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©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Naureen Rehman 54 

 

Case Report                                                                                       DOI: 10.29052/2412-3188.v5.i1.2018.54-58             

Dealing with the psychosocial and spiritual aspects 

in palliative care 
Naureen Rehman 

Aga Khan University, Pakistan 

Corresponding Author Email: nrpunjwani@gmail.com 

Received 03/04/2018; Accepted 25/09/2018; Published 10/10/2018  

 

Abstract 

Background: Palliative care is the provision of end of life care to the patient with a terminal 

disease; its primary focus is on improving the quality of life rather than quantity of life.  While 

palliative care emphasizes over physical body pain reduction, it also suggests psychological 

comfort and spiritual wellbeing. Several research studies corroborate that interventions are 

done to keep the patient mentally relaxed greatly affects the patient's bodily functions and 

reduces the sensation of pain. Case Presentation: In this case, the physical attributes were 

excellently managed but neglect was done in terms of mental and spiritual need that was 

evident through her verbalization of hopelessness and fear, that the disease condition is a severe 

punishment by God. In addition, the patient was less likely to socialize with people including 

friends and family. Therefore, this case has been investigated in light of multiple recent articles 

(2010-2015) and pointed out the evidenced-based practices that need to be done to provide care 

emphasizing holistic approach in order to enhance comfort to the terminally sick patients. 

Management & Results: It was observed that the health care providers were only concerned 

for the physical problems and they provided care focusing only physiological component 

whereas the psychological and spiritual determinants of health were greatly neglected as such 

that they were not included in the plan of care of the patient. Conclusion: Palliative care 

involves not just physiological, but also psychological and spiritual care. Based on the findings 

of the case study, caregivers must consider psychological and spiritual aspects of care in order 

to provide holistic as well as peaceful end of life care. 

 

Keywords 
Palliative Care, Psychosocial Support, Spirituality, Holistic Care, Quality of Life. 

 

Introduction 

Chronically or terminally ill patient suffers 

physically, emotionally, socially, morally 

and spiritually thus they encounter an 

immense number of symptoms associated 

with each domain. Similarly, the pain of 

such people is impossible to treat just 

through painkillers, so it is important to 

assess every aspect of health in order to 

provide holistic care (Maqsood et al., 

2013). According to bio-psycho-socio-

spiritual model given by George Engel in 

1977, an individual with a life-threatening 

disease responds in many different ways 

like physically, psychologically, socially 

and spiritually (Maqsood et al., 2013). 

According to World Health Organization, 

(2018) the palliative care is defined as 

“Palliative care is an approach that 

improves the quality of life of patients and 

their families facing the problem associated 

with life-threatening illness, through the 

prevention and relief of suffering by early 

identification, impeccable assessment, 

treatment of pain and providing physical, 

psychosocial and spiritual care (WHO.int, 

2018).”  

Successful palliative care is achieved 

through a health care provider's ability to 

elicit and comprehend the problems of 

dying patients; however, many health care 

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Annals of Psychophysiology 
©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Naureen Rehman 55 

 

workers are reluctant to talk about it due to 

lack of comfort (Berton, 2015). 

Understanding patients' concerns and 

addressing it affects positively on patient's 

wellbeing and improves the dignity of 

patients (Von Blanckenburg & Leppin, 

2018). Psychological fears are sometimes 

associated with spiritual concerns as well 

that hinders in the achievement of mental 

peace (Gunser, 2017). In other words, 

spiritual coping is associated with positive 

mental health, similarly, if health care 

providers solely emphasize over physical 

and mental health excluding the spiritual 

aspect of care then the goal of complete 

wellbeing will not be attained (Selman et 

al., 2014). 

Active listening, therapeutic 

communication using a nonjudgmental 

approach and using therapeutic touch helps 

in fears verbalization by the patient (Rego 

& Nunes, 2016). Psychological, social and 

spiritual distress are common among 

palliative care patients and they often 

trigger the thoughts of accelerated death 

while physical symptoms have been treated 

that lead to demoralization and 

hopelessness (Fan et al., 2017). According 

to the proximal-distal model of kidney 

disease, it has been observed that 

physiological factor along with 

psychological factors influences the overall 

health outcomes (Chan et al., 2011). 

Case-Presentation 

A 63 years old female patient with a 

complaint of chronic renal failure came for 

routine dialysis at a private hospital. 

Patient's comorbid were type 2 diabetes and 

hypertension. Complete interview using 

Gordon's functional health pattern was 

conducted with the patient. Patient was 

haemo-dynamically stable and oriented to 

time, place and person. Physical 

examination showed severe lower back and 

limb pain, using the numeric pain scale, the 

patient's pain score was 6/10. Secondly, the 

psychological assessment was done using 

Gordon’s psychological assessment tool, 

revealed hopelessness and depression 

related to lack of social support system 

patient also verbalized spiritual distress due 

to inability to perform spiritual practices 

moreover patient’s social domain was also 

compromised because meeting people 

increases pessimistic thoughts in her mind. 

After the case analysis, spiritual and 

psychological domains of palliative care 

were prioritized. 

