Transformational Spiritual Care: An Interprofessional Team Approach

1. Transformational Spiritual Care:An Interprofessional Team Approach Presented by: Donna Mann, MTS Maureen Quinn, MScN NP-Adult Waterloo/Wellington CCAC

2. Community HPC Initiativein Waterloo/Wellington(WW) This initiative is funded by the WWLHIN A partnership of Palliative Care Physicians, WWCCAC, Acute Care Centers, Family Health Teams, Hospice Organizations, The Waterloo Wellington Hospice Network and WWLHIN Funding initiated October 2009

3. The Cambridge HPC Team Planning and development commenced February 2010 Located at Cambridge Memorial Hospital in the Medical Day Clinic The program began April 2010 Approximately 125 patients and families have received care

4. What is a Community HPCTeam? A geographically based inter-professional team of specialized care providers who work together with primary health care providers to develop and implement a plan of care to facilitate the delivery of end-of-life care for patients and their families

5. Who is the HPC Team? The team consists of: Palliative Care Physician Consultants A Nurse Practitioner A Clinical Resource Nurse A Spiritual Care Provider Administrative Support

6. What is the Purpose of the Team? To enhance palliative care in the home or community clinic setting by providing expert consultative services To facilitate seamless transitions from one care setting to another To build capacity within the palliative health care system

7. Criteria Diagnosis of a life threatening illness “Would you be surprised if this person were to die in the next 12 months?” Require symptom management for end-of-life issues (physical, psychosocial, spiritual care)

8. The Dimension Of Spiritual Care In Palliative Care The Archstone Foundation of Long Beach, California sponsored a Consensus Conference in 2009 focused on the role of spirituality in palliative care. Leaders in all relevant healthcare disciplines were invited to work together to formulate a consensus report on the issues, barriers and recommendations for spiritual care in hospice and palliative care.

9. Spirituality The definition of spirituality agreed upon by this inter-professional group is as follows: “Spirituality is the aspect of humanity that refers to the way individuals make and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and the significant or sacred.” (Journal of Palliative Medicine, 2009)

10. The Dimension Of Spiritual Care In Palliative Care Among the many recommendations made in this inter-professional group’s report are these: Spiritual distress or religious struggle should be treated with the same intent and urgency as treatment for pain or any other medical or social problem. Patients should be encouraged and supported in the expression of their spiritual needs and beliefs as they desire and this should be integrated into the treatment or care plan and reassessed periodically. In order to integrate information from a spiritual assessment into a patient’s care plan, an appropriate process would include: screening and assessing the spiritual needs, identifying spiritual goals, and determining, implementing and evaluating the appropriate spiritual interventions.

11. Spiritual careThe value “ The field of palliative care is well served when attention is paid to the physical as well as the spiritual dimensions of the end of life”(Sinclair, S., 2010) “Spiritual and religious beliefs can also create distress and increase the burdens of illness”(Puchalski, C. et al 2009) Kenneth Pargament emphasizes the importance of addressing spiritual struggles in psychological distress.

12. Integrating Spiritual Care into Health Care and into HPCThe challenge It is important to understand perspectives of other people on the interdisciplinary team. one study reported that “physicians with no experience with spiritual care feared that the chaplains would ignore patients’ concern and disrespect patients beliefs” (Fitchett,G., Rasinski,K., Cadge,W., Curlin,F. 2009) According to Weinberger et al. nurses are more likely to refer to spiritual care providers but have some discomfort in addressing spiritual care matters directly.

13. Integrating Spiritual Care into Health Care and into HPCHow To Integrate into the team? Educating the interdisciplinary team is essential. 1/3 of chaplains reported they have experienced role conflict, predominately with social work. (Wittenberg-Lyles et al 2008) gently provide literature and education to your team. Create a quick reference screening tool

14. Integrating Spiritual Care into Health Care and into HPC Create an environment of support and of spirituality Wittenberg-Lyles et al. reported in their survey that 73% of the chaplains report that other team members look to them for guidance and are labeled “the encourager” Create rituals for the team to acknowledge a loss of a patient and to highlight the team’s successes

15. Interfacing with the Other Members of the Health Care Team Screen your content and condense it before you communicate with other health care professionals – be “translators” (Wendy Cage, 2010) Recognize that everyone in health care is busy and this will only get worse.

16. Creation of a screening tool.A stroke of brilliance! Spiritual Care Working Group of area hospital chaplains and the three WWCCAC Spiritual Care Providers A pocket tool developed to help care providers in recognizing a need for their patients/clients to receive spiritual care support

17. Spiritual Care Pocket Tool Front of Pocket ToolBack of Pocket Tool

18. Front Of Pocket Tool – Identifying A Spiritual Need Service Providers & Inter-Professional Team Members – ask yourself the following three questions: Is the client struggling to find relief from physical symptoms, feelings of abandonment, conflict, despair, fear, anger or guilt? Is the client asking, “Why is this happening to me?” or, “How much longer will this go on?” or, “How will I be remembered?” Does the client talk about being a spiritual or religious person and/or want spiritual or religious practices at home? If you answered “yes” to ANY of the above, then the client would benefit from contact by your local Spiritual Care Provider.

