The impact of spirituality in healthcare
The views and opinions expressed are solely those of the author(s) and do not
necessarily reflect those of the European Union. Neither the European Union
can be held responsible for them.
S. Buchter and C. Odier
The impact of spiritualityin healthcare
How (to dare) to address it?
Tools for supporting conversation on an existential-spiritual topic and how to use them
Objectives
- Understand the role of spirituality within the care relationship.
- Explore existing tools that help address patients' spiritual needs.
- Identify the necessary conditions for using these tools appropriately in different contexts.
Training content
Practical tools for recognizing and opening conversations about existential, spiritual or religious aspects.
1. Impact of spirituality in care
= why ?
2. Ways to address and better understand it
= how ?
Tools for supporting conversation on an existential-spiritual topic
Exploration tools
1. Impact of spirituality
Why address this dimension with the family ?
= personalized care
Establishing a connection
Resource
/ Obstacle
Acceptance and respect
Values, Beliefs, Hopes, Meaning, ...
1. Impact of spirituality
embarrassing !
Important but...
support tools
+ practical advice
1. Impact of spirituality
Representations
Death
Spirituality
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
1. Impact of spirituality
Representations
Way of LIVING life to the fullest
Spirituality
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
Spirituality
Resource
Check !
2. Ways to approach and better understand it
identify observable elements
dare to talk about spirituality with simple questions
BUT FIRST
establish a relationship of trust
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
a. establish trust
"being"
"doing"
rythm and energy
eye contact at eye level
position
+ introduce yourselves
is it the right moment for the other person ?
ensure conditions for listening (internal and external)
prepare questions
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
b. dare to address spiritualité through simple questions
Exploration tools
(Standardized questionnaires)
... ?
... ?
Open-ended questions to start a conversation
for research purposes
Open-ended questionsto start a conversation
... ?
... ?
= a step-by-step process
trust
meaning
hopes
expectations
daily life
Daily life :
How are you feeling today? or : How are you doing today?
Expectations :
What do I need to know today to provide you with the best possible care or support?
Hopes :
What are your hopes? What are your expectations right now?
Meaning :
What gives you strength? Are there things that give meaning or special significance to your life/current situation?Or even more explicit questions: Is there anything that gives meaning to your life? Would you describe yourself in a broader sense as a religious person?
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of pivacy
neglect of spiritual needs, expectations, desires
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of privacy
neglet of spiritual needs, expectations, desires
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of privacy
neglect of spiritual needs, expectations, desires
finding the right balance
Exploration tools to support a conversation
Models based on medical practice and research
Models from nursing sciences
HOPE, FICA and SPIR conversation tools
4-letter acronym for 4 subdomains
Questions for spiritual history/assessment
assessing needs
... ?
... ?
adapting care
stimulating spiritual resources
improving the therapeutic alliance
Inspiration + adaptation
Standardized use
preparing yourself to ask your own questions
training - objective - interdisciplinary collaboration
The FICA Spiritual Assessment Tool
The HOPE Questions for a Formal Spiritual Assessment in a Medical Interview
Sources of hope, meaning, comfort, strength, peace, love and connection
= Hope
or Beliefs
= Faith
= Importance
or Influence
= Organized religion
= Personal spirituality and Practices
= Community
= Address
= Effects
on medical care and end-of-life issues
Examples of Questions for the HOPE Approach to Spiritual Assessment
= Hope
What are your sources of hope, strength, comfort and peace? What do you hold on to during difficult times? What sustains you and keeps you going?
= Organized religion
Do you consider yourself part of an organized religion? How important is this to you? What aspects of your religion are helpful and not so helpful to you?
= Personal spirituality and Practices
Do you have personal spiritual beliefs that are independent of organized religion? What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)
= Effects
Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?) Would it be helpful for you to speak to a clinical chaplain/community
spiritual leader? Are there any specific practices or restrictions I should know about in providing
Examples of Questions for the FICA Spiritual Assessment Tool
FICA is an acronym that can be used to remember what is asked in a Spiritual History. Specific questions you can use to discuss these issues are:
= What is your faith or belief ?
Do you consider yourself spiritual or religious?
What things do you believe in that give meaning to your life?
= Is it important in your life ?
What influence does it have on how you take care of yourself?
How have your beliefs influenced your behavior during this illness?
