{"id":4389,"date":"2023-01-19T08:27:59","date_gmt":"2023-01-19T08:27:59","guid":{"rendered":"https:\/\/www.paliatia.eu\/new\/?p=4389"},"modified":"2024-01-31T13:01:08","modified_gmt":"2024-01-31T13:01:08","slug":"editorial-2","status":"publish","type":"post","link":"https:\/\/www.paliatia.eu\/new\/2023\/01\/editorial-2\/","title":{"rendered":"Editorial"},"content":{"rendered":"

<\/a><\/h2>\n
    \n
  1. Palliative care and spirituality
    \nSebastian Moldovan1
    \n, Daniel Hinshaw2
    \n, Invited Editors
    \n1Orthodox Faculty of Theology, Lucian Blaga University of Sibiu, Romania\/ Facultatea de Teologie Ortodox\u0103, Universitatea Lucian Blaga Sibiu,
    \nRom\u00e2nia
    \n2Consultant in Palliative Medicine, Geriatrics Center & Professor Emeritus of Surgery, University of Michigan and Visiting Professor
    \nTransilvania University, Brasov, Romania
    \n____________________________________________________________________________________________________
    \nPalliative care (PC), one of the newest specialties of modern
    \nmedicine, has brought one of the oldest human concerns back
    \ninto the field. With an equally modern term, spirituality, it refers
    \nto that part of the personal lifeworld which addresses the
    \nquestion of what lies or can lie beyond the immediate known of
    \neveryday experience, both within the self and beyond, to the
    \nflow of human interactions and the cosmic environment in
    \nwhich we are immersed. Starting from the recognition of the
    \nmultiple dimensions of the experience of suffering, in the
    \nfundamental concept of “total pain” [1, 2], PC first contributed,
    \nwith others, to the launch of the three-dimensional, bio-psychosocial model in medicine, and later succeeded in gaining
    \nacceptance, as yet limited, of the fourth dimension, that of
    \nspirituality. Professional disciplines with a close affinity to PC,
    \nsuch as nursing, oncology, psychiatry, and clinical psychology,
    \nas well as the new “patient or person-centered” orientations in
    \nmedicine, influenced by the humanistic psychology and
    \npsychotherapeutic schools, already include, to one extent or
    \nanother, a concern for spirituality and spiritual care [3, 4].
    \nThe World Health Organization (WHO) is showing signs of
    \nfollowing this trend too, albeit still timidly. In 1998, for instance,
    \nthe WHO Department of Mental Health published a report on
    \nspirituality\/religion\/personal beliefs as a dimension of quality of
    \nlife (QOL) and a manual on QOL assessment that includes this
    \ndimension [5, 6]. Subsequently, the 2014 resolution
    \n“Strengthening of palliative care as a component of
    \ncomprehensive care throughout the life course” explicitly
    \nrecognizes the relevance of spirituality and its place in
    \n“comprehensive care”. Without examining it separately, the
    \nresolution includes spirituality in a definition of palliative care
    \nthus: “palliative care is an approach that improves the quality
    \nof life of patients (adults and children) and their families who
    \nare facing the problems associated with life-threatening illness,
    \nthrough the prevention and relief of suffering by means of early
    \nidentification and correct assessment and treatment of pain
    \nand other problems, whether physical, psychosocial or
    \nspiritual” [7]. Although there are initiatives in this regard, WHO
    \nis not yet willing to include spirituality in its general definition of
    \nhealth. But the way was already opened [8].
    \nThere are some major barriers to the full acceptance of
    \nspirituality and spiritual care in contemporary medicine. The
    \nfirst and most formidable is its conceptualization and
    \noperationalization in utilitarian terms for the purposes of clinical
    \nresearch and implementation, indispensable for the rigors of
    \nevidence-based medicine [9]. Spirituality seems resistant to
    \ndefinition and especially to a universal definition, valid over the
    \nenormous diversity of its manifestations. Not only its intimate
    \nconnection with religious traditions and faith-based practices,
    \nbut also the exuberant new forms of secular spirituality seem
    \nboth to argue for and at the same time undermine this
    \nuniversality. This is why we are witnessing in medicine
    \nspirituality\u2019s recognition and affirmation, as well as debates
    \nand even contestations. Sometimes the risk of parochialism is
    \nraised (e.g. the Christian content with which PC began) leading
    \nto marginalization or exclusion of different forms of spirituality.
    \nOthers fear the risk of essentialism (postulating a homo
    \nreligious) in which spirituality and spiritual care might be
    \nimposed upon those who do not want them at all [10]. On the
    \nother hand, the search for a universal meaning, without a
    \nspecific spiritual experience, seems to lead to its reduction to
    \na “thin”, purely operational content, to procedures and
    \nprotocols that identify and address whatever might be
    \n“spirituality” in patients’ experience of their own ill-health
    \ncondition. A similar approach has already been tried by
    \nbioethics, with uncertain results. The alternative, to recognize
    \nhowever a “thick” content, involves not only changing the
    \nconceptualization from “spirituality” to “spiritualities”, but also
    \nendowing medical and palliative care with very diverse and
    \nrobust ‘cultural competencies’ while acknowledging the limited
    \nrelevance of the highly regarded research and validation tools
    \nsuch as meta-analyses and randomized controlled trials [11].
