June 14, 2019 at 12:16 pm #4851
Our Week One lessons will include reading the Archstone Report entitled “Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference.
The report suggests that “whenever possible a standardized instrument should be used to assess and identify religious or spiritual/existential background, preferences, and related beliefs, rituals and practices of the patient and family.”
What tools do you use to assess these essential elements? What other standardized tools have you seen?
Please discuss anything that caught your eye in the report.
The second lesson for Week One will include the video recording “A Physician’s Perspective on Spirituality in Palliative Care”
I look forward to your impressions of these works.
June 17, 2019 at 11:28 am #4855
I have read the Consensus Report and listened to the video. Some thoughts from the report:
1. It was overwhelming all that can be done. However, for a hospital with a small pastoral care department – we have two chaplains for 300 beds – it seems impossible to do all that is suggested. I like that it supports that “spiritual care is a fundamental component of quality palliative care.” We have always struggled in my hospital with palliative care being confused with end of life care, or hospice. I like that the consensus reports that “palliative care is viewed as applying to patients from the time of diagnosis of serious illness to death.” Let me just say that I have served on several committees within our system in the past five years to begin a more organized palliative care program. We had a nurse and SW leading it, but now it is just our SW. We are heading towards an APRN to join our SW and have a few docs already working in the hospital that are more palliatively inclined. We struggle with our oncology doctors to give a clear, honest outlook for our patients.
I like the definition of spirituality – “Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” That seems to cover it all, and this was written by an interdisciplinary group. The doctor I have worked most closely with is big on getting the patient story. Finding how to record that in the EHR is difficult. Like the consensus reports, “life is essentially relationship.” I do agree that getting the story is one of the key roles of the chaplain and then connecting that story to the treatment plan.
You asked about an instrument to guide the chaplain. Although I am board certified, I have not used an instrument in my own work. I do think the spiritual distress screening is good, but questionnaires that ask questions without interaction or exploration can become simply a box to tick off. I did like that the consensus recommended that “spirituality should be considered a patient vital sign.” Not sure how you get there, but I like that idea – like we do pain screenings regularly. I also hear that other disciplines can be involved in early screening but that the chaplain is the one to do the spiritual assessment. This is great if you can get other disciplines to comply. We have spiritual screening questions about stress, but they are not routinely asked. Only those who indicate severe levels of stress are referred, and I believe it should be high and severe. I am in a hospital system, so some departments are worried about having too many referrals. That is not the case at my hospital.
I agree that inter-professional rounds are great, but again when there are only two chaplains and rounds are long and not on a particular time schedule makes it difficult to participate. I also agree that professionals need care so as to not face compassion fatigue and burnout. At my hospital I have initiated a cart that is for staff. It roams around the hospital and includes massage therapy, aromatherapy, music, and some other stress relieving items. Staff love it when they come, but will often say “who has time for that.”
I also agree with the consensus that it is hard to accurately measure pastoral care. I think it has less to do with how satisfied patients are with their stay, although that is a good thing to show to administration. I think it is much deeper than that and am not sure how it could be measured. We have attempted to measure response to our Schwartz Rounds – another great staff support – and how often we are called when there is a death and our responsiveness to that. But overall I struggle with metrics and find myself more in the personal and spiritual world of patients.
The video was good but seemed more basic to me. I liked her four boxes for care – spiritual, physical, social, emotional. That is a good way to approach patients. As a current cancer patient myself, I would have to say that the spiritual, social, and emotional elements of my care have been missing from professionals. I go to a cancer center for my treatments and there is no support offered other than physical. I was told to check out a support group, but I lead the one at my hospital with our oncology nurse navigator and am not aware of any others in our city. I have good support from friends and family and church, but I am still struggling with things in each of these areas.
Enough for today. Will continue on with other lessons,
June 18, 2019 at 11:18 am #4856
Thank you, Trish, for your very thoughtful response! My thoughtful reply from last night got lost somehow and I will try again later with it. For now, I wonder if you can say more about the questions you do ask on an assessment? What seems most important for you to know about the person?
