Paediatric Chaplaincy Network Meeting
Spiritual Care for Sick
Children and young
people:
Good practice in relating to
children and young people
Paediatric Chaplaincy Network Meeting
The spiritual needs of sick children and
adolescents in a paediatric hospital context:
outcomes and reflections from a participation
project
Revd Paul Nash, Revd Kathryn Darby, Dr Sally Nash
Chaplaincy, Birmingham Children’s Hospital, Steelhouse Lane,
Birmingham, B4 6NH.
paul.nash@bch.nhs.uk, kathryn.darby@bch.nhs.uk, s.nash@stjohnsnottm.ac.uk.
Birmingham Children’s Hospital and Midlands Centre for Youth
Ministry.
Paediatric Chaplaincy Network Meeting
Birmingham Children’s Hospital
•260 beds
• 2,500 staff
• located in the centre of Great Britain’s second
largest city
•Birmingham population 2008 - 1.02 million
22% are 0-15 years olds(higher than national
average)
•multi-faith, multi-cultural context
BCH Participation Project
• many of your orgs with have them
• different to research, less
regularised but same good
principles; consent, open environ.
• inductive and deductive
• pilot resources / ideas
Context: whole family; whole org.
How: 1-1, small groups
Where: School, wards, clubs, play
centre, patient participation
groups
Write up as case studies and
triangulate to each other and
spirituality theory
Try ideas with well CYP groups
Ideas we started with:
• Art, music, beads
• Journal / scrap book
• Play / Godly Play
• Stories
• Pictures
• Blobbys
• Activities
• Pets as therapy
• Remember a time when….
• Parents questionnaire
• Staff questionnaire
List is endless
Paediatric Chaplaincy Network Meeting
An Action Research Project :
• staff, children and young people work together to improve spiritual
and religious care
• core activities are reflection, research and action and outcome is
improved practice
• project approved by the relevant hospital authorities
• briefing session for staff and volunteers; developed a feedback form
• voluntary informed ongoing consent
• activities took place in an open environment and the parent was
present if the child wanted this
• a convenience sample was used consisting of 12 encounters.
Our 6 “Ps”
1. Places
2. Parents
3. Patient issues
4. Participation activities
5. Principles and practices
6. Products
Participation activities
• sought to facilitate ways into the inner world, to
explore and understand the spiritual self.
• range of resources to use were developed by
the team
• team used activities that built on their own
strengths and interests where appropriate
Principles and practices of spiritual care
for sick children
1) Create spaces for spiritual care to occur and relationships to develop
2) Empowerment is a core underpinning value of spiritual care
3) Offering “episodes of spiritual care” reflects the often integrated nature of
assessment and intervention and the element of reciprocity
4) Developmental and learning context is important to understand in
choosing activities, resources and language
5) Identity may have a heightened significance in sickness
6) We need to connect and build on existing spirituality and if appropriate
faith
7) Meaning making helps children and young people articulate, identify and
understand their spiritual needs
8) Spiritual care occurs within and by a community and can offer windows of
normalization
9) Metaphor is a significant tool for spiritual care
10) Concrete and visible expressions and reminders of spiritual care are
important
Principles and practices of spiritual care
for sick children
1) Create spaces for spiritual care to occur
and relationships to develop
•attitude of openness and acceptance
•attentive listening, rapport, trust, acceptance
•offering choice, autonomy and gaining consent
•involves a relationship with the patient and
often their family
Joe’s postcard
Joe remembers
Principles and practices of spiritual care
for sick children
2) Empowerment is a core
underpinning value of
spiritual care
• best practice in
spiritual care is
empowering patients to
choose, ask, understand
and express
• keep checking that they
still want to continue.
Teddy’s stay in hospital
Principles and practices of spiritual care
for sick children
3) Offering “episodes of
spiritual care”
• reflects the often
integrated nature of
assessment and
intervention and the
element of reciprocity
Principles and practices of spiritual care
for sick children
4) Developmental and
learning context is
important to
understand in choosing
activities, resources
and language
• sickness may cause a
developmental issues; disability
• potential issues around literacy,
language and cultural and
religious beliefs.
I can make it too
Principles and practices of spiritual care
for sick children
5) Identity may have a heightened significance in
sickness
• identity is significant in spiritual care
• affirming a positive identity for a child:
• names are highly important
• the vicarious patient.
• engaging with the whole family
Principles and practices of spiritual care
for sick children
6) We need to connect and
build on existing spirituality
and if appropriate faith
for some spiritual care is
more meaningful if religious
care
• think what lifts the spirits of
the patient and build on this
• prayer may be an integral
element of this connecting
•
• consider giving space for children to pray too
Principles and practices of spiritual care
for sick children
7) Meaning making helps children and young
people articulate, identify and understand their
spiritual needs
• show and tell
•building on what has gone before
• mark significant moments
• use mapping or reflection exercises
•avoid loading the child with our expectations and
assumptions
There is always someone listening….
Jules’ prayer
… thank you for all the children
that are laid now in this hospital
today. Make them better … also
those going through worse, and
for those who’s getting out.
Thank you Lord for everything
you did for them. Make them to
thank you. Then show them that
you exist. Show them that You
are there for them, that You’re
their Father. Thank you for
everything that You did from
when I come in till the last day I
go away. Thank you, very, very
much. Amen.
Principles and practices of spiritual care
for sick children
8) Spiritual care occurs within and by a
community and can offer windows of
normalization
• community is a significant concept in spiritual
care
• hospital is a new community
• finding opportunities for patients to be together
• windows of normalization.
• children care about other children and can be
impacted emotionally by them
Making friends
Principles and practices of spiritual care
for sick children
9) Metaphor is a
significant tool for
spiritual care
• examples from the project
include using a butterfly
image, the story of the lost
sheep, blob pictures.
• metaphors have the
potential to nurture the
child in the longer term
Stories
Principles and practices of spiritual care
for sick children
10) Concrete and visible expressions and reminders
of spiritual care are important
• reminders
facilitate ongoing
reflection
• such reminders can be given
purposefully or left for children
to find themselves
• we leave behind who we are
Products
most helpful was focused activity
• useful products include:
• art and craft materials
• visual stimuli
• age and developmental stage appropriate books
and stories;
• godly play resources;
• songs and musical instruments;
• toys that can be used in bed;
• things that relate to helpful metaphors
•
ISE: Interpretive Spiritual Encounters
• interpretive spiritual
care encounters are
core activities – first
step in spiritual care
plan
• in paediatrics a
standard list of
questions is not usually
appropriate for
assessment
Conclusions
• changes occurred in both patient and
practitioner experience
• there was a sense of energy and enthusiasm,
discovery and surprise within the team indicating a
shift in awareness and practice
• bringing resources to the bedside leads to a more
child-centred and child-directed contact
• the intended outcome is a change in multidisciplinary practice
Ongoing
Developments
• 2 more days in 2012 trial more resources with other paediatric
chaplains etc joining us
• Multi disciplinary meeting (psychology, Play, Youth Work, Nursing
and Chaplaincy) to discuss what is distinctive and crossover in our
roles and professions in offering spiritual care (Sept ‘12; Feb ‘13)
• Explore wider trialling with the Paediatric Chaplaincy Network
(GB&I) from Nov 12
• Integration into daily care offered by BCH Chaplaincy
• Triangulate findings with teenage oncology research in the same
subject
• More participation days in 2013
• Publication and wider distribution 2013 onwards