    \nAnother important aspect that PC particularly highlights is the
    \nintimate connection between spiritual and social needs,
    \nbetween the universe of the inner life and belonging to a
    \nhuman community. And here the connection of spirituality with
    \nreligion – viewed sometimes with suspicion – can prove to be of
    \nparticular practical relevance, with religious communities
    \nusually providing important, sometimes indispensable, support
    \nnetworks [12, 13].
    \nAt the heart of these difficulties in adopting spirituality – or
    \nmultiple spiritualities – in medical theory and practice are the
    \ndifficulties of the professionals, from all the fields of expertise
    \ninvolved. However, they define spirituality, they cannot
    \nrecognize and address the spiritual needs of patients and
    \ncarers without a minimum personal familiarity with spirituality,
    \nwithout skills in interacting with the diversity of spiritual
    \nmanifestations of others (including colleagues), and skills in
    \nfunctioning in multi-disciplinary teams, which require a
    \nthorough, appropriate education, still under-represented in the
    \nprevailing medical educational system [14, 15].
    \nWithout being a substitute for systematic education, academic
    \nresearch makes an important contribution to it through the
    \nVol 17 \/ Nr. 1 \/ January 2024 https:\/\/www.paliatia.eu
    \nISSN 1844 \u2013 7058 4 Funda\u021bia HOSPICE Casa Speran\u021bei
    \nliterature it produces. Recently, in 2023, two renowned
    \njournals, one in the field of medicine and the other in the field
    \nof religion, published issues specifically dedicated to spiritual
    \ncare in PC [16, 17]. The journal Paliatia also offers some
    \nmaterial on this topic in this issue.
    \nThe first piece belongs to a chaplain priest, a professional
    \ncategory present in most PC units, but little represented in the
    \nresearch field. While the work of chaplains, lay or clerical, is
    \nalready a relevant research topic, their quality as researchers
    \nis still undervalued. Chaplains represent a highly significant
    \nresource of knowledge by their proximity to the most intimate
    \ncontents of the lifeworld of patients and their families, contents
    \nthat are difficult to access by their very nature [18, 19, 20].
    \nFather Florin Cristea offers us a qualitative foray into the
    \nuniverse of the perceptions of paediatric patients at a major
    \nchildren’s hospital in Romania, perceptions concerning illness,
    \nsuffering, fears, the thought of death and relationships with the
    \nDivine and the chaplain priest. Although life-threatening
    \nillnesses represent a severely disruptive experience in their
    \nlives, causing suffering and major fears, the children and
    \nadolescents interviewed do not appear to be overwhelmed by
    \nthem, and the significant narrowing of the possibilities of
    \nmanifestation specific to their age (play, school education)
    \nseems to be accompanied by a widening of the universe of
    \nconcerns for those around them (parents, other fellow
    \nsufferers, friends), as well as for practices with religious
    \ncontent. The phenomenon of accelerated maturation noted by
    \nthe author would be worth investigating further.
    \nA second piece also belongs to a clerical chaplain, active in
    \nanother PC context, in the USA, who reflects on his own
    \nactivity. An autoethnographical case study, from a theological
    \nperspective specific to a particular tradition, namely the
    \nOrthodox Christian tradition, a tradition not far from the origins
    \nand the spirit of PC and the hospice movement [2, 21, 22].
    \nFather Adrian Budica reflects on the theological foundations of
    \nhis role and the ways in which it is performed. A role par
    \nexcellence of mediation and connection, at the heart of which
    \nis, in fact, the ever-deepening connection with one’s own heart,
    \none’s own self, both for patients, their carers, but also for
    \nmembers of the multidisciplinary team, including the chaplain.
    \nIn this deepening of\/in oneself, one can discover both one’s
    \nown humility (limitations and helplessness, physical,
    \npsychological, and moral) and one’s own dignity (“I am a child
    \nof God”; “image and likeness of God”, in theological terms).
    \nThe trajectory of a chaplain in the clinical space appears as a
    \nvisitation and accompaniment of those present in this space,
    \nwhich connects with an invisible thread their hearts to each
    \nother and also to themselves. For Father Adrian Budica to visit
    \nmeans, in this space, to follow Christ where He is already
    \nhidden, which means to be visited by Him.
    \nThe PC started from the very beginning with a fundamental
    \nconcern for how patients affected by life-threatening illnesses
    \nfeel and express their own situation. Dame Cicely Saunders
    \nmade extensive use of the narrative method, transcribing
    \nthousands of pages of testimonies from those being cared for,
    \nwhich led her to the concept of “total pain” [2]. Narrative
    \nmethods represent a going beyond and complementing of the
    \n“medical history” by developing it in all four dimensions of
    \nhuman experience, but not only for a symptomatologic search
    \nfor illness, but for a search for meaning and coherence of
    \npersonal experience in its entirety. In the third piece of this
    \nthematic volume, professor Ovidiu Gavrilovici gives a brief
    \npresentation of narrative methods, this time from the
    \nperspective of their rediscovery in medicine and psychology
    \nvia psychotherapy. Two methods of narratological practice are
    \nillustrated, on either side of the often traumatic experience of
    \ndeath and dying. Although, for the patient, PC ends with death,
    \nfor those left behind the experience continues with mourning
    \nand grief, their remembering being both a cause for grief and
    \nan opportunity for companionship and care [23].
