Spirituality in end of life care

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Published: 28 Mar 2017
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Mark Thomas - Gold Standard Framework Centre, Shrewsbury, UK

Mark Thomas teaches spiritual care for the end of life setting, not only for patients but also for their family and for the health professionals who care for them.

He explains how strong inner resources enable healthcare professionals to care compassionately and this is often achieved through practising mindfulness.

One area where compassionate caring is particularly important is in having advanced care planning conversations where patients need to determine what they want to happen to them towards the end of their life.

One of my roles is to teach spiritual care. One of the important things at the outset is to make a distinction between spirituality and religious practice in that some people have religious practices, some don’t, but we all have a spiritual core. There’s lots of research to show how important it is to acknowledge and bring to the surface that spiritual core when we’re facing our mortality at the end of our life and how addressing that spiritual core means that we can address our mortality and end of life better.

As part of teaching spiritual care the aim is to build resilience and hope in those who we are caring for and also in ourselves as carers. Because, as carers, we need to acknowledge that caring for somebody who is dying places big demands upon us. Therefore we have to find strategies of self-care; finding resilience in ourselves and that would be partly how we operate as a team with those around us but also how we find resources within ourselves. So when I’m teaching spirituality I’m not just teaching spirituality in the cared for, I’m also saying that as carers we need to find our own resources, we need to actually find out what it is that gives us strength to live each day and that would be different for each of us.

Our own inner resources are a key part of what we bring to our task of caring compassionately and that caring compassionately really is what this is all about. In our task of caring compassionately, building resilience and hope, this is about how we are with those we care for. Listening, of course, and listening is not just about listening with our ears; we listen with different parts of ourselves, our eyes, our touch and perhaps most importantly of all our presence - how we are with somebody. That stillness we need to bring, no matter how busy we are, before that particular conversation and how busy we’re going to be; in that two or three minutes, or whatever it is, the quality of our presence that we bring is a key thing because if we’re distracted that will kill the quality of a conversation. We need to know how to be still, to bring that stillness, to bring 100% of our attention to that particular conversation.

So actually I’m often teaching mindfulness, which is often used these days, because mindfulness cuts across all different… it can be religious or non-religious. Mindfulness is about finding that stillness within ourselves which means we can actually be with somebody more effectively.

This task of listening, we bring in particular to what we call advanced care planning conversations. Helping somebody work out for themselves what is important for them and what isn’t important to them; what they do want to happen and what they don’t want to happen as they are facing the end of their life. There’s a particular skill in an advanced care planning conversation and we need to be able to listen to somebody effectively so that we can draw out of somebody what their own priorities are as they face this most important task of their life.

And, of course, the aim of all this, as I said earlier on, is that we are able to be a compassionate presence, that we are able to care compassionately for somebody as they face this most important part of their lives. Of course we bring our professional status as a doctor or a nurse or whatever it is but also, particularly as we’re facing mortality, we share in common with those we care for the fact that we’re all human therefore we are going to die too. It’s really important, therefore, that we acknowledge that we won’t have all the answers and that’s OK because as human beings we don’t know certain things and it’s alright to admit that. As human beings we are mortal too, we bring our own uncertainties about that and it’s important we don’t hide behind the stethoscope, that we do acknowledge that we’re human too and that’s a challenge we face together.