The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 13: Spiritual CareOnce a spiritual assessment has been made, then the appropriate spiritual intervention shouldbe offered. While spiritual and religious interventions can be provided by any clinician, integratinga pastoral care provider in the health care team will ensure that the team becomes familiarwith religious26 picasand spiritual issues and that patient’s spiritual needs are met. Some examples ofspiritual practices are meditation, guided imagery, art, journaling, spiritual direction, pastoralcounseling, yoga, religious ritual and prayer.Appropriate referrals to chaplains and other pastoral care providers are as important to goodhealthcare practice as are referrals to other specialists. It has been argued that discussionswith patients about spiritual matters should be initiated solely by chaplains. 21 Others recognizethat healthcare providers can use spiritual histories as a screening tool to understand the rolethat a patient’s beliefs play in his or her health and illness. Some patients may have complicatedethical and spiritual issues. Providers need not feel that they must solve these dilemmas;most physicians are not trained to deal with complex spiritual crises and conflicts. Chaplainsand other spiritual caregivers are, and often work with physicians in the care of patients.It is important that healthcare providers be aware of their own values, beliefs, and attitudes,particularly toward their own mortality. A spiritual perspective on care recognizes that the clinician-patientrelationship is ultimately a relationship between two human beings. Confrontingpersonal mortality enables a provider to better understand and empathize with what the patientis facing, to better handle the stress of working with seriously ill and dying people, and to formdeeper and more meaningful connections with the patient.PASTORAL CAREXIIIThe Role of the ChaplainIn recent years the chaplain has become an increasingly important member of the healthcareteam. Traditionally, the role of the chaplain has been to administer to the patient certain prayersand rites particular to the patient’s religion. Today the role of a chaplain is often much broader.The chaplain can act as an extension of the patient’s personal and community support system,as well as be a source of spiritual support for the patient. When the chaplain has a regularpresence in a healthcare setting, the opportunity exists to provide support to the staff as well.William Hulme, a Christian minister and author, defines pastoral care as the following:Pastoral care is a supportive ministry to people and those close to themwho are experiencing the familiar trials that characterize the world,such as illness, surgery, incapacitation, death and bereavement. 22It is the spiritual aspect of human nature that raises questions about ultimate meaning andpurpose, questions for which medicine and science have no answers. These issues require aunique language in which symbolism, story, and ritual are often involved. Chaplains have expertisein this form of communication and are often best able to answer such questions.Some of these questions and concerns might be stated in the language of faith or religion. Herethe patient might invoke God, and in this instance statements of faith would be used to deal withthe questions. At other times, questions dealing with the purpose of one’s life might be moreappropriately answered in existential terms. The chaplain can deal with these issues in terms ofhow the world works, spirituality, and what we consider the essence or meaning of life. 23U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 293