Do caregivers understand what spiritual care is and how to meet residents’ spiritual needs as they approach end of life? JUDITH HARDIE discusses her research into spiritual care in New Zealand rest homes.

Some years ago a friend’s mother asked that I visit her. A resident in care, her life was nearing its end and now the estrangement from her childhood faith caused by a marriage that had not been accepted by her denomination caused her to be fearful of death. She was distressed by her memories of childhood teachings of what her fate might be. She wanted help. I listened. We talked. She gave permission for me to contact a leader of her former denomination to visit her. This was done, her fears dispelled in the light of her denomination’s current teachings and a few weeks later she died in peace. For me this was a profound experience.

It raised the question, what exactly is meant by ‘spiritual care’ ? Furthermore, if the provision of spiritual care to rest home residents is mooted then a further series of questions arise – who is likely to need spiritual care? Who is to provide it? Finally, and of real importance to the frail elderly, when does such care need to be offered?

It was with questions such as these in mind that I began two years of research to discover answers. I had some knowledge of the spiritual needs of the frail elderly in rest homes, gained from many years of pastoral work amongst them. However, I came to understand there were greater, often unspoken, spiritual needs amongst the residents with whom I had no contact. As a consequence, I began to explore a way to discern the spiritual needs of the frail elderly and whether or not these were being met.

To accomplish this I employed a qualitative research methodology. I gained the support of the managers at two rest homes who gave permission to work and talk with residents and caregivers. Residents, staff and management were then interviewed to address the question: to what extent and in what ways is spiritual care a part of the caregiver role in New Zealand rest homes?

Holistic care in rest homes has long been regarded as providing the physical, mental and social care so essential for residents’ quality of life. Only since the latter part of last century has the importance of spiritual care of the elderly become more widely recognised.

Caregivers providing spiritual support 

Within the rest homes of my study, religious care was officially provided by chaplains, local church workers or leaders of other faiths, all of whom ministered to those for whom both the teachings and participation in the rituals of their faiths was important. But there was another group of workers to whom some residents turned – the caregivers.

The rest home caregivers were aware it was possible to call on the help of religious professionals if a resident asked for this. However, when talking with caregivers I found the need for spiritual care was less well understood. Spirituality was regarded as an element of the residents’ culture – I was given as examples the food constraints of Jewish residents and the dying rituals of Māori as being their ‘spiritual’ needs. Otherwise spirituality was felt by caregivers to be a deeply personal and private element of life beyond a boundary that must not be crossed. Yet I found that it was often the trusted caregiver, the woman or man who offered intimate, personal care each day, to whom a resident would turn for help in sorting through the spiritual dilemmas that troubled them.

Religion or spirituality?

It is not easy to make a clear distinction between religion and spirituality, as each, to a greater or lesser extent, may embody elements of the other. Their significance in the life of the ageing will depend on the individual life experiences of those to whom care is offered. In assessing the role of caregivers in attending to spiritual needs, dimensions of religion and spirituality are both therefore relevant. Understanding the ways in which thoughts of religion and spirituality converge or diverge as ageing brings changes in the lives of those cared for was particularly relevant to my study.

I found that caregivers, exposed to the spiritual needs of rest home residents, needed to be helped through training to recognise that it is not always a religious response that is required – sometimes attention to the spiritual response is more appropriate.

Through religious practices some people are able to find shared answers to questions evolving from transcendental experiences. People in such a community find comfort and strength in facing the unknown in daily life. For many people, however, the practices of religions have no significance, yet they do not deny the need to understand the meaning of life. At the heart of this study, therefore, was spirituality defined as a personal quest for meaning of life, for answers to definitive questions about life. At no time does this quest become more important than when life appears to be drawing to an end.

Within the rest home community the residents’ frailty and inability to participate in life as it was formerly lived now gives long hours for private contemplation. Pain and helplessness, fears of death and what, if anything, might be faced after death, become accentuated, particularly in the long hours of night. Caregivers on night shifts spoke of distressed residents – when loneliness, deterioration in health, hopelessness or seeming alienation from loved ones became too much to bear. When asked if residents ever spoke to them about their fears, most answered that spiritual questions revolved around how the residents expressed a wish to die but feared the outcome of death. The caregivers listened but were only able to respond to residents from their own religious or spiritual backgrounds, constantly aware that there were boundaries they must not overstep.

More training needed

From my research, I consider that caregivers are very likely to be the staff members in rest homes to hear residents’ stories, through which their spiritual needs might be identified. Caregivers’ personal involvement in the life and concerns of those for whom they care appears to be a positive factor in promoting the residents’ wellbeing. However, it must be acknowledged that while they are intelligent women and men, many caregivers have limited educational backgrounds or skills. This, accompanied by ethnic and language difficulties, places them in a complicated position with regard to finding the resources or opportunities to develop skills in understanding or responding to residents’ spiritual needs. The training curricula for caregivers could include a greater emphasis on this aspect of caregiving.

Spiritual care is an important aspect of holistic care. The context of the work of caregivers places them in positions to hear residents express their spiritual needs. Their caring brings them into the wider network of physical and social care offered by rest homes. A greater understanding of the spiritual needs of residents will enhance the care they offer and contribute to the holistic care so important to the frail elderly.

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