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Tuesday, August 11, 2020  

When to call the chaplainPublished 10/13/2003

Pain management is a key component of hospice care in America. When we think of pain management, physical pain and managing that pain through proper medication most likely comes to mind. But for those facing a serious illness, successful pain management goes beyond the physical to the emotional and spiritual.

Most of us probably have a fair understanding of emotional pain and social work’s role in addressing it, but what about spiritual pain? How do you know when your seriously ill patient is suffering from spiritual pain? When is it time to call a chaplain, and will a chaplain be able to help?

Understanding spirituality and the sources of spiritual pain will help you understand when it’s time to seek outside help. Most researchers define spirituality as the search for meaning. Spirituality is broader than any one religion alone, in that all of us seek to make sense of our existence.

Spiritual pain develops when patients begin to question past beliefs or question their own reason for existing. Recent research with hospice patients also points to the loss of intimate connections with life through family, home, friends, leisure and work as a source for spiritual pain.

Knowing the signs of spiritual pain, taking the time to listen to your patients and hearing the underlying messages of what they share will help you decide when to seek the assistance of a chaplain.

Loss of physical capabilities

For many, the disbelief that they are seriously ill after maintaining a healthy lifestyle can create distress. After a lifetime of eating healthy, exercising and seeing their doctor regularly, they are unable to accept that they are now sick. For others, becoming reliant on loved ones to provide daily care is a source of frustration and embarrassment.

A dramatic change in appearance, such as losing a breast to cancer or having a scar from a major surgery, can leave a patient with a painful sense of self. Ongoing fatigue or the inability to perform ordinary physical tasks, such as walking or breathing, can also lead to a downward spiral into spiritual pain.

Loss of career

When I frequently traveled for work, I could always count on the person sitting next to me on the airplane to ask what I did for a living. Our careers often define who we are. They are not only a source of income, but provide recognition, satisfaction in seeing the results of our efforts, a connection to those we work with, and often a sense of giving back or making a difference in the lives of those around us.

When serious illness leads to the end of a career, patients grieve the loss, lose their sense of connection to their colleagues and may grow frustrated at their inability to work. They need new companionship and need to find meaning for themselves in areas of their lives other than work.

Loss of leisure and pleasure

In addition to defining ourselves by the work we do, many of us find meaning in the activities we do simply for pleasure—singing, gardening, writing, fishing, running and so on. Not only do these experiences help define who we are, we often find important meaning for our lives in these activities, especially if they are related to family life or community involvement. Losing these activities creates a sense of a loss in the quality of life and can lead to questions about a patient’s reason for living.

Loss of relationships

Life’s meaning can often be found in relationships with family, friends and community. A serious illness can intensify existing problems or create new problems with relationships. Spiritual pain can result from the stress placed on a relationship by one family member having to care for another. Sharing the news of a serious illness with those we love results in pain for many patients, and a fear of neglect or abandonment distresses some.

Many patients become distressed when they realize that they won’t be here to see a child or grandchild graduate from high school, marry and have children. They may also worry about what will happen to their loved ones when they are gone.

Loss of perspective

Confronting a serious illness changes our perspective of life. Those who have trouble defining meaning and the reason for their own existence can become cynical. They may feel that their illness is unjust, or they may be angry with the medical professionals who are unable to provide a cure. The strain of coping with new challenges may cause them to simply want to give up. While there may not be hope for physical healing, we need to help them find spiritual healing through spiritual support and a new sense of meaning.

How the chaplain can help

If your seriously ill patient expresses frustration, anger or sadness about one of these losses, calling a chaplain can help. Chaplains help patients cope through the following strategies:

Focusing on activities they can do and on the satisfaction they find in these activities;

Valuing relationships with their family and friends;

Relying on inner strengths or on their belief in God;

Coming to terms with their illness and accepting the situation;

Completing unfinished business, such as deciding who will receive their special possessions or planning their memorial service;

If appropriate, affirming their religious beliefs.

These strategies not only help patients face serious illness, they often help loved ones, as well. Understanding the signs of spiritual pain and recognizing the chaplain’s role in addressing the underlying causes will help you direct your patients to the path of spiritual healing.

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