    \nA fourth piece is a welcome literature review on the sensitive
    \nissues raised by communication between the interdisciplinary
    \nteam, parents\/carers and patients about end-of-life care and
    \ndeath in the paediatric oncology context. Doctor Olivia Drinca
    \nprovides a welcome addition to the first material, from the
    \nperspectives of the experiences of all those affected and
    \ninvolved in paediatric PC. Interest in systematic research into
    \nthese issues is rightly growing. On a more general level,
    \ncommunication is undoubtedly not only an indispensable
    \nmeans of our coexistence and coaction, but also a place where
    \nspirituality and spiritual care are manifested par excellence
    \n(and not only verbal, but also non-verbal, through gestures and
    \ntouch). It is admirable how wholeness and coherence (in a
    \ndynamic sense, as positive, fulfilling experiences, but also as
    \nnegative, emptying experiences) can be expressed in narrative
    \nand storytelling (with its sayings and non-sayings). Spirituality
    \n– as a dimension that accounts for meaning, coherence,
    \nwholeness, integration, connection with the self and the
    \nbeyond – and its approach through spiritual care also benefit
    \nfrom communication research and contribute to its facilitation.
    \nA medical clinical case study and a section of book reviews,
    \nalso dedicated to spirituality in PC, complete this thematic
    \nissue, which can be considered only a start, as Paliatia
    \nlaunches, on this occasion, a call to all interested professionals
    \nto form a national support network to promote the recognition
    \nof the role and improvement of the integration of spiritual care
    \nin PC, both through research, educational and administrative
    \napproaches.
    \nThe invited editors of this issue express their gratitude to the
    \neditorial and technical team for the wonderful collaboration
    \noffered!
    \n\u00cengrijirea paliativ\u0103 \u0219i spiritualitatea
    \n\u00cengrijirea paliativ\u0103 (IP), una dintre cele mai noi specialit\u0103\u021bi ale
    \nmedicinei moderne, a readus \u00een actualitate una dintre cele mai
    \nvechi preocup\u0103ri umane. Cu un termen de asemenea modern,
    \nspiritualitatea, aceasta se refer\u0103 la acea parte a vie\u021bii personale
    \ncare abordeaz\u0103 problema a ceea ce se afl\u0103, sau poate s\u0103 se
    \nafle, dincolo de ceea ce ne este imediat cunoscut din
    \nexperien\u021ba cotidian\u0103, at\u00e2t \u00een interiorul sinelui, c\u00e2t \u0219i dincolo de
    \nsine, \u00een fluxul interac\u021biunilor umane \u0219i \u00een mediul cosmic \u00een care
    \nsuntem scufunda\u021bi. Pornind de la recunoa\u0219terea multiplelor
    \ndimensiuni ale experien\u021bei suferin\u021bei, \u00een conceptul fundamental
    \nde \u201edurere total\u0103” [1, 2], IP a contribuit, mai \u00eent\u00e2i, al\u0103turi de al\u021bii,
    \nla introducerea modelului tridimensional bio-psiho-social, \u00een
    \nmedicin\u0103, iar mai t\u00e2rziu a reu\u0219it s\u0103 ob\u021bin\u0103 acceptarea, \u00eenc\u0103
    \nlimitat\u0103, a celei de-a patra dimensiuni, cea a spiritualit\u0103\u021bii.
    \nDisciplinele profesionale cu o afinitate str\u00e2ns\u0103 cu IP, cum ar fi
    \nasisten\u021ba medical\u0103, oncologia, psihiatria \u0219i psihologia clinic\u0103,
    \nVol 17 \/ Nr. 1 \/ January 2024 https:\/\/www.paliatia.eu
    \nISSN 1844 \u2013 7058 5 Funda\u021bia HOSPICE Casa Speran\u021bei
    \nprecum \u0219i noile orient\u0103ri \u201ecentrate pe pacient sau pe persoan\u0103,
    \ninfluen\u021bate de \u0219colile de psihologie umanist\u0103 \u0219i
    \npsihoterapeutic\u0103, includ deja, \u00eentr-o m\u0103sur\u0103 sau alta, o
    \npreocupare pentru spiritualitate \u0219i \u00eengrijire spiritual\u0103 [3, 4].
    \nOrganiza\u021bia Mondial\u0103 a S\u0103n\u0103t\u0103\u021bii (OMS) pare s\u0103 se alinieze la
    \naceast\u0103 direc\u021bie, chiar dac\u0103 \u00eenc\u0103 timid. \u00cen 1998, de exemplu,
    \nDepartamentul de S\u0103n\u0103tate Mintal\u0103 al OMS a publicat un
    \nraport privind spiritualitatea\/religia\/credin\u021bele personale ca
    \ndimensiune a calit\u0103\u021bii vie\u021bii (QOL) \u0219i un manual privind
    \nevaluarea QOL care include aceast\u0103 dimensiune [5, 6].
