Spiritual Care Special Interest Group Toolkit

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Role of Ritual

Overview

Developing an appreciation of the rituals associated with various religious belief systems aids spiritual care-giving for oncology patients. As spiritual needs such as meaning, purpose, hope, love, forgiveness and gratitude, or spiritual issues such as fear, anger, guilt, shame, or sadness are identified, patients may find hope and comfort in the practices and rituals of their religious beliefs. Although religion and spirituality are different, the rituals of religion may be an avenue to the spiritual connectedness with self, others, and God and help with questions of suffering or an afterlife. Rituals alone can become mechanical but with faith they can give shape to the more abstract beliefs one holds. The practice of a particular ritual can be the means that we outwardly express an inner belief or prepare our hearts and minds to inwardly accept a divine intervention. Rituals can point to the sacred, the holy, the transcendent.

Rituals belong to the social life of society. They can remind us of who we are or to whom we belong. They place a present circumstance into the traditions of history and those who have gone before us. For someone that has long been alienated from their religion, a cancer diagnosis may the catalyst for a return to the practice of one’s faith. A life review may remind a patient of times of religious support or meaning. Oncology nurses can assist in mobilizing spiritual resources as they are familiar with the rituals of one’s religion. An awareness and respect of the rituals at the end of life are essential in compassionate caregiving and will have continual effects as they may help to meet the spiritual needs of loved ones who are left to grieve, mourn and find meaning in their loss.

Case Study

In Diane Brady's case, careful assessment at each stage of the cancer trajectory will reveal spiritual issues that are important for Diane. Research indicates that spiritual needs differ with each phase of the cancer experience (Halstead & Hull, 2001; Taylor, 2000). Thus, rituals may be more important for the individual at certain timeframes, and interventions will also differ. For example, if the individual is angry at God, or a spiritual care provider such as a pastor or rabbi, the suggestion of practicing religious rituals may not be helpful until the anger is "worked through." Rather, an intervention such as writing God a letter or journaling could be more appropriate.

Examples of religious and end-of-life traditions/rituals:

Christian or associated with Christianity:

Catholic....................	Mass Praying the rosary Holy water, icons Annointing of the Sick (last rites) Sacrament of Reconciliation (confession) Eucharist Funerals usually 2-3 days after death Mass may be held on anniversary of death.
Orthodox...................	Last annointing before or after death Confession and holy communion done by priest Memorial service on a Sunday closest to 40th day after Widows avoid social activities for one year
Protestant....................	Baptism, confirmation Worship, prayer, singing, sermon No last rites, prayers for comfort and support Annointing of the sick accepted by some Some believe in faith healing
Church of Latter Day Saint(Mormon)..............	Sacrament if patient requests Baptism for the dead Endowment for the dead and the living Sealings for the dead and the living Second anointing
Jehovah’s Witnesses...	Do not belive in sacraments Commemorate the Memorial of Christ’s Death/Lord’s Supper annually May attend meetings 3/wk in Kingdom Hall Door to door evangelizing Refuse to accept blood transfusions Do not use images/icons in worship

Judaism:

Yom Kippur (Day of Atonement)
Passover
Bar Mitzvah, Bat Mitzvah
Kosher foods (alternative might be vegetarian)
Emphasis on prolonging life
Dying person not left alone, rabbi presence desired
Death ritual—Shema (confession prayer)
After death, body placed on the floor with feet towards the door, covered with a sheet, candle placed near head
Body not moved if at home on Sabbath.
Mourning-tearing of a garment symbolized in pinning a black ribbon to garment and tear the ribbon
Funerals- day after death,white shroud, wood,closed coffin, brief service
Stages of mourning-death until 30 days from burial
Autopsy and cremation forbidden
Death anniversaries are noted

Islam:

5 pillars of Islam (confession of faith daily; prayer five times a day; fasting during month of Ramadan;almsgiving; pilgrimage to Mecca)
Fasting under Ramadan not required for the sick
Pork forbidden, other meats prepared under Islamic law
Alcohol forbidden
Second degree male relative (uncle/cousin) is contact
Patient may choose to face Mecca
Discussions about death may not be welcomed
Stopping medical treatment against Allah’s will
Grief may be expressed by slapping bod
Same sex Muslim handle body after death, otherwise non-Muslim should wear gloves

Hinduism:

Vegetarians
Fasting during festivals not required of patients
Hindu priest assist in death process-tying thread around neck of wrist, sprinkling with water from Ganges River, or placing leaf of basil on tongue
Do not wah body after death
Death seen as philosophical

Buddhism:

Vegetarian diet because of belief in reincarnation
Consult Buddhists monks to offer spiritual support
Shrine to Buddah may be placed in patient’s room to spend time meditating
Mindfulness important, may refuse mind altering opiods
After death, monk recites prayers for one hour
Most have body cremated
Ceremony after one year to generate energy for the dead in new incarnation

Native American:

Sweat lodge place of ritual for purification, healing and spiritual renewal
Hunting ceremonies and rituals dealing with spirits
Fire men, drummers, chanting at healing services
Circle dances, joining hands

Resources:

Kirkwood, N. A. (1993). A hospital handbook on multiculturalism and religion: Practical guidelines for health care workers. Harrisburg, PA: Morehouse Publishing.

Kagawa-Singer, M. (1998). The cultural context of death rituals and mourning practices. Oncology Nursing Forum, 25, 1752-1756.

Simpson, C. (2005)