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Spiritual and Psychosocial Care


... and spiritual care interventions for a resident during the later stages of life. ... Views of dying. Desire for CPR, artificial nutrition and hydration ... – PowerPoint PPT presentation

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Title: Spiritual and Psychosocial Care

Spiritual and Psychosocial Care
  • Purpose To present the resident as a whole
    person with physical, psycho- social, and
    spiritual needs.

  • Understand the importance of psychosocial and
    spiritual care.
  • Know how to provide psychosocial and spiritual
    care interventions for a resident during the
    later stages of life.
  • Understand the regulatory requirements for
    meeting the needs of residents as whole persons.

View each individuals needs holistically.
Physical Psychosocial Spiritual
Spiritual and Psychological care giving requires
team approach
Palliative Care Team nurse family aide pati
ent social worker physician chaplain volunteer
Assessing Psychosocial and Spiritual Suffering
Purposeful Observations
  • Purposeful
  • Conversations

Purposeful observations and discussions should be
  • On-going as the patients condition changes.
  • Documented to show individualization and
    coordination of care.
  • Note Advance directives are one way to document
    patients wishes however, purposeful
    conversations are still necessary.

Purposeful observations and conversations may
  • Patients cultural and religious beliefs
  • Values
  • Preferences
  • Fears
  • View of quality of life
  • Family relationships
  • Views of dying
  • Desire for CPR, artificial nutrition and
  • Understanding of diagnosis and prognosis
  • Desired/acceptable treatments

Assessing Psychosocial and Spiritual Suffering
  • Psychosocial and spiritual suffering is real, but
    can be difficult to recognize and treat.
  • Psychosocial and spiritual suffering can be
    translated into physical complaints.
  • Listening is the best assessment tool.
  • Listen for hope vs. fear, joy vs. sadness, good
    memories vs. missed opportunities.

Assessing Psychosocial and Spiritual Suffering,
  • Facility staff listens and reports signs and
    symptoms to the appropriate healthcare
    professional for further intervention.
  • Facilities should develop access to community
    professional spiritual caregivers of all faiths.
  • Facility staff may consider accessing the
    services of a hospice agency.

MDS Items for Assistance
  • Section AC. Customary Routine
  • Usually attends church, temple, etc.
  • Finds strength in faith
  • Section F. Psychosocial well-being
  • 1. Sense of initiative/involvement
  • Establishes own goals
  • Pursues involvement in life in facility

MDS Items for Assistance, cont.
  • Unsettled relationships
  • Openly expresses conflict/anger with
  • Absence of personal contact with family/
  • friends
  • Past roles
  • Strong identification with past roles and life
  • Expresses sadness/anger/empty feelings over lost

MDS Items for Assistance, cont.
  • Past roles, cont.
  • Resident perceives that daily routine is very
    different from prior pattern in the community.
  • Section N Activity Pursuit Patterns
  • General Activity Preferences
  • Spiritual/religious activities

Psychosocial Care
  • Encompasses both cognitive function and emotional
  • Calls for openness and sensitivity to feelings
    and emotional needs of the resident and the
  • Caregiving typically combines clinical and
    nonclinical interventions.

Psychosocial Care
Emotional pain is the dimension of end of life
care that 1. Causes the most suffering. 2. Is
the most difficult to treat. 3. Requires most
interventions by staff. a) clinical b)
Psychosocial Care, cont.
  • Symptoms associated with emotional and spiritual
  • Anxiety
  • Depression
  • Helplessness
  • Aloneness
  • Financial distress
  • Meaninglessness

Psychosocial Care, cont.
  • Need for forgiveness
  • Fear of the unknown
  • Loss of important roles
  • Conflicted relationships
  • Hopelessness
  • Inability to enjoy/celebrate
  • Need to forgive

Spiritual Care
  • Residents are diverse in their spiritual needs.
  • Facilities and caregivers are diverse in their
    ability to meet spiritual needs.
  • Some facility staff may feel uncomfortable or
    inadequate in the role of meeting spiritual or
    psychosocial needs.

Spiritual Care, cont.
  • World Health Organization (WHO)
  • Palliative care is the active total care of
    patients whose disease is not responsive to
    curative treatment. Control of pain, of other
    symptoms, and psychological, social, and
    spiritual problems is paramount.

Spiritual Care Religion and Spirituality
  • The search for peace and inner healing, replacing
    fear and despair with hope and serenity.
  • Basic tenet is to view the individual as a whole
    being-physical, psychological, social, and
    spiritual being.
  • All team members can listen and refer.
  • Professional caregivers-chaplain, priest,
    psychologist, or social worker is needed for more
    intensive spiritual or psychological

Is Palliative Care Giving up Hope?
  • Inability to cure physical disease does not
    necessarily equate to lost hope.
  • Providers behaviors interpreted by patients as

Types of hope
  • Physical healing
  • Comfort
  • Personal growth
  • Love
  • Reconciliation
  • Courage
  • Self-forgiveness
  • Fulfillment of ones afterlife belief

Religion and Spirituality, cont.
  • Hope is an ongoing need throughout life.
  • Support depends on knowing what the resident or
    family is hoping to achieve.
  • Listening to what the resident or family hopes
    for and validating the residents feelings
    provides groundwork for meaningful support.