    \nUlterior, rezolu\u021bia din 2014 \u201eConsolidarea \u00eengrijirii paliative ca
    \no component\u0103 a \u00eengrijirii complete pe tot parcursul vie\u021bii”
    \nrecunoa\u0219te \u00een mod explicit relevan\u021ba spiritualit\u0103\u021bii \u0219i locul
    \nacesteia \u00een \u201e\u00eengrijirea complet\u0103”. F\u0103r\u0103 s\u0103 o examineze separat,
    \nrezolu\u021bia include spiritualitatea \u00eentr-o defini\u021bie a \u00eengrijirii
    \npaliative, astfel \u201e\u00eengrijirea paliativ\u0103 este o abordare care
    \n\u00eembun\u0103t\u0103\u021be\u0219te calitatea vie\u021bii pacien\u021bilor (adul\u021bi \u0219i copii) \u0219i a
    \nfamiliilor acestora care se confrunt\u0103 cu problemele asociate
    \nbolilor amenin\u021b\u0103toare de via\u021b\u0103, prin prevenirea \u0219i alinarea
    \nsuferin\u021bei, prin identificarea timpurie \u0219i prin evaluarea \u0219i
    \ntratamentul corect al durerii \u0219i al altor probleme, fie ele fizice,
    \npsihosociale sau spirituale” [7]. De\u0219i exist\u0103 ini\u021biative \u00een acest
    \nsens, OMS nu este \u00eenc\u0103 dispus\u0103 s\u0103 includ\u0103 spiritualitatea \u00een
    \ndefini\u021bia sa general\u0103 a s\u0103n\u0103t\u0103\u021bii. Dar calea a fost deja deschis\u0103
    \n[8].
    \nExist\u0103 c\u00e2teva bariere majore \u00een calea accept\u0103rii depline a
    \nspiritualit\u0103\u021bii \u0219i a \u00eengrijirii spirituale \u00een medicina contemporan\u0103.
    \nCea mai important\u0103 dintre acestea este dificultatea
    \nconceptualiz\u0103rii \u0219i opera\u021bionaliz\u0103rii \u00een scopul cercet\u0103rii \u0219i al
    \nimplement\u0103rii clinice, indispensabile pentru rigorile medicinei
    \nbazate pe dovezi [9]. \u201eSpiritualitatea\u201d pare rezistent\u0103 la definire
    \n\u0219i mai ales la o defini\u021bie universal\u0103, valabil\u0103 peste diversitatea
    \nenorm\u0103 a manifest\u0103rilor sale. Nu doar leg\u0103tura sa intim\u0103 cu
    \ntradi\u021biile religioase \u0219i practicile bazate pe credin\u021b\u0103, ci \u0219i noile
    \nforme exuberante de spiritualitate secular\u0103 par s\u0103
    \nargumenteze \u0219i, \u00een acela\u0219i timp, s\u0103 submineze aceast\u0103
    \nuniversalitate. Acesta este motivul pentru care asist\u0103m \u00een
    \nmedicin\u0103 la recunoa\u0219terea \u0219i afirmarea spiritualit\u0103\u021bii, dar \u0219i la
    \ndezbateri \u0219i chiar contest\u0103ri. Uneori se eviden\u021biaz\u0103 riscul
    \nparohialismului (de exemplu, con\u021binutul cre\u0219tin cu care a
    \n\u00eenceput IP), ceea ce poate duce la marginalizarea sau
    \nexcluderea unor forme de spiritualitate. Al\u021bii se tem de riscul
    \nesen\u021bialismului (postularea unui homo religios), prin care
    \nspiritualitatea \u0219i \u00eengrijirea spiritual\u0103 ar putea fi impuse celor
    \ncare nu le doresc deloc. [10] Pe de alt\u0103 parte, c\u0103utarea unui
    \nsens universal, f\u0103r\u0103 o experien\u021b\u0103 spiritual\u0103 specific\u0103, pare s\u0103
    \nduc\u0103 la reducerea acesteia la un con\u021binut \u201esub\u021bire”, pur
    \nopera\u021bional, la proceduri \u0219i protocoale care identific\u0103 \u0219i
    \nabordeaz\u0103 orice ar putea fi \u201espiritualitatea” \u00een experien\u021ba
    \npacien\u021bilor cu privire la propria lor stare de nes\u0103n\u0103tate. O
    \nabordare similar\u0103 a fost deja \u00eencercat\u0103 de bioetic\u0103, cu rezultate
    \nincerte. Alternativa, de a recunoa\u0219te totu\u0219i un con\u021binut
    \nsubstan\u021bial, implic\u0103 nu numai schimbarea conceptualiz\u0103rii din
    \n\u201espiritualitate” \u00een \u201espiritualit\u0103\u021bi”, ci \u0219i \u00eenzestrarea \u00eengrijirii
    \nmedicale \u0219i paliative cu \u201ecompeten\u021be culturale” foarte diverse
    \n\u0219i solide, recunosc\u00e2nd \u00een acela\u0219i timp relevan\u021ba limitat\u0103 a unor
    \ninstrumente de cercetare \u0219i validare foarte apreciate, cum ar fi
    \nmeta-analizele \u0219i studiile controlate randomizate. [11]
