Barriers to considering the spiritual dimension of our residents' lives is an issue which needs to addressed in interdisciplinary care teams. Some clinicians may honestly believe that it is inappropriate for them to bring up or respond to spiritual issues. Medicine, although in ancient times associated with priestly healing, is generally practiced without reference to the patient's spirituality. Psychiatry, with some notable exceptions, is notoriously hostile to religion. Psychologists and social workers vary greatly in their willingness to integrate spiritual concerns into therapeutic practice. Reluctance may not actually be caused by issues of professional boundaries so much as the personal comfort level of the clinician in dealing with spiritual concerns.
Some caregivers, not being religious themselves are uncomfortable touching religious issues with residents. Some fear that they will be drawn into discussing beliefs they do not share or even understand. Others may be reasonably secure about their own spiritual orientation but may feel unprepared to integrate spiritual issues into their professional practice. It is appropriate to be sensitive about addressing religious and spiritual issues. Especially in residential care it is important to respect religious differences and to protect residents from the intrusion or imposition of another religion. Proselytizing for any faith is inappropriate within the walls of a long-term care facility where frail, elderly, often vulnerable people are living out their lives. What is appropriate is to invite residents to express their own spirituality, in religious or non-religious ways.
Religion is often confused with spirituality, but they are not the same. Religion refers to a community of faith--Jewish, Muslim, Hindu, Christian, and any number of smaller denominations. Being religious usually means belonging to a religious group with particular beliefs and practices. However, we cannot assume, when one of our residents is identified as being a Catholic or a Buddhist that we therefore know what they believe or what their wishes might be regarding a particular treatment decision. Some completely admirable and moral people claim no particular religion. But every person, whether they are aware of it or not, has a spiritual dimension to their life.
Spirituality is hard to define precisely, but it is about how we understand life and our place in it. Spirituality is about how we relate to ourselves and to others and to that which is beyond us but which connects us. Our spiritual sense may be expressed through religious belief and practice or it may take other forms of creative expression, appreciation of music or nature, faith in a particular ideal or community or in relationships. Our spiritual identity is personal. It describes 'what works for us.' In other words, our spirituality is what makes us feel at home in the universe.
Spirituality is dynamic, evolving in response to life experience. Those of us who work with older adults know that concern with spiritual issues seems to increase with age. Questions of the meaning and purpose of life, the value of a life lived, feelings of connection and disconnection, concerns about death and dying, and issues of reconciliation abound. Some residents express these concerns quite openly, sometimes disturbingly if the caregiver is not prepared to listen to painful feelings. Shared reminiscence and life review are natural ways in which elderly residents may engage in the process of coming to terms with life and death. We do not have to share a resident's feelings or faith system to be supportive of his/her spiritual expression. But, if we are not prepared to recognize the spiritual dimension of our residents' lives we are not fulfilling our ethical mandate as caregivers.
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