Providing holistic care

Providing holistic care

By providing holistic care - meeting both the spiritual as well as the physical needs of their patients - people who work in the caring professions have a very special role in helping the dying.

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Holistic care for the dying

Holistic care is a concept receiving increasing attention across the caring professions. In short, it involves recognition that the needs of a dying patient go beyond just the clinical and physical.

It also emphasises the responsibility of all of those who are providing care for the dying to both look out for and address the spiritual needs of their patients.

This can sometimes be a challenge to some caregivers, who may associate spirituality only with chaplains or view ‘spiritual’ and ‘religious’ needs as the same thing.

Understanding the meaning of a life

In fact, spirituality can be defined in many ways but its essence is to do with how people understand the meaning of their life. Dr Karen Groves from Merseyside has developed a series of courses to help clinical staff provide great spiritual care, entitled Opening the Spiritual Gate.

She explains: “Whether or not they recognise it – and whether or not it is recognised by other people – everybody has a spiritual dimension.

“There is always something that gives them meaning in life, whatever that is. Therefore, at the end-of-life everyone will have spiritual needs of some sort – and we should be recognising those. A holistic approach is crucial.”

What are spiritual needs?

So what exactly are spiritual needs and how do you spot them? Dr Karen continues: “It’s very easy to focus on what you can see. Physical and social needs may be quite easy to recognise. Psychological needs are a bit more difficult to spot. When it comes to spiritual needs, unless a caregiver is aware of what to look out for, it’s easy to miss them altogether.”

Spiritual needs can include ethical concerns (e.g. a need for forgiveness), questions about meaning (e.g. a need to ‘make sense’ of what’s happening) or specifically religious issues (e.g. a wish to see a priest or minister). Read more about spiritual needs.

What to look out for

Things to look out for might include questions about life after death, expressions of sadness about family relationships, or a prayer book by a patient’s bedside.

The truth is, worrying over ‘spiritual’ issues can cause a patient real suffering. As a result, the spiritual needs of people whose life is reaching an end are at least as important as their physical needs.

Further, physical pain can have its roots in spiritual distress, so to provide genuinely patient-centred care, it’s important to think holistically.

Spiritual pain

Dr Liz Toy, an Oncologist from Exeter, is alert to this connection. She says: “Spiritual pain is often quite deeply buried by either the patient or the family – and maybe not even recognised as such.

“More often, I see it expressed in a physical or emotional way, such as pain, nausea or another symptom that’s difficult to control such as poor appetite or difficulty in sleeping. At other times, it’s more of a change in behaviour such as withdrawing from usual interactions, a loss of confidence, or a reluctance to be discharged home.”

Tackling the underlying causes of these physical symptoms can be critical. Dr Liz adds: “For those who have either a long-term or terminal condition, unaddressed spiritual pain will affect not only the manner of their dying, but also, their family.

“The memories of that death will then follow on into the way they respond to their own illnesses in the future, and how they respond to future problems. Difficult deaths very often lead to very difficult bereavements.”

Asking open questions

However, getting to the bottom of these ‘hidden’ spiritual issues requires great communication skills. This involves asking open questions, not making assumptions and allowing people to speak for themselves.

This kind of communication, which is an art in itself, generates trust, which in turn encourages people to open up about what’s really bothering them.

And for Dr Karen, this is the key. She says: “If you speak at a superficial level and you only ask closed questions, then you’re never going to get to the nub of the story.

“You need to be able to ‘unpeel the onion’. And nobody is going to unpeel the onion if they don’t trust you. And they are not going to trust you if you don’t listen. But you’re not going to be able to listen unless you have good communication skills.”

Helping the patient to ‘let go’

To help with this, the American Academy of Hospice and Palliative Medicine has developed a useful acronym for caregivers, to help them talk to dying patients about their spiritual needs. The overall aim, as the acronym says, is to help the patient to ‘let go’:

L – Listen to stories Stay present with the patient
E – Encourage search for meaning Ask open questions
T – Tell the patient of your concern Show you care
G – Generate hope whenever possible Help them be positive about the time left
O – Own your limitations Know when to refer the patient to others

Florence Nightingale, the founder of modern nursing, trained with several orders of nursing nuns. As a result, she was inspired in her work by a saying from one of the parables of Jesus –”I was sick and you visited me” (Matthew 25:31-46).

In the parable, Jesus described how those who care for the sick are actually doing a great work for God.

The Art of Dying Well