unit 304: support the spiritual wellbeing of individuals · 4 | page table 1: learning outcomes and...

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UNIT 304:

Support the Spiritual Wellbeing of Individuals

Learner’s Workbook

Learning Activities

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Acknowledgements Skills for Care is pleased to acknowledge the work of St Luke’s Hospice Plymouth and Venus Training & Consultancy in researching and writing these learning materials. In the course of developing these materials they have drawn on the resources available through the National End of Life Care Programme, Social Care Institute for Excellence, Help the Hospices, e-ELCA and others. Skills for Care wishes also to thank all those individuals and organisations that supported the external consultation. All sources have been acknowledged and references have been cited at the point of contribution. This unit of learning has been developed and written by Jane Mason MSc; BSc (hons); RNT; RN; DN St Luke’s Hospice Plymouth Edited by Jane Kellas Director Venus Training and Consultancy Limited Katherine Kelleher Director Aspira Consultancy Externally reviewed by Geraldine Clay. MSc; BA(Ed); RGN; RHV; RNT

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Table of Contents Section Content Page

Table of the learning outcomes and assessment criteria

4

Section 1

Introduction to the unit: • Introduction to the unit and the activities • What types of evidence are acceptable for each

learning outcome

7

Section 2

Activity 1 – Professional Discussion (meets learning outcomes 1.1; 1.2; 1.3; 1.6; 1.7 and 2.2)

16

Activity 2 – ‘An Individual Experience’ (meets learning outcomes 1.4 and 1.5)

27

Activity 3 – Life Story (meets learning outcomes 1.3; 1.7; 2.1; 3.2; 4.2; 4.3 and 4.6)

33

Activity 4 – Care Plan (meets learning outcomes 2.3)

48

Activity 5 – Reflective Account (meets learning outcomes 3.1 and 4.4)

53

Activity 6 – Reflective Account (meets learning outcome 3.3)

56

Activity 7 – Support at End of Life (meets learning outcomes 4.1; 4.2; 4.3 and 4.5)

59

Glossary of terms

69

Continuation sheets (for photocopying)

70

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Table 1: Learning Outcomes and Assessment Methods EOL 304: Support the spiritual wellbeing of individuals Unit level 3 Credit value 3 Study/activity hours 26 Unit aim: The purpose of this unit is to assess the learner’s knowledge, understanding and skills in supporting the spiritual well-being of individuals. Learning outcomes The learner will:

Assessment criteria The learner can:

Own evidence log (optional)

Assessment Type

Page No

Type of evidence presented

1. Understand the importance of spirituality for individuals

1.1. Outline different ways in which spirituality can be defined

Knowledge

1.2. Define the difference between spirituality and religion

Knowledge

1.3. Describe different aspects of spirituality

Knowledge

1.4. Explain how spirituality is an individual experience

Knowledge

1.5 Explain how spirituality defines an individual’s identity

Knowledge

1.6 Outline the links between spirituality, faith and religion

Knowledge

1.7 Explain how an individual’s current exploration of spirituality may be affected by their previous experience of spirituality, faith or religion

Knowledge

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Table 1 continued Learning outcomes The learner will:

Assessment criteria The learner can:

Own evidence log (optional)

Assessment Type

Page No

Type of evidence presented

2. Be able to assess the spiritual needs of an individual

2.1. Support the individual to identify their spiritual needs and how and by whom these can be addressed

Competence

2.2. Identify how an individual’s emphasis on spirituality may vary at different stages of their life experience

Knowledge

2.3. Take action to support that the individual’s spiritual wellbeing is recognised appropriately in their care plan

Competence

3. Understand the impact of values and beliefs on own and an individual’s spiritual wellbeing

3.1. Analyse how your own values and beliefs may impact on others when communicating about the individual’s spiritual wellbeing

Knowledge

3.2. Identify how the values and beliefs of others may impact on the individual

Knowledge

3.3 Identify the effects on own values and beliefs when meeting the spiritual needs of individuals and others

Knowledge

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4. Be able to support the individual’s spiritual wellbeing

4.1. Access resources and information to support the individual’s spiritual wellbeing

Competence

4.2. Contribute to the creation of an environment that enables individuals to express aspects of their spiritual wellbeing

Competence

4.3 Support the individual to take opportunities to explore and express themselves in ways that support their spiritual well-being

Competence

4.4 Support the individual to participate in their chosen activities to support their spiritual well-being

Competence

4.5 Access any additional expertise required to meet the individual’s spiritual needs

Competence

4.6 Outline the benefits of working in partnership with faith and non-religious communities to support the spiritual needs and preferences of the individual

Knowledge

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Section 1: Introduction to EOL Unit 304 General Introduction This unit will help you to develop an understanding of spiritual wellbeing and the forms spiritual care may take. The unit provides you with the skills to support the spiritual wellbeing of individuals you care for. The unit covers the importance of spirituality as part of the care for an individual, especially at the end of life. It covers how to assess the spiritual needs of individuals and how best to offer support. There is opportunity to consider your own beliefs and values and those of others. There is opportunity to consider how these can impact on each other. There will be discussion about how you might get further help and support from a range of other services to provide spiritual care. This workbook contains a range of different learning activities that will assist you in meeting the learning outcomes for the unit. Table 1 shows you the type of activities you may be asked to complete. Learning Support Due to the sensitive nature of End of Life (EOL) care, sometimes learners can become upset whilst completing the learning activity. For example you may be asked to consider your thoughts about your own death, or watch video clips that include the views of people who are actually dying. At your introductory session your tutor/assessor will ask you to complete a support agreement, which will identify what you should do if you should become upset whilst undertaking any of the following learning activities.

• Lone study – The tutor/assessor will ask you to identify support networks (these could be friends, family, colleagues) if you should become upset.

• One to one – The tutor/assessor will ask how you would like to be supported by your tutor/assessor should you become upset.

• Work based learning- The tutor/assessor will ask you to identify a mentor/or supervisor to whom you could go if you became upset at work

• Classroom based learning - The tutor/assessor will ask how you would like to be supported should you become upset during classroom sessions. The tutor/assessor will not be able to leave the rest of the class, so you may wish to nominate a classroom buddy who could leave the classroom with you or identify a quiet place where you can go to be alone and have a cup of tea. This will be your decision and based on the facilities available.

