Spiritual Care Champions Series

1. Spiritual Care Champions Series Chaplain as Trainer Mary Heintzkill, MThS, BCC Martha Rucker, M.Div., BCC, CT Benjamin Schaefer, M.Div

2. Rightful Place at the Table

3. World Health Organization • Includes a spiritual dimension of health • Recognition that each person is unique • Need to respond to each individual’s quest for meaning, purpose, belonging, and oneness. Derek Yach, “Health and Illness: The Definition of the WHO”

4. By Inviting the Soul to Speak • Like a wild animal, the soul is tough and resilient, resourceful, savvy, and self-sufficient: it knows how to survive in hard places…Yet despite its toughness, the soul is also shy. Just like a wild animal, it seeks safety in the dense underbrush, especially when other people are around. If we want to see a wild animal, we know that the last thing we should do is go crashing through the woods yelling for it to come out. But if we will walk quietly into the woods, sit patiently at the base of a tree, breathe with the earth, and fade into our surroundings, the wild creature we seek might put in an appearance… - Parker Palmer

5. Spiritual Support from Medical Team at End of Life Less likely to receive aggressive treatment More likely to transition to hospice Higher Quality of Life

6. High Spiritual Support from Religious Communities More Likely to receive aggressive treatment Less likely to receive hospice support More frequently die in ICU • Balboni, Tracy et al. “Religious and Spiritual Support Among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life”, NIH Public Access, Feb. 10, 2002/

7. Grounding of Team Moral Distress Compassion Fatigue Hectic Pace Competing Priorities Reactive

8. Re-engineering Professional PracticeStarting with David Weissman MD’s 10 Steps Conducting a Goals of Care Conversation • Establish Proper Setting • Introductions • Assess Patient/Family Understanding • Medical Review/Summary • Silence/Reactions • Discuss Prognosis • Assess Patient/Family Goals • Present Broad Care Options • Translate Goals into Care Plan • Document and Discuss - Adapted from: Weissman DE. Conducting a Family Goal Setting Conference Pocket Card; Palliative Care Center, Medical College of Wisconsin, 2010

9. Side-by-Side Comparison

10. A Look at the Specific Behaviors • Modified 10 stages, including practices that honor the sacredness of this encounter • Invite care team to be spiritually grounded and present • Inquire about the patient’s spirituality, hopes and fears • Honor silence that may facilitate deeper listening and sharing • Assess for spiritual distress/suffering • Draw upon patient/family’s spiritual strengths (faith, beliefs, values) in addressing goals of care • Express gratitude to patient and family • Team self evaluation/reflection

11. GRACE Acronym Ground, be intentional Reflect what draws you to this work Acknowledge thoughts or emotions that may interfere with work that needs to be done Compassionately detach from those emotions Enter the room

12. Dignity Question “What do we need to know about you as a person to give you the best care possible?” - Harvey Max Chochinov, OM, MD, PHD, FRSC Dignity in Care http://www.dignityincare.ca/en/toolkit.html#The_Patient_Dignity_Question

13. Conference Evaluation Facility__________________________________________ Date of conference _______________________________ Patient’s initials __________________________________ Patient previously completed an Advance Healthcare Directive Y N PC team participants: (circle) Physician APN RN SW Chaplain Other _____________ Patient present Y N Number of family/others present _______ 1. Preparatory visit with patient/family prior to conference preferably in-person, by phone if necessary. If yes, by who: (circle) Physician APN RN SW Chaplain Other ________ 2. Team spiritual grounding reflection/meditation prior to conference? 3. Introductions to build relationships? 4. Dignity Question asked: What do we need to know about you as a person to give you the best care possible? 5. Patient/family invited to articulate personal/social/cultural strengths/resources? 6. Patient/family invited to articulate spiritual strengths/resources? 7. Patient/family asked about fears/distress? 8. Patient/family asked what they know about medical condition? 9. Patient/family asked if they were told what to expect? 10. PC clinician provided medical review and prognosis? 11. Patient’s goals/preferences addressed? 12. Patient/family invited to explore what they hope for? 13. PC clinician provided summary of conversation and outlined next steps? 14. Team expressed gratitude to patient/family? 15. PC team debriefed following meeting with patient/family? 16. How satisfied were you that the team listened intently for patient/family’s spiritual concerns/ beliefs/values and integrated these into the goals of care and treatment discussions? (Circle) 5-Very satisfied 4- Somewhat satisfied 3- Neutral 2- Somewhat unsatisfied 1- Very unsatisfied Comments:

