Spiritual, religious, and cultural beliefs and practices play a significant role in the lives of patients who are seriously ill and dying. Attention to the spiritual component of the illness experienced by the patient and family is not new within the context of nursing care, yet many nurses lack the comfort or skills to assess and intervene in this dimension. Spirituality contains features of religiosity, but the two concepts are not interchangeable (Puchalski, Lunsford, Harris, et al. 2006). Spirituality refers to “one’s relationship with the transcendent questions”. For most people, contemplating one’s own death raises many issues, such as the meaning of existence, the purpose of suffering, and the existence of an afterlife. Goal of End of Life Care A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy.
Such an experience includes support for the patient’s suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death. I have had the opportunity to be present at several of my family member’s bedside at the time of their deaths. The common factors they each had was trying to find hope in the middle of the despair of death.
I believe spirituality gives individuals facing death hope and provides the comfort they need to resolve conflicts, release anxieties and fears, and finally to get a sense of purpose for their lives. I personally believe that the aim of opening the communication about ones spirituality at the end of life or to someone facing a terminal diagnosis is to encourage a time of self reflection and open dialogue between the patient, family and caregivers. The more often the health care professionals begin this type of open dialogue it will become common practice and it will enhance their own understanding of the practice of spiritual care.
It doesn’t necessarily mean that you have to be a spiritual person to be able to communicate with your patients about their spirituality and how they want that incorporated into their end of life care/experience. I think it means that you want to make that patients experience meaningful by providing holistic care; care of the whole patient. FICA The FICA Spiritual History Tool was developed by Dr. Puchalski and a group of primary care physicians to help physicians and other healthcare professionals address spiritual issues with patients.
Spiritual histories are taken as part of the regular history during an annual exam or new patient visit, but can also be taken as part of follow-up visits, as appropriate. The FICA tool serves as a guide for conversations in the clinical setting. The acronym FICA can help structure questions in taking a spiritual history by healthcare professionals. F – Faith and Belief Do you consider yourself spiritual or religious? ” or “Do you have spiritual beliefs that help you cope with stress? If the patient responds “No,” the health care provider might ask, “What gives your life meaning? ” Sometimes patients respond with answers such as family, career, or nature. I – Importance “What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness? What role do your beliefs play in regaining your health? ” C – Community “Are you part of a spiritual or religious community? Is this of support to you and how? Is there a group of people you really love or who are important to you? Communities such as churches, temples, and mosques, or a group of like-minded friends can serve as strong support systems for some patients. A – Address in Care “How would you like me, your healthcare provider, to address these issues in your healthcare? ” CONCLUSION It is the obligation of all physicians and other health care professionals to respond to, as well as attempt to relieve, all suffering if possible (Puchalski, 2002). The culture in which we live today have to look at the dying in a different way. Dying is a natural part of life it is not a medical problem or diagnosis.
It can be meaningful and peaceful when we as health care professionals take the time to inquire about our patients spiritual beliefs. Wayne Muller wrote: There are times in all our lives when we are forced to reach deep into ourselves to feel the truth of our real nature. For each of us there comes a moment when we can no longer live our lives by accident. Life throws us into questions that some of us refuse to ask until we are confronted by death or some tragedy in our lives. What do I know to be most deeply true? What do I love, and have I loved well?
Who do I believe myself to be and what have I placed on the center of the altar of my life? Where do I belong? What will people find in the ashes of my incarnation when it is over? How shall I live my life knowing that I will die? And what is my gift to the family of earth? Dying is the most difficult experience we all must have. The moment of death, and the dying that that precedes it, brings to a close our life-long journey. We are the privileged person who attend people while they are dying, be they our patients or our loved ones and friends (Puchalski, 2002).
We are the ones that can bring hope and comfort to them as they complete their lives. All it takes is time to listen to them and their families and this time can be a meaningful one.
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