Spiritual Care Giving as Life Draws to a Close

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SPIRITUAL CARE GIVING: As Life Draws To a Close
Each person who interacts effectively with a dying person cannot leave emotionally and spiritually untouched and unchanged in some way.
My Mother lived the last months of her life in a palliative care setting. I spent many hours at her bedside. This time together was a privilege and a gift. It afforded me an immense opportunity for spiritual growth. I took full advantage. Because of my Mother’s willingness to trust me with the sacred knowledge being revealed to her, and because of my courage to hear stories which many might consider hallucinations or paranormal (and, therefore, block the communication with verbal and nonverbal messages of discomfort), I left my Mother’s death bed grateful for the learning that had taken place during those precious and loving moments. I left my mother’s death bed assured that somehow, somewhere, life goes on, even when the one we love is no longer visible to us. 1
While conscious and orientated to the end of her life, my mother spent many hours engaged in trance-like conversations. She would turn her head, as if listening intently, and would nod and smile as if in agreement, or to indicate an understanding of what she was being told. Following one such conversation I asked, Mom is daddy here? My dad had died years previous. She nodded in agreement. I asked is Billy present? She smiled indicating that the spirit of my son was right behind me. He holds a rose for you “ can you not smell it?”
Because of my educational background and personal and professional experiences I was able to acknowledge her dreams and the visitations as important aspects of her life review process. I knew my mother was deeply engaged in a spiritual endeavor of examining and sorting the details of her life. In so doing she was being afforded an opportunity to bless the events and experiences she felt satisfied with, and to make amends with the circumstances in her life which she viewed as less than satisfactory all being done in an earnest effort to bring a satisfactory closure to the life she was completing. In reviewing her Balance Sheet of Life, my mother was making efforts to ensure that the Gods; would be pleased. 2
While aspects of her religion and her religious beliefs were interwoven into her process, the process was of a spiritual, as versus religious, nature. And while the words religion and spirituality are often used interchangeably, they are not synonymous.
The Spiritual Care Work Group of the International Work Group on Death, Dying, and Bereavement 3 noted that by virtue of being human, all people are spiritual regardless of whether or how they participate in religious practices. Religion is a belief system. These beliefs are based upon doctrines and creeds and are demonstrates in practices. The word religion comes from the root phrase meaning to bind together. Religious practices are often fused to cultural beliefs and customs and many people find significant support and comfort from these, as well as from the community of common believers. Spirituality, however, is a dimension of person hood. It pertains to the search for values and meaning which flow, not from beliefs, but from attainment of personal knowing gained from experiences.
The concept spiritual comes from the Medieval Latin word spiritualis, pertaining to breath, wind, or air and suggesting that Divine or Spiritual Energy is essential to all life. Eastern and aboriginal cultures view the spiritual
as having immortal qualities connecting all life forms to the environment and the universe. In these cultures the spiritual is often explained in symbols, such as appear in the directions, nature, dreams, art work and the medicine wheels. The health care literature tends to define and describe the spiritual in terms of one’s life long search for what matters, and one’s purpose in life within the connections of God, self, others and creation. This connection brings faith, hope, peace and empowerment. The results are joy, forgiveness of oneself and others, awareness and acceptance of hardship and mortality, a heightened sense of physical and emotional well-being and the ability to transcend beyond the infinities of existence. 4, 5, 6
It is important for those of us who walk beside others during their life’s turning points – during times after which life will never again be the same, to recognize that while some find spiritual meaning in religious practices, others find spiritual fulfillment outside of traditional religions. It is also necessary to acknowledge that regardless of religious affiliations we each have experiences which are of a spiritual rather than of a religious nature. Acknowledged as having supernatural significance, such experiences appear to occur with increased frequency and intensity during times when people are moving through challenging circumstances. There is a growing body of literature validating such experiences and begging professionals and loved ones to be more fully present to those who are attempting to work through the spiritual questions which surface during such times. 7, 8, 9
Turning point events frequently catapult us on an inward journey there to examine the meaning and the purpose of the experience being faced as well as the meaning and purpose of our entire life and of life in general. The journey inward is almost always accompanied by some degree of spiritual distress. During such times the need to pay attention to these important questions and the search for answers which fit our own experiences, dominate our thoughts demanding full attention.
I have come to acknowledge that during such times, the spiritual journey unfolds in distinct yet overlapping phases. In the beginning, and in an attempt to hold to old ways of being and believing, many try to satisfy soul’s questions with familiar rhetorical reassurances such as: It must be God’s will; It is all for the best.” By the second phase, there is a clear recognition of the challenge and acknowledgment of being forced into combat with long-held beliefs. During this testing time every assumption about life and life’s meaning and about death and death’s meaning is grappled with. This is a time of separating old beliefs from what is essential for continued spiritual growth and transformation. It can be a time of barrenness, desolation and depression. It can be a time of feeling abandoned by others and totally and completely forgotten by God. But this dark night of the soul experience is not without merit for it is often during the bleakest moment that the real message of transformation comes. As the poet Roethke noted, It is during our dark time, that the eye begins to see. The final phase of this spiritual process begins with the recognition that the experience and the spiritual journey have brought change and transformation. There is a clear recognition of which old beliefs must be let go of. The beliefs now held, are beyond beliefs. These have become personal knowing and there is a clear awareness that the distress of the quest has been worth the while. 10
Because of this reward – the personal and spiritual growth which results from dark night of the soul experiences, it is essential for professionals who work with those who move through crises turning points to acknowledge that during such times there is frequently a major re-framing of the person’s image of and relationship to, themselves, others and their God. During this intensely difficult time many face what is known as a personal beliefs crisis- for belief are challenged by the experience being faced, and many of the long-held beliefs do not hold up against the torturous fires of the lived experience. Since no degree of distraction can keep the person from paying attention to the important soul questions that nag for answers, professionals must learn to resist the desire to move the person from this obviously distressing time and instead acknowledge and respect that the time within affords an opportunity for incredible spiritual growth. It is a time to be honored rather than feared.