What role do your beliefs play in regaining your health?
= Are you part of a spiritual or religious community ?
Is this of support to you and how?
Is there a person or group of people you really love or who are really important to you?
= How would you like me, your healthcare provider, to address these issues in your healthcare?
Examples of Questions for the SPIR
= Spirituality
Would you describe yourself – in the broadest sense of the term – as a believing/spiritual/religious person?
= Place and influence
What is the place of spirituality in your life? How important is it in the context of your illness?
= Integration
Are you integrated in a spiritual community?
= Role
What role would you like to assign to your doctor,
nurse or therapist in the domain of spirituality?
Frick, E., Riedner, C., Fegg, M. J., Hauf, S., & Borasio, G. D. (2006). A clinical interview assessing cancer patients’ spiritual needs and preferences. European Journal of Cancer Care, 15(3), 238-243.
HOPE, FICA and SPIR : precautions for use
I think the only thing she needs is a chaplain to pray with her.
are you a believer?
transmission
interpretation
Verification at every stage!!
Rephrasing builds trust
by Karen Scott Barss (2008)
The TRUST model for Spiritual Assessment and Care
Personal beliefs and how they influence well-being positively and/or negatively (ie : sustaining? distressing?)
Closed question
Unresolved issues and exploration of how/if these might be reconciled
Existential and/or faith questions prompted by current challenges
nderstandings
econciliation
no
Spiritual and/or religious practices, individually or in community, current and past (as relevant to care/healing)
yes
earching
Spiritual/religious mentors and internal/external resources the individual trusts to help sort through relevant issues
Open questions
raditions
eachers
Availability of the team for later if desired
The Ross & McSherry 2 Question Spiritual/Holistic Assesment Model (2Q-SAM)
© University of South Wales 2018
- Explicit or implicit spiritual history?
- At a specific point in time or throughout/at any time?
What's the most important to you right now ?
How can we help ?
Exploration tools : will it take a lot of time ?
A quiet inner space and avaibility to welcome patient’s spiritual experience
Time saving because :
- more intimate relationship
- important information
- value the importance of the moment
- rephrase ensuring trust
- ask for permission to pass on information
For chaplaincy, spiritual care practitioners, …
Specialized assessment tools for spiritual care
express spiritual experience using more precise vocabulary
identify spiritual resources and disruptions
assess the need for spiritual support
facilitate communication (interdisciplinary collaboration and respect for confidentiality)
Two exemples
RePer STIV
Repères pour l'évaluation en soins spirituels
CHUV (Lausanne, Suisse)
CS Santé (Québec)
Repères pour l'évaluation en soins spirituels
CS Santé (Québec)
- identifies the spiritual experience
- verifies that what was shared during the meeting has been understood by the professional
- assesses the need for spiritual support
- facilitates communication with the healthcare team
RePer STIV
CHUV (Lausanne, Suisse)
de la dimension spirituelle
dessine la visée de l'accompagnement
= Sens
vision du monde
= Transcendance
relation d'attachement à une figure spirituelle
= Identité
rôles et modèles auxquels s'identifier et dimension collective et communautaire
= Valeurs
dimension éthique
Which tool should you choose?
An existing tool !
They're not set in stone
homecare
Which tool should you choose?
paediatrics
They can be adapted for
psychiatry
Which tool should you choose?
Your own!
Module design and direction
Proofreading
Collaboration
Serena Buchter
Mario Drouin
Johanne Lessard
Head of Pastoral Care Training, Chaplaincy. Vaud University Hospital (CHUV), Lausanne, Switzerland.
Nurse, PHD, MPH, coordinator and scientific director of the RESSPIR network, Institute for Research on Religions, Spiritualities, Cultures and Societies, UCLouvain, Belgium
Lecturer and Assistant to the Chair of Religion, Spirituality and Health, Faculty of Theology and Religious Studies, ULaval – Quebec
Graphic design
Etienne Gourdin
Cosette Odier
Sabine Norro
Theologian, formerly: CPT supervisor (pastoral training), coordinator and trainer at the CHUV, Lausanne, Switzerland
SISU nurse in intensive care, trainer and facilitator in healthcare ethics, CHU-UCL Namur Mont-Godinne, Belgium
Physiotherapist, Graphic Designer at the RESSPIR Network, UCLouvain, Belgium.
