Layers of engagement: Staff perceptions of spiritual care in residential aged care

ABSTRACT

Addressing the spiritual care needs of residents living in aged-care facilities should be an important dimension of quality care. We conducted semi-structured interviews with residential aged-care staff (including caregivers, nurses, managers, and chaplains) in New Zealand to explore how spiritual care is understood and operationalized. Many participants appeared to equate spiritual care with holistic care that respects the whole person. Participants discussed five types of spiritual care engagement requiring different skills, knowledge, and personal commitment, including information gathering, facilitation, companionship, end-of-life care, and counseling. Our findings suggest that the spiritual care that was offered by our participants, clergy and non-clergy alike, was predominantly informal and unplanned.     

On the notion of home and the goals of palliative care

The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. It is argued that this metaphor can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and “coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment, and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a normative point of view. It represents central human values and refers not only to the medical-technical and care aspects of health care, but also to the moral context.     

Cancer Survivors’ Spiritual Well-Being and Use of Complementary Methods: A Report from the American Cancer Society’s Studies of Cancer Survivors

We examined associations between spiritual well-being and CAM use among 4,139 cancer survivors. We also explored the classification of religious/spiritual practices (R/S) as CAMs and alternative subscale structures of the Functional Assessment of Chronic Illness Therapy—Spiritual Well-being (FACIT-Sp). We evaluated three aspects of spirituality, Faith, Peace, and Meaning, and use of 19 CAMs in 5 domains. Mind–body methods were subdivided into R/S and non-R/S. All FACIT-Sp factors were associated with CAM use, but in different directions: Meaning and Faith were positively associated; Peace was negatively associated. Peace was negatively associated with R/S CAMs, but not non-R/S CAMs. The prevalence of CAM use dropped from 79.3 to 64.8% when R/S items were excluded. These findings confirm an association between spiritual well-being and CAM use, including some non-R/S CAMs, and provide evidence of the benefits of using the three-factor FACIT-Sp solution and treating R/S CAMs as a separate category.     

The Confucian Self and Experiential Spirituality

Since the publication of his book on Zhongyong (Tu 1976), Tu Weiming has worked for more than 30 years on an anthropocosmic reconstruction of the Confucian universe, in which self-transformation is defined both as the starting point and as the necessary vehicle for one’s spiritual journey. This article is primarily intended to examine Tu’s attempts to reconstruct Confucian spirituality but further to take a step forward to argue that in the spiritual world as construed by Confucius and Mencius, the experiential functions as transcendental by which the self initiates and empowers the transformative process. Through exploring the spiritual significance of Confucian experiences, this essay will conclude that although “transcendental experience” is only one of many dimensions in other religious or intellectual traditions, it is the most important path for Confucians by which the self is enabled to become fully integrated with ultimate reality.     

The Impact of a Breast Cancer Diagnosis on Religious/Spiritual Beliefs and Practices in the UK

The use of religious/spiritual resources may increase when dealing with the stress of a cancer diagnosis. However, there has been very little research conducted into changes in religious/spiritual beliefs and practices as a result of a cancer diagnosis outside the USA. The aim of this study was to examine the impact of a breast cancer diagnosis on patients’ religious/spiritual beliefs and practices in the UK where religious practice is different. The study used two methods. One compared the religious/spiritual beliefs and practices of 202 patients newly diagnosed with breast cancer with those of a control group of healthy women (n = 110). The other examined patients’ perceived change in religious/spiritual beliefs and practices at the time of surgery with those in the year prior to surgery. The aspects of religiousness/spirituality assessed were: levels of religiosity/spirituality, strength of faith, belief in God as well as private and public practices. Patient’s perceived their belief in God, strength of faith and private religious/spiritual practices to have significantly increased shortly after surgery compared with the year prior to surgery. However, there were no significant differences in religious/spiritual beliefs and practices between patients and healthy participants. Change scores demonstrated both a reduction and an increase in religious/spiritual beliefs and practices. Although belief in God, strength of faith and private religious/spiritual practices were perceived by patients to be significantly higher after their cancer diagnosis, no significant differences in religious/spiritual beliefs and practices were found between the cancer group at the time of surgery and the control group. Different methodologies appear to produce different results and may explain contradictions in past US studies. Limitations of this study are discussed and suggestions for future research are made.     

