Diverse Voices: Building Bridges

1. Diverse Voices: Building Bridges Partnering with Nurses in providing Spiritual-Cultural Care in Healthcare Settings Janet Stark, Spiritual Care Manager and Multifaith Chaplain, Brockville General Hospital

2. Objectives • To address the concept of “Culturally- Appropriate Care” in the provision of religious, spiritual and cultural care • BGH spiritual care nursing survey will be discussed • A Spiritual Care Assessment Tool will be shared • Participants will be invited to share questions, barriers and what they have found works well in their practice

3. The Big Question As spiritual care providers, how are we going to improve nursing staff comfort level with the topic, and ensure that patients are provided with best practice spiritual-cultural care?

4. A Nurse’s Perspective Religious Care “Are you kidding?” Spiritual Care “What’s that?” Culturally-Appropriate Care “Ah… we get it!”

5. A Nurse’s Perspective Spiritual care is often poorly addressed in health organizations. We may profess to provide holistic care - body, mind and spirit - but are we all on the same page when it comes to “spirit” care? If we are not all on the same page, how can we provide ‘spirit’ care to a consistent standard?

6. A Nurse’s Perspective …..Vast range of educational backgrounds when it comes to spiritual health…

7. On a nursing team there may be: • An older nurse who was trained by the Catholic nuns • A nurse with Aboriginal roots who feels that often traditional medicine is at odds with his customs and practices • A young nurse who proudly claims to be an atheist • A middle-age nurse who is an evangelical Christian and attends every worship service held in the hospital.

8. On a nursing team there may be: • A nurse who is of oriental background and Buddhist in practice • A nurse who seems angry at the ‘church’ and fights against any personal connection with organized religion • A nurse who is very spiritual and finds strength in sports and nature

9. Research Shows • Health professionals are often inadequately prepared to provide spiritual care Penman et al 2009 • Nurses tend to equate “spirituality” with “religion” Oldnall, 1996 • Nursing assessment has been dominated by the medical model (physical needs) Baldacchino, 2006

10. Research Shows • 87% of patients consider spirituality to be important in their lives • Between 51% and 77% consider religion to be important in their lives Edwards et al 2010 • Outcomes of spiritual care is that patients: can count their blessings, achieve inner peace and explore coping strategies Baldacchino 2006

11. A Nurse’s Perspective Spiritual Care is most often consulted at end-of-life Palliative Care nurses seem to have the most comfortable relationship & practice with psycho-social-spiritual needs

12. Canadian Nursing Association Position – Spirituality, Health and Nursing Practice The CNA expects registered nurses to be respectful of and sensitive to diversity in spiritual beliefs, to support spiritual preferences and to attend to spiritual needs

13. CNA Position • When planning for and providing care, nurses have an ethical responsibility to be aware of and adjust for an individual’s spiritual beliefs as a component of a holistic nursing assessment and practice. • Nurses are uniquely situated to ensure that an individual’s spiritual values, beliefs and experiences are taken into account

14. A Nurse’s Perspective Results from 121 nursing surveys at Brockville General Hospital in 2011 identified the vast differences in understanding nurses have for what constitutes best practice spiritual care. A key finding is that often the terms ‘spiritual care’ and ‘religious care’ are misunderstood. The term ‘culturally-appropriate’ care seems better understood in the current Canadian environment of inclusiveness and tolerance.

15. Spiritual Care Nursing Survey Where are you at? RN RPN PSW 1. What is the difference between Religious and Spiritual care? 2. What is spiritual strength fostered by? 3. What is spiritual distress fostered by? 4. Do you have a developing spirituality of your own?

16. Spiritual Care Nursing Survey What is your role? 1. Is spiritual care within your scope of practice? 2. Are you comfortable providing a spiritual assessment? If not, why? 3. Do you currently refer patients to the spiritual care department? 4. Do you currently call a patient’s own clergy when needed?

