The FICA tool can help you think about your personal spiritual history:
- F - Faith and Belief. Do I have a spiritual belief that helps me cope with stress? With illness? What gives my life meaning?
- I - Importance. Is this belief important to me? Does it influence how I think about my health and illness? Does it influence my healthcare decisions?
- C - Community. Do I belong to a spiritual community (church, temple, mosque or other group)? Am I happy there? Do I need to do more with the community? Do I need to search for another community? If I don't have a community, would it help me if I found one?
- A - Address in Care. What should be my action plan? What changes do I need to make? Are there spiritual practices I want to develop? Would it help for me to see a chaplain, spiritual director, or pastoral counselor?
FICA Recommendations
We recommend the following for healthcare providers taking a patient's spiritual history:
- Consider spirituality as a potentiality important component of every patient's physical well being and mental health.
- Address spirituality at each complete physical examination and continue addressing it at follow-up visits if appropriate.
- In patient care, spirituality is an ongoing issue. Respect a patient's privacy regarding spiritual beliefs; don't impose your beliefs on others.
- Make referrals to chaplains, spiritual directors, or community resources as appropriate.
- Be aware that your own spiritual beliefs will help you personally and will overflow in your encounters with those for whom you care to make the doctor-patient encounter a more humanistic one.
JEAN WATSON’S CARITAS PROCESSES
Jean Watson’s Caritas Processes® and caring practices which facilitate spiritual care to the patient and family
Caritas Processes® Caring practice
1 Practicing loving-kindness and equanimity within context of caring consciousness.
- Center self-prior to patient interaction
- Practice authentic presence,
- Get to know the patient
2 Being authentically present and enabling, and sustaining the deep belief system and subjective life world of self and one-being cared for
- Sit at eye level with patient.
- Practice deep listening-be fully present
- Resist impulse to fix patient problems
- Develop a level of comfort sitting in silence
3 Cultivating one’s own spiritual practices and transpersonal self, going beyond ego self.
- Explore the meaning of spirituality in the life of your patient and the patient’s family.
- Develop understanding self-spirituality
- Ask yourself- what gives your life meaning, hope what role does spirituality play in your life?
4 Developing and sustaining a helpingtrusting, authentic caring relationship
- Ask simple yet meaningful questions to understand the role spirituality plays in the patient’s life. Questions such as “what gives you hope?” “Are you at peace?”
5 Being present to, and supportive of the expression of positive and negative feelings
- Explore existential concerns including: life review, assessment of hopes, values, fears, meaning purpose, belief about the afterlife.
6 Creatively using self and all ways of knowing as part of the caring process; engaging in artistry of caring-healing practices.
- Engage in care modalities designed to enhance the patients experience, such as guided imagery, reiki, music, progressive relaxation, therapeutic touch
7 Engaging in genuine teaching-learning experience that attends to wholeness and meaning, attempting to stay within other’s frame of reference.
- Initial spiritual assessment should take place early during the patients care to identify patient needs. A simple spiritual assessment tool can include the question, “are you at peace” can elicit information about the patient’s spiritual concerns.
- Complex spiritual needs such as acute spiritual distress must be identified and referred to chaplaincy.
8 Creating healing environment at all levels, whereby wholeness, beauty, comfort, dignity, and peace are potentiated.
- Attention should be paid to the patient’s physical space to ensure comfort, such as soft lighting, encourage comfort items from home such as soft blankets and comforters, pictures and familiar objects from home, private rooms whenever possible.
9 Assisting with basic needs, with an intentional caring consciousness, administering ‘human care essentials,’ which potentiate alignment of mind-bodyspirit, wholeness in all aspects of care.
- Offer comfort care, swabbing the mouth, lip and mouth care, gentle repositioning, hand, and foot rubs, teach the family to provide this care
10 Opening and attending to mysterious dimensions of one’s life-death; soul care for self and the one-being-cared for; “allowing and being open to miracles
- Determine what gives your patient hope and support this hope. Be aware that not everything that happens in life can be explained. Help the patient to achieve the 5 tasks before the end of life. Recognize this work is difficult. Care for your own physical, spiritual, and psychological needs as you care for your patient. Help celebrate each day.
“If you are not providing excellent spiritual care, you are not providing palliative care.”
