Background
Definitions of spirituality are debated in the literature and often described as making connections, searching for or giving meaning and purpose to life, and seeking transcendence. [1-7,9,11-13] A comprehensive definition is offered by Puchalski et al. [9] ‘‘Spirituality is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, and transcendence, and experience relationship to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions, and practices.” (p. 646) A person's spirituality may be independent of religious belief, affiliation or practice. [1-5,7,9,11-13]
Spiritual care is an important aspect of holistic and compassionate care. [1,4,7-9] Acknowledging and supporting a person’s spirituality has been shown to reduce the distress that many people experience when they are ill or dying. [6] Pastoral care and spiritual care can be considered to be synonymous. [4,7]
Evidence Summary
Spirituality - searching for purpose, meaning and connectedness - can occur in the absence of any religious affiliation or practice. [1-5] The experience of ill-health particularly at end-of-life can rekindle or intensify spiritual or religious awareness. [4,5] Research suggests positive associations between spirituality and religion, emotional and mental health. [2-4,6,7] When approaching death, spiritual or religious belief may help with coping, finding meaning and purpose, and facilitate a renewed peace of mind in for the final days. [3]
The recognition that health professionals have a role in spiritual care is relatively recent. [1,3,4,7-9] The authors of the National Guidelines for Spiritual Care in Aged Care suggest this is best delivered through a whole-of-organisation approach. [1,7,11] The authors also highlight the importance of a spiritual assessment for all people receiving aged care: an initial spiritual screening and an in-depth spiritual assessment. [1] A recent qualitative study outlines nine principles for the organisational support for spiritual care at the end of life. [10] These principles may help guide secular health organisations implement comprehensive, high-quality spiritual care in palliative care. [10]
Due to the subjective nature of spirituality, it may resist quantifying. However, to overcome spiritual distress and promote spiritual wellbeing, the measurement of spirituality is essential in screening and assessment. [6,12-14] Instruments to measure spirituality have been researched in order to validate them in a palliative care context and to test their validity and their cross-cultural applicability. [6,12,13] The McGill Quality of Life Questionnaire (MQOL), the Measuring the Quality of Life of Seriously Ill Patients Questionnaire (QUAL-E), and the Palliative Outcome Scale (POS) are recommended as the most appropriate multidimensional measures containing spiritual items for use in multicultural palliative care populations. [13] The ConnecTo Tool is also recommended. [14]
Spirituality and religion appear to have positive effects on older adults with dementia. [2,5,11] Benefits are derived from the maintenance of social interactions, [2,5] the stimulation of neural pathways through prayer [2] and the comfort provided by familiar rituals. [5,11] Meaningful activities may help people come to terms with the diagnosis of dementia, the decline in function and capacity, and to facilitate their preparedness for death. [2,5]
Spiritual care is an important aspect of palliative care, holistic or inclusive care, dignity-conserving care, respectful and culturally appropriate care, and compassionate care. [1,4,7-9] Spiritual care can be provided by all members of an aged care or palliative care team [11] and is optimised if a whole-of-organisation approach is taken. [1,10,11] Establishing trusting relationships and providing opportunities for older people to maintain connections with family, friends and nature are important parts of spiritual care. [4] As is the older person feeling safe and able to participate in meaningful activities or to give back to others. [4] Spiritual care includes sensitive and respectful interactions, empathetic communication, activities like storytelling, reminiscing, mindfulness and meditation, prayer, [4,11] therapeutic life review [15] or dignity therapy. [8]
For Aboriginal and Torres Strait Islander people, the connection to Country is deep and spiritual. Their connections to family, culture, community, ceremony and their roles as Elders in community will influence their health and wellbeing and the way they seek and accept palliative care and aged care services. [16-18]
Deathbed phenomena (DBP), usually characterised by visions, is an unusual and hard-to-explain end-of-life experience. Although it is not uncommon in the health care setting, DBP may not always be reported by the person or their carers. If such phenomena are recounted, health professionals may use this as an opportunity to discuss spiritual and existential concerns, which have the potential to offer hope, meaning and connection. [19]
Quality Statement
Overall, the quality of the reviews included in this summary was good, with most reviews considered to be of acceptable or of high quality.
Page updated 24 June 2021