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Spiritual Pain In Palliative and End of Life Care

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Title: Spiritual Pain In Palliative and End of Life Care


1
Spiritual Pain In Palliative and End of Life Care
  • By Dennis Harvey, M Div
  • Chaplain Coordinator
  • Hospice of East Texas

2
  • Dame Cicely Saunders, founder of the modern
    hospice movement, coined the phrase TOTAL PAIN.

3
Total Pain refers to various kinds of
suffering
  • Physical
  • Emotional
  • Spiritual

4
  • Palliative Care, through the workings of the
    Interdisciplinary Team, acknowledges the
    relationship between these areas of pain.

5
What is Spiritual Pain?
  • Emotional or Physical distress due to unresolved
    spiritual or religious issues
  • (spiritual or religious, the two are not
    necessarily the same)

6
Spiritual is that which gives a person meaning
in life.
  • a higher power
  • a life style in tune with nature
  • a belief in the overall goodness of man
  • a connection with a traditional religion

7
Religious tends to be tied to a traditional
belief system
  • Maintaining rites and rituals of a specific group
  • part of a community with shared beliefs

8
Unresolved Issues
  • Relation to self  (loss of dignity, loss of
    control, loss of hope, loss of purpose, etc)
  • Relation to others (broken relationships,
    forgiveness, loss of dreams, etc)
  • Relation to God (punishment, need for
    forgiveness, abandonment, etc)

9
  • There may be no answer to, or resolution of
    issues.  They are expressions of the patients
    grief.  We must acknowledge the patients search
    and journey.

10
Symptoms of Spiritual Pain
  • constant chronic pain
  • insomnia
  • anxiety
  • anger
  • conflict (with family, spiritual representatives,
    staff)
  • depression
  • withdrawal from support system
  • feeling of failure
  • refusal of medication

11
Cultural and or Beliefs that influence Spiritual
Pain
  • deserve the pain
  • must suffer to earn acceptance or share in
    Christs suffering
  • being tested be God
  • God has a purpose
  • Satan is trying me

12
Interventions for Spiritual Pain
  • Refer to the patients Spiritual Assessment
  • Use both Practical and Relational Interventions

13
Spiritual Assessment
Determine the basic belief system by asking
simple questions such as
  • Are you a member of a local church or place of
    worship?
  • Are spiritual things an important part of your
    life?
  • Is there some one you talk to about spiritual
    matters?
  • Do you have any spiritual concerns?
  • Would you like a spiritual counselor to visit?

14
Practical Interventions
  • Prayer
  • Relaxation techniques
  • Rituals
  • Religious symbols (cross, bible, prayer book,
    rosary, candles)
  • Guided imagery

15
Relational Interventions
  • be present, be real
  • listen, you dont have to have answers
  • be sensitive to Patients particular belief
    system leave your own at the door
  • use Life Review, through telling his or her own
    story, unresolved feelings or issues may come
    forth
  • ask about unfinished dreams or last wishes

16
Case studies
  • 75 year old male with COPD was admitted to
    hospice
  • inpatient care for symptom management of pain and
  • shortness of breath.   Patient became increasing
    agitated
  • and verbally abusive to nursing staff.  Pt. and
    family very
  • reserved during chaplain visits revealing very
    little about
  • spiritual background except to say they were
    spiritual
  • people.   The contact information listed a son
    who had not
  • visited.  Any questions about the son were
    dismissed as a
  • non issue.  All attempts to medicate symptoms
    were
  • unsuccessful.
  •  

17
Case studies
  • 65 year old male with lung cancer was admitted to
    hospice
  • inpatient care actively dying.  Two daughters
    present were
  • extremely emotional and seem to compete for Dads
  • attention (even in his unconscious state). 
    Patient became
  • very restless as the daughters continued to pat
    and rub
  • Dads arm.  Attempts to calm patient with
    medication had
  • very little success.  Attempts to educate the
    family members
  • on the dying process yielded very little positive
    results.
  •  

18
BIBLIOGRAPHY
  • JOURNAL OF PALLIATIVE MEDICINE
  • Volume 8, Number 6, 2005
  • Mary Ann Liebert, Inc.
  • JOURNAL OF PALLIATIVE MEDICINE
  • Volume 8, Number 5, 2005
  • Mary Ann Liebert, Inc.
  • CLOSE TO THE BONE  LIFE-THREATING ILLNESS AND
    THE SEARCH FOR MEANING.
  • J. S. Bolen.  New York  Touchstone.
  • JUNIOR ROTATION IN HOSPICE AND PALLIATIVE
    MEDICINE
  •           University of Maryland School of
    Medicine. 
  •           Spirituality and Palliative Care
  •           July 17, 2002.
  • www.endoflife.northwestern.edu/religion_spirituali
    ty/pain.cfm
  • Module 14, Part III  Spiritual Pain/Spiritual
    Suffering.
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