17. Spiritual Care Nursing Survey What do you need? In order to improve your knowledge, skills, and comfort level with assessing & providing spiritual care, I need: ____short in-services ____half-day workshops ____full day workshops ____pastoral care course ____brochures, books & websites ____mentoring ____other: _____________________________________

18. Findings: • Some nurses are well-informed but not comfortable • Some nurses are not well-informed and not comfortable • Some nurses are well-informed and comfortable

19. Culturally-Appropriate Care Open, sensitive & inquiring Proactive and not Reactive A harm reduction model explores early on-- being aware of, and adjusting to a person’s own spiritual-religious culture.

20. Culturally-Appropriate Care A person or family’s lifestyle— • Education • Economic background • Sexual orientation • Ethnicity • Religion • Local culture • Family tradition

21. What is Culturally-Appropriate Care? • Understanding the patient’s living environment • Being open and sensitive to diverse beliefs and practices • Leaving personal bias’ at the door • Not making assumptions • Knowing where to find resources

22. K-S-A • Knowledge– can be gained by study • Skills—can be learned from experience • Attitude—the hardest to change. Attitude is inherent in the individual and reflects the desire to stretch, grow, and self-reflect

23. Barriers to being consulted Experiences in: Personal bias or negativity Emergency Department Mock Disaster Exercise

24. Spiritual-Cultural Assessment Patient/Client/Resident: ___________________________________ Faith Group/Religion/ Ethnic Background:____________________ Spiritual Contact:_______________________Phone ___________ Spiritual-Cultural History: Do you have a faith practice or religion? _____________________________________________________ How would you describe your culture?_________________________ Do you have any rituals you wish to practice?____________________

25. Spiritual-Cultural Assessment What spiritual practices gave you support in the past? (sometimes concrete examples need to be suggested: prayer, nature, reading, pets, art, music, worship services, visits from family, clergy etc) ___________________________________________________ Who gives you support? ___________________________________________________ Tell me about your family__________________________________ Is there anyone else who should be involved in making decisions about your care?______________________________________

26. Spiritual-Cultural Assessment Goals of Care: What is really important and meaningful to you right now?______ Is there anything the care team needs to know about health practices or restrictions important in your culture/faith group?_________________________ What do you believe about your illness? ________________________________

27. Spiritual-Cultural Assessment Spiritual Distress: Is there anything bothering you right now?___________________ Is there anything you are afraid of?__________________________ How are your loved ones coping right now?___________________ What would help?_________________________________________ How can we include this in the hospital setting?________________ Are there any other concerns you would like to share with me? ________________________________________________________

28. Helpful Strategies Communication Relationship with Staff Team Concept Education

29. What can help? Be sure nurses realize that you have the patient’s (& family) permission to be part of their care team Permission does not have to be in writing Gain permission of the patient to include their own personal clergy- person if desired

30. What can help? Be sure nurses can observe spiritual care at the bedside. Seeing the interaction, developing relationship and the positive response can result in an informal mentoring opportunity Gain the support of the nursing manager—make sure he/she totally “gets it” Ask for occasional moments to speak at nursing staff meetings

31. What can help? Be sure nurses know that you are available to help provide spiritual care, bereavement care and stress mgt for them personally Make the referral process easy! Find opportunities to ‘debrief’ nurses when something has worked well/not well

32. What can help? Plans for mandatory annual education sessions to improve the healthcare provider’s comfort and skill in providing appropriate bedside spiritual care. Have up-to-date area clergy contacts lists available in all nursing areas Compliment nurses on specific interactions that are helpful

33. What can help? Doing a really good job of explaining the role of spiritual care during new staff orientation education. Open discussion during annual nursing education days about what spiritual care is all about, and training in assessment Attending multidisciplinary patient rounds and having a voice at the table.

34. What can help? Show nurses the value of including spiritual care volunteers in patient care Offer to assist/facilitate family meetings Get to know and build rapport with physicians

35. Brainstorm Session!What works well in your practice?