    \nUn alt aspect important pe care IP \u00eel eviden\u021biaz\u0103 \u00een mod
    \ndeosebit este leg\u0103tura intim\u0103 dintre nevoile spirituale \u0219i cele
    \nsociale, dintre universul vie\u021bii interioare \u0219i apartenen\u021ba la o
    \ncomunitate uman\u0103. \u0218i aici, leg\u0103tura dintre spiritualitate \u0219i
    \nreligie – privit\u0103 uneori cu suspiciune – se poate dovedi deosebit
    \nde relevant\u0103 din punct de vedere practic, comunit\u0103\u021bile
    \nreligioase oferind de obicei re\u021bele de sprijin importante, uneori
    \nindispensabile. [12, 13]
    \n\u00cen centrul acestor dificult\u0103\u021bi \u00een adoptarea spiritualit\u0103\u021bii – sau a
    \nspiritualit\u0103\u021bilor multiple – \u00een teoria \u0219i practica medical\u0103 se afl\u0103
    \ndificult\u0103\u021bile profesioni\u0219tilor, din toate domeniile de expertiz\u0103
    \nimplicate. Indiferent cum definesc spiritualitatea, ei nu pot
    \nrecunoa\u0219te \u0219i aborda nevoile spirituale ale pacien\u021bilor \u0219i ale
    \n\u00eengrijitorilor f\u0103r\u0103 o minim\u0103 familiaritate personal\u0103 cu
    \nspiritualitatea, f\u0103r\u0103 abilit\u0103\u021bi de interac\u021biune cu diversitatea
    \nmanifest\u0103rilor spirituale ale celorlal\u021bi (inclusiv ale colegilor) \u0219i
    \nf\u0103r\u0103 abilit\u0103\u021bi de func\u021bionare \u00een echipe multidisciplinare, care
    \nnecesit\u0103 o educa\u021bie temeinic\u0103 \u0219i adecvat\u0103, \u00eenc\u0103
    \nsubreprezentat\u0103 \u00een sistemul educa\u021bional medical predominant.
    \n[14, 15]
    \nF\u0103r\u0103 a fi un substitut pentru educa\u021bia sistematic\u0103, cercetarea
    \nacademic\u0103 aduce \u0219i o contribu\u021bie important\u0103 la aceasta prin
    \nliteratura pe care o produce. Recent, \u00een 2023, dou\u0103 reviste de
    \nrenume, una din domeniul medicinei \u0219i cealalt\u0103 din domeniul
    \nreligiei, au publicat numere dedicate \u00een mod special \u00eengrijirii
    \nspirituale \u00een IP. [16, 17] Revista Palia\u021bia ofer\u0103 \u0219i ea c\u00e2teva
    \nmateriale pe aceast\u0103 tem\u0103 \u00een acest num\u0103r.
    \nPrimul articol apar\u021bine unui preot misionar de caritate
    \n(capelan), o categorie profesional\u0103 prezent\u0103 \u00een majoritatea
    \nunit\u0103\u021bilor de IP, dar pu\u021bin reprezentat\u0103 \u00een domeniul cercet\u0103rii.
    \nDe\u0219i activitatea capelanilor, laici sau clerici, este deja un
    \nsubiect de cercetare relevant, calitatea lor de cercet\u0103tori este
    \n\u00eenc\u0103 subestimat\u0103. Capelanii reprezint\u0103 o resurs\u0103 de
    \ncunoa\u0219tere extrem de important\u0103 prin proximitatea lor fa\u021b\u0103 de
    \naspectele cele mai intime ale lumii vie\u021bii pacien\u021bilor \u0219i a familiilor
    \nacestora, aspecte care sunt greu accesibile prin \u00eens\u0103\u0219i natura
    \nlor. [18, 19, 20] P\u0103rintele Florin Cristea ne ofer\u0103 o incursiune
    \ncalitativ\u0103 \u00een universul percep\u021biilor pacien\u021bilor pediatrici de la un
    \nmare spital de copii din Rom\u00e2nia, percep\u021bii referitoare la boal\u0103,
    \nsuferin\u021b\u0103, temeri, g\u00e2ndul mor\u021bii \u0219i rela\u021bia cu Divinitatea \u0219i cu
    \npreotul capelan. De\u0219i bolile care le amenin\u021b\u0103 via\u021ba reprezint\u0103 o
    \nexperien\u021b\u0103 grav perturbatoare \u00een via\u021ba lor, provoc\u00e2nd suferin\u021b\u0103
    \n\u0219i temeri majore, copiii \u0219i adolescen\u021bii intervieva\u021bi nu par a fi
    \ncople\u0219i\u021bi de acestea, iar restr\u00e2ngerea semnificativ\u0103 a
    \nposibilit\u0103\u021bilor de manifestare specifice v\u00e2rstei lor (jocul,
    \neduca\u021bia \u0219colar\u0103) pare s\u0103 fie \u00eenso\u021bit\u0103 de o l\u0103rgire a universului
    \nde preocup\u0103ri pentru cei din jur (p\u0103rin\u021bi, al\u021bi colegi de suferin\u021b\u0103,
    \nprieteni), precum \u0219i pentru practicile cu con\u021binut religios.
    \nFenomenul de maturizare accelerat\u0103 remarcat de autor ar
    \nmerita s\u0103 fie investigat \u00een continuare.