The impact of spirituality in healthcare
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Transcript
The impact of spirituality in healthcare
The views and opinions expressed are solely those of the author(s) and do not necessarily reflect those of the European Union. Neither the European Union can be held responsible for them.
S. Buchter and C. Odier
The impact of spiritualityin healthcare
How (to dare) to address it?
Tools for supporting conversation on an existential-spiritual topic and how to use them
Objectives
Training content
Practical tools for recognizing and opening conversations about existential, spiritual or religious aspects.
1. Impact of spirituality in care
= why ?
2. Ways to address and better understand it
= how ?
Tools for supporting conversation on an existential-spiritual topic
Exploration tools
1. Impact of spirituality
Why address this dimension with the family ?
= personalized care
Establishing a connection
Resource
/ Obstacle
Acceptance and respect
Values, Beliefs, Hopes, Meaning, ...
1. Impact of spirituality
embarrassing !
Important but...
support tools
+ practical advice
1. Impact of spirituality
Representations
Death
Spirituality
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
1. Impact of spirituality
Representations
Way of LIVING life to the fullest
Spirituality
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
Spirituality
Resource
Check !
2. Ways to approach and better understand it
identify observable elements
dare to talk about spirituality with simple questions
BUT FIRST
establish a relationship of trust
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
a. establish trust
"being"
"doing"
rythm and energy
eye contact at eye level
position
+ introduce yourselves
is it the right moment for the other person ?
ensure conditions for listening (internal and external)
prepare questions
mort?
spiritualité
manière de vivre pleinement
VIE
pour approfondir les représentations de la spiritualité => voir notre module pédagogique 1
b. dare to address spiritualité through simple questions
Exploration tools
(Standardized questionnaires)
... ?
... ?
Open-ended questions to start a conversation
for research purposes
Open-ended questionsto start a conversation
... ?
... ?
= a step-by-step process
trust
meaning
hopes
expectations
daily life
Daily life :
How are you feeling today? or : How are you doing today?
Expectations :
What do I need to know today to provide you with the best possible care or support?
Hopes :
What are your hopes? What are your expectations right now?
Meaning :
What gives you strength? Are there things that give meaning or special significance to your life/current situation?Or even more explicit questions: Is there anything that gives meaning to your life? Would you describe yourself in a broader sense as a religious person?
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of pivacy
neglect of spiritual needs, expectations, desires
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of privacy
neglet of spiritual needs, expectations, desires
Open-ended questionsto start a conversation
... ?
... ?
intrusion, violation of privacy
neglect of spiritual needs, expectations, desires
finding the right balance
Exploration tools to support a conversation
Models based on medical practice and research
Models from nursing sciences
HOPE, FICA and SPIR conversation tools
4-letter acronym for 4 subdomains
Questions for spiritual history/assessment
assessing needs
... ?
... ?
adapting care
stimulating spiritual resources
improving the therapeutic alliance
Inspiration + adaptation
Standardized use
preparing yourself to ask your own questions
training - objective - interdisciplinary collaboration
The FICA Spiritual Assessment Tool
The HOPE Questions for a Formal Spiritual Assessment in a Medical Interview
Sources of hope, meaning, comfort, strength, peace, love and connection
= Hope
or Beliefs
= Faith
= Importance
or Influence
= Organized religion
= Personal spirituality and Practices
= Community
= Address
= Effects
on medical care and end-of-life issues
Examples of Questions for the HOPE Approach to Spiritual Assessment
= Hope
What are your sources of hope, strength, comfort and peace? What do you hold on to during difficult times? What sustains you and keeps you going?
= Organized religion
Do you consider yourself part of an organized religion? How important is this to you? What aspects of your religion are helpful and not so helpful to you?
= Personal spirituality and Practices
Do you have personal spiritual beliefs that are independent of organized religion? What aspects of your spirituality or spiritual practices do you find most helpful to you personally? (e.g., prayer, meditation, reading scripture, attending religious services, listening to music, hiking, communing with nature)
= Effects
Has being sick (or your current situation) affected your ability to do the things that usually help you spiritually? (Or affected your relationship with God?) Would it be helpful for you to speak to a clinical chaplain/community spiritual leader? Are there any specific practices or restrictions I should know about in providing
Examples of Questions for the FICA Spiritual Assessment Tool
FICA is an acronym that can be used to remember what is asked in a Spiritual History. Specific questions you can use to discuss these issues are:
= What is your faith or belief ?
