Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Hospice care at the end of life acknowledges the importance of holistic approaches for the dying patient and the family. Yet, social workers often feel less than prepared to address the spiritual needs of patients and families (Canda &Furman, 1999).

This study attempted to test a taxonomy of major spiritual issues in terminal illness, developed by Dona Reese (2005). This taxonomy identifies two dimensions: one intellectual in nature, including meaning of life and suffering, unfinished business, and belief systems; the other trans-rational in nature, including an experience with the Ultimate, isolation, and transpersonal experiences (Reese, 2005).

24 hospice spiritual caregivers, representing a variety of spiritual orientations, were invited to participate in a focus group exercise. A video depicting a final visit or gathering among family members and a dying member, facilitated by a spiritual caregiver, was shown to the group. The video captured aspects of closure, ritual, and expressions of meaning.

Using a focus group approach, spiritual caregivers were asked to identify the spiritual needs they observed to be met, and the spiritual needs that were not met. Nominal group process was used, until all ideas had been elicited. All responses, which were recorded on flip charts, were reviewed by the participants, who then developed summary statements, intended to identify the iterative categories or themes of responses to both questions.

Following the focus group process, responses were analyzed and coded according to themes. Bracketing, reflection, visual mapping, and review were used to establish identification of meaning units, common themes, and summative statements.

Results indicate that spiritual caregivers identified a broad range of spiritual issues, both met and unmet, within the video of a bedside gathering at the end of life. The rich detail of language provides new evidence supporting a taxonomy of major spiritual issues, defined by Reese (2005). Expressions of the intellectual, including meaning, unfinished business, and beliefs were observed, and expressions of the transcendent, connections, and experience of the ultimate, were also identified. A visual mapping model for assessing spiritual needs and providing spiritual care at the end of life, linked to this taxonomy, is presented. Results suggest a third component for the taxonomy: the development of a climate which supports the opportunity for both intellectual and trans-rational aspects of spirituality at the end of life. Specific suggestions for social workers to assist in supporting a climate of openness to these spiritual dimensions are presented. Implications

Social work practice at the end of life incorporates spiritual care and the meeting of spiritual needs for patient and family. New tools exist to support spiritual assessment by social workers (Hodge, 2005). Social workers can learn from the discourse of spiritual caregivers, and will benefit from closer collaboration with spiritual caregivers on the team. Reese, D. (2005). Addressing spirituality in hospice: A role for transpersonal practice. Social Work, / . Canda, E. & Furman, L. (1999). Spiritual diversity in social work practice. New York: Free Press. Hodge, D. (2005). Spiritual life maps. Social Work , / .