    \nAl doilea articol apar\u021bine tot unui capelan cleric, activ \u00eentr-un alt
    \ncontext IP, \u00een SUA, care reflecteaz\u0103 asupra propriei sale
    \nactivit\u0103\u021bi. Un studiu de caz autoetnografic, dintr-o perspectiv\u0103
    \nteologic\u0103 specific\u0103 unei anumite tradi\u021bii, \u0219i anume tradi\u021bia
    \ncre\u0219tin\u0103 ortodox\u0103, tradi\u021bie care nu este departe de originile \u0219i
    \nde spiritul IP \u0219i al mi\u0219c\u0103rii hospice [2, 21, 22]. P\u0103rintele Adrian
    \nBudic\u0103 reflecteaz\u0103 asupra fundamentelor teologice ale rolului
    \ns\u0103u \u0219i asupra modalit\u0103\u021bilor de \u00eendeplinire a acestuia. Un rol prin
    \nexcelen\u021b\u0103 de mediere \u0219i de conectare, \u00een centrul c\u0103ruia se afl\u0103,
    \nde fapt, conectarea tot mai profund\u0103 cu propria inim\u0103, cu
    \npropriul sine, at\u00e2t pentru pacien\u021bi, c\u00e2t \u0219i pentru \u00eengrijitorii
    \nacestora, dar \u0219i pentru membrii echipei multidisciplinare,
    \ninclusiv pentru capelan. \u00cen aceast\u0103 aprofundare de\/\u00een sine, se
    \npoate descoperi at\u00e2t propria smerenie (limit\u0103ri \u0219i neputin\u021be,
    \nVol 17 \/ Nr. 1 \/ January 2024 https:\/\/www.paliatia.eu
    \nISSN 1844 \u2013 7058 6 Funda\u021bia HOSPICE Casa Speran\u021bei
    \nfizice, psihologice \u0219i morale), c\u00e2t \u0219i propria demnitate (\u201esunt un
    \ncopil al lui Dumnezeu”; \u201echip \u0219i asem\u0103nare a lui Dumnezeu”,
    \n\u00een termeni teologici). Traiectoria unui capelan \u00een spa\u021biul clinic
    \napare ca o vizit\u0103 \u0219i o \u00eenso\u021bire a celor prezen\u021bi \u00een acest spa\u021biu,
    \ncare leag\u0103 cu un fir invizibil inimile lor \u00eentre ele, dar \u0219i de ele
    \n\u00eensele. Pentru p\u0103rintele Adrian Budic\u0103 a vizita \u00eenseamn\u0103, \u00een
    \nacest spa\u021biu, a-L urma pe Hristos acolo unde El este deja
    \nascuns, ceea ce \u00eenseamn\u0103, totodat\u0103, a fi vizitat de El.
    \nIP a pornit de la bun \u00eenceput de la o preocupare fundamental\u0103
    \npentru modul \u00een care pacien\u021bii afecta\u021bi de boli care le amenin\u021b\u0103
    \nvia\u021ba se simt \u0219i \u00ee\u0219i exprim\u0103 propria situa\u021bie. Dame Cicely
    \nSaunders a folosit pe scar\u0103 larg\u0103 metoda narativ\u0103, transcriind
    \nmii de pagini de m\u0103rturii ale celor \u00eengriji\u021bi, ceea ce a condus-o
    \nla conceptul de \u201edurere total\u0103”. [2] Metodele narative reprezint\u0103
    \no dep\u0103\u0219ire \u0219i o completare a \u201eistoricului medical”, dezvolt\u00e2ndul \u00een toate cele patru dimensiuni ale experien\u021bei umane, dar nu
    \ndoar pentru o c\u0103utare simptomatologic\u0103 a bolii, ci pentru o
    \nc\u0103utare a sensului \u0219i a coeren\u021bei experien\u021bei personale \u00een
    \nansamblul ei. \u00cen cea de-a treia pies\u0103 a acestui volum tematic,
    \nprofesorul Ovidiu Gavrilovici face o scurt\u0103 prezentare a
    \nmetodelor narative, de data aceasta din perspectiva
    \nredescoperirii lor \u00een medicin\u0103 \u0219i psihologie prin intermediul
    \npsihoterapiei. Sunt ilustrate dou\u0103 metode narative, de o parte
    \n\u0219i de alta a experien\u021bei adesea traumatizante a mor\u021bii \u0219i a
    \nmuribundului. De\u0219i, pentru pacient, IP se \u00eencheie cu moartea,
    \npentru cei r\u0103ma\u0219i \u00een urm\u0103 experien\u021ba continu\u0103 cu doliul \u0219i
    \ndurerea, amintirea lor fiind at\u00e2t un motiv de suferin\u021b\u0103, c\u00e2t \u0219i o
    \noportunitate de \u00eenso\u021bire \u0219i \u00eengrijire. [23]
    \nUn al patrulea articol este o trecere \u00een revist\u0103 a literaturii de
    \nspecialitate referitoare la problemele sensibile ridicate de
    \ncomunicarea dintre echipa interdisciplinar\u0103, p\u0103rin\u021bi\/\u00eengrijitori \u0219i
    \npacien\u021bi cu privire la \u00eengrijirea la sf\u00e2r\u0219itul vie\u021bii \u0219i la moarte \u00een
    \ncontextul oncologiei pediatrice. Doctorul Olivia Drinca aduce o
    \ncompletare binevenit\u0103 la primul material, din perspectiva
    \nexperien\u021belor tuturor celor afecta\u021bi \u0219i implica\u021bi \u00een IP pediatric\u0103.
