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Spirituality and Elders

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Title: Spirituality and Elders


1
Spirituality and Elders
  • Emily K. Schulz, PhD, OTR/L
  • OT 665

2
Todays Topic of Discussion is
SPIRITUALITY (not Religiosity)
SPIRITUALITY
RELIGIOSITY
3
Spirituality
  • Why do we need to know about it for Occupational
    Therapy?

4
Literature Review
  • The literature indicates that
  • Spirituality is important in Health Care,
    including occupational therapy.
  • Spirituality is part of an holistic approach,
    wellness, and quality of life, all issues that
    occupational therapists are concerned about.
  • However - Occupational therapists are unsure how
    to address spiritual issues in practice.

5
AOTA and Spirituality
  • The Representative Assembly recently adopted the
    Commission on Practice's (COP) Occupational
    Therapy Practice Framework Domain and Process.
  • The Framework describes the professions domain
    of activity and explains how the process of
    occupational therapy service delivery occurs
    within that domain, using updated language and
    terminology that is more easily understood by
    external audiences. The Framework replaces the
    "Uniform Terminology for Occupational
    TherapyThird Edition (UT-III)."
  • Terminology
  • A motion that was submitted to the RA to add the
    words "spirit/spiritual" to the philosophical
    base was defeated as the concept is included in
    the Occupational Therapy Practice Framework
    document. (fromhttp//www.aota.org/members/area6/l
    inks/link40.asp?PLACE/members/area6/links/link40.
    asp)

6
AOTAs Commission On Practice and Spirituality
  • Context a variety of interrelated conditions
    within and surrounding the client that influence
    performance (COP, 2002, p.54)
  • Spiritual Context the fundamental orientation
    of a persons life that which inspires and
    motivates that individual (COP, 2002, p.42).
  • Examples Essence of the person, greater or
    higher purpose, meaning, and substance (COP,
    2002, p.42).

7
Spirituality
  • Experiential Learning

8
Instructions
  • Working in small groups, take about 10 minutes to
    come up with a definition of spirituality.
  • Write the definition down on a piece of paper.
  • Choose a spokesperson to share your definition
    with the larger group.

9
Definition of Spirituality
10
Ross (1995) Description of Spirituality
Connectedness to Beliefs/Values and/or a Higher
Power
VERTICAL ELEMENT
Connectedness to Self, Others, and/or the World
HORIZONTAL ELEMENT
11
A Proposed Definition of Spirituality for
Occupational Therapy From a Literature Review
  • Experiencing a meaningful connection to our
    core self, other humans, the world, and/or a
    Greater Power, as expressed through our
    reflections, narratives, and actions.

12
Research Study about Spirituality
  • And individuals with disabilities

13
Research Questions
  • 1. What is the meaning of spirituality in the
    lives of individuals with disability?
  • 2. How has the spirituality of individuals with
    disability evolved across the life span?
  • 3. How does spirituality relate to the adaptation
    process of individuals with disability?

14
Three Studies
  • Study 1 Reviewing Literature (from which
    definition of spirituality was derived).
  • Study 2 Interviewing Adults with Childhood
    Onset Disabilities
  • Study 3 Interviewing Adults with Adult Onset
    Disabilities

15
Methodology and Data Analysis
  • Study 1
  • Literature review OT and Other Health
    Professions re Spirituality
  • Proposed Definition of Spirituality
  • Applying Themes from Definition of Spirituality
    to autobiographical, empirical and philosophical
    writings of individuals with disabilities

16
Methodology and Data Analysis
  • Study 2 Study 3
  • Qualitative research
  • Semi-structured, face to face, audio taped
    interviews
  • Verbatim transcription of interviews
  • Two levels of member checking
  • (1) transcriptions (2) open coding
  • Three levels of Coding open, axial, selective
  • axial coding Causal Conditions, Strategies,
    Context, Intervening Conditions,Consequences
  • Demographic questionnaire

17
Participants
  • Study 2
  • Three men and three women with visibly apparent
    childhood onset disabilities.
  • 5 Caucasian 1 Hispanic
  • Age range 30-58
  • All grew up with some form of Christianity.
  • Study 3
  • Three men and three women with visibly apparent
    adult onset disabilities.
  • All 6 Caucasian
  • Age range 40-82
  • All grew up with some form of Christianity.

18
Study 1- Childhood Onset Demographics of
Participants
  • Name Age Marital Childhood Current
    Cause of
  • (gender) Status Religion
    Religion Disability
  • Butterfly(f) 37 Married Methodist
    Baptist C.P.
  • Lisa(f) 47 Married Catholic
    Catholic Post-Polio
  • Marie(f) 35 Married Non-Den.
    Lutheran R.A.
  • Mikey(m) 58 Single Methodist
    None C.P.
  • Jack (m) 30 Divorced Methodist
    Exploring C.P.
  • GeeTee(m) 48 Single Catholic
    Catholic C.P.

