Initiating Religious Talks in Hospice Care

Dear Barbara, I work at an inpatient hospice facility. My question is this. Is spiritual assistance required in hospice?  Also, can a Bible be offered to patients, or can they be left in a drawer in the rooms?  

I’m a bit concerned that you work in a hospice and had to ask these questions but on that same note I am so glad you reached out to me for an answer.

Spiritual assistance is part of the hospice offering. It is why chaplains are part of the hospice team.  HOWEVER, here is the tricky part, where we walk a thin line. We must NOT express our personal spiritual beliefs or offer specific denomination prayer books or Bibles. The hospice philosophy is not faith based.

If you are a religious based hospice, caring for people of the same faith, then, of course, you can offer support and written materials that are related to the specific belief system. Everyone there is on the “same page.” Plus, by choosing the faith based agency, everyone is expecting and wanting their specific spiritual guidance.

For the rest of the hospice agencies, non specific based hospices, they support all religious and non religious beliefs. Part of the hospice intake is asking about the patient and family's spiritual preference and if they would be interested in visiting with a chaplain or would they like their church or clergy contacted. Following the initial information gathering meeting spirituality is in the hands of the hospice chaplain. 

What happens if you are a hospice nurse or CNA or social worker and the patient or family begins a conversation about spirituality? Listen, facilitate the conversation but do not share your personal beliefs. Explain that you would like to tell the chaplain about this conversation and have him/her come and visit.

As a health care worker you do not initiate a conversation about God and spiritual beliefs. It is not our role. If you observe or believe there is spiritual unrest, confusion, or you think the patient would benefit from some spiritual guidance, contact the hospice chaplain assigned to that patient/family and ask for a consult.

There tends to be such strong energy surrounding religious beliefs. Getting involved in those conversations can disrupt and confuse the end of life we are there to support and guide.

Something more... about Initiating Religious Talks in Hospice Care

The Final Act of Living: Reflections of a Long-Time Hospice Nurse  goes into more detail about boundaries around this topic. As does THIS IS HOW PEOPLE DIE my comprehensive educational DVD. 

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I believe it is a Christian duty to try to help save someone’s soul. So yes, I’m going to talk about it. It’s not like we’re talking about football teams and who is the best. This is someone’s possible salvation. I will do what God directs me to do and not man. I wouldn’t ever force it and if I offend someone, well, sorry.. I’m offended everyday at commercials and tons of other things I see.
BK Books replied:
I’m sorry to hear this, Kim. When working with end of life situations we leave our own beliefs at home. We respect the patient and their family’s beliefs whatever they may be. Blessings! Barbara
BK Books replied:
BK Books replied:

christine shekoski

I thank you for clarification. You express it in a clear manner as how to handle and who is responsible for what as lines get confusing at times.
I have had families ask me directly what is my spiritual belief. Do I tell them or direct them to the chaplin. They have said to me I want to hear My belief when I would say I can call the chaplin.

BK Books replied:
Hi Christine, over the years I’ve had many people ask me about what I personally believe in regard to spirituality and religion. I tell them that I do not share my personal beliefs, that there are such diverse and often strong feelings and thoughts about religion and spirituality that I don’t want what I am teaching about end of life to get lost because we may think differently about religion and spirituality. I then offer to have the Chaplain come and visit. It just seems like a no win situation for us healthcare workers to venture into, however cautiously, the religious, spiritual realm. Thanks for asking and blessings to you in the work you are doing. Barbara

Cheryl Ferguson

I am a home care social worker for a rural hospice and although you stated that initiating a conversation regarding spirituality is not advisable for other disciplines on the team, it is part of our Social Work initial assessment and options in other routine assessment. If a patient’s spirituality is part of how they cope with their diagnosis and prognosis then it is part of social work as well. We have found that it is difficult to have patients accept spiritual care and we carefully explain that it is non denominational and our chaplains are versed in all faith paths and visits are encouraged but when spiritual care is declined and faith is part of coping then we have to address at least in how their faith sustains them.

Chaplain Michael Zoosman

Dear Barbara,

Just a note to thank you for this most meaningful post. As a multifaith hospital chaplain myself (not hospice, but at a government organization), this very much hits home for me. Not that you need my affirmation, but for what it’s worth, I personally heartily support and agree with all you have said above.

Thank you for the truly sacred work you do…


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