By Eboni Green
In the book Trees: Reflections and Poems, Herman Hesse (1984) shares a poignant poem about the sacred life of trees. Hesse says that, “when a tree is cut down and reveals its naked death-wound to the sun, one can read its whole history in the luminous, inscribed disk of its trunk: in the rings of its years, its scars, all the struggle, all the suffering, all the sickness, all the happiness and prosperity stand truly written, the narrow years and the luxurious years, the attacks withstood, the storms endured.”
Hesse’s poem is analogous to the human experience of caregiving. More specifically, his words speak to the many physical, emotional, and spiritual losses associated with caring for and then losing a loved one or client. One might conclude that, just as the earth is forever changed by the death of a life-giving tree, so too is the spiritual landscape of the caregiver altered following the loss of a loved one or client. With Hesse’s analogy in mind, it is possible to infer that because the pain experienced during the lifetime of a living tree is concealed, the pain of grief among seemingly healthy caregivers could also be obscured. In fact, in many instances, the first sign that a caregiver is experiencing spiritual distress related to grief and loss is when the caregiver disengages from work, when there is a disruption in personal relationships, or when the caregiver discontinues activities that once brought meaning and purpose to life. For others, it is only after having the opportunity to reflect and begin to process their feelings and associate their disengagement with having cared for and then lost a loved one or client. One might conclude that when grief is not properly addressed, the spiritual well-being of caregivers suffers.
Caregiver Grief as a Disrupter of Spiritual Wellness
Caregivers often play a significant role in caring for a loved one or client at the end of life, yet few feel as though they are prepared to do so, and fewer still are afforded the opportunity to express their sadness after a loved one or client passes away. In fact, most caregivers do not receive training on grief and bereavement, despite the regular occurrence of caring for a client or loved one nearing the end of life. Additionally, few caregivers are provided with adequate space, time, or professional assistance to process their grief. The truth is that the agony associated with loss can disrupt the caregiver’s spiritual well-being and increase their mortality. If one takes into consideration the intimate relationship that exists between the caregiver and a loved one or client, it is not hard to understand why some will experience spiritual distress in their grief.
Spiritual Wellness as a Disrupter of Caregiver Grief
Just as grief can be a disrupter of spiritual wellness, it is plausible that a strong spiritual foundation can be helpful as caregivers cope with their sadness. The term spiritual wellness encompasses religion, faith, and belief but also refers to the opportunity to achieve self-actualization. Spiritual well-being has been linked to better mental health, including less depression and positive coping mechanisms for stressful situations (Yeh & Bull, 2009). Spirituality can serve as a coping mechanism for family and frontline caregivers, particularly when the emphasis is placed on empowerment, resilience, and incorporating one’s caregiving experience as an activity that provides meaning and purpose to life (Lopez, Romero-Moreno, Marquez-González, & Losada, 2012). It should be noted that spiritual wellness is primarily achieved through a combination of activities that are both unique to an individual caregiver and share common themes that are evident throughout one’s life-span. For example, the path to spiritual wellness for some may involve meditation, prayer, spiritual affirmations, or specific spiritual practices to which individuals ascribe to connect with their higher power. Therefore, it is vital that caregivers be encouraged to be diligent in identifying strategies that nurture their spiritual core, with the goal being that caregivers actively engage in activities that contribute to their spiritual growth.
Why Spirituality Matters: Strategies That Support and Empower Grieving Caregivers
Spirituality is broader than one’s faith or specific spiritual practice. In fact, according to Hall, Hughes, and Handzo (2016), “spiritualty is a dynamic and intrinsic aspect of humanity through which persons seek ultimate meaning, purpose, transcendence, and experience relationships to self, family, others, community, society, nature, and the significant or sacred. Spirituality is expressed through beliefs, values, traditions and practices” (p. 3). Caregivers should be afforded the opportunity to nurture their spirituality both in the community and in their workplace, as spirituality has been identified as a positive method for coping with grief and loss among caregivers (Delgado-Guay et al., 2013).
Spiritual carers (pastors, priests, clergy, etc.), employers, family members, friends, and communities must be alert for grieving caregivers. Not only do we have a moral imperative to lift up our brothers and sisters in their pain, but we also have a practical purpose to retain caregivers as communities face a shortage of family and frontline caregivers both now and into the future.
