Introduction

In this article, I outline key points my fellow hospice team members and I have observed in our day to day work. In addition, my perspective is also enriched by having worked as a Spiritual Counselor in Hospice Care for over 9 years. Each person teaches me something, though it is I who is supposed to minister to them in their final moments. For my colleagues and me, working in hospice is an ongoing challenge and learning experience that presents us with learning of the deepest kind. In this article, I share with you the perspectives of my colleagues and myself, at The Center for Hospice and Palliative Care, Inc. in South Bend, IN (USA). We work together as a team and here are some of our insights.

Philosophy Behind Hospice Care

Hospice is not a place. Rather, it is a concept of care. Hospice staff go to people's homes and extend care for the mind, body, and soul. Much of our work is to free people of physical pain, so a patient can be attentive to living until he or she dies. This is a time when many patients reflect on their life. This integration occurs naturally and is deeply embedded in the psyche and soul of an individual.

At this stage of care, we are supporting a dying patient as he or she moves towards the end of his or her bodily life. It is work that challenges and changes anyone who is touched by this process that I describe as a patient "awakening into their most authentic self."

The Benefits of Early Referral

Our Hospice President wanted me to remind doctors of the need to have appropriate points of referral to Hospice Care. Early referrals enable all the services of Hospice care to be offered in a timely manner that integrates various disciplines. In addition to physicians, hospice centers are comprised of volunteers, social workers, nurses, bereavement counselors, and spiritual counselors who work to establish care, thereby creating the opportunity for patients and families to share their deepest concerns.

The Importance of Good Listening Skills

My co-workers in the social work department wanted me to share the importance of good listening skills. The patient is dying to everything he or she has ever known. As he or she begins to die, they become very reflective, and may want to share their reflections with their caregivers.

Through these reflections, a patient gives meaning to their life. When we listen to a patient share their story, we are being invited into their soul. The tears that surface are symbols of love a person acknowledges and has encountered during the course of his or her life.

The Importance of Good Pain Management

My colleagues in Nursing wanted me to remind healthcare professionals to be liberal with medications for pain relief. It is vital to give a patient enough medication to keep him or her from being in pain. Hospice Nurses gauge this daily in their patients. The doctor/nurse team in palliative care is so important that one cannot underestimate the cooperation and good communication needed between health care team members to do what is in the best interest of the patient.

When a patient's pain is under control, the ability to focus on living creates hope in the midst of dying. This capacity to preserve quality of life in the midst of dying gives the patient a chance to regain a sense of control that the disease takes away. Our ability to create this quality of life for a dying patient is a wonderful use of our medical capacities in order to bring healing comfort to those who need it.

Keep the Family in Mind and Involved

The Bereavement Counselors on my team wanted to share with medical professionals the importance of taking time to understand and comfort family members, especially those who are care givers of the terminally ill. It is vital to the bereavement process that doctors and nurses take time to share medical information with the caregivers about their loved ones.

Watch out for technical medical language - or jargon - when you speak with family members. It is not always understood, and in fact, has a way of blocking a sense of personal closeness that family members need, in order to fully participate in what their loved one is facing.

Intellectual understanding of a patient's prognosis is important. In addition, a family member also needs to know that their loved one is personally cared for until he or she dies. Here, we enter into a realm of care that transcends the body, and where we care for the minds and souls of all the family members who are involved in a patient's care. The way we care for the family during this process can either promote or hinder the bereavement process.

Recognize the Importance of Faith

My fellow Spiritual Counselor and I believe that our ability to be open to a patient's personal faith is what leads to a sense of peace beyond death. Many of our patients have religious thoughts of God, as he or she understands God at this point in their lives.

A person's capacity to believe in a higher power that is beyond themselves is a vital part of the dying process. Here, a patient moves through merely what he or she has been taught to a more intimate and direct experience of what lies beyond concepts, labels, and formal religion. Regardless of what path people have taken to reach this point, for most every one, endings become a time for spiritual awareness.

Endings - a Time for Spiritual Awareness

Dying people have much to teach us about living. For many persons, facing the end of their life might be the first time they have confronted this topic. For others, it may be something they have thought about intellectually, but now have to confront it through experience.

My first Hospice patient taught me something I will never forget. Even to this day, I remember her words: "What matters in life IS NOT matter." It was her way of telling me that there is more to life than what we see and touch. And as she neared the end of her life, it was the inner, spiritual aspect of life that was taking on a life of its own.

Honor the Patient's Belief in the Soul

Regardless of your philosophy, if you are a health care provider who is dealing with the terminally ill, it becomes important to respect the idea of soul, even if you do not believe in it yourself. By soul, I do not mean something specific to a particular religion. I mean, rather, an awareness that can be experienced among persons of all paths and religions.

As professionals who care for those who are dying, it is vital we remember we are caring for a person's body, psyche and their soul.

Awareness of Soul

As part of the process of turning towards non-material things, a person begins to let go of the various roles he or she carried out in life. At such a time, the need to find meaning and hope beyond this existence becomes vital to the wellbeing of a patient who is dying.

As a dying patient begins to let go of their personality, an identity with something else within him or her begins to emerge. This emergence is related to a calm awareness that has been with them their whole life but is more apparent now. It is the part of us not attached to the experiences of the world. It is an identity with an aspect of us that transcends even death itself. In some ways, this perspective on dying enables the one who is dying to awaken into eternal life.

What is the Soul?

There are many definitions of the word soul. But most everyone agrees that it refers to something unseen, and yet we know exists. Inside us is a landscape of the soul. It is the part of us that knows without a doubt that an experience is true without having a tangible experience of it. This part of us guides us through some of life's most difficult circumstances. It gives us hope beyond our present circumstances transcending us from self-centered awareness to life-centered awareness. This part of us is the same part a dying person begins to identify with at the end of their life giving them a sense of peace beyond anything he or she has been able to conceive up to this point in life.

Lessons from the Dying

As the dying person makes their journey towards his or her end, and beyond, he or she is engaging in one of life's most sacred journey. As the spiritual aspects of a person unfold along this journey, it becomes a chance for others to learn from them. As a health care provider, you are in a unique position, not only to comfort people as they make this final journey, but to also learn from and be deepened by your patients.

The spiritual awareness that can develop within you as a result of the peace that grows in a dying person can be a lesson that you carry with you, and share not only with other hospice patients, but all of your patients, family and friends.