Healthcare Delivery in the 21 st Century: Providing Interdisciplinary Spiritual Care

1. Healthcare Delivery in the 21st Century: Providing Interdisciplinary Spiritual Care Facilitators: Alan E. Bowman, MDiv, MBA VP, Ministry Formation Catholic Health Initiatives Rose Shandrow, MDiv System Director ,Mission Operations & Spiritual Care Franciscan Health System

2. Healthcare Delivery in the 21st Century: Providing Interdisciplinary Spiritual Care • Opening Prayer • A Brief Review • Objectives for this Session • Interdisciplinary Care: • Inpatient Example - Palliative Care • Outpatient Example – Parish Nursing • Interdisciplinary Care: - Use of Technology to Offer Spiritual Care Beyond Physical Boundaries

3. Opening Prayer Irish Blessing May the morning sun stir you from bed May the winds of March move you on the road May the rains of April renew your strength May the flower of May captivate your sight May summer heat inflame your zeal May autumn color stimulate your dreams May the silver moon make you wiser; yet may you never be with your self content. May Jesus and Mary keep you young, Full of life, laughter; and an Irish song. Edited and adapted from A Blessing for Challenge by Fr. Andrew Greeley

4. Healthcare Delivery in the 21st Century: Providing Interdisciplinary Spiritual Care • Objectives • At the end of the module, participants will be able to: • Articulate how chaplains can effectively participate in the interdisciplinary team to empower a team approach to the provision of spiritual care • Will be able to articulate specific examples of how chaplains can support interdisciplinary team members in a collaborative approach to spiritual care • Identify some innovative ways to use technology to expand the provision of spiritual care over distances that were previously viewed as barriers

5. Environmental Assessment and Key Drivers of Change Treatment & Technology Talent Rural Challenges Payment / Financial Trends Physician Dynamics Chronic Disease Catholic Identity Aging Consumerism Health Care Reform

6. Interdisciplinary Spiritual CarePalliative Care Juan Iregui, MD Franciscan Health System

7. Interdisciplinary Spiritual CareParish Nursing Debbi Saint, RN, BSN, FCN Coordinator, Congregational Health Ministries Franciscan Health System

8. Objectives • Provide a brief history and definition of faith community nursing and its roles. • Describe our health care organization’s spiritual care program and its relationship with faith community nurses. • Provide examples and ideas of collaborative practice between health care chaplains, faith community nurses and community clergy.

9. Faith Community Nursing History • Judeo-Christian roots with deacons and deaconesses, monks and nuns, parish nursing and the nursing profession itself • Modern day pioneer: Granger Westburg, a Lutheran pastor and hospital chaplain • Relationship between spiritual well-being and physical health • 1984, pilot project of partnership of 6 community churches with • Lutheran General Hospital in Chicago, first parish nurse program • A. Djupe, et al., Reaching Out: Parish Nursing Services, International Parish Nurse Resource Center, 1994

10. What is a Faith Community Nurse? (Parish Nurse) • The intentional integration of the practice of faith with the practice of nursing. • Assumes that health is a journey toward well being and is the interrelationship of body, mind, and spirit. • Assumes that health is not merely the absence of disease. It is related to everything a person does, thinks, and feels; therefore parish nurses focus on the whole person as they promote wellness, disease prevention, health education, and healthy spirituality. • International Parish Nurse Resource Center - A Ministry of the Church Health Center

11. Faith Community Nursing Roles • Integrator of faith and health • Health Educator • Health Advocate • Health Counselor • Referral Advisor • Support Group Developer • Health Team Volunteer Coordinator

12. What a Faith Community Nurse is not: • Not a physician • Not a home health nurse • Will not dispense medications or provide prescribed treatments • Not a therapist • Not clergy

13. Mission Operations and Spiritual Care Department

14. Congregational Health Ministries • Sponsored by Franciscan Health System • Network of faith community nurses and health ministers • Sharing and supporting each other • Continuing education and training • Opportunities for grant funded projects • Guidance in starting a health ministry programs • Access to health system resources • Monthly support meetings • Partners with Pacific Lutheran University and Northwest Parish Nurse Ministries

