Finding comfort with the concept of spirituality

Having put forward the case that spirituality is an integral part in any ageing well activity or initiative, what is the best way to elevate the subject matter to wider attention?

A leader in the field is the Australian Meaningful Ageing organisation, the national body for all things to do with spiritual care and ageing. 

Their mission is to enable access to high quality pastoral and spiritual care for all older people in the country. 

The orientation they adopt is this: Spirituality is integral to, but not confined by, religion and faith. It is about what gives us a purpose to our lives. It is about our sources of meaning and hope, which in turn is intimately related to our connectedness to ourselves, to others and to the world. There is now a large body of emerging evidence showing that pastoral and spiritual care is an essential part of holistic care for everyone, particularly older people including, importantly, those with dementia.

From their experience many working in aged care who understand the value of pastoral and spiritual care and want to have the conversations around spirituality. These tend to stay at a superficial level because they don’t feel they have the knowledge or skills to respond at a deeper level. Nor necessarily in ways that are meaningful to those they are caring for. 

On that basis they developed what is believed to be the world’s first Guidelines for spiritual care in the context of ageing care. These have been formulated to recognize that the spiritual ‘dimension’ is an important aspect to cater for diversity and individual needs. 

The way forward

The Selwyn Institute has elevated spirituality to the forefront of its ageing well agenda and believes that contributions can be made to develop national standards in order to provide Guidelines for organisations, and individuals, working in the space as well as those who benefit from these. 

The driving focus, and force, behind the Institute’s work is a philosophy and methodology known as The Selwyn Way. This is based on the over-riding premise that to Care for Older People You Have to Care About Them. 

Part of this caring ‘mix’ is an emphasis on spirituality which is defined as a dimension that brings meaning to life. This could include a religious influence or even the joy of watching a sunset in a calm, relaxed and natural environment. 

Going forward with Guidelines   

As a world first the Meaningful Ageing set of Guidelines currently represents international best practice and, as such, provide a useful starting point for the process. One developed in a way that is appropriate, and meaningful, for the New Zealand context. 

Step 1 Finding out what matters: 

Some key resources and relationships are already in place to work toward the development process and accompanying fieldwork. This step would be to source input from older people family; their carers/representatives; aged care providers; front line staff and volunteers; experts; Ministry and District Health organisations; spiritual providers/practitioners. This would then help to define and refine what should be covered in any Guidelines.   

Step 2 Audit of what currently exists: 

What resources are currently available to satisfy a person’s spiritual requirements? How are these accessed and how do they apply in the context of ageing well?

Step 3 What spirituality might include: 

Meaningful Ageing recognized that the subject could be ‘uncomfortable’ for those new to the notion of spirituality. What does it include or cover and is it just another way of proselytizing? Defining what the concept means in the context of ageing well would be required. A starting point is W. McSherry’s Spiritual Assessment in HealthCare Practice (2013) which found that definitions cover notions of both ‘art’ and ‘science’. Information gathered from Step 1 will also be useful in fine tuning appropriate notions.

Step 4 Creating the framework: 

As a working and information gathering document and process a possible framework would need to cover:

• Key definitions and terms of reference.
• Overlap and intersection of traditional religious care and broader pastoral/spiritual care.
• Terms of reference and Guidelines philosophy and orientation.
• Standalone values and connection to other national/international ageing well initiatives.
• Spirituality on the context of its place and influence toward physical, social and mental wellbeing.
• Other approaches/care models that could be considered as having spiritual components.
• Guiding principles including The Selwyn Way and any collaborative organisations/individual’s mandates or orientations.

Step 5 Special consideration and needs for delivering on the Guidelines: 

Covering the likes of Tangata whenua; people living with dementia; those living in remote or rural areas; any other factor outside the mainstream of programme/service implementation and delivery.

Step 6 The points and places where the domains of ageing and spirituality will interconnect and be applied: 

The New Zealand context will be different and could be developed using elements of The Selwyn Way and any other policy initiatives or organizational mandates. In particular, the concept that To care for older people you have to care about them determinant and point of motivation.

The Australian Guidelines identified the following domains:

• Organisational leadership and alignment. Where spiritual care is systematically embedded and practiced at all levels and in all processes throughout the organization.
• Relationships and connectedness. Recognising older people experience care in a relational context where they feel connected and welcome; and where their individual worth is respected and preserved. Those who have contact with other people are equipped and supported to spiritually engage and connect so as to establish and maintain mutual, respectful and genuine relationships.
• Identifying and meeting spiritual needs. Understanding that spiritual care is based on choices, preferences and individually-assessed needs that are identified, documented, evaluated and shared by the care team in a way that recognizes the dynamic and changing nature of these needs.
• Ethical context and spiritual care. Demonstrating spiritual care is provided within an ethical framework that is reflected in organizational policies, procedure, processes and practices.
• Enabling spiritual expression. Acknowledging that a range of individualized activities and interventions is available to encourage the finding of meaning, purpose, connectedness and hope; and to transcend loss and disability. These options, activities and interventions occur in the context of deep and abiding relationships.

For each of these a series of Outcomes & Actions were developed in relation to meeting the delivery criteria for the National Guidelines. Again, a similar initiative would be developed for the New Zealand process and procedures. 

Step 7 Turning the Guidelines into Going Forward: 

There would obviously need to be a ratification process for the Guidelines before any ‘roll out’ policy development and process were introduced. Once completed the focus would need to be on:

• Education and training. At a tertiary, institutional, corporate, organizational and individual level.
• Formal and informal spiritual practitioners and providers.
• Points of provision for spiritual care. Who, what, where and how.
• Monitoring, management and modification.
• Integration with other nationally focused undertakings related to Ageing Well.