19. Front of Pocket Tool – Referral Process Do you know whom to contact when a client expresses a spiritual need? Is there a designated Spiritual Care Provider for your organization and do you know how to contact that person? If there is not, then whom do you contact when a client has spiritual needs?

20. Back Of Pocket Tool – What Is Spiritual Care? Your local Spiritual Care Provider is a source of comfort and support for clients and families who are: Asking questions such as, “Why is this happening to me?”; “How much longer with this go on?”; “How will I be remembered?” Feeling lonely, discouraged, anxious or misunderstood Struggling with a sense of well-being Wanting to discuss faith, hope or meaning in the midst of illness Needing assistance in contacting a local faith community or having spiritual and/or sacred items available

21. Permissions declaration of verbal permission from the families of both patients in these case studies their hope that these stories would support the ongoing integration of spiritual care in Hospice Palliative Care provision

22. Transformational Spiritual Care: The Art and the Science

23. Bibliography Cage, W. (2010). “Hospital Chaplains: Listening to What They Say and Watching What They Do.” Association of Professional Chaplains Annual Meeting (Invited Lecture). Elman, L.B., Houghton, M.P.H. et al. (2007). Palliative Care in Amyotrophic Lateral Sclerosis, Parkinson’s Disease, and Multiple Sclerosis. Journal of Palliative Medicine, Vol. 10, No. 2, 433-457. Exline, J.J. & Martin, A. (2005) Anger toward God: A new frontier in forgiveness research. In E.L. Worthington (Ed.) Handbook of Forgiveness (pp. 73-88). New York, NY: Routledge. Fitchett, G., Rasinski, K., Cage, W. & Curlin, F. (2009). Physicians’ experience and satisfaction with chaplains: A National Survey, Arch Intern Med, Vol. 169, No. 19.

24. Bibliography Harvey, J., Barnett, K. & Rupe, S. (2006). Posttraumatic Growth and Other Outcomes of Major Loss in the Context of Complex Family Lives. In L.G. Calhoun & R.G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practice (pp. 100 – 117). New York: Lawrence Erlbaum Associates. Kirkpatrick, L.A. & Shaver, H. (1992). An attachment-theoretical approach to the psychology of religion. International Journal for the Psychology of Religion, 2, 336-51. Lanoix, M. (2009). Palliative care and Parkinson’s disease: managing the chronic-palliative interface. Chronic Illness 2009, 5, 46. Lawrence, R.T. (1997). Measuring the image of God: The God Image Inventory and the God Image Scales. Journal of Psychology and Theology, 25, 214-226.

25. Bibliography Liben, S., Papadatou, D. & Wolfe, J. (2008). Paediatric palliative care: challenges and emerging ideas. The Lancet, Vol. 371, No. 9615, 852-864. McWilliams, N. (1994). Psychoanalytic diagnosis: Understanding personality structurein the clinical process. New York: The Guilford Press. Moriarity, G. (2006). Pastoral Care of Depression: Helping Clients Heal Their Relationship with God. Binghamton, NY: Haworth Press. Pargament, K.I., Desai, K.M. & McConnell, K.M. (2006). Spirituality: A Pathway to Posttraumatic Growth or Decline? In L.G. Calhoun & R.G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practice (pp. 121 – 137). New York: Lawrence Erlbaum Associates.

26. Bibliography Puchalski, C., Ferrell, B., Virani, R. et al. (2009). Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference. Journal of Palliative Medicine, Vol. 12, No.10, 885-904. Rees, J., O’Boyle, C., & MacDonagh, R. (2001). Quality of life: impact of chronic illness on the partner. J R Soc Med 2001; 94:563-566. Rizzuto, A.M. (1979). The birth of the living God. Chicago: University of Chicago Press. Rodnitzky, R. (2010) Parkinson disease dementia. www.uptodate.com. Schrag, A., Hovris, A., Morley, D., Quinn, N. & Jahanshahi, M. (2006). Caregiver-burden in parkinson’s disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism Related Disorders 2006;12:35-41.

27. Bibliography Sinclair, S. (2010). Impact of death and dying on the personal lives and practices of palliative and hospice care professionals. CMAJ, DOI:10.1503. Snow, K.N (2010). Resolving Anger Toward God: Lament as an Avenue Toward Attachment. Unpublished doctoral dissertation, George Fox University. Thomas, S. & MacMahon, D. (2004). Parkinson’s disease, palliative care and older people. Nursing Older People, 16, 1, 22-27. Weinberger-Litman, Muncie, M., Flannelly, L. & Flannelly, K. (2008). Holistic NursingPractice, Vol. 24, No. 1

28. Bibliography Wittenberg-Lyles, E. et al. (2008). Communication Dynamics in Hospice Teams: Understanding the Role of the Chaplain in Interdisciplinary Team Collaboration. Journal of Palliative Medicine, Vol. 11, No. 10, 1330–1335. Zornow, G.B. (2001). Crying out to God: Uncovering prayer in the midst of suffering. Unpublished manuscript.

29. Contact Information Donna Mann, Spiritual Care Provider: donna.mann@ww.ccac-ont.ca Maureen Quinn, Nurse Practitioner maureen.quinn@ww.ccac-ont.ca