Verbalizing spiritual needs in palliative care: a qualitative interview study on verbal and non-verbal communication in two Danish hospices

Abstract

Denmark is considered one of the World’s most secular societies, and spiritual matters are rarely verbalized in public. Patients report that their spiritual needs are not cared for sufficiently. For studying spiritual care and communication, twelve patients admitted to two Danish hospices were interviewed. Verbal and non-verbal communication between patients and healthcare professionals were identified and analysed. Methodically, the Interpretative Phenomenological Analysis was used, and the findings were discussed through the lenses of existential psychology as well as philosophy and theory of caring sciences. Three themes were identified: 1. When death becomes present, 2. Direction of the initiative, and 3. Bodily presence and non-verbal communication. The encounter between patient and healthcare professional is greatly influenced by sensing, decoding, and interpretation. A perceived connection between the patient and the healthcare professional is of great importance as to how the patient experiences the relationship with the healthcare professional.The patient’s perception and the patient’s bodily experience of the healthcare professional are crucial to whether the patient opens up to the healthcare professional about thoughts and needs of a spiritual nature and initiates a conversation hereabout. In this way we found three dynamically connected movements toward spiritual care: 1. From secular to spiritual aspects of care 2. From bodily, sensory to verbal aspects of spiritual care and 3. From biomedical to spiritual communication and care. Thus, the non-verbal dimension becomes a prerequisite for the verbal dimension of spiritual communication to develop and unfold. The behaviour of the healthcare professionals, characterised by the way they move physically and the way they touch the patient, was found to be just as important as verbal conversation when it comes to spiritual care. The healthcare professional can create a connection to the patient through bodily and relational presence. Furthermore, the healthcare professionals should let their sensing and impressions guide them when meeting the patient in dialog about matters of a spiritual nature. Their perception of the patient and non-verbal communication are a prerequisite for being able to meet patient’s spiritual needs with care and verbal communication.

Nurses' Subjectivity in Patient-Centered Communication for End-of-Life Patients

“…This perspective recognizes the value of incorporating diverse approaches to address patients' emotional and spiritual needs. This finding is consistent with recent research highlighting the benefits of incorporating spiritual care into end-of-life communication 21 …”

A qualitative meta-synthesis examining spirituality as experienced by individuals living with terminal cancer

“… Aoun and colleagues (2016) found that many participants accepted their death through ‘biographical closure’ where death was normalized as they approached the end of their lives without fear. The finding of acceptance through the normalization of death was also found by authors in seven further studies ( Hughes et al, 2015 ; Liu et al, 2021 ; Maiko et al, 2019 ; Thompson et al, 2009 ; Tuck et al, 2012 ; Voetmann et al, 2022 ; Yoon Sun Kim, 2021 ). Acceptance of dying was found through many means, including feeling love and support from family and friends ( Adorno and Brownell, 2014 ; Lee et al, 2013 ; Thompson et al, 2009 ), spiritual beliefs, faith and practices and a belief in the afterlife ( Alcorn et al, 2010 ; Maiko et al, 2019 ; Thompson et al, 2009 ).…”

“… McTiernan and O’Connell (2015) found that participants lived with dying by focussing on living life, rather than dying. Living life on a daily basis and deciding to maintain a positive approach to life were important factors in helping participants to live with their prognosis ( Bentur et al., 2014 ; Liu et al, 2021 ; Maiko et al, 2019 ; Nedjat-Haiem et al., 2020 ; Thompson et al., 2009 ; Tuck et al, 2012 ; Voetmann et al, 2022 ). Through living in the present, participants reported an increased appreciation of what they found to be meaningful in their lives ( McTiernan and O’Connell, 2015 ).…”

“…In many included studies, spirituality, as experienced by those living with terminal cancer, involved reflecting on one’s own mortality, re-evaluating one’s life history, appreciation of life ( Alcorn et al., 2010 ; Mok et al, 2010 ; Yoon Sun Kim, 2021 ) and previous life choices and decisions ( Hughes et al, 2015 ; McTiernan and O’Connell, 2015 ). Time was identified as a facilitator for participants of one study, which enabled them to complete essential life tasks and make pivotal decisions ( Voetmann et al, 2022 ). Participants of four studies reported having ‘unfinished business’ with others, such as organizing personal affairs ( Tuck et al, 2012 ), and saying goodbye to loved ones and dealing with relationships ( Hughes et al, 2015 ; McTiernan and O’Connell, 2015 ; Sherman et al, 2018 ).…”

Nora’a Keke Oral Tradition: Kaili Tribe Disaster Control Rituals in Palu Valley (Tradisi Lisan Nora’a Keke: Ritual Pengendalian Bencana Suku Kaili Di Lembah Palu)

“…The results showed that people's confidence level was only 7% from verbal, 28% from vocal sounds and 55% from facial expressions. Other research also adds that if there is a conflict between what someone says and his actions, then other people tend to believe things that are nonverbal (Voetmann et al, 2022). The equipments that the researchers found are as follows; a) Toko Tampi 'Tombak' as a symbol of the glory of the people in the Kaili area in general because it was used as a tool of war in ancient times.…”