Tagged: Response to Week 1
July 28, 2019 at 8:49 pm #5138
Please introduce yourself.
August 13, 2019 at 11:18 am #5177
<span style=”color: #737373; font-family: Lato; font-size: 12px;”>Good Morning! My name is Rev. Mark Pedersen. I serve First United Methodist Church of Grand Saline as their pastor. The church is a part of the Texas Annual Conference. I have been in ministry for 30 years as a Youth Director, Associate Pastor and Senior Pastor. I graduated from Stephen F. Austin State University in 1991 with a Bachelor of Business Administration and from Texas Christian University’s Brite School of Theology in 1995. I have done two CPE Units so far in my career. One at Terrell State Hospital in 1994 and one at Mother Francis Hospital in Bryan, Texas. I look forward to our time together!</span>
August 13, 2019 at 1:50 pm #5183
I am David Brinker, full time chaplain at Normandie Ridge a continuing care facility which includes independent living, memory care, personal care and long term care. Looking forward to this course and improving my skills.
August 13, 2019 at 2:03 pm #5184
My name is Larry Lawhon and am I one of two chaplains serving at Shenandoah Valley Westminster Canterbury which is a continuing care retirement community (CCRC) located in Winchester, VA. I’m glad to be a part of this journey with you all as we look specifically at best practices in long term care.
August 13, 2019 at 9:07 pm #5188
Hi everyone! My name is Jennifer Gingerich, and I’m your facilitator for this course. Please be patient with me as this is my first Oates Institute course. I am chaplain at two senior apartment buildings that are part of Christian Care Communities in Louisville, Kentucky. I received my board certification with APC last March, having finished a CPE residency in 2017. I spent several years as a chaplain in nursing facilities and an assisted living/personal care with Presbyterian Homes and Services of Kentucky before that. My M.Div. is from Louisville Presbyterian Theological Seminary. I look forward to learning and conversations with you all!
David and Larry, out of curiosity, what are your denominational backgrounds?
August 14, 2019 at 8:52 am #5189
Jennifer and Colleagues,
I am an ordained United Methodist, Elder 1983 Susquehanna Conference. I have served parishes since 1976, starting as a Licensed Local Pastor. I attended Wesley Theological Seminary in Washington, D.C., M. Div. 1982. In addition to parish ministry I was a founding Board member of the Center for Spiritual Formation, having served for two years as the Dean of Ministry of Spiritual Direction. I have completed two units of CPE, and I am endorsed by the General Board of Higher Education and Ministry as a U.M. Chaplain. I have served as a Chaplain in the Pennsylvania State Park system under the auspices of the Pennsylvania Counsel of Churches, I have volunteered as a hospital Chaplain, and serving in my 8th year full time here at Normandie Ridge as an extension ministry appointment. https://normandieridge.org/ Looking forward to this experience and learning from everyone. David
August 14, 2019 at 10:57 am #5191
My name is Orlow Lund. I am originally from Montana where I went to school through a Bsc in Sociology at Montana State in Bozeman. My MDiv is from Lutheran Theological Seminary in Saskatoon, Saskatchewan Canada. I serve 269 long term care residents in two facilities for the Good Samaritan Society of Canada. I have been doing this since finishing my Advanced standing in CAPPE, now CASC in 1996. I am looking for an overview and deeper learning of this topic to brush up and get more informed on the topic. I look forward to sharing this course together.
August 14, 2019 at 5:29 pm #5195
Spiritual Care in Long Term Care: Best Practices
“APC Standards of Practice for Professional Chaplains in Long-Term Care”
Reflection 1: One of my first responses to this document is excitement. It is not the first time I have seen this. I would like to know is there any long-term care facility where this has been put into practice? How long has it been used and what have been the positive outcomes along with the challenges of implementation?
My next reflection is how is it possible to move forward in these directions if you are a department of one and the facility doesn’t follow these standards. I observe that I can at least initiate the implementation a few of these principles. A chaplain benefits from being a “self-starter.”
