Case Reports

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The Rehabilitative Practice

Spiritual Care

When the Toronto Rehabilitation Institute became part of the University Health Network, the Department of Spiritual Care was faced with developing a spiritual care program that would meet the needs of the rehabilitation patients and families that we serve across all sites: University, Lyndhurst and Bickle Centres. Here are the stories of four spiritual care practitioners who have made the transition from an acute care setting and developed a model of care specific to the rehabilitation population.

sol-face4Klara Siber-Simic, MDiv, MHSc, RP

Prior to coming to Toronto Rehab—Bickle Centre, I was a spiritual care practitioner in intensive care. When patients left acute care, I wondered how life changed for them and how they adjusted to their  “new normal.” Working at Toronto Rehab, I provide spiritual care to patients and families who are coping with ongoing medical concerns, shifting expectations, limited mobility and multiple losses. I create a safe space where patients can express emotions, talk about relationship challenges, and process the grief that accompanies life’s transitions and the struggle to find meaning in suffering.

Together, we celebrate joyful victories such as being able to eat solid food, standing for a few seconds without assistance or visiting the mall by Wheel-Trans for the first time. To mark significant events and promote healing, patients have also asked me to facilitate rituals. In collaboration with a speech language therapist, I co-lead therapeutic groups where patients with communication challenges are able to voice what matters to them and support each other. When patients identify what gives them joy and a reason to live, I am gifted with a hope that each of us can find meaning in life. As I witness the commitment of the many caregivers who continue to visit, advocate for and do whatever they can to support patients, I am encouraged by the love that is shared regardless of illness.

Using my spiritual care lens, I see patients as sacred beings with a lifetime of human experiences, as opposed to labelling them as patients with dementia who cannot carry a logical conversation.

sol-face3Stefan Pankiw, BTS

When I started working in geriatric psychiatry at Toronto Rehab—University Centre, I was introduced to a very new patient population. The centre is a behavioural assessment unit for patients with advanced dementia, and therefore my conventional way of conducting spiritual care through exploring feelings and delving into meaning and purpose was not going to work.

Patients here often have a hard time being oriented in the moment, so I asked myself: How can I use my spiritual care skills to be effective on this unit? As I started spending time on the unit, the answer became clear: Through my “presence.” Now my interventions revolve around how I actively participate in group activities. Through my calm presence, I acknowledge each patient’s sacredness and honour their dignity, regardless of their cognitive state.

Each patient has a lifetime of lived experiences that is often lost due to the severity their condition. Helping to facilitate groups in a compassionate way where patients engage in the activities they were involved in prior to their illness best acknowledges those experiences at this point in their lives.

sol-face2Rena Arshinoff, RN, BA, MHSc, MAHL, PhD (c), RP

As the spiritual care practitioner for seven years on the spinal surgical unit at Toronto Western Hospital, I learned of the spiritual issues patients and family members often encountered in their acute care experience. Now I am on “the other side,” learning about spiritual concerns in rehabilitation at Toronto Rehab—Lyndhurst Centre. While everyone wants to go home to what was once a personal sanctuary, returning home after a spinal cord injury presents unique challenges—especially when the home is not set up for new needs and accommodations or if a change in housing is necessary.

I am learning of spiritual issues such as: Will I be safe at home? Will my spouse be able to care for me, and work? Will my family view or treat me differently? Will my spouse and I be able to have a sexual relationship?

Family members worry about how they will care for their loved one at home and how life has changed. A spinal cord injury is a crisis for both the patient and their family, with profound losses that need to be grieved. Family members often feel overwhelmed and are searching for coping strategies. I have a proposal in preparation to create a support group for family members so that they have the opportunity to share their experiences, feelings and concerns for the future.

sol-face1Suraj George, BRE, MDiv, RP

Rehabilitation within the acquired brain injury (ABI) units at Toronto Rehab—University Centre focuses on a holistic approach, in that the physical, emotional and spiritual domains of patients are cared for.

Whether the ABI is caused by a motor vehicle accident, fall or medical illness such as a stroke, patients and family members are often going through a rollercoaster of emotions: From being grateful for surviving the initial trauma and having another opportunity at life, to grief that life is never going to be the same.

As a spiritual care practitioner on the unit, my role often involves facilitating an exploration of the tough questions of life following ABI: Who am I? Why did this happen to me? What is my life going to look like going forward?

Exploring these questions and their implications, providing opportunities to facilitate rituals and offering grief support are some of the interventions I employ while providing care to this population. In contrast to spiritual care in the acute setting, I am privileged to have multiple conversations with patients and families during their hospitalization, and am thus able to witness the growth that often takes place as patients find a reason to continue living with an ABI.

Introduction by Marc Doucet MDiv, DMin (cand), RP.
To Learn more about the spiritual care services offered by the University Health Network, visit www.uhn.ca/PatientsFamilies/Patient_Services/Spiritual_Care

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