UNIT 304:
Support the Spiritual Wellbeing of
Individuals
Tutor’s / Assessor’s Handbook
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Acknowledgements Skills for Care is pleased to acknowledge the work of St Luke’s Hospice Plymouth
and Venus Training & Consultancy in researching and writing these learning
materials.
In the course of developing these materials they have drawn on the resources
available through the National End of Life Care Programme, Social Care Institute for
Excellence, Help the Hospices, e-ELCA and others.
Skills for Care wishes also to thank all those individuals and organisations that
supported the external consultation. All sources have been acknowledged and
references have been cited at the point of contribution. This unit of learning has been developed and written by
Jane Mason
MSc; BSc (hons); RNT; RN; DN
St Luke’s Hospice Plymouth
Edited by
Jane Kellas
Director
Venus Training and Consultancy Limited
Katherine Kelleher
Director
Aspira Consultancy
Externally reviewed by
Geraldine Clay.
MSc; BA(Ed); RGN; RHV; RNT
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Table of Contents
Section
Section 1
Section 2
Content
Page
Table of the learning outcomes and assessment criteria
5
Introduction to the unit:
• Introduction to the unit and the activities
• What types of evidence are acceptable for each
learning outcome
8
Activity 1 – Professional Discussion (meets learning
outcomes 1.1; 1.2; 1.3; 1.6; 1.7 and 2.2)
18
Activity 2 – ‘An Individual Experience’ (meets learning
outcomes 1.4 and 1.5)
31
Activity 3 – Life Story (meets learning outcomes 1.3; 1.7;
2.1; 3.2; 4.2; 4.3 and 4.6)
37
Activity 4 – Care Plan (meets learning outcome 2.3)
52
Activity 5 – Reflective Account (meets learning outcomes 3.1
and 4.4)
57
Activity 6 – Reflective Account (meets learning outcome 3.3)
61
Activity 7 – Support at End of Life (meets learning outcomes
4.1; 4.2; 4.3 and 4.5)
64
Appendix
73
•
Continuation sheets for photocopying as required
•
Glossary of Terms
•
Template Support Agreement
•
Lesson Plans
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The purpose of this tutor book
This book illustrates the learners’ resources and provides you with the answers and
the learning points for each activity contained in the learner handbook. The answers
provided are indicative answers and have been highlighted in red. It is important to
note that a lot of questions ask the learners for their own views and opinions
therefore in these cases there are no right or wrong answers.
This book also provides a resources guide at the end of each activity. This will
signpost you to the various learning resources you will need to support the learner
on an individual basis and/or support classroom based activities.
The resource guide will inform you about lesson plans which can be found in the
appendices of this document. The resource guide also signposts you to the elearning resources that are available to support the units learning activities, which
are an optional resource. This information can also be found in the appendices. The
resources are all in an editable format so that you can amend them as required. The
way you deliver this unit is at your discretion and calls upon you to modify the
materials in the way that suits your learners’ needs.
These workbooks have been formatted for print and it is therefore advised that you
print the PDF version of the Learner Handbook for learners to use as a hard copy.
PDF versions should also be available to the learner electronically so they can
access the links to various Internet sites directly.
The Word version is available, however, for those who wish to use the workbook
electronically, please note that in this instance the formatting of the workbook will be
altered.
All the resources to support this learning can be found on the following website:
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Table 1: Learning Outcomes and Assessment Methods
EOL 304: Support the spiritual wellbeing of individuals
Unit level 3
Credit value 3
Study/activity hours 26
Unit aim: The purpose of this unit is to assess the learner’s knowledge,
understanding and skills in supporting the spiritual well-being of individuals.
Learning
outcomes
The learner
will:
Assessment
criteria
The learner can:
Own evidence log
(optional)
Assessment
Type
Page Type of evidence
No
presented
1. Understand
the importance
of spirituality
for individuals
1.1. Outline different
ways in which
spirituality can be
defined
1.2. Define the
difference between
spirituality and
religion
1.3. Describe
different aspects of
spirituality
1.4. Explain how
spirituality is an
individual experience
1.5 Explain how
spirituality defines an
individual’s identity
1.6 Outline the links
between spirituality,
faith and religion
1.7 Explain how an
individual’s current
exploration of
spirituality may be
affected by their
previous experience
of spirituality, faith or
religion
Knowledge
Knowledge
Knowledge
Knowledge
Knowledge
Knowledge
Knowledge
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Table 1 continued
Learning
outcomes
The learner
will:
Assessment
criteria
The learner can:
Own evidence log
(optional)
Assessment
Type
Page Type of evidence
No
presented
2. Be able to
assess the
spiritual needs
of an individual
3. Understand
the impact of
values and
beliefs on own
and an
individual’s
spiritual
wellbeing
2.1. Support the
individual to identify
their spiritual needs
and how and by
whom these can be
addressed
Competence
2.2. Identify how an
individual’s emphasis
on spirituality may
vary at different
stages of their life
experience
Knowledge
2.3. Take action to
support that the
individual’s spiritual
wellbeing is
recognised
appropriately in their
care plan
Competence
3.1. Analyse how
your own values and
beliefs may impact
on others when
communicating
about the individual’s
spiritual wellbeing
Knowledge
3.2. Identify how the
values and beliefs of
others may impact
on the individual
Knowledge
3.3 Identify the
effects on own
values and beliefs
when meeting the
spiritual needs of
individuals and
Knowledge
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4. Be able to
support an
individual’s
spiritual
wellbeing
others.
4.1. Access
resources and
information to
support the
individual’s spiritual
wellbeing.
4.2. Contribute to the
creation of an
environment that
enables individuals
to express aspects of
their spiritual
wellbeing.
4.3 Support the
individual to take
opportunities to
explore and express
themselves in ways
that support their
spiritual well-being.
4.4 Support the
individual to
participate in their
chosen activities to
support their spiritual
well-being.
4.5 Access any
additional expertise
required to meet the
individual’s spiritual
needs.
4.6 Outline the
benefits of working in
partnership with faith
and non-religious
communities to
support the spiritual
needs and
preferences of the
individual.
Competence
Competence
Competence
Competence
Competence
Knowledge
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Section 1: Introduction to EOL Unit 304
General Introduction
This unit will help learners to develop an understanding of spiritual wellbeing and the
forms spiritual care may take. The unit provides them with the skills to support the
spiritual wellbeing of individuals they care for.
The unit covers the importance of spirituality as part of the care for an individual,
especially at the end of life. It covers how to assess the spiritual needs of individuals
and how best to offer support.
There is opportunity to consider their own beliefs and values and those of others as
well as opportunity to consider how these can impact on each other.
There will be discussion about how they might get further help and support from a
range of other services to provide spiritual care.
The workbook contains a range of different learning activities that will assist you to
support learners in meeting the learning outcomes for the unit. Table 2 shows them
the type of activities they may be asked to complete.
Learning Support
Due to the sensitive nature of End of Life (EOL) care, topics may be covered that
can cause upset to learners, for example asking them to consider their thoughts
about their own death, or watch video clips that include the views of people who are
actually dying. Tutors / Assessors have a responsibility to ensure that learners are
supported to learn safely and at their own pace, through a blended delivery style.
It is recommended that at the introductory session with learners you complete a
Support Agreement together, which will identify how they wish to be supported if they
become upset whilst undertaking any of the following learning activities. You have a
template Support Agreement in the appendix of this pack to use if you wish.
•
•
•
•
Lone study – Identify support networks (these could be friends, family,
colleagues) if the learner becomes upset.
One to one – Ask the learner how they would like to be supported if they
become upset.
Work based learning- Ask the learner to identify a mentor or supervisor to
whom they can go if they became upset at work.
Class room based learning - Ask the learner how they would like to be
supported should they become upset during classroom sessions. You will not
be able to leave the rest of the class, so you should encourage learners to
nominate a classroom buddy who could leave the classroom with them or
identify a quiet place where they can go to be alone and have a cup of tea.
This will be their decision and based on the facilities available.
Learners’ workbooks remind them that providing good EOL care can be one of the
most rewarding caring experiences they can have. It is a privilege to know that they
have cared for someone as they have taken their last breath in the world and that
they have been part of their end of life journey. It is often a comfort to know that they
have helped someone meet their EOL wishes and they have had a comfortable,
dignified death. How they care for someone at end of life can remain with relatives
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and loved ones for a long time and you only have one chance to get it right. This is a
big responsibility and so it is really important that learners take the learning activities
seriously and that they also ensure that they learn at their own pace, to fully reflect
and absorb the new EOL knowledge and skills they will be developing throughout
this unit.
Learning Activities
As everybody has different ways of learning new information, the learner’s workbook
contains a range of learning activities which will assist them in meeting the learning
outcomes for the unit. Table 2 shows you the type of activities they may be asked to
complete.
Table 2: Type of learning activities and symbols
Activity Symbol
Explanation
This symbol means you will need to access the internet *
This symbol means you will be reading something
This symbol means you will be asked to talk about something
with friends, colleagues, your tutor or assessor
This symbol means you will be asked to think about
something and you may be required to write your thoughts
down
This symbol means you will be asked to watch a clip from a
movie, TV programme or from the Internet e.g. youtube film
clip *
This symbol means you will be asked to write something in a
workbook or a worksheet or even provide examples of your
work with a service user e.g. a plan you have written
This symbol means you be asked to research some
information. This might be through the internet, books, and
articles or from talking to people you know
This symbol means your assessor will plan to conduct an
observation of your practice or will examine a work product
* Although every effort has been made to ensure video clips are appropriate, as they
are often freely available to all, we cannot be held accountable for any inappropriate
comments made about the clips. If you should see something offensive please
following the offensive reporting guidelines of the web site concerned.
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For each activity, learners will see a clock symbol which will provide you
and them with a guide to how long the activity could take. Remember this
is a guide and the activity may not take as long as it says!
Each activity will signpost learners to a range of resources to support their learning
and where appropriate learning materials will be provided e.g. an information leaflet
or a section of a website for them to read. If they are not in the Learner’s Workbook
you will find these in the appendices of this handbook for photocopying.
