Spiritual Care for Palliative Care/End of Life Pingfen Tang Professor of nursing Kunming Medical University

Spiritual care for palliative care had positive effect in mitigating fear, gaining emotional support and establishing good interpersonal relationships. Mitigating [mitigatin]减轻 Cobb M, Dowrick C, L Loyd- Williams M. What can we learn about the Spiritual needs of palliative care patients from the research Literature [J] . Pain Symptom Manage, 2012,43(6):1105-1119

The Relationship Between Spirituality and Religion Spirituality is inextricably linked to religion, resulting in spirituality being defined as a “conversation between the classics of various religious traditions and contemporary human experience Inextricably不可避免的， contempoary 现代 McGinn B. Spirituality confronts its future. Spiritus. 2005:5(1):88–96.

China is a multi religious country China is a multi religious country. Taoism, Buddhism, Confucianism ,Islam, Catholicism, Christianity six religions are the main body. Gao Zhennong. Chinese Buddhism. Shanghai Academy of Social Sciences Press, 1986

Taoism Attitudes Towards Death Life and death follows nature, but reborn is lightly than life and immortality as core belief. Immortality 永生 道教以道家学说为主干，讲求长生不老，画符驱鬼。从“天”、“地”、“人”、“鬼”四个方面展开教义系统的。天指现实的宇宙，又指神仙所居之所；地既指现实的地球和万物，又指鬼魂受难之地狱；人既指总称之人类，也指局限之个人；鬼指人之所归，神仙也是道教教义思想的偶像体现。道教是一种多神教，沿袭了中国古代对于日月、星辰、河海山岳以及祖先亡灵都奉祖的信仰习惯，形成了一个包括天神、地祗和人鬼的复杂的神灵系统。 Gao xiuchang Taoist beliefs about life and death. Religious study 2002：4，102-105

Confucian Attitudes Towards Death Death is natural as living virtue and morality is important than life and Confucius pay attention to the funeral and mourning as the traditional filial piety. Virtue & morality 美德和道德；funeral & mourning 葬礼和哀悼；filial & piety孝顺和虔诚 孔子(前551-前479)，名丘，字仲尼。孔子兄弟中排行第二，中国春秋后期鲁国人。 儒家文化是以儒家学说为指导思想的文化流派。儒家学说为春秋时期孔丘所创，倡导血亲人伦、现世事功、修身存养、道德理性，其中心思想是恕、忠、孝、悌、勇、仁、义、礼、智、信，其核心是“仁”。 Ma TianXiang Chinese believe in life and death. Journal of China university of political science law。2011：6，55-61

Buddhism Attitudes Towards Death The concept of life and death in Buddhism is not only in life and death, but in the eternal destiny of the individual. Eternal 永恒 destiny 归属 佛教距今已有两千五百多年，是由古印度迦毗罗卫国（今尼泊尔境内）王子乔达摩·悉达多所创（参考佛诞）。西方国家普遍认为佛教起源于印度，而印度事实上也在努力塑造“佛教圣地”形象。佛教主张诸法因缘而生，因此命运也是因缘生法。在第一次佛教分裂后，原始佛教分成了上座部和大众部。上座部诸派向南传播，盛行于斯里兰卡，遍传缅甸、泰国等东南亚地区，后传入中国云南，广西等地。称为南传佛教。由于中华文化的社会环境和人文根性，汉传佛教主流为菩萨乘佛教（又称大乘佛教），声闻佛教在汉地一直不如菩萨乘佛教被接受和流行，尤其到后代，“汉传佛教”几乎成了大乘佛教的代名词。由于汉传佛教所使用的语言是以汉语为主，故也称为“汉语系佛教”。藏传佛教有两层含义：一是指在藏族地区形成和经藏族地区传播并影响其他地区（如蒙古、锡金、不丹等地）的佛教；二是指用藏文、藏语传播的佛教，如蒙古、纳西、裕固、土族等民族即使有自己的语言或文字，但讲授、辩理、念诵和写作仍用藏语和藏文，故又称“藏语系佛教”。 Ji chengdong, Cui ming et,al.,The exploration of the application of Buddhism in hospice care[J]. Medical ethics 2014:6(35) ,37-39

Death Culture Differences in Minorities

Last Rites of the Han Nationality Han culture believe that children should be kept at the side when their parents is dying . Bathing and changing clothes for the dead is filial duty and responsibility.

Last Rites of the Bai Nationality Dying have to back to home before death，the younger generation have to give care beside dying’s bed in 24 hours. 黄岚云南元江白族丧葬习俗探析曲靖师范学院学报，2003，22（5）47-49

Wa Ethnic Beliefs The worship of the nature, the gods and the ancestors, and the spiritual religion of the Wa nationality. 李有清.神奇的沧源[ M] .昆明:云南民族出版社,2001 , 30 -31 , 170.

The culture diversity is different between countries

Because of the differences of national culture of the meaning of spiritual care is more outstanding To explore and understand the spiritual demand of palliative care under different cultural background, is the issue of nursing staff need to think about.

Holistic Family Process Term China's four full care model

Sweden Perfect Social Welfare and Health Care System

The Guide of Spiritual Communication with Patient and Family SACR-D

SACR-D A clinical guide promote healing by acknowledging, listening to, and providing a compassionate presence to deep spiritual questions.

Compassionate presence Refer to additional spiritual supports SACR-D MODEL Self awareness Assessment Compassionate presence Refer to additional spiritual supports Dialogue Sinclair S, Chochinov HM. Communicating with patients about existential and spiritual issues: SACR-D work. Prog Palliat Care. 2012;20(2):72–78.

Definition Sample Questions Concept A— Assessment D— Dialogue S— Self-awareness Conscious knowledge of how one’s own spirituality or beliefs, practices, behaviors, and experiences related to ultimate meaning impact clinical communication ♦ What are my spiritual beliefs and how do they impact my clinical practice? ♦ How can I express spiritual sensitivity in my clinical communication? ♦ What is the impact of frequent exposure to death and dying on me as a person and as a healthcare provider?67 A— Assessment Extrinsic and intrinsic means that enable healthcare providers to determine the role and importance of spirituality in a patient or family member’s life and healthcare Are there visual cues available to me that can help me understand this person’s spirituality? ♦ As I listen to this person, what are the sources of meaning and purpose in his or her life C— Compassionate presence The use of healthcare providers whole self when engaging a person in suffering, coupled by a desire and action aimed at alleviation ♦ How is my presence impacting the clinical encounter? ♦ Who is the person behind the disease?29 ♦ How can I actively engage in and alleviate this person’s suffering? ♦ How does this person best receive compassion? R— Refer to additional spiritual supports The act of referring to a spiritual care professional (chaplain), healthcare team member, or community spiritual/religious resource for additional support Which member of the healthcare team is best suited to address this person’s spiritual needs? ♦ Are they a part of a religious or spiritual community? ♦ Is there a spiritual care professional/chaplain I can refer to? D— Dialogue Clinical conversations intended to understand and/ or address a person’s spirituality in a language that is accessible to them How can I communicate about clinical matters in a language that honors this person’s sense of meaning and purpose? Dialect of meaning

SPIRIT Sharing Patients’ Illness Representations to Increase Trust (SPIRIT) is an evidence-based on the Advance care planning (ACP) intervention. Advance care planning Freyer DR. Care of the dying adolescent: Special considerations. Peds. 2004;113:381–388.

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