Providing good EOL care can be one of the most rewarding caring experiences you can have. It is a privilege to know that you have cared for someone as they have taken their last breath in the world and that you have been part of their end of life journey. It is often a comfort to know that you have helped someone meet their EOL wishes and they have had a comfortable, dignified death. How you care for someone at end of life can remain with relatives and loved ones for a long time and you only

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have one chance to get it right. This is a big responsibility and so it is really important that you take the learning activities seriously and that you also ensure that you learn at your own pace, to fully reflect and absorb the new EOL knowledge and skills you will be developing throughout this unit. Learning Activities As everybody has different ways of learning new information, this workbook contains a range of learning activities, which will assist you in meeting the learning outcomes for the unit. Table 2 shows you the type of activities you may be asked to complete. Table 2: Type of learning activities and symbols Activity Symbol Explanation

This symbol means you will need to access the internet *

This symbol means you will be reading something

This symbol means you will be asked to talk about something with friends, colleagues, your tutor or assessor

This symbol means you will be asked to think about something and you may be required to write your thoughts down

This symbol means you will be asked to watch a clip from a movie, TV programme or from the Internet e.g. youtube film clip *

This symbol means you will be asked to write something in a workbook or a worksheet or even provide examples of your work with a service user e.g. a plan you have written

This symbol means you will be asked to research some information. This might be through the internet, books and articles or from talking to people you know

This symbol means your assessor will plan to conduct an observation of your practice or will examine a work product

* Although every effort has been made to ensure video clips are appropriate, as they are often freely available to all, we cannot be held accountable for any inappropriate comments made about the clips. If you should see something offensive please following the offensive reporting guidelines of the web site concerned.

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For each activity you will see a clock symbol, which will provide you with a guide to how long the activity could take you. Remember this is a guide and the activity may not take as long as it says!

Each activity will signpost you to a range of resources to support your learning and where appropriate learning materials will be provided e.g. an information leaflet or a section of a website for you to read. As you complete the activities in each section, it will be important for you to log your evidence in the relevant evidence log that your awarding body has provided for you. You can see which learning outcomes each activity covers by the table at the top - below is an example; the learning outcome shaded in green is the one you have covered when you successfully complete the activity. Your tutor/assessor will support you to complete the activity. If you don't succeed at first, they will give you further support to get it right!

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Table 1 (page 4) shows you what learning outcomes you will have to achieve to pass this unit and what the assessment criteria will be. The table also identifies whether it is a skill or knowledge competency. The table also provides you with an optional ‘own evidence log’. This is so you can keep your own learning log and can discuss your learning and evidence with your tutor and/or your assessor. Keeping your own learning log can be a useful tool to help you keep track of your learning and progress. At the end of each activity you will be reminded to complete the evidence log.

Each section will outline the activity and provide guidance on how to do the activity. Look for this symbol to help you with ideas and suggestions on completing the activity.

Plagiarism and Confidentiality Plagiarism relates to claiming work to be your own when it is not. All work submitted must be your own and not copied from anyone or anywhere else unless the source of the information has been clearly referenced. Confidentiality is essential in all aspects of care and that includes during your learning. You may be asked to reflect upon aspects of your role and people for whom you provide end of life care but it is very important that you do not disclose any personal information about them. You must also be very careful not to include any evidence that relates to them in your portfolio e.g. photographs or documents with their details on.

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Portfolio of Evidence It is recommended you keep a folder to record all the evidence you collect for this unit. This will be your portfolio, which demonstrates your understanding on the subject and will help your tutor/assessor ensure you are meeting the learning outcomes. End of Life Care for All (e-ELCA) End of Life Care for All (e-ELCA) is an e-learning platform from the Department of Health and e-Learning for Healthcare (e-LfH) in partnership with the Association for Palliative Medicine of Great Britain and Ireland to support the implementation of the Department of Health's National End of Life Care Strategy (July 2008). The e-learning platform is aimed at health and social care staff working in end of life care. The e-learning enhances the training and education of these staff, increasing their confidence and competence to ensure well informed, high quality care is delivered to people at the end of their life. There are over 150 highly interactive sessions of e learning within e-ELCA. These are arranged in 4 core modules:

• Advance Care Planning • Assessment • Communications Skills • Symptom Management, comfort and wellbeing

Also, there are 3 additional modules in social care, bereavement and spirituality. All of these sessions are freely available to NHS staff, social care staff who work in an organisation registered with the Skills for Care National Minimum Data Set (NMDS) or staff who work in a hospice. Staff who do not meet these criteria can register at a cost of £199. There are twelve sessions which are freely available to everyone, including volunteers and clerical and administrative staff on an open access website: www.endoflifecareforall.org.uk. For further details see 'Access the e-learning'. This is an additional resource and not mandatory for this unit as it may not be freely available to every learner.

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Providing the right evidence It is important that you provide the right type of evidence for the outcome you are trying to achieve. Remember there are 2 types of evidence:

a. Competence / Skill – This is where you need to demonstrate something about your practice.

b. Knowledge – This is where you need to demonstrate that you have learned and understood some new information.

Table 3 shows you the type of evidence that is acceptable for the type of outcome. Table 3: Suitable Evidence

Evidence methods Explanation Suitable for evidencing

Competence

Suitable for evidencing Knowledge

Direct observation of you by assessor

You will be observed by your assessor carrying out your everyday work activities in your learning environment

YES YES

Professional discussion

You will take part in a pre-planned and in-depth discussion with your assessor

YES YES

Expert Witness evidence

An expert witness, such as a qualified professional, completes a testimony of your competence in the learning environment where it would not be possible for your assessor to observe

YES YES

Work products A work product is evidence used in your work setting and produced, or contributed to, by you. For example care plans, daily diaries, assessments

YES YES

Reflective diary An on-going record of events produced by you that take place relating to your work, including evaluation and reflection

YES YES

Reflective statement A record of events, produced by you, that relate to an event that happened in your learning environment, including evaluation and reflection

YES YES

Written and pictorial information

Written answers and completed activities set by your tutor or assessor

NO YES

A scenario or case study

Written or verbal account of how you would respond to specific events set down by your tutor / assessor

NO YES

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Reflective Practice and Reflective Accounts Reflective practice is a process, which enables you to achieve a better understanding of yourself, your skills, knowledge and practice. Although most of us engage in thinking about experiences either before, during or after an event, we need to document our understanding in order to clearly identify our learning, consider the outcomes and evaluate the experience. The aim is to identify what we have learnt in order to find new or different approaches to our future practice, or to recognise when something was best practice. Learning comes from many different incidents and experiences that we have in life. We can learn much about ourselves, others, our job, our organisation, and professional practice, as well as our abilities and skills, if we consciously take the time to reflect on our learning. A popular model of reflection is Gibbs 1988 – The Reflective Cycle. This is shown in the diagram below:

In some of the activities in this workbook, you will be asked to complete reflective accounts. We recommend that you follow the model above to ensure that you include everything.

