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Spirituality and Clinical Care

Assess religious and spiritual issues. Not just recording their religion ... I= Integration with spiritual community. R= Ritualized practices and ...

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Spirituality and Clinical Care

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    Slide 1:Spirituality and Clinical Care

    Course Faculty Directors Kay Sandor, PhD RN, LPC, AHN-BC Victor S. Sierpina, MD Harold Vanderpool, PhD, ThM

    Slide 2:Spirituality and Clinical Care

    Contributing Faculty Susie Gerik, MD Ruth Levine, MD Rodger Marion, PhD Research Assistants Ernest Aguilar, PhD (IMH), Joseph Amos (SOM) Elizabeth Gressle, RN, MSN, FNP-C (SON) Syllabus at: http://cam.utmb.edu/curriculum/spirit-syllabus-06.asp

    Slide 3:Three Domains of Spirituality

    Integral model Goal oriented health care Spiritual history/competency

    ARCHAIC/ INSTINCTUAL EGOCENTRIC/MAGIC CONFORMIST/ MYTHIC RATIONAL/ FORMAL PLURALISTIC INTEGRAL TRANSPERSONAL

    Slide 7:From Life goals to health goals: Integrating values and practice

    “Tell me, what is it you plan to do With your one wild and precious life?” Mary Oliver, The House of Light, 1990

    Slide 8:A new covenant…

    . We need a different understanding between the patient and the doctor, nurse, or other health care provider In this model, the patient carries a clear understanding of his/her responsibility, based on their own life goals Meaning, purpose, and motivation are key issues

    Slide 9:Life Goals

    Are harder to elicit than health goals, But much more important to decisions. What people care about being able to do, now and in the relatively near future; From which health goals are derived, And on which health decisions are based, With the patient at the center of the process, And in fairly complete control.

    Slide 10:Goal-Oriented Health Care

    Designed to move away from provider-centered care, and push, and “taking care of” people And away from health goals as the main issue of medical care And away from symptom reduction as a definition of health…

    Slide 11:Goal-Oriented Health Care

    …and toward life goals and a fundamental understanding of who this person is and what they care about being able to do as the basis of medical care So that health goals are built around life goals And the patient decides what gets done, based on information and discussion

    Slide 12:How would we do this? (example questions)

    What are your…..? Goals Dreams Passions What do you care about the most? Who do you really want to be ? What do you want to achieve? What would you still like to do with your life? What is your “dream-shot”?

    Slide 13:What would it look like?

    Life Goal conversation is crucial Tie health goals to life goals – with details Clarify the patient’s choices carefully Clarify the shared responsibility, and the individual responsibilities Be realistic about what patients can do and what kind of support they need

    Slide 15:What is “Spirituality Competency” in the Clinical Setting?

    Openness to a patient’s worldview, perception of illness as different from your own Non-judgmental listening Thoughtful semi-structured inquiry (spiritual history) Empathy Referral and use of appropriate resources

    Slide 16:Spiritual History

    Assess religious and spiritual issues Not just recording their religion Determine based on patient guidance how or if to include spirituality in the interdisciplinary team approach

    Slide 17:Taking a Spiritual History

    Delicate, nuanced communication Appropriate timing Supportive listening

    Slide 18:How we are wounded

    Shame Betrayal Abandonment Mario Martinez, PhD Author, lecturer, Biocognitive Psychology http://www.biocognitive.com

    Slide 19:Recognize Common Spiritual Dilemmas

    Unfairness—Why me? Unworthiness—I don’t want to be a burden Hopelessness—What’s the point? Guilt and punishment—I’m being punished but I led a good life Isolation and anger—No one understands me Vulnerability—I am afraid Confusion—Why is this happening to me? Abandonment—God (or family) doesn’t care

    Slide 21:Spiritual History Models

    FAITH IMPACT COMMUNITY ASSIST

    Slide 23:Three Questions

    What helps you get through the tough times? Who do you turn to when you need support? What meaning does this experience have for you?

    Slide 24:HOPE

    H: Sources of hope, meaning, comfort, strength, peace, and connectedness? O: Organized religion? P: Personal spirituality or practice? E: Effects on medical care and end of life issues?

    Slide 25:SPIRITual History

    S= Spiritual belief system P= Personal spirituality I= Integration with spiritual community R= Ritualized practices and restrictions I= Implications for medical care T= Terminal events planning

    Bridging the Gap Learn about your patients’ goals, culture, and beliefs Your role as a health care provider and healer is to be NON-JUDGEMENTAL, TOLERANT, INTEGRAL, PLURALISTIC Use appropriate interpreters/pastoral care services Practice culturally sensitive interpersonal dynamics Accommodate to your patients’ health beliefs Practice the Platinum Rule: “Treat others the way they want to be treated.”

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