Here is an example of how each activity works: The Learner’s Workbook shows
each activity in the style below:
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page 4). Those
highlighted green are the ones you will cover when you have successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
2.4
3.4
4.4
2.5
Assessment Method: Reflective account
Assessment Type: Knowledge
Learners are provided with space to complete each activity where appropriate. You
will be provided with suggested answers. The answers given may not be exhaustive
and you will need to draw upon your own knowledge and experience as well as
additional research if required.
The appendices relating to this unit will provide you with all the resources you will
need to deliver learning and support assessment for this unit. It supports classroom
delivery, one to one delivery and distance learning for some aspects. We
recommend that a blended delivery approach is most effective.
As learners complete the activities in each section, it is recommended that they log
their evidence in table 1 (page 5). The grid at the beginning of each activity will show
them assessment criteria they have covered (highlighted green). This will help you to
map evidence across to awarding body matrix forms when you are confident that
learners have demonstrated knowledge or competence. If learners don't succeed at
first, you can give your further support to get it right!
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Table 1 (page 5) shows you and learners what learning outcomes will have to be
achieved to pass this unit and what the assessment criteria will be. The table also
identifies whether it is a skill or knowledge competency.
Each section will outline the activity and provide guidance on how to do
the activity. Look for this symbol to help you with ideas, further learning
and suggestions on completing the activity.
Plagiarism and Confidentiality
In their workbooks learners are reminded that plagiarism relates to claiming work to
be your own when it is not. All work submitted must be the learners own and not
copied from anyone or anywhere else unless the source of the information has been
clearly referenced.
Learners are also reminded that confidentiality is essential in all aspects of care and
that includes during their learning. They may be asked to reflect upon aspects of
their role and people for whom they provide end of life care but it is very important
that they do not disclose any personal information about them. They must also be
very careful not to include any evidence that relates to individuals in their portfolios
e.g. photographs or documents with their details on.
Portfolio of Evidence of Learning
We have recommended that learners keep a portfolio to record all the learning they
have collected for this unit. This portfolio will demonstrate their understanding on the
subject and will help you assess how the learner is meeting the relevant learning
outcomes.
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End of Life Care for All (e-ELCA)
End of Life Care for All (e-ELCA) is an e-learning platform from the Department of
Health and e-Learning for Healthcare (e-LfH) in partnership with the Association for
Palliative Medicine of Great Britain and Ireland to support the implementation of the
Department of Health's National End of Life Care Strategy (July 2008).
The e-learning platform is aimed at health and social care staff working in end of life
care. The e-learning enhances the training and education of these staff, increasing
their confidence and competence to ensure well informed, high quality care is
delivered to people at the end of their life.
There are over 150 highly interactive sessions of e learning within e-ELCA. These
are arranged in 4 core modules:
•
•
•
•
Advance Care Planning
Assessment
Communications Skills
Symptom Management, comfort and wellbeing
Also, there are 3 additional modules in social care, bereavement and spirituality.
All of these sessions are freely available to NHS staff, social care staff who work in
an organisation registered with the Skills for Care National Minimum Data Set
(NMDS) or staff who work in a hospice. Staff who do not meet these criteria can
register at a cost of £199.
There are twelve sessions which are freely available to everyone, including
volunteers and clerical and administrative staff on an open access website:
www.endoflifecareforall.org.uk.
For further details see 'Access the e-learning'.
This is an additional resource and not mandatory for this unit as it may not be freely
available to every learner.
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Providing the right evidence
In their workbooks learners are informed that it is important that they provide the
right type of evidence for the outcome they are trying to achieve. Remember there
are 2 types of evidence:
a. Competence / Skill – This is where they need to demonstrate something
about their practice.
b. Knowledge – This is where they need to demonstrate that they have
learned and understood some new information.
Table 3 shows them the type of evidence that is acceptable for the type of outcome.
Table 3: Suitable Evidence
Evidence methods
Direct observation of
you by assessor
Professional
discussion
Expert Witness
evidence
Work products
Reflective diary
Reflective statement
Written and pictorial
information
A scenario or case
study
Explanation
You will be observed by your
assessor carrying out your
everyday work activities in your
learning environment
You will take part in a preplanned and in-depth discussion
with your assessor
An expert witness, such as a
qualified professional, completes
a testimony of your competence
in the learning environment
where it would not be possible
for your assessor to observe
A work product is evidence used
in your work setting and
produced, or contributed to, by
you. For example, care plans,
daily diaries, assessments
An on-going record of events
produced by you that take place
relating to your work, including
evaluation and reflection
A record of events, produced by
you, that relate to an event that
happened in your learning
environment, including
evaluation and reflection
Written answers and completed
activities set by your tutor or
assessor
Written or verbal account of how
you would respond to specific
events set down by your tutor /
assessor
Suitable for
evidencing
Competence
YES
Suitable for
evidencing
Knowledge
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
YES
NO
YES
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Reflective Practice and Reflective Accounts
Learners have been provided with the following information:
Reflective practice is a process, which enables you to achieve a better
understanding of yourself, your skills, knowledge and practice. Although most of us
engage in thinking about experiences either before, during or after an event, we
need to document our understanding in order to clearly identify our learning,
consider the outcomes and evaluate the experience. The aim is to identify what we
have learnt in order to find new or different approaches to our future practice, or to
recognise when something was best practice.
Learning comes from many different incidents and experiences that we have in life.
We can learn much about ourselves, others, our job, our organisation and
professional practice, as well as our abilities and skills, if we consciously take the
time to reflect on our learning. A popular model of reflection is Gibbs 1988 – The
Reflective Cycle. This is shown in the diagram below:
In some of the activities in this workbook, you will be asked to complete reflective
accounts. We recommend that you follow the model above to ensure that you
include everything.
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Pre and Post Learning Assessment
We have provided learners with pre and post learning assessments in their
workbooks. This will support you and them to assess what they knew before and
what they have learned when completed.
The Learner’s Workbook has a table asking the learner to rate how confident they
feel about understanding and supporting the spiritual needs of those they care for.
1 being not very confident and 5 very confident. There is a second, identical table, at
the end of the workbook for them to complete again.
Confidence level
1
2
3
4
5
Understanding what
spiritual needs are
Talking about spiritual
needs
Supporting an individual’s
spiritual needs
Supporting the spiritual
needs of those with
different beliefs or culture
from your own
Knowing who can help you
to meet an individual’s
spiritual needs
Knowing who can support
you and understanding how
to care for yourself.
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Section 2:
Activities
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Introduction to supporting the spiritual wellbeing of
individuals
Providing care for an individual starts with a complete assessment of that person’s
needs. This includes physical, psychological, social, cultural, environmental, spiritual
and financial needs (EOL Care Strategy 2008). An area that a lot of health and social
care staff find difficult is meeting the spiritual care needs of an individual. This can be
a challenge for many reasons as care workers may feel that:
•
This is an area for experts only
•
They do not understand what spirituality is
•
Spirituality refers only to religion
•
It is intrusive to discuss such personal matters with an individual they care for
•
Worried that questions will be asked they cannot answer
•
They have never thought about what their own spiritual needs are
•
They will not know how to help someone whose ideas and beliefs are different
from their own
•
They may not know where to look for help and support
•
They may worry they may not be able to meet the needs they find
•
They have not have enough training about spirituality
This unit will look at the meaning of spirituality, religion and faith and how these may
be linked. It will give learners the opportunity to think about their own spirituality and
beliefs.
The unit will give guidance about assessing and meeting spiritual needs. There will
be opportunity to see how these ideas can be practiced in the workplace.
Examples will be given of different individual spiritual needs and how these have
been met.
Ideas will be provided of where other support is available to help the learners and
resources to use in the work place.
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Activity 1 - Professional Discussion
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Professional Discussion
Assessment Type: Knowledge
Tutor/Assessor Guidance:
Points that should be covered in the discussion:
§ Definition of spirituality
§ Outline of the difference between spirituality and religion
§ Indicate the links between spirituality, faith and religion
§ Explore how an individual may place different emphasis on spirituality at different
stages of life and how this can apply particularly at the EOL when the individual
may wish to gain extra support from religious communities (even if not usually a
regular member), from family and friends or from carers
§ Discuss how individuals may question their past beliefs; may question what the
future holds including what happens after death; may have issues from the past
they wish to resolve or may have wishes they want to achieve in their remaining
time left.
§ Consider how an individual’s previous experiences may have an affect on their
current beliefs, for example they may have lost people close to them.
You should be confident the learner understands the concept of spirituality and
particularly ensure that they don’t confuse it with religion. The learner should be clear
that spirituality is a broad term that encompasses those things that give purpose and
meaning to life. The learner should be aware that everyone needs to have a sense of
being valued as an individual and secure in their surroundings.
The learner can work through the workbook and follow the video links or this session
may be delivered as a face to face session; a lesson plan and short PowerPoint
presentation are included. The lesson plan encompasses the use of the video clips
that can be used to foster discussion.
The End of Life Care Strategy (DH 2008) recognises that it is important for each
individual to have a holistic (complete) assessment. This assessment should include
physical, social, cultural, environmental, spiritual and financial needs.
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Often we think of each part of the holistic assessment as something separate from
the other parts but a holistic assessment means all the parts are important.
Evidence shows that spiritual wellbeing is important to physical and emotional
wellbeing.
The need for an individual to find meaning in life and think about what gives them
comfort and purpose in life is most likely to come to arise at times of trauma, illness,
great life changes or facing the end of life.
As people reach the end of life, their physical needs may increase and it is easy to
forget the other areas. It is known that spiritual issues in particular, are often ignored
by care staff but spiritual needs may also become more important at this time as an
individual looks back over their life and thinks about the future.
Activity 1: Professional Discussion
Approximately 8 hours (including preparation time)
For this activity you will be need to work with your tutor/assessor to book
and plan a discussion. You will be required to talk about the following
topics:
• The different definitions of spirituality
• The different aspects of spirituality
• How spirituality differs from religion
• How spirituality, religion and faith are linked
• How someone’s spirituality might be affected by previous
experiences of spirituality, faith or religion
• How someone’s feelings about spirituality might change at different
stages of their life and when it might have more emphasis
Before your discussion you should complete the tasks below, which will
help you, think about the points above. Your answers will form part of your
discussion with your tutor or assessor.