Do you consider yourself spiritual or religious? What things do you believe in that give meaning to your life?
= Is it important in your life ?
What influence does it have on how you take care of yourself? How have your beliefs influenced your behavior during this illness? What role do your beliefs play in regaining your health?
= Are you part of a spiritual or religious community ?
Is this of support to you and how? Is there a person or group of people you really love or who are really important to you?
= How would you like me, your healthcare provider, to address these issues in your healthcare?
Examples of Questions for the SPIR
= Spirituality
Would you describe yourself – in the broadest sense of the term – as a believing/spiritual/religious person?
= Place and influence
What is the place of spirituality in your life? How important is it in the context of your illness?
= Integration
Are you integrated in a spiritual community?
= Role
What role would you like to assign to your doctor, nurse or therapist in the domain of spirituality?
Frick, E., Riedner, C., Fegg, M. J., Hauf, S., & Borasio, G. D. (2006). A clinical interview assessing cancer patients’ spiritual needs and preferences. European Journal of Cancer Care, 15(3), 238-243.
HOPE, FICA and SPIR : precautions for use
I think the only thing she needs is a chaplain to pray with her.
are you a believer?
transmission
interpretation
Verification at every stage!!
Rephrasing builds trust
by Karen Scott Barss (2008)
The TRUST model for Spiritual Assessment and Care
Personal beliefs and how they influence well-being positively and/or negatively (ie : sustaining? distressing?)
Closed question
Unresolved issues and exploration of how/if these might be reconciled
Existential and/or faith questions prompted by current challenges
nderstandings
econciliation
no
Spiritual and/or religious practices, individually or in community, current and past (as relevant to care/healing)
yes
earching
Spiritual/religious mentors and internal/external resources the individual trusts to help sort through relevant issues
Open questions
raditions
eachers
Availability of the team for later if desired
The Ross & McSherry 2 Question Spiritual/Holistic Assesment Model (2Q-SAM)
© University of South Wales 2018
What's the most important to you right now ?
How can we help ?
Exploration tools : will it take a lot of time ?
A quiet inner space and avaibility to welcome patient’s spiritual experience
Time saving because :
For chaplaincy, spiritual care practitioners, …
Specialized assessment tools for spiritual care
express spiritual experience using more precise vocabulary
identify spiritual resources and disruptions
assess the need for spiritual support
facilitate communication (interdisciplinary collaboration and respect for confidentiality)
Two exemples
RePer STIV
Repères pour l'évaluation en soins spirituels
CHUV (Lausanne, Suisse)
CS Santé (Québec)
Repères pour l'évaluation en soins spirituels
CS Santé (Québec)
RePer STIV
CHUV (Lausanne, Suisse)
de la dimension spirituelle
dessine la visée de l'accompagnement
= Sens
vision du monde
= Transcendance
relation d'attachement à une figure spirituelle
= Identité
rôles et modèles auxquels s'identifier et dimension collective et communautaire
= Valeurs
dimension éthique
Which tool should you choose?
An existing tool !
They're not set in stone
homecare
Which tool should you choose?
paediatrics
They can be adapted for
psychiatry
Which tool should you choose?
Your own!
Module design and direction
Proofreading
Collaboration
Serena Buchter
Mario Drouin
Johanne Lessard
Head of Pastoral Care Training, Chaplaincy. Vaud University Hospital (CHUV), Lausanne, Switzerland.
Nurse, PHD, MPH, coordinator and scientific director of the RESSPIR network, Institute for Research on Religions, Spiritualities, Cultures and Societies, UCLouvain, Belgium
Lecturer and Assistant to the Chair of Religion, Spirituality and Health, Faculty of Theology and Religious Studies, ULaval – Quebec
Graphic design
Etienne Gourdin
Cosette Odier
Sabine Norro
Theologian, formerly: CPT supervisor (pastoral training), coordinator and trainer at the CHUV, Lausanne, Switzerland
SISU nurse in intensive care, trainer and facilitator in healthcare ethics, CHU-UCL Namur Mont-Godinne, Belgium
Physiotherapist, Graphic Designer at the RESSPIR Network, UCLouvain, Belgium.