ABOUT THIS MODULE Included here you will find 8 pages of a 35 page educational module which is intended for use by nursing homes who wish to promote more social, non-traditional models of long-term care. The intent of the PEAK-ED project is to assist organizations in implementing progressive, innovative approaches to care that should make a significant difference in the quality of care and the quality of life for those living and working in long-term care environments. Full copies of the modules are available upon request, and will be distributed in pdf format on a CD. When requesting the PEAK-ED modules please include the following information and send your request to gerontology@ksu.edu. þ Name of Individual and title þ Name of Organization/Facility þ Complete mailing address including zip code þ Telephone number þ Email address Modules will be sent free of charge to any nursing home in Kansas, and will be sent to those outside Kansas for a fee of $24.00 to cover costs of materials, postage and handling. Requests by Kansas nursing homes for duplicate copies of the PEAK-ED CD will require a fee of $5. For further information on the PEAK-ED project please email gerontology@ksu.edu. The development of PEAK-ED materials is supported by the Kansas Department on Aging and the Kansas Department of Social and Rehabilitation Services through a Title XIX contract and matching funds provided by Kansas State University, Kansas Association of Homes and Services for the Aging, Kansas Health Care Association, and volunteers from the Long-Term Care profession. Kansas State University is committed to nondiscrimination on the basis of race, sex, national origin, disability, religion, age, sexual orientation, or other nonmerit reasons, in admissions, educational programs or activities and employment (including employment of disabled veterans and veterans of the Vietnam Era), as required by applicable laws and regulations. Responsibility for coordination of compliance efforts and receipt of inquiries concerning Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and the Americans With Disabilities Act of 1990, has been delegated to Clyde Howard, Director of Affirmative Action, Kansas State University, 214 Anderson Hall, Manhattan, KS 66506-0124, (Phone) 785-532-6220; (TTY) 785-532-4807. Revised December 1, 2003 Pioneering Change Spiritual Needs: Are They Being Met? Education Module to Promote Excellent Alternatives in Kansas Nursing Homes Table of Contents NURSING HOME RESIDENTS' DIVERSE SPIRITUAL NEEDS: ARE THEY BEING MET? Course Objectives ...................................................................2 Pretest......................................................................................3 Introduction ........................................................................5 Activity: Emily's Spiritual Moment.............................................. 5 Religion vs. Spirituality.............................................................. 6 Understanding Spirituality.............................................................6 Case Study: Rituals............................................................ 7 Residents' Spiritual Needs.............................................................8 Case Study: Conflict of Needs...................................................10 Physical & Mental Health Limitations and Spirituality................................... 10 Culture and Health, Health Practices, & Old Age........................................ 12 Addressing Spiritual Needs........................................................... 13 Spiritual Assessment Tools........................................................... 15 Activities..................................................................................16 Ethical Will.........................................................................17 Case Study: Gregory's Ethical Will.............................................17 Life-Review.........................................................................18 Case Study: George's Unfinished Business.......................................18 Writing to God/Higher Being......................................................... 19 Validation Therapy.................................................................. 19 Being Present with People............................................................ 20 Healing Circle.......................................................................20 The Relaxation Response.............................................................20 Engagement in Action................................................................21 Walking the Labyrinth............................................................... 21 Humor............................................................................. 22 Project Evaluation........................................................................ 22 Summary.......................................................................... 23 Post-test........................................................................... 26 Pretest & Post-test Answers............................................................... 28 Appendix.......................................................................... 29 Bibliography ....................................................................... 30 Course Objectives: 1. Understand what spirituality is and how it can be manifested. 