Section 1, Standard 1 speaks of Assessment. After reading the following article I wonder if “assessment” is the proper term to be used in this place at the beginning of the list of Standards. I am referring to the Drummond, Carey article, page 377 on screening, history-taking and assessment. In this article it is recognized that ‘assessment is the correct nomenclature having to do with analysis of relevant information. I believe the article was suggesting that spiritual assessment culminate in a specific plan of spiritual care.
I have always used “assessment” in a very general way describing all the task of initial screening, learning history, and analyzing information for a care plan. Is this the broad meaning of the word in the Standards of Practice?
In my seven years of working full time in a continuing care facility as the only staff chaplain, I have used several assessment tools: S.P.I.R.I.T, F.A.I.T.H, H.O.P.E, F.I.C.A, and F.A.C.T. Over time, I have gotten away from strictly following a form and have gather the needed information in a conversational manner over several visits. On the whole, the one I have used the most has been FACT.
“Do you think assessment in your setting is important or not?” Yes…but! I practice spiritual assessment of all residents in the facility. I understand the value of initial screen and initial assessment. In a long-term facility, a resident’s condition often changes. Therefore, I see the need for ongoing spiritual assessment as a basic care which I offer. The challenge is staying current in this regard with 250+ residents. As a result, I practice a kind of spiritual care triage. I try to visit each newly admitted resident within the first three days. This visit is at least a screen. Next I note those who are struggling or having spiritual distress or having a status change and visit these as follow up contacts. Finally, I rely on staff to alert me spiritual crisis needs, such as end of life concerns.
While I see holes in this approach it seems to work most of the time, especially since I have built up a long term relationship with long term residents. A place for improving this approach is to train and enlist the help of volunteer chaplains in the work of initial spiritual screening. This is a goal I am currently working on for this year, I now have trained two volunteers as chaplains. I think nursing staff could do a spiritual screen-in theory. However, I find that they feel over worked, with too many tasks and unrealistic expectations already laid upon them. Therefore, I don’t really expect nurses to screen for spiritual concerns. Similarly, out Social Worker asks a few spiritual affiliation / practice questions during intake. However, my company does not allow me to see this information in the social worker’s electronic record and this colleague does not transfer this info to the face sheet of the resident.
I believe that a best practice for spiritual care in long-term care is exemplified by the APC Standards of Practice. Unfortunately, in the non-profit CCRC I work for, HR has determined that I may not have access to the clinical electronic health record. Therefor, I can’t effectively document or communicate a spiritual plan of care in a collaborative way with the interdisciplinary team. I struggle with this.
“Assessing Spiritual Well-Being in Residential Aged Care”
Reflection 2: I resonated with the first sentence: “there is a need for a clear and validated process of spiritual review that can be understood across multidisciplinary teams.” I have encountered other staff who don’t understand what I do as a chaplain; likewise, I have struggled to communicate spiritual needs of residents to the staff. Often, I find staff believing all I do for residents are religious things, like prayer and read the Bible.
I have an affinity with the broad task of working with residents to build a plan to help each person continue on their own spiritual journey. Assessment in this sense involves finding out how they cope, what their religious/spiritual practice may be, learning about their struggles, resources, support, goals and hope. These are foundations for building a spiritual care plan which allows a resident to continue on the journey.
This article was helpful in clarifying the distinctions between the activities of screening, history-taking, and assessment. In practice I admit that I often move back and forth between these activities as new information or experiences emerge.
The information about spiritual care taxonomy was very interesting. Previously I have known about the taxonomy described in the white paper by Spiritual Care Association: https://spiritualcareassociation.org/docs/resources/taxonomy_white_paper/chaplaincy_taxonomy_standardizing_spiritual_care_terminology_r1.pdf While helpful this document is also complex and cumbersome for me.
Page 380 of our document seemed much more practical, warranting further thought and practical use:
Loss of identity, fear/dread, anger/depression, existential concerns, abandonment by God, anger at God, relationship with God, conflicted belief system, despair/hopelessness, grief/loss, guilt/shame, reconciliation, isolation, religious/spiritual struggle.