19
Study 2 - Adult Onset Demographics of Participants
  • Name Age Marital Childhood
    Current Cause of
  • (gender) Status Religion
    Religion Disability
  • Joy (f) 52 Married Baptist
    Non-Den. A.V.M.
  • Avis (f) 82 Widowed Lutheran
    Lutheran Surgery(blind)
  • DeeGee(f) 57 Widowed Baptist
    Pentecostal knee surgery
  • Kermit(m) 40 Married Baptist
    None S.C.I.
  • Alton (m) 66 Engaged Ch. of
    Christ Ch. of Christ Spinal tumor
  • Butch (m) 46 Single Methodist
    Non-Den. Diabetes-BKA

20
Findings
  • The Meaning of Spirituality

21
Findings Meaning of Spirituality Analysis
Process
  • Meaning of Spirituality
  • Definition of Spirituality
  • Responses to Literature Review Definition of
    Spirituality.
  • Number of times a dimension of spirituality was
    mentioned was tallied and organized into chart
    format.

22
Meaning of Spirituality - Childhood Onset
  • Butterfly Spirituality to me means having a
    relationship with Jesus Christ and knowing Him as
    the person who came to save them from death and
    an eventuality of eternal hell.... Spirituality
    is the daily decision making.
  • Lisa spirituality means belief in a Higher
    Power, something greater than you, and it also
    deals with your responsibility towards the rest
    of mankind and the world that you live in.
  • Marie It is something that keeps you going when
    you are really upset and you cant do anything
    else that keeps you truly structured and reality
    based and where you need to be. … it is something
    inside you that is connected to your life, to
    your world and to the world outside you. …
    Timeless, ageless, it doesnt matter how old you
    are, where you are, it is something inside you
    that you can access through whatever methods are
    tangible to you.

23
Meaning of Spirituality - Childhood Onset
  • Mikey Im not sure what spirituality is.
  • Jack Spirituality to me means a connection with
    a higher power … and its about learning lessons
    that a higher power whos higher than you is
    trying to teach you.
  • GeeTee Spirituality is very important. It helps
    me look at myself and follow through with my
    life. Without spirituality I wouldnt be able to
    exist. … Spirituality is a blessing and if you
    believe in it, it works. If you believe
    wholeheartedly that your spirit can be cleansed
    and in yourself and God things can come true.

24
Meaning of Spirituality - Childhood Onset
  • Name self others world G.Power reflections
    narratives actions
  • Butterfly x
    x x
  • Lisa x x
    x x
    x
  • Marie x x x
    x
    x
  • Mikey
  • Jack
    x x
  • GeeTee x
    x x
  • Totals 3 2 2 4
    5 0
    2

25
Meaning of Spirituality- Adult Onset
  • Joy Its what you have in your heart, I think,
    and its not what you have in your head but what
    you have in your heart. … what you want to do
    everyday … Its what a person feels.
  • Avis Thats your trust in the Lord and your
    faith.
  • DeeGee Anyway you look at spirituality. Its a
    type of love, and love is something that you give
    whether it be a small smile, a hug, or if you
    give money to your church, your tithe,
    spirituality - it comes from nature, from Gods
    goodness and its love.

26
Meaning of Spirituality - Adult Onset
  • Kermit to me, you dont have to have religion in
    order to have spirituality. Spirituality is how
    one feels within themself and to me the way they
    treat others and society and our earth.
  • Alton I would define spirituality as being a
    guideline to follow and adhere to and to use to
    understand myself.
  • Butch its something that comes over you … a
    warm fuzzy feeling… Or sometimes it just strikes
    you just like you know its there and its just
    like a bolt - ...and you know thats what it is.
    To me, thats spirituality.

27
Meaning of Spirituality - Adult Onset
  • Name self others world G.Power reflections
    narratives actions
  • Joy x

    x
  • Avis
    x x
  • DeeGee x x
    x
    x
  • Kermit x x x

    x
  • Alton x
    x
    x
  • Butch x
    x
  • Totals 4 2 2
    3 2 0
    4

28
Meaning of Spirituality
  • Group self others world G.Power
    reflections narratives actions
  • Child
  • Onset 3 2 2 4
    5 0
    2
  • Adult
  • Onset 4 2 2 3
    2 0
    4
  • Totals 7 4 4 7
    7 0
    6

