What do you think when you hear the words ‘Spiritual Care’? What role does it play in 21st century hospice care?
Many of you might think that spiritual care won’t be for you if you’re ever in need of hospice care and you’re not a regular churchgoer or don’t have a religious belief. Indeed, the original role of the Chaplain half a century ago was predominantly limited to offering support from the perspective of the Christian faith, conducting the appropriate religious ceremonies in death, or helping to arrange a funeral.
Dame Cicely saw that emotional, psychological and indeed spiritual care were integral to good end of life care
Dame Cicely Saunders, who founded the Modern Hospice Movement 50 years ago, had a very strong Christian faith; it was a great source of compassion and it sustained her in her role to care for the dying. Importantly, her excellent qualities as a dedicated physician coupled with this compassionate faith meant that she always saw the person in the patient. She was the first to recognise a greater need among people living with a life-limiting illness beyond the need for physical care. She saw that emotional, psychological and indeed spiritual care were also integral to good end of life care, vital to ensuring as good a life as possible and consequently, a ‘better’ death. Upon strong Christian foundations holistic hospice care was built.
But that was half a century ago! Where does spiritual care sit today, in our more secular, multi-cultural, multi-faith society where traditional Christian beliefs may not be as prevalent in people’s lives? What advice can Spiritual Care Chaplains give outside of religion? Well, an awful lot as it happens.
It opens the doors to people of any, or no, faith or belief system.
Upon Googling the word “spiritual”, one definition listed was indeed “relating to religion or religious belief”. However, this wasn’t the first definition listed in the results. It was actually “relating to or affecting the human spirit or soul as opposed to material or physical things”. This much broader term can be applied to our values, emotions, thoughts and desires, and opens the doors to people of any, or no, faith or belief system. Wikipedia states that “There is no single, widely agreed definition of spirituality”; it goes on to discuss a number of interesting and broad descriptions.
As an Anglican priest Carol believes that her faith sustains her in her role, but it by no means defines what she does
Carol Gully, Spiritual Care Chaplain at Rowans Hospice, struggles to define her role. As an Anglican priest Carol believes like Dame Cecily that her faith sustains her within her role as Chaplain, but it by no means defines what she does. “I do something different every day, and I can never predict how my day will go… I’m just there in the gaps, for those ‘in-between’ moments” she says, humbly.
What she means is that she, and her dedicated Spiritual Care volunteers, are there to do anything and everything that deals with an individual’s wishes, needs and fulfilment for mind, body and spirit, regardless of religious faith or worldly outlook. The fact is that they are an individual person with their own unique desires and wishes, right up until and beyond the moment they die. The key words are “individual” and “fulfilment”.
She asks rhetorically “why do we have fish in the courtyard pond? Why do we put flowers in the rooms and comfy chairs in the garden? Why do we have a CD player in the chapel? It’s these almost indefinable dimensions that are added to the patient’s experience that I call Spiritual Care”.
In that moment they say something seemingly insignificant that actually uncovers what they’re really thinking
The philosophy here is to allow the patient to lead the conversation as much as possible. “We keep people company while they explore their thoughts” Carol confirms. And, some of the most valuable moments Carol’s had with a patient are what we call ‘doorknob moments’. She explains, “when you’ve had a conversation with someone for an hour without saying much at all, your hand’s on the door and you’re about to leave, and in that moment they say something seemingly insignificant that actually uncovers what they’re really thinking and feeling at a deeper level within themselves. If you’ve been listening, it’s from this tiny moment of insight that you can gain a better idea of how you can support them”.
We work to understand what is important to that person, and we do this by listening.
Jean Hooper, who is a retired professor of nursing, Methodist preacher and volunteer at the Hospice since it opened in 1994 (more recently in a Spiritual Care role), feels the same. She explained “We work to understand what is important to that person, and we do this by listening. We don’t go in talking about our own faith, or any faith for that matter, or presume to know what they need, or that they need us at all. We let them know we are there, we offer our time, we give them choice, we we aim to meet their needs and wishes, should they wish us to do so. Sometimes that might just be holding someone’s hand in silence – it doesn’t matter”.
All the staff and volunteers to know that, every time they do something extra special, they are delivering spiritual care - everyone delivers spiritual care
Carol also feels strongly that modern spiritual care is a truly a hospice-wide endeavour. “We deliver spiritual care to patients in all shapes and forms, of course, but I equally encourage and support all the staff and volunteers to know that, every time they do something extra special, or even the ordinary, to fulfil a person’s individual wishes, whether big or small, they are delivering spiritual care. Everyone delivers spiritual care”.
“A lady recently revisited the Hospice for the first time since her husband died within our care. I spoke briefly to her, but it was a coffee shop volunteer who then listened to her for a further two hours. There were tears, there was laughter, and the lady told me she left feeling much better. It wasn’t planned, but the volunteer took the time to listen. That is spiritual care!”
“I’ve brought in an Eric Clapton CD so that a patient’s relative could listen to their favourite music while sitting in the chapel – I’ve since had Bluetooth installed so people’s choice of music is entirely their own now!; I’ve printed off the words to a patient’s favourite poem and placed them where they could see them and read them every day; I’ve said the prayers of commendation for a Christian and conducted a natural funeral for an atheist; and for another patient I’ve been out to the corner shop on a Sunday with my dog collar on to get some cigarettes! This is all in a day’s work for me, and is what I call Spiritual Care!”
We should not presume to know what they want, but we can let them know we are here
So as inclusive, non-judgemental, individually focused and non-presumptive as our Spiritual Care team are, does everyone feel like they have the choice to access spiritual care, and hospice care in general?
Sadly no. Carol explains, “A challenge that still exists within modern hospice care today is to widen accessibility to all. Specifically for us it is to overcome cultural and religious barriers that exist within our multi-faith community, which come from a belief that we cannot cater for their particular need”. Carol has met with cultural leaders in our area of care from both the Muslim and Jewish communities, to listen to their needs and learn from them. “We should not presume to know what they want, but we can let them know we are here, that we can provide for their community’s needs in end of life care if they tell us what’s important to them. Conversations so far have been very positive”.
Spiritual care today is simply about journeying with the patient
As part of the 50th anniversary of the founding by Dame Cicely Saunders of Modern Hospice Care, Spiritual Care was the focus of the latest in a series of celebratory conferences hosted by St Christopher’s Hospice, which Carol attended. “The over-arching feeling was that spiritual care today is simply about journeying with the patient, and giving them the choice. I couldn’t agree more!”
So, far from being a redundant feature of hospice care, modern Spiritual Care seems to transcend religious support to become that which simply offers everyone individual choice, hope, fulfilment... and always a listening ear.
Carol Gully and her volunteers are based at the Hospice and in the Living Well Centre. They also make regular visits to the hospital and often go to people in their homes. If you or someone you know are already in the care of Rowans Hospice or thinking of receiving hospice care and wish to talk to Carol or discuss spiritual care further, you can get in touch here.
Carol and other members of staff from the Hospice visit the Al Mahdi Centre in Portsmouth to build cross-cultural relations across our community.
Carol Gully, pictured here in the Hospice Chapel, which Carol refers to as "a space for everyone whenever they need it, where they can just be".