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

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.

Caring Existentially and Spiritually for Young Children and Close Grandchildren of Life-Threatened Cancer Patients in Secularized Denmark.

PURPOSE: When children are given opportunities to talk about their existential and spiritual concerns and needs, different health risks related to parents' illness and death may be reduced. The existential and spiritual care and conversations provided during parents' and close grandparents' cancer illness are insufficient. This article presents a practical and theoretical perspective on how to care for the existential and spiritual needs of children at three different age stages. DATA SOURCES: Data from a research project guided the process of synthesizing the theoretical aspects with the practical. The theoretical perspective comprises Majbrit Guldin's theory of children's age-related grief reactions and James Fowler's three stages about children's spiritual and cognitive development. The empirical study is based on qualitative interviews with 16 children or close grandchildren of cancer patients at hospice. CONCLUSION: The theoretical and practical perspective function as a guide for existential and spiritual care and conversation with children at three different ages. The preschool child needs adults to support their growing spirituality and help them show, express, and understand their feelings. The school-aged child needs adults who listen to and acknowledge the child's understandings, experiences, and feelings as well as challenge their rigid thinking. The young adult needs adults who are willing to be there for them physically, mentally, socially, and spiritually in a genuine relationship. IMPLICATIONS FOR NURSING PRACTICE: The perspective might function well for nurses and other health professionals as it is generic and addresses barriers for communication with children found in different healthcare contexts.