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Introduction to supporting the spiritual wellbeing of individuals

Providing care for an individual starts with a complete assessment of that person’s needs. This includes physical, psychological, social, cultural, environmental, spiritual and financial needs (EOL Care Strategy 2008). An area that a lot of care providers find difficult is meeting the spiritual care needs of an individual. This can be a challenge for many reasons as care workers may feel that:

• This is an area for experts only

• They do not understand what spirituality is

• Spirituality refers only to religion

• It is intrusive to discuss such personal matters with an individual they care for

• Worried that questions will be asked they cannot answer

• They have never thought about what their own spiritual needs are

• They will not know how to help someone whose ideas and beliefs are different from their own

• They may not know where to look for help and support

• They may worry they may not be able to meet the needs they find

• They have not have enough training about spirituality

This unit will look at the meaning of spirituality, religion and faith and how these may be linked. It will give you the opportunity to think about your own spirituality and beliefs. The unit will give guidance about assessing and meeting spiritual needs. There will be opportunity to see how these ideas can be practiced in the workplace. Examples will be given of different individual spiritual needs and how these have been met. Ideas will be provided of where other support is available to help the care staff and resources to use in the work place.

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Pre-learning assessment – Rate how confident you feel about understanding and supporting the spiritual needs of those you care for. 1 being not very confident and 5 very confident If you are not sure about completing this table please discuss with your tutor/assessor. Confidence level

1 2 3 4 5

Understanding what spiritual needs are

Talking about spiritual needs

Supporting an individual’s spiritual needs

Supporting the spiritual needs of those with different beliefs or culture from your own

Knowing who can help you to meet an individual’s spiritual needs

Knowing who can support you and understanding how to care for yourself.

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Section 2: Activities

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Activity 1 - Professional Discussion ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Professional Discussion Assessment Type: Knowledge The End of Life Care Strategy (DH 2008) recognises that it is important for each individual to have a holistic (complete) assessment of their needs. This assessment should include physical, social, cultural, environmental, spiritual and financial needs. Often we think of each part of the holistic assessment as something separate from the other parts but a holistic assessment means all the parts are important. Evidence shows that spiritual well-being is important to physical and emotional wellbeing. The need for an individual to find meaning in life and think about what gives them comfort and purpose in life is most likely to arise at times of trauma, illness, great life changes or when facing the end of life. As people reach the end of life, their physical needs may increase and it is easy to forget the other areas. It is known that spiritual needs in particular are often ignored by care staff. Spiritual needs may become more important as end of life approaches and an individual looks back over their life and thinks about the future.

Activity 1: Professional Discussion

Approximately 8 hours (including preparation time)

For this activity you will need to work with your tutor/assessor to plan and book a Professional Discussion with your tutor/assessor. You will need to be ready to talk about the following topics:

• The different definitions of spirituality • The different aspects of spirituality • How spirituality differs from religion • How spirituality, religion and faith are linked • How someone’s spirituality might be affected by previous

experiences of spirituality, faith or religion • How someone’s feelings about spirituality might change at different

stages of their life and when it might have more emphasis Before your discussion you should complete the tasks below, which will

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help you think about the points above. Your answers will form part of your discussion with your tutor or assessor. You should also gather any evidence you feel appropriate to support your discussion, this could include, for example, references to websites, films, TV programmes or books.

Why might spiritual needs be ignored? This can be for many reasons as care workers may feel that:

• This is an area for experts only • They do not understand what spirituality is • Spirituality refers only to religion • It is intrusive to discuss such personal matters with an individual

they care for • They may be worried that questions will be asked they cannot

answer • They have never thought about what their own spiritual needs are • They have never thought about what might be important to them at

the end of their life • They will not know how to help someone whose ideas and beliefs

are different from their own • They may not know where to look for help and support • They may worry they may not be able to meet the needs they find • They have not have enough training about spirituality

Completing this unit will help you to gain confidence and overcome many of the barriers that result in spiritual needs being ignored.

What does the word ‘spirituality’ mean? Different people will think of different things when asked to say what spirituality means.

• Some people will think about being part of a religious group and the rituals and prayers involved

• Some people will think about the importance of relationships such as families and friends

• Some people will think about being close to nature, walking, gardening

• Some people will think about marking important feasts or festivals in the year

• Some people will think of special celebrations such as birthdays or anniversaries

• Some people will think about helping others, being involved in their community

• Some people will think of taking part in hobbies and being creative This list does not cover all the meanings of spirituality. Spirituality is very individual. Spirituality is more than a belief in a greater power or being part of a religion, though for some people these will be a very important part of their spirituality.

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You will now be asked to say what you think spirituality means. Below are examples of what other people have said. You are being asked to think about your views first as it is important to know what spirituality means to you personally. There is not just one right or wrong answer but many answers that are true. Write a sentence in the thought bubble below that says how you would describe ‘spirituality’ Below are some examples of how others have described spirituality. “Spirituality is difficult to define, analyse or quantify. It is generally related to the search for meaning and purpose in life. It may or may not include a belief in a higher power (such as god or several gods) or the supernatural world. Each person searches for meaning in life in their own way but spiritual beliefs usually bring together ideas about themselves, their relationships with others and with the world. Religion is closely linked with spirituality but the two words mean different things. A person may have an active spiritual life without considering themselves to be religious or being involved with a religious organisation” www.scie.org.uk “We recognise that the idea of spiritual care is complex. It includes faith based needs but also encompasses those who are not allied to a particular faith.” “Many people have difficulties in completing the spiritual element of a care plan. Because spiritual is seen only about being religious, because the focus is on which church or faith someone belongs to with little attention being paid to understanding that a person’s life history, likes and dislikes, routines and rituals are necessary elements of enabling someone to have their spiritual needs met” www.faithinolderpeople.org.uk

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Religion and spirituality are related –but not identical concepts. Spirituality is ‘a quality that goes beyond religious affiliation, that strives for inspiration, awe, meaning and purpose even in those who do not believe in a God’ Religion is ‘the rituals, beliefs and power structures found in different religious creeds –or more succinctly, as the means by which we relate to God’ www.gerimed.co.uk (accessed via dementia.stir.ac.uk) Some have their spiritual needs met through their religion and faith but that is not true for all. Spiritual care is that which gives meaning, worth and value to the life of an individual. Helping to find a sense of peace. National EOL Programme materials www.e-lfh.org.uk Spiritual Care is – That care which recognises and responds to the needs of the human spirit when faced with trauma, ill health or sadness and can include the need for meaning, self worth, to express oneself, for faith support, perhaps for rites or prayers or sacrament, or simply for a sensitive listener. www.rcn.org.uk/spirituality

Difference between spirituality and religion There is no clear agreement about the difference between religion and spirituality. In general though religion refers to a more organised practice. Religious practice takes place within an organisation with specific beliefs and practices. Spirituality refers to a more personal experience of what gives hope, purpose and meaning to an individual’s life and provides them with comfort. As you have worked through the section above you may have started to think about how spiritual needs may or may not include religious needs. Some people have their spiritual needs met through their religion and faith but that is not true for all. Those who have no belief in a god and believe that there is nothing after death still seek meaning and purpose to their lives. Notice that some of the quotes refer to belief in a god or gods. The way we approach religious or spiritual beliefs is often closely linked to the beliefs of the culture in which we were brought up or live. Even when people have stated they have religious beliefs it is important to understand that how they wish to practice these beliefs may be different.