    \nInteresul pentru cercetarea sistematic\u0103 a acestor aspecte este
    \n\u00een cre\u0219tere, pe bun\u0103 dreptate. La un nivel mai general,
    \ncomunicarea este, f\u0103r\u0103 \u00eendoial\u0103, nu numai un mijloc
    \nindispensabil al coexisten\u021bei \u0219i coac\u021biunii noastre, ci \u0219i un loc \u00een
    \ncare spiritualitatea \u0219i \u00eengrijirea spiritual\u0103 se manifest\u0103 prin
    \nexcelen\u021b\u0103 (\u0219i nu numai verbal, ci \u0219i nonverbal, prin gesturi \u0219i
    \natingere). Este admirabil modul \u00een care plenitudinea \u0219i
    \ncoeren\u021ba (\u00een sens dinamic, ca experien\u021be pozitive, de \u00eemplinire,
    \ndar \u0219i ca experien\u021be negative, de golire) pot fi exprimate \u00een
    \nnara\u021biune \u0219i \u00een povestire (cu zicerile \u0219i ne-zicerile sale).
    \nSpiritualitatea – ca dimensiune ce \u021bine cont de sens, coeren\u021b\u0103,
    \nplenitudine, integrare, conexiune cu sine \u0219i cu lumea de
    \ndincolo – \u0219i abordarea acesteia prin intermediul \u00eengrijirii
    \nspirituale, beneficiaz\u0103, de asemenea, de cercetarea \u00een
    \ndomeniul comunic\u0103rii \u0219i contribuie la facilitarea acesteia.
    \nUn studiu de caz clinic \u0219i c\u00e2teva recenzii de carte, dedicate \u0219i
    \nacestea spiritualit\u0103\u021bii \u00een context medical, \u00eencheie acest num\u0103r
    \ntematic, care poate fi, \u00eens\u0103, considerat doar un \u00eenceput,
    \ndeoarece Palia\u021bia lanseaz\u0103, cu aceast\u0103 ocazie, un apel c\u0103tre
    \nto\u021bi profesioni\u0219tii interesa\u021bi s\u0103 formeze o re\u021bea na\u021bional\u0103 de
    \nsprijin pentru a promova recunoa\u0219terea rolului \u0219i \u00eembun\u0103t\u0103\u021birea
    \nintegr\u0103rii \u00eengrijirii spirituale \u00een IP, at\u00e2t prin cercetare, c\u00e2t \u0219i prin
    \ndemersuri educa\u021bionale \u0219i administrative.
    \nEditorii invita\u021bi ai acestui num\u0103r \u00ee\u0219i exprim\u0103, \u0219i pe aceast\u0103 cale,
    \ngratitudinea fa\u021b\u0103 de echipa de redac\u021bie \u0219i tehnoredactare
    \npentru minunata colaborare oferit\u0103!
    \nReferences:
    \n1. Saunders C. The symptomatic treatment of incurable malignant
    \ndisease. Prescribers\u2019 Journal. 1964; 4(4): 68-73.
    \n2. Clark D. Cicely Saunders: A life and legacy. Oxford University
    \nPress; 2018.
    \n3. Timmins F, Caldeira S, editors. Spirituality in healthcare:
    \nPerspectives for innovative practice Cham: Springer; 2019.
    \n4. Silbermann M, Berger A, editors. Global perspectives in cancer
    \ncare: religion, spirituality, and cultural diversity in health and
    \nhealing. Oxford University Press; 2022.
    \n5. World Health Organization. WHOQOL and Spirituality,
    \nReligiousness and Personal Beliefs; 1998.
    \nhttps:\/\/iris.who.int\/handle\/10665\/70897 (accessed 15.01.2024).
    \n6. World Health Organization. WHOQOL: Measuring Quality of
    \nLife; 2012. https:\/\/www.who.int\/tools\/whoqol (accessed
    \n15.01.2024).
    \n7. World Health Organization. Resolution WHA67.19:
    \nStrengthening of palliative care as a component of
    \ncomprehensive care throughout the life course; 2014.
    \nhttps:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/WHA67\/A67_R19-en.pdf
    \n(accessed 15.01.2024).
    \n8. Peng-Keller S, Winiger F, Rauch R. The spirit of global health:
    \nthe World Health Organization and the spiritual dimension of
    \nhealth, 1946-2021. Oxford University Press; 2022.
    \n9. Kruizinga R, Scherer-Rath M, Schilderman HJ, Puchalski CM,
    \nvan Laarhoven HH. Toward a fully fledged integration of spiritual
    \ncare and medical care. Journal of pain and symptom
    \nmanagement. 2018; 55(3): 1035-1040.
    \nhttps:\/\/doi.org\/10.1016\/j.jpainsymman.2017.11.015.