14. After Conference Summary Palliative Care Goals of Care After Conference Summary Name of Patient: ___________________________________________________________________________ Family Members Present: ____________________________________________________________________ Thank you for helping us understand what is important to you as you live through this difficult time. This is a summary of the conference we had with you on ___________________________________________ with Members of our Palliative Care Team: (date) Name:______________________ __________________________ Role:_______________________________________ Name:________________________________________________ Role:________________________________________ Name: _______________________________________________ Role:________________________________________ Name: _______________________________________________ Role:________________________________________ Contact information for our Palliative Care Team: __________________________________________________________  Reason for Visit What We Heard From You What matters most to you: What you hope for: Our Recommendations We recommend: Our next steps are:

15. What People Are Saying • Dignity Question: “It helps people know we value them and are not the death squad.” Dr. Michael Trexler, MD, FACP Borgess Medical Center. • “…such a compassionate way to demonstrate our true interest in the person.” Shawna Brown, LCSW, Borgess Medical Center.

16. The Presence of the Chaplain • “The Chaplain creates a place for the soul.” Sam Robbins, ARNP, St. Thomas Health. • “When a Chaplain is present I feel less depleted.” Sam Robbins, ARNP, St. Thomas Health. • “Spirituality is crucial. I have seen that upon acknowledging spiritual needs, something happens.” Dr. Sarah Fremont, St. Thomas Health

17. Listening to the Soul • 58 year old patient • Married, one son. • Mother still living • Supportive family • Family meeting with Nurse Practitioner • “I don’t want to go alone” • Listened in the silence

18. We Journey Together • What are we doing? • Continuing to Learn • Our own circle of trust • Valuing our gifts • Facing challenges • Being intentional • Training to practicing

19. Helping staff talk about spirituality • It can be hard helping other staff understand what the chaplain role is and how spirituality can be integrated in to the plan of care. • More than just “the prayer person” • Staff can inadvertently reinforce stereotypes

20. Spirituality conversation groups • Goal of groups: • To raise staff members’ “spiritual literacy” • Increase referrals to spiritual care • Help staff understand the importance of a spiritual assessment • Help staff integrate their own spirituality This Spirituality conversation group program is adapted from the work of Chaplain Laura Kaufmann, BCC at Gundersen Health System, La Crosse, WI

21. conversation groups (cont.) • Groups could be done in three one hour sessions or in one half-day session • Could have continuing education credit offered • Leader promotes conversation/facilitates conversation rather than giving a lecture

22. Examples of conversation questions • Introductory questions: • How do you define spirituality? • What do you think about the statement: “Everyone has a spirituality” (something that helps them make sense of the world and the events they experience)

23. Examples • Applying this to those they work with: • What are some ways that a hospital admission can affect a person’s (patient, loved one) Spirituality? • What are some positive (or negative) ways that spirituality can affect their experience at Borgess?

24. Examples • Integrating spirituality into their practice: • What effects does working with those who are sick and suffering have on your spirituality? • How can you help make a person’s spirituality be a part of their plan of care? • What are some ways you could introduce the topic of spirituality to a patient or family? • What are some new ways you might utilize the chaplain?

25. Promoting conversations • Have an “elevator speech” • Bring up Spiritual components of care during IDT/rounds • Write chart notes that are helpful and add to the understanding of how to best care for the patient • Offer support groups/spiritual resources to the staff of your institution

26. Questions? Comments?