Anger, Spiritual Meaning and Support from the Religious Community in Dementia Caregiving

This study explores the relationships between spiritual meaning and social support from the religious community and problem behaviors, anger and depression in 128 dementia caregivers. The results suggest a mediating role of anger in the relationship between the appraisal of problem behaviors and depression. Support from the religious community is directly and negatively associated with anger, but the relationship between spiritual meaning and anger is mediated by caregivers’ appraisals of problem behaviors, suggesting that spiritual beliefs might help caregivers to find meaning in caregiving experiences and thus appraise care recipients’ behavioral problems as less stressful.     

Religious and Spiritual Practices Among Patients with Cancer

The aim of this study was to investigate the frequency with which cancer patients engage in religious and spiritual practices, the methods used, the reasons for such a search, and the levels of depression and hopelessness in patients who seek spiritual assistance. One hundred and ten radiation oncology patients, who gave voluntary informed consent were included in this study. Questionnaires about religious and spiritual practices were administered, along with the Beck Depression and Beck Hopelessness scales. Twenty percent of the patients preferred spiritual practices. Female gender, lower education levels, and higher depression and hopelessness scores were associated with this preference. The frequency of depression was 18.2%, and the frequency of hopelessness was 20.9%. A significant number of cancer patients engaged in religious and spiritual practices. We recommend that practitioners offer their patients brief but sufficient information about religious and spiritual support and determine their patients’ depression and hopelessness levels.     

Children as Mystics, Activists, Sages, and Holy Fools: Understanding the Spirituality of Children and Its Significance for Clinical Work

This article explores children's spirituality and its significance for health care providers seeking to provide “spiritually competent care” of children amidst religious and spiritual diversity. Four metaphors of different spiritualities evidenced among children are explored: mystics, activists, sages, and holy fools. The article addresses issues clinicians face such as the problem of defining spirituality in relation to religion, and countertransference around religious and spiritual matters. Current research shows that spiritual and religious involvements constitute positive factors promoting resiliency and health in children. James W. Fowler's theory of faith development facilitates an exploration of questions concerning how children develop a belief system, leading to a view of children's spirituality as multidimensional. This article preserves the less formal conversational style of an earlier version's presentation in Grand Rounds at the UCLA Medical Center's Neuropsychiatric Hospital on December 10, 2003.     

Spiritual health,illness, and death

This essay outlines a view of spiritual health in middle life, particularly as it relates to an individual's confrontation with mortality. It was originally offered as part of a symposium on “Living and Dying” at the twenty-fifth reunion of the Harvard-Radcliffe Class of 1968 in Cambridge, Massachusetts, in June, 1993.     

Mark Graves <Emphasis Type="Italic">Mind,Brain and the Elusive Soul: Human Systems of Cognitive Science and Religion</Emphasis>

This article explores the use of Graves’ theory of the soul as an interdisciplinary tool to facilitate a holistic approach to healing. Graves’ discussion is applied to the use of therapeutic interventions to facilitate the emergent processes of healing and spiritual growth in traumatized persons.     

Sedation and care at the end of life

This special issue of Theoretical Medicine and Bioethics takes up the question of palliative sedation as a source of potential concern or controversy among Christian clinicians and thinkers. Christianity affirms a duty to relieve unnecessary suffering yet also proscribes euthanasia. Accordingly, the question arises as to whether it is ever morally permissible to render dying patients unconscious in order to relieve their suffering. If so, under what conditions? Is this practice genuinely morally distinguishable from euthanasia? Can one ever aim directly at making a dying person unconscious, or is it only permissible to tolerate unconsciousness as an unintended side effect of treating specific symptoms? What role does the rule of double effect play in making such decisions? Does spiritual or psychological suffering ever justify sedation to unconsciousness? What are the theological and spiritual aspects of such care? This introduction describes how the authors in this special issue wrestle with such questions and shows how each essay relates to the author’s individual position on palliative sedation, as developed in greater detail within his contribution.     

