The contribution of silence to spiritual care at the end of life: a phenomenological exploration from the experience of palliative care chaplains

Abstract

At the end of life, silence often takes increasing prominence in caregiving encounters. Valued in spiritual and religious traditions, silence lends itself to the spiritual and existential dimensions of healthcare but lack of familiarity with the phenomenon can lead to anxiety or avoidance. Greater understanding of the contribution of silence to care may support professional caregiving practice. This paper reports research that explored the nature, meaning and value of silence in palliative spiritual care. In a two-phase phenomenological approach, data were gathered through self-inquiry and unstructured interviews with 15 palliative care chaplains. A descriptive and hermeneutic analysis facilitated explication of the lived experience to produce an interpretation of essential qualities of silence in this context. 'Spiritual caregiving silence' emerged as a person-centred phenomenon that supports patients and their relatives. It is described as a way of being with another person, complementary to speech and non-verbal communication, which evokes a sense of companionship and connection. The caregiver takes both active and participative roles in the silence to create an accompanied space that allows the other person in the relationship to be with her or himself in a way that may not be possible when alone. This demands engagement and commitment. Silence provides a means of, and a medium for, communication that is beyond the capacity of words and has the potential to enable change. This insight into the specialist experience of chaplains may resonate with the experience of other professional caregivers to stimulate reflection and discussion, and to benefit patient care. KEYWORDSSilence; spiritual care; palliative care; end of life; caregiver

Análisis del uso y funciones del silencio en la comunicación de los profesionales sanitarios en una unidad de oncología pediátrica

“…El estudio ha permitido hacer una valoración del uso y de las funciones del silencio a un equipo de profesionales sanitarios de manera integral. Hasta ahora solo se habían realizado estudios a psicoterapeutas (13,14,(19)(20)(21)(22)(23) , sacerdotes (25) o enfermeras (24) .…”

“…Tornøe et al (24) llevaron a cabo una investigación con enfermeras que trabajaban con pacientes en cuidados paliativos como resultado una mayor frecuencia de consolar a través del silencio, la conversación y la conversación religiosa. En esta misma línea, Bassett (25) llevó a cabo una investigación fenomenológica con capellanes del área de cuidados paliativos a través de entrevistas no estructuradas.…”

End-of-Life Care Mobile App for Intensive-Care Unit Nurses: A Quasi-Experimental Study

“…To improve the ICU nurses' self-efficacy in end-of-life care in this study, a surrogate experience was included in the EOL app. The observation of the experience of others through the surrogate experience could increase the confidence of an individual [24]. Another study [25] showed that self-efficacy in end-of-life care was strengthened by providing information that senior nurses were able to collaborate effectively with medical staff or families.…”