10/31/2008
Honoring My Own Spiritual Beliefs…While Respecting Others
Brian Jones, MS
Thought to Ponder…
• Most of us enter into hospice with a specific set of beliefs relative to the afterlife salvation and death
beliefs relative to the afterlife, salvation and death. How can we make sure we don’t compromise our own belief systems while ministering to those who have views which may conflict with out own?
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Outline…
• Importance of Spirituality in Healthcare
• Newfound Recognition of Spirituality in Healthcare
• Importance of Knowing our own Spiritual Beliefs
• When Views Conflict: How to Handle
• How to Effectively Minister to Patients
• Personal Growth in the Process
Characteristics distinguishing religion and spirituality.
Religion
• Community focused
C
i f
d
• Observable, measurable, objective
• Formal, orthodox, organized
• Behavior oriented, outward practices
• Authoritarian in terms of A th it i i t
f
behaviors
• Doctrine separating good from evil
Spirituality
• Individualistic
• Less visible and measurable, more subjective
• Less formal, less orthodox, less systematic
• Emotionally oriented, inward directed
• Not authoritarian, little accountability
• Unifying, not doctrine oriented
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Victor Frankl
• “Man is not destroyed by suffering; he is destroyed ff
g;
y
by suffering without meaning.”
• One of the challenges healthcare professionals p
face is helping people find meaning and acceptance in the midst of suffering and illness.
• Medical ethicists remind us that religion and spirituality form the basis of meaning and purpose for many people.
Rachel Naomi Remen, MD
• “Helping, fixing, and serving represent three g p
different ways of seeing life. When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fi i
Fixing and helping may be dh l i
b
the work of the ego, and service the work of the soul.”
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What patients desire…
• Ten percent of patients with a serious illness h
have the spirituality factor addressed by their th
i it lit f t
dd
d b th i
physician, yet sixty to seventy percent would like it addressed. • Forty‐eight percent would like their physicians to pray with them if they could. p y
y
Research on the Role of Spirituality in Healthcare
• Mortality
• Coping
• Recovery
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So…important, right? Impact?
• 72 of the 125 undergraduate medical schools in the US run courses on how to deal with patients’ spiritual concerns.
• Joint Commission, “For many patients, pastoral care and other spiritual services are an integral part of health care and daily life. The hospital is able to provide for pastoral care and other spiritual services for patients who request them.”
• American College of Physicians convened an end‐of‐
American College of Physicians convened an end of
life panel that concluded by saying that physicians should extend their care by attention to psychosocial, existential or spiritual suffering.
Continued…
• Association of the American Medical Colleges, Physicians must be compassionate and must be compassionate and
“Physicians
empathic in caring for patients…they must seek to understand the meaning of the patients’ stories in the context of the patients’ beliefs and family and cultural values.”
• John Templeton Foundation supports John Templeton Foundation supports
curriculum in medicals schools and residency training programs on spirituality. 5
10/31/2008
Walls Broken Down
• “It’s becoming clear that medicine and religion are entering a new dynamic of mutual respect t i
d
i f
t l
t
and inquiry. This is a convergence – not a collision – and it will determine the future of healthcare.”
Virginia Harris, chairman of the Board of g
,
Directors of The First Church of Christ, Scientist.
The Forgotten Factor
• According to Dr. David Larson, president and primary founder of the National Institute for i
f
d
f th N ti
l I tit t f
Healthcare Research in Rockville, MD, faith has long been considered the “forgotten factor” in healthcare. • Larson attributes the influx of females into the medical field as physicians as a primary element. 6
10/31/2008
Reality…
• Chaplains receive training to address the spiritual needs of patients.
• However, hospitals across the country have been reducing their pastoral services or combining them with others.
• Hospice chaplains often carry very high caseloads.
• Unlike nurses, chaplains in hospice are rarely U lik
h l i i h i
l
available 24/7.
• Thus, spiritual care often falls upon other direct care professionals in hospice. Before I can help others spiritually, I have to have an understanding of my own spirituality.
• A starting place…
www.beliefnet.com
THE BELIEF‐O‐MATIC
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Stoll’s (1989) Conceptual Model
GOD
Self
Person
Others
Environment
Facts on the Spirituality of the Nurse
• The nurse’s own personal spirituality will permeate individual nursing practice.
t i di id l
i
ti
• Becoming aware of one’s spiritual perspective will enhance personal awareness and, thereby, contribute to the spiritual care of patients.
