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Identifying and managing spiritual pain in palliative care – Memory’s story

Author: Franciscah Tsikai, Palliative Care Nurse Practitioner, Island Hospice and Healthcare, Zimbabwe
30 April 2018
  • Sr Franciscah Tsikai, Palliative Care Nurse Practitioner, Island Hospice and Healthcare, Zimbabwe

Spiritual pain is common among patients and families and is defined under the umbrella of psychosocial pain which includes psychological, social and emotional pain. Spiritual pain is among the pains that a patient or family member may present with but may not be identified and managed fully.

This could be due to the complexity of spirituality itself as well as the fact that spirituality may be interpreted as religion. As a palliative care nurse, I know that it is of paramount importance that the palliative care team should be able to identify and address spiritual pain.

In the provision of palliative care, there is need for a multidisciplinary team which includes nurses, doctors, social workers and others including – when required – spiritual leaders.

These leaders must not be biased towards one religion and critically be able to communicate across the spectrum of belief systems.

Spiritual pain in palliative care emanates from a person questioning the meaning of their life and searching for meaning of their illness.

Patients often say: “Why is this is happening to me.” Cultural beliefs have an effect on and may influence one’s spirituality.

Some causes of spiritual pain include guilt, fear of death, deterioration of condition, lack of resources in the form of treatment and lack of rituals perceived to be helpful during one’s illness.

There are useful tools that can be used to assess spiritual pain such as the FICA Spiritual Assessment Tool. Below I present a case study of a lady who had spiritual pain and how I managed this as a palliative care nurse at Island Hospice & Healthcare.

Memory's story

Memory (not real name) a 45 year-old housewife was diagnosed of cancer of the cervix following the delivery of her last child. She was tested for HIV on several occasions and on each found to be negative.

Memory received radiotherapy as an out-patient. Suddenly and out of character Memory stopped attending her clinical review appointments instead choosing to consult both traditional and faith healers as referred by her family.

When I met Memory she relayed that the traditional healers informed her that she had been ‘bewitched by jealous neighbours’ and that was the reason she had cancer. The family took measures and moved from where they were staying to an unfinished house still under construction.

The faith healer gave her ‘Holy Water’ and strings to tie around her waist to chase the ‘evil spirits’ and her cancer away. At the same time the traditional healers gave her a mixed concoction to drink as a ‘cure for the cancer’.

The FICA Spiritual Assessment tool was used to assess Memory’s spirituality. Memory considered herself religious though she strongly believed that she had been bewitched. Her other losses included that she was failing to perform household chores and was depending on other lodgers to do the activities for her.

She questioned the meaning of her suffering and wondering why she developed the cancer, saying: “My parents do not have cancer and my grand- parents died of old age, where did this cancer come from?” 

In Shona culture, there is a belief that there are external causes to illness such as angry ancestral spirits, avenging spirits or witchcraft.

In this case the family consulted traditional healers and faith healers for confirmation and the outcome of the witchcraft findings determined how the family was supposed to work together to assist Memory. In her quest for total healing she had to perform rituals as prescribed by the traditional healer.

Memory and her husband were given information and support in caring for her at home. This included symptom and pain management. 

Memory and her family continued working with their traditional healer for spiritual support in collaboration with a clinical social worker from Island Hospice & Healthcare.

Through working with the social worker Memory was able to express her anger which was directed to her sisters for not visiting, and her enemies for bewitching her. 

With the on- going support from the multi disciplinary team, Memory is at the time of writing this gradually coming to terms with her illness and she is beginning to talk about dying. 

In my last visit she said: “Sister, I think I will die soon and I feel it is better for me to go because I am weak, and am always sitting here alone, those witches will rejoice.”

Memory’s culture also fed into her spirituality. The spiritual intervention prescribed by the traditional healers required that the family buy a basket with special pieces of cloth and keep it in the house to appease the ancestral spirits so that they would provide protection for Memory. 

In her quest for total healing she had to perform this ritual as prescribed by the traditional healer, and her faith healer would pray for her and give her holy water to drink.

The writer explored the meaning of all these rituals with Memory where she expressed satisfaction that at least she is being protected by her Ancestors and God.  

It was apparent that Memory’s physical pain was also affected by her psychosocial and spiritual issues which were causing her physical pain to be worse.

In Memory’s culture, illness and death occur as a result of avenging spirits, witchcraft by enemies or lack of rituals to appease the spirits.

Through working with the multi-disciplinary team including spiritual advisors, I was able to distinguish spiritual problems from psycho-social problems which led to planning of appropriate interventions for Memory and thereby upholding the holistic approach concept of which requires that spiritual, social, emotional and physical issues be afforded equal attention in order to provide quality care and prevent suffering. 

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