Lori Casey BSN MDiv., BCC-PCHAC

Hi Dina,  I had a hard time getting to the forums page earlier today but tonight had no problem.  I used Dr. Christina Puchalski’s FICA tool to gather a spiritual history. I had to create my own charting and did this by looking at the NCPQPC report and also Joint Commissions standards.  Information Technology people were my BFF’s because I am not technically minded and we had to to all of our charting electronically.  I did create boxes to check off for the reason that to chart on each pt in narrative form would have been exhaustive and almost impossible from a timeframe standpoint.  We were seeing 15-25 patients a day.  Sitting with them, creating a sacred space and engaging them in the deeper conversations of life, death, hope, and meaning was the best part for me, so I created tools that worked for me.  Our director of Palliative Care created most of the team forms.  We met daily to review our patients and there was a form we passed around and each member of the team would update their  patient assessments. We had frequent family conferences and all members of the palliative team were expected to be there.  In the video Dr. Kvale mentioned three areas where the chaplain is invaluable and one of these is decision making at the end of life.  Being in those family meetings was really important for several reasons.  First it established that the chaplain was a credible and important member of the palliative team.  (When we received a palliative consult, our palliative doctor would often say to the the families that “his team” would be by to introduce themselves, the nurse, social worker and chaplain.  Wow, this opened so many doors because when I introduced myself as the palliative chaplain, patients would say “Oh yes, Dr. Brewer said you would be coming”  instead of “I didn’t ask for a chaplain.”  Being in those family meetings allowed me to offer support, provide clarity,  and discern spiritual issues as well as family dynamics.   It was interesting to me that Dr Kvale said that most patients confused palliative treatments with curative.  I remember having to explain more often with patients that palliative care was not the same as hospice- and the treatments, medicines etc…ordered by Dr. Brewer were palliative-(to make something more tolerable)  in nature, usually geared towards symptom management.  Dr. Kvale’s said the second area where the chaplain is invaluable is in helping with the symptom issues.  I agree with her because many patients I talked with were fearful of death, struggling with guilt or regret in their faith, or angry with God.   The third thing she identified was team care and that the chaplain on her team was the one to check in with  palliative team members and ensure they were doing self care or identifying signs of burnout.  I never did this so much as I created a ritual for our team as a way of saying goodbye.  We would divide up the names of all the palliative patients who had died in the last month (either in the hospital, hospice, or at home) and each person would read a name and pause, read a name and pause etc…  I enjoyed her talk and I always like to see how other places offer palliative care.   More on the next lessons tomorrow.