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Consider the scenarios below – each of these ladies were brought up in the Christian faith and have been baptised and confirmed. They have stated their present religion as Christian. Mrs A attends her local church regularly and enjoys joining in the activities associated with the church Mrs B asks for a vicar to visit to give her communion monthly but does not want to attend church services Mrs C observes the major festivals and celebrations of the religious year but does not attend church Mrs D never talks about her religious beliefs but enjoys watching ‘Songs of Praise’ on the television and joins in the singing of hymns Mrs E does none of the above things but always wears a necklace with a cross and is always keen to help others These different approaches to religion can be found in all faiths. Just as spirituality is individual so is the way those with religious beliefs understand and practice their religion. The only way to understand what is important to the individual is by talking and listening to them. Faith We have considered spirituality and religion and how they can mean similar or different things for any individual. The other idea we need to consider is faith and how this is linked to spirituality and religion. Consider the following definition. Spirituality is about: ‘Belief and faith: in self, others and, for some, a belief in a deity or higher power is important to some people. A person’s belief or faith gives them a framework of ideas, stories, narratives, symbols and rituals that they use to make sense of their situation. A person’s illness experience will be deeply affected by what they believe about their faith, the world and the meaning of their illness.’ RCN Spirituality in Nursing Care www.rcn.org.uk Faith can also be thought about as believing in something despite having no evidence for it. As the quote above shows, faith may be based in religion but it relates to whatever our beliefs are. No one can know what happens after death but individuals may have clear beliefs – or a faith – in what happens. This faith may be based on religious beliefs or it may be based on scientific decision making. Think about this when you watch the video clips in the next section and listen to people thinking about their beliefs about life, dying and life after death.

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Now listen to some individuals talking about their own beliefs about life, dying and life after death. Follow this link: www.healthtalkonline.org/Dying_and_bereavement/Living_with_Dying and click on religion, faith and philosophy from the left hand column. Here people talk about their own approaches and beliefs about living with dying. Select as many as you like but include: ‘He believes in life after death and thinks we should pray for the grace…” ‘Says she is probably a humanist’ ‘Says people live after death through their genes’ ‘Says that death is part of life’ In preparation for the professional discussion, write down your thoughts now you have listened to the views of different people. The views these people have are very different from each other. Think about how they are similar or different from your own views. How can you help someone who has very different views from your own?

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This video clip looks at spirituality in the care setting and will help to summarise the ideas we have looked at so far. ‘Spirituality: Have you found any yet? www.dementia.stir.ac.uk (go to ‘library and info services’ then select ‘dementia now’ from the tabs at the top of the page and click on Autumn 2011 bulletin on Spirituality and look under web resources (or follow this link directly http://www.youtube.com/watch?v=YpMcqR9Sh5I)

Click on the link below to access Spirituality in Nursing Care – A Pocket Guide. If the link doesn’t work visit the Royal College of Nursing website and enter ‘spirituality’ in the search field and then click on ‘Spirituality in Nursing Care – A Pocket Guide’ in the results. http://bureau-query.funnelback.co.uk/search/search.cgi?query=spirituality&collection=rcn-meta&form= Read the Pocket Guide and concentrate on the sections: • Spirituality is about • Spiritual Care is not

Make some notes about what you have learnt from watching the video and reading the pocket guide to discuss with your tutor/assessor during the professional discussion. Think about how you already include spiritual aspects in your work and what you might do in the future. You may want to think about how many issues can be classed as spiritual care and what role religion has. Had you considered the importance of cultural practices? You may want to include your thoughts on what spirituality meant to different people. You may want to comment on how people looked and reacted when they spoke of what was important to them. NOTES:

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Before you meet your tutor for the professional discussion, undertake the quiz below and take the answers with you to form part of the discussion.

Quiz

Understanding what is meant by Spirituality

1. Spirituality is the same as religious beliefs:

True or false

2. Those who do not believe in a god have spiritual needs:

True or false

3. Name five reasons why spiritual needs may be ignored.

1. 2. 3. 4. 5.

4. Give five examples of what spirituality may mean to an individual.

1. 2. 3. 4. 5.

5. Write a sentence that shows how spirituality, religion and faith are

linked.

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6. Write a sentence showing how you understand people’s previous experiences of spirituality, religion or faith may affect how they view spirituality now.

7. Write a short paragraph identifying how an individual’s emphasis on spiritual needs may vary at different stages of their life. Include your thoughts on why spiritual needs may be particularly important at End of Life.

8. In the clip you viewed above ‘Says she is probably a humanist’ the

lady talks of others telling her they are praying for her or offering to pray with her –what do you think of these offers within your professional role?

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Write notes here about what you have learnt so far. This will help you prepare for the discussion with your tutor/assessor.

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Completed Activity Now you have completed this activity we recommend you go back to your own evidence log on page 4 and fill in the page number and type of evidence (e.g. case study or reflective account) for the assessment criteria you have completed in this activity. Remember – these are highlighted green in the grid at the start of each activity.

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Activity 2 – ‘An Individual Experience’ ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Written and pictorial information Assessment Type: Knowledge

Activity 2: An Individual Experience

Approximately 2 hours and 30 minutes

‘In every human being there seems to be a spiritual dimension, a quality that goes beyond religious affiliation that strives for inspiration, reverence, awe, meaning and purpose’ Murray and Zenter 2003 from e-lfh materials In this section you will have the opportunity to explore your own beliefs and identify what is important to you. We know from research that a lot of health and social care workers recognise the need to support the spiritual needs of those they care for but do not have the confidence to do so. Understanding the role spirituality plays in our own life can help us to recognise spiritual needs in others. It gives confidence that we know what is important to us as individuals and fellow human beings. As we will see from the models discussed below, the amount of support we can offer personally may vary. The assessment of spiritual needs may lead us to realise that other agencies are required to provide support. Realising that we are part of a wider care team can take away a lot of the concerns about supporting spiritual needs. The important thing is to recognise that people have spiritual needs and to ensure appropriate support is in place.