29
Findings - Meaning of Spirituality Combination
of Responses to all 3 questions
  • Group self others world G.Power
    reflections narratives actions agree
  • Child
  • Onset 12 8 8 16
    15 6 11 4/6
  • Adult
  • Onset 18 10 9 11
    9 5 10 4/6
  • Totals 30 18 17 27
    24 11 21 8/12

30
The Meaning of Spirituality Model - Childhood
Onset
Others
Connecting to Others through kindness, helping,
hugs, smiling, email, support groups
Higher Power
Meaning and Purpose in Life
Self
Connecting to Self and Gaining Meaning and
Purpose in Life
Connecting to a Higher Power through outward
expression (anger, gratitude, asking for help,
faith) and inward receiving (learning and
understanding)
The World
Connecting to the World through social activism,
travel and the Internet
31
The Meaning of Spirituality Model Adult Onset
Connecting to a Higher Power through Faith, Hope,
and Beliefs
Higher Power
Connecting to Others through Trust, Kindness,
Listening, Helping, Hugs, Smiling, Love
Self and Feelings
Others
Connecting to Self through Feelings From That
Connection Expressing Spirituality Through
Actions.
Connecting to the World through taking care of
Nature, Enjoying Nature, Participating in Sports,
Treating Society well.
The World
32
Spirituality
  • Experiential Learning

33
Instructions
  • Analyze your definition of spirituality using the
    categories of self, others, the world, greater
    power, reflections, narratives, and actions.
  • Write your responses down on a piece of paper.
  • Choose a spokesperson to share your results with
    the larger group.

34
Analysis of Definitions Of Spirituality From
Experiential Learning
  • self others world G.Power
    reflections narratives actions

35
Analysis of Definitions Of Spirituality From
Experiential Learning
  • self others world G.Power
    reflections narratives actions

36
Spirituality and Occupational Therapy Theory
  • Occupational Adaptation

37
Occupational Adaptation Schematic
OCCUPATIONAL ENVIRONMENT Element
PERSON Element
INTERACTION Element
Demand for Mastery
Desire for Mastery
Press for Mastery
Occupational Challenge
Occupational Environment
Person
Occupational Role Expectations
Adaptive Response Generation Subprocess
Incorporation into Occupational Environment
Occupational Response
Adaptive Response Integration Subprocess
Adaptive Response Evaluation Subprocess
Assessment of Response Outcome
38
The Person System and the Adaptive Response
Generation Subprocess
Person
Adaptive Response Generation Subprocess
Adaptive Response Mechanism
Adaptation Gestalt
39
The Person
Adaptive Response Generation Subprocess
Adaptive Response Mechanism
Adaptation Gestalt
Adaptive Response Modes
Adaptive Response behaviors
Adaptation Energy Primary Energy Secondary Energy
Cognitive
Psychosocial
Hyperstable Hypermobile Blended
Existing Modified New
Sensorimotor
40
The Adaptation Gestalt
Psychosocial
Cognitive
Sensorimotor
41
Adaptation According to Occupational
Adaptation Frame of Reference (Schkade Schultz,
Schultz Schkade, 1992)
  • Adaptation is
  • A Constant
  • A Life long normative process
  • Involves the whole person
  • Cognitive
  • Psychosocial
  • Sensorimotor

Adaptation Gestalt
Cognitive
Psychosocial
Sensorimotor
42
The Adaptation Gestalt and Spirituality
Connecting to self, others the world and/or a
greater power Expressing through reflections
narratives, and actions
Expressing through reflections and narratives
Psychosocial
Cognitive
Sensorimotor
Expressing through narratives and actions
43
Spirit as Integrator of the Adaptation Gestalt
Spirit
Psychosocial
Cognitive
Sensorimotor
Spirit
44
A Third Dimension of Spirituality
  • Time

45
A Quote From Adolf Meyer (1922/1977)
  • …the culminating feature of evolution is mans
    capacity of imagination and the use of time with
    foresight based upon a corresponding appreciation
    of the past and of the present… proper use, and…
    a religious conscience, of time with its
    successive opportunities(p.640 642).

46
Ross (1995) Description of Spirituality
Connectedness to Beliefs/Values and/or a Higher
Power
VERTICAL ELEMENT
Connectedness to Self, Others, and/or the World
HORIZONTAL ELEMENT
47
Temporal Aspects of Spirituality
  • The past holds a rich reservoir of spiritual
    resources for healing and recovery.
  • The present offers a potent opportunity to
    connect to ones spirituality for
    self-transformation.
  • The future is a beacon of hope and possibility
    for healing and recovery.

48
Three Dimensions of Reality (Smith, 1976,p.24).
49
A Revised Proposed Definition of Spirituality for
Occupational Therapy
  • Experiencing a meaningful connection to our
    core self, other humans, the world, and/or a
    Greater Power, as expressed through our
    reflections, narratives, and actions within the
    context of space and time.