You should also gather any evidence you feel appropriate to support your
discussion, this could include references to websites, films, TV
programmes or books for example.
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Why might spiritual needs be ignored?
This can be for many reasons. Care workers may feel:
• This is an area for experts only
• They do not understand what spirituality is
• Think that spirituality refers only to religion
• Feel it is intrusive to discuss such personal matters with an
individual they care for
• Worried that questions will be asked they cannot answer
• They have never thought about what their own spiritual needs are
• They have never thought about what might be important to them at
the end of their life
• That they will not know how to help someone whose ideas and
beliefs are different from their own
• They may not know where to look for help and support
• They may worry they may not be able to meet the needs they find
• They have not have enough training about spirituality
Completing this module will help care workers gain confidence in
supporting spiritual needs.
What does the word ‘spirituality’ mean?
•
•
•
•
•
•
•
•
Different people will think of different things when asked to say what
spirituality means.
Some people will think about being part of a religious group and the
rituals and prayers involved
Some people will think about the importance of relationships such
as families and friends
Some people will think about being close to nature, walking,
gardening
Some people will think about marking important feasts or festivals in
the year
Some people will think of special celebrations such as birthdays or
anniversaries
Some people will think about helping others, being involved in their
community
Some people will think of taking part in hobbies and being creative
This list does not cover all the meanings of spirituality.
Spirituality is very individual. Spirituality is more than a belief in a greater
power or being part of a religion, though for some people these will be a
very important part of their spirituality.
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You will now be asked to say what you think spirituality means.
Below are examples of what other people have said. You are being asked
to think about your views now, as it is important to know what spirituality
means to you personally. There is not just one right or wrong answer but
many answers that are true.
Write a sentence in the thought bubble below that says how you would
describe ‘spirituality’
Ensure that the learner has answered the
question and describing spirituality from
their own point of view and not reworded
the examples given. There is no right or
wrong answer but learners have to
demonstrate an understanding of what
spirituality is. Spirituality may or may not
include religious beliefs.
Spirituality covers everything that gives
meaning and purpose to life.
Below are some examples of how others have described spirituality.
“Spirituality is difficult to define, analyse or quantify. It is generally related
to the search for meaning and purpose in life. It may or may not include a
belief in a higher power (such as a god or several gods) or the
supernatural world. Each person searches for meaning in life in their own
way but spiritual beliefs usually bring together ideas about ourselves, our
relationships with others and with the world.
Religion is closely linked with spirituality but the two words mean different
things. A person may have an active spiritual life without considering
themselves to be religious or being involved with a religious organisation”
www.scie.org.uk
“We recognise that the idea of spiritual care is complex. It includes faith
based needs but also encompasses those who are not allied to a particular
faith.”
“Many people have difficulties in completing the spiritual element of a care
plan. Because spiritual is seen only about being religious, because the
focus is on which church or faith someone belongs to with little attention
being paid to understanding that a person’s life history, likes and dislikes,
routines and rituals are necessary elements of enabling someone to have
their spiritual needs met” www.faithinolderpeople.org.uk
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Religion and spirituality are related, but not identical, concepts.
Spirituality: ‘a quality that goes beyond religious affiliation, that strives for
inspiration, awe, meaning and purpose even in those who do not believe in
a God’
Religion: the rituals, beliefs and power structures found in different
religious creeds –or more succinctly, as the means by which we relate to
God’ www.gerimed.co.uk accessed via dementia.stir.ac.uk
Some have their spiritual needs met through their religion and faith but that
is not true for all. Spiritual care is that which gives meaning,worth and
value to the life of an individual. Helping to find a sense of peace. National
EOL Programme materials
www.e-lfh.org.uk
Spiritual Care is – That care which recognises and responds to the needs
of the human spirit when faced with trauma, ill health or sadness and can
include the need for meaning, self worth, to express oneself, for faith
support, perhaps for rites or prayers or sacrament, or simply for a sensitive
listener.
www.rcn.org.uk/spirituality
Difference between spirituality and religion
There is no clear agreement about the difference between religion and
spirituality. In general though religion refers to a more organised practice.
Religious practice takes place within an organisation with specific beliefs
and practices. Spirituality refers to a more personal experience of what
gives hope, purpose and meaning to an individual’s life and provides them
with comfort.
As you have worked through the section above you may have started to
think about how spiritual needs may or may not include religious needs.
Some people have their spiritual needs met through their religion and faith
but that is not true for all.
Those who have no belief in a God and believe that there is nothing after
death still seek meaning and purpose to their lives.
Notice that some of the quotes refer to belief in a god or gods. The way we
approach religious or spiritual beliefs is often closely linked to the beliefs of
the culture in which we were brought up or live.
Even when people have stated they have religious beliefs it is important to
understand that how they wish to practice these beliefs may be different.
22 | P a g e
Consider the scenarios below – each of these ladies were brought up in the
Christian faith and have been baptised and confirmed. They have stated
their present religion as Christian.
Mrs A attends her local church regularly and enjoys joining in the activities
associated with the Church
Mrs B asks for a vicar to visit to give her communion monthly but does not
want to attend church services
Mrs C observes the major festivals and celebrations of the religious year but
does not attend church
Mrs D never talks about her religious beliefs but enjoys watching ‘Songs of
Praise’ on the television and joins in the singing of hymns
Mrs E does none of the above things but always wears a necklace with a
cross and is always keen to help others
These different approaches to religion can be found in all faiths. Just as
spirituality is individual so is the way those with religious beliefs understand
and practice their religion. The only way to understand what is important to
the individual is by talking and listening to them.
Faith
We have considered spirituality and religion and how they can mean similar
or different things for any individual. The other idea we need to consider is
‘faith’ and how this is linked to spirituality and religion.
Consider the following definition. Spirituality is about:
‘Belief and faith: in self, others and for some a belief in a deity or higher
power is important to some people. A person’s belief or faith gives them a
framework of ideas, stories, narratives, symbols and rituals that they use to
make sense of their situation. A person’s illness experience will be deeply
affected by what they believe about their faith, the world and the meaning of
their illness.’
RCN Spirituality in Nursing Care www.rcn.org.uk
Faith can also be thought about as believing in something despite having
no evidence for it. As the quote above shows that faith may be based in
religion but it relates to whatever our beliefs are.
No one can know what happens after death but individuals may have clear
beliefs –or a faith –in what happens. This faith maybe based on religious
beliefs or it may be based on scientific decision making. Think about this as
you listen to people thinking about their beliefs about life, dying and life after
death when you watch the video clips in the next section.
23 | P a g e
Now listen to some individuals talking about their own beliefs about life,
dying and life after death.
Follow this link:
www.healthtalkonline.org/Dying_and_bereavement/Living_with_Dying
Here people talk about their own approaches and beliefs about living with
dying. Select as many as you like but include:
‘He believes in life after death and thinks we should pray for the grace…’
‘Says she is probably a humanist’
‘Says people live after death through their genes’
‘Says that death is part of life’
In preparation for the professional discussion write down your thoughts now
you have listened to the views of different people.
The views these people have are very different from each other. Think
about how they are similar or different from your own views. How can you
help someone who has very different views from your own?
They may realise that not having religious beliefs but being an atheist,
agnostic or humanist still means the individual has beliefs and can find
purpose and meaning in life
They may have understood that faith is about having beliefs despite there
being no solid evidence.
They might have thought about how cultural upbringing impacts on beliefs
and practises.
They may have started to think about the importance of respecting different
views and remaining neutral when helping to support what an individual
believes or practises.
This video clip looks at spirituality in the social care setting. It will help to
summarise the ideas we have looked at so far.
‘Spirituality: Have you found any yet? ‘
www.dementia.stir.ac.uk (go to ‘library and info services’ then select
‘dementia now’ from the tabs at the top of the page and click on Autumn
2011 bulletin on Spirituality and look under web resources (or follow this link
directly http://www.youtube.com/watch?v=YpMcqR9Sh5I)
24 | P a g e
Click on the link below to access Spirituality in Nursing Care – A Pocket
Guide. If the link doesn’t work visit the Royal College of Nursing website
and enter ‘spirituality’ in the search field and then click on ‘Spirituality in
Nursing Care – A Pocket Guide’ in the results.
http://bureauquery.funnelback.co.uk/search/search.cgi?query=spirituality&collection=rcnmeta&form=
Read the Pocket Guide and concentrate on the sections:
• Spirituality is about
• Spiritual Care is not
Make some notes about what you have learnt so far from these tasks to
discuss with your tutor during the professional discussion. Think about how
you already include spiritual aspects in your work and what you might do in
the future.
NOTES:
Again there are no right or wrong answers but things the learner may raise
are:
An understanding of spirituality being wider than religious beliefs.
They might look at what they do in their work area –are personal beliefs
recognised.
They might think about how people may state they have the same religion
but practise it in different ways.
They might have looked at the differences and similarities between religion
and spirituality.
Before you meet your tutor for the professional discussion, undertake the
quiz below and take the answers with you to form part of the discussion.
Quiz
Understanding what is meant by Spirituality
1. Spirituality is the same as religious beliefs:
False though for some people many of their spiritual needs will be met by
their religious beliefs
2. Those who do not believe in a God have spiritual needs:
True even people who profess to have no faith seek purpose and meaning
to their lives
25 | P a g e
3. Name five reasons why spiritual needs may be ignored.
Suggested answers are below but this is not an exhaustive list and learners
may have others to add.
This can be for many reasons. Care workers may feel
•
•
•
•
•
•
•
•
•
•
This is an area for experts only
They do not understand what spirituality is
Think that spirituality refers only to religion
Feel it is intrusive to discuss such personal matters with an individual
they care for
Worried that questions will be asked they cannot answer
They have never thought about what their own spiritual needs are
That they will not know how to help someone whose ideas and
beliefs are different from their own
They may not know where to look for help and support –this will be
discussed further later in the unit
They may worry they may not be able to meet the needs they find
They have not have enough training about spirituality
4. Give five examples of what spirituality may mean to an individual.
Again this is far from an exhaustive list but suggestions are:
• Different people will think of different things when asked to say what
spirituality means.
