Below are segment highlights from the In-Service: Spirituality End-of-Life Care
From Hospice Foundation of America's 18th Annual Living with Grief Program.

Spiritual Care at the End of Life
Spiritual care is a critical aspect of end-of life care. As people face loss and dying, they inevitable encounter meaning, connection, sources of hope, and transcendence.

End-of-life professionals need to understand the concept of spirituality and be aware of their own spirituality.  These professionals should be comfortable in addressing and, when necessary, referring client’s spirituality.

Spirituality is distinct from religion. Spirituality ultimately relates to the very individual ways a person finds connection and meaning in life.  This is different from religion because religion entails adherence to a communal sense of belief. We recognize the countless ways people may make these distinctions as well as the many ways that spirituality may or may not be defined by religious beliefs.

As people face illness, dying, loss, and grief, they may encounter spiritual questions and conflicts, issues of meaning and significance, questions of an appropriate death, and challenges to their spiritual assumptions and/or beliefs or hopes about what occurs during and after death.

Spiritual development continues throughout the life-cycle as people continually reassess their beliefs and the value of spirituality. Often, these beliefs and values are triggered and reassessed in crises. As we age and face our own mortality, we may also reassess our spirituality.

Assessing Spirituality
Spiritual screenings and assessments are critical aspects of patient care. While spiritual care professionals have a key role in a spiritual assessment, all staff should be involved in evaluation. Such assessments should appraise spiritual and religious beliefs that might affect health care decision-making, spiritual needs or concerns, meaning making, and connections to community and spiritual resources.

A number of tools can be used to conduct spiritual assessment. Some are know by the acronyms of FICA(Faith, Importance, Community, and Address), SPIRIT( Spiritual belief system, Personal spirituality, Integration with a spiritual community, Ritualized practice and restrictions, Implications for medical care, and HOPE( Sources of Hope, Organized religion, Personal spirituality and practices, Effects on medical care and end-of-life issues.)

Remember, because spiritual issues continue to change at the end-of life, spirituality needs to be continually reassessed.

The family is the unit of hospice care, and therefore, spiritual assessments should include an evaluation of the family as well as the patient.

The increasing standardization of spiritual assessments presents challenges. Although standardized forms can offer essential documentation, it is important that spiritual assessment goes beyond simple checklists.

We need to do spiritual assessments of people with cognitive impairment, including, for example, those with dementia or who are comatose. Family members can offer vital information about the spiritual needs and care essential to patients with cognitive impairment.

Responding to Spiritual Needs
One of the most important roles for hospice and end0of-life spiritual professionals is to complement and supplement other spiritual resources. Such professionals shoud strive to connect clients to their own communitiy of meaning as well as to their clients' beliefs and practices. One critical aspect of spiritual care is to indentify spiritual needs that would include attention to special rituals that may be used during and after the dying process and to find spiritual resources that assist cllients in fulfilling these needs.

Spiritual care professionals should recognize the varied ways that individuals may access their own spirituality---including expressive modalities such as art, poetry, or music.
Therapeutic ritual can be a powerful bridege to spirituality and culture. Such rituals should be planned and processed and related to the personal marrative. They should use items that are both tangible and symbolic. And they should make use of promal elements that stimulate a range of senses.

When a client's understanding of his or her religious traditions or spiritual beliefs is a source of distress, spiritual care professionals may help to reframe those beliefs or traditions within the client's' spiritual perspective. There is value in a ministry of presence where spiritual counselors remain with clients who struggle with such spiritual concerns.

Reminiscence and life review approaches can play many positive roles, including meaning-making, stimulating equity between patient and staff, and enhancing mood. All senses and a variety of modalities can be used to stimulate reminiscence. Reminiscence is a technique that is useful for families as well as patietns.

Life review is an intensively reflective experience that involves reminiscence. People should be assessed by qualified spiritual care professionals to see if there is need for life review and if life review is an appropritate intervention.

Other spiritual process such as ethical wills, heart wheels, and living eulogies facilitate legacy building as a way to affirm a meaningful life.

There is an emerging body of research that supports the value of dignity enhancement theraphy in assisting clients and families in reconstructing meaning at end of life.

Spiritual care is an essential aspect of end-of-life care. An individual's' spirituality--that is, how they find personal meaning, transcendence, and connection--needs to be carefully assessed. As we develop approaches to assist clients in meeting their spiritual needs, spiritual professionals must be careful in honoring client needs rather than their own spiritual concerns.