Chaplain Jeremy Hudson MA, BCC Spiritual Services Department

1. Out of the Mystery and into the Light: Screening Patients for Spiritual Needs. Chaplain Jeremy Hudson MA, BCC Spiritual Services Department University of Iowa Hospital and Clinics

2. Objectives • Participants will be able to define/describe spirituality, spiritual care, and spiritual distress to healthcare colleagues. • Participants will be able to understand the importance of building key relationships and identify allies with in their organization. • Participants will be able to recognize barriers to spiritual care with in the institution and identify opportunities for collaboration with other disciplines to improve patient satisfaction.

3. “Knowledge is static; wisdom is active and moves knowledge, making it effective.” -Dr. Will Mayo

5. Do you have a religious affiliation?

6. Spiritual Care Be Offered to Every Patient Every Time.

7. Our Story - Background • UIHC is a 732-bed hospital that annually admits more than 33,000 patients for in-patient hospital care. • UIHC has more than 57,000 emergency department visits annually. • UIHC has more than 935,000 clinic visits at our main campus and community and outreach clinics annually.

8. Our Story - Background • Spiritual Care is Provided 24/7 • Director of Spiritual Care • Chaplains • 3 Denominational Chaplains • 1 Pediatric Chaplain (outside funded) and 2 Adult Palliative Care Chaplains • 4 Inter-Faith Staff Chaplains (1 FT, 2 PT, 1 PRN) • All of the Intensive Care Units, Peds, Palliative Care, Day of Surgery, and Psych have assigned chaplains.

9. Background • May 2014 - BMT inquired about identifying pt/families who desire/could benefit spiritual care. • Ground Work (May 2014) • Conversations with Dr. George Fitchett • Formulation of a pilot project • Trained Volunteers to administer screening (position description completed) • BMT Chaplain visit pts/families who desire care • Prepare to submit project for IRB review • Project submitted to IRB for review (June 2014)

10. Modified Rush Screening

11. Background • Four Units – BMT adult and peds, CVICU, and Med Psych unit. • The unit social worker used a modified version of the Rush Spiritual Screening tool added to EPIC. • Patient/families would be automatically be added to a system list for the Spiritual Services department to visit if they desired care. • The spiritual care assigned chaplains to visit.

12. Pilot • Pilot from 2/7 – 3/31 had a 62% referral rate. • Social Work Assessments are complete on about 50% of patients. • April 2015 collaboration began between Spiritual Care and Nursing at the request of CNO. • CNO requested July 1st rollout in the Nursing Assessment.

13. Pilot Spiritual Care and Nursing began collaboration on Screening. 6/16/15 Screening went live on the Peds units. Screening became required in Nursing Assessment. 7/14/2015 Screening went live for the rest of the hospital. 5/19/2015 Screening went live in the Nursing Assessment on 7 units.

14. Nursing Assessment

15. It was all smooth sailing and really easy.

16. Opportunity 1: Education “The Mysterious Realm”

18. Exercise • What is the role of chaplain/spiritual care department in your institution? • How does your institution see role of chaplain/spiritual care department? • Are there gaps?

19. @ UIHC • How does your institution see role of chaplain/spiritual care department? • Priests • Attending Deaths • Pray with people • Rituals/Sacraments • Baptize infants • Communion • “Last Rites” • Supportive/Good Listeners • Ethics

20. Confusion doesn’t stop there…

21. Definitions of Spirituality Those who speak of spirituality outside of religion often define themselves as spiritual but not religious and generally believe in the existence of different "spiritual paths," emphasizing the importance of finding one's own individual path to spirituality. Wikipedia

22. Spirituality: the quality or state of being concerned with religion or religious matters, the quality or state of being spiritual. Merriam-Webster Dictionary

23. “…the search for transcendent meaning” – can be expressed in religious practice or …expressed ”exclusively in their relationship to nature, music, the arts, a set of philosophical beliefs, or relationships with friends and family” (Astrow et al. 2001)

24. Definitions of Religion • Outward practice of a spiritual system of beliefs, values, codes of conduct, and rituals (Speck 1998). • Set of beliefs, practices, and language that characterizes a community that is searching for transcendent meaning in a particular way, generally based upon belief in a deity (Astrow et al. 2001).

25. Definitions of Spiritual Distress • Spiritual distress “a disruption in the life principle that pervades a person's entire being and that integrates and transcends one's biological and psychological nature.” (North American Nursing Diagnosis Association (NANDA), 1999, page 67) • A person’s present experience is in conflict with personal beliefs, values, purpose, and meaning

27. How we communicate our craft in a way that connects with non-chaplains?

28. Exercise • Discuss and define spiritual/spirituality. • Discuss and define religion/religious. • Discuss and define spiritual distress. • How would you explain those to a non-chaplain colleague in under sixty seconds in a way that they would understand?

