Background
Theoretical framework
Methods
District | Represented hospice # | No of participants from represented hospices | Designation of participants at the represented hospices | Palliative care background of the hospice participants: Medical, psychosocial, spiritual, bereavement |
---|---|---|---|---|
Eden District, Western Cape | Hospice #1 | 4 | Psychosocial Counsellor (1) Social Worker (1) Manager (1) Pastor (1) | Medical (1) Psychosocial (2) Spiritual (1) |
Hospice #2 | 3 | Professional Nurse (1) Chief Executive Officer (1) Psychosocial Manager (1) | Medical (2) Psychosocial (1) | |
Hospice #3 | 1 | Chief Executive Officer (1) | Psychosocial (1) | |
Hospice #4 | 1 | Nursing Manager (1) | Medical (1) | |
Cape Town District, Western Cape | Hospice #5 | 2 | Social Worker (1) Medical Doctor (1) | Medical (1) Psychosocial (1) |
Hospice #6 | 2 | Professional Nurse (1) Social Worker (1) | Medical (1) Psychosocial (1) | |
Hospice #7 | 4 | Spiritual Care Coordinator (1) Training Facilitator: Professional Nurse (1) Chief Executive Officer (1) Spiritual Care Worker (1) | Medical (1) Psychosocial (1) Spiritual Care (2) | |
Hospice #8 | 1 | In-Patient Unit Manager (1) | Medical (1) | |
Hospice #9 | 3 | General Manager (1) Patient Care Manager (1) Social Worker (1) | Medical (1) Psychosocial (2) | |
Hospice #10 | 1 | Nursing Manager (1) | Medical (1) | |
Hospice #11 | 1 | Chief Executive Officer (1) | Medical (1) |
Results
Providing relevant spiritual care services in a religiously, culturally, and racially diverse population
I was sitting here thinking that should the whole spirituality curriculum then not focus a whole lot on those who do the training to reach highest level of self-awareness because when you are self-aware, your ability to tell and convey to others their worth and their value within their existence is just so much easier … because I think that we are kind of stuck in the thing about spirituality equals religion … it doesn’t and to break that mind-set in people, especially in Christians, I find very difficult.
And if it’s about self-awareness, then if you’re not comfortable with homosexuality for example, it would affect you if your patient is requiring, or if your patient who is homosexual needs your help …(Participant of Hospice #5)
Racial, cultural and linguistic diversity
The other thing of course we started looking at (was) for Xhosa speaking patients we want somebody that can support them in their mother tongue language.(Participant of Hospice #5)
… the patient died, and the family came back for the spirit … they want to catch the spirit and they ask us if we can allow them to come catch that spirit because they believe (after the) patient (died) … the spirit stayed behind … we had to (allow for this ritual), but in the specific way where we say we will give you this part of the area (hospice) because we have to think about our other patients and protect them and they don’t see somebody is looking for a spirit here. So we make space for them and they came and catch the spirit and they spent a few hours in ways to get the spirit and then eventually they leave.
(A Muslim, Afrikaans-speaking patient) overheard me speaking to other patients after the (Christian Xhosa-speaking) pastor had visited … about what is going on in spirituality, in the Christian work. (The Muslim patient asked me): “Can the pastor come pray for me?” I said, “We’ve called your Imam (Islamic priest); he’s going to help you.” But she keeps on asking (for the Christian pastor). So there comes a time that they don’t understand their religions, I would rather say that.
The organisational context
Hospice-specific palliative care team dynamics and organisational culture
So for me it’s working with what you have (the staff) and enable that to be completely comfortable and open and that’s where we start, because … a lot of the staff cannot do it (spiritual care). They want to run when there’s an existential need expressed (by a patient) …
We trust each other … when we hire … we hire for a fit on the team … the person that gets chosen may not have all the qualifications but if they fit in the team … we can grow (that person).
The ability to know even if you are trained, that if you can’t handle a situation, that you need help. I have seen many people go under (burn out) because they take on more and more.You don’t go in alone because two is stronger than one.
What culture the organisation lends itself to … whether spirituality is embraced or not … will set the tone in terms of the spiritual care (that it provides or does not provide).… the culture of spirituality … in this organisation … is how we do things and people who come in new will automatically sense the culture of that organisation.
… we have a (formally employed) spiritual care worker, volunteer spiritual care worker that sits on our IDT, and are (present) at all our meetings and we also have a counsellor and our social worker, nurses, doctors.(Representative of Hospice #12)
Ja (Yes), so for me … my thinking is that in terms of addressing spiritual existential needs, one would have to situate all members of the hospice team that at any given time or any given point in the journey with that patient, they are open and available to address any existential need because you can’t box that need at any point in time.(Representative of Hospice #11)
Conflicting demands
And then I just need to say that most of the time we find out that the value of what we do is only seen after we’ve seen the patient and family and up to two, three months, four months. We get a card or we get a phone call to say thank you that you have helped us through this journey. And every so often our doctor here will come back to me and say (representative’s name), what did you do to that man (patient)? And then I will say, well, you asked me to do some support and uh the guy never wanted to be compliant or didn’t want to work along with the doctor and the nurse and was always angry or aggressive maybe. Then after I’ve seen the person (patient), the doctor comes back and wants to know what I did. Well, I think I did what I was asked to do.(Hospice #11 representative)