Learning from Spiritual Models and Meditation: A Randomized Evaluation of a College Course

Effects of two meditation and mindfulness-based spiritual interventions were examined in college undergraduates (N=44). Compared to a control group, both interventions decreased negative religious coping (d=−0.80, p<.01) and images of God as mainly controlling (d=−.73, p<.01). One intervention provided more training in tools for learning from community and tradition-based spiritual exemplars. It produced gains in famous or traditional spiritual exemplars’ perceived influence (d=+.81, p<.05) and availability (d=+.66, p<.10), in self-efficacy for learning from spiritual exemplars (d=+.92, p<.05), and in nonmaterialistic aspirations (d=+0.65, p<.05).     

The Spiritual Implications of Interpersonal Abuse: Speaking of the Soul

A holistic view of the person includes body, mind and spirit, or soul. The purpose of this paper is to explore the concepts of “soul” and “radical evil” within a conversation about destructive interpersonal abuse. Most religions and spiritual disciplines understand the human person, especially the human soul, as sacred. When the perpetrator, propelled by his own internal alienation, desecrates the soul of his victim through relational sexual abuse, the victim often experiences herself as a no-person. Her ongoing sense of identity is fragmented, her capacity for spiritual experience, for imagination, creativity, relatedness are deeply wounded. With the help of information from the field of neuroscience, as well as other theological perspectives, some pathways for healing of the soul are discussed.     

‘Minimal Religion’ and Mikhail Epstein’s Interpretation of Religion in Late-Soviet and Post-Soviet Russia

This is an examination of two essays on minimal religion by Mikhail Epstein (1982 and 1999), assessing the usefulness of the term ‘minimal religion’ for the analysis of religion in contemporary Russia. An adapted version of a paper delivered at the School of Slavonic and East European Studies (SSEES), University of London, on 8 December, 2003. Note regarding Mikhail Epstein’s use of the words ‘religion’, ‘religiosity’ and ‘spirituality’: Epstein uses the word ‘religion’ to signify ‘mainstream’, church-based manifestations of religion and also the institutional, hierarchical structures related to those. Although in English usage the word ‘religiosity’ has negative connotations – signifying either a superficially felt religious sentiment or a somehow false and insincere expression of religious feeling, intended for outward show – Epstein appears to use the term entirely neutrally. For him it simply serves as a synonym for the word ‘spirituality’. In the two essays examined in the present article the word ‘spirituality’ signifies the whole inner spiritual life and aspirations of the individual and her/his reflection on an ethical way of living, whether the person concerned is a committed, church-going believer, or someone engaged in a personal spiritual or philosophical quest for meaning, or else someone who has experienced what Epstein refers to as ‘the wilderness’ of the Soviet years and has learnt of a spiritual dimension to life through that formative experience.     

The Meanings and Manifestations of Religion and Spirituality among Lesbian, Gay, Bisexual, and Transgender Adults

The present study employed a mixed method approach in the effort to explore religious and spiritual practices among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as the meanings ascribed to the terms religiosity and spirituality by LGBT adults. Data were collected via a cross-sectional survey consisting of open- and close-ended items among 498 LGBT (lesbian, gay, bisexual, transgender) identified individuals attending an annual Pride event in a large northeastern city. Both quantitative and qualitative findings suggested that consistent with other studies, spirituality was defined largely in relational terms (e.g., in terms of one’s relationship with God and with self). Religion, in contrast, was defined largely in terms of communal worship and in terms of its negative influences in the lives of individuals and communities. For this sample of LGBT persons, spiritual identities were more pronounced than religious ones, and this pattern may be explained by their understanding of the spiritual self in relation to prosocial engagement and interconnectedness with others, the world around them, and the universe. Further, religious affiliation and practices were explained, in part, by the religion in which the individual was raised, level of educational attainment, as well as the developmental stage in which the person is currently situated. The findings highlight the reality that a substantial number of LGBT individuals may remain committed to religious and spiritual life, which may be related to a motivation to make sense of one’s place in the world especially in light of societal misunderstandings and intolerance to LGBT individuals.     