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Answer the following questions (add your answers to the diagrams):

What gives you pleasure and help in

life?

What customs, celebrations or beliefs are important to you?

Walking by the sea

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What supports and helps you in difficult times in your life?

What is most important to you in life?

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You may have deliberately not included some things because you did not wish to let the tutor/assessor know about them. Perhaps that is because they are not a person you know well or because you do not feel it is relevant for them to know some things about you. It is natural to protect ourselves by only letting people know what we want them to know. How much we reveal will depend on how we view or feel about the person we are with.

Think about which things are more personal and harder to share with others and write your thoughts in the space below.

Can you think of people you would be happy to share these things with?

What is it about the relationship that makes it easier to share these things that are important and personal to you as an individual?

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These private and personal areas or thoughts can include our religious, cultural or spiritual beliefs. It is important to recognise that not everyone will want to share this very personal information.

• You may have identified there are some things you would share with family or friends who share the same values or beliefs as you or will understand your different point of view

• You may have identified a religious or cultural representative who will understand your beliefs or may have answers to important questions

You will certainly have identified someone you can trust and who will not judge your thoughts and beliefs. This is not an excuse though to ignore spiritual needs or not be prepared to support any individual to meet their spiritual needs. Support may be given directly by you or it may involve asking others to help. We will explore involving others in spiritual care later in this unit. ‘Meeting spiritual needs is everyone’s responsibility. It is an important part of person centred care’ SCIE website. In meeting those spiritual needs we need to respect religious, cultural and spiritual beliefs.

“Support people with the same respect you would want for

yourself or a member of your family”

(The Dignity Challenge DH 2006)

The right of any individual not to share their spiritual

beliefs must always be respected.

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Activity 3 – Life Story ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Written and pictorial information Assessment Type: Knowledge and Competence In this section we will continue to explore how spiritual needs can be identified so that a plan can be made for each individual for the best way to meet those needs. “How do you provide the right care to individuals if all you know is their age, state of health and disability? All too often this can happen if we don’t know the uniqueness of that life.” www.communitycare.co.uk

Everybody has a life story. Telling their story can be important to an individual for many reasons.

• It can give them back a sense of their own identity that may have been lost because of changes in health that have limited their independence. This may include serious illness, facing the end of life or disability

• To help cope with of changes in circumstance such as the need to enter a care home or be cared for in their own home

• It can increase self esteem as they remember who they were e.g. their job, their role in their family or community

• It can help to identify how they have developed their understanding of life

• It can help to identify what is important to them • It can help to identify what gives them hope and pleasure • It can help the individual make sense of their life and the stage they are

at now • It can help them to plan for the future and make sure their wishes are

known.

“The diagnosis of a life threatening disease or knowing that they are approaching the End of Life can raise unsettling questions for some individuals. Some people may re-examine their beliefs whether spiritual or religious in nature. Other people may take comfort in their religion and its associated rituals.” “Remembering and revisiting the past can help to make sense of the future. It enables the individual to identify what their priorities in life are. This is particularly

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important as End of Life approaches and there is limited time to fulfil any last things you want to do.” (e-lfh) These things may be as simple as a visit to a favourite place. It may involve contacts with family and friends and the opportunity to say goodbye. For some people it may be about resolving a quarrel or conflict from the past. Other people will want to plan for what they want to happen in the last hours of life; who they want to be present including family, friends or religious representatives and any special requests such as a favourite piece of music to be played. Many people take comfort from knowing that their funeral arrangements are in place and will be conducted according to their wishes. When we think about end of life we often consider older people who are able to look back over a long life. It is important to remember that younger people may die as well. It can be harder as carers to help them face a shortened life - especially if they are near our own age. For many people who are younger the important things are to ensure that their family will be able to mange without them. They may wish to complete practical things such as leaving letters to be opened in the future so they will not be forgotten. If they have young children they may want to leave items and photographs for them to look at in the future when memories of the person who has died are not as clear. The beliefs people hold about death affect the meaning they give to life. The telling of these life stories can help others to understand who that person was before they were ill, what is important to them, what has happened to them to influence how they view living and dying, what their beliefs and cultural practices are. Undertaking life story work enables carers to see people as individuals and in the context of their relationships with others. Knowing about the person before they were in need of care enables the carer to see beyond how the individual now presents. In this way their unique identity is uncovered and preserved.

Activity 3: Life Story – Life Story


Read the following famous poem ‘Crabbit Old Woman’

This poem is now thought to have been written by a nurse – Phyllis McCormack in 1966. For many years though it was thought to be anonymous and written by an old lady in a nursing home as she looked back over her life. It was said to have been found in the old lady’s locker after she had died.

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What do you see, what do you see? Are you thinking, when you look at me-

A crabbit old woman, not very wise, Uncertain of habit, with far-away eyes,

Who dribbles her food and makes no reply When you say in a loud voice,

I do wish you'd try. Who seems not to notice the things that you do

And forever is losing a stocking or shoe. Who, unresisting or not; lets you do as you will

With bathing and feeding the long day to fill. Is that what you're thinking,

Is that what you see? Then open your eyes,

nurse, you're looking at me. I'll tell you who I am as I sit here so still!

As I rise at your bidding, as I eat at your will. I'm a small child of 10 with a father and mother, Brothers and sisters, who loved one another-

A young girl of 16 with wings on her feet, Dreaming that soon now a lover she'll meet, A bride soon at 20- my heart gives a leap,

Remembering the vows that I promised to keep. At 25 now I have young of my own

Who need me to build a secure happy home; A woman of 30, my young now grow fast,

Bound to each other with ties that should last; At 40, my young sons have grown and are gone,

But my man's beside me to see I don't mourn; At 50 once more babies play around my knee, Again we know children, my loved one and me. Dark days are upon me, my husband is dead,

I look at the future, I shudder with dread, For my young are all rearing young of their own.

And I think of the years and the love that I've known; I'm an old woman now and nature is cruel- Tis her jest to make old age look like a fool.

The body is crumbled, grace and vigor depart, There is now a stone where I once had a heart,

But inside this old carcass, a young girl still dwells, And now and again my battered heart swells,

I remember the joy, I remember the pain, And I'm loving and living life over again.

I think of the years all too few - gone too fast. And accept the stark fact that nothing can last-

So open your eyes, nurse, open and see, Not a crabbit old woman, look closer-

See Me.

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The lady who wrote this poem was asking the people caring for her to look beyond her present illness and remember she was once young. She talks about different stages in her life.

It is easy just to see the person as we know them now. To see them as a person who is vulnerable and in need of care. This poem highlights the importance of looking beyond that and recognising what is and has been important to that individual. Looking at an individual’s life story can allow us some of that sight of the person before they became in need of care.

