clinical focus
This resource doesn’t get too far into that
because to be able to help someone with
that, you do need some time and space.
That’s where the spiritual care practitioner
role really comes to the fore.
This resource sits alongside of that. It’s
really about giving people some general
time and space and not being afraid. So if
they do start to ask some things, you are
open to letting them speak.
If they’re really starting to express some
distress around those things, that’s where
the staff are encouraged to refer. That’s
part of the resource, as well as helping
them to be aware of other channels for
other kinds of support for the person.
It also invites some reflection on cultural
rituals or certain things that people might
need to have in the space around them,
to be able to support them to die well. All
of that is based on what’s meaningful for
people, which is of course the heart of
spirituality and spiritual care.
Some people might baulk at the word
‘spirituality’ – thinking you’re bringing
religion into it, which some people
might not be interested in. Can you
explain what you mean by spirituality?
around their level of confidence and their
ability to accompany people around the
spiritual side of dying.
People do start to ask some big
questions about their life, and it’s really
important that staff aren’t afraid of that and
don’t skirt around the issues or try to shut
them down or try to avoid them altogether
because they know that the person might
say something that they don’t know how to
respond to.
For the patients, is it about getting them
past fear? Does it include preparing the
families for this?
Yes. For the person who is preparing for
the end of their life, what we’re really
hoping for is that their death will be as
good as possible, but that varies a lot
depending on the person. There are
some common themes that come up
for people, which is around the need for
reconciliation, the need to say thank you
and the need to ask for forgiveness or
offer forgiveness.
Spirituality is a term that can often be
misunderstood. I think we’re improving as a
community and certainly in the aged care
sector, but we’ve still got a way to go.
In the past, it was assumed that
spirituality was all about religion, but we
can’t make that assumption anymore.
If you look at the international literature,
there has now been a lot of research to try
to explore and explain this aspect of life.
The major themes that come up
are around meaning, purpose and
connectedness in people’s lives and then
connectedness with ourselves, with others,
with creativity, with nature, and with some
sense of something bigger than ourselves.
For some people, absolutely they’ll have
a faith, they’ll have a religious tradition,
and that’s all interwoven with that.
But for others they don’t. Everyone has a
spirituality; not everyone has a religion.
I’ve interviewed death doulas or end-of-
life doulas and they also talk about this.
Would you see a space for those people
in aged care?
Yes. I think that if an organisation has a
spiritual care practitioner, then quite often
it will be able to do the kinds of things that
death doulas are doing.
However, if an organisation doesn’t
have a spiritual care practitioner, then it
may want to explore having a death doula
involved in the care system alongside
the other support roles. I think it’s so
important that there are people around
who are able to explore these things and
support individuals with this part of the
ageing journey.
Is part of this helping to avoid ambiguity
for people’s end-of-life plans?
It is. And if there is a religious component,
well what should that look like and what
does that mean? Really, best practice
spiritual care is all about understanding
what’s most meaningful to that person
regardless of any labels that they might
be carrying.
Just because someone’s ticked a certain
box for a certain religion or not, we can’t
then assume that we know exactly what
that means in their life. We need to explore
it with them, which is why it’s important
to have those discussions well before the
person is actually about to die, so they’ve
got that chance to reflect and explore and
express, and the team around them has
time to prepare and know what sort of
things need to be in place.
This brings us to the other resource,
which is the implementation tool that
relates to the National Guidelines for
Spiritual Care in Aged Care.
The national guidelines for spiritual care
in aged care have 50 different outcomes
and actions, and this is one of them. But it’s
actually a kind of meagre outcome. It’s got
lots of different sub-components that all
relate to these things around preparation
for end of life, but it’s not so much the
pointy end, if you like. It’s stepping back a
number of months, if not a couple of years,
before that where it’s talking about letting
people reflect on their life contribution
and legacy, affirming their worth, identity
and uniqueness, helping them to explore
unresolved issues, and also advance care
planning, and so on.
Are these tools and resources available
to any aged care facilities who might
be interested?
In their entirety, they are freely available
to our members. To be a member of
Meaningful Ageing Australia, you need
to be providing support, care and/or
accommodation to older people.
We’re a growing group nationally.
We are publishing excerpts from them
later in the year to be able to provide
some more access to organisations that
aren’t members. ■
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