Also, as you are personally finding little attention given to the social, emotional, and spiritual in your own care, what in particular would you find most helpful?
And, Mark Deanna–your responses to the first lesson materials?
June 19, 2019 at 3:43 pm #4859
I am sorry for the tardy replies. I am a married, mother of two adult children, ordained United Methodist minister. I was out of town last week at our UM Annual Conference last week. Compounding that, our daughter is getting married in another state June 29th. I really want to take this Oates course on palliative care. Until recently I was the Palliative Care (PC) chaplain at Baptist Health Lexington. I sadly had to leave but for a good reason- my husband has to retire at 65 per FAA rules and I am traveling with him whenever I can before he retires. I miss my patients very much. I am going to answer many of these questions as the palliative chaplain. The team consists of a dedicated PC physician, social worker, several nurse practitioners, RNs and our director is an RN. We pursued and obtained Joint Commission certification in PC for the hospital. A part of my requirements when I was hired to be the palliative care chaplain was to pursue specialty certification for palliative care and hospice and I did.
I’ve read the NCP for quality palliative care report before and each time I glean something different. I love the diversity of all who participated, the very inclusive definition of spirituality, and the latitude in how the team and practice of palliative care is to be offered. Trish I can only imagine how hard it would be for 2 chaplains to cover the entire hospital as well as palliative care practice and patient needs. It took a while for the doctors in the hospital to get on board with palliative care, but when they learned how helpful palliative care is in the face of uncontrolled symptoms and eventually dying (if no hospice referral made) the practice really grew. I will post more later tonight about the first week and I will catch up to week two.
June 20, 2019 at 1:59 pm #4860
Welcome aboard, Lori! I’m glad you are part of us, and grateful for your ministry. What did you find important in your assessments? Did you use a certain tool?
On a personal note–how lovely that you get to travel!
June 21, 2019 at 2:52 am #4862
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.
June 21, 2019 at 2:58 am #4863
One more thing, I didn’t realize how emotionally exhausted I was until I had this break. Whether its chaplaincy or pastoral ministries, I think we keep pushing ourselves, giving out and not always taking time to “fill our well” because of the needs we see.
June 21, 2019 at 2:23 pm #4864
Wow, 15-25 patients per day is a lot! I can imagine that you are, indeed, exhausted! I like that you were able to incorporate both an established spiritual assessment tool along with your own needs for assessment in your area.
What did you find to be the biggest need of your palliative patients?
June 23, 2019 at 9:12 am #4867
Dina, very good question, and in my humble opinion I think the number one need of the palliative patients we cared for was “peace.” Whether it was peace through the resolution of excruciating pain/symptoms or existential peace or spiritual peace, patients and their families needed/need relief (or coping tools) for their suffering. That said, I think spiritual peace trumps all other needs (and I am a fan of Dame Cicely Saunders “total pain” model) because even though their pain may be relieved, at a deeper level their spiritual belief(s) underlies their personal hope (or fears) for coping with pain, existential issues, and ultimately their own mortality.
I know I keep saying this, but I will post more after church and the celebration of our pastor retiring after decades of ministry.
August 1, 2019 at 5:04 pm #5167
My apologize for not writing sooner! Along with my pastoral duties within the church, I have been dealing with two hernias for the past two months. I have been involved in Tae Kwon Do for 30 years but all of that exercise has caused my hernia problems. My surgery has been put off twice so far because of infection issues on my skin. Thank you for understanding.
In terms of our course, I have been ministering to a members whose brother had been sick for about one year for fluid on the brain. The sister was watching her young brother going down hill quickly over the last few months. I lost the ability to speak, eat and everything else at the end. She was a faithful sister and went to visit him every other day.
We spoke often about her brother, how his wife was doing and how she was doing throughout his illness.
Along with my work as a pastor and my physical issue, my wife and I are foster parents to four children ages 5, 5, 7, and 9.
More to come….
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