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?
Hospices really should be training their staff on exactly this topic. And 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 denomination-specific prayer books or Bibles. The hospice philosophy is not faith-based.
If you are a religion-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 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 if they would 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, 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 healthcare 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.
9 comments
Daniel
As an atheist who is disgusted by so much organized religion, in particular the obnoxious evangelist type personified by your first commenter, I would be dismayed if my last days alive were marred by a zealot hospice nurse trying to talk to me about things I find truly upsetting. My goodness, the brazen selfishness is astounding. That said, if one of MY patients wanted to discuss their beliefs, I am more than happy to offer active and compassionate listening, suspending my own strong convictions in order to prioritize my patient’s spiritual and emotional comfort. Thanks for being clear on this, Barbara.
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BK Books replied:
Hi Daniel, your comments reminds me that no matter the situation or gathering, sharing our personal and religious beliefs are to be kept to ourselves and shared only if asked. Blessings! Barbara
As an atheist who is disgusted by so much organized religion, in particular the obnoxious evangelist type personified by your first commenter, I would be dismayed if my last days alive were marred by a zealot hospice nurse trying to talk to me about things I find truly upsetting. My goodness, the brazen selfishness is astounding. That said, if one of MY patients wanted to discuss their beliefs, I am more than happy to offer active and compassionate listening, suspending my own strong convictions in order to prioritize my patient’s spiritual and emotional comfort. Thanks for being clear on this, Barbara.
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BK Books replied:
Hi Daniel, your comments reminds me that no matter the situation or gathering, sharing our personal and religious beliefs are to be kept to ourselves and shared only if asked. Blessings! Barbara
Barb
I often call our chaplains “Miracle workers”…they don’t like it , but if I have a patient struggling at the end of life and I have the chaplain visit, I can’t tell you how often the patient is far more peaceful after the chaplain has left.
Very often the need is for forgiveness.
Also, before that “end of life”.. the value of a hospice chaplain – perhaps greater than the pt’s personal spiritual support- is that the chaplain is often more comfortable with talking about the pt’s. impending death (as opposed to the pastor etc who may be struggling themselves about losing their long time friend) and also the chaplain doesn’t have the personal knowledge of complex personal family dynamics that may make the patient more likely to share their true actual final feelings about a painful history.
This is what I’ve seen in my 40 years as a hospice nurse.
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BK Books replied:
Hi Barb, thank you for pointing out the chaplain’s role in hospice. I want to add they are not there to share their personal beliefs but to support the patient and/or family in their beliefs. Chaplains approach in hospice is nondenominational. Blessings! Barbara
I often call our chaplains “Miracle workers”…they don’t like it , but if I have a patient struggling at the end of life and I have the chaplain visit, I can’t tell you how often the patient is far more peaceful after the chaplain has left.
Very often the need is for forgiveness.
Also, before that “end of life”.. the value of a hospice chaplain – perhaps greater than the pt’s personal spiritual support- is that the chaplain is often more comfortable with talking about the pt’s. impending death (as opposed to the pastor etc who may be struggling themselves about losing their long time friend) and also the chaplain doesn’t have the personal knowledge of complex personal family dynamics that may make the patient more likely to share their true actual final feelings about a painful history.
This is what I’ve seen in my 40 years as a hospice nurse.
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BK Books replied:
Hi Barb, thank you for pointing out the chaplain’s role in hospice. I want to add they are not there to share their personal beliefs but to support the patient and/or family in their beliefs. Chaplains approach in hospice is nondenominational. Blessings! Barbara
Melissa
Thank you, Barbara for so clearly explaining. When my mom recently passed we had a hospice nurse who unfortunately expressed her beliefs that my mom needed to be sure she was ‘saved’ so she would not be agitated in her final hours. My mom was a devout believer. My daughter, her adult granddaughter, was not and was very upset with the nurse’s comments, especially when my mom showed agitation. It was a very difficult time, one my daughter continues to worry over. The nurse’s comments were unsolicited. We had our own minister. I did not report it. Maybe I will eventually. Thank you for all you do, Barbara.
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BK Books replied:
Hi Melissa, I am sorry for your experience. I would talk with the Hospice Administrator about this and explain your discomfort. It won’t change or fix your experience but by letting the agency know this is happening you may help others from having the same experience. Blessings to you a and your family. Barbara
Thank you, Barbara for so clearly explaining. When my mom recently passed we had a hospice nurse who unfortunately expressed her beliefs that my mom needed to be sure she was ‘saved’ so she would not be agitated in her final hours. My mom was a devout believer. My daughter, her adult granddaughter, was not and was very upset with the nurse’s comments, especially when my mom showed agitation. It was a very difficult time, one my daughter continues to worry over. The nurse’s comments were unsolicited. We had our own minister. I did not report it. Maybe I will eventually. Thank you for all you do, Barbara.
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BK Books replied:
Hi Melissa, I am sorry for your experience. I would talk with the Hospice Administrator about this and explain your discomfort. It won’t change or fix your experience but by letting the agency know this is happening you may help others from having the same experience. Blessings to you a and your family. Barbara
Michelle
Thank you for your position on this! As a spiritual and moral person, and a non-Christian, I would not want anyone to shove their religious beliefs down my throat at such a vulnerable time. That’s a sin in my book.
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BK Books replied:
Thank you, Michelle, Bessings! Barbara
Thank you for your position on this! As a spiritual and moral person, and a non-Christian, I would not want anyone to shove their religious beliefs down my throat at such a vulnerable time. That’s a sin in my book.
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BK Books replied:
Thank you, Michelle, Bessings! Barbara
Joy Schierer
I have been a volunteer at the local hospice care center for the past 12 years. During that time I have encountered 2 patients that have been very vocal in “spreading the Word”. They have had literature to hand out and have wanted to discuss my beliefs, not taking “no thanks” for an answer. I have felt guilty for not allowing them to “live their faith” in the last moments of their life but I have remembered my training and have backed off.
Your words have been a reinforcement to my volunteer training and hopefully, in the future, if this happens again, the guilt will not surface. thank you for your great words!
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BK Books replied:
Hi Joy, interesting, I have not heard of patient’s “spreading the word” to the hospice staff. We, the staff, do not have to listen or be involved. I would say “I am not here to discuss me. I am here to support you. I think you might enjoy a visit from our chaplain”. Thank you for sharing. Blessings! Barbara
I have been a volunteer at the local hospice care center for the past 12 years. During that time I have encountered 2 patients that have been very vocal in “spreading the Word”. They have had literature to hand out and have wanted to discuss my beliefs, not taking “no thanks” for an answer. I have felt guilty for not allowing them to “live their faith” in the last moments of their life but I have remembered my training and have backed off.
Your words have been a reinforcement to my volunteer training and hopefully, in the future, if this happens again, the guilt will not surface. thank you for your great words!
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BK Books replied:
Hi Joy, interesting, I have not heard of patient’s “spreading the word” to the hospice staff. We, the staff, do not have to listen or be involved. I would say “I am not here to discuss me. I am here to support you. I think you might enjoy a visit from our chaplain”. Thank you for sharing. Blessings! Barbara
Kim
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.
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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
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BK Books replied:
Whoa!
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BK Books replied:
WOW!!!
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.
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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
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BK Books replied:
Whoa!
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BK Books replied:
WOW!!!
christine shekoski
Barbara,
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.
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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
Barbara,
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.
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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.
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…
Sincerely,
Michael
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…
Sincerely,
Michael