I have also found the list of pastoral diagnosis a possible source for a taxonomy to communicate the spiritual care needs in a care plan and with the staff:
Connection with God, Searching for the Holy, Questions about why God has done this to me, or what has God promised, Expressions of gratitude, Concerns about death/afterlife, Repentance, Sense of identity or purpose, Hope, Search for meaning, Isolation, Faith, Conflict of religious beliefs and recommended treatments, Ritual needs, Spiritual practices, Grief, Loss.
List is drawn from Paul W. Pruyser, Minister as Diagnostician. Philadelphia: Westminster Press, 1976
Also, this article FACT, A Chaplain’s Tool for Assessing Spiritual Needs in an Acute Care SettingMark LaRocca-Pitts BCC, Chaplaincy Today. e-Journal of the Association of Professional Chaplains • Volume 28 Number 1 • Spring/Summer 201225 may be helpful in this discussion: http://www.professionalchaplains.org/files/publications/chaplaincy_today_online/volume_28_number_1/28_1laroccapitts.pdf
I appreciate the listing of various assessment tools. It confirms to me that there is not one approach in this task. It also shows the common concerns and general focus of attention in spiritual assessment care. It was reassuring to see many that I was familiar with and have used. I would like to know from my colleagues:
1) Do you only use one assessment approach, tool?
2) How do you communicate assessment and spiritual care plan to the interdisciplinary team? If so how?
3) How do you practice assessment with memory care / cognitively challenged residents?
David Brinker, 8/14/19
August 19, 2019 at 11:45 am #5219
David, as I read what you are thinking about and working on related to Spiritual Assessment I can relate to some of that struggle. I know that I am not the most well versed chaplain when it comes to Spiritual Assessments. Several years ago I worked on a project for our department – I am one of two chaplains serving almost 400 residents plus staff – the project was to develop a spiritual history and assessment model that we might use for our work as chaplains. It was a work in process but got shot down by my co-chaplain, who is my supervisor, who felt that it would be too much work to try to go back and get spiritual information on every resident. She was right to the extent that there is no place in our medical records for spiritual history, VERY LITTLE spiritual or religious info is gathered during admission nor on an ongoing basis. If the chaplains want the info we have to get. The initial part of what I was working on might be better seen as a screening. I like your idea of using volunteer chaplains to help gather that initial kind of info and hope it develops for you in your setting.
I really struggle in our environment because it seems that our nurses, and to some extent our social workers, see the chaplains as who to call when some dies or when someone goes tot he hospital. I wonder from our group in this session, how to you get nursing and SW to be more understanding of and engaged in the awareness of spiritual needs of the residents and their families. Our nurses are really struggling with issues of low moral. They work hard 12 hour shifts and we have a lot of turn over in that department so they don’t always see as clearly as they might the spiritual or emotional issues at play with some residents so it is a challenge. What works for you all to help staff be more aware of spiritual needs and issues?
August 15, 2019 at 9:18 pm #5202
David, thank you for getting us started with your reflections. A few responses and questions for you:
You wonder about how to use the APC standards in your setting where the administration is not aligned to these. I wonder if this is something you could bring to your next annual eval or a goal-setting session and introduce them to your administrator? Or maybe, as you said, pick a few that you would like to work toward? It’s interesting that this document assumes that chaplains will take a leadership role in the organization. Sometimes that is a natural fit, and other times the chaplain is seen as peripheral, right? Which particular standards are you most interested in developing in your setting?
It’s a little surprising to me that you are not allowed access to the electronic medical record. That makes it challenging when the social worker can chart info that would be beneficial to you, and you can’t see it! Are you present in some care conferences? With that number of residents, I’m sure you cannot make it to all of them. I wonder if there is one interdisciplinary team (IDT) member who values your work and could be an ally in bringing you more into the IDT? Sharing these standards and some of the palliative care literature with your administrator might help him/her understand how chaplains are becoming more widely considered an essential part of the care team, not an “extra” or outsider.
