Spiritual Care in a Pandemic
Six Knox MPS students (two of whom have now graduated as of May) are providing spiritual care in local hospitals, on the front lines of COVID-19. The following article features three of those students – Hannah Smele, Perry So, and Jonathon Zarb – who are serving in three different hospitals.
Fears and stresses
Hannah: “Hospitals are always places of high need, but the coronavirus added several other layers for both patients and the hospital staff. The virus meant everyone experienced additional stresses, both physical and psychological.”
Perry: “In the initial stages of the pandemic, the fear for staff was primarily around whether we’ve caught the virus, or whether we’re bringing it home to our families; I have two small children. There is hyper-vigilance, and a lot of self-monitoring.”
Jonathon: “Safety was at the front of everyone’s mind. The first couple of months of COVID were quite scary – especially since my husband and I were living with my in-laws, and my father-in-law was immuno-suppressed.”
Hannah: “We all had lots of questions. Did we need to cover our hair at work? Should we shower after every shift? It was pretty nerve-wracking; you have fears that maybe you missed something. What happens if you or someone else makes a mistake with their Personal Protective Equipment (PPE)?”
Perry: “Then there were all the changes in the hospital. Wards and Intensive Care Units were being repurposed to accommodate and prepare for the anticipated wave of COVID patients. Part of the stress and fear was keeping up with all the changes. We were navigating how Spiritual Care would function given the ever-changing policies, procedures for our own patient interactions, revisions on how to use PPE, family/visitor restrictions, and changes in death protocol.”
The effects of visitor restrictions
Jonathon: “Because visitors have been restricted, many times oncology and palliative care patients haven’t been able to have family with them as they received bad news about their health. Checking in on those patients is a big part of our job normally, but normally the family has also been present to hear the news with the patient. Now I’m one-on-one with the patient, helping him or her figure out how to tell family. It’s been quite an emotional part of my work.
“All patients feel more isolated without visitors. The lack of visitors also means lack of advocacy for family members, especially for those with language barriers or other communication difficulties. Often loved ones are the only ones who can communicate with them. End-of-life rules during COVID have changed now, but for a time family members weren’t allowed to visit even end-of-life COVID patients. In one situation, for example, a family spoke Punjabi, and the patient (the father) didn’t respond to any English at all. So it was vital for me to connect the patient with his family over videoconference.
“Also, religious leaders haven’t been allowed in to the hospital other than for end-of-life situations. Patients in the hospital for mental health, or surgery, or any other reason weren’t able to have their religious leaders visit. So we as spiritual care providers also stepped up to assist in those areas. Being asked to pray for people of many diverse religions has really challenged me to step out of my comfort zone.
“Some of my most meaningful moments revolve around being able to be truly present in other people’s time of need, when they can’t have other people with them. It’s as if I stand in place for their loved ones; I’m a complete stranger, but they’re so open about their life. It’s a privilege to be there. It’s beautiful. These moments are what keep me going.”
Perry: “Part of the challenge has been determining how to provide that calm, compassionate presence safely, especially when being physically present in the room is not always possible. We cannot always see isolation patients in person, so I take the time to call those patients and their families. In times of isolation, many of our patients are not able to reach out to their families or support systems – whether because they are admitted under unexpected circumstances as a trauma, are part of our vulnerable population, or are otherwise unable to utilize the provided technology to reach out.
“I am able to offer safe space for both patients and families – to address their feelings of guilt or sorrow around having entrusted a family member to a seniors’ home that’s now having an outbreak; or to acknowledge the death anniversary of a loved one and support their grieving ritual while in hospital; or to show compassionate care by listening and accompanying patients in their time of loneliness and fear. We are able to be with our patients in their loneliness and remind them that despite the physical distance and visitor restrictions, they are not alone; we are there for them.”
Hannah: “Most of my work is spent in the women and infants program, particularly in bereavement and neonatal intensive care. For example, I had an opportunity to provide some support for a woman who had an unexpected and late loss. She was devastated and was alone. In her home life, her role was much more about taking care of others. As a spiritual care practitioner, I was able to support her by simply sitting quietly with her while the nurse was preparing to bring her deceased baby into the room. There was nothing to say; it was a terrible loss. By the end of our time together she shared a bit, and as I prayed for her, she was able to grieve more deeply.
“In the same case, I also met with the nurse who was preparing the baby. I gave the nurse some extra support to encourage her during what is a really difficult part of her job. I am able to be with others in the presence of death.
“It was particularly meaningful that I had been able support both nurse and patient in this situation, demonstrating the value of spiritual care for both. We offer care to patients when they are in the saddest and hardest moments of their life; and we also help to care for the carers, the nurses and other staff who are doing their best to care for people, but who are also human.”