Results  

Based on the patient’s interview and 

assessment done by Gordon’s functional 

health pattern it was observed that this 

patient was mentally depressed and 

hopeless that may be due to lack of 

someone who actively listens to her and 

empathize her current health state.  It was 

also observed that most of the time, due to 

lack of attention from the immediate 

surroundings such as family, friends, 

significant others as well as health care 

personnel, the patient was reluctant to share 

her concerns, fears, emotions to others that 

further made her stressed and uninterested 

to life. Further, it was also observed that the 

patient was spiritually depressed; due to 

lack of privacy and physical problems, she 

was unable to perform her practices that 

increased her stress as well as 

remorsefulness, therefore, like many other 

patients, she considered her illness as God's 

penalty and she was guilty about that. This 

also increased levels of anxiety in the 

patient that also resisted her from 

socialization with other people that is why 

she needed care providers who not only 

treat her physically but also 

psychologically and spiritually in order to 

provide comfort and healthy mind, body 

and spirit.  

Discussion 

Suffering involves the perception of feeling 

fearful, helpless and danger about the 

disease (Juarez et al., 2013). Mostly people 

response in such a way that they think now 

the life has completely changed and it is 

irrevocable, while many people face guilt 

that this is all because of their mistakes in 

life (Mateo-Ortega et al., 2018). They 

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Annals of Psychophysiology 
©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Naureen Rehman 56 

 

regret that if they had approached for the 

treatment earlier so they might not be this 

close to death. Another thing is that like the 

above patient, many people with the 

terminal disease become hopeless and 

depressed (Mateo-Ortega et al., 2018).  

Whereas some people feel anxious about 

the time they have to live with their 

significant others regarding the fulfillment 

of their impending responsibilities based on 

their role within the family (Juarez et al., 

2013).  

 Researchers have also shown that 

spirituality has a greater impact on 

individual health and disease onset. It 

expresses various aspects of individual 

personality and views of their life 

(Gualdani & Pegoli, 2014). According to 

Dallas and his colleague, palliative clients 

want optimism, hope and gratitude for their 

values and need to follow all the religious 

beliefs for the sake of spiritual healing 

(Dallas et al, 2012). People sometimes due 

to sedation or lack of privacy cannot 

verbalize their intense need of spirituality 

thus they face the guilt of not following 

their practices so they end up into spiritual 

distress (Maqsood et al., 2015). Just like 

mentioned in the above case scenario, many 

patients perceive illness as God's 

punishment for them or because of their bad 

deeds (Berton, 2015).  

Several interventions can be helpful for 

patients to relieve their emotional pain like 

mind based techniques such as yoga, 

meditation, muscle tensing exercises, 

relaxation techniques (Malik, & Mazahir, 

2015).  Nurses should perform a complete 

psychological assessment to understand 

that mind and body are associated so 

sometimes psychological treatment also 

reduces patient’s physical suffering 

(Gunser, 2017). Active listening, using 

verbal cues and providing emotional 

support may help in reducing fears and 

anxiety regarding death as it allows patients 

to ventilate their feelings and thoughts (Fan 

et al., 2017) Nurses should reassure that 

they are always available to help them 

whenever they want. In addition, nurses 

must also encourage patients to reflect back 

to their lives, recall their strong and positive 

points so that they can attain self-

satisfaction (Maqsood et al., 2015). 

It is an important responsibility for nurses 

to assess clients and families spiritual 

beliefs to overcome spiritual distress but for 

that first of all, they need to be self-aware 

about their own spiritual beliefs (Dallas et 

al., 2012). They must ask those questions to 

themselves before inquiring the patients 

(Hendrick & Cobos, 2010). For this 

category (Dallas et al., 2012). Institutes 

must train the nurses regarding the way of 

proper psychological and spiritual 

communication and an assessment on daily 

basis, In addition, they must get spiritually 

engaged with the patient for their wellbeing 

(Penman et al., 2013). Health care 

personals should provide culturally 

appropriate care based on patients beliefs 

with the purpose of meeting client's needs 

and optimum care (Gualdani & Pegoli, 

2014). Encouraging patients to perform 

their respective religious practices are 

helpful in the spiritual expression of 

individual and family (Rego & Nunes, 

2016).  

Conclusion 

Palliative care deals with the provision of 

holistic care to terminal patients and 

caregivers in every aspect of their lives. 

Mind based researches say that making a 

person mentally relaxed, effects positively 

on bodily functions so proper psychological 

assessment must be done to identify their 

emotional needs and interventions should 

be done accordingly. Everyone has a 

different way of expression of spirituality 

so nurses must be aware of the fact that 

spiritual beliefs also affect a person’s 

health. Health care providers should 

analyze and understand a patient‘s spiritual 

concepts. And they must work to find out 

patients spiritual needs and address them. 

As it is beneficial in palliative care to 

provide comfort, reduce pain and other 

symptoms that improve quality of life.  

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Annals of Psychophysiology 
©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Naureen Rehman 57 

 

Conflicts of Interests 

None.  

Acknowledgment  

I would like to thank Nimira Asif for 

providing support and guidance regarding 

writing the research paper as well as Aga 

Khan University, school of nursing for 

organizing this project. 

Funding   
This was an academic assignment so all the 

funding was done by Aga Khan university, 

Pakistan. 

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Annals of Psychophysiology 
©Advance Educational Institute & Research Centre 

Volume 5, October 2018  
www.aeirc-edu.com 

ISSN 2412 - 3188 
 

Naureen Rehman 58 

 

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