OUR hospice has been moving from “chaplaincy” to “spiritual care” over the past two years — not just in name, but, crucially, in philosophy of care. We have been developing a model that overtly honours the human spirit, and cares for each person as a spiritual being, however they might express their spirit: be it, for example, through the arts, creation, or adherence to a world faith. But questions remain about how we can deliver such a big concept as “spiritual care”.
The starting-point, for me, is: taking a wide interpretation of “spiritual”; encouraging and empowering the largest number of people to engage with it, both within and beyond the hospice community; working as a fully integrated member of the multidisciplinary team; enabling and developing the volunteer workforce; exploring new models of spiritual care; being brave in our theology.
And we are doing this while all the time listening to, and being led by, our patients and their families.
At St Margaret’s Hospice, where I work as Spiritual Care Co-ordinator, by “spiritual” we mean the spirit — human and divine — in each person. The model for honouring the human spirit is, however, very broad, and belief in a faith is an inherent part of it, not distinct from it. In our day-to-day experience, some people choose to express their spirit through a faith, while many others choose to express their spirit in alternative ways.
As I was embracing a man who had tears pouring down his cheeks at the prospect he was facing, I noticed that he had unusually striking tattoos. Just admiring and talking about them gave him a glimmer, because it validated something that gave him meaning.
OUR question when a patient is admitted to the hospice is not “Would you like to see a member of the spiritual-care team?” but, rather, “What is the focus of your life; what gives it meaning?” Or, to a couple: “What keeps you together?”
These open questions help the multidisciplinary team, including doctors, nurses, and therapists, to engage in the holistic care of the patient, and his or her family, from the outset. As one of our senior nurses put it: “Spiritual care at this hospice is what each patient says it is.” This person-centred approach was favourably commented on in our Care Quality Commission inspection.
On admission, one patient made it known that he did not want to see the chaplain. But as I am not known as the chaplain, I called by, and we soon got talking about his allotment, and the birds in his garden. After this, he told me that he was depressed. Then he said: “I wish someone would give me a hug.” So we had a long hug.
I do not wear a clerical collar. I approach every encounter from the basis of one human spirit to another, and, as with this patient, I am often led into meaningful spiritual care of this kind.
One common misconception about hospices is that their main focus is on dying, whereas they are actually places where people do living, and where the end of life is made the very best that it can be — whether for an hour, a day, a week, or longer.
We care for people with all life-limiting illnesses, not just cancer, and more than one third of our patients either return home, or move to a care home. It is all the more important, therefore, that our spiritual care supports what gives meaning to their life in the widest sense.
For those who express their spirit through a faith, or a particular spiritual pathway, we ensure that they are supported by a practising member of that faith or pathway.
It is significant that St Margaret’s advertised for an ordained person to develop the new philosophy, as it showed a commitment to retaining and building on the faith traditions of this hospice, at the same time as seeking to develop a model that reflected the spiritual profile of our patients.
MY VISION is that, as spiritual beings, all staff and volunteers — clinical and non-clinical — are spiritual carers. We are developing simple competencies, adapted from the Marie Curie charity model, potentially for all members of the workforce.
Some of the best spiritual care that a patient or family member receives may be from a nurse in the middle of the night, from a volunteer receptionist, or from a volunteer in one of our retail shops. I am finding an increasing interest in being involved from across our workforce.
A woman who had recently been bereaved said to me: “You were right about the spiritual care in the shops: when I took in my husband’s things, they were so kind, and spent time with me.”
What we see emerging is a vision that more and more hospice care across the board is provided in the community. I have begun working with church communities in our area to equip lay people to offer spiritual care to those at home at the end of their lives.
In our deanery, this is now included in its mission action plan as part of “Reimagining Ministry”. In a benefice near by, the Rector is facilitating bringing church and health-care professionals together to receive training.
At St Margaret’s, we rely heavily on our outstanding volunteer workforce — all 1200 of them. In the realm of spiritual care, I have been seeking out an eclectic group of people, of faith and no faith, and I now lead a team with a range of skills and experience. They are recruited, above all, for their gifts as human and spiritual beings.
These spiritual-care volunteers are empowered to offer the Christian sacraments, and to attend multidisciplinary team-meetings in my absence. For the future, they are beginning to visit patients at home, and will undoubtedly have a place in supporting lay pastoral teams.
Increasingly, my volunteers and I work alongside all members of the clinical team, and I receive referrals to visit at home as well as on the wards. One of my recent referrals was to baptise a four-year-old boy whose father had only a short time to live. It is critical that spiritual care is considered alongside all other aspects of care.
Spiritual care is, above all, about human presence: “being there”. But we are now wondering, can we — or should we — begin to use social media to reach more people? I am hoping that we might soon set up a pilot to explore this further.
WHEN we accompany people towards the end of their lives, we are on holy ground. If they are willing to let us in, then we take off our shoes, like Moses at the burning bush, to be alongside them, bringing simply our own humanity. I do not “bring God” into the hospice; when people are as poorly as they are, I believe that God is already in charge.
Moreover, in my experience, anger at God among people of faith is not uncommon. This is the God that they have served and believed in all their life; so they might ask, what have they done to deserve their illness? By the time they come in, they have often been through a great deal, including years of continuing treatment — and our God is supposed to be loving.
”Compassion” means “to suffer with”, and this is what we do. A bit of me goes out to them when I hear their stories, and how it has been for them.
While we do not “bring Christ” into the hospice, I believe we are “being Christ” — not by using those words, but by entering daily the spiritual and emotional pain of those in our care. We do not offer any platitudes: the idea is to enter the darkness with them — and therein lies the quiet sacramental nature of this ministry. The gentle touch or open hug, and the tears (and also the laughter) freely shared, are all daily symbols of love, both human and divine.
I believe that, as chaplains, we are called to be constantly rekindling the spiritual flame that has been handed to us, looking for ways that can draw us ever closer to the spirituality of all our patients and their families in a fast-changing world.
IT IS also important to me that my Christian faith is not compromised by the wider philosophy of spiritual care. My leanings are towards the mystical tradition, and I draw great nourishment from the mystics, including Meister Eckhart and his writings about the “ground of the soul”.
I agree with those who see, in this concept, links with contemporary spirituality; for me, it is a way in, towards the ground of our common being — of “God filling all in all” (1 Corinthians 15.28).
I ponder on St Paul’s “third heaven” (2 Corinthians 12.2): I believe that God is working his purpose out in this hospice by opening up an ever wider vision of his call to spiritual care at the end of life — a call that is very exciting.
In Acts 2, we read of “each one hearing them [the apostles] speak in their native language”. In our own time, Nelson Mandela is quoted as saying: “If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.”
End-of-life spiritual care that speaks into the heart of each of our patients and those close to them: that, we believe at St Margaret’s, is the model fit for the future.
The Revd Ann Fulton is Spiritual Care Co-ordinator for St Margaret’s Hospice, Somerset.