Spiritual care is enshrined within the philosophy of palliative and end of life care, yet it continues to be easily side-lined in the ever increasing and complex demands of end of life care.
In ‘Spiritual care at the end of life – a systematic review of the literature’, commissioned by the Department of Health as part of its End of Life Care Strategy, the core task of chaplaincy is identified as being “to respond to the spiritual needs of patients and staff by accompanying them on their spiritual journey.”1
Among many definitions of spirituality, the NICE Quality standard for end of life care for adults defines it as: “those beliefs, values and practices that relate to the human search for meaning in life. For some people, spirituality is expressed through adherence to an organised religion, while for others it may relate to their personal identities, relationships with others, secular ethical values or humanist philosophies.”2
If palliative care professionals are to offer spiritual care to their patients, it can be argued that there is a need for them to have the space and opportunity to reflect on and understand their own spirituality and what gives their life meaning.
Additionally, for nursing staff in palliative care settings, the constant exposure to trauma, suffering and dying, as they accompany patients on their final journey, requires good spiritual care for the sake of the nurses own wellbeing.
The idea for a weekly ‘time out’ session for nursing and other clinical staff was developed as one way of recognising the emotional pressures of working in a palliative care environment and of nurturing wellbeing and valuing the spiritual care needs of staff.
‘Soul Space’ is held in the chapel/prayer room of the hospice – a calm and peaceful space away from the patient area. The room is arranged with the chairs in an open circle and with a small table in the centre with some tea lights on, and other objects – for example flowers, stones, shells – as an aid to stillness and relaxation.
The session lasts for between 10 and 15 minutes and is introduced by a welcome and simple explanation of what will happen in order for anyone new to ‘Soul Space’ to feel comfortable with what’s happening and thereby be enabled to relax into the time.
A simple relaxation exercise follows with participants being encouraged to attend to their breathing and begin to take some slower and deeper breaths and to become aware of their body and notice any tension that may be carried and then consciously relax those areas of the body.
A piece of music is then be played – varying in style from classical to light folk or jazz, but will always be soothing and gentle. Participants are encouraged to close their eyes or focus on the flame of a candle and to let go of work responsibilities and allow themselves to be carried to an inner place of peace.
Each session has a theme to it, such as choice, perseverance, gratitude, courage or hope. The theme will be developed in some way by a short reflection, poetry or story. The aim of these is to inspire and encourage and in some way lift people’s spirits. The stories or reflections chosen are accessible and meaningful to those of all faiths and none, and themes chosen which resonate with the experiences of our common humanity and journey through life.
The Soul Space sessions are open for any members of the hospice staff to attend and the number of participants varies each week from between 6 and 20 and has included nurses, doctors, social workers, physiotherapists, occupational therapists, administrators and trainers.
Challenges and developments
‘Soul Space’ began as a chaplaincy initiative, but the facilitation of sessions is now shared by a small team which includes physiotherapists and an occupational therapist as well as two spiritual care chaplains.
One key challenge has been to enable nurses to take time off the ward in order to attend and this is something we are still working on.
A recent survey carried out with members of staff who have attended ‘Soul Space’ has given a strong indication that it is valued and makes a significant contribution to staff wellbeing.
Feedback from this survey included::
- “It is lovely to have ‘breathing space’ of peace and relaxation, with a time to gather thoughts, or sometimes just be still and listen to a calming voice or music.”
- “Being prompted to let go of any tension is useful, as I often hold tension without realising it.”
- “I find it supportive. It helps me feel a valued member of staff. It enables me to ground my thoughts and body to continue the day.”
- “It is a wonderful peaceful place. I always feel refreshed when I come out. Sometimes I feel emotional but that is a positive thing. I think it’s an indication that our organisation values its staff.”
As well as helping staff feel valued and supported, as well as less stressed and less frustrated, attendees have commented that the sessions help them focus on what’s important and prioritise their care.
The feedback given suggests that a time out session for staff is a good investment into staff wellbeing and helps them to feel valued.
The challenge is to make these sessions available to more of the nursing staff who are on the front-line of patient care and are those who face heavy emotional and spiritual challenges in their constant encounter with very ill and dying patients.
The majority of those who have been able to access ‘Soul Space’ have found it beneficial and I suggest it has contributed to personal wellbeing as well as enhancing effective engagement with patients and families.
- Spiritual care at the end of life – a systematic review of the literature, Universities of Hull, Staffordshire and Aberdeen, 2011.
- NICE QS13: Quality standard for end of life care for adults, National Institute for Health and Care Excellence, 2011.