29. πνεῦμα ancient Greek word for "breath", and in a religious context for "spirit" or "soul" spiritus Latin term for breath, often used figuratively to mean spirit. Hebrew term for breath, wind, and spirit.

30. Spirituality - is that which gives breath to life.

31. Religion Vocation/Calling Spirituality Hobbies Relationships Places Literature Music Science Nature Arts

32. “Never Happen” Events Stressful, sometimes unanticipated, events that don’t fit in our plan for life. Events that threaten or challenge the very things that give breath to our life. Events that stretch even the healthiest individuals, families, and communities.

33. “Never Happen” Events (Holmes & Rahe Social Readjustment Rating Scale) Death of spouse or child Death of a close family member (parent or sibling) Major change in health or living conditions Major change in church or spiritual activities Major change in health of family member Major change in financial state Death of a close friend Violence/Abuse Revision of personal habits Major change in social activities

34. Signs of Spiritual Distress • Questioning the meaning of life • Loss of purpose • Being afraid to fall asleep at night • Anger at God/higher power • Feelings of being abandoned by God/higher power • Questioning their own belief system • “What good are they?” Adapted from the Hospice and Palliative Nurses Association

35. Signs of Spiritual Distress • Feeling a sense of emptiness/loss of direction • Loss of hope • Impaired ability to cope • Questioning the meaning of suffering • Is this punishment? • Pain and other physical symptoms can be expressions of spiritual distress Adapted from the Hospice and Palliative Nurses Association

36. Why is the spiritual important? • Helps us know and understand our patients. • What is at stake? • At crossroads that requires a decision, we should ask: 'Where are you today, what's important to you, what gives breath to your life, and how does this affect your decisions?' • Helps inform us of the whys… • Why they do or don’t… • Research shows it can impact patient outcomes.

37. Spirituality and Patient Outcomes

38. Spirituality and Patient Outcomes

39. Spirituality and Patient Outcomes

40. Opportunity 2: Identifying Allies and Growing Your Influence

41. Making Inroads at UIHC • Find a need, meet a need • Mutual Benefit • Nurse Manager and Social Worker on the BMT units need was identifying pts who would like spiritual care. • Spiritual Care department would benefit from a greater presence and relationships on BMT and increase care to pts on BMT. • It meets the pt/family’s need for spiritual care if desired. • Know your audience

42. Making Inroads at UIHC • Be open to risk • A growing opportunities. • Origin Pilot on 1 Unit • Partnering with Social Work – Grows to 4 units • Partnering with Nursing – Goes House Wide • Weighing the risk. • Living into the unknown – not knowing the numbers • Will an opportunity be lost by not acting? • Expect resistance

43. Making Inroads at UIHC • The Ripple Effect • One unit, a Nurse Manager, a Social Worker, and a Chaplain. • Personally presented to over two hundred fifty collogues at UIHC and at the UIHC Management Meeting. • Every nurse, inpatient, and family at UIHC.

44. Exercise • Who promotes spiritual care in you institution? • Who are potential allies of spiritual care in your institution?

45. Opportunity 3: Small Changes Big Impact

46. Small Changes Big Impact • Don’t Overlook the Mundane • A simple spiritual screening has had a huge impact • Better patient care • Better utilization of limited spiritual care providers. • Greater collaboration among disciplines to provide better patient care and increased visibility for spiritual care. • Expanded opportunities – Grand Rounds and Outpatient Areas

47. Results

48. Results • On average 260 additional requests per month mainly from units without a dedicated chaplain. • 3100 additional patients indicating a desire for spiritual care per year. • Monthly visits up by an average of 114 visits per month over the same period last year. • Pilot is capturing a wide scope of patients.

49. Exercise • What are the opportunities at your institution? • Who do you need as your allies to make this happen? • What are the obstacles? • What are you going to do about it?

50. References Astrow, A.B., Puchalski, C.M., Sulmasy, D.P. (2001) Religion, spirituality, and health care: social, ethical, and practical considerations. Am. J. Med. 110:283-287. Bay, Paul S., Daniel Beckman,James Trippi, Richard Gunderman, and Colin Terry. 2008. “The Effect ... Journal of Religion and Health 47, no. 1:57–69 Iler, William L., Don Obershain, Mary Camac (2001). “The Impact of Daily Visits from Chaplains on Patients with Chronic Obstructive Pulmonary Disease (COPD): A Pilot Study”. Chaplaincy Today, 17(1):5-11. NANDA Nursing Diagnoses: definitions and classification, Philadelphia : North American Nursing Diagnosis Association, 1999 Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. “Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT–Sp)” Annals of Behavioral Medicine. 2002;24:49–58. doi: 10.1207/S15324796ABM2401_06.