others are by asking questions pertaining to what they believe. Chaplains are often asked, "What denomination are you?" and "What do you believe?" Common methods of discussing patients in the medical field are, "He is Baptist," or "The family is Catholic." These labels describe in vague and stereotypical ways what a person believes.

A father once looked at me with anxiety in his eyes, worrying what others would think if he told them he did not know if he could believe in an all-powerful God. When I asked him to explain, he stated, "I don't want my church to think I backslid." He had asked for healing for his daughter. When nothing happened after a year, he prayed for God to take her. When that failed, his internal faith structure began to crumble. In reality, some would have focused on what the father believed. An attempt to maintain "proper" theology would have been a priority for others, as opposed to providing a nonjudgmental and embracing atmosphere. The definition of spirituality is more personal and unique and takes on a broader form, encompassing a way of being or existing. This moves the mindset from "What do I believe?" to "Who am I?" This process is constant for each individual, ever moving and changing.

Imposing Beliefs

Hospice serves a community that is composed of a variety of ethnic, religious, and traditional backgrounds. Nevertheless, any team member can be tempted to impose his or her own beliefs, values, ideas, and decisions. A young man, slowly losing his ability to articulate, asked me to help him explore ideas of the afterlife. Some acquaintances had already given him various images of the afterlife. This is called imposing.

A Chaplain is trained to set no agenda as he or she walks into a home or room. I asked the patient, "Do you want me to reinforce these images, and help you feel convinced?No," he slowly answered. "Do you want me to introduce other images that you may find interesting?" The answer was still no. I got the impression the patient had more than enough people introducing images to him. Before his death, he felt comfortable not knowing. The patient experienced religious figures imposing what they felt to be true. As the Chaplain, I aimed at letting the patient set the plan of care.

A Team Spiritual Approach

How does an interdisciplinary team respect the spiritual care of patients and families, which can so often be clouded by preconceived ideas and stereotypes, and tend to the soul of patients and their families? To do this, a few useful tools are to exercise active listening, embrace the practice of silence, and ask questions for clarification in order to provide a deeper experience.[2] Chaplains refer to these methods as the ministry of presence, where they embrace silence as part of a process and explore questions that may not have quick answers.

In such an atmosphere, team members can provide for discussions where the patient and family can define how hope operates for each of them. This approach was discussed by Brad DeFord, MDiv, PhD, of Torrance Memorial Hospice, Torrance, California; and Suzanne Bushfield, PhD, Arizona State University, Tempe, Arizona, in their presentation, "The Social Work of Spiritual Care and the Spiritual Work of Social Work: The Meanings of Hope and Love."[3] The presenters pointed out that social workers could discover the patient's and family's understanding of hope and meaning through their assessments in family systems.

Clinicians can learn about a patient's spiritual distress by asking questions such as: "How do you view pain?" or "What do you think about when you can't sleep?"[2] Nurses may explore the spiritual truths of patients as they seek pharmaceutical answers for comfort care. The team members would not be taking the place of the Chaplain in exploring these personal truths with patients and families. Chaplains with an interdisciplinary mindset do not see these types of interventions as boundary crossing. Spiritual coordinators welcome this kind of interaction as one that will increase the effectiveness of the interdisciplinary model.

Spiritual and Cultural Sensitivity

Religious and cultural diversity even influences what Richard Fife, MDiv, DMin,[4] VITAS Healthcare Corporation, Miami, Florida, termed "death talk." Grief is a unique experience for each individual. In a hospital emergency waiting room, I have seen grief displayed similarly, and differently, among different cultural and religious groups. Some screamed and wailed, while others cried quietly. Some faith groups make it a point to believe God does not make mistakes, while others feel at liberty to ask God why