Family and friends can also prepare life stories where a person cannot voice their own story –for instance for those people with dementia or other cognitive impairment. In many care settings the gathering of life story information forms part of the initial assessment process or even part of the pre admission process. In the domiciliary care setting you are unlikely to have the opportunity to sit with the individual specifically to gather the life story information. The story will be built up as you talk to the person on your visits and perform their care. Remember you are a guest in their home so make sure to respect the individual’s privacy but talking about pictures or items in the home can be a good way to open conversations. Listening to and gathering life stories can be useful because:

• It can be a way of understanding how an individual feels about their experience of their illness or disability

• It helps staff to understand that individual and know the best way to support them

• A person may feel less vulnerable if they feel the staff are taking an interest in them as an individual

• It can help the individual to prepare for the end of life and make their particular wishes known

• It can help staff to work with people with dementia by reminding them of past events

• Supplying the information can help the family to remember the person as they were before the illness

• It is a lasting reminder of that person for the family who are left. Before undertaking the task below there are some important points to remember about collecting an individual’s life story.

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• The individual or the person acting in their best interests must give consent • The individual must be made aware and agree to how and with whom the

information will be shared • The individual must be aware they do not need to tell you anything they do not

want to • Talking about their life history can be tiring especially if you are ill or frail so

short several conversations are best. In fact life stories are often built up over long periods of time

• There must be a quiet and private place to speak to the individual • The individual’s dignity must be maintained at all time. The conversation

should stop if the individual wishes it to • It is important to listen rather than interrupt • You must be prepared that the individual may take this opportunity to ask you

questions that you cannot answer. Do not try to answer if you are not able to, be prepared to ask for other support for that person

• Ensure you listen carefully and record information accurately. It can help to pause at intervals and recap what has been said to ensure you have understood correctly and identified what is important to that individual

• The individual may disclose information that it is not appropriate for others to know and would not improve the quality of care. Agreement should be reached with the individual to give them the opportunity to leave out certain areas.

• Safeguarding issues may be revealed

Before undertaking the activity below, complete the following tutorial, which will help you to think about how you might deal with difficult questions. Go to www.helpthehospices.org.uk/clip/index.htm and click on the ‘Answering difficult questions’ tutorial which is number 6 under the Psychological needs section

To make sure you are prepared to talk to the individual, think about and write down some of the difficult questions you might be asked that you can’t answer and think about your response. You are less likely to be taken by surprise if you have thought about this in advance.

You should be aware of your local safeguarding policy and

your role as an ‘alerter’ It is a good idea to read this

again before undertaking this activity.

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Prepare a life story with an individual you care for to allow them to identify what is important to them at the end of life. Take particular note of their spiritual needs. Gathering a life story is about listening to that individual tell you about their life in their own words and in their own way. A life review or life story is:

• A process which allows a person to reflect on the course of life events… may give new and significant meaning to one’s life: it may also prepare one for death, mitigating one’s fears (Butler 1974)

• Not a random sharing of past events but a structured process enabling evaluation of those events

• Something that can provide emotional and spiritual support to those who are dying and their families

• A way to help families and carers cope better with bereavement

You may already have a template in your place of work to help you collect this information. If so, do use it and compare it with the

There are no definite answers to many of these questions. Do not try to impose your beliefs. Acknowledge their question. Reassure them that they are not alone in asking such questions. Think about other support that can be offered.

Difficult questions I might be asked

What happens after death?

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suggested areas of information to be collected listed below. You may decide your present paper work is better or that you would like to suggest some changes. If you do not presently collect this information you may wish to look at some existing templates or devise your own. There are also some nationally produced templates

• This is Me www.alzheimers.org.uk/thisisme

However you choose to record the information you should consider the following:

• Childhood – earliest memories, family life, brothers and sisters • Adulthood – important events, work and what it meant to you,

important relationships, hobbies and pastimes, achievements, obstacles overcome.

• Overall –happiest moments, most important things, any regrets, what sort of person do you think you have been

• Here and now –What’s important to you What worries you What helps you cope What do you want to be remembered for Futures wishes, hopes or requests

In the case of individuals with dementia, the history can be obtained from family and friends. Use photos and objects to spark memories and learn more about the individual. Remember you are thinking about the life story in terms of spirituality.

What did you learn about their spirituality? Q

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Are there any past events or experiences of spirituality, faith or religion that you feel may have affected or led the individual to their current spiritual beliefs?

Was there anyone in particular whose values and beliefs had an effect on the individual’s beliefs and values from their life story? Explain how.

Now you have learnt more about the individual and their spirituality, is there anything you can change in their environment to help them express their spirituality?

Q

Q

Q

Did you identify any issues relating to End of Life that may form part of your care planning for this individual?

Q

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Remember that small changes can make a difference to someone’s life. Consider the scenarios below. For each scenario below, write what small changes you could make to improve the environment for the person.

John had expressed his love of the countryside but was now confined to a wheelchair and living in a care home.

Mary said she had been part of her local church for years and felt the vicar ‘knew a thing or two’ but she was no longer well enough to go to services Solution:

Solution:

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After you have completed the life story with the individual, support them to make at least one change that allows them to explore or express themselves and their spirituality further. Remember that there are many definitions of spirituality. As you choose an example it may relate to religious concerns or it may relate to anything that gives meaning and purpose to life. It may relate to achieving something special in the time they have left. Complete the paragraph: I supported the service user to make a change that allowed them to explore/express themselves and support their spirituality by....

Mustafa said his religion stated that on certain days he could only eat vegetarian meals but he found this difficult to manage with the food on offer at the Home. Solution:

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Now read the following scenarios. Scenario one Mrs A was a very friendly lady who always welcomed the care workers who visited her. She was usually ready with a joke when they arrived and seemed interested in their lives and families. They found her easy to talk to about their own families and concerns because she seemed so interested in them. One November the agency was surprised to get a complaint from Mrs A about one of the care workers. Mrs A stated she no longer wanted this member of staff in her home. This care worker had been visiting for nearly a year and there had never been any other problems. It was decided that the best thing was for that staff member to move to other duties and a new care worker started to visit. Mrs A got on well with the new care worker and all went well until the following November when the agency again received a complaint from Mrs A, who said she no longer wanted that care worker to visit. The manager of the agency was puzzled and arranged to visit Mrs A personally to discuss the letter. When she arrived, Mrs A had a visitor from a local bereavement charity with her. Mrs A asked the bereavement visitor to stay for the discussion. The bereavement visitor was there because Mrs A lost her husband in the month of November and always got upset during this month. Think about how the situation could have been avoided and write down your thoughts on the following in the box below:

1. Do you think the lady was aware of why she acted as she did? 2. What is the importance of anniversaries? 3. What were the benefits of having the opportunity to communicate

with someone from Mrs A’s community group? 4. Could the staff have helped the lady with her spiritual needs in

relation to the loss of her husband?

