South Florida Hospital News
Thursday October 18, 2018

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December 2009 - Volume 6 - Issue 6




For Optimal End-of-Life Care, Spiritual Comfort Complements Pain Control

Religious issues and spirituality are as much a part of the nationís best hospice programs as are adequate pain control and home care visits.

Many think of end-of-life healthcare as a somewhat disconcerting departure from medicineís traditional "fix-it" mentality. But when a curative approach is no longer the best option, palliative and hospice care take patients to a different place, both physically and spiritually.

At VITAS Innovative Hospice Careģ, "a good death" is not an oxymoron; it is the ultimate goal that we strive to meet for our almost 200 patients every day. Our interdisciplinary teams of physicians, social workers, chaplains, nurses, hospice aides, volunteers and bereavement specialists are as alert to a patientís spiritual needs as they are to decubitus and nausea.

A common misconception is that hospice is about death. In fact, hospice is about lifeó some of the most important moments in life. In 20 Common Problems in End-of-Life Care (Barry M. Kinzbrunner, Neal J. Weinreb, Joel S. Policzer; 2002; McGraw-Hill), the end of life is embraced as an opportunity for growth by:

  • Moving patients and families through fear to peace
  • Moving patients and families through despair to hope
  • Moving patients and families from isolation to community
  • Moving patients and families from loss to closure
Any one of these can improve a hospice patientís quality of life immeasurably. For that reason, every VITAS hospice team includes a social worker and chaplain with extensive training and experience in spiritual awareness, end-of-life issues and bereavement. Often they are the only spiritual advisors a patient sees, but they also can work with the patientís physician and religious advisor to ensure a holistic prescription for quality of life.

Not every patient is open to spiritual care at the end of life, however. "Spirituality is an individual concept," notes Gustavo Giraldo, M.Div., a chaplain in the VITAS Miami-Dade and Monroe Counties program, "so we take great pains at VITAS to respect and honor everyoneís wishes. What is interesting, however, is that sometimes it is the patients who say they donít need spiritual support to help them through the dying process who actually need it the most."

Remy Nelson, M.Div., M.Ed., VITAS chaplain in Broward County, agrees. "There certainly is no formal religious aspect to our team membersí visits unless the patient and family specifically ask for it. But our training helps us gain acceptance from the patient and family, meet them where they are spiritually, hear their concerns and offer non-judgmental support."

When spiritual care is declined, VITAS hospice team members work together to find non-threatening, non-intrusive ways to include support and companionship in the patientís care plan. The chaplain might accompany the admitting nurse at the initial patient assessment, or the social worker is introduced by the nurse as a member of the team who occasionally accompanies her on her rounds.

Whatever the method, the results are always worth the effort. "The level of intimacy achieved when we address the spiritual concerns of any patient," says Amy Baer, M.Div., VITAS chaplain in Palm Beach County, "opens the door to a vulnerability that can be rich with meaning."

Spiritual support is so important in end-of-life care that it is legally mandated. Psychosocial/spiritual support is a basic component of the Medicare Hospice Benefit. Hereís a case of the government doing the right thing, because the last days of life donít need to be painful or lonely or confusing. With spiritual support, the last days of life can be an opportunity for growth, remembrance and closure.

Martha Rutland is Director of Clinical Pastoral Education, VITAS Innovative Hospice Careģ. For more information about VITAS and/or spiritual care in hospice care, call 1-800-93-VITAS.
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