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Objectives
Focus on documenting spiritual assessments as professionally collaborative
Value spiritual assessment as a major, perhaps the primary component of patient oriented health care experience
Consider bullet points as a style of charting spiritual assessments
To Assess or to Sedate? Sedere – to sit, remain, take a seat, perch
Sedare – settle, allay, calm down, (sedate, sedative, sedation)
Ad – next to, right up close (adjust, adorn, adhesion)
Assess - Ad+sedeo= to sit next to, to consider together – implies depth
Rapport- First Three Minutes
Creatively establishing
a helping relationship
in ways that are: Beyond social Time/space-creating Transcendence
allowing Profoundly accepting Earthily engaging
Communicating about Spiritual Care
The art of Combining:
Creativity regarding human perspectives
Substance, worth reading/considering by other clinicians
Usefulness to colleague chaplains and interdisciplinary teams, for patient care
Clinician (Greek – clinos = bed)
A professional prepared to use direct observation, developed frameworks of understanding, and pertinent data in order to fashion interventions of assistance to people in serious need.
2 - Assessment
3 - Care (Function)
4 - Documentation
5 - Continuing Ed.
6 - Consultation
1 - Rapport
Spiritual Clinician
Becoming (and remaining) a Spiritual Clinician
Why Bullet Points?
The day of a physicianThe day of a nurseThe day of a social workerThe day of a chaplain
Bullet points are efficient, focused, useful, easy to comprehend and the most likely way to slice through to the human side of other interdisciplinary team members who are intensely engaged in completely different professional missions and assessment frameworks.
Bullet points are: Efficient Focused Useful Easy to comprehend Effectively penetrating for other IDT members
Narrative and 3 or 4 Bullet Points
Intro narrative: Why did you converse with this patient / family? Who is this patient/family (Capture the soul)? How did this patient/family relate to you?
Assessment: 2 to 4 bullet point issues that surfaced in the conversation?
Functions: What did you do to help this person/family?
Plan: What do you plan to do to help this person/family?
Spiritual Assessment Framework
A basic structure with which to organize spiritual care work for enhancing patient care through interdisciplinary and intra-disciplinary communication
Professional vs. Interdisciplinary Assessment
Assessment frameworks for certification
Assessment frameworks for data collection
Assessment frameworks for interdisciplinary teamwork
Paragraph chart note:I saw this patient at the request of her father who I had
met in the hallway. She is a 57 year old widowed Philippine woman with a daughter in California and a son that lives in town. She spoke in sad tones about her nagging knee pain leading to tomorrow’s surgery and her mother who died in February. She has been crying this morning, somewhat overwhelmed by her inability to lift her grandson and by her grief over her mother’s death. I listened, facilitated her grieving and prayed with her, though she is currently not practicing her Catholic heritage. I will suggest the evening chaplain drop in on her for further support. She declined my offer of her being visited by a priest.
JACHO Ready Spiritual Assessment Form
What are the needs?
What did we provide?
What is the plan of care?
Chaplain Focused Bullet Point Note
57 year old widowed Pilipino woman with a supportive father and a son living here, and a daughter in California
Teary today, open and verbal with me about her life situation. Pt aware of surgery and its implications, fairly hopeful of a favorable outcome to improve her life.
Mother died in February, knee pain prevents her from lifting her grandson. We began grief work.
Appreciates prayer though she is currently not practicing her Catholic heritage. Declined being visited by a priest.
I will continue grief work tomorrow and suggest the evening chaplain drop in on her for further support.
IDT Bullet Point Assessment
Saw pt. on suggestion of her father in the hallway. She is a 57 year old widowed Pilipino woman with a son living here, and a daughter in California. She is teary today, open and verbal with me about her life situation.
Pt fairly hopeful of a favorable surgery outcome Active grief issues, mother died in February, knee pain prevents
her from lifting her grandson. Appreciates prayer, currently not practicing her Catholic
heritage. Declined being visited by a priest.
Chaplain began grief work, prayed with patient, and supported.to be continued tomorrow
Chaplain to continue grief work and support after surgery
Reduce Defensive Entries
Excess verbiage Unnecessary Rationalizations Pedantic Over-explaining Superfluous Self reference Annoying redundancy Subtle image enhancement Justifications for your worth Critique of other professionals’ care
Four Axes of Spiritual Needs Assessment
Emotional SupportLoss/AdjustmentReligion/SpiritualityAdvocacy/Referral
1. What does this person need from me emotionally right now?
2. What losses, recent and previous, has this person experienced that continue to surface painfully at times?
3. How does this person nurture her/his own human spirit, relative to established religious traditions and apart from them?
4. What does this person need that I can’t provide?
Bullet Point Issue Recording
Saw pt. on suggestion of her father in the hallway. She is a 57 year old widowed Pilipino woman with a son living here, and a daughter in California. She is teary today, open and verbal with me about her life situation.
Pt fairly hopeful of a favorable surgery outcome Active grief issues, mother died in February, knee
pain prevents her from lifting her grandson. Appreciates prayer, currently not practicing her
Catholic heritage. Declined being visited by a priest.
