Spirituality
I work with a colleague who believes that she has a duty to share her religious faith with dying people. I sometimes feel she is not respecting the patient’s privacy or boundaries, but what should I do about this?

Death and dying often elicit a heightened awareness of the importance of spirituality in patients, families and health care professionals. Caring for dying people and their families may offer opportunities to help them find meaning, love, hope and peace in the midst of very difficult circumstances. With these opportunities comes the responsibility of respecting patients’ right to embrace their own values and traditions and to protect them from those who might take advantage of their vulnerable situation.

Your colleague certainly seems to recognize that dying people and their families may have religious questions or spiritual struggles and seems ready to share her own answers. As you suggest, though, it’s not clear whether in doing so she is meeting her own needs or those of her patients. The SACR-D model outlines the five key elements that health care professionals should consider when addressing spiritual issues[1]:

  • S-self-awareness: the need for self-awareness and spiritual sensitivity on the part of the spiritual care professional;
  • A-assessment of the patient’s spirituality: standardized tools and clinical skills to help health care professionals assess patient spirituality;
  • C-compassionate presence: the effect of clinicians’ presence in the provision of spiritual care;
  • R-referral for additional support: recognition of the availability and need for additional supportive and specialized resources;
  • D-dialogue: discussion of spiritual issues by communicating with patients in a language that is based on their spiritual perspective.

You can address how staff share their faith with patients at both a personal and team level. At a personal level, you could engage your colleague in conversation about what her religious faith means to her. Begin by simply acknowledging that her faith is important to her before offering your observation that she often speaks of her religious faith to the patients she cares for. You might then express curiosity about the importance of her faith in her own life. If the opportunity presents itself, it might be helpful to clarify with her where her sense of duty to share her religious faith with patients comes from—does she see it as her duty as a health care professional or is it a personal conviction? Your conversation could include questions like these[2]:

  • How did you come to have your religious faith and how has it affected your life?
  • What meaning and purpose does your faith give you?
  • What beliefs and values are important in your personal faith?
  • In what ways does your faith help you to feel part of something bigger than yourself?
  • How does your faith influence your relationship with God (or a higher power)? With other people? With the world?
  • How does your faith affect your goals or direction in life?

If you are able to find an appropriate time and space for such a conversation, your role is simply to listen and to seek understanding without judging your colleague’s religious orientation and the story of her spirituality. By doing this, you model a respectful way of entering into conversations with patients and their families. If she is open to it, you might, at times, offer your own perspectives. Do this without suggesting that your way of looking at things is right or better. Sharing your views is a way of revealing something of yourself, which may enrich the relationship. It also models how to share faith perspectives in a respectful, supportive way. Conversations about faith with patients should not be off limits for professional caregivers. However, caregivers should conduct these discussions in a spirit of openness, acceptance, respect and mutual sharing.

Responding to the spiritual needs of patients should be addressed at a team and/or organizational level. A spiritual care provider may be able to provide further guidance on how to best broach this conversation with your colleagues. A spiritual care provider may also be able to offer an in-service session on appropriate and effective spiritual care interventions that would help team members develop spiritual care capacity. The report on the 2009 Consensus Conference on Spiritual Care in Palliative Care includes recommendations for educational programs to help team members develop spiritual care capacity. Of special importance, is the recommendation that all team members should have training in compassionate presence and active listening[2].

The 2009 report also notes a number of ethical considerations that must remain central for staff who attend to the spiritual needs of patients[2]:

  • Because those who are dying often perceive professionals to have all the power and control, professionals “must never exploit a patient’s weakness or vulnerability” and “must exercise care, restraint, and confidentiality” in relation to their spirituality.
  • Boundaries that recognize physical, social, emotional and spiritual limits for the health care professional and patient need to be maintained.
  • Proselytizing within the clinical relationship is a “violation of the trust the patient has given to the health care professional.”

The goal in all encounters about spirituality is to “open a dialogue that can be tailored to the specific needs of the individual patient.”[2]

References

1. Martsolf D. Cultural aspects of spirituality in cancer care. Semin Oncol Nurs. 1997;13(4):231-236.

2. Puchalski C, Ferrel B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med. 2009;12(10):885-904.

Other reference

Sinclair S, Chochinov HM. Communicating with patients about existential and spiritual issues: SACR-D work. Prog Palliat Care. 2012;20(2):72-78.