• Some people will think about being part of a religious group and the
rituals and prayers involved
• Some people will think about the importance of relationships such as
families and friends
• Some people will think about being close to nature, walking,
gardening
• Some people will think about marking important feasts or festivals in
the year
• Some people will think of special celebrations such as birthdays or
anniversaries
• Some people will think about helping others, being involved in their
community
• Some people will think of taking part in hobbies and being creative
5. Write a sentence that shows how spirituality, religion and faith are
linked.
Should include something about religion meeting spiritual needs for some
people but not all and that everyone has beliefs (or faith) of what life and
death mean to them. The learner may also include that faith is having a firm
belief even in the absence of concrete evidence.
26 | P a g e
6. Write a sentence showing how you understand people’s previous
experiences of spirituality, religion or faith may affect how they view
spirituality now
May look at culture, religion, major events in life, prospect of facing death
7. Write a short paragraph identifying how an individual’s emphasis on
spiritual needs may vary at different stages of their life. Include your
thoughts on why spiritual needs may be particularly important at End
of Life.
May include following cultural and religious beliefs as a child as part of
upbringing
May include questioning these beliefs as you experience the world
May include effect of major life events such as relationships, parenthood,
and losses. Illness, disability
Reaching end of life being a chance to reflect on their life, to find purpose
and meaning in living, to understand their beliefs about what may happen
after death, to find peace by preparing to say goodbye to friends and
families, possibly to resolve old conflicts, chance to fulfil some last wishes,
chance to organise their wishes with regard to care and last hours of life,
possibly to organise funeral wishes.
8. In the clip you viewed above ‘Says she is probably a humanist’ the
lady talks of others telling her they are praying for her or offering to
pray with her –what do you think of these offers within your
professional role?
Reflect on importance of respecting others and not imposing your own
beliefs. There have been some high profile cases in recent years where
professionals have been disciplined for imposing their beliefs e.g offering to
pray with an individual and the tutor/assessor may wish to use these
examples in discussion.
27 | P a g e
Write notes here about what you have learnt
so far. This will help you prepare for the
discussion with your tutor/assessor.
The notes above reflect
the learning indicated in
the previous section and
should summarise the
notes prepared
28 | P a g e
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
29 | P a g e
Activity 1 - Resources
Web resources
www.dementia.stir.ac.uk go to library and information services and click on
Dementia Now tab at top of page
http://bureauquery.funnelback.co.uk/search/search.cgi?query=spirituality&collection=rcnmeta&form=
www.healthtalkonline.org/Dyingandbereavement/LivingwithDying
Activity Sheets
Quiz
Scenario sheet
Power Points/ Lesson Plans
Pre course assessment
Lesson plan
Power point
Quiz
Scenario sheet
E- learning Resources
www.scie.org.uk -enter ‘scie spirituality’ in search engine and you will reach
Dementia Gateway and information about spiritual care to work through
Further Reading
Department of Health End of Life Care Strategy (DH 2008)
Royal College of Nursing –Spirituality – www.rcn.org.uk
www.e-lfh.org.uk
Social Care and Wellbeing –Policy on Spirituality in Social care via Google search
Spiritual Care: enter www.nes.scot.nhs.uk and search ‘spirituality’
30 | P a g e
Activity 2 – ‘An Individual Experience’
__________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones Learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Q&A and reflection
Assessment Type: Knowledge
Tutor/Assessor Guidance:
This section asks the learner to look at what is important to them in life.
The questions do not require the learner to disclose very personal issues such as
religious beliefs. The questions are posed in a way that asks the learner to look at
what gives them pleasure in life, what customs or celebrations are important to them,
what supports and helps them in difficult times and what is most important in their life.
Some learners will include their religious or spiritual beliefs and the tutor needs to
recognise that they may need support in understanding how these beliefs can impact
on their work role.
The purpose of this activity is to start the learner thinking about what it feels like to be
asked this sort of question in preparation for talking to their clients.
It is a chance for learners to start to reflect on their own beliefs and what gives
meaning and purpose to their life. This will help them to start to look at what could be
important to the individuals they care for and is preparation for looking at how they
can meet the spiritual needs of those individuals.
It is a useful point to start to discuss the sensitivity of discussions about spirituality.
The learners are asked to look at if there are some things they have chosen not to
share with you and who they might feel comfortable sharing these things with.
This exercise should help the learner to see how spiritual needs are individual to each
person. It may be useful to discuss how they would feel if people held very different
views from their own.
By telling the learners they may choose not to disclose some aspects, they can start
to understand that any individual they care for has: 1. The right not to discuss certain
issues and the learner should be aware this needs to be respected. 2. An individual
may feel more able to disclose personal wishes and fears to one person and not
another. The person they choose to speak to will have built up a trusting relationship
with that individual. It may or may not be any particular care worker.
31 | P a g e
Activity 2: An Individual Experience
Approximately 2 hours and 30 minutes
‘In every human being there seems to be a spiritual dimension, a quality
that goes beyond religious affiliation that strives for inspiration, reverence,
awe, meaning and purpose’ Murray and Zenter 2003 from
e-lfh materials
In this section you will have the opportunity to explore your own beliefs
and identify what is important to you.
We know from research that a lot of health and social care workers
recognise the need to support the spiritual needs of those they care for
but do not have the confidence to do so.
Understanding the role spirituality plays in our own life can help us to
recognise spiritual needs in others. It gives confidence that we know what
is important to us as individuals and fellow human beings.
As we will see from the models discussed below the amount of support
we can offer personally may vary.
The assessment of spiritual needs may lead us to realise other agencies
are required to provide support. Realising that we are part of a wide care
team can take away a lot of the concerns about supporting spiritual
needs. The important thing is to recognise that people have spiritual
needs and to ensure appropriate support is in place.
Answer the following questions (add your answers to the diagrams):
There are certainly no right and wrong answers to this. The learner should
be encouraged to think as widely as possible about the answers to these
questions.
It may include firm views and beliefs including religious beliefs. It may
include hobbies, creative activities, being able to enjoy nature and the
outdoors. It may include the support of friends, family, belonging to groups
who share the same interests in life.
The learners may use drawings or spider diagrams here to illustrate their
answers.
32 | P a g e
Walking
by the sea
What gives you
pleasure and
help in life?
What customs,
celebrations or
beliefs are
important to you?
What supports
and helps you in
difficult times in
your life?
What is most
important to
you in life?
33 | P a g e
You may have deliberately not included some things because you did not
wish to let the assessor know about them. Perhaps that is because they
are not a person you know well or because you do not feel it is relevant
for them to know some things about you.
It is natural to protect ourselves by only letting people know what we want
them to. How much we reveal will depend on how we view or feel about
the person we are with.
Think
about
Can you think of people you would be happy to share these
things with?
May be family, friends, a religious representative or
members of a similar belief community.
The learner should also be encouraged to think about how
sometimes, especially with end of life issues, it may be
easier to share them with someone who is not too closely
emotionally involved. There may be a fear of upsetting
family/friends
which things are more personal and harder to share with others and write
your thoughts in the space below.
What is it about that relationship that makes it easier to share
these things, which are important and personal to you as an
individual?
These private and personal areas or thoughts can include our religious,
cultural or spiritual beliefs. It is important to recognise that not everyone
will want to share this very personal information.
•
You may have identified there are some things you would share
with family or friends who share the same values or beliefs as you
or will understand your different point of view
34 | P a g e
•
You may have identified a religious or cultural representative who
will understand your beliefs or may have answers to important
questions
You will certainly have identified someone you can trust and who will not
judge your thoughts and beliefs.
The right of any individual
not to share their spiritual
beliefs must always be
respected.
This is not an excuse though to ignore spiritual needs or not be prepared
to support any individual to meet their spiritual needs.
Support may be directly given by you or it may involve asking others to
help. We will explore involving others in spiritual care later in this module.
‘Meeting spiritual needs is everyone’s responsibility. It is an important part
of person centred care’ Scie website accessed 2/13.
In meeting those spiritual needs we need to respect religious, cultural and
spiritual beliefs.
“Support people with the same
respect you would want for
yourself or a member of your
family”
(The Dignity Challenge DH
2006)
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
|Page
activity. Remember – these are highlighted green in the grid at the start of35
each
activity.
Activity 2 - Resources
Web resources
Nil
Activity Sheets
Exploring your own Spirituality questions
PowerPoints/ Lesson Plans
E- Learning Resources
Nil
Further Reading
36 | P a g e
Activity 3 – Life Story
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Written and pictorial information
Assessment Type: Knowledge and Competence
Tutor/Assessor Guidance:
In this activity the learners are asked to work with an individual to create a life story.
There are various activities in preparation for this.
Firstly the learners are asked to read the poem ‘Crabbit Old Woman’.
No specific questions are attached to this but the purpose of the exercise is to help
the learners realise that the individual they care for has had a different life before
age, illness or disability altered them. The tutor/assessor may wish to discuss this
with the learner particularly in regard to the individuals the learner is caring for.
There is a video clip on youtube that illustrates this poem –it has not been included
for the learners as there are some emotive comments that have been added and
may cause distress to lone learners but the tutor/assessor may like to use in the
classroom. Likewise a reply to the poem can be accessed online and the
tutor/assessor may also wish to use this in a classroom setting.
Next the learners are asked to consider difficult questions that they may be asked
so that they can be prepared to deal with these in a positive and supportive
manner.
To support this they are directed to an e-learning clip about dealing with difficult
questions.
Before collecting the life story there is guidance to the learners in the workbook
about issues to be considered before undertaking this activity. The learners should
have read and understood these and ensured they are familiar with any relevant
local policies.
There is specific guidance for those working in domiciliary care who may be less
familiar with collecting life stories and who may not have the opportunity to gather
information in a specific interview with an individual.
Learners are asked to write a life story with a resident to contribute to identification
of their spiritual needs (this may include pictures and drawings as well as words). In
the case of the individuals being cared for having dementia, the family the friends
can help with the life story.
