Psychological & Spiritual Care

Psychological & Spiritual Care in Palliative care

Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. Palliative Care (WHO, 2003) definition showed us the importance of the holistic approach That means looking body, mind, and soul seen as a whole in a social setting. ‘An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and Spiritual.

Psychosocial care

Psychosocial care, as defined by the National Council for Hospice and Specialist Palliative Care Services, is care concerned with the psychological and emotional well-being of the patient and their family/carers, including issues of self-esteem, insight into an adaptation to the illness and its consequences, communication, social functioning and relationships. It is a form of care that encourages patients to express their feelings about the disease while at the same time providing ways by which the psychological and emotional well-being of such patients and their caregivers are improved. At the start of modern medicine, the ancient holistic paradigm of healthcare that was present in many cultures gradually became replaced by a dualistic approach that separated cure for the body and care for the soul. Presently, care of the cancer patient is moving from the patient-centered approach to the ‘whole-system approach’ that encompasses the patient’s interpersonal and family relationships as well as the best of medical and social care, in order to optimize the quality of life for such patients. Stress is implicated in the development of physical symptoms such as pain and fatigue, as well as in reductions in physical quality of life for cancer patients. Psychological interventions are a plausible strategy to modify this scenario as they have shown substantial efficacy in reducing emotional distress for cancer patient.

Stress is arousal of mind and body in response to demands made on them.Crisis is when a stressful situation approaches or exceeds the adaptive capacities of a person or group. Wellness is the process of living at one’s highest possible level as a whole person and promoting the same for others. Stress relates to wellness in two ways. On the one hand, constructive, adaptive stress habits will contribute to wellness. On the other hand, living a wellness lifestyle will help minimise distress. When there is a detection of cancer it leads to more than the stress it is a crisis situation. Most of the time people cope with the crisis with their excising resources. Coping is an ongoing, dynamic process where there is a constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding theresources of the person.

Character of distress

 behavioural (the things people do)
 Physical (what happens to our bodies)
 Emotional (how we feel)
 Individual personal thinking style (our cognitions)

Most common distressing symptoms are anxiety, depression, anger, fear, sadness, frustration, guilt, shame, Internal and environmental coping constraints act against using coping resources.

 Guilt
 Unexpressed anger
 Hostility
 Fear
 Lack of confidence
 Perceived social prohibitions
 Unwillingness to seek or accept assistance from others
 Social norms emphasising self-sufficiency
 Lack of financial resources
 Absence of health care or counselling services
 Time

Coping options

 Adaptive Versus Maladaptive Coping
 Adaptive coping options contribute to wellness – good health, productivity, life satisfaction and personal growth
 Maladaptive coping options erode wellness
 Emotion Focus Versus Problem-Solving Focus
 Lack of confidence
 Emotion – focussed coping, in which the focus is dealing with your own fear, anger, or guilt as you react to the situation
 Problem-focused coping in which the focus is attempting to deal constructively with the stressor
 Transformational Versus Regressive Coping

Transformational coping

Taking constructive action to change the stressor This coping option emerges from: A sense of internal control, a sense of challenge, a sense of commitment. Fundamentally, it is based on optimism Regressive coping Thinking pessimistically and avoiding the stressor Depression is an emotional state and a form of psychological distress that commonly occurs in patients with life-threatening illness. It is associated with significant mortality and morbidity and can drastically alter any meaningful palliative care treatments rendered to the patient. It is estimated to have a prevalence rate of between 3 and 45%. WHO has proposed that mental health is: a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health interventions can be individual therapy or a group interventions.

Why use groups ?

 Reach more people.
 Create contact and social relationship.
 Realize that other people have the same problem.
 Learn from each other people have the same problem
 Learn from each other and develop coping skills.
 It helps to help others. How to create a group.
 Have something in common.
 Do something together.
 Share information and motivation.

There should be a well trained multidisciplinary team to do the interventions. Members of the multidisciplinary team must arm themselves with good communication skills. In addition, healthcare providers must be careful not to unconsciously portray a sense of hopelessness to their patients with regards to the disease diagnosis or prognosis. Compassion and empathy should be their watchword. Prevention of Mental Disorders. It’s our common public health model as in other disorder Primary prevention

 Promoting mental health
 protection against specific diseases Secondary Prevention
 Screening large population group
 Educating the public.
 Promoting mental health

‘Rehabilitation after the occurrence of defect and disability in an attempt to reduce the disability.’

SPIRITUAL CARE

Spire ritual care- Care that recognizes patient religion and/or spirituality and attends to spiritual needs—Data suggest that provision of spiritual care by medical teams to terminally ill patients is associated with better patient quality of life, greater hospice utilization, and less aggressive medical interventions at the end of life. The diagnosis of chronic or life-threatening illness can lead to spiritual struggles for patients. Spirituality is founded in cultural, religious and family traditions and is modified by life experiences .It is the basis for an individual’s attitude, values, beliefs, and actions. However in palliative care spiritual needs are crucial. It includes assisting patients to live with the uncertainty of life shortening illness, assisting patients and families to preparee for death, Reviewing life: identity, professionally, & what matters to the individual, providing ritual to help prepare for death, to live fully in the moment, transcend the present situation, or celebrate life. We need to clarify our objectives: everybody will agree that in palliative care and probably in all care “sensitivity” for the patient’s spiritual need is necessary. However, this sensitivity is of course something else than the “integration” of religious or spiritual beliefs into for instance medical practice.

To achieve good palliative care, good psychosocial care and spiritual care is imperative. Terminally ill patients who are well supported by religious communities access hospice careless and aggressive medical interventions more near death. Providing ritual to help prepare for death, to live fully in the moment, transcend the present situation, or celebrate life. Importance of religion and spirituality in palliative care

 Important connection to mental health and well-being
 Connected to bigger and powerful one leads to secure feeling
 Important connection to mental health and well-being
 Giving a meaning to existence in the world
 Coping strength against depression and fear of death.

Spirituality has been found to be a predictor of quality of life and Impending death prompts questions about spirituality and meaning. Spiritual needs are important aspect in the total interventions. Therefore early assessment of need is important and the assessment must be ongoing one. So the clients ongoing,current, desired practices, attitudes, expectations and beliefs are influencing our interventions and prepare them to face the consequences.

 

 Dr. S. Sivathas
 Consultant Psychiatrist
 Vavuniya (Vanni)