− Betty Ferrell, PhD, RN, FAAN, FPCN
https://web.archive.org/web/20210617103452/https://www.spiritualcareassociation.org/docs/learning_center/7_26_2017_chaplaincy_palliative_care_competencies_infographic.pdf
Palliative and end of life care communication
as emerging priorities
in postgraduate medical education
COMMUNICATION TOPICS:
- Establishing rapport
- Informed consent
- Adverse event disclosure
- Bad news
- Advance care planning
- Goals of care
- Family meetings
- Conflict management
- Counseling about emotional impact of emergency situations
- Organ donation
Due to new treatments and technology in critical care units, more patients now survive critical illness.
However, even with this help, 15-20% of UK critical care patients die in hospital.
End-of-life care therefore remains a necessary core skill for intensive care teams.
Such care includes:
• Assessing and managing symptoms e.g. pain, nausea, anxiety, delirium,
• Enabling patients and those close to them to take part in care decisions;
• Understanding legal and ethical processes for withdrawal and withholding treatments
• Minimising distress
• Ensuring patients (and those close to them) do not feel abandoned
• Meeting beliefs and religious needs
Some general groups of symptoms and behaviours can signify the terminal phase for a person with dementia:
• Increased incidence of infections, such as urinary tract infections or pneumonia
• Impaired movement, including difficulty walking and moving, which causes the individual to be bed- or chair-bound
• Incontinence of bowel and bladder, leading to full dependence on others for toileting and hygiene.
• Loss of the ability to communicate through words
• Difficulty swallowing and eating, leading to weight loss and pneumonia
Palliative care concentrates on providing comfort in an active way and all involved in decision making need to be flexible, sensitive and realistic when attending to the physical comfort needs of the dying person.
The following areas are all likely to need careful thought and attention:
• Positioning to promote comfort
• Mouth care
• Difficulty in breathing
• Skin care
• Bowel and bladder management
• Mobilisation
• Personal support
Oral Care for the Dying Patient
This is an important aspect of end of life care and is something that family members can be taught to do if they wish. This may help lessen their distress at not being able to feed their loved one.
- ☛ Find out from patient and /or family what fluids they like
- ☛ Mouth care should be done two hourly or more frequently if required
- ☛ Use maxi swabs (like oversize cotton buds), not the green sponge swabs as they are impregnated with sodium bicarbonate and this is unpleasant for the patient
- ☛ Use any fluids familiar to the patient to swab the mouth – cooled tea or coffee, fruit juice, carbonated drinks, alcohol, cooled clear soups, ice cream or yogurt. This will allow the family to provide special things for their loved one and the familiar fluids and touch of family will lessen the shock for the patient of having something placed in their mouth if they have altered consciousness
- ☛ Avoid iced water – this can be a shock for a semiconscious patient especially if they have sensitive teeth
- ☛ It is the act of moistening the mouth and NOT the fluid you use that is important
- ☛ Take care if the mouth is painful or ulcerated and bonjela or lignocaine viscous may be appropriate
- ☛ If a patient has a history of high alcohol intake, swabbing their mouth with alcohol may keep them more settled
How to use the GSF PIG in your practice.
• Metabolic disturbance:
– Hypercalcaemia
– Hyponatraemia
– Hypernatraemia
– Dehydration
– Hypoglycaemia or hyperglycaemia
• Organ failure
• Drugs: benzodiazepines, corticosteroids, anticholinergics, opioids, and other drugs with psychoactive properties
• Sepsis
• Brain pathology:
– Primary tumour or metastases
– Cerebrovascular ischaemia
– Status epilepticus
• Hypoxia
• Drug withdrawal states
• Haematological causes:
– Disseminated intravascular coagulation
– Anaemia
http://www.dickyricky.com/Medicine/Papers/2016_06_11%20BMJ%20Delirium%20and%20agitation%20at%20the%20end%20of%20life.pdf
Palliative and End of Life Care Profiles
The data in the profiles are grouped into domains. These include:
- place of death
- underlying cause of death
- mortality
- death in usual place of residence (DiUPR)
- care homes and community
- hospital care
- dementia
https://fingertips.phe.org.uk/profile/end-of-life
Guidance Classification of place of death
A guide that supports the methods used for all place of death indicators as classified by Office for National Statistics (ONS) death certificate data.
