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Developing a Spiritual Plan of Care Session 01: Assessment and Documentation. Introductions I. D.W. “Donovan” Director of Mission Leadership in Mission Hills (Los Angeles), CA Providence Holy Cross Medical Center Board Certified Chaplain - PowerPoint PPT Presentation
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Developing a Spiritual Plan of Care
Session 01: Assessment and Documentation
Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Introductions I
D.W. “Donovan” Director of Mission Leadership in
Mission Hills (Los Angeles), CA Providence Holy Cross Medical Center Board Certified Chaplain Author of “Assessments” in Professional
Spiritual and Pastoral Care: A Practical Clergy and Chaplain’s Handbook, Rabbi Stephen Roberts, Editor.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Introductions II
Jane Mather Director, Spiritual Care Providence Sacred Heart Medical Center
Mark Thomas Director, Mission Integrity and Ethics Providence Hood River Memorial
Tim Serban Vice President, Mission and Spiritual Care Providence Health and Services, Northwest Region
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Special Thanks
Special thanks to Alan Sanders and Catholic Health East for their commitment to contribute to the development of professional chaplaincy.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Outline I: Preliminaries
I. Preliminaries / PremisesA. Do we have something to offer?B. If so, WHAT?C. How can we be more effective
in integrating our work into the care of each patient/family?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Outline II:The Assessment
II. The AssessmentA. Covey: Begin with the End in MindB. What Elements Do We / Should We
Consider in our Assessment?1. Current practices2. A proposed model
C. Tips: Developing an Assessment Model
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Outline III:Documentation &
Discussion
III. DocumentationA. Tips for Developing a
Documentation ToolB. Tips for Documenting in the
Medical Record
IV. DiscussionV. Closing Comments
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Do we have something to
offer? Does anyone
read our notes? If not, why not?
Have we allowed our work to be put in a silo?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
What Is It That Chaplains Do?
The Equilibrium Model
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
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The Equilibrium Model
The role of the clinically-trained chaplain is to assess the degree to which the patient's
emotional and spiritual equilibrium has been disturbed by the healthcare event and to determine what interventions would be
appropriate to help the patient restore their equilibrium and when such interventions
should be employed. (Donovan / Dowdy)
Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
What Is It That Chaplains Do?
The Equilibrium ModelMoving from A to W, then X, Y, and ZHelping the Patient / Family Apply
Existing Values and Beliefs to the Current Clinical Situation
Key Points / Executive Elevator Speech
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
What Is It That Chaplains Do?
Key Points / Elevator Speech:The chaplain is an integrated member of the interdisciplinary team,
contributing to the overall plan of care for the whole person from a spiritual perspective. Our particular expertise lies in our ability to help create a sacred space where the relevant values and beliefs can be explored and applied to the current situation / decisions.
Requires that “emotional and spiritual needs are considered inextricable from physical and psychological needs.” (Clark)
Visualizes spirituality as the leaven that permeates the bread, rather than the icing that covers the cake. (Dowdy)
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
What Is It That Chaplains Do?
Key Points:Our ministry is grounded in extensive training
to help us recognize emotional and spiritual distress and to help people process through emotionally-charged experiences. Our assessments reflect a “whole person” approach, and require us to be familiar with interpersonal dynamics, theology and theodicy, and the medical milieu in which these dynamics are now operative.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Integrated Chaplaincy
Holistic Health Care …Requires that “emotional and spiritual
needs are considered inextricable from physical and psychological needs.” (Clark)
Visualizes spirituality as the leaven that permeates the bread, rather than the icing that covers the cake. (Dowdy)
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
A Question …
How effective have we as a profession been in integrating attention
to the spiritual perspectives, values
and beliefs of our patients and families
into each plan of care?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
… and a Challenge
How can we be more effective in integrating our
work into the care of each
patient/family?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Integration-Focused
DocumentationMany answers
Focus today on how we do that through documentation that includes a professional assessment.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Outline II:The Assessment
II. The AssessmentA. Covey: Begin with the End in MindB. What Elements Do We / Should We
Consider in our Assessment?1. Current practices2. A proposed model
C. Tips: Developing an Assessment Model
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Covey: Begin with the End in Mind
Preliminary Note: Assessment Vs. Screening
Important at the Personal Level: Know Me … Care for Me … Ease My Way
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Covey: Begin with the End in Mind
Important at the Plan of Care Level for your Colleagues: “How does your
expertise make my job easier?”
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Is it accessible by our colleagues and useful to
our colleagues?
Accessibility: Speaking the
Language Providing
Takeaways Accessibility:
Nuts and Bolts
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Is it accessible by our colleagues and useful to
our patients?
Useful : The “Quality Question” How do we “assess” the quality of
our documentation? Advance the plan of care Advance the professionalism of the
chaplain
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Covey: Begin with the End in Mind
Important at the Organizational Level:Reduced LOSReduced
Turnover
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Wait A Second!!!!
“Many pastoral care professionals believe that presence and relationship are the alpha and omega of their work. …”
“They hold that pastoral care cannot be measured; that to attempt it would be almost an affront to God.”
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Wait A Second!!!!
“We say beware. Those who shun accountability should not be surprised if they are first in line for budget cuts.”