2. Understand how one's own physical and mental health limitations and losses can shape spiritual needs. 3. Understand why residents' spiritual needs are an important element of their quality of life. 4. Develop non-pastoral skills to address spiritual needs of nursing home residents. PreTest The pre-and post-tests included with this module are optional. The questions provide information about the material to be covered and can be used for learning self-evaluation. 1. Spirituality is always part of a religion. (a) True (b) False 2. Spirituality can be expressed by: (a) Love for music and art (b) Caring for people ) A prayer (d) All of the above 3. When people are admitted to nursing homes, what kind of losses do they deal with? (a) Identity (b) Independence ) Lifestyle (D) All of the above 4. What is the most important function of spirituality? (a) Be prepared for afterlife (b) Follow the Ten Commandments ) Help one die with dignity (d) Finding the meaning and purpose of life 5. Why is it important to meet nursing home residents' spiritual needs? (a) Spirituality helps nurture hope (b) Spirituality is part of holistic care ) Spirituality helps adjust to losses (d) All of the above 6. Staff can meet residents' spiritual needs even when they both represent different belief systems. (a) True (b) False 7. What percentage of Americans consider themselves to be non-religious? (a) 5-7% (b) 1-3% ) 10-15% (d) 15-22% 8. Which of the following statements is true? (a) Only a person who has declared a religion has spiritual needs. (b) All people are spiritual regardless of being religious or not. 9. Which of the following activities would you consider to be spiritual care? (a) Comforting a resident who is concerned about incontinence issues. (b) Discussing with a resident their funeral wishes. ) Saying a prayer with a resident when asked to do so. (d) All of the above. 10. Only a pastor or a priest can meet one's spiritual needs: (a) True (b) False Answers can be found on page 28. Introduction Read the story to staff members and ask them for feedback. Activity: Emily's Spiritual Moment Emily's day started off badly. Her car would not start and she had to ask her neighbor to drop her off at the Green Hills Home where she worked as a CNA. She was anxious, as she did not yet know how she would be getting home. She thought about asking one of her co-workers who lived near her, but she was not comfortable putting her co-worker out like that. She was also worried about how she would pay for yet another car repair. Emily fulfilled her shift duties, but she was not engaged with the residents like she usually was. During her morning break, Emily went outside. She was pleasantly surprised to see so much sunshine and a feeling of spring in the air. She took a walk around the home. Emily noticed that the grass was greener. She spotted a few tulips in the neighbor's front yard. All of a sudden she was filled with an indescribable feeling of lightness and happiness. The beauty of the awakening spring made her feel like she was connected to something bigger than herself. Her problems with the car seemed trivial now. Emily decided to ask her co-worker for a favor and did not see it as a big deal anymore. She also realized that she could work a few extra shifts to pay for the car repair. The beauty and energy generated by the first signs of spring filled Emily with optimism, the power to solve her problems, a connection to a higher being and an appreciation of the moment. Some people use rituals or spiritual practice to help them reach the state that Emily reached. 1. Can you name some of them? (you can find a list of some rituals in the Appendix). 2. What were the circumstances of your spiritual experience? 3. What emotions and actions did the spiritual experience create for you? 4. What can you do to help residents experience and/or enhance their spirituality? When an event or experience moves people to a feeling of awe, or opens them to seeing a glimmer of goodness or beauty, they become attuned to a quality of being and living that will help them cope with negative events. Spiritual well-being is considered an important part of both quality of care and quality of life in long-term care. Nurturing spiritual well-being for residents has been identified as a significant quality of life and care element that is not always present in nursing homes (Kane, 2001). One's religion and/or spiritual belief system is significant to the identities of many people. It is also used to cope with life problems. Ignoring spiritual needs is like ignoring a person's social support or psychological state (Koenig, 2002). "Holistic health care" promotes health-nurturing spirituality that helps residents connect to their spiritual needs (Martin & Fuller, 1991). Genuinely holistic health care must address the elements of human existence: physical, psychological, social and spiritual. One cannot assume that all spiritual needs of residents who declare "a main stream" religion are entirely met by providing them with pastoral care. Many long-term care facilities, even when they are faith-based, have neglected religion and spirituality (Moody, 2005). In addition, it is important to remember that there are also residents who do not proclaim any religion, but whose spiritual needs still require staff attention and concern. Potential residents and their families should actively educate themselves about the match between their own beliefs and that of a particular nursing home, so that before