What Causes Spiritual Distress?

In homecare, caring for patients’ physical health is paramount; no less so, is nurturing their spirit.

People returning home from an acute hospital stay or episode of inpatient rehab may face disarray on multiple fronts. Some are at a critical crossroads—trying to adjust to, make sense of, and cope with significant health challenges that affect their intimate relationships, finances, living circumstances and spiritual worldviews. Homecare patients may not be dying imminently, but challenges in their lives can make their day-to-day existence an entirely new reality that can be daunting and incomprehensible at times.

How well-prepared are we when it comes to elevating hands-on physical interventions to healing the whole person? We assist patients in healing their physical ailments, but to fully recuperate, patients often need to process, plan, reflect, integrate or grieve. A nurse may be called to heal a patient’s wounds and hear her fears of reinfection. A physical therapist not only works to establish a care plan to help a patient ambulate to the mailbox, but also needs to empathize with his anxieties about falling. A home health aide may assist a patient with bathing and grooming, while also needing to express compassion for her feelings of ineptitude. An occupational therapist may teach a patient how to manage safely in his kitchen, while at the same time being sensitive to his grief that he can no longer truly be the family chef, a proud and precious role he held for decades.

As care providers, we maximize our effectiveness when we support patients as they heal both physically and spiritually. Optimizing patients’ capacity to return to an improved and meaningful existence relies on all team members’ openness to addressing spiritual distress. Integrating professional chaplains on the health care team would be ideal. Services chaplains provide include spiritual counseling, crisis intervention, spiritual support, addressing end-of-life concerns, liaison with patients’ clergy/spiritual leaders, ethics consultation, community education, bereavement services, and rituals and spiritual services for employees.

Interprofessional attentiveness to “whole person” concerns is consistent with various credentialing agencies’ mandates. Here are a few examples:

Nurses, as part of their assessments, are to collect data that includes the “spiritual/transpersonal”; elicit “values, preferences, expressed and unexpressed needs”; and engage in “holistic, culturally sensitive data collection…,” as detailed in Nursing: Scope and Standards of Practice, 3rd Ed., American Nursing Association, 2015.

Physical therapy is an “art and science…” addressing “health and wellness,” reads Physical Therapy Practice Act (CA), Article 2, Provision 2620, a.

Occupational therapy uses “purposeful and meaningful goal-directed activities which engage the individual’s body and mind…,” advising on how to enhance function and quality of life, says the CA Business and Professions Code, Section 2570-2571, k.

Speech therapists’ interventions include “counseling related to the development and disorders of speech, voice, language or swallowing,” according to the CA Business and Professions Code, Speech-Language Pathologists, Audiologists & Hearing Aid Dispensers, (d) 1.1.

What Causes Spiritual Distress?

• Terminal diagnoses—It is at home that patients are likely to begin to have the time and space to truly think about a difficult and possibly fatal diagnosis.
   
• Long, slow declines—The continual and incremental losses that can come with old age—falls, frailty, loss of mobility, diminishing independence and declining health­—may raise questions of life’s meaning, such as, “Why am I still here? For how long will I suffer? What is my life worth now?”
   
• Ambivalence about healing—Patients may waver between embracing and losing the will to live. This soul-level vacillation can impact patients’ motivation for adhering to the care plan.
   
• Adjusting to changes, disabilities—Surrendering to changes and accepting new realities can be a painful process needing our empathy.
   
• Recent death or expected death of a family member—Some patients have recently lost a spouse and are experiencing fresh grief. The physical and emotional demands of caregiving for a dying relative may have contributed to the onset of their own health crisis.
   
• Anxiety, depression—Patients coping with a serious health concern often struggle with anxiety and/or depression. One of the most challenging spiritual concerns is entrenched despair. Relatedly, loneliness can impact patients’ energy and motivation for getting better.
   
• Caregiver overwhelm—When caregiving stresses family relationships, our compassionate listening, encouragement and support can help ease the tensions.
   
• Religious/spiritual identities—Patients affiliated with a religious/spiritual community may feel cut off from their faith community by their isolation at home.
   
• Advance care planning—Religious/spiritual beliefs and precepts may inform patients’ life priorities and ethical decision-making. Pertinent questions might include: When does life begin/end? What does my religion and/or life philosophy say about organ donation? What funeral traditions are important to me?

Listening: A Most Potent Intervention

Compassionate listening is not only good for patients, but also is good for business. Research in recent years affirms the measurable value of attentive listening. Hospital patients report higher levels of satisfaction with doctors who sit down to talk with them compared to doctors who do not sit, even when these patients are unaware that the sitting doctors had spent less time with them.

A 2014 Canadian study concluded that a substantial portion of patients’ healing from chronic back pain came from communication and connection with patients. The physical therapists treating them asked open-ended questions, listened attentively to answers, expressed empathy about the patients’ situation, and offered words of encouragement about getting better.

Listening Skills: Reviewing the Basics

• Reportedly, up to 85 percent of all communication is nonverbal. Gestures and body language may communicate more effectively than words. Pay attention to your posture and body orientation—how you sit, stand, hold your head, and walk, as well as your facial expressions and eye contact, voice volume, tone and pace.
   
• Opt for a nondistracting environment when possible.

• Paraphrase what you hear. Give space for silence; this is especially important with elderly patients who may process more slowly. Invite patients to elaborate, saying for instance, “Would you like to say more?” Make it safe for patients to share feelings. You can do this directly, simply by saying, “How are you feeling about all this?” Or you can be more indirect, saying, “Sounds as if you are feeling…” or “I imagine this must be very hard.” Remain humble.

Incorporating Spiritual Care into Your Organization

How does your organization screen for the spiritual needs of homecare patients? Is there a professionally trained chaplain available to respond to these needs? What training does staff receive for engaging the multiple dimensions involved in healing?

Being an effective caregiver requires cultivating skills for addressing the whole person, to help patients process the full impact of their health condition.

Skills related to listening, empathizing and being a confidante are key. To use these practices will support and sustain the healing we ultimately hope to provide—body and spirit.