37 | P a g e
§
§
§
§
§
Learners are encouraged to recognise the importance of building professional,
trusting relationships with individuals
Learners are encouraged to understand that they may not be able to meet an
individuals’ spiritual needs and may need to involve others
Learners are instructed in the importance of listening and picking up clues from
pictures or artefacts about what is important to that individual
Learners are instructed about the importance of respecting the individual
including the right not to share information about their spiritual beliefs
Learners should review the questions in the handbook before writing the life
story with the individual
Once the learner has collected the information they are asked a series of questions
to help them identify areas of relevance to the spiritual care of that individual. The
questions help to consolidate the learning so far and include asking them to think
about end of life issues and finally to identify one thing they can change to support
that individual’s spiritual needs.
Finally in this section the learners are asked to consider a scenario relating to the
importance of recognising spiritual needs and the importance of anniversaries to an
individual.
In this section we will continue to explore how spiritual needs can be identified so
that a plan can be made for each individual for the best way to meet those needs.
“How do you provide the right care to individuals if all you know is their age, state of
health and disability? All too often this can happen if we don’t know the uniqueness
of that life.” www.communitycare.co.uk
Everybody has a life story. Telling their story can be important to an individual
for many reasons.
•
•
•
•
•
•
•
•
It can give them back a sense of their own identity that may have been
lost because of changes in health that have limited their independence.
This may include serious illness, facing the end of life or disability
To help cope with changes in circumstance such as the need to enter a
care home or be cared for in their own home
It can increase self esteem as they remember who they were e.g. their
job, their role in their family or community
It can help to identify how they have developed their understanding of
life
It can help to identify what is important to them
It can help to identify what gives them hope and pleasure
It can help the individual make sense of their life and the stage they are
at now
It can help them to plan for the future and make sure their wishes are
known.
38 | P a g e
“The diagnosis of a life threatening disease or knowing that they are approaching the
End of Life can raise unsettling questions for some individuals. Some people may reexamine their beliefs whether spiritual or religious in nature. Other people may take
comfort in their religion and its associated rituals.”
“Remembering and revisiting the past can help to make sense of the future. It
enables the individual to identify what their priorities in life are. This is particularly
important as End of Life approaches and there is limited time to fulfil any last things
you want to do.”
(e-lfh)
These things may be as simple as a visit to a favourite place. They may involve
contacts with family and friends and the opportunity to say goodbye. For some
people it may be about resolving a quarrel or conflict from the past. Other people will
to think about what they want to happen in the last hours of life; who they want to be
present and any special requests such as a favourite piece of music to be played.
Many people take comfort from knowing that their funeral arrangements are in place
and will be conducted according to their wishes.
When we think about end of life we often consider older people who are able to look
back over a long life. It is important to remember that younger people may die as
well. It can be harder as carers to help them face a shortened life; especially if they
are near our own age. For many people who are younger the important things are to
ensure that their family will be able to mange without them. They may wish to
complete practical things such as leaving letters to be opened in the future so they
will not be forgotten. If they have young children they may want to leave items and
photographs for them to look at in the future when memories are not as clear of the
person who has died.
The beliefs people hold about death affect the meaning they give to life.
The telling of these life stories can help others to understand who that person was
before they were ill, what is important to them, what has happened to them to
influence how they view living and dying, what their beliefs and cultural practices are.
Undertaking life story work enables carers to see people as individuals and in the
context of their relationships with others. Knowing about the person before they were
in need of care enables the carer to see beyond how the individual now presents.
In this way their unique identity is uncovered and preserved.
Activity 3: Life Story – Life Story
Approximately 5 hours and 30 minutes
Read the following famous poem ‘Crabbit Old Woman’
This poem is now thought to have been written by a nurse – Phyllis
McCormack in 1966. For many years though it was thought to be
anonymous and written by an old lady in a nursing home as she
looked back over her life. It was said to have been found in the old
lady’s locker after she had died.
39 | P a g e
What do you see, what do you see?
Are you thinking, when you look at meA crabbit old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her food and makes no reply
When you say in a loud voice,
I do wish you'd try.
Who seems not to notice the things that you do
And forever is losing a stocking or shoe.
Who, unresisting or not; lets you do as you will
With bathing and feeding the long day is fill.
Is that what you're thinking,
Is that what you see?
Then open your eyes,
nurse, you're looking at me.
I'll tell you who I am as I sit here so still!
As I rise at your bidding, as I eat at your will.
I'm a small child of 10 with a father and mother,
Brothers and sisters, who loved one anotherA young girl of 16 with wings on her feet,
Dreaming that soon now a lover she'll meet,
A bride soon at 20- my heart gives a leap,
Remembering the vows that I promised to keep.
At 25 now I have young of my own
Who need me to build a secure happy home;
A woman of 30, my young now grow fast,
Bound to each other with ties that should last;
At 40, my young sons have grown and are gone,
But my man's beside me to see I don't mourn;
At 50 once more babies play around my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead,
I look at the future, I shudder with dread,
For my young are all rearing young of their own.
And I think of the years and the love that I've known;
I'm an old woman now and nature is cruelTis her jest to make old age look like a fool.
The body is crumbled, grace and vigor depart,
There is now a stone where I once had a heart,
But inside this old carcass, a young girl still dwells,
And now and again my battered heart swells,
I remember the joy, I remember the pain,
And I'm loving and living life over again.
I think of the years all too few- gone too fast.
And accept the stark fact that nothing can lastSo open your eyes, nurse, open and see,
Not a crabbit old woman, look closerSee Me.
40 | P a g e
The lady who wrote this poem was asking the people caring for her to
look beyond her present illness and remember she was once young.
She talks about different stages in her life.
It is easy just to see the person as we know them now. To see them
as a person who is vulnerable and in need of care. This poem
highlights the importance of looking beyond that and recognising what
is and has been important to that individual. Looking at an individual’s
life story can allow us some of that sight of the person before they
became in need of care.
There are no specific questions related to this poem. It is meant to
start the learners thinking about how the person they see today has a
history and a story to tell about their life. Sometimes it may raise
strong emotions in the reader and the tutor should be prepared to
discuss the poem if the learner wishes to.
Family and friends can also prepare life stories where a person cannot voice their
own story –for instance for those people with dementia or other cognitive
impairment.
In many care homes the gathering of life story information forms part of the initial
assessment process or even part of the pre admission process.
In the domiciliary care setting you are unlikely to have the opportunity to sit with the
individual specifically to gather the life story information. The story will be built up as
you talk to the person on your visits and perform their care. Remember you are a
guest in their home so make sure to respect the individual’s privacy but talking about
pictures or items in the home can be a good way to open conversations.
Listening to and gathering life stories can be useful because:
•
•
•
•
•
•
•
It can be a way of understanding how an individual feels about their
experience of their illness or disability
It helps staff to understand that individual and know the best way to support
them
A person may feel less vulnerable if they feel the staff are taking an interest in
them as an individual
It can help the individual to prepare for the end of life and make their particular
wishes known
It can help staff to work with dementia patients by reminding them of past
events.
It may supply information that can help the family to remember the person as
they were before the illness
It can be a lasting reminder of that person for the family who are left.
41 | P a g e
Before undertaking the task below there are some important points to remember
about collecting an individual’s life story.
•
•
•
•
•
•
•
•
•
•
•
The individual or the person acting in their best interests must give consent
The individual must be made aware and agree to how and with whom the
information will be shared
The individual must be aware they do not need to tell you anything they do not
want to
Talking about their life history can be tiring especially if individuals are ill or
frail so short several conversations are best. In fact life stories are often built
up over long periods of time
There must be a quiet and private place to speak to the individual
The individual’s dignity must be maintained at all times. The conversation
should stop if the individual wishes it to
It is important to listen rather than interrupt
You must be prepared that the individual may take this opportunity to ask you
questions that you cannot answer. Do not try to answer if you are not able to,
be prepared to ask for other support for that person
Ensure you listen carefully and record information accurately. It can help to
pause at intervals and recap what has been said to ensure you have
understood correctly and identified what is important to that individual
The individual may disclose information that it is not appropriate for others to
know and would not improve the quality of care. Agreement should be
reached with the individual to give them the opportunity to leave out certain
areas.
Safeguarding issues may be revealed
You should be aware of your
local safeguarding policy and
your role as an ‘alerter’
It is a good idea to read this
again before undertaking this
activity.
Before undertaking the activity below, complete the following tutorial,
which will help you to think about how you might deal with difficult
questions. Go to www.helpthehospices.org.uk/clip/index.htm and click
on the ‘Answering difficult questions’ tutorial.
To make sure you are prepared to talk to the individual, think about and
write down some of the difficult questions you might be asked that you
can’t answer and think about your response. You are less likely to be
taken by surprise if you have thought about this in advance.
42 | P a g e
What
happens
after death?
Why me?
Am I
dying?
Difficult questions
I might be asked
How
long
have I
got left?
Is my illness a
punishment?
I wish
it were
all over
The learner may identify other questions.
There are no definite answers to many of these questions. Do not try to
impose your beliefs. Acknowledge their question. Reassure them that
they are not alone in asking such questions. Think about other support
that can be offered.
Activity 3: Life Story – Service User Life Story
Prepare a life story with an individual you care for to allow them to
identify what is important to them. Take note of their spiritual needs.
Gathering a life story is about listening to that individual tell you about
their life in their own words and in their own way.
A life review or life story is:
•
•
•
•
A process which allows a person to reflect on the course of
life events… may give new and significant meaning to one’s
life: it may also prepare one for death, mitigating one’s fears
(Butler 1974)
Not a random sharing of past events but a structured
process enabling evaluation of those events
Can provide emotional and spiritual support to those who are
dying and their families
Helps families and carers cope better with bereavement
You may already have a template in your place of work to help you
43 | P a g e
collect this information. If so do use it and compare it with the
suggested areas of information to be collected listed below. You may
decide your present paper work is better or that you would like to
suggest some changes.
If you do not presently collect this information you may wish to look at
some existing templates or devise your own.
There are also some nationally produced templates
• This is Me www.alzheimers.org.uk/thisisme
However you choose to record the information you should consider
the following:
•
•
•
•
Childhood –earliest memories, family life, brothers and sisters
Adulthood –important events, work and what it meant to you,
important relationships, hobbies and pastimes, achievements,
obstacles overcome.