Supporting staff, and the necessity of self-care
Jonathon: “A big part of my work is supporting the staff in working on self-care, meditation, stress reduction, and compassion awareness – so that they can care better for their patients. I’ve been working with one health team member who sent her two young children to live with their uncle and aunt for the last three months, to protect them from COVID. She’s one example of the many who have had to make similar hard choices as they continue to do their jobs. We’ve discussed feelings of guilt, feelings of fear, and the loss of her connection with her children over this time.
“I and a few other colleagues also run wellness groups for staff, inviting anyone who’d like to participate in a short meditation. I also do adult colouring with staff in short drop-ins. Colouring in itself isn’t spiritual, but when people are relaxed and doing something fun, then we have conversations around how they’re doing and explore what’s going on in their minds. Having some time of relaxation, humour, and fun is a really important intervention.”
Perry: “COVID offered a special opportunity for us to raise awareness around Spiritual Care as a resource for staff – whether that means providing prayer and meeting religious needs; connecting them with EAP and wellness resources; or addressing their concerns when patients have been exposed or fallen sick. We distributed Spiritual Care ‘care packages’ to staff, with literature on ’10 spiritual tips for resiliency during pandemic’ and with chocolate and treats. This was a way to affirm and appreciate the meaningful work that our colleagues have been doing, and to reinforce the meaning and purpose of their work. This particularly helped to affirm those staff who are not always ‘remembered,’ or those feeling tremendous stress because of their changing role – such as the clinical assistants/porters moving bodies, phlebotomists taking blood from patients, or nurses providing care for agitated patients wanting to leave isolation.
Hannah: “Because the spiritual care role is for both patients and staff, we need to learn how to take care of ourselves and then offer what we can to everyone around us. It’s intense. We have highs and lows, as everyone does. We have to make sure we’re doing our own spiritual practices in order to be healed and whole people.
“I’ve been really fortunate to be surrounded by a lot of key supports, including weekly psychotherapy (as recommended – if not required – for all spiritual care workers). Also, my coworkers and manager are more senior in spiritual care; they’ve been wonderful in teaching me the ropes but also the importance of balance. They remind me, ‘Do what you can as long as you can, and accept your own humanity.’ We know that Jesus rested, even though there are always needs. So I try to be someone who takes seriously how important this work is, and also who recognizes that I am part of a larger whole. Self-care has to be a serious focus; otherwise we can only do this work for so long.”
Jonathon: “In the spiritual care and psychotherapy world, there’s a concept called ‘safe and effective use of self.’ It has to do with knowing our boundaries, and doing our own self-care in order to do spiritual care. I certainly notice the times I let that self-care go, and then I experience compassion fatigue or I find myself in a place that’s not as calm or inviting as I’d like to be. We really have to keep working on resetting through reflection, meditation, and prayer.
“That’s something our professors really emphasize as we learn how to do spiritual care. I also find that, whenever I feel like I’m getting flustered or worked up, I bring myself back to the introductory course at Knox and remember Professor Angela Schmidt’s teaching on ‘joining with people’ as the only real way to do spiritual care. If you don’t join with people, there’s no connection, no relationship. The basics that I learned at Knox have built the foundation and given me the practical skills to do my job well.”
Learning from COVID times
Hannah: “The coronavirus gave our interdisciplinary team an opportunity to be more unified. We suddenly had a common enemy and had to unify to meet the threat. It had a positive effect on the team. The pandemic also helped us to ask, How can we do this better? People became more creative, seeing where things could improve. Usually when you’re working on ‘autopilot’ because of the environment’s fast pace and many demands, you don’t have a lot of time to reflect on what’s working and what’s not. But COVID highlighted opportunities for change, and it was possible to move more quickly toward the changes. When corona became the front concern, we were able to push through barriers in a new way. It gave opportunity for better patient care and better support for the staff.
Perry: When we couldn’t function in our usual patterns, people found creative solutions. One of my colleagues played Duas (Muslim prayers) over a baby monitor for a patient as part of her end-of-life care. These intentional and often creative ways of reaching out inspire me. Despite all the restrictions, our team was able to uphold our patients’ worth and dignity, and honor their personhood and religious needs.
Jonathon: One other notable thing has been the support from the community; so many people have celebrated and recognized healthcare workers. I’m just finding my place in that. I always saw doctors and nurses as frontlines workers, but thinking of myself now in that way has taken some reframing. When I met my first COVID patient face to face, I was sitting there in respirology thinking, I think this is what they mean by front lines! And I could see that I’m not just working with frontlines workers, I am a part of that team. As spiritual care workers, we are very much on the front line – and I’m proud of the face-to-face care that we’re able to do here at this hospital. I’m also proud of the fact that the hospital decided that we are essential workers.
“That’s a good reminder of the value and necessity of spiritual care, and an invitation for others, too. Please continue to reach out to vulnerable people in your lives – whether they’re mentally, spiritually, or physically vulnerable. There’s a lot of isolation happening outside the hospital, so I encourage people to reach out. A lot of people might not ask for help, but a simple check-in can be meaningful to them.”
By Stephanie Hanna, for Knox College Communications.