they choose a home they can process information similar to the way they may search for a church family. Homes should provide adequate and accurate information about what they offer to meet residents' spiritual needs, especially when residents' needs cannot be met through traditional pastoral care. Understanding what spirituality is and how it can be manifested. What is the difference between religion and spirituality? "You are not a human being in search of a spiritual experience. You are a spiritual being immersed in a human experience." Pierre Teilhard De Chardin Religion is generally seen as a practical expression of spirituality: the organization, rituals and practices of one's beliefs (Davis, 1995). The word "religion" is often identified as a set of institutionalized belief systems. The term "spirituality" is more neutral and much broader, suggesting our common human need to find meaning in our lives and in our relationship to something beyond ourselves. Spirituality is a transformational process. The different elements of life are integrated through this process (physical, emotional, intellectual, and relational). Spirituality encompasses love, compassion, trust, play, forgiveness and respect for life (Staude, 2005). Spirituality gives people a source of meaning and understanding about the significance of what it is to be human (Habel, 2001). Many definitions of spirituality include a sense of transcendence, the supreme, or surpassing others (Brennan, 2004). Transcendence is defined as the ability "to look beyond one's individual concerns" (Moughty, 2004). The nature of this transcendent belief can be manifested in many ways. One may express it through continuing or starting a special religious tradition or through a regard for nature (viewing beauty in nature may be a powerful expression of spirituality), music or visual art. Some people may adopt traditions and rituals from a community or a person. For other people, spirituality may be expressed through connection to the human family itself. Each habit, ritual, gesture and symbol can help a person interpret and manage life. What clearly distinguishes spirituality from religiousness is that "spirituality is not defined with a reference to a specific belief system or creed" (Brennan, 2004). In 1971, the White House Conference on Aging defined spirituality stating that "all persons are spiritual, even if they have no use for religious institutions and practice no personal pieties" (Thibault, 1995). Definition of a ritual: a set of actions, performed mainly for their symbolic value, which are prescribed by a religion or by traditions of a community. (Wikipedia) Case Study: Rituals Mary Schmidt, an 87-year-old resident at the Maple Tree Park Home, declared her religion as Lutheran. The fact had been noted during Mary's admission. The home administration made sure that a Lutheran pastor would visit Mary each Sunday and Wednesday. Mary seemed to enjoy talking to the pastor, praying and singing hymns with him and a few other residents who had signed for his services as well. One day Mary started crying. Staff tried to console her but all their efforts did not help Mary to calm down. Mary did not open up to staff about what bothered her. Eventually the administrator asked the pastor to visit Mary face to face. The pastor sat next to Mary and indicated that the sole purpose of his visit was to find out what had troubled Mary and to help her in the crisis. Mary confessed that her anxiety grew when she realized how much she missed the rituals of the Catholic Church on which she was raised. During services she attended at the nursing home, she realized how much she would like to have somebody pray the rosary with her. The pastor offered to ask a Catholic priest to visit with her in the near future. Mary calmed down and for the first time in a few weeks she was able to sleep well. 1. Why did the pastor promise Mary to invite a Catholic priest to visit with her even though she declared herself a Lutheran? 2. Why did Mary open up to the pastor but not to staff? 3. Was Mary's faith in conflict with the rituals she wanted to observe? 4. Have you observed other rituals that are not necessarily associated with residents' declared religion? 5. What celebrations and rituals are important in the life of your family? Science is not unified in its understanding of the relationship between spirituality and religion. Some regard these two systems as intimately connected (Hill & Pargament, 2003). Others view religion and spirituality as independent from each other. One can be spiritual without being religious, and one can be religious without being spiritual. Spirituality is more difficult to define due to its multidimensional nature and unclear boundaries with religion (Miller & Thoresen, 2003). The difference between a religion and spirituality is that all religions claim ultimate truth. Spirituality is derived from experience rather than a religious doctrine (White & MacDougal, 2001). It is important to remember that an expression of spirituality can occur without any specific religious beliefs. This expression often contains habits, rituals, gestures, objects and symbols that help people interpret and manage their lives. Research increasingly demonstrates that spiritual practices play a positive effect on overall health and well-being. When social support is provided, such practices decrease or even eliminate stress and enhance coping with life difficulties.