The following content is from the National Guidelines for Spiritual Care in Aged Care and should be read in the context of the whole document, downloadable here. To order printed copies of the Guidelines, use our Order Form.
4. Domains of Spiritual Care
I. Organisational leadership and alignment
Spiritual care is systemically embedded and practiced at all levels and in all processes throughout the organisation.
Outcomes and actions
1.1 The governing body incorporates spiritual care into the organisation’s overall strategy, including setting strategic goals to foster spiritual care.
1.2 There are corporate strategies in place to respond to the spiritual needs of older people and staff. Strategies are incorporated into operational plans and quality management systems, and these are measured.
1.3 Policies and procedures reflect a culture of recognising the spirituality of those who have contact with older people and carers/representatives.
1.4 Leadership at all levels demonstrates awareness of spirituality, particularly in relation to supporting staff through the inevitable transitions of their direct care giving role.
1.5 Spiritual training commensurate with role and responsibilities is available for all personnel who have direct and/or frequent contact with older people, regardless of whether they are employees or contracted through another organisation.
1.6 There is a system that respects the confidentiality of a person’s life history and enables the appropriate referral to specialists as required.
1.7 Information technology and communications infrastructure supports older people with the capacity to digitally connect with people, events and places. Access to technology such as: video calls, podcasts, web-casting, tablets, messaging/emails is available.
1.8 Care recipients are supported and encouraged to access outdoor areas. Those who cannot physically move outside are assisted to connect with the natural world.
1.9 For residential care homes, there is a reasonable physical space (other than in their room) for families/loved ones and spiritual carers to meet with the older person in ways that are private and uninterrupted.
1.10 For residential care homes, a dedicated inclusive, sacred space is available for meditation or contemplation as well as community or faith activities.
II. Relationships and connectedness
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 older people are equipped and supported to spiritually engage and connect so as to establish and maintain mutual, respectful and genuine relationships.
Outcomes and actions
2.1 Leaders and managers support those who have contact with older people in developing the spiritual and emotional resources they need.
2.2 Recruitment and selection processes place a high priority on attracting and selecting those who demonstrate empathy, genuine care and the capacity to connect appropriately with older people.
2.3 To enable mutual relationships of trust and openness to develop, staff are consistently assigned as caregivers to the same older person.
2.4 All those who have contact with older people have responsibility and accountability for spiritual well-being of those in their care.
2.5 Performance appraisal and quality improvement processes include seeking the views of older people regarding their satisfaction with spiritual care and services in a way that maintains confidentiality.
2.6 A culture of connectedness, compassion, ‘being with’ and ‘being present to’ older people is reflected in recruitment and selection, training, rosters, position descriptions, work values and performance appraisal systems.
2.7 Those who have direct contact with older people are trained and equipped with spiritual awareness to: • Understand their own spirituality and a diverse range of spiritual experiences and expressions • Be able to enter into a conversation/have connection with older people about what gives their life meaning • Know when, how and whom to refer to when spiritual needs arise • Incorporate spirituality into their role/function • Provide compassionate partnering.
2.8 Spiritual care needs are sensitively shared to ensure that all those who have direct contact with older people have access to information appropriate to their role and relationship.
2.9 Relationships and connectedness with God/divine power, life force, or places, events, animals, objects that bring meaning, are fostered and facilitated.
2.10 In residential care, relationships and connections with family, carers and loved ones is supported and encouraged with visitor-friendly spaces, telephone and use of technology/social media.
III. Identifying and meeting spiritual needs
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 recognises the dynamic and changing nature of these needs.
Outcomes and actions
3.1 Upon commencement of care services, spiritual choices, preferences and needs are identified to establish immediate and ongoing care, with the consent of the older person.
3.2 The spiritual choices, preferences and needs of older people are assessed using valid and reliable tools within one month of commencement and at least six monthly thereafter, with the consent of the older person.
3.3 Spiritual choices, preferences and needs are documented, addressed and integrated with clinical and lifestyle plans to facilitate holistic care.
3.4 The approach to providing spiritual care is multi-disciplinary, inter-disciplinary and includes the older person and/or their circle of support.