• Nurses with a religious affiliation have a Nurses with a religious affiliation have a
stronger spiritual base and are more likely to provide spiritual care in practice. 8
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Spiritual Nursing Care
• At its foundational level, spiritual nursing is an
spiritual nursing is an expression of self. Patients will ask…
• “…What do you believe?” They genuinely want to know. It can be supportive to share tt k
It
b
ti t h
something of what you believe, but only if your words will be helpful to the patient. 9
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Convergence
• “The chaplain’s job as a religious person is to d l hi
develop his or her own faith to the point where h
f ith t th
i t h
they can relax or surrender their beliefs enough to join another person in theirs.”
Tim Ford, MA, MS, CT
When belief systems conflict…
• “The Chaplain serves as an advocate for the spiritual values and religious beliefs held by i it l l
d li i
b li f h ld b
the patient, even when those values and beliefs are not those of the Chaplain.”
Guidelines for the Chaplain’s Role in Health
Care Ethics Association of Professional
Care Ethics, Association of Professional
Chaplains
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Scenarios…
• “I think I’m right with God, I’m ready to die and meet Him,” says the Jewish patient to the d
t Hi ”
th J i h ti t t th
Baptist nurse.
• “I’m afraid of dying, I’ve been taught it’s a black hole,” says the patient to the Methodist home health aide. Scenarios…
• “My priest just left he said I’m okay with God. I never really felt good about being Catholic. What
never really felt good about being Catholic. What do you think?” says the Catholic patient to the agnostic nurse.
• “Would you mind praying for me?” says the patient who claims no religious affiliation to the Unitarian social worker.
• “II think my disease is all about my thinking. I think my disease is all about my thinking I
need to be more positive, don’t you think?” says the Christian Scientist patient to the social worker who is a Latter Day Saint. 11
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Scenarios…
• “My minister never comes to see me. I don’t like the hospice chaplain because she’s a female
the hospice chaplain because she’s a female. Would you read from the Bible for me?” says the Presbyterian patient to the male Lutheran social worker.
• “What I really need right now are some comforting words from the Koran. Would you pick mine up and read some to me please?” says the young Islamic patient to the Catholic nurse.
Scenarios…
• While tearing up over his constant paint, the Ch i ti
Christian nurse asks her self‐declared atheist k h
lf d l d th i t
patient if he would mind if she prayed for him.
• “Do you believe in hell?” asks the Disciple of Christ patient to the Evangelical Lutheran hospice medical director. p
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From the Chaplains
• “We have a phrase we use called cooperation without compromise.”
ith t
i ”
• “You cooperate with people of all faiths without compromising your beliefs.”
• “It’s not as difficult as it is sometimes portrayed ”
portrayed.
• “Respecting the right of the nonbelievers to be left alone.”
From the Chaplains
• “We are not generic chaplains.”
• “You walk with the person in the midst of their brokenness, using the resources of their faith to help heal them.”
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Dr. R. Murali Krishna, president of the James L. Hall Center for Mind, Body and Spirit
• “If we’re imposing our belief system on them
belief system on them, then its crossing the boundary. We live in a world where people believe different things, and boundaries are important.”
Personal Reflections of a Buddhist Chaplain
• “I journey with my patients to the very depths of meaning in their lives and then invite them to apply that meaning to the present moment. Ultimately the healing comes in the companioning them on thi j
this journey, not t
championing any one form of dogma over another.”
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Takes me back to my counseling days…
• I did not agree morally with all the decisions my clients chose. My faith was part of who I
My faith was part of who I was. However, I recognized my role was to help them in their journey. If asked, I would tell them my views, but assure them our time together was about them and not me. I never offered to pray with a g
counseling client, however I had a few clients who requested it and I obliged in soft tones and in short display. Caution…
•
•
•
•
Aesculapian Power
Recognize your own limitations. You may be a Sunday School teacher with
may be a Sunday School teacher with a lot of biblical knowledge, but that doesn’t mean you are trained to help terminal patients wrestle with spiritual abstracts. Scope of practice is a legitimate issue. You don’t want a chaplain doing the heaving lifting for a patient who requires catheter insertion, so don’t try to cross a line and do his/her job. Sounds like a spiritual problem to me:
Sounds like a spiritual problem to me: Something you need to be able to identify to pass on to a spiritually/religiously trained individual. 15
10/31/2008
Okay, so how can I help?
