It appears that spiritual harmony, which is so vital for human equanimity, has been greatly challenged, and even eroded, during the coronavirus pandemic. The unprecedented nature of the coronavirus infection has caused thousands of human deaths in the UK and around the world. The infections and subsequent deaths tend to shatter purpose and meaning of life among survivors and the bereaved while testing their resilience. With that comes spiritual distress, which is correlated with increased anxiety, pain, sadness and, eventually, depression (Gilbert, 2013). To compound this situation is the impact of social distancing-there is no contact between patients and their families, and staff must wear personal protective equipment (PPE), which places barriers between them and their patients, so both can be protected from the virus. Self-quarantine when experiencing coronavirus symptoms creates isolation, which again impacts people's spiritual harmony. Therefore, it is important that palliative care delivered during and after the coronavirus pandemic seeks to enhance the spiritual harmony of those receiving care.
Many years of experience working in palliative care has led me to assert that spiritual care requires our genuine presence and not medication. Our patients should hear and ‘feel’ us saying to them that ‘they are not alone’; for football enthusiasts, this is similar to the Liverpool Football Club anthem ‘you will never walk alone’, which suggests that, no matter what you may be going through in life, no matter how tough things are, there will always be someone caring by your side. Our patients and their families should always be able to feel our presence and compassion. This presence and support help patients and families with their own efforts of resilience and self-confidence, which, in turn, may give them a sense of purpose in life. In other words, spiritual care is about enabling patients to have a purpose and meaning in life.
These are also ideals that could help those nearing death. The courage to live and die with dignity is an outcome that palliative care aims to encourage in all. Equally, each community health professional should also feel the support and presence of caring colleagues and managers while caring for their patients.
Indeed, we need to assess patients for spiritual distress using available diagnostics, but it is also important to allow time to listen to their stories. We will soon understand what matters most to them, and what triggers that classic question ‘why me’ that we often hear in palliative care. This classic or, in some cases, rhetorical question often disrupts human equanimity (the ability to maintain inner and outer peace), and Wigglesworth (2012) argued that, even in death and dying, we can employ spiritual intelligence to help patients enhance their spiritual equanimity. Here, spiritual intelligence is the ability to offer compassion and our wealth of knowledge to all recipients of palliative care. It is important to add that spiritual intelligence accepts and encourages engaging with different worldviews, cultural variations and belief systems. It is beyond the scope of this column to dissect spiritual intelligence, but it is worth noting that there are 21 attributes that lead to spiritual intelligence (Wigglesworth, 2012), which community nurses can master in order to help patients withstand spiritual challenges even when death is inevitable. Dying in spiritual harmony also goes a long way in helping the grieving relatives' bereavement phase, as their last memories are bound to be those of a peaceful and dignified death. Indeed, they, too, have spiritual concerns, which community health professionals are expected to assess and help ameliorate under the palliative care ethos.
Achieving these outcomes for patients and their families is in line with the core principles of palliative care and, more importantly, would be most welcome during this time of the COVID-19 pandemic.