Spotlight on Spirituality: Spirituality and COVID-19 in Hospice and Palliative Care
It is natural for spiritual needs to emerge in response to life-limiting illness (Callahan, 2017; Reese, Nelson-Becker, & Callahan, under review), but the limits imposed by COVID-19 can leave patients and their families vulnerable to spiritual suffering. This necessitates a closer look at the spiritual implications of COVID-19 for hospice providers, people at the end of life, their loved ones, and those who are grieving a death.
The following COVID conversation is in response to questions posed by Faith & Hope Hospice & Palliative Care. It is a reminder of the importance of being spiritually sensitive, which may necessitate having the technical skills to support access to quality spiritual care as well as ongoing virtual support to process grief.
What is spiritual well-being, and how is COVID-19 impacting it? Simply stated, spiritual well-being is the product of meeting one’s spiritual needs. Like any challenging life event, COVID-19 can be an opportunity to experience spiritual well-being if one’s spiritual needs are met. If spiritual needs go unmet, this risks spiritual suffering.
Relational spirituality is the experience of meaningful relationships, a type of connection that enhances life quality (Callahan, 2017). How and the extent to which relationships enhance life quality is relative to each person. Social workers can help patients meet their spiritual needs by helping them cultivate significant relationships. Sometimes these relationships are specific to the delivery of spiritual care.
How can religion/faith/spirituality be used to cope with or make sense of COVID-19 and the changes it’s having on society? This is relative to what informs your definition of spirituality and/or your faith or religious tradition. Based on Callahan’s (2017) relational model, COVID-19 is a reminder of the significance of relationships and the need to facilitate relationships that support life quality. COVID-19 can help us be more intentional about how we cultivate healthy relationships with ourselves, with others, and beyond (with a transcendent being or larger environment).
For those who are religious, prayer or communal worship may cultivate meaningful relationships that inspire resilience. Traditional social work theories and skills can help patients and their families in this process, starting with an assessment to clarify how relationships inform life quality and ways to support them (Reese, Nelson-Becker, & Callahan, under review).
There are many religious traditions that occur before and after a death. How are these being impacted by COVID-19, and what workarounds have you seen? Much like how health care professionals have relied on telemedicine for service delivery, religious leaders have relied on technology. With coordination, rituals that occur before and after death can be delivered virtually. This necessitates access to broadband internet, a computer, and/or phone as well as technology skills to facilitate virtual presence. Additional accommodations are needed for a conference call and/or if patients have special needs (i.e., cognitive or hearing impairments, non- or minimally responsive).
Social workers can help patients and their families access spiritual care by facilitating this “safe” connection in the following ways:
• Evaluate accessibility: Assess comfort (fear of Zoom bombing or a computer virus with Zoom download), technology (type of technology, age of technology), broadband connectivity (internet speed, connection stability), and skills (logging into Zoom, Skype, etc).
• Prepare the environment: Provide adequate lighting to highlight facial features, position the screen for face/eye contact, find a quiet space to meet, wear solid colors to avoid distraction, and monitor the environment for privacy.
• Facilitate a quality transmission: Ensure computer settings support a continuous quality transmission of live or prerecorded audio/video. For live transmissions, audio alone is most stable. An auxiliary speaker may allow better sound quality and volume range.
There are a number of online toolkits that support professional preparedness for other types of interventions (see sidebar).
How can health care professionals or the average person support patients and families facing life-limiting illness and grief? Support opportunities to grieve and seek closure rather than leave loose ends of ambiguous loss. As described by Doka (1989), grief that is socially sanctioned and publicly mourned facilitates healing. Ambiguous loss risks prolonged grief.
Most traditional means of coping transcend the limits of COVID-19. This includes crying, talking with others, creating a memory book/container, creating a playlist of songs, journaling, planting a tree/plant/flowers, creating commemorative art, visiting a loved one’s final resting place, and reading books that inspire spiritual healing.
With the assistance of technology, personal protective equipment (PPE), social distancing, and good hygiene/cleaning practices, other opportunities to grieve and seek closure over time can be modified. For example, PPE can allow a loved one to sit with the patient while photographs, memorabilia, and other items can be displayed to symbolize a loved one’s presence.
Healing prayers and last rites may be delivered remotely. Small groups can attend a memorial service that can be livestreamed, recorded, or documented to share with those not present. Loved ones could have a candle-lighting ceremony consisting of special readings, music, and the sharing of memories.
These extraordinary times have led to extraordinary access to bereavement support across geographic bounds and belief systems. For example, GriefShare provides a Christian bereavement support group curriculum featuring videos and a workbook produced by the Church Initiative (2020). The organization, which delivers daily inspirational messages via an e-mail listserv, has traditionally delivered its services onsite at Christian churches, but some groups have moved online.
There are many other online resources, some of which are accessible through social media platforms for synchronous and asynchronous connections.
From a strengths perspective, how might COVID-19 affect faith/spiritual well-being? It is hard to predict how COVID-19 will impact an individual’s long-term faith/spiritual well-being. It may depend on what becomes the “new normal.” Virtual resources have allowed access to spiritual care that might not otherwise be available. There is also increased awareness of health care providers as essential workers and a commitment across professions to support self-care.
Taken together, it seems COVID-19 has highlighted the importance of relationships as people have fought to find ways to cultivate relationships that sustain them, even in the face of death.
— Ann M. Callahan, PhD, LCSW, is an associate professor and master of social work program director and online coordinator at Eastern Kentucky University who has more than 20 years of social work–related experience. Her research focuses on spiritually sensitive social work in hospice, palliative, and long term care, and she’s the author of Spirituality and Hospice Social Work, published by Columbia Press.
HealthCare Chaplaincy Network. (2014). Patient’s spiritual and cultural values for healthcare professionals. https://www.spiritualcareassociation.org/docs/resources/patients_spiritual_
Hospice Foundation of American. (2018). Providing spiritual and pastoral care during COVID-19. https://hospicefoundation.org/Education/Free-COVID-19-Programs.aspx. Note: This is an on-demand webinar with 1.5 complimentary continuing education credits available until April 21, 2021.
Social Work Hospice & Palliative Care Network. (2019). Resources for hospice & palliative care social work professionals during the COVID-19 crisis. Retrieved June 22, 2020, from https://www.swhpn.org/COVID19.
Spiritual Care Association. (2020). Coronavirus pandemic resources from SCA. Retrieved June 22, 2020, from https://www.spiritualcareassociation.org/coronavirus.html.
Spiritual Care Association. (2020, March 24). Strategies for spiritual caregivers dealing with the chaos of coronavirus and other infectious disease threats. https://spiritualcareassociation.org/
Church Initiative. (2020). Creating life-changing support groups in your church. https://www.churchinitiative.org/?_ga=2.232420439.979921721.1592839509-1847480318.1592572378.
Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books.
Reese, D., Nelson-Becker, H. & Callahan, A. M. (under review). Spirituality and social work practice in palliative care. In T. Altilio, S. Otis-Green, J. Cagle, & R. Brandon (Eds.), Oxford textbook of palliative social work. 2nd edition. (pp. TBA). New York: Oxford University Press.