Spiritual Pain In Palliative and End of Life Care

1
Spiritual Pain In Palliative and End of Life Care

• By Dennis Harvey, M Div
• Chaplain Coordinator
• Hospice of East Texas

2

• Dame Cicely Saunders, founder of the modern
  hospice movement, coined the phrase TOTAL PAIN.

3
Total Pain refers to various kinds of
suffering

• Physical
• Emotional
• Spiritual

4

• Palliative Care, through the workings of the
  Interdisciplinary Team, acknowledges the
  relationship between these areas of pain.

5
What is Spiritual Pain?

• Emotional or Physical distress due to unresolved
  spiritual or religious issues
• (spiritual or religious, the two are not
  necessarily the same)

6
Spiritual is that which gives a person meaning
in life.

• a higher power
• a life style in tune with nature
• a belief in the overall goodness of man
• a connection with a traditional religion

7
Religious tends to be tied to a traditional
belief system

• Maintaining rites and rituals of a specific group
  
• part of a community with shared beliefs

8
Unresolved Issues

• Relation to self  (loss of dignity, loss of
  control, loss of hope, loss of purpose, etc)
• Relation to others (broken relationships,
  forgiveness, loss of dreams, etc)
• Relation to God (punishment, need for
  forgiveness, abandonment, etc)

9

• There may be no answer to, or resolution of
  issues.  They are expressions of the patients
  grief.  We must acknowledge the patients search
  and journey.

10
Symptoms of Spiritual Pain

• constant chronic pain
• insomnia
• anxiety
• anger
• conflict (with family, spiritual representatives,
  staff)
• depression
• withdrawal from support system
• feeling of failure
• refusal of medication

11
Cultural and or Beliefs that influence Spiritual
Pain

• deserve the pain
• must suffer to earn acceptance or share in
  Christs suffering
• being tested be God
• God has a purpose
• Satan is trying me

12
Interventions for Spiritual Pain

• Refer to the patients Spiritual Assessment
• Use both Practical and Relational Interventions

13
Spiritual Assessment
Determine the basic belief system by asking
simple questions such as

• Are you a member of a local church or place of
  worship?
• Are spiritual things an important part of your
  life?
• Is there some one you talk to about spiritual
  matters?
• Do you have any spiritual concerns?
• Would you like a spiritual counselor to visit?

14
Practical Interventions

• Prayer
• Relaxation techniques
• Rituals
• Religious symbols (cross, bible, prayer book,
  rosary, candles)
• Guided imagery

15
Relational Interventions

• be present, be real
• listen, you dont have to have answers
• be sensitive to Patients particular belief
  system leave your own at the door
• use Life Review, through telling his or her own
  story, unresolved feelings or issues may come
  forth
• ask about unfinished dreams or last wishes

16
Case studies

• 75 year old male with COPD was admitted to
  hospice
• inpatient care for symptom management of pain and
  
• shortness of breath.   Patient became increasing
  agitated
• and verbally abusive to nursing staff.  Pt. and
  family very
• reserved during chaplain visits revealing very
  little about
• spiritual background except to say they were
  spiritual
• people.   The contact information listed a son
  who had not
• visited.  Any questions about the son were
  dismissed as a
• non issue.  All attempts to medicate symptoms
  were
• unsuccessful.
•  

17
Case studies

• 65 year old male with lung cancer was admitted to
  hospice
• inpatient care actively dying.  Two daughters
  present were
• extremely emotional and seem to compete for Dads
  
• attention (even in his unconscious state). 
  Patient became
• very restless as the daughters continued to pat
  and rub
• Dads arm.  Attempts to calm patient with
  medication had
• very little success.  Attempts to educate the
  family members
• on the dying process yielded very little positive
  results.
•  

18
BIBLIOGRAPHY

• JOURNAL OF PALLIATIVE MEDICINE
• Volume 8, Number 6, 2005
• Mary Ann Liebert, Inc.
• JOURNAL OF PALLIATIVE MEDICINE
• Volume 8, Number 5, 2005
• Mary Ann Liebert, Inc.
• CLOSE TO THE BONE  LIFE-THREATING ILLNESS AND
  THE SEARCH FOR MEANING.
• J. S. Bolen.  New York  Touchstone.
• JUNIOR ROTATION IN HOSPICE AND PALLIATIVE
  MEDICINE
•           University of Maryland School of
  Medicine. 
•           Spirituality and Palliative Care
•           July 17, 2002.
• www.endoflife.northwestern.edu/religion_spirituali
  ty/pain.cfm
• Module 14, Part III  Spiritual Pain/Spiritual
  Suffering.