Spirituality can also be described as a vigorous process of looking within oneself to reflect on your own life and at the same time turning outward to seek what is actually beyond what is being experience on a daily basis. For many people, spirituality is found in religion but for others spirituality can be found in nature, art or music. There are also those who will reflect on spirituality as being what occurs in everyday life through their association with friends and family.
For anyone facing an end to their physical life, religion and spirituality are two causes of deep apprehension and pain. Sometimes these two subjects may never have even been previously considered, let alone talked openly about. The sudden sharp focus on either or both of them, are not only reasons for apprehension and pain in the person facing end of life, but also for the caregiver and other family members.
In discussing this area of care it is difficult to separate spirituality in the terms relating to carers and that which relates to the person who is coming to the end of their physical life, so the two need to be intertwined.
Religion and spirituality are often blended together, but they are in fact not the same and it is possible to have either a secular spirituality or a religious spirituality.
Spirituality and spiritual care are acknowledged as central topics when professional carers are responsible in the delivery of a high quality end of life care. Spirituality, however, is difficult to define and many health care professionals themselves feel ill at ease in their attempts to provide spiritual care for those who are dying and/or bereaved. These challenges seem to emerge out of a number of issues concerning the diverse meanings of spirituality in a culturally diverse society, as well as the complexities of our current day, contemporary health-care delivery systems. Even those health-care providers who are the most sensitive to including all aspects of spiritual care in their caring role are often very daunted by the thought of engaging such a vague or ill-defined expression of need.
Over recent years many studies have been conducted into aspects of spiritual care in both the home and health facility setting and a study that was conducted by KE Steinhauser, NA Christakis, EC Clipp (and others) considered several factors that were pointed out to be highly important at the end of life by patients, family, physicians and other care providers. This study was reported on in the Journal of American Medical Association in 2000, and indicated that both the person dying and their families considered spiritual care to be important. The range of expectations expressed and the desire for spiritual care was found to be very expansive, but the emotionally sensitive indicators that were paramount, were the ability to be listened to and be cared for with love and trust.
Yet to be able to just listen with intent and show unconditional love and care is often the hardest aspect of providing end-of-life care.
Once one grasps the concepts and skills to listening with intent they develop a better understanding of what the person is really saying. The spiritual aspect of terminal care becomes a journey which is then more emotionally satisfying and healing for all concerned.
Spiritual pain can be the result of a past experience that has been filed away in their subconscious mind. Perhaps it was an experience that totally traumatized them and may have for a period of time, left them in a state of helplessness, and now with their death looming this past memory resurfaces and becomes the center of their being; it is how they are viewing their life, once again in a state of devastation and hopelessness. This is often expressed by the person continually saying thing like - 'Why?' or 'Why me?' or 'I am lost and lonely.' They feel that their life is devoid of all hope and if they used a religious term it probably would be "dark night of the soul". As with any pain, spiritual pain does present with known symptoms. A fear of dying is very widespread and deep and the following seven fears represent the major symptoms of spiritual pain:
Fear of the dying process "what will it be like?" Will it be painful?
Fear of loss of control "will I be dependent on others? Will I be unable to care for myself?
Fear of loss of loved ones "How will they manage without me?
Fear of others reaction to them "How will people cope with seeing me like this?
Fear of isolation "Will people stop coming to see me?
Fear of the unknown "what happens after you die?
Fear that life will have been meaningless.
By being aware and responding appropriately to what these questions represent, caregivers can reduce the person's fear and alleviate their spiritual pain.
Spiritual pain does not require a dose of pharmaceutical medication, it requires all those delivering care to be able to let go of their ideas, roles and agendas, to listen intently, to provide encouragement and to acknowledge as necessary. Put simply those experiencing this pain require their carers to listen with their heart.
By listening with your heart, there is no need to respond, the love and feeling are passed through your looks and your touch, their spiritual pain is only healed from within.
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