Chaplain began grief work, to be continued tomorrow
ASSESSING
6.Grief Support7.Grief Counseling8. End of Life Care9. Adjustment Counseling
16. Ethics Consulting17. Family Systems Facilitating18. Advocacy19. Mental Health/Addictions Consult20. Family Behavioral Concerns21. Love Life Consulting.
10. Instructing 11. Religious Support12. Spiritual Support13. Spiritual Counseling14. Self- Forgiveness15. Healing Estrangement
Screening for Spiritual Pathologies
Loss / Adjustment
Spiritual / Religious Support
Advocacy /Referral /Ethics
Establishing Rapport
Emotional Support
•Careful Listening•Empathic Reflecting•Gentle Querying•Insightful Interpreting
1. Crisis Ministry2. Supportive/Validating3. Informing 4. Presence and Networking5. Empowering
Axis One:
Emotional Support
What does this person need emotionally right now, (from me)?
30
(Mad, Sad, Glad, Hurt, Afraid,
Ashamed)
1. The Crisis
Need for Stabilizi
ng
EMOTIONAL SUPPORT
2. The Expression Need to Engage
and Share
3. The Anxious Need of
Waiting Too Long
4. The Bewildering
Need for Basic
Information
5. The Regression Need to be
Empowered
1 - Stabilizing - Personal support when familiar patterns are disrupted by crisis events
Helping people pull themselves
together
2. The Expression Need to Engage and Share
Supportive validating (listening) - the Need to cry, yell, share, or just tell somebody how you feel about what is happening to you
34
2. An Expressing person
Supportive
Validating
•Talks openly
•Expresses Feelings
•Cries
•Relaxes
•Considers Resources
FunctionFunction Desired OutcomesDesired Outcomes
4 - W a i t i n gUpset feelings from waiting too long in an important situation
Presence and
Networking
37
4. A person who is waiting too long
Presence &
Networking
•Expresses situation
•Acknowledges health care system limitations
•Prays
•Expresses Gratefulness
•Calm
FunctionFunction Desired OutcomesDesired Outcomes
5-Empowering - Need to find and use your own best ways of dealing with difficult times
Helping people extricate
themselves from regressing
after being overwhelmed
Axis Two: Loss and Grief
What has this person lost, recently and historically, that still disturbs her/him at times?
6 - Current Grief Major loss in previous 48 hours
Facilitating saying
goodbye to somebody
recently lost
7 - Prior Grief Major past loss being currently grieved
Recognizing current warm-sad memories and facilitating the past loss grief that enkindled them
43
7. Prior Grief
Grief Counseling
•Mentions previous loss•Expresses emotion•Receives validation•Shares reminiscences •Cries while talking about the lost loved one•Receives referral for further grief assistance•Expresses greater hope
FunctionFunction Desired OutcomesDesired Outcomes
Grief Counseling Outcomes(%)
0
10
20
30
40
50
60
70
80
90
1
Mention of the Loss
Observable Emotion
Receives Validation
Reminisces
Shows Tears
Considers Referrals
Signs of New Hope
8 - Dying Dealing with the goodbyes of the dying process
Helping people say goodbye when they’re
dying
9-Life adjustment Making peace with a major change in appearance or function
Getting used to the new way things will be
Axis Three: Spiritual-Religious Care
How does this person maintain and nurture her own human spirit?
47
48
15. Estrangement
14. Self Forgiveness
13. Spiritual Counsel
12. Spiritual Support
11. Religious Support
10. Instruction
Religious/ Spiritual
Care
11 - Religious Support - Needing to feel the immediate positive presence of Transcendence
“I want to feel God all around me!”
50
51
Person who is needing God
Religious Support
•Sacrament/ spiritual ritual
•Spiritual leader of choice
•Religious questions/problems
•Prays
Desired OutcomesDesired OutcomesFunctionFunction
56
A person regretting estrangement
FunctionFunction Desired OutcomesDesired Outcomes
Reconciling
•Talks with emotion about an estranged relationship •Agrees to receive contact with an estranged person •Agrees to take initiative to contact an estranged person•Accepts the adequacy of one’s efforts at reconciling
Axis Four:
Advocacy and Referral
What does this What does this person need person need that may be that may be beyond my beyond my relationship relationship with her/him?with her/him?
58
21. Love Life
20. Family Dysfunction
Concerns19. M. Health/
Addiction Concerns
18. Advocacy
17. Family Conflict
16. Medical Ethics Concerns
Referral/Ethics
Begin the process of using professional help to sort out options when there is no clear best care direction
17 - Family Conflict – Needing help with upset feelings among family members
Facilitating healing/referral of family conflict
62
19 - Mental Health/Addictions - Need to explore concerns about one’s mental health or mood altering chemical abuse
63
19.Person with mental illness or addiction concerns
FunctionFunction Desired OutcomesDesired Outcomes
Referral
•Concern verbalized
•Feelings expressed
•Calm conversation
•Accepts consultation
Recap
Rapport firstCreativity & imaginationIdentify issues in bullet pointsFramework for assessmentAugment electronic chartingReduce defensive chart entries