https://www.gov.uk/government/publications/classification-of-place-of-death
Research and analysis Electronic Palliative Care Co-ordination Systems (EPaCCS)
EPaCCS record people’s care preferences and important details about their care at the end of life.
https://www.gov.uk/government/publications/electronic-palliative-care-co-ordination-systems-epaccs
Simple acts of caring are rituals. In difficult times, these ritualistic acts may take on extra significance. They can become ways of ordering and calming the feelings that arise; they provide a way to express the love you may hold for the person who is dying. You might consider these:
https://diigo.com/0hufbj
- sitting with the dying person while gentle music plays in the background;
- quietly humming or singing a song;
- reading a favourite story, scripture or poem;
- reading cards or notes sent by friends, colleagues or neighbours;
- holding or stroking the person’s hand or arm;
- brushing the person’s hair or wiping the person’s face;
- giving mouth care or giving small sips of water or ice chips (with guidance from the health care team);
- rubbing the person’s feet or legs;
- reminding the person that he or she is loved and will be remembered;
- thanking the person for the ways he or she has touched your life.
The Liverpool Care Pathway was first published in the late 1990s and went through 12 iterations until it was finally withdrawn after the Neuberger review recommended its cessation. The history of the LCP was by no means all bad. Indeed, much anecdotal evidence suggests that it helped clinicians and others provide a high quality experience of dying within an NHS setting. However it was let down by three serious failings.
https://commissiononthevalueofdeath.wordpress.com/2019/09/19/lessonsfrom-the-liverpool-care-pathway/
Palliative care incorporates the whole spectrum of care — medical, nursing, psychological, social, cultural and spiritual. A holistic approach, incorporating these wider aspects of care, is good medical practice and in palliative care it is essential.
The principles of palliative care might simply be regarded as those of good clinical practice, whatever the patient’s illness, wherever the patient is under care, whatever his / her social status, creed, culture or education.
https://hospicecare.com/what-we-do/publications/getting-started/6-principles-of-palliative-care
Top 10 Measures That Matter:
https://www.urmc.rochester.edu/
- Palliative care and hospice patients receive a comprehensive assessment (physical, psychological, social, spiritual and functional) soon after admission.
- Seriously ill palliative care and hospice patients are screened for pain, shortness of breath, nausea and constipation during the admission visit.
- Seriously ill palliative care and hospice patients who screen positive for at least moderate pain receive treatment (medication or other) within 24 hours.
- Patients with advanced or life-threatening illness are screened for shortness of breath and, if positive to at least a moderate degree, have a plan to manage it.
- Seriously ill palliative care and hospice patients have a documented discussion regarding emotional needs.
- Hospice patients have a documented discussion of spiritual concerns or preference not to discuss them.
- Seriously ill palliative care and hospice patients have documentation of the surrogate decision-maker’s name (such as the person who has healthcare power of attorney) and contact information, or absence of a surrogate.
- Seriously ill palliative care and hospice patients have documentation of their preferences for life-sustaining treatments.
- Vulnerable elders with documented preferences to withhold or withdraw life-sustaining treatments have their preferences followed.
- Palliative care and hospice patients or their families are asked about their experience of care using a relevant survey.
Steve Pantilat, MD, Palliative Care Part 4: PSYCHOSOCIAL SUPPORT
Clinical Practice Guidelines
for Quality Palliative Care, 4th edition,
(NCP Guidelines)
creates a blueprint for excellence
by establishing a comprehensive foundation
for gold-standard palliative care for all people
living with serious illness,
regardless of their
diagnosis,
prognosis,
age
or setting.
https://www.nationalcoalitionhpc.org/ncp/
Palliative care needs
to be person-centred
and available when it is needed,
regardless of diagnosis,
and in the setting of choice.
This approach will require
collaboration
and partnership
between services and providers,
including aged residential care,
primary health,
community support
and hospital.
Care needs
to be respectful,
empathetic,
compassionate,
effective
and culturally
appropriate for all people.
This requires
innovation,
flexibility,
resources,
a skilled
and competent workforce,
and care based on evidence
and research.
Ookay kan, Bro!
