Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 12
SPIRITUAL SUPPORT
Dein and Stygall (1997) [364] (Level EO) explored whether being religious helped or hindered
in coping with a chronic illness, and distinguished between religion and spirituality. Their
review showed that religion is a common coping mechanism that may have a positive effect.
The importance of an effective coping mechanism is that it could reduce the psychological
morbidity associated with chronic and terminal illness, and therefore, to overlook the spiritual
component of a palliative approach by ignoring spiritual matters would be an omission of
care [365] (Level EO).
Spirituality’s role as a coping mechanism was supported by a review of studies dealing with
religion and spirituality [366] (Level EO). The reviewers found that most studies have shown
that religious involvement and spirituality seem to be associated with positive health outcomes.
Six themes associated with spirituality have been identified: needs for religion, need for
companionship, need for involvement and control, need to finish business, need to experience
nature and need for a positive outlook [367,368] (Level QE; Level EO).
Spirituality was found to be an important predictor of the quality of life of individuals receiving
a palliative approach [367,369,370] (Level QE; Level QE; Level QE). Indeed, impending death is
considered a powerful stimulus for reflection on the significance of life and destiny for residents
in RACFs [371] (Level IV). Providing spiritual support is a responsibility of the aged care team
that must be fulfilled to enhance a resident’s quality of life [367] (Level QE).
Research indicates that people are receptive to carefully worded inquiries about their spiritual
and religious beliefs [372] (Level QE) and that providing spiritual support was an area identified
as important by families [373] (Level QE). Aspects of spiritual support included staff talking
about religion and spiritual matters, visits from clergy, and prayers. [373] Additionally, early
assessment of the spiritual needs of residents is important and should not be relegated to a later
stage of the illness.
12.1 ASSESSMENT
Spiritual assessment is an ongoing process. Understanding the resident’s current or desired
practices, attitudes, experiences and beliefs assists in meeting their spiritual needs [367] (Level
QE). Unfortunately few spiritual assessment tools have been validated; however, one tool that
has been validated is the System of Belief Inventory (SBI). [374] The SBI is a self-report inventory
that measures two domains: 1) Presence and importance of religious and spiritual beliefs and
practices, and 2) the value of support from a religious / spiritual community. [374]
The SBI originally contained 54 questions and was developed for use with cancer patients;
however, the tool was revised to broaden the applicability to people with non-cancer diagnoses
and to shorten the number of questions to 15 (SBI-15R) to reduce participant burden [375]
Guidelines for a Palliative Approach in Residential Aged Care 151