50
SPACE
Spirit
Cognitive
Psychosocial
Time
Time
Sensorimotor
Spirit
SPACE
51
Three Dimensional Spirituality Model
The Mystery that is Spirituality
Experiencing a meaningful Connection to a Higher
Power, Values and/or Beliefs as Expressed
through our reflections, narratives and actions.
The Past
The Adaptation Gestalt
Experiencing a disconnection from the Core self,
Others and/ or the World as Expressed through our
reflections, narratives and actions.
Experiencing a meaningful connection to the Core
Self, Others and/or the World as Expressed
through our reflections, narratives and actions.
The
Person
The Future
The Present
Experiencing a Disconnection from a Higher Power,
Values, and/or Beliefs as Expressed through our
reflections, narratives and actions.
52
Why is Spirituality
  • Important to address with Elders?

53
Developmental Life Task - Integrity versus Despair
  • Some elders develop a sense of pride and
    contentment with both the past and present with a
    stronger sense of community.
  • Others experience despair Too many mistakes
    were made and theres no time to fix it now.
  • Death as a feared end, or as a part of the cycle
    with a new view of survival the afterlife
    i.e. meeting my maker going to Heaven etc…

54
Community and Connectedness
  • Elders value a sense of community
  • Many elders may experience isolation and
    loneliness especially the old-old
  • Addressing spirituality may lead to ways to
    minimize the isolation and loneliness that elders
    experience through discovering new ways to
    facilitate connectedness.

55
Elders and End of Life
  • Developmentally, elders are addressing the life
    task of Integrity versus Despair
  • Life review may be painful for them.
  • Helping them to find positive and healing ways to
    connect to the past and themselves (the core
    self) may be useful.
  • Finding ways to help them resolve old hurts and
    reconnect with loved ones in positive ways
    through meaningful occupation may also be
    appropriate.

56
Religion and Spirituality
  • Many elders equate their spirituality with their
    religious practices and beliefs.
  • Finding ways to facilitate their participation in
    those practices in spite of sensory and mobility
    losses will be extremely meaningful to them.

57
Spirituality and Occupational Therapy
  • Case Studies

58
Case Study
  • An Elderly woman.
  • A resident of a nursing home.
  • Fell and fractured her right hip.
  • Underwent ORIF to her right hip.
  • Prior to her fall, was alert and lucid.
  • Upon return to the Nursing Home after surgery,
    demonstrated increased confusion.
  • Difficult to engage her in occupational therapy.

59
Case Study (continued)
  • As a visiting therapist, I was asked to treat
    her.
  • When I entered her room she was sitting in a
    wheelchair with her eyes closed.
  • When she saw me asked me to please pray for her.
  • I asked her to say the prayer instead, which she
    did.

60
Case Study (continued)
  • Following her prayer, she engaged in therapy
    (grooming activities at the sink) and stayed
    focused on the task.
  • She also engaged in conversation with her new
    roommate.
  • They discovered they had something in common that
    they both enjoyed doing in the past (picking
    cotton as a child).

61
Case Study (continued)
  • I reported to the in-house therapist the apparent
    importance of prayer to her.
  • I also suggested that he set up an activity that
    simulated picking cotton for a future treatment
    session as that task might be something she would
    find engaging.

62
Another Case Study -An Elder and Spirituality
  • Example A woman who was a resident in a NH who
    had organic brain disease.
  • We will call her Gladys.
  • The only time Gladys would not constantly call
    out was when we were discussing her baptism
    and/or reading the Bible.
  • That was the last remaining aspect of her life
    that was meaningful enough to her to maintain her
    focus and attention.

63
Incorporating Spirituality into Practice
  • Brainstorming

64
Instructions
  • Working in small groups, take about 10 minutes to
    come up with suggestions on how to incorporate
    spirituality into practice.
  • Write the groups ideas down on the paper
    provided.
  • Choose a spokesperson to share the ideas with the
    larger group.

65
Spirituality Assessment Treatment Planning Grid
Connectedness Past Present Future
Why ? How ? Goals To Self High
3 3
3 Medium 2 2 2 Low
1 1
1 None 0
0 0 To Others High
3 3
3 Medium 2 2 2 Low
1 1
1 None 0
0 0 To the World High
3 3
3 Medium 2 2 2 Low
1 1
1 None 0
0 0 To a Greater Power High
3 3
3 Medium 2 2 2 Low
1 1
1 None 0
0 0
66
Questions and Answers
  • ?

67
  • References
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    The philosophical base of occupational therapy.
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68
  • References (Continued)
  • Dunn, W., Foto, M., Hinojosa, J., Schell, B.,
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69
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70
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71
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