Overall –happiest moments, most important things, any regrets,
what sort of person do you think you have been
Here and now –What’s important to you
What worries you
What helps you cope
What do you want to be remembered for
Futures wishes, hopes or requests.
In the case of individuals with dementia the history can be obtained
from family and friends.
Use photos and objects to spark memories and learn more about the
individual.
Remember you are thinking about the life story in terms of spirituality.
Q
What did you learn about their spirituality?
May include religious beliefs
May include who is important to them
May include what is important to them
May include hobbies, pastimes
Q
Are there any past events or experiences of spirituality,
faith or religion that you feel may have affected or led the
individual to their current spiritual beliefs?
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The examples given will be specific to the individual whose life
story has been recorded but there may be some of the following
included
• Childhood –earliest memories, family life, brothers and sisters
• Adulthood –important events, work and what it meant to you,
important relationships, hobbies and pastimes, achievements,
obstacles to overcome.
• Overall –happiest moments, most important things, any regrets,
what sort of person you think you have been
• Here and now –What’s important to you
What worries you
What helps you cope
What do you want to be remembered for
Futures wishes, hopes or requests.
Q
Did you identify any issues relating to End of Life that may
form part of your care planning for this individual?
This may include wishes such as not to die alone, to have relatives
contacted when they are near to death, religious or cultural
observances. It may link to decisions to discontinue active treatment
or to decide that they do not want resuscitation if their heart stops- this
should lead the learner to consider who else needs to be involved e.g.
doctor and what paperwork would need to be completed.
Q
Was there anyone in particular whose values and beliefs
had an effect on the individual’s beliefs and values from
their life story? Explain how.
People may find comfort in their religious or cultural upbringing as
they face end of life even if they have turned away from this in the
past. Familiar ceremonies or prayers or chants may bring comfort to
people even if they are not active in their spiritual community.
A particular spiritual leader or community may have offered support at
a difficult time in their lives e.g. when someone close to them died.
Q
Now you have learnt more about the individual and their
spirituality, is there anything you can change in their
environment to help them express their spirituality?
45 | P a g e
This is an opportunity for the learner to relate theory to practice. The
example(s) given should be something the learner has the power to
change or organise. Encourage the learner to be as creative as
possible.
Remember small changes can make a difference to someone’s life.
Consider the scenarios below.
For each scenario below, write what small changes you could make to
improve the environment for the person.
John had expressed his love of the countryside but was
now confined to a wheelchair and living in a care home.
Solution:
Arrange for him to go on outings from the home
Mary said she had been part of her local church for years
and felt the vicar ‘knew a thing or two’ but she was no
longer well enough to go to services.
Solution:
Arrange for that particular vicar to visit her
46 | P a g e
Mustafa said his religion stated that on certain days he
could only eat vegetarian meals but he found it difficult to
achieve with the food on offer at the Home.
Solution: discuss his needs with the cook to ensure
they are catered for.
After you have completed the life story with your service user, support
them to make at least one change that allows them to explore and
express themselves and their spirituality further and complete the
paragraph below.
Remember that there are many definitions of spirituality. As you
choose an example it may relate to religious concerns or it may relate
to anything that gives meaning and purpose to life.
Complete the paragraph:
I supported the service user to make a change
that allowed them to explore/express themselves
and support their spirituality by....
Suggestions are: take part in hobbies/activities in Home;
arrange visits outside home; arrange for favourite music or books to
be available; contact friends/family who may have lost touch; arrange
for spiritual leader to visit; arrange for continued attendance at local
groups they have belonged to.
Now read the following scenarios.
Scenario one
Mrs A was a very friendly lady who always welcomed the care
workers who visited her. She was usually ready with a joke when they
arrived and seemed interested in their lives and families. They found
her easy to talk to about their own families and concerns because she
seemed so interested in them.
One November the agency was surprised to get a complaint from Mrs
A about one of the care workers. Mrs A stated she no longer wanted
47 | P a g e
this member of staff in her home. This care worker had been visiting
for nearly a year and there had never been any other problems. It was
decided that the best thing was for that staff member to move to other
duties and a new care worker started to visit.
Mrs A got on well with the new care worker and all went well until the
following November when the agency again received a complaint from
Mrs A, who said she no longer wanted that care worker to visit. The
manager of the agency was puzzled and arranged to visit Mrs A
personally to discuss the letter.
When she arrived, Mrs A had a visitor from a local bereavement
charity with her. Mrs A asked the bereavement visitor to stay for the
discussion. The bereavement visitor was there because Mrs A lost her
husband in the month of November and always got upset during this
month
Think about how the situation could have been avoided and write
down your thoughts on the following in the box below:
1. Do you think the lady was aware of why she acted as she did?
2. What is the importance of anniversaries?
3. What were the benefits of having the opportunity to
communicate with someone from Mrs A’s community group?
4. Could the staff have helped the lady with her spiritual needs in
relation to the loss of her husband?
Write your thoughts down here:
No –this was probably a subconscious act. The lady felt
sad at this time and no one but she seemed to care
about her sadness so she ‘attacked’ those nearest.
Anniversaries are important as ways of marking events.
In this case part of the bereavement process is to
remember especially when she lost her husband. Even
though she may remember him every day the
anniversary heightens the feelings of loss and brings
back sad memories.
If the staff had listened more rather than sharing their
own lives they might have realised how important the
anniversary and the chance to remember her husband
was. They might have arranged to spend extra time with
her that day to talk about him or possibly arrange for her
to send flowers to a grave or however she chooses to
mark his passing.
It may not have been possible to avoid this situation. The important
thing is to remember how important it is to give the individual
opportunity to discuss what is important to them and to listen carefully.
Knowing who else was involved in the lady’s care is also important.
48 | P a g e
Scenario two
It was Christmas day and all the staff were wearing tinsel in their hats.
Mrs G had stated that she wished to remain in her room that day. The
carer was concerned that she would miss out on all the fun and
festivities that had been planned to celebrate the day. He said ‘Come
on now Mrs G you will have a good time’ and began to wheel her
towards the lounge. Mrs G. became very distressed. The manager
noticed what was happening and asked the carer to respect the lady’s
decision not to join in. She later told him that Mrs G was a Jehovah’s
Witness
Think about and write down your thoughts on the following in the box
below:
1. What significance do Mrs G’s religious beliefs have regarding
her care?
2. How could the carer have dealt differently with the situation?
3. What influence did the carers own beliefs have on the
situation?
4. How could the home have made sure everyone was aware of
Mrs G’s wishes?
Jehovah’s witnesses generally do not mark Christmas.
They do not celebrate or send cards or presents. The
lady felt under pressure to join in with beliefs other than
her own.
If the carer had known of her beliefs and talked to her
about how she as an individual practised her religion
they would have been aware of her wish to remain in
her room and apart from the celebrations
The carer did not see the situation from another
person’s point of view. They assumed that everyone
celebrated Christmas as they do.
Communication and having a care plan that included her
personal beliefs and wishes could have avoided the
situation –the manager appears to have been aware but
did not communicate this to her staff.
Much of the work on using life stories to ensure that care is individual
and appropriate has been done in settings where people have
dementia. It is particularly useful in dementia, however, the scenarios
you have just completed show the importance of understanding the
spiritual beliefs of and recognising what is important to every person.
Watch this video clip and see how looking at individual needs in a new
way can give new meaning and purpose to an individual’s life.
It demonstrates that sometimes risks, suitably assessed, need to be
49 | P a g e
taken to improve the quality of an individual’s life.
Giving meaning and purpose to life can give a spiritual peace to that
person.
www.myhomelife.org.uk/reources/8-key-themes/
Watch the clip entitled Maintaining Identity
Write here any thoughts you have after watching the video clip.
Perhaps it has given you an idea about how you could help someone
you care for. Write down how you can help.
The learners are asked to look at a video clip that shows how a very
innovative way of allowing a resident to be involved was implemented.
The gentleman with dementia was able to help with decorating the
home and when he could not be supervised was given a brush with
plain water so that he was not doing any harm.
The purpose of this is to encourage the learners to think about
imaginative ways in which individuals can find meaning and purpose
in life.
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
50 | P a g e
Activity 3 - Resources
Web resources
This is Me www.alzheimers.org.uk/thisisme
www.myhomelife.org.uk/reources/8-key-themes/ and watch the clip entitled
Maintaining Identity
Activity Sheets
Difficult questions
Crabbit old woman poem
Writing a life story
Scenarios 1 and Scenarios 2
PowerPoints/ Lesson Plans
Lesson Plan
E- learning Resources
www.helpthehospices.org.uk/clic/index.htm and click on the ‘Answering difficult
questions’ tutorial
www.macmillan.org.uk -search on spirituality and select the section ‘How to talk to
and be
www.myhomelife.org.uk/reources/8-key-themes/ and watch the clip entitled
Maintaining Identity
Further Reading
Dying matters –www.dyingmatters.org.uk 5 Things to do before I die postcards
And 5 things I want to be remembered for
www.dementia.stir.ac.uk
and go to library and information and select life story work
51 | P a g e
Activity 4 – Care Plan
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones Learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Planned activity
Assessment Type: Competence
Tutor/Assessor Guidance:
This activity will involve an observation of work products produced by the learner.
Learners are asked to provide an example of a care plan that identifies spiritual needs
at EOL
§
§
§
§
Learners will be encouraged to identify if there is already a care plan in their work
place that identifies and plans spiritual care
Ensure that guidance regarding the use of confidential information is followed
Learners will be encouraged to adapt the care plan or devise a section for spiritual
care planning as appropriate
The learner may not be in a position of being able to make changes to the method
of care planning but is encouraged to discuss with their manager if changes are
needed to reflect spiritual care planning
Activity 4: Care Plan
Approximately 3 hours
Provide an example from a care plan you have completed or contributed to that
ensures spiritual needs at End of Life are identified.
Answer the summary questions below.
You may want to look at the care plan template used in your place of work –
does it clearly address spiritual needs? What could you do to make sure
52 | P a g e
spiritual needs are always addressed with individuals?
