Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Spiritual Welbeing Assessment

Definitions

 

Part of the problem with incorporating spirituality into scientific thinking has been the confusion associated with the terms religion and spirituality (Krause N, 1993).

 

Religion:

refers to beliefs, practices and traditions associated with religious groups (e.g. Catholic, Protestant, Jewish, Buddhist) (Sherman DW, 2006).

 

Spirituality:

refers to the personal search for meaning and purpose in life (relationship to self, others, nature, world, God) (Sherman DW, 2006).

 

Spiritual Care:

Spiritual care is defined as “meeting people where they are and assisting them with connecting or reconnecting with things, practices, ideas, and principles that are at the core of their being-the breath of their life, making a connection between yourself and that person (Chochinov H, 2005).

 

 

The need for spiritual care.

The word spirituality comes from the expression spiritus, which means breath of life.

It is related with higher questions in life, as it permits to query, seek and find the meaning of its life (Monod S, 2009).

Every person will have different ways of finding the meaning of life, giving spirituality an individual, dynamic and subjective character.

Hence, every person is a spiritual being and primary carers should consider the needs of religious patients and of those who consider themselves atheists or agnostics.

 

Elderly patients, as they approach the end of life, will adopt a more regular religious or spiritual practice, resuming the comfort of faith or a way of life that will permit finding meaning and peace (Vachon M, 2009).

The more critical situations in life that convey the possibility of death, confronting the person with its end, are the ones swathed in spiritual nature (Crowther MR, 2002).

 

 

Barriers to Spiritual Care

  • Spirituality confused with religiosity

  • Lack of training

  • Poor understanding about what the spiritual dimension comprises

  • No prior self-assessment

  • Discomfort with the dimension

 

 

Spiritual Distress

 

Reasons for Spiritual Distress

  • Disruption in usual religious activity

  • Personal and family disasters

  • Loss of significant other

  • Behaviors contrary to society/cultural norms

 

Characteristics of Spiritual Distress

  • Feeling separated or alienated from the deity

  • Dissatisfaction with personal past or present

  • Depression

  • Crying

  • Self-destructive behavior or threats

  • Fear

  • Feelings of abandonment

  • Feelings of hopelessness

 

Spiritual Cues indicating unanswered spiritual or existential needs9

  • I am wondering if God is here for me now.

  • I feel as though God is punishing me.

  • I am angry at God.

  • Why is this happening to me?

  • I feel abandoned.

  • God has not been fair to me.

  • I failed God.

  • I am worried that my children is not going to remember me.

 

Spiritual pain may manifest as the following :

  • Physical (intractable pain)

  • Psychological (anxiety, depression, hopelessness)

  • Religious (crisis of faith)

  • Social (denigration of human relationships)

 

Spiritual crisis at the end of life may take the form of: 2

  • Losing one’s will to live

  • Heightened desire for death

  • Loss of dignity

  • Loss of control

  • Fear of being a burden to others

 

 

Offering Spiritual Care

  • Acknowledge spiritual pain

  • Therapeutic use of self

  • Listening

  • Presence

  • Non-abandonment

 

  • Create a spiritually healing environment through use of music, art, massage, aromatherapy, guided imagery, or therapeutic touch.

  • Offer in-depth work as an approach that moves individuals toward a deeper level of the psyche, helping create a sense of meaning and reconnection to the ordinary things of life. Discuss areas of concern such as relationships, control, identity and meaning.

  • Encourage patients and family to speak of aspects of their life they were most proud of or that were most meaningful; the personal history they would like remembered, or things that need to be said.

  • Provide referral to clergy or spiritual advisor

 

 

Interdisciplinary Approach/Resources

  • All team members are responsible for holistic care.

  • Referral to chaplain, massage therapist, art therapist, music therapist.

  • Use of individual’s personal clergy, faith community, identified supports

The Spiritual Welbeing Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

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Spiritual Welbeing Assessment

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