3.5 After critical life events such as trauma, crisis, illness, losses or significant changes, older people are offered opportunities to reflect on their life’s meaning or purpose.
3.6 There is a referral system in place to enable access to specialised spiritual carers at short notice and on an on-going basis.
3.7 Older people are supported to find meaning, purpose and connectedness as they transition through the different stages associated with ageing.
3.8 Finding meaning and purpose through relationship and connection is central to all activities and lifestyle programs based on individual choices, preferences and needs.
3.9 Older people are supported to prepare for end of life: • By reflecting on their life, contribution and legacy • By affirming worth, identity and uniqueness • By exploring unresolved issues such as ‘unfinished business’, fear, guilt, need to reconcile, meaning and purpose, and life review • End of life spiritual care needs and preferences are documented, supported and respected • Palliative care preferences • Advance care planning is offered • Death and dying rituals and preferences are documented and respected.
3.10 The environment, routines and practices are conducive to acknowledging and supporting the emergence of spiritual ‘moments’, reflections and insights.
IV. Ethical context of spiritual care
Spiritual care is provided within an ethical framework that is reflected in organisational policies, procedures, processes and practice.
Outcomes and actions
4.1 Spiritual care for older people with special needs takes into account their personal situation and how this may impact their experience of care.
4.2 Spiritual care recognises and respects the older person’s choices and preferences in the context of holistic care. It is integrated with the physical, psychological, social and cultural dimensions of the whole person and their carers and family/loved ones.
4.3 Those who have contact with older people work within their scope of competency and are aware of the referral process and role of spiritual care specialists.
4.4 Spiritual care is provided within a culture of acceptance, tolerance and inclusivity. Spiritual views, beliefs, culture, values and affiliations are respected. The individual’s right to self- determination regarding spirituality and spiritual care is upheld.
4.5 Provision of spiritual support resources is adequate to meet the identified spiritual needs of older people.
4.6 Spiritual practices such as prayer, healing rites, rituals or religious sacraments are respectfully offered within the context of choice, preferences and assessed needs.
4.7 Spiritual assessments and relevant personal information are made available to those who have contact with older people commensurate with their role and responsibility,and the older person’s consent and preferences.
4.8 Spiritual care practitioners have access to care information and are required to notate relevant information that enhances holistic care.
4.9 Older people who express a desire to explore alternative faith/beliefs and/or change their view of faith/beliefs/values are provided with information and access to faith representatives. Family and loved ones are supported to understand and respect the older person’s choices.
4.10 Spiritual care complies with all relevant legal requirements and codes of conduct/codes of practice.
V. Enabling spiritual expression
A range of individualised 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.
Outcomes and actions
5.1 Individual and group activities promote spiritual growth and attainment of spiritual maturity, for example: spiritual reminiscence groups, life history and life review.
5.2 Older people have access to the natural environment through gardens, outings and/or bringing nature inside through flowers, plants, photos, sounds and fragrances.
5.3 Older people are supported and encouraged to connect with their loved ones and/or religious/ community/cultural group by participating in person, visitation and/or via technology (video call, podcasts, virtual reality etc).
5.4 Older people have access to spiritual care practitioners to share their spiritual journey.
5.5 Sacred, cultural, religious and other special days, festivals, periods of religious observance and celebrations, are acknowledged and observed on an individual or group basis.
5.6 Cultural and spiritual needs and preferences in relation to food, eating and fasting rituals are identified, documented, supported and observed.
5.7 Older people are supported to participate in the arts such as music, singing, dancing, drawing, painting, poetry and story-telling.
5.8 Participation and observation of rituals, worship, rites, sacraments, devotions, prayer, recitation of creeds, meditation, chants, self-affirmations and mantras are supported and facilitated to promote spiritual growth and resilience.
5.9 The organisation facilitates older people having access to sacred texts, daily readings, biographies, poetry, other texts and or study/discussion groups that promote spiritual growth and resilience.
5.10 Loss and grief in relation to death and dying of loved ones and/or other residents/clients is acknowledged. The life of the deceased is celebrated in some form such as a commemoration service, book or photos.