Spiritual Pain In Palliative and End of Life Care

1
Spiritual Pain In Palliative and End of Life Care

• By Dennis Harvey, MDiv
• 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.
• 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.
•  

17
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.