Paul C. Edwards
I’m going to respond to a few of Dina’s questions and then post a few comments in response to Kirstin’s comments.
1) Some prominent question I hear arising from patients in regard to their relationship with the sacred after a diagnosis/illness is, “Is God punishing me?” Another is, “Why did God allow this to happen?” (I’ve always been a good person).
2) Our Palliative Care team does not do initial spiritual needs assessments. That is handled by our admissions intake folks and then some follow-up questions are asked when our RN’s do their psycho-social history assessment. That’s where I would get a sense of what role religious practice and spirituality plays in a person’s life. Unfortunately, we migrated to that new system I mentioned and we have had some kinks in that part of the software design. I’ve been working with all involved, including the Nurse Informatics Teams and have had some measured success. Without going into intense details, some were not asking the prescribed questions and, thereby, leaving the fields blank, some were randomly entering anything just to “complete” the task, some were uncomfortable (as Kirstin noted in her post) with asking the questions.
Our Palliative Care team places a high value on spirituality and I have been a part of many initial or follow-up consults. I am not quite sure if they use any formal tools but they do ask patients to identify coping mechanisms and that gets the conversation going. It helps that our team comprises of individuals (from the director to all the others on the service) who have strong spiritual practice. Being comfortable in their own spiritual rootedness as physicians and RNs have allowed our team to not shy away from addressing those “spiritual vital signs” questions. My Director always says that one of the tasks of the team is to alleviate pain and suffering, and she constantly references “spiritual pain” among the varieties of suffering a patient on consult could have. Notably, we are not all from Judaeo-Christian traditions, but we value and affirm the richness of our spiritual diversity as a team.
The great need that our team has (and the Director has said that to me several times over the years) is that I be with them on every consult. The problem is I am solo and do have other patients to see and other department responsibilities that make that impossible. Nonetheless, I am consulted quite frequently when they have assessed my input would be of invaluable to their patients/their loved ones.
A note here also is that my current setting had historically religious roots, so spirituality was always what we used to call one of our “core values”. Since our corporate merger, that is not so much highlighted, not in the ways it used to be, but there are still many of us there who continue to model those values.
I’ll address the other three questions in another post.