Spirituality in the ICU
Deborah Cook
Critical Illness Triggers…..
• Existential questions about
– purpose
– meaning
– relationships
– destiny
• Spirituality attends to
– matters beyond the physical
– where hope, support, peace and comfort live
J Pain & Symptom Mangmt 2015
• 6% ICU patients seen
by chaplain
• 80% decedents seen
by chaplain
• 1 day between consult
and patient’s death
J Relig Health 2012
• Objective: to explore contributions of spiritual
care providers in healthcare
• Setting: 2 tertiary care & 7 community
Canadian hospitals
• Methods: interviews, focus groups, document
analysis; interpretive description of themes
• Participants: 14 spiritual care providers & 7
spiritual care volunteers
Crafting
the role
Becoming
Legitimizing
Spiritual part of the
the role
team
Care
Providers
Brokering
diversity
Relevant Trends
• Globalization of information
• Diversification of religion
• Secularization of society
• Popularization of spirituality
….. Unprecedented spiritual plurality
A Definition of Spirituality
the aspect of humanity
that refers to the way
individuals seek and
express meaning and
purpose, and the way
they experience their
connectedness
to the moment,
to self, to others,
to nature, and to the
significant or sacred
Spirituality and/or Religiosity
Have No Role
Spirituality but not Religiosity
Spirituality > Religiosity
Spirituality = Religiosity
Physician Views on Spirituality
The Past The Future
• Obscure • Understood
• Ignored • Acknowledged
• Avoided • Embraced
• Outsourced • Integrated
National Consensus Project
For Quality Palliative Care
1) Structure and processes of care
2) Physical aspects of care
3) Psychological-psychiatric aspects of care
4) Social aspects of care
5) Spiritual-religious-existential aspects of care
6) Cultural aspects of care
7) Care of the imminently dying patient
8) Ethical-legal aspects of care
Who Else Says It Matters?
• WHO: spirituality as a core dimension of health,
which may sustain people at times of distress
• Joint Commission & National Quality Forum for
Palliative Care: spiritual care as a component of
quality of care standards
• ATS Policy Statement: identifying spiritual needs is
a core competency for ICU practitioners
• Families of ICU patients: often want their spiritual
values incorporated into discussions, which is
associated with family satisfaction
JAMA 2015
• Goals of care conversations in 40 ‘religious
conferences’ in 6 US centers
• 77% SDMs: spirituality was fairly/very important
• Professional responses:
– review medical plan
– commitment to quality care
– empathetic statement or closed statement
– change the subject
It Matters to ICU RNs
The value and role of spiritual care clinicians in ICU:
• Support of patients, families and staff - not just when
patients are dying
Nurses’ experience working with spiritual care clinicians:
• Relating to culturally and spiritually diverse persons -
knowing the right thing to say - and do
ICU nurses provide spiritual care:
• Intention, presencing, acts of compassion
Bone et al, 2016
It Matters to ICU Patients
Berning, Picture Guide to Improve Spiritual Care & Reduce Anxiety in MV Patients
Annals of American Thoracic Society 2016
Berning, Picture Guide to Improve Spiritual Care & Reduce Anxiety in MV Patients
Annals of American Thoracic Society 2016
Overall Goal of
The 3 Wishes Project
To improve the quality of the dying
experience for patients and their
families
Wish
Categories
Humanizing
Tributes
the Connections
Environment
Rituals Paying It
Forward
What is a Wish?
A wish is a Process…. And a Product
• A manifestation of hope
• An act of compassion
• A therapeutic connection
• A means to recognize the patient
• An example of dignity-conserving care
• An opportunity for reflection
• A vehicle for inter-professional care
• A transitional activity
• An expression of spirituality
• A secular prayer
ARRCCM 2016
“There are times in life when we are called to be bridges
-not a great monument spanning a distance and carrying loads of heavy
traffic - but a simple bridge to help one person from here to there over
some difficulty such as pain, fear, grief, loneliness, a bridge which
opens the way for ongoing journey.”
-Joy Cowley
Some Spiritual Care Interventions
• Presencing • Pet therapy
• Reflective listening • Outdoor therapy
• Story telling • Music therapy
• Life review • Touch therapy
• Reconciliations • Dignity therapy
• Celebrations • Readings & rituals
• Diaries/journaling • Counselling
• Biofeedback – Individual, group
• Meditation – Spiritual, grief
Reflections
• Medicine, in its fullest expression, may be
a spiritual discipline
• The austere ICU setting can suppress
spirituality
• Expressions and experiences of spirituality
abound in the ICU
….. and can bring clinician humanity and
compassion to the fore
Spirituality doesn’t have to be a black box.
…..It can be a bright light.
