Description
Although listed here as a religious problem, both religious and spiritual beliefs
and practices can influence the ways patients react to illness. This is particularly
true in the case of terminal illnesses that raise fears of physical pain, the
unknown risks of dying, the threat to integrity, and the uncertainty of life
after death. In addition, religious and spiritual changes often occur during
terminal illness related to feelings of loss, alienation, abandonment, anger,
suffering; and dependency. Issues such as forgiving others, discovering peace,
discussing death, grieving, and planning the funeral often involve religion.
Loss of hope and meaning of life evident in some patients, and the transitions
from living to dying are essentially spiritual, and clearly not solely physiological,
psychological, or social.[1]
Religious coping is one of the main strategies used
to address these fears, along with exercising self-control
and talking to friends and family about them. In her
research on narrative life story therapy with the
elderly, Viney [2]
found that prayer was particularly helpful for dying
persons: "Talking with God can provide opportunity
to make the pain meaningful, confront the risks, confirm
the integrity and give more certainty about life after
death" (p. 165).
Associated
Clinical Problems
The nursing diagnostic nomenclature specifically
notes that Spiritual Distress can be related to the
inability to practice religious rituals, and the conflict
between religious or spiritual beliefs and prescribed
health regimen[3]
(as illustrated in the case example below). Religious
beliefs, participation in religious rituals, and affiliation
with a religious community can all be affected by serious
illness. Loss or questioning of faith, anger at God,
guilt over "sins", and discontinuation of
religious practices are frequent sequelae of terminal
and life-threatening illness.
Treatment
In hospices, treatment of the terminally ill has been generally recognized
to include a spiritual dimension. Hospice philosophy and accreditation standards
require that spiritual care be a component of hospice care. Spirituality
is useful in addressing "why me?" questions that patients frequently raise,
and therapists and caregivers should actively support and facilitate spiritual
thinking in terminally ill patients. Millison [4]
maintains that "The caregiver needs to understand the power of spiritual
beliefs in helping the patient cope with dying, and needs to be aware of
the ways that spiritual striving can be helped, hindered, or undermined." Many
terminal patients return to their childhood religious beliefs and practices,
while others search for new forms of spirituality. Treatment often includes
working with or consulting with a religious professional. For many with a
serious or life-threatending illness, the same questions and concerns arise.
Conducting a Religious and Spiritual History is usually
an important part of this type of clinical work. (See
lesson on Assessing
Spirituality)
Case Examples
A woman hospitalized with a spinal injury following
an automobile accident showed symptoms consistent with
a depressive disorder, and the consulting psychiatrist
found that she missed the religious and spiritual practices
that were part of her life before the hospitalization.
The consultant recommended psychotherapy to explore
her religious belief's in light of her accident, and
helped her obtain a tape player so she could listen
to religious music. A clergy member of her faith was
contacted and made several hospital visits to provide
support. The authors concluded, "Although religious
interventions are not substitutes for therapeutic interventions,
'religious prescriptions' are ethically sound and may
complement more traditional therapies" (p. 475).
Waldfogel S, Wolpe PR. Using
awareness of religious factors to enhance interventions in consultation-liaison
psychiatry. Hosp Community Psychiatry 1993 May;44(5):473-7
This is case study of a patient who experienced "losing God" as a Hodgkin's
disease survivor with metastatic prostate cancer and severe coronary artery
disease. His caregivers were able to provide the sense of community in which
he could re-establish his faith. Health care providers do not have to be religious
in order to help patients deal with a spiritual crisis. The clinical skills
of compassion need to be deployed to diagnose and respond to spiritual suffering.
Acknowledging and addressing anger or guilt, common sources of suffering, are
essential to adjustment. Simply being there for the patient and being open
to their hurt can help resolve their spiritual crisis.
Penson RT, Yusuf RZ, Chabner BA, Lafrancesca JP, McElhinny M, Axelrad AS, Lynch
TJ Jr. Losing
God. Oncologist 2001;6(3):286-97
WW LIBRARY of Religion
and Spirituality
The WWW
LIBRARY of Religion and Spirituality contains articles on spiritual issues
in dying, interviews with Elizabeth Kubler-Ross MD and Stephen and Ondrea Levine.
QUIZ EXERCISE 9:
According to the authors of Losing God, what factors confound spiritual aspects of cancer care?
a) nebulous language b) distrust c) dogma d) all of the above.
Record your answers for later insertion into the Quiz. |
References
Aldridge, D. (1993). Is
there evidence for spiritual healing? Advances, 9(4),
5-21.
2 Viney, L (1993) Life stories:
Personal construct therapy with the elderly.NY: Wiley.
3 Kim MJ, McFarland G, McLane
A (eds): Classification of Nursing Diagnoses: Proceedings
of the Fifth National Conference. St. Louis, CV Mosby,
1984.
4 Millison, M. (1988). "Spirituality
and the caregiver: developing an underutilized facet
of care." The American Journal of Hospice Care: 37-44.