Confucianism between Tradition and Modernity, Religion, and Secularization: Questions to Tu Weiming

The article discusses central assumptions of Tu Weiming’s program of overcoming the “enlightenment mentality” and throws a critical light on his conceptions of religious or spiritual Confucianism, of a Confucian modernity, and of the “multiple modernities” theory in general. It defends a unitary rather than multiple concept of modernity in terms of the realization of a morally controlled “principle of free subjectivity” and tries to show how Confucianism, understood as a secular ethics, could contribute to this goal.     

道德与自然:"形上之道"与"形而上学"的本质区别

Both thinkings on Dao in Chinese philosophy and metaphysics in Western philosophy investigate things on a spiritual level that transcends experience, but there are incommensurable differences between them. The objective of “metaphysics” is ontological knowledge about nature from the perspective of epistemological “truth-pursuing”. Western metaphysics is thus a “metaphysics of nature”. Dao in Chinese philosophy, on the other hand, more often manifests itself in “good-pursuing” by means of the internal, experiential pursuit of moral stature and spiritual security. Philosophy of Dao is thus a “metaphysics of ethics”. The cause of this difference can be traced back to the differences between the rational tradition of the West, characterized by the dualism of the subject and the object, and the moral tradition of China, characterized by the integration of man and nature. __________ Translated by Zhang Lin from Lunlixue yanjiu 伦理学研究 (Studies in Ethics), 2007, (4): 62–65     

Being grateful for being: Being, reverence and finitude

Atheists are rarely associated with holiness, yet they can have deeply spiritual experiences. Once such experience of the author exemplified ‘the holy’ as defined by Otto. However, the subjectivism of Otto’s Kantianism undermines Otto’s otherwise fruitful approach. While the work of Hegel overcomes this, it is too rationalistic to account for mortal life. Seeking to avoid these shortcomings, this paper places ‘holiness’ within a self-differentiating ontological unity, the Heideggerian ‘fourfold’. This unity can only be experienced by confronting groundless finite mortality, and the resulting existential disposition is characterized as ‘reverence’. Reverence is gratitude for mortal existence, and existence itself. Moreover, it is as much political as it is ontological, atheistic as it is theistic.     

Guaranteed not to shrink: Spiritual direction in pastoral care

Interest in spiritual direction flourishes in all parts of the Christian tradition. The author notes several reactions of Protestants to this development before describing a biblical view of spirituality. He then sets out essential guidelines for spirituality and spiritual direction which are consistent with the Reformed tradition for churches wishing to include prayer and spiritual direction as a dimension of pastoral care.His article was presented initially as one of a series of convocation lectures marking the formal commencement of the Center's work and his installation as Director on February 4, 1982.     

The spiritual care of sick children: reflections from a pilot participation project

The authors are a multi-disciplinary team of chaplains, one with a counselling qualification, and an academic with a research background in spirituality and youth work. A pilot participation project undertaken at Birmingham Children’s Hospital (UK) focused on increasing the understanding of the spiritual needs of sick children and young people and involving children and young people in improving the service and provision of spiritual and religious care to them. Views from children, young people and parents were sought with the intention of developing resources and training that help facilitate the meeting of spiritual and religious needs of children and young people in hospital. Within the wider chaplaincy team are chaplains from the six major world faiths and this project considers spiritual needs of children and young people who perceive themselves as belonging to a faith group or not. Reflections from the pilot include identifying ten principles and practices to inform the spiritual care of sick children and proposing the concept of interpretive spiritual encounters as a tool for spiritual care. The pilot study indicated that being more proactive in offering spiritual care enhanced the quality of service offered by Chaplaincy.