Could you adapt an existing care plan template or produce a new section
which clearly identifies the spiritual needs of all individuals at your place of
work e.g if the section presently only asks for religion could this be changed?
You may not be able to make the change yourself but could open discussions
with your manager.
Q
How does the care plan ensure the spiritual needs of the
individual are being met?
Answer should include:
• Lets others know of wishes
• Enables appropriate plans to be made
• Individualises spiritual needs for that person
• Allows review of needs to see if they still meet the individuals needs and
wishes
• Identifies who else needs to be involved
Q
How did you/could you improve the care plans used in your
place of work to address spirituality for all service users?
Often care plans do not specifically mention spiritual needs and a section may
need to be added for this
May only ask for religion with no indication of how the individual follows their
beliefs or if they actively practise that religion
There may not be a section for hobbies, pastimes, who or what is important to
that person.
Q
Refer to the life story you completed in Activity 3 – did you
learn anything about the service user which you think
needs to be addressed in their care plan?
Individual to each case. Below are some suggestions
May have uncovered unmet needs such as
• Needing to talk to other professionals about their condition
• Needing to contact family or friends especially if they have been
estranged
• Need to re engage with the community they were in before illness or
disability e.g. clubs, pastimes, religious organisations
• May want to have closer involvement with a religious or cultural leader
from their faith.
• May have wishes they want to fulfil before they die
• May wish to organise funeral, ensure that relatives who are left will be
cared for
• May want specific things at end of life e.g. not to be alone, to have visit
from religious representative, to have particular music played
53 | P a g e
This video clip is an example of good practice in meeting the spiritual needs
within end of life care.
Watch the video clip Supporting Good End of Life Care
www.myhomelife.org.uk/resources/8key-themes/
How did the care planning reflect the spiritual needs of the couple?
The couple had been married a long time and relied on each others’ company
and support
How were these spiritual needs met?
The couple were allowed to remain in a room together even though he
was nearing end of life. The lady was able to get into bed with him if
she wished, offering them both the comfort of touch and closeness and
knowing they were not alone
Why was it important to look at the needs of these people as a couple?
The couple had spent many years together. There spiritual needs were
intertwined in that each gave meaning and purpose to the life of the other.
How was the dignity of the couple maintained?
The couple were given privacy in their room. They were respected as
a couple and no attempts were made to part them. The lady was able
to be involved in caring for her husband as much as she was able and
wished to do so.
When he died she was shown dignity and respect by being involved in
a ceremony to mark his death even though she had dementia and it
was difficult to know how much she understood.
Who was involved in caring for this couple?
The couple continued to care for each other.
The staff at the Home
Other residents
Family members
Health Care professionals.
54 | P a g e
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
55 | P a g e
Activity 4 - Resources
Web resources
www.myhomelife.org.uk/reourcewww.myhomelifes/8-key-themes/ and watch the
clip entitled Maintaining Identity
Activity Sheets
Questions for care planning
Questions from video clip
PowerPoint’s / Lesson Plans
E- learning Resources
Further Reading
www.nice.org.uk and search on spiritual care
www.nhs.uk/Planners/end-of-life-care/Pages/End-of-life-care.aspx enter
spiritual care in search
56 | P a g e
Activity 5 – Observation and Reflective Account
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones Learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Reflection on own practice in real work environment
Assessment Type: Knowledge/Competence
Tutor/Assessor Guidance:
This activity includes an observation of practice. It is important that the observation is
not intrusive for any people concerned in the visit addressing spiritual needs is a
sensitive and personal area of care. The learner should follow a plan of care for the
individual and examples of observation might be that the learner ensures the individual
has familiar pictures near them or supports the individual to undertake particular
activities that are important to that individual.
Learners must also write a reflective account of how they have cared for the spiritual
needs of an individual highlighting how their views were similar or different from the
learners
§
§
Learner will select an individual they have worked with
Where there are similar spiritual needs, the learner should be encouraged to
explore how they would feel if this were not the case and how they would cope in
that situation
Activity 5: Observation and Reflective Account
Approximately 2 hours
You will need to work with your assessor to plan an observation of your
practice in the work place. Your assessor will want to see you
supporting a service user to participate in their chosen activities to
support their spiritual wellbeing. It will be the responsibility of both you
and your assessor to ensure that the observation is not intrusive and
does not impact on the dignity of any service users.
To prepare for the observation write a reflective account of how you
have cared for the spiritual needs of an individual. Highlight how their
57 | P a g e
views were similar or different from your own.
You should reflect on:
• Was it difficult not to give your personal views on spirituality and
the end of life?
• How your values and beliefs may have impacted on the individual
when communicating with them, including non-verbal
communication
•
•
•
How did you care for their spiritual needs? Did you help them
participate in certain activities they wanted to do?
How did you feel helping them to participate in such an activity
and how did you communicate this?
Was your role to involve other support for the person?
If so who else was involved and how did they help the individual.
You may choose to look at the individual needs of the person whose life
story you wrote.
You may choose to write about someone else you have met in your
caring role.
Remember that gathering a life story only gives a brief snap shot of that
person. As you continue to work alongside that person the relationship
between you will grow.
Often it is a chance conversation that leads to identifying and being able
to care for spiritual needs.
It is perfectly normal and acceptable for people to have different views
on spirituality; what is important is how everyone’s needs are respected.
Make sure you record any difficulties you may have felt and how you
dealt with them.
In a reflective account you should record your thoughts and feelings and
how you dealt with them.
Should include factors relating to the above bullet points.
The piece should also include what they have learnt from undertaking
this exercise and what they might do in a similar way or do differently in
future.
58 | P a g e
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
59 | P a g e
Activity 5 - Resources
Web resources
Activity Sheets
Reflective Account
PowerPoints/ Lesson Plans
E- Learning Resources
Further Reading
60 | P a g e
Activity 6 – Reflective Account
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Reflective Account
Assessment Type: Knowledge
Tutor/Assessor Guidance:
Learners must write a reflective account of how they care for their own needs to
enable them to continue in their caring role.
§
§
This need only be a short account (approx.150 words) but it is important learners
identify their own support both professionally and away from work. They should
include people to talk to; any group sessions in workplace; hobbies and social
activities that allow them to cope with the emotional nature of their work
Learners appear reluctant to focus on their own needs and often need
encouragement to complete this section
Activity 6: Reflective Account
Approximately 1 hour and 30 minutes
Write a reflective account of how you care for your own spiritual needs
to enable you to continue in your caring role.
Think about:
• How you feel your spiritual needs, beliefs and values may have
been affected when meeting those of the individuals you are
caring for at the end of life.
Providing care for others can be emotionally demanding and tiring for
the care worker. It is not possible to continue caring for others unless
we take care of our own needs.
It is important to identify who is able to support you at work.
61 | P a g e
Identify who you go to for advice and support.
It is important to identify who is able to support you outside work –
remembering that what happens at work must remain confidential.
It may be that your spiritual needs are very different to those you are
caring for. In meeting those needs, our own beliefs and views may be
challenged.
How do you continue to hold your own beliefs while respecting those
of others?
You may also want to think about your spirituality may have changed
as a result of meeting the spiritual needs of others.
Remember, spirituality is about everything that gives your life purpose
and meaning. How do you use your social activities and interests to
ensure you have a release from caring and can remain well and able
to continue supporting others?
The purpose of this piece is to enable the learner to recognise the
importance of having support to allow them to continue in an
emotionally demanding role
Sometimes caring for others leads us to question our own beliefs or
alternatively to hold them more strongly.
Supporting the spiritual needs of others, especially at end of life can
be very difficult and raise emotional issues.
The purpose of this piece is to allow the learner to recognise any
issues that have arisen about their own beliefs and explore how they
gain support at work and in their own lives.
It is important they include the things that give them happiness in life
such as hobbies and social activities that give a release from the
caring role.
Be aware that you are not there to provide ongoing support but may
need to signpost an individual if they require help from others.
Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
62 | P a g e
Activity 6 - Resources
Web resources
Activity Sheets
Reflective Account
PowerPoints/ Lesson Plans
E- Learning Resources
Further Reading
63 | P a g e
Activity 7 – Support at End of Life
___________________________________________________________________
Learning outcomes and assessment criteria
This activity links to the following learning outcomes and assessment criteria (page
5). Those highlighted green are the ones learners will cover when they have
successfully completed it.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
Assessment Method: Portfolio
Assessment Type: Competence
Tutor/Assessor Guidance:
Learners are asked to identify information available in their work place to support
spiritual care
§
§
§
May include information available to the staff in the workplace about different
religions, cultures and beliefs
May include leaflets or posters
May include information about regular visits to the home or how special
occasions are marked or celebrated
Learners are asked to provide an up-to-date contact list of outside agencies that
can support spiritual care
§
§
Details will vary dependent upon the spiritual needs identified and may include
secular or voluntary groups as well as faith organisations.
Learners are encouraged to think widely about what local and national contacts
are included
Learners must collect samples of information available locally and nationally to
provide extra information in the workplace. Examples are given in the further
reading to give you some ideas.
§
§
Learners should be encouraged to access generic information available via
websites
Encouraged to make local links with faith groups or cultural organisations
especially those relevant to their present client group
So far we have looked at gaining more understanding of what spirituality means to
an individual. We have considered how to respect and support individuals to meet
those needs. It is important that spiritual needs are met at the end of life so that an
individual can have a peaceful death. Sometimes referred to as a ‘good death’.
64 | P a g e
Having our spiritual needs met helps to provide peace at the end of life.
We have looked at the importance of allowing time to build a trusting relationship so
that an individual feels safe to express his or her spiritual wishes. We have
considered how a carer can be involved in helping to meet those wishes.
In this section we will look more closely at
• Who else may be involved in meeting those wishes
• What other agencies may need to be contacted
• How can an environment be created to support spiritual needs
Activity 7: Support at End of Life
Approximately 3 hours and 30 minutes
Who do you think might
be involved in meeting
an individual’s spiritual
needs?
This could be anyone who spends time with that individual – an
individual will choose whom they wish to speak to about spiritual
matters.