15. Spiritual Care Triad:Health Care Chaplain, Faith Community Nurse and Community Clergy Health Care Chaplain Patient/ Congregation Member Faith Community Nurse Community Clergy

16. Triad Collaborative Activities • Cross referrals • Pre-hospitalization preparation (ie Advance Directives, chaplaincy services) • Hospice • Discharge/Care transition referrals • Education • Clinical Pastoral Education • Chaplains faculty for Faith Community Nurse Course • Community Forums • Promotion • Introduction of faith community nursing • Promotion of Hospital Services

17. Outcomes • a strengthened link between faith and healing at the congregational and health care level • increased support for church health ministry programs that also transect health care organizations • promotion of health care organization and its outreach into the community • increased coordination of care that focus on achieving holistic health, • an opportunity to learn and utilize the knowledge, skills and talents of the other • resulting opportunities that this will unfold for further collaboration.

18. Interdisciplinary Spiritual CareUse of Technology to Offer Spiritual Care Beyond Physical Boundaries Julie Jones, Executive Director, Mission & Ministry Mercy Mission & Ethics

19. Interdisciplinary Care: Use of Technology to Offer Spiritual Care Beyond Physical Boundaries • Trends & Context • E-chaplaincy • Collaboration with Mercy Clinics (physician offices) • Emerging Integration

20. Trends impacting pastoral services • Mercy’s strategic plan • Electronic medical records • Emergence of medical home model and care management • Telemedicine • Growing consumer desire for on-line information

21. Context: “New and exciting method for the delivery of spiritual care” • This is a complete paradigm shift: • from a pastoral visit to an ongoing relationship • from pen/paper to computer/technology • from acute care to patient care site/home • from “come to us” to “we meet you where you are” • From in-person encounter to contact • from silo to integration -Kenneth Potzman, Director, Pastoral Services, Mercy’s Eastern Communities

22. E-chaplaincy • Using e-mail to provide spiritual care • Allows access to a chaplain at times that are convenient • Enables Mercy to extend pastoral services beyond acute care center

23. E-chaplaincy growth • Initial thought of way to extend staff ministry • Offer chance for co-workers to connect with chaplain via e-mail • Intranet • Built and expanding • Internet • Patient Portal

24. Extending Pastoral Care to Clinic • 95% of patient encounters are outside of hospital • Pastoral Services strategic goals are aligned with Mercy’s • VISION: Everywhere and every way Mercy serves, attention to spiritual needs will be evident.

25. Assumptions in Planning • The delivery of pastoral services will look different in clinic setting than it does in hospital. • Cannot just export what exists in hospitals • Need to intentionally plan appropriate attention to spiritual care in Mercy Clinic sites

26. Assumptions in Planning • Redesign priorities and expectations of where chaplains spend time • Pastoral Services resources (people, expertise, printed materials, successful practices) shared across the ministry • Use new technology to connect chaplains with patients in clinics

27. Clinic Demonstration Projects • Approach clinic leaders—physicians and office managers • Invite to be “learning partners”

28. Focus of Demonstration Projects • Process to identify spiritual needs • Screening, Awareness • Referral process • Patient education • Strong suggestion • Consult ordered • Response to the referral • Timing • How: in person, phone, e-mail, video • Outcomes and quality

29. Lessons Learned – Referrals • Education is not enough to generate referrals • Referrals cannot be dependent on the personality of or relationship with a chaplain • Need screening tools and “triggers” to ensure appropriate referrals

30. Referrals - What worked • Integration into the care team model • Medical home • Oncology – navigator (care management)

31. Lessons Learned – Staffing • Do not need a chaplain physically present in clinic setting • Technology enables coverage • E-chaplaincy (e-mail) • Phone • Video consult • Video training

32. Emerging Integration • Work with Care Managers to identify protocols for referrals • Triggers for a referral • Appropriate responses • Communicating interventions • Outcomes • Exploration about how to support growing telemedicine consults

33. Healthcare Delivery in the 21st Century: Providing Interdisciplinary Spiritual Care • Dialogue: What are your questions?