Write your thoughts here:

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It may not have been possible to avoid this situation. The important thing is to remember how important it is to give an individual the opportunity to discuss what is important to them and to listen carefully. Knowing who else was involved in the lady’s care is also important. Scenario two It was Christmas Day and all the care staff were wearing tinsel in their hats. Mrs G had stated that she wished to remain in her room that day. The care worker was concerned that she would miss out on all the fun and festivities that had been planned to celebrate the day. He said ‘Come on now Mrs G you will have a good time’ and began to wheel her towards the lounge. Mrs G became very distressed. The manager noticed what was happening and asked the care worker to respect the lady’s decision not to join in. She later told him that Mrs G was a Jehovah’s Witness.


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Think about and write down your thoughts on the following in the box below:

1. What significance does Mrs G’s religious belief have regarding her care?

2. How could the care worker have dealt differently with the situation?

3. What influence did the care worker’s own beliefs have on the situation?

4. How could the care home have made sure everyone was aware of Mrs G’s wishes?


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Much of the work on using life stories to ensure that care is individual and appropriate has been done in settings where people have dementia. It is particularly useful in dementia, however, the scenarios you have just completed show the importance of understanding the spiritual beliefs of and recognising what is important to every person. Watch the following video clip and see how looking at individual needs in a new way can give new meaning and purpose to an individual’s life. It should demonstrate that sometimes risks, suitably assessed, need to be taken to improve the quality of an individual’s life. Giving meaning and purpose to life can give a spiritual peace to that person. www.myhomelife.org.uk/reources/8-key-themes/ Watch the clip entitled Maintaining Identity This clip looks at someone with dementia. However, at end of life anyone can find that due to their condition there are things they can no longer do. This can be very difficult to cope with. It is important to help an individual to achieve what they are able to by offering support and finding out what they can achieve. Think back to the clip about Finding Spirituality in Activity 1. Although Amanda could no longer climb mountains she took pleasure in thinking about trips and tracing them on a map.

Write here any thoughts you have after watching the video clip. Perhaps it has given you an idea about how you could help someone you care for. Write down how you can help:

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Activity 4 – Care Plan ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Planned activity Assessment Type: Competence

Activity 4: Care Plan

Approximately 3 hours

Using a care plan that you have completed or contributed to, give an example of how spiritual needs at End of Life are identified. Answer the summary questions below.

You may want to look at the care plan template used in your place of work – does it clearly address spiritual needs? What could you do to make sure spiritual needs are always addressed with individuals? Could you adapt an existing care plan template or produce a new section which clearly identifies the spiritual needs of all individuals at your place of work e.g if the section presently only asks for religion could this be changed? You may not be able to make the change yourself but could open discussions with your manager.

How does the care plan ensure the spiritual needs of the individual are being met? Q

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How did you/could you improve the care plans used in your place of work to address spirituality for all service users? Q

Referring to the life story you completed in activity 3 – did you learn anything about the service user which you think needs to be addressed in their care plan?

Q

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This video clip is an example of good practice in meeting the spiritual needs within end of life care. Watch the video clip Supporting Good End of Life Care www.myhomelife.org.uk/research/8-key-themes/ scroll down to the video clip Supporting Good End of Life Care. How did the care planning reflect the spiritual needs of the couple?

How were these spiritual needs met?

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Why was it important to look at the needs of these people as a couple?

How was the dignity of the couple maintained?

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Who was involved in caring for this couple?


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Activity 5 – Observation and Reflective Account ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Reflection on own practice in real work environment Assessment Type: Knowledge/Competence

Activity 5: Observation and Reflective Account

Approximately 2 hours

You will need to work with your assessor to plan an observation of your practice in the work place. Your assessor will want to see you supporting a service user to participate in their chosen activities to support their spiritual wellbeing. It will be the responsibility of both you and your assessor to ensure that the observation is not intrusive and does not impact on the dignity of any service users. To prepare for the observation write a reflective account of how you cared for the spiritual needs of an individual. Highlight how their views were similar or different from your own. You should reflect on:

• Was it difficult not to put your personal views across on spirituality?

• How your values and beliefs may have impacted on the individual when communicating with them, including non verbal communication

• How did you care for their spiritual needs? Did you help them participate in certain activities they wanted to do?

• How did you feel helping them to participate in such an activity and how did you communicate this?

• Was your role to involve other support for the person? If so who else was involved and how did they help the individual.

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You may choose to look at the individual needs of the person whose life story you wrote. You may choose to write about someone else you have met in your caring role. Remember that gathering a life story only gives a brief snap shot of that person. As you continue to work alongside that person, the relationship between you will grow. Often it is a chance conversation that leads to identifying and being able to care for spiritual needs. It is perfectly normal and acceptable for people to have different views on spirituality, what is important is how everyone’s needs are respected. Make sure you record any difficulties you may have felt and how you dealt with them. In a reflective account you should record your thoughts and feelings and how you dealt with them.

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Activity 6 – Reflective Account ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Reflective Account Assessment Type: Knowledge

Activity 6: Reflective Account

Approximately 1 hour and 30 minutes

Write a reflective account of how you care for your own spiritual needs to enable you to continue in your caring role. Think about:

• How you feel your spiritual needs, beliefs and values may have been affected when meeting those of the individuals you are caring for at the end of their life.

• How you do you ensure your own needs are met to ensure you can continue in a demanding caring role.

Below are some things to consider and include in your reflective piece.

Providing care for others can be emotionally demanding and tiring for the care worker. It is not possible to continue caring effectively for others unless we also take care of our own needs. It is important to identify who is able to support you at work. Identify who you go to for advice and support. It is important to identify who is able to support you outside work –remembering that what happens at work must remain confidential. It may be that your spiritual needs are very different to those you are caring for. In meeting those needs, your own beliefs and views may be challenged.

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How do you continue to hold your own beliefs while respecting those of others? You may also want to think about how your spirituality may have changed as a result of meeting the spiritual needs of others. Remember, spirituality is about everything that gives your life meaning and purpose. Finally but very importantly- how do you use your social activities and interests to ensure you have a release from caring and can remain well and able to continue supporting others?

