Partners in Healing: Medical and Spiritual Care

1. Partners in Healing:Medical and Spiritual Care Chaplain Jason Mann, MD, MPH Rev. Bruce Cwiekowski, D.Min, BCC Rev. John A. Hubbard, D.Min, BCC

2. Questions and Objectives • What is Pastoral Care? • What are the requirements and training necessary to become a health care chaplain? • What do chaplains do here in the hospital to improve the care of the patients and support staff? • How does incorporating knowledge about spirituality and pastoral care services improve the quality of care that providers deliver to the patients here at Providence Portland Medical Center?

3. Curing vis-a-vis Healing • Curing – the provider directs his/her efforts on the physical manifestation of the illness. The focus is on elimination of symptoms and signs of disease. • Healing – the provider directs his/her efforts onthe effects of the illness on the patient beyond its physical manifestations; this can include its social, psychological and its spiritual effects.

4. Empathy Involves a deep understanding of another person’s feelings and point of view aboutthemselves and the world they live in.

5. Summary Physical---------------Psychological Empathy Social-------------------Spiritual

6. Medical School Survey 1992 Survey – 2% of medical schools have some courses on the role of spirituality in medicine. 2004 Survey – 75% of medical schools now have courses either elective or required on spirituality in medicine.

7. Spirituality vs. Religion Spirituality – an inner path enabling a person to discover the essence of their being or the deepest values and meanings by which people live. Religion – belief in a divine power or powers to be recognized and worshiped. Expression of this belief may take place in day to day life and ritual.

8. A Patient’s Thank You Note: I was hospitalized for an attempted suicide in May and he came to visit me several times. I was so out of it during my week at Providence that I could not remember his name after my stay, and I wanted to send him a thank you. He really made a difference. Everyone in my life seemed alien to me, my family was angry instead of understanding, the nurses seemed to assume I tried to kill myself because I broke up with someone, when really my whole family has suffered and fallen apartin the course of a few years. I was truly miserable, but when Dr. Mann came to visit me I felt relaxed and hopeful. He never preached to me, but told me a quote which I do not remember now word for word . . . but went along the lines of even in the darkest places light shines through and told me he could see my light. I just had to take a minute until I could see it too. His few kind words changed my thinking from being really angry with myself for the attempt to not have worked, to thanking god that I was still alive. If you could pass on my thanks to him I would really appreciate it! 

10. The Need for Spiritual Care World Health Organization (Proposed preamble to WHO Constitution) “Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity.” JCAHO (Joint Commission Accreditation of Health Care Organization) Standard RI.2.10EP 4 “The hospital accommodates the right to pastoral and other spiritual services for patients.” Ethical and Religious Directives for Catholic Health Care Services Part Two, Directive 10 “. . . should provide pastoral care to minister to the religious and spiritual needs of those it serves . . .”

11. Understanding the Ultimate Concern of Patients • Each person seeks an understanding of reality and meaning that satisfies the heart and mind.  • Some find satisfaction in the answers provided by a religion.  • Others find a nonreligious worldview that gives purpose and meaning to their lives. Paul Tillich PhD adapted.

12. A medical event is life changing emotionally and spiritually shattering 2007 Steve Roesler Learning, Adapted from Kuebler-Ross “On Death and Dying”

13. Spiritual History/Assessment History – The patient’s spiritual practice and community is identified during the admission process. Assessment – The spiritual assessment identifies the patient’s ultimate meaning and spiritual strength.

14. Tools for Spiritual History and Assessment Over the years a number of tools have been developed and mnemonics or acronyms have been designed to remember them; i.e., FACT.

15. FACT F = Faith (beliefs): What things do you believe that give your life meaning and purpose? A = Active: Is there a person or a group whose presence and support you value at a time like this? C = Coping: How is your faith (your beliefs) providing Comfort in light of your diagnosis? T = Treatment plan: If patient is coping well, then either support and encourage or reassess at a later date as patient’s situation changes.

16. Bargaining with God “Be careful what you ask for Doc.” F – Faith A – Active and Accessible C – Coping T – Treatment

17. Our Goals Are… … to be present to the patient and their loved ones and to identify their hopes and fears and expectations. … to assess the strength of their spiritual and emotional support. … to guide the patient and their loved ones to connect their spiritual resources to their point of need. … to walk along side of the patient and their loved ones to a place of healing and hope.

