Dr. Saul Ebema

When I think of spiritual care in the context of Hospice, I think of it as a movement in three vital rhythms:

• The traditional rhythm: In this rhythm, the hospice chaplain directs spiritual care through traditional methods of sacred texts, sacred symbols and rituals, devotionals, and communal worship.
• The psycho-spiritual: In this rhythm, the hospice chaplain utilizes evidence-based theories in medical and social sciences as well as theological perspectives in providing spiritual care.
• The Collaborative rhythm: In this rhythm, the hospice chaplain seeks out new possibilities of care through collaborating with the patient and caregivers.

The task of the hospice chaplain therefore is both to honor the distinctiveness of each of these rhythms as well as to have the flexibility of moving through these rhythms interchangeably and simultaneously.

The Traditional Rhythm of spiritual care

In the traditional rhythm of spiritual care, hospice patients and their caregivers seek spiritual comfort and experience from the hospice chaplain in ways that appear immediate, intuitive, and unquestionable. One time, I remember receiving a call from the hospice nurse, the patient we had in common had become imminent. She stated that the daughter wanted me to visit for spiritual support.

The day before this call from the nurse, I had communicated with the daughter, and she requested for anointing from the Catholic priest. The priest visited that day and performed the needed ritual. When I arrived at the skilled nursing facility for the visit, I met the daughter by the bedside. I sat down to offer some comfort but all she wanted was for me to read some scriptures, recite the hail Mary and the Lord’s prayer with her. She craved for that traditional rhythm of spiritual care that offers immediate, intuitive, and unquestionable experience of the sacred and divine.

I also used to visit a patient who expected my visits to involve worship and a devotional. We would play some worship songs on YouTube, read some scriptures and I was expected to share a devotional. That’s what she wanted and expected from the chaplain visits.

In hospice care, the hospice chaplain will often encounter these moments that demand for the traditional rhythm of spiritual care for comfort and support.

The psycho-spiritual rhythm of spiritual care

In the psychospiritual rhythm, authentic spiritual care is steeped in the traditions of religious care and informed by current clinical research and the social sciences.

Some of the methods and interventions that may be used by hospice chaplains in counseling patients and caregivers in this rhythm of spiritual care are:

• Empathetic Listening and Support: The ability for emphatic listening enables hospice chaplains in this rhythm to support the patient and caregivers in whatever grief they are expressing. Each person’s grief journey will be different. Providing empathetic listening shows the patient and caregivers that the chaplain genuinely cares. Patients and caregivers feel empowered and might be able to say what they are thinking because they are able to express their emotions. This thinking out loud with an empathetic hospice chaplain may help patients process their issues without fear.
• Life-review and Reminiscing therapy: The idea of life review is usually associated with Robert Butler. “Butler explains that a life review is where a patient remembers the events of his or her life and reflects upon the meaning of them. Unresolved issues can be remembered, addressed, and possibly resolved.”[1] Life review can be done in an unstructured way as a normal conversation or in a structured way. A life review is typically structured around one or more life themes, most often family theme ranging from one’s own childhood, to the experience of being a parent, to being a grandparent; and work themes from first job, to major life’s work, to retirement. Other commonly used themes, but by no means the only ones, are: major turning points; impact of major historical events; role of education, health, holidays, music, literature, or art in one’s life; experiences with aging, dying and death; and meaning, values, and purpose.^[2]
• Dignity Therapy: Dignity therapy is a form of psychotherapy designed for terminally ill patients and their caregivers. The focus is to document the most meaningful moments of a dying person’s life. In dignity therapy, the patients are asked a series of questions about their life history, and the parts they remember most, or think are most important. Their answers are transcribed by the hospice chaplain and edited into a polished document that could be passed on to the patient’s family members as the patient’s legacy.
• Narrative Therapy: A skill that is being increasingly recognized for its importance in the area of hospice care is attending to the patient’s narrative, listening to the stories patients tell during chaplain visits. Hospice chaplains need to dip themselves in the details of the narratives that unfold in during patient visits. This is because the patient’s and the caregiver’s narratives have a way of revealing their coping mechanisms when confronted with a life crisis. Also, narrative therapy can help “uncover unresolved conflicts that the patient has which could be important in the patient’s healing process.”^[3]

Collaborative rhythm of spiritual care

Spiritual care in the collaborative rhythm attends to a person’s process of meaning-making – a process that is embedded in larger cultural, religious, and family contexts. Hospice chaplains invite themselves as participants in these personal quests for meaning while identifying and, hopefully, deconstructing and reconstructing destructive themes. This happens all in collaboration with the patient and caregiver.

The most common example of the collaborative rhythm is legacy projects. In a legacy project, the hospice chaplain helps a patient craft something meaningful and memorable through music, art, writing or other creative processes. For example, a patient might need help writing a first-person account of the most significant events and lessons learned during their lives to pass on to their loved ones. Or it could be the recording of a special song that incorporates the sound of the patient’s heartbeat. Sometimes, a patient might want help with an unfinished quilt to pass along to loved ones or writing a letter to be opened on a grandchild’s wedding day.

Conclusion

All these are important rhythms in provision of spiritual care in the context of hospice. The task of the hospice chaplain therefore is to honor the distinctiveness of each of these rhythms as well as to have the flexibility of moving through these rhythms interchangeably and simultaneously.

---

[1] Rebecca L. Caldwell, “At the confluence of memory and meaning-life review with older adults and families: Using narrative therapy and the expressive arts to re-member and re author stories of resilience.” The Family Journal 13 (2005): 172- 175

[2] David Haber, “Life review: Implementation, theory, research, and therapy.” International Journal of Aging and Development 63(2006): 153- 171.

[3] Arthur Frank, The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995), 121.