Assisting Another on their Spiritual Journey
Nurture Your Own Soul
To be of real assistance to another as they search within the caverns of their soul we, as professionals and caregivers, must first recognize the sacred trust being invested – the sacredness of the bond developing. We must recognize when and how the struggles and the questions of another challenge our own beliefs, trigger our own fears. For the moment we convey disbelief or judgment in any form, either verbally or non-verbally, we block the soul to soul communication required during those intensely sacred moments.
To have the ability to stay connected to the soulful experiences of another we as professionals and loving caregivers, must be on our own spiritual growth journey. This automatically increases our comfort level with the doubts and questions beings raised, for we have likely worked through some very hard ground (or are presently doing so) in our own efforts to unearth answers to spiritual questions similar to those being raised by the ones we are now walking beside. This requires that we examine and perhaps expand personal definitions of spirituality, for to work at a soul level, we must view spirituality beyond the boundaries and limits of religious models, regardless of the religion.
Extend care, love and compassion
Numerous studies have identified that good spiritual care requires that health professionals replace the mechanism of their practice with compassion, love and caring. Patients in these studies reported that for a caring relationship to develop the listener must be fully present to suffering and existential questions.11 To do so we must listen:
· Deeply – for soul pain is often disguised in physical and/or psychological complaints.
For themes of questioning and /or dissatisfaction with past beliefs and practices.
For themes of hopelessness and despair.
For expressions of loss of control, of fear, of dread.
To what is said, as well as to what is avoided.
To the stories and life metaphors that surface from dreams and visitations
To the life memories stimulated during therapeutic activities such as guided imageries and art making and as stimulated by music and song.
Meet spiritual needs by addressing religious needs
As mentioned earlier, some individuals meet their spiritual needs through formalized religious practices or rituals. These will vary from faith to faith, and may include prayer, meditation, study of religious writings or scriptures, sacraments, and confession. Religious needs and concerns may be best addressed by a religious elder, leader, clergy or by a pastoral care worker. All care givers should, however, recognize that myth, metaphor, poetry, music and song can be religious or spiritually based and are time-honored ways of addressing individual religious and spiritual needs. It is important to also pay attention to the inclusion of meaningful objects or symbols, such as pictures, music, or books, in the individual’s environment. These may be of a religious (statues, pictures, rosaries,
beads, medals) or of a non-religious, but spiritual nature (feathers, rocks, water or other elements, crystals, symbols).
In conclusion, just as spirituality may encompass but is not limited to religion, spiritual interventions may encompass but are not limited to religious practices. Although religious leaders and/or clergy play a role in addressing religious and spiritual issues, the ethical codes of all health care professionals mandate care that is holistic in nature. Hence all health care professionals have the potential and ethical obligation to provide spiritual care. In doing so, we must however, be ever cognizant of each individual’s strengths and wishes. The person making the sacred journey gets to choose who will accompany and what methods will help advance their spiritual progress. Our major obligation, our sacred trust is to insure that the strategies we offer move those we work with along a path toward healing and wholeness- in the direction of self discovery and personal and spiritual empowerment.
May we always do so – and in such a way – that when the life review is complete and we leave for the last time – we smell the fragrance of new roses – acknowledging a job well done.
References
1. Simington, J. 2005. The Heart and Science of Palliative Care. Living Our Losses Bereavement Magazine. Otter Publications. Fall/Winter.
2. Erickson, E. 1963. Childhood and Society (2nd Ed). Horton.
3. Spiritual Care Work Group of the International Work Group on Death, Dying, and Bereavement. 1990. Assumptions and principles of spiritual care. Death Studies, 14(1), 7581.
4. Burkhardt, M.A. and Nagai- Jacobson, M.G. 2002. Spirituality: Living our Connectedness. Albany, NY: Delmar/Thomson Learning.
5. Coyle, J. 2002. Spirituality and health: Toward a framework for exploring the relationship between spirituality and health. Journal of Advanced Nursing, 37(6), 589-597.
6. Simington, J. 2003. Ethics for an evolving spirituality. In J. L., Storch, P. Rodney & R. Starzomski (Eds.). Toward a moral horizon: Nursing ethics for leadership and practice, Chapter 23, pp.465-484. Toronto: Pearson Education Canada.
7. Simington, J. 1996. The response of the human spirit to loss, Living With Our Losses Bereavement Magazine 1(1), 9-11.
8. Simington, J. & VON. 2003. Listening to Soul Pain. Audiovisual. Edmonton, AB: Souleado Publications.
9. Boehm, R., Golec, J., Krahn, R. & Smyth, D. 1999. Lifelines: Culture, Spirituality and Family Violence. Edmonton, AB: University of Alberta Press.
10. Simington, J. 2003. Journey to the Sacred: Mending a Fractured Soul. Edmonton, AB: Taking Flight Books.
11. Simington, J. 2003. Psychological, Social and Spiritual Aspects of Palliative Care. Palliative Care Certification Training Program. Edmonton, AB: Grant Mac Ewan College.
First publiched in Pilgrim’s Progress: Hospice News. Nov, 2005, 11(3), 10-13.
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Website: www.takingflightinternational.com
Copyright Dr. Jane A. Simington Ph. D.