Religion and Spirituality
  • Religion and Spirituality are different.
  • Religion, according to Webster, is belief in a
    divine or superhuman power or powers to be obeyed
    and worshiped as the creator and ruler of the
  • Spirituality, according to Webster, is of the
    spirit or soul as distinguished from the body or
    material matters.
  • Spirituality explores the inner meaning of life
    now and after death.

Psychosocial and Spiritual Care Interventions
  • Basic caregiving involves listening.
  • Professional caregiving involves listening and
    seeking further explanation of life stories
    involving fear, anger, and other affective
  • Referral to other professionals frequently
    needed, i. e., chaplain, psychologist, social

Developing Palliative Care Psychosocial and
Spiritual Plans of Care
Identify problems and concerns. Establish patient
centered goals. Write interventions that include
family and patient involvement. Be sure and
clearly identify scope and frequency of
interventions provided by SNF, Hospice, Counselor
or Spiritual Support staff. Designate
responsible discipline/organization.
Psychosocial and Spiritual Care Interventions
  • The following can be helpful
  • Put aside your tasks and offer your presence.
  • Arrange for a spiritual leader to visit if
  • Listen to stories or life reviews.
  • Allow expressions of anger, guilt, hurt and fear.
    Encourage the resident to acknowledge these
    feelings, and then let them go.
  • Avoid clichés like It is Gods will. Never say
    Everything is going to be all right or You
    shouldnt feel that way.

Psychosocial and Spiritual Care Interventions,
  • Read scriptures or other materials if the
    resident wishes.
  • Encourage appropriate joy and humor. Laughter
    lifts the spirit, celebrates life and keeps
    things in perspective.
  • Share prayers, meditation or music if the
    resident wishes.
  • Use massage and relation to help the resident
  • Encourage completion of funeral arrangements.

Psychosocial and Spiritual Care Interventions,
  • Encourage the resident to accept gratitude from
  • Identify what constitutes a good death.
  • Identify specific rituals or ceremonies important
    to the resident/family.
  • Identify cultural issues that affect the
  • Encourage the family to give the resident
    permission to let go, when appropriate.

Psychosocial and Spiritual Care Interventions,
  • Explain that it is alright to cry tears are
    normal and show caring.
  • Encourage expressions of affection.
  • Be present with the resident and family if they
    want support.
  • Listen to the last wishes and regrets of the
  • Communicate that what is happening is natural.

Psychosocial and Spiritual Care Interventions,
  • Assist the resident in reframing goals that are
    attainable and meaningful.
  • Help the resident identify relationships that
    need closure.

Regulatory Requirements
  • 42 CFR Section 483.25 (a)
  • Each resident must receive and the facility
    must provide the necessary care and services to
    attain or maintain the highest practicable
    physical, mental, and psycho-social well-being in
    accordance with the comprehensive assessment and
    plan of care.

Right to Participate in Groups
  • State Licensure Requirement
  • 19 CSR 30-88.010 (30)
  • Each resident shall be permitted to
    participate, as well as not participate, in
    activities of social, religious or community
    groups at his/her discretion, both within the
    facility, as well as outside the facility ,
    unless contraindicated for reasons documented by
    physician in the residents medical record.

Right to Participate in Groups, cont.
  • Federal Requirement
  • 42 CFR Section 483.15 (d), F245
  • A resident has the right to participate in
    social, religious, and community activities that
    do not interfere with the rights of other
    residents in the facility.

Right to Participate in Groups, cont.
  • F245, Interpretive Guidance to Surveyor
  • The facility, to the extent possible, should
    accommodate an individuals needs and choices for
    how he/she spends time, both inside and outside
    the facility.

Social Services
  • Federal Requirement
  • 42 CFR Section 483.15 (g), F250
  • The facility must provide medically related
    social services to attain or maintain the highest
    practicable physical, mental, and psychosocial
    well-being of each resident.

Social Services
  • F250 Interpretive Guidance to Surveyor
  • Medically related social services means
    services provided by the facilitys staff to
    assist residents in maintaining or improving
    their ability to manage their everyday physical,
    mental or psychosocial needs.

Social Services
  • Interpretive Guideline, samples
  • Maintain contact with family to report changes
    and encourage participation in care planning.
  • Assisting staff to inform residents of their
    health status, health choices, and ramifications.
  • Assist resident with financial and legal matters.
  • Providing or arranging for counseling services
    identify and seek ways to support residents
    individual needs and preferences, customary
    routines, concerns, and choices.

Social Services
  • Interpretive Guidelines, samples, cont
  • Building relationships between residents and
    staff and teaching staff how to understand and
    support residents individual needs.
  • Assisting residents to determine how they would
    like to make decisions about their health care
    and whether or not they would like someone else
    to be involved in those decisions.
  • Finding options that most meet the residents
    physical and emotional needs.

Social Services
  • Interpretive Guidelines, samples, cont
  • Providing alternatives to drug therapy or
    restraints by understanding and communication to
    staff of why residents do what they doand what
    needs the staff must meet.
  • Meeting the needs of residents who are grieving.
  • Finding options, which most meet their physical
    and emotional needs.

You matter because you are you. You matter to
the last moment of your life, and we will do all
we can not only to help you die peacefully, but
also to live until you die. -Cicely Saunders-
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