Te Wairuatanga / Spirituality

Table of contents
  1. Assessing Spirituality
  2. Spiritual Distress

He kākano ahau i ruia mai i Rangiātea.
I am a seed which was sewn in the heavens of Rangiatea.

Part of the ‘task of dying’ is to hold space to contemplate and possibly resolve spiritual concerns. Spiritual and existential concerns are not uncommon for people at end-of-life. Spirituality should be routinely assessed, documented and addressed just as other elements of the patient’s care are. Spiritual concerns may influence other symptoms. Spiritual care needs to be patient-led and should be a normal part of history taking and care plans at end-of-life.

There are several points to remember when exploring someone’s spirituality:

Assessing Spirituality

Many seriously ill patients are likely to want their spirituality attended to, however there are a proportion who will find this intrusive. Chochinov’s enquiry of ‘‘What do I need to know about you as a person to give you the best care possible?’’ (Chochinov et al. 2014) can open up this space allowing the patient to establish the direction and priorities. “Are you at peace?” (Steinhauser, K., et al. 2006) is an alternative engagement phrase.

This can be further expanded using a variety of subsequent explorative questions, such as

The advantage of a genuine enquiry that is a patient led conversation is that assumptions are dispelled on behalf of the care professional and allows for the patient to hear the articulation of their own internal thoughts and beliefs. To hold this space for a patient to think, speak and explore their true hopes and beliefs requires the care professional to have settled many of these things in their own self.

Alternatively, a spiritual wellbeing survey may be used, for example:

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Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days.

Not at all A little bit Some-what Quite a bit Very much
I feel peaceful 0 1 2 3 4
I have a reason for living 0 1 2 3 4
My life has been productive 0 1 2 3 4
I have trouble feeling peace of mind 0 1 2 3 4
I feel a sense of purpose in my life 0 1 2 3 4
I am able to reach down deep into myself for comfort 0 1 2 3 4
I feel a sense of harmony within myself 0 1 2 3 4
My life lacks meaning and purpose 0 1 2 3 4
I find comfort in my faith or spiritual beliefs 0 1 2 3 4
I find strength in my faith or spiritual beliefs 0 1 2 3 4
My illness has strengthened my faith or spiritual beliefs 0 1 2 3 4
I know that whatever happens with my illness, things will be okay 0 1 2 3 4

Spiritual Distress

This may include a questioning of their own assumed beliefs and making peace with themselves, others or their God or Divine. Understanding and achieving forgiveness for themselves and forgiving others are often essential spiritual tasks that contribute to a “good death”.

Assisting someone to do this requires:

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