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•
•
•
•
•
•
•
•
•
The individual themselves may choose to organise how to meet
their own spiritual needs
Friends
Family
Carers
Religious or faith group leaders or representatives
Volunteers
Specialist nurses and district nurses
Hospice staff
GP
Hospital staff
You may have been surprised at how many different people can be
involved in providing spiritual support.
Did your list include the individual themselves?
People at the end of life need time not only to express their thoughts
but may wish to have quiet time to reflect on their life.
Did your list include family and friends?
Family and friends can be very important in supporting an individual. In
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some cases an individual will look only to their family and friends to
share their wishes and hopes.
Others may not wish to upset those closest to them by talking about the
future and will find it easier to talk to someone who is not so close to
them.
You have spent some time thinking about spiritual care now it is time to
think about how you will involve others and to look at your work
environment where that care takes place.
Identify information available in your workplace to support spirituality
and make a record of it stating what it is and where it is available. You
can include this record in your portfolio.
This might include
• Written information.
• Marking special events such as birthdays or anniversaries
• Marking significant religious occasions
• Considering the environment such as provision of quiet areas
and privacy
• Books of remembrance or other memorials such as coffee
mornings to allow other residents and staff to remember
someone who has died
• Special activities or outings
• Do other staff have access to information and training about
spirituality
• Do staff have support in the workplace to meet spiritual needs
e.g. supervision, talking openly.
This might include written information, marking special events, marking
significant religious occasions, the environment such as provision of
quiet areas and privacy. It might include books of remembrance, special
activities or outings. Do other members of staff have access to
information and training about spirituality?
You may have identified gaps in the information or in how accessible it
is to other staff. Collect samples of further information on spiritual
wellbeing available locally and nationally to provide extra information in
the workplace.
Add a copy of the information (or make reference to where it can be
found) in your portfolio.
This will be dependent upon what already exists in answer to the
question above
Often there is little information about other religions and culture in the
workplace
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You may find information available in your local library or community
centre or on the internet for example. Local information might be a
leaflet or booklet produced by a local spiritual, faith or religious
community group; national information could be something produced by
a charity or governing body such as Age UK or the Department of
Health.
Write down three ways you can share the information you have found
about spirituality with others in your work place.
Ideas could include –teaching sessions based on the module
they have undertaken and their extra learning.
Posters, displays,
Making discussions of end of life care, including spirituality, part
of regular staff meetings
Arranging memorial events
Looking at how staff, relatives and other residents are supported
when a death has occurred.
Looking at information available
Contacting local spiritual leaders and arranging for their
involvement with the Home
Ensuring that there is a section on the care plan about spiritual
needs and that this is used appropriately for each resident
In the sections above we have talked about the importance of
recognising that spiritual care is not supplied by any one person. We
have talked about recognising our limitations and knowing when to
involve others.
To involve others we need to know who to contact and when to contact
them. Ensure that this is clear in the care plan. If a person wants their
family with them in the last hours of life do the family want to be
contacted even if it is the middle of the night.
It is also important to have a general contact list of who to contact to
give support.
Find out if there is a contact list in your workplace of people who can
support spiritual wellbeing, if there is, you should ensure the list is up to
date and add any new relevant contacts. If you don’t have one in your
workplace you should produce one.
Place a copy in your portfolio.
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Individual to the workplace but should include:
•
•
•
•
Local religious leaders
Local chaplain (who will be trained to support many faiths and
beliefs)
Local hospice
Funeral directors
Read the following case study and identify the spiritual needs of the
individual and how they were met and what the benefits of working with
the external organisation were.
Case Study:
http://labspace.open.ac.uk/mod/resource/view.php?id=454457
Answer the questions following the case study.
To start with, read the case study through completely before looking at
the questions and then read it again and make notes after looking at the
questions you need to answer. You might find it useful to highlight parts
of the case study as you go through.
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Questions:
Li was cared for in a residential home that had some native speakers
from the same culture as Li but this may not always be the case.
How would you gain information about Li and her culture?
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•
•
•
From Li and her family
From local Chinese community
From staff with knowledge of her culture
Written information
Who would be involved in the discussions about using both
Western and Chinese medicine? What would your role be in
this?
Those involved could include
• GP and hospital medical staff
• District nurses
• Pharmacist
Your role would be to ensure that the information was carefully
documented and to liaise between those involved in her care
How could you ensure spiritual support for Li in view of the fact
she had strong cultural beliefs but also became a Baptist and
attended Western religious services?
This would need to be carried out in consultation with Li and her family.
As she approaches end of life she may wish the comfort of her new
religion and practises combined with her cultural beliefs. She may
change her mind about this at any time and this should be reviewed.
She may welcome visits from the Baptist representatives or she may
decide not to.
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With limited understanding of her language how might you
communicate with Li to relieve her loneliness?
By using non-verbal communication such as touch, smiling. By
being with Li even sitting quietly and possible holding her hand if
she welcomes this. If she is trying to communicate something
that appears important to her and the family are not available
you may need to think of using interpreters
How would you ensure that everyone was aware of her belief
that it is unwise to associate with people who are sick and
ensure this is respected?
Recording in care plan and ensuring everyone is aware of the
plan
How could you support the family during their bedside vigil?
Allowing privacy but letting them know you are close by
Providing refreshments
Possibly offering a bed near to Li if possible
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What do you think the issues were with the GP being away
and how could this have been overcome to reduce the
distress caused to the family and allow them to receive a
death certificate?
Li’s death was expected. Forward planning could have enabled
another doctor to be in a position to issue the certificate in her own
GP’s absence. This may be out of the learner’s direct control but
ensuring appropriate planning is undertaken in advance is important in
minimising distress to relatives at the time of and after death.
What support could be available to the family after death had
occurred?
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Direct support from the carers
Information about what to do next
Information about bereavement
Signposting to other services for longer term support
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Completed Activity
Now learners have completed this activity we recommend they go back to their own
evidence log on page 5 and fill in the page number and type of evidence (e.g. case
study or reflective account) for the assessment criteria they have completed in this
activity. Remember – these are highlighted green in the grid at the start of each
activity.
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Activity 7 - Resources
Web resources
Activity Sheets
Who else is involved in care
Identify information in workplace
Collect information for workplace
Case study and questions
Post course assessment
PowerPoints/ Lesson Plans
E- learning Resources
Further Reading
www.kissingitbetter.co.uk and scroll to BBC video clip
Religion and Belief matter via www.healthscotland.com
A Multi-faith resource for Healthcare staff via www.healthscotland.com
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Summary
The good news is that you have nearly completed this unit!
You have had the chance to think about spirituality, faith and religion.
You have considered how to assess and support an individual’s needs.
You have thought about the importance to the individual of different people such as
family, friends and religious leaders.
You may have been surprised that spiritual care is not something separate but is part
of everyday life and the activities that give purpose to life.
You have looked at how your work environment can be made more supportive of
spiritual needs of those at the end of life.
As a last task, repeat the assessment you completed at the start of the unit to see if
your confidence has increased and discuss this with your tutor/assessor.
Confidence level
1
2
3
4
5
Understanding what
spiritual needs are
Talking about spiritual
needs
Supporting an individual’s
spiritual needs
Supporting the spiritual
needs of those with
different beliefs or culture
from your own
Knowing who can help you
to meet an individual’s
spiritual needs
Knowing who can support
you and understanding how
to care for yourself.
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CONGRATULATIONS!
You have now undertaken all the activities in this unit.
You now need to meet with your tutor/assessor – to discuss how you might present
these completed activities as evidence towards meeting the unit learning outcomes.
1.1
2.1
3.1
4.1
1.2
2.2
3.2
4.2
1.3
2.3
3.3
4.3
1.4
1.5
1.6
4.4
4.5
4.6
1.7
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Appendix
•
Continuation sheets for photocopying as required
•
Glossary of Terms
•
Template Support Agreement
•
Lesson Plans
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Continuation sheets
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Continuation sheets
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Glossary of terms
Term
End of Life
Definition
Considered to be the last 12 months that a person is
expected to live
Assessment
Gathering information about a person’s needs and how an
illness is affecting their ability to live their normal lives.
Factors
The things, events or circumstances which will affect
something e.g. what is affecting an individual’s ability to
cope with an illness
Holistic
Holistic means considering care or assessment from the
physical, psychological, environmental and spiritual needs
of an individual.
This enables people to be treated as whole human beings
and the impact of the illness on their quality of life is also
considered.
Person Centred
Person-centred care is providing care that is responsive to
individual personal preferences, needs and values and
assuring that the individual’s values guide all clinical
decisions.
Rituals
Actions or ceremonies relating to a particular religious
belief. Examples are songs or chants or particular
ceremonies
National End of Life
Care Programme
This is a national programme funded by the NHS which
works across health and social care in England to improve
end of life care and support people to live and die well.
Humanist
Non-religious person who believes this life is the only one
we have. Believes one can live an ethical and fulfilling life
on basis of reason and humanity
Agnostic
One who believes it is impossible to know whether there is a
god or is sceptical about the existence of a god.
Atheist
One who disbelieves in the existence of a god
Best Interest Decision
This has to occur if someone does not have the mental
capacity (see below) to make a legal, healthcare, welfare or
financial decision for themselves.
This is one of the principles of the Mental Capacity Act.
The decision can only be made after an assessment has
deemed the individual doe s not have capacity.
Strict principles and codes of practice should be followed to
carry out the assessment and to make the best interest
decision, these are set out in the Mental Capacity Act.
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Support Agreement
Learners Name:
Tutor / Assessor:
Unit / Qualification Title:
Date:
Due to the sensitive nature of End of Life (EOL) care, topics may be covered that
can cause upset for example you may be asked to consider your thoughts about
your own death, or watch video clips that include the views of people who are
actually dying. Before you begin learning activities, spend some time with your Tutor
/ Assessor to complete the boxes below:
Lone study – Identify support networks (these could be friends, family, colleagues) if
you are upset by topics:
One to one – Outline how you would like to be supported if you are upset by topics:
Work based learning- Identify a mentor or supervisor to whom you can go if you are
upset by topics at work:
Class room based learning - Outline how you would like to be supported if you are
upset by topics (take in to account that your tutor / assessor will not be able to leave
the classroom):
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