I have also had times when I felt like other staff members did not understand my role. Folks can be territorial, and I’ve encountered questions about why I would be talking with residents about more than just “spiritual” matters. They did not necessarily see the spiritual as encompassing more than simply the vertical connection to God. I appreciate the way both the standards and the Drummond and Carey article imply that as chaplains are able to articulate clearly what we do and how it is effective, we gain acceptance in the IDT. I’ve learned it also helps to very clearly collaborate with and refer to my colleagues in other disciplines. For example, sharing with the social workers when I learn a resident has had a death in the family.
Thank you for sharing Pruyser’s categories of pastoral diagnosis. That is a good reminder for me.
August 16, 2019 at 9:46 am #5203
Jenifer wrote: I wonder if this (APC Standards) is something you could bring to your next annual eval or a goal-setting session and introduce them to your administrator?
I have brought this up for several years at my annual review. The Corporate HR person is administratively above my campus Executive Director/supervisor. HR is the one who removed me from the interdisciplinary team, electronic record interdisciplinary notes, and the care plan meetings. I receive your guidance and suggestions as thoughtful, affirming, grounded in best practices, and logical. However, at this point, it feels like a dead-end issue.
It’s interesting that this document assumes that chaplains will take a leadership role in the organization. Sometimes that is a natural fit, and other times the chaplain is seen as peripheral, right?
After several years of observing the executive administration I have come to the conclusion that they are not open to views other than their own. I find it sad in that I believe we are delivering care at a level below the standard of “best practices.” On a number of occasions I have put forward ideas for improvement and ways to reach compliance. It has gone no where. A previous campus Exec Dir hired three years told me she wanted me on the ITeam. After six months of trying to negotiate this with the corporate folks she said it was a dead issue. She is now fired and replaced. A new RN Director of Nursing in the Nursing Care Center asked my why I didn’t chart in the Interdisciplinary notes. I told her the story of how I used to do this at the request of my then Exec.Dir., but was told to stop by corporate HR. I directed her to clarify her request with corporate, this went no where also…
For a while I was angry about this and felt diminished in value. I have refocused on doing my work as best I can. I have good rapport with residents. As I may have two years until retirement, I am looking at continuing on a selectively choosing which fights are work the “leadership” battle.
Which particular standards are you most interested in developing in your setting?
I would like to have more organic, structural part in the Interdisciplinary Team communication. A first step may be to have permission to attend the weekly meeting where there is a review of resident’s transition from one status / intervention to another. Previously I have be excluded, even though the sales staff is allowed to attend this.
It’s a little surprising to me that you are not allowed access to the electronic medical record. That makes it challenging when the social worker can chart info that would be beneficial to you, and you can’t see it! Are you present in some care conferences?
I used to participate in Care Plan meetings. As stated, for five years I have been removed from them. It is interesting to me that at the time I was removed, the Activities staff were also removed from attending. In the past year, Activities staff are back in the care conference meetings. The explanation I was given was that HIPPA prohibited me from attending. I think this is false and silly.
Sharing these standards and some of the palliative care literature with your administrator might help him/her understand how chaplains are becoming more widely considered an essential part of the care team, not an “extra” or outsider.
Agreed. That was my motivation for sending white papers, research journal articles, and APC Standards of Practice to several in corporate administration. One response I received was “We are not a hospital so we don’t have to do those things.”
I appreciate the way both the standards and the Drummond and Carey article imply that as chaplains are able to articulate clearly what we do and how it is effective, we gain acceptance in the IDT. I’ve learned it also helps to very clearly collaborate with and refer to my colleagues in other disciplines.
I also appreciate this role of a chaplain. Coming from almost 40 years of parish leadership in congregations I feel I have several skills that would help this organization. I keep looking for opportunities to advocate for my work. The SW has just left so with a new hire, perhaps it will present new opportunities.
David Brinker 8/16/19
August 16, 2019 at 8:48 pm #5204
What a challenging environment, David. It sounds like you are doing well to stay focused on the areas that you do have the power to influence. Hopefully with time and the inevitable turnover among staff, attitudes with begin to shift.
- You must be logged in to reply to this topic.