All Courses Forums Course Discussion Forums Integrating Spirituality and Health Care Reflection -Week 2 – Puchalski Article

4 replies, 3 voices Last updated by Carl Aiken 3 years, 5 months ago
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    • #3606

      Dierdre Jarrett
      Participant
      @Dierdrej

      First a disclaimer, over the years I have not been a big fan of Dr. Puchalski.  Its not that what she writes and teaches is wrong, it is just that I have always wished she shared the stage with a chaplain as she was saying it!  This article is an example.  She does not co-author the article with a chaplain but seems to talk as an expert, although she does toward the end request doctors refer to chaplains for in depth spiritual counseling and prayer.  I found this ironic because I used to work with a heart surgeon who prayed with almost every patient before surgery, whether they wanted it or not, from the Christian tradition, whether he/she was Christian or not.  We never got any complaints.  This is not to justify his actions, but I often wondered if it was because he approached his work with such a humbleness, requesting God’s guidance and strength for the task at hand. He is also quite open about his faith and how he sees it supporting his work. I had no complaints and several patients told me how much his prayer meant to them.

      I whole heartedly agree with the author that doctors need to pay more attention to the spiritual side of their patients, or at least be willing to admit their patients have spiritual needs that can impede their healing. I wonder if instead of all the research of how valuable faith, prayer, etc are to recovery are to patient’s health a study was done to find out why doctors are so hesitant to discuss spirituality?  Is it the time constraints?  Is religion an area that is private and not even a doctor should go there with a patient?  Things have gotten better, especially in the last ten years when it comes to doctors being aware of the importance of holistic care but doctors still seem a bit skittish about including a patient’s spirituality in their care plan God. Do we need to provide them first with a place to talk about their own spirituality?  I do find that the doctors who are more spiritual, or at least identify that way seem more open to seeing their patients as spiritual beings, and more likely to care about their spiritual health.

      I am reminded of the first doctor’s visit I had with my doctor a month after my mom died. My doctor seemed uncomfortable, asked me if I was depressed, I said “of course, my mom just died”  She followed up with asking me if I wanted to go on something for awhile, like an antidepressant!  I said no, and told her I knew it was normal to be sad, that I was still eating, sleeping, and working and that it would just take time but I thanked her for asking about how I was doing.

      Puchalski has contributed to the amount of material available on spirituality research and it does surprise me that prayer is the number one “most commonly used non-drug method” for pain. Our hospital is currently trying to ramp up the non-pharmaceutical alternatives to pain management.  Has anyone used the intervention she mentions “relaxation response’?  I wonder how it differs from guided meditation or the breathing exercises we offer.

       

    • #3625

      Michael Porter
      Participant
      @mkporter

      Dierdre,

      Thank you for sharing.  You mentioned what I though as well.  Puchalski insights are good, but I believe she would do well to have a Chaplain on board.

      You raised the possibility of doctors being hesitant about discussing spiritualty because “Is religion an area that is private …”  I do a presentation for nursing students a couple times a year and I raise up this issue.  My comment is – And asking someone if they have had a bowl movement isn’t personal?  I believe that time is an issue, especially with the push to see as many people as possible in a day to boost revenue.  But, I believe it may be more that they do not have the knowledge in the area.  If they think spirituality is about religion and they do not have one – or they practice differently than their patient – they are uncomfortable talking about it – so the avoid it.  Maybe education is need to show them that spirituality is may or may not involve religion.  This is what we as Chaplains bring to the table.  We can help them understand what it is about.

      You ask if “we need to provide them first with a place to talk about their own spirituality?”  I say most definitely.  I learned this from my CPE training.  When we know more about ourselves and become more comfortable with ourselves, the better we are able to be more present to people for whom we care.

      Mike

    • #3626

      Carl Aiken
      Participant
      @CarlAiken

      Deidre and Michael
      Thanks for the comments.
      I think you both raise and important issue – the inclusion of chaplains in the conversation. May I suggest that to some extent it is our fault? Until recently we have been tardy as a profession to get involved in writing, research and publication. And when we do we tend to write in ‘in house’ journals. While I am overstating a little to make the point, and many good people have tried to contribute.
      Tomorrow morning at the Spiritual Care Australia (SCA – not the US one!) conference I will be attending a research seminar, George Fitchett is advocating for research in the US and also running seasons soon. Spiritual Health Victoria and SCA have a member on an international research team working with Fitchett, so it is changing and hopefully growing.
      Can I also ask, given that the docs are the gatekeepers for nearly all care, how we co-opt them to include us?
      Cheers
      Carl

    • #3629

      Dierdre Jarrett
      Participant
      @Dierdrej

      Carl,

      First, as a professional chaplain I have often considered participating in research and writing for publication, and you are correct, my writing is for inhouse publications. I have found when I have wanted to pursue a special project beyond direct patient care it is a struggle. There are always more patients to see than I can see, and no “free time” for those special projects unless I pursue them after hours.

      The other block for me in pursuing research is that early on a study was done on prayer and the finding were that those who were prayed for did not have better outcomes than the control group that was not prayed for. I had an immediate repulsion to research that wanted to “test” God’s workings. I often say I pray for miracles but do not get to choose them. As the research has shifted to more how do spiritual practices assist in healing, like the study mentioned in the article where the number one non medicine pain relief used is prayer, I am more interested in participating in research.

      At our hospital we are beginning a patient improvement project, that is collaborative, and I am on the team because I raised the concern. We have cancer patients that are newly diagnosed, or are tested but may not receive the results, and may or may not be referred to all available services (counseling, support groups, spiritual care etc) I am very excited about this project, led by our lead nurse educator and she is going to chart the number of new diagnosis and what referrals they receive. Our first improvement  is to create an order set of sorts for newly diagnosed patients that includes a referral to a chaplain and a patient and family counselor.

      I am very supportive and willing to participate in research that improves patient care, especially when it addresses their spiritual needs. I am not supportive of research that tries to prove the reliability of God or the benefits of chaplains.

    • #3630

      Carl Aiken
      Participant
      @CarlAiken

      Hi Deirdre

      Well said about poor research – sadly some still tout it!

      You have also identified the change in research focus, from counting what we do to evaluating patient experience/satisfaction. It is harder work as the methodologies take longer but give more relevant outcomes. And, yes too it takes time, and our focus is on caring for our patients and staff. Good on you for getting into collaboration, an important step, and indeed for being the one who pushed it! I trust that the outcomes provide helpful insights.

      BTW, at the SCA conference in Newcastle yesterday we had a full day research seminar. Exciting stuff! My close colleagues were leading it an made me sit at the back in the naughty corner with an insistence that I behave:) It was great with lots of energy in the room.

      Cheers

      Carl

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