3 Keys to Spiritual Care in Hospice

Posted on June 21, 2016 by Cynthia Robbins Hospice chaplains work within the realms of mystery and meaning. When you work with the soul of a person rather than their physical body, you are in a place that defies definition and is so vast in its importance, it can seem daunting. There are no specific protocols to follow, no prescribed systems for “fixing” what might be ailing the spirit of a patient.

I have learned that as a spiritual caregiver, your effectiveness has very little to do with what you bring to the patient. It has everything to do with how you are with the patient.

I focus on these three areas in offering spiritual care to hospice patients:
 

I Honor the Patient’s Larger Context

No two patients are alike in how they define who they are spiritually or what they find meaningful. Attaining a patient’s spiritual background is an important first step in getting acquainted, but can be much harder than it sounds. Many of my patients have advanced dementia, so I often need to seek information from family members who may or may not know much about the spiritual life of their loved ones. If there was religious background, it certainly helps to find that out. But in a country where much of the population is described as “spiritual and not religious”, religious background sheds only a partial light on what really matters to an individual. As a chaplain, I find myself on tender holy ground. Many patients can be awkward in talking about what really matters, even though I come to them at a very momentous time for such conversations. Matters of the spirit are private and personal, and suddenly sharing these deepest feelings to a stranger can be difficult.

As I walk the hospice journey with a patient, I gradually understand more clearly their big picture of meaning and then I support that. If a patient is a devout Jew, I would connect him or her to a Rabbi, if needed, and I would provide Jewish prayers during my visits. If a patient is Buddhist, I would offer guided meditation. Or, the big picture of meaning might not be religious but rather, all about the patient’s family. The most important thing may be the patient’s love for their family. Engaging in life review while looking at family photos is one way I have honored this very common life meaning.

Whatever the larger context of meaning is for a patient, I hope to help that individual connect to it in a way that honors the mystery and meaning of what their life has been and their legacy will be.
 

I Make a Connection

Being at the end of your life can be a very lonely time. Everyone must make this journey. No one can do it for us and we only do it once. When I meet patients for the first time, I am deeply aware of what a solitary process dying is. The biggest comfort of all is to know that you are not alone, that someone cares you are going through this experience, and that your life matters. It is very important that I am able to provide a warm and positive moment with my patients. I do this through compassionate presence and attentive deep listening. A gentle touch to the shoulder for a nonverbal patient and the playing of soothing music can help provide a feeling of connection. Just bringing a smiling face into the room is a comfort to many patients. As always, I am very conscious that my work is not about me and what I bring to patients. It is all about the patient and what they need. So I watch for ways to connect that allow for an enriching visit in natural ways.

For example, I have a 90-year-old-male patient who has dementia and is largely nonverbal. Most of my visits have been ones of quietly providing presence and music for him. I learned from his family that he -is not religious so I do not offer prayers. One time I visited, he was wearing a University of Michigan hat. After I had been with him a few minutes and discovered him to be largely non-responsive and sleepy, I asked, “Did you go to the University of Michigan?” He perked right up, opened his eyes and said, “Yes.” “I did, too!” I exclaimed. Then he brightened with a smile and said, “You did?” Afterwards we were able to have a simple but sweet talk about Michigan and a connection was born. When I left the visit, I said, “Go Blue!” and this patient smiled again and seemed warmed by our interaction. Feeling a connection to another is elemental to what matters to our soul. It can be as simple as noticing what hat the patient was wearing and bringing attention to it.
 

I am a Non-Anxious Presence

  My most important aim as a chaplain is to be a non-anxious presence for the dying. Being admitted to hospice care and knowing you are in your final chapter is naturally anxiety producing. It is essential in spiritual care to provide a sense of calm and peace in the midst of this new reality. Spiritual care is not about providing a toolkit of strategies to fix souls before the end of life happens. It is about sharing this important chapter and providing comfort and peace by how I am with the patient. Being a non-anxious presence allows the patient to be however they need to be in this moment. They can express their fears and grief and I will hold those feelings for them and stay calm. I can embody the larger context of peace and meaning and enable the patient to learn to relax into the process of letting go.

Spiritual care is about being there when it matters most and embodying loving presence at difficult times. It is not all that mysterious. It is, however, quite momentous and essential for a beautiful ending.

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At Care Dimensions, our focus is on compassionate, quality patient care that embraces the whole person: body, mind and spirit. Learn more about how Massachusetts’ hospice leader can help you or someone you love with advanced illness.