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Activity 7 – Support at End of Life ___________________________________________________________________ Learning outcomes and assessment criteria This activity links to the following learning outcomes and assessment criteria (page 4). Those highlighted green are the ones you will cover when you have successfully completed it.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

Assessment Method: Portfolio Assessment Type: Competence For this activity you will need to work with your tutor/assessor to arrange a visit. In preparation for this visit you will need to gather information and complete the tasks below. So far, we have looked at gaining more understanding of what spirituality means to an individual. We have considered how to respect and support individuals to meet those needs. It is important that spiritual needs are met at the end of life so that an individual can have a peaceful death - sometimes referred to as a Good Death. Meeting an individual’s spiritual needs helps to provide peace at the end of life. We have thought about the need to allow time to build a trusting relationship so that an individual feels safe to express his or her spiritual wishes. We have considered how a care worker can be involved in helping to meet those wishes. In this section we will look more closely at

• Who else may be involved in meeting those wishes • What other agencies may need to be contacted • How an environment can be created to support spiritual needs

Activity 7: Identify and Collect Information


Who do you think might be involved in meeting an individual’s spiritual needs?

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You may be surprised at how many different people can be involved in providing spiritual support. Did your list include the individual? People at the end of life need time not only to express their thoughts but may wish to have quiet time to reflect on their life. Did your list include family and friends? Family and friends can be very important in supporting an individual. In some cases an individual will look only to their family and friends to share their wishes and hopes. Others may not wish to upset those closest to them by talking about the future and will find it easier to talk to someone who is not so close to them. You have spent some time thinking about spiritual care, now it is time to think about how you will involve others and to look at the work environment where that care takes place.

Identify information available in your workplace to support spirituality and make a record below stating what it is and where it is available:

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This might include written information, marking special events, marking significant religious occasions, the environment such as provision of quiet areas and privacy. It might include books of remembrance, special activities or outings. You might ask whether staff have access to information and training about spirituality.

You may have identified gaps in the information or in how accessible it is to other staff. Collect samples of further information on spiritual wellbeing available locally and nationally to provide extra information in the workplace. Add a copy of the information (or make reference to where it can be found) in your portfolio.

You may find information available for example, in your local library or community centre or on the internet. Local information might be a leaflet or booklet produced by a local spiritual, faith or religious community group. National information could be something produced by a charity or governing body such as Age UK or the Department of Health.

Write down three ways you can share the information you have found about spirituality with others in your work place.

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In the sections above we have talked about the importance of recognising that spiritual care is not provided totally by any one person. We have talked about recognising our limitations and knowing when to involve others. To involve others we need to know who to contact and when to contact them. It is important to ensure that this is clear in the care plan. If a person wants their family with them in the last hours of life record whether the family want to be contacted even if it is the middle of the night. It is also important to have a general contact list of who to contact to give support.

Find out if there is a contact list in your workplace of people who can support spiritual wellbeing. If there is, you should ensure the list is kept up to date and add any new relevant contacts. If you don’t have one in your workplace you could produce one and place a copy in your portfolio.

We have looked at several different aspects of providing spiritual care. Read the following case study and identify the spiritual needs of the individual, how they were met and what the benefits of working with the external organisation were. Case Study: http://labspace.open.ak/mod/resource/view.php?id=454457 Answer the questions following the case study.

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To start with, read through the case study completely before looking at the questions. Then read it again, looking at the questions you need to answer and make notes after. You might find it useful to highlight parts of the case study as you go through.

Questions: Li was cared for in a residential home that had some native speakers from the same culture as Li but this may not always be the case.

How would you gain information about Li and her culture?

Who would be involved in the discussions about using both Western and Chinese medicine. What would your role be in this?

How could you ensure spiritual support for Li in view of the fact she had strong cultural beliefs but also became a Baptist and attended Western religious services?

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With your limited understanding of her language, how might you communicate with Li to relieve her loneliness?

How would you ensure that everyone was aware of her belief that it is unwise to associate with people who are sick and ensure this is respected?

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How could you support the family during their bedside vigil?

What do you think the issues were with the GP being away and how could this have been overcome to reduce the distress caused to the family and allow them to receive a death certificate?

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What support could be available to the family after death had occurred?


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Summary The good news is that you have nearly completed this unit! You have had the chance to think about spirituality, faith and religion. You have considered how to assess and support an individual’s needs. You have thought about the importance to the individual of different people such as family, friends and religious leaders. You may have been surprised that spiritual care is not something separate but is part of everyday life and the activities that give purpose to life. You have looked at how your work environment can be made more supportive of spiritual needs of those at the end of life. As a last task, repeat the assessment you completed at the start of the unit to see if your confidence has increased and discuss this with your tutor/assessor. Confidence level

1 2 3 4 5

Understanding what spiritual needs are

Talking about spiritual needs

Supporting an individual’s spiritual needs

Supporting the spiritual needs of those with different beliefs or culture from your own

Knowing who can help you to meet an individual’s spiritual needs

Knowing who can support you and understanding how to care for yourself.

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CONGRATULATIONS! You have now undertaken all the activities in this unit. You now need to meet with your tutor/assessor – to discuss how you might present these completed activities as evidence towards meeting the unit learning outcomes.

1.1 1.2 1.3 1.4 1.5 1.6 1.7 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 4.5 4.6

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Glossary of Terms Term Definition End of Life Considered to be the last 12 months that a person is

expected to live

Assessment Gathering information about a person’s needs and how an illness is affecting their ability to live their normal lives

Factors The things, events or circumstances which will affect something e.g. what is affecting an individual’s ability to cope with an illness

Holistic Holistic means considering care or assessment from the physical, psychological, environmental and spiritual needs of an individual. This enables people to be treated as whole human beings and the impact of the illness on their quality of life is also considered

Person Centred Person centred care is providing care that is responsive to individual personal preferences, needs and values and assuring that the individual’s values guide all clinical decisions

Rituals Actions or ceremonies relating to a particular religious belief. Examples are songs or chants or particular ceremonies

National End of Life Care Programme

This is a national programme funded by the NHS which works across health and social care in England to improve end of life care and support people to live and die well

Humanist Non-religious person who believes this life is the only one we have. Believes one can live an ethical and fulfilling life on basis of reason and humanity

Agnostic One who believes it is impossible to know whether there is a god or is sceptical about the existence of a god

Atheist One who disbelieves in the existence of a god

Best Interest Decision This has to occur if someone does not have the mental capacity (see below) to make a legal, healthcare, welfare or financial decision for themselves. This is one of the principles of the Mental Capacity Act. The decision can only be made after an assessment has deemed the individual does not have capacity. Strict principles and codes of practice should be followed to carry out the assessment and to make the best interest decision, these are set out in the Mental Capacity Act

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Continuation Sheets

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Continuation Sheets

unit 304: support the spiritual wellbeing of individuals · 4 | page table 1: learning outcomes and...

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