Spiritual Inventory
• FICA
• SPIRIT
• CSI‐MEMO
• Kuhn’s
• Matthew’s • HOPE
• ACP
Four Approaches
• Personal
• Procedural
• Culturalist
• Evangelical
Key Points to Remember
• You can always pray silently for your patients everyday. everyday
• Expressions such as love, hope and compassion constitute the most basic and universal approach to spiritual care. • It can be risky. The caregiver must have excellent verbal and non verbal communication skills,
verbal and non verbal communication skills, including listening. There must be an attitude of warmth, respect, and empathy. • A time for openness and nonjudgmentalism. 16
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Key Points to Remember
• We must constantly exam our own personal agendas in the process Remember it is
agendas in the process. Remember it is patient‐centered care, not clinician‐centered care. • Always ask permission to pray. Never ask unless you know it would be meaningful to the patient
the patient. • Spiritual care in hospice is always interdisciplinary. Outcomes of Spiritual Care
More peaceful, relaxed, calm and grateful.
Feelings of being comforted.
g
g
Bring a “connection” to the patient/clinician relationship.
Altruistically, being able to share of your self spiritually to a patient provides more inner satisfaction and feeling of providing truly holistic care.
• Learn from your patients. A living, breathing classroom in world religions, cultures and spiritual paths.
• Each new experience will help you with the next patient. Each new experience will help you with the next patient
• A greater appreciation that not all questions have easy answers. Perhaps helping us with humility!
•
•
•
•
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Compassion
• “to suffer with”
• Compassionate care C
i
t
calls clinicians to walk with people in the midst of their pain, to be partners with patients rather than
patients rather than experts dictating information to them.
• Listen to their hopes, their fears and their
their fears and their beliefs and incorporate these beliefs into their plans of care.
References
Dubee, Bryce S. “Chaplains Reflect on 232 Years of Being There for Troops at War.” Military.com. Retrieved 18 August 2008 http://www military com/features/0 15240 145378 00 html
http://www.military.com/features/0,15240, 145378,00.html Dunn, Linda. “Spirituality and Nursing: Personal Responsibility.” Online Journal of Rural Nursing and Health Care Vol. 8 No. 1, Spring 2008: 3‐4.
Ford, Tim. “Interacting with Patients of Different Faith.” Southern Medical Journal June 1, 2006. Retrieved 18 August 2008 http://www.thefreelibrary.com
//
Goodstein, Laurie, “Evangelicals Are a Growing Force in the Military Chaplain Corps.” The New York Times July 12, 2005. Retrieved 18 August 2008. http://www.nytimes.com
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References
Guidelines for the Chaplain’s Role in Health Care Ethics.
Retrieved 29 July 2008 http://www.professionalchaplains.org/index.aspx?id=222
Hospice News Network Newsletter. Vol. 12 No. 33. Koenig, Harold G. Spirituality in Patient Care Radnor, Pennsylvania: Templeton, 2002. Leach, Susan L. “Spirituality and Healing in Medical Practice.”
Retrieved 15 August 2008 EBSCOhost. Leeuwen, Rene, Lucas Tiesinga, Doeke Post and Henk Jochemsen.
“Spiritual Care: Implications for Nurses’ Professional Responsibility.” Journal of Clinical Nursing 15, 875‐885, 2006. References
McEver, Melissa. “Health Providers Beginning to Use Spirituality in Patient Care.” Valley Morning Star 07/15/07 Retrieved 15 August 2008 EBSCOhost.
Mitchell, David. “Spiritual and Cultural Issues at the End of Life.”
Medicine 36:2, 109‐110, 2007. Narayanasamy, Aru and Jan Owens. “A Critical Incident Study of
Nurses’ Response to the Spiritual Needs of Their Patients.” Journal of Advanced Nursing 33 (4), 446‐455, 2000.
Post, Stephen, Christina Puchalski and David Larson. “Physicians
and Patient Spirituality: Professional Boundaries, Competency, and Ethics.” Annals of Internal Medicine Vol. 132 (7), 578‐583, April 4, 2000. 19
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References
Puchalski, Christina M. “The Role of Spirituality in Health Care.”
BUMC Proceedings 14, 352‐357, 2001. Roeder, Tom. “Ex‐Air Force Chaplains: Debate is Nothing New.” Colorado Springs Gazette February 12, 2006. Retrieved 18 August 2008 http://findarticles.com
Sawatzky, Rick and Barbara Pesut. “Attributes of Spiritual Care
In Nursing Practice.” Journal of Holistic Nursing, Vol 23
No. 1, 19‐33, March 2005. Sulmasy, Daniel. “Spiritual Issues in the Care of Dying Patients.” Journal of the American Medical Association Vol. 296, No. 11, September 20, 2006.
References
Table 1.1 “Characteristics Distinguishing Religion and Spirituality.” Retrieved 19 August 2008 h //
http://www.tufts.edu/med/ebcam/religion/index.html
f d / d/ b
/ l
/ d h l
Yeun, Elaine. “Spirituality and Patient Care.” Health Policy Newsletter Vol. 21, No. 1, March 2008. 20