1.1 Background to development
Need for spiritual care guidelines
An extensive search of the academic and ‘grey’ literature indicated that no guidelines were available that specifically related to spiritual care for older people living in residential aged care or receiving care and support at home. This gap led to a successful funding application through the Australian Government Department of Social Services (later changed to the Department of Health) to develop National Guidelines for Spiritual Care in Aged Care. As spirituality is integral to quality of life and well-being, it should be accessible to all older people in way that is meaningful to their beliefs, culture and circumstances. The identification of spiritual needs and offering of spiritual care is the responsibility of all care-givers and must be undertaken in ways that are appropriate to their role. Development process and fieldwork A project was established to develop and pilot National Guidelines for Spiritual Care in Aged Care. The Guidelines reflect best-practice in spiritual care, therefore most organisations are likely to have some gaps and areas for improvement. The Guidelines were developed following a literature review to establish an evidence-based framework and fieldwork that involved close consultation with the sector:
• Older people and their carers/representatives, staff, volunteers and aged care providers were consulted through focus groups, interviews and surveys;
• An Expert Advisory Panel steered development of the content, format and structure of the Guidelines;
• The Draft Guidelines were published and feedback sought through submissions and survey;
• The Guidelines were piloted and the outcomes incorporated into revisions;
• The Guidelines were subjected to technical review and critical analysis prior to publication.
Click here for the Stakeholder Consultation Report and the National Guidelines Literature Review that outlines the key findings from each development phase listed above.
1.2 Guidelines scope and intentions
These Guidelines are designed specifically for offering spiritual care and support to older people living in residential aged care, or receiving care and support through home care packages. However, the Guidelines may have relevance in care contexts such as independent living, Commonwealth home support program, transitional care, palliative care, multi-purpose services and flexible care programs. Within the contexts of residential aged care and home care packages, the Guidelines have been designed to apply to a diverse range of organisational characteristics in terms of size, ownership,mission/values, structure and locations. Therefore, the Guidelines must be sufficiently flexible to be equally relevant to a small ‘stand-alone’ service providing home care packages in a remote area; as well as a large, complex organisation with a central office supporting a number of residential care homes and other services. For this reason, the Guidelines focus on the outcomes and actions in key processes, rather than being specific about particular roles as these vary across organisations. The Guidelines are intended to support organisations to embed spirituality into key systems and processes with the goal that all older people (and their loved ones) are offered best-practice in spiritual care. Therefore, the target audience for the Guidelines are those with the capacity, skills and knowledge to lead, influence and implement cultural change at a senior level. Across the pilot sites, a key success factor was the active engagement and hands-on involvement of executives,site managers and senior program managers. Feedback from the pilot sites consistently reported that involvement of the chief executive officer and senior executive/s responsible for oversight of care and services is essential for successful implementation of the Guidelines.
1.3 Existing spiritual care
Effective spiritual care is already taking place in many organisations. This could be through the provision of pastoral care and religious activities, or through principles and philosophies such as active ageing, well-being, person-centred care, relationship-based care and holistic care. Spiritual care is also being offered by staff through every day encounters such as genuinely enquiring how a person is feeling, offering empathy, sharing joys, exchanging stories and humour. Whilst the spiritual dimension is often acknowledged, spiritual care may not always be offered systematically or consistently to all older people. Linking spiritual care as an extension to related and familiar concepts such as active ageing, well-being, person-centred care, relationship-based care and holistic care was found to gain greater acceptance and understanding.
1.4 Language of spirituality
It is acknowledged that spirituality can be an uncomfortable concept for those who may not be familiar with it. Throughout the development of the project, it was observed that for those new to spirituality, the language and concepts can be challenging at first. However, once the key concepts are clarified, for the vast majority of people it became clear and well-understood. Spirituality by its very nature brings complexities and it is difficult to simplify without losing the meaning and intent. There is a balance between the ‘art’ and ‘science’ of spiritual care as described by McSherry (1). The ‘art’ represents the qualities that individuals bring to spiritual care such as warmth, empathy and connecting in meaningful ways. The ‘science’ represents the more technical and clinical aspects of care that can be measured. The Guidelines have been written with a view to balancing both the ‘art’ and ‘science’ of spirituality. If the Guidelines were too weighted towards the ‘art’ they would lack rigour and it would be difficult for organisations to identify, implement and measure spiritual care. Similarly, if the Guidelines were too weighted towards the ‘science’, there is a risk the humanistic essence of spirituality would be lost.
1.5 Implementation of the Guidelines
The purpose of this document is to provide a framework for best practice in spiritual care. Resources, suggestions and ideas for implementing the Guidelines are provided separately on the Meaningful Ageing Australia website. Providing implementation resources separately recognises that introducing the Guidelines is a dynamic and interactive process where others on the same journey can share their experiences and benefit from others. It also enables new resources to be readily accessible and updated as these become available.