Northeast Florida Medicine, Spring 2016

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54 Vol. 67, No. 1 2016 Northeast Florida Medicine DCMS online . org
Palliative Care
Spiritual Assessment: An Important Role in Alleviating
Pain and Suffering in Patients and their Families
with Advanced Serious Illness
Introduction
For over two decades, spiritual care has played an
important role throughout the continuum of quality
palliative care. Spiritual, religious and existential concerns
are indispensable elements of healthcare in general and,
especially, in palliative care.1 Therefore, in order to deliver
competent and responsible health care, it is necessary for
health care professionals to recognize spiritual need and
existential suffering (which includes religious distress) as
they focus on the overall well-being of patients.
Although the most common model for palliative care
programs includes a professional chaplain as an inte-
gral member of the team, a basic spiritual history and
screening is often the responsibility of other members
of the interdisciplinary team. For these team members,
fundamental skills, tools and techniques – in addition
to a basic knowledge of spirituality terms and concepts
– are needed to screen and recognize spiritual need and/
or distress that might be affecting a patient’s healing
process. These skills are essential for team members in
determining when to refer to a professional chaplain for
more advanced, in-depth spiritual care.
The chaplain’s responsibilities are not limited to the
patient but include the family, the interdisciplinary team
and other health care professionals. Regarding palliative
care patients in particular, spiritual support is best when
given intentional and focused attention in the process of
alleviating pain and suffering. 2
Recognizing spiritual
and existential distress
Awareness of spiritual concerns and spiritual needs is
prevalent among the administration and staff in most
major health care settings; however there is a growing
concern for service to outpatients (which often includes
palliative patients). To illustrate one of the reasons for
this concern, a survey completed locally among Baptist
Health’s home health population revealed that, while
over 65 percent of home health patients desired religious
support, more than 70 percent of patients reported they
were not receiving support from their congregations.3
Historically, the widely-accepted practice for outpatients
has been the provision of basic religious resources (such
as rituals, sacraments and prayer) which most agree is
an act of benevolence. Today there is increasing aware-
ness of a deeper level of spirituality and, often, spiritual
distress, which warrants more extensive attention that a
professional chaplain is needed to provide. 3
The fundamental skills, tools, and techniques for
recognizing spiritual, religious and existential distress
requires an understanding of the terms and concepts. This
can be problematic as definitions vary and the concepts
are often broad.4 For example, the word “spiritual” comes
from the Latin word, spiritus, meaning breath. Synonyms
helpful in understanding this concept are psyche, with
origins in Latin and Greek, meaning breath, soul or
mind. Psyche comes from the Greek word psychein which
By David G. Morrell, MDIV, CT1 and Andrew Daigle, MD2
1 Pastoral Care Department, Baptist Health System, Jacksonville, FL
2 Medical Director, Community Palliative Consultants, Jacksonville, FL
Address correspondence to:
David G. Morrell, MDIV, CT
Pastoral Care Department, Suite 308
Baptist Health System
800 Prudential Drive
Jacksonville, FL 32207