    \n10. Lundberg E, \u00d6hl\u00e9n J, Dellenborg L, Ozanne A, Enstedt D.
    \nDeconstructing spiritual care: Discursive underpinnings within
    \npalliative care research. Nursing Inquiry. 2024, e12622.
    \nhttps:\/\/doi.org\/10.1111\/nin.12622
    \n11. Gijsberts MJH, Liefbroer AI, Otten R, Olsman E. Spiritual care in
    \npalliative care: a systematic review of the recent European
    \nliterature. Medical Sciences. 2019; 7(2): 25.
    \nhttps:\/\/doi.org\/10.3390\/medsci7020025.
    \n12. Mills J, Abel J, Kellehear A, Noonan K, Bollig G, Grindod A et al.
    \nThe role and contribution of compassionate communities. The
    \nLancet. 2023. https:\/\/doi.org\/10.1016\/S0140-6736(23)02269-9
    \n13. Idler E, Jalloh MF, Cochrane J, Blevins J. Religion as a social
    \nforce in health: complexities and contradictions. BMJ 2023; 382:
    \ne076817. https:\/\/doi.org\/10.1136\/bmj-2023-076817.
    \n14. Hinshaw DB, Carnahan JM, Breck J, Mosoiu N, Mosoiu D.
    \nSpiritual issues in suffering: creating a dialogue between clergy
    \nand palliative care providers. Progress in Palliative Care. 2011;
    \n19(1): 7-14.
    \nhttps:\/\/doi.org\/10.1179\/174329111X12967522394254.
    \n15. Best M, Leget C, Goodhead A, Paal P. An EAPC white paper on
    \nmulti-disciplinary education for spiritual care in palliative care.
    \nBMC Palliative Care. 2020; 19(1): 1-10.
    \nhttps:\/\/doi.org\/10.1186\/s12904-019-0508-4
    \n16. Quinn B, Connolly M. Spirituality in palliative care. BMC Palliat
    \nCare. 2023; 22:1. https:\/\/doi.org\/10.1186\/s12904-022-01116-x
    \n17. Best MC, Vivat B, Gijsberts MJ. Spiritual Care in Palliative Care.
    \nReligions. 2023; 14(3): 320. https:\/\/doi.org\/10.3390\/rel14030320
    \n18. Cadge W. Healthcare chaplaincy as a companion profession:
    \nHistorical developments. Journal of Health Care Chaplaincy.
    \n2019; 25(2): 45\u201360.
    \nhttps:\/\/doi.org\/10.1080\/08854726.2018.1463617
    \n19. den Toom N, Visser A, K\u00f6rver J, Walton MN. The perceived
    \nimpact of being a chaplain-researcher on professional practice.
    \nJournal of Health Care Chaplaincy. 2024; 30(1): 19-32.
    \nhttps:\/\/doi.org\/10.1080\/08854726.2022.2132036.
    \n20. Fitchett G. The State of the art in chaplaincy research: Needs,
    \nresources and hopes. In: Kruizinga R, K\u00f6rver J, Den Toom JN,
    \nWalton MN, Stoutjesdijk M, editors. Learning from case studies
    \nVol 17 \/ Nr. 1 \/ January 2024 https:\/\/www.paliatia.eu
    \nISSN 1844 \u2013 7058 7 Funda\u021bia HOSPICE Casa Speran\u021bei
    \nin chaplaincy. Towards practice based evidence &
    \nprofessionalism Utrecht: Eburon; 2020. p. 21\u201335.
    \n21. Clark D. Cicely Saunders: founder of the hospice movement:
    \nselected letters 1959-1999. Oxford University Press; 2005.
    \n22. Bouri M. Medicine, Suffering and Death: Palliation and the
    \nEthics of Caring for Those We Cannot Cure. In: Kampakis K,
    \nHaralambos V, editors. Orthodox Christianity and Modern
    \nScience: Past, Present and Future, Brepols Publishers; 2022. p.
    \n83-117.
    \n23. Hedtke L, Winslade J. Remembering lives: Conversations with
    \nthe dying and the bereaved. Routledge. 2017.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Palliative care and spirituality Sebastian Moldovan1 , Daniel Hinshaw2 , Invited Editors 1Orthodox Faculty of Theology, Lucian Blaga University of Sibiu, Romania\/ Facultatea de Teologie Ortodox\u0103, Universitatea Lucian Blaga Sibiu, Rom\u00e2nia 2Consultant in Palliative Medicine, Geriatrics Center & Professor Emeritus of Surgery, University of Michigan and Visiting Professor Transilvania University, Brasov, Romania ____________________________________________________________________________________________________ Palliative care […]<\/p>\n","protected":false},"author":431,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[996],"tags":[],"_links":{"self":[{"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/posts\/4389"}],"collection":[{"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/users\/431"}],"replies":[{"embeddable":true,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/comments?post=4389"}],"version-history":[{"count":7,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/posts\/4389\/revisions"}],"predecessor-version":[{"id":4842,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/posts\/4389\/revisions\/4842"}],"wp:attachment":[{"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/media?parent=4389"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/categories?post=4389"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.paliatia.eu\/new\/wp-json\/wp\/v2\/tags?post=4389"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}