18. An Encounter in ER Know me.  Care for me.  Ease my way 

19. Spiritual Distress “A Grief Observed”

20. Chaplains shape their encounters. They do not control them. A Care Conference Story

21. A Peaceful Death The Story of John

22. But it is not just about death • Chaplains are also present with patients who are going to get well! • We assuage patient fears before surgery and procedures. • We provide presence and emotional support when patients are lonely and afraid.

23. Pastoral Care Professionals provide and participate in a variety of services • Connections Team/Care Conferences • Critical Incident Stress Debriefings • Ethics Consult Team • Support to Clinical Staff • Memorials and Celebrations • Worship Services • End Of Life Issues • Advanced Directives • Music-thanatology

24. Saints Cosmas and Damian They were twins who practiced the art of healing. They are the patron saints of Physicians, Surgeons and Pharmacists.

25. Training and Requirements for Chaplains • Master Degree in Divinity, Theology or related field. • Successful completion of Clinical Pastoral Care Training Program. • 1600 hours of supervised training and education: • Loss and Grief Issues • Ethical Issues • Spiritual Assessment Training • Human Development • Family Dynamics • Cultural and Religious Competencies

26. Training and Requirements for Chaplains • Successful interview with certifying board of chaplains. • 50 hours of continuing education per year: • Theory of Pastoral Care • Identity and Conduct • Pastoral Training • Professional Training

27. Thomas McCormack, MD“Ethics of Medicine” — 1998 95% of patients have a belief in God. 77% would have liked spiritual issues discussed by health care provider.

28. Doctor/Patient Discussions What Patients Want 68% of patients would welcome spiritual discussion during health care visits. 65% of patients reported that discussion of spiritual issues would strengthen their trust in their health care provider. Christina Puchalski, MD 2001

29. Doctor/Patient Discussions What Patients Want 85% – increased trust if physician addressed their spiritual concerns. 95% – if spirituality is important to them – want their doctor to be sensitive to their spiritual needs and to integrate it in their treatment.

30. Doctor/Patient DiscussionsWhat Patients Want 50% – if spirituality is not important to them – want spiritual issues addressed in the case of serious and/or chronic illness. J.W. Ehman, B.B. Ott, T.H. Short, R.C. Ciampa, J. Hansen-Flaschen 1999

31. Doctor/Patient DiscussionsWhat Patients Want 95% – in a family practice setting – want spiritual beliefs addressed in serious illness. 86% – when admitted to the hospital. 60% – during routine history. G. McCord, V.J. Gilchrist, S.D. Grossman, et al. 2004

32. Physician Response to Patient Spirituality 31% of MDs in his group discussed spiritual issues during routine visits. 39% discussed these issues during acute hospital visits. 74% of his physician group discussed these issues when the patient was dying. Harold Koenig, MD 2007

33. Physician Understanding of Impact of Patient’s Spirituality 76% of physicians felt that a spiritual discussion helped patients cope. 75% believed that it improved the patient’s state of mind. 53% saw a practical and supportive value of being part of a spiritual community. Harold Koenig, MD 2007

34. Outcomes of Patient’s Spirituality 56% of physicians believed spiritual issues had some influence on patient outcome. 6% believed that spiritual beliefs could transform a bad medical outcome into a good one. Farr Curlin, MD 2007

35. Spiritual Needs: Met and Unmet Two million people surveyed in American hospitals: • 33% felt their spiritual and emotional needs were unmet during their hospital visit. • 20% of doctors state they routinely take a spiritual history.

36. FICA: F – Faith –What do you believe in that gives meaning to your life? I – Importance and Influence – How important is your faith (or religion or spirituality) to you? C – Community – Are you a part of a religious or spiritual community? A – Address or Application – How would you like me to address these issues in your health care?

37. Possible Endowed Pastoral Care Positions • Emergency Department • Cancer Services • Cardiac Services • Palliative Care Services • ICU/CICU • Clinical Pastoral Education Program • Music-thanatology

38. “To put it bluntly, it is not about you. It is about the patient and family. In teaching spirituality as a component of a broader curriculum, it is not what I, the teacher, believe or you, the learner, believes that is most important. It is about acquiring skills necessary to address the spiritual needs of patients and families. Period. “ James Hallenbeck, MD“Palliative Care Perspectives: Psychosocial and Spiritual Aspects of Care”2003

39. To make a referral: • Contact Pastoral Care at: • 503-215-6833 • on-call pager 74-0133 • ProvExpert: consult/Pastoral Care