Building on the research which Faith in Older People has undertaken Health Improvement Scotland requested an article on spiritual care which we are pleased to do. FiOP wants to ensure that there is increased knowledge and understanding amongst health and social care staff and value this will bring to the well-being of older people. This is the article which Health Improvement Scotland has published, the link is http://www.knowledge.scot.nhs.uk/sdun/our-network.aspx
Spiritual care is often seen as a difficult concept. The initial perception of many people is that it is only about religion and therefore if they do not have a faith then they do not consider it to be their business. However, this ignores the fact that faith may be of great importance to the person for whom they care, and that spiritual care has a much wider dimension to it.
Defining spiritual care is complex and many definitions are used but fundamental to all of them is ‘what gives meaning and purpose to our lives and how we express it’. In terms of current thinking this is an intrinsic element of the ‘what matters to me’ approach’. It is also important in understanding our own attitudes and values and how we bring this into the care we provide. “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” (Remen, R.N(2006) Kitchen Table Wisdom, Stories that Heal).
In the preface to the Faith in Older People Cameo article for Scottish Care, Donald Macaskill its Chief Executive wrote:
“Spirituality has to do with the heart and pulse of being human; it is the soundless language which communicates our deepest emotions of love, anger, fear and belonging. It is the rhythm which gives form to many of our innermost thoughts and feelings. It is the space where we rest in the awareness of meaning beyond comprehension and experience beyond description. To offer spiritual care is to give opportunity, time and place to enable an individual to explore and to express who they are as a human individual” (Scottish Care Cameo 2018
The Scottish Government has shown a commitment to spiritual care which is provided through the Spiritual Care Teams in each health board. This commitment is reflected for example in the Palliative Care Delivery Framework; the Dementia Strategy and the National Care Standards. These are all underpinned by an acknowledgement of human rights in emphasising our care values. However, we need to close the gap between the words and the action by ensuring ‘that the provision of spiritual care by NHS staff is not yet another demand on their – pressed time. It is the very essence of their work and it enables and promotes healing in the fullest sense to all parties, both giver and receiver, of such care” (Spiritual Care Matters; 2009 NHS Education for Scotland).
To consider these issues Faith in Older People undertook two research projects. One in care homes in Scotland and the other being a smaller study in nine Hospital Based Complex Clinical Care Units. What we found was that spiritual care appeared to be little understood as concept, but staff were providing good spiritual support without defining it as such. There was an anxiety about spiritual being religious and therefore beyond their field of knowledge and competence and so someone else’s responsibility. But the approach of listening, touch, music and finding out someone’s story was evident.
The research highlighted that education in spiritual care was found to be inconsistent and rarely accessible together with a lack of awareness of its availability. It also appeared that many staff seemed unaware that a spiritual care team existed, neither did they know of resources to draw on if they required spiritual care intervention for their patients (Aird, R and O’Neill, M 2018 ‘Is spiritual care in the health care setting everyone’s business? Faith in Older People
Both the research projects concluded that training, capacity building and the sharing of good practice needed to be improved. A key to any training will be establishing a clear and shared understanding of what is meant by ‘spiritual care’. Also understanding the roles played by different people in offering support should be explored – family members, friends, staff and the chaplaincy. (Jaquet, S. 2018 ‘De-mystifying Spiritual Care; Faith in Older People
A key issue in enabling this to happen is to develop flexible learning opportunities to fit round the working day and to be seen to have a relevance to day to practice rather than a strong emphasis on the theoretical. It would be important to ensure that there was access to IT as a way of enabling the sharing of ideas given that the two research projects found interesting and creative ways in which spiritual care was being enabled.
We were made aware of many very valuable resources that have been developed by NHS Education for Scotland, the Royal College of Nursing and others which should be made available to medical staff and both student nurses and allied health professionals as well as contributing to CPD. Spiritual Care Matters published by NHS Education for Scotland provides excellent explanations of spiritual care and the evidence to support its efficacy. Faith in Older People has developed two eLearning courses called Spiritual Care Matters for health and social care staff which are easily accessed and can be done on a flexible basis
These courses consider both the needs of the person cared for and staff needs and were developed in consultation with a range of health and social care staff. The Scottish Social Services Council includes the courses in its Badge scheme.
So, is spiritual care everyone’s business? The answer is yes. We can each contribute to enhancing a person’s spiritual well-being through an understanding of the wider dimension of spirituality; acknowledging that for some faith is really important in sustaining resilience in the face of diminishment and in knowing about and calling upon the spiritual care teams to provide religious care as well as comfort. We all have a role in supporting body, mind and spirit.
Maureen O’Neill – Director Faith in Older People