--Brian Yanofchick Health Progress, May 2009,
p. 21
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Current Practices
Christina Puchalski, G-Wish: FICA (Spiritual History Tool) Faith and Belief Importance Community Address in Care(See
http://www.hpsm.org/documents/End_of_Life_
Summit_FICA_References.pdf)26
Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Current Practices
The Joint Commission Q&A: “Does the Joint Commission specify what needs to be included in a spiritual assessment?”
“No. Your organization would define the content and scope of spiritual and other assessments …. Examples of elements that could be … but are not required include the following questions:”
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Current Practices
Who or what provides the patient with strength and hope?
How does the patient express their spirituality?
How would the patient describe their philosophy of life?
What is the name of the patient’s clergy, ministers, chaplains, pastor, rabbi?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
OtherCurrent Practices
Are there values and beliefs that would affect your treatment decisions?
Would you like to see a chaplain / pray with a chaplain?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
A Proposed Model
Assessments: A Medical Model Listen Observe Evaluate Determine
Paradigm Shift from Faith-Based Coping Mechanisms to Values and Beliefs
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
A Proposed Model
Three Elements Element I: Relationships and
Connectivity Element II: Meaning and Purpose Element III: Degree of Understanding
and Congruence of Response
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Element I: Relationships and
ConnectivityObservations from Unit 01: Counting
People and CardsSpectrum from Fully Connected to Sense
of Isolation / AbandonmentTo / from friends and familyTo / from a sense of the sacred / divine
Theological Principle: RelationshipsPossible Interventions
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Element II: Meaning and
PurposeObservations
Often a Need to “Make Sense” of the Illness / Injury / Event
Coping Mechanisms / Complex Beliefs May Be Compromised
Values and Beliefs Applied to Current Situation
Possible InterventionsTheological Principle
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Element III: Degree of Understanding and
Congruence of Response
Assessment A: Does the patient / family / surrogate have an accurate understanding of what the physician has indicated to them? (LaRocca, Assessing)
Assessment B: Is the response internally congruent with previously expressed values and beliefs? (NCCN)
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Element III: Degree of Understanding and
Congruence of Response
Look for statements such asWhat does the doctor know anyway!?! She’s
not God!God’s in charge and my baby won’t go
anywhere until God decides it’s time. (But don’t you dare touch the ventilator!)
Possible Interventions -- with a goal in mind!
Theological Principle
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Developing an
Assessment ModelBuild on what comes naturally:
relationships, meaning, medical.Build upon the uniqueness of the
chaplain: “connecting the dots” between the individual and the institutional milieu.
Thus, work to be “out of the box” of any particular faith tradition.
Don’t confuse “tools” with an assessment.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Outline III:Documentation &
Discussion
III. DocumentationA. Tips for Developing a
Documentation ToolB. Tips for Documenting in the
Medical Record
IV. DiscussionV. Closing Comments
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Developing a
Documentation Tool
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics39
Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Documenting in
the Medical RecordAvoid Statements that are Not
Observable.Patient understood the clinical situation.Patient stated, “I understand what the doctor
is saying.”Avoid Statements that are Outside your
Scope of Practice.The patient is close to death.The nurse indicated “death is imminent.”
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Documenting in
the Medical RecordReinforce your Professionalism.
Visited with nurse before seeing patient.Consulted with RN to review recent events /
social hx. (Note: families visit; professionals see patients or consult.)
Do Not Imply that Showing Up Is EnoughPlan: Follow-up DailyYour suggestions?
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Documenting in
the Medical RecordUse Legal Language Carefully and
CorrectlyAMD Consult: Patient did not seem
competent.Patient was alert and oriented to year,
but not to place, president, or situation. I was not comfortable proceeding at this time.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Tips for Documenting in
the Medical RecordDo Not Put Another Team Member in
a CornerThe family is upset because their
questions have not been answered.Family indicated that they have
additional questions to ask and would appreciate additional time with Dr. X. Called Dr. X’s office and left a message for her with Nurse Susan.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Discussion
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
References
Clark, Paul A. Drain, Maxwell, and Malone, Mary P. Patient Centeredness: Addressing Patients’ Emotional and Spiritual Needs. Joint Commission Journal on Quality and Safety. Dec 2003 (29:12).
Dowdy, Melvin, and Donovan, D.W. The Pastoral Assessment Tool: Developing the Centerpiece of the Pastoral Care Strategic Plan (unpublished presentation).
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
References
Joint Commission, The. Standard FAQs: Spiritual Care. Downloaded from:
http://www.jointcommission.org/mobile/standards_information/jcfaqdetails.aspx?StandardsFAQId=290&StandardsFAQChapterId=29
.
LaRocca, Mark. Assessing the 4-F’s of Spiritual Assessment. Downloaded from: http://www.plainviews.org/AR/c/v2n23/pp.html.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
References
Puchalski, C. Spiritual Assessment Tool: FICA. Downloaded on July 14th, 2012 from http://www.hpsm.org/documents/End_of_Life_
Summit_FICA_References.pdf.
Roberts, Stephen, ed. Professional Spiritual and Pastoral Care. Skylight Paths Publishing. 2011.
Yanofchick, Brian. Do We Care Enough about Pastoral Care? Health Progress. May 2009.
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Chaplain D.W. Donovan, BCC M.A. Theology M.S. Patient Counseling M.A. Medical
Ethics
Thank you!!!
Looking Ahead! August 15th, 2012
Communicating the Spiritual Care Plan: Chaplain as Educator
Jane Mather: September 12th, 2012
Integrating into a Holistic Plan of Care Mark Thomas
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