The following are suggested strategies that one might utilize to support and empower grieving caregivers:
Encourage caregivers to participate in personal self-care activities that center on empowerment, spirituality, and working through grief. Grieving caregivers can benefit from having access to tools like mindful meditation, journaling, guided imagery, and spiritual affirmations. For some, grief is so overwhelming that the caregiver may for a time feel powerless over their emotions. Not only might these self-care activities help with grief, but some caregivers might find that the activities are empowering and contribute to their overall spiritual well-being.
Encourage caregivers to participate in a grief support group. Most communities offer support groups for individuals who are grieving. Many of these groups are free and open to the public. During the support group meeting, caregivers are afforded the opportunity to share their experiences and may benefit from supporting and receiving the support of others who are also grieving. If there is not a support group offered in your community, you might consider starting one or access self-help online resources.
Employers of caregivers might consider offering staff grief support programs. Having a trusted source to whom caregivers can talk privately about their feelings of loss can be of great benefit. Also, consider hiring a consultant who specializes in caregiver grief. There are some nuances that occur specifically when caregivers work in a professional capacity. Having someone who understands the risk these professional caregivers face spiritually over the long term may not only help the individual caregiver but assist with retention as well.
Reach out to trusted spiritual and religious leaders in the community. Spiritual carers are a trusted source on whom caregivers can depend. Spiritual carers who specialize in working with congregations are aware of the signs of spiritual distress and understand its relationship to complicated grief. Many caregivers depend on their spiritual carers as a source to talk through the challenging feelings that often accompany grief and loss. Spiritual carers are also adept at helping caregivers understand that questioning of faith that sometimes occurs when someone you love dies as normal. Caregivers benefit from confiding in someone who is nonjudgmental during one of the more stressful times that is experienced in life.
Access the Four FACTS Spiritual Assessment. If you are a spiritual carer, you might turn to the Four FACTS Spiritual Assessment as a resource. Although the tool is designed for clergy and spiritual leaders for the purpose of creating a spiritual care plan, caregivers (both family and professional) might benefit from the opportunity to document their personal feelings regarding spirituality.
Caregiving often involves coping with loss. It is vital that caregivers feel supported in their grief and have an opportunity to lean on their spiritual sources of support. This includes using every resource available in the community to support both family and frontline caregivers who are one of our most valuable treasures.
Eboni Green, Ph.D., R.N., Chair of ASA’s Forum for Religion and Spirituality (FoRSA), is a registered nurse, a family caregiver and a co-founder of Caregiver Support Services, a nonprofit offering training and consulting for family caregivers in Omaha, Neb.
Delgado-Guay, M. O., Parsons, H. A., Hui, D., De la Cruz, M. G., Thorney, S., & Bruera, E. (2013). Spirituality, religiosity, and spiritual pain among caregivers of patients with advanced cancer. American Journal of Hospice and Palliative Care, 30, 455–461.
Green, Eboni I. (2017). Reflections from the soul. Omaha, NE: Green Publishing.
Hall, E. J., Hughes, B. P., & Handzo, G. H. (2016). Spiritual care: What it means, why it matters in health care. Retrieved from https://healthcarechaplaincy.org/docs/about/spirituality.pdf
Hesse, H. (1984). Bäume: Betrachtungen und Gedichte. Germany: Insel. Retrieved from http://www.goodreads.com/book/show/1552368.B_ume_Betrachtungen_und_Gedichte
LaRocca-Pitts, M. (2015). Four FACTs Spiritual Assessment Tool. Journal of Health Care Chaplaincy, 21(2), 51–59.
Lopez, J., Romero-Moreno, R., Marquez-González, M., & Losada, A. (2012). Spirituality and self-efficacy in dementia family caregiving: Trust in God and in yourself. International Psychogeriatrics, 24, 1943–1952. https://doi.org/10.1017/S1041610212001287
Stajduhar, K. (2013). Burdens of family caregiving at the end of life. Clinical and Investigative Medicine, 36, E121-6.
Yeh, P. M., & Bull, M. (2009). Influences of spiritual well-being and coping on mental health of family caregivers for elders. Research in Gerontological Nursing, 2, 173–181.