research-J.Kim

AN ANANLYSIS of

SPIRITUAL RISK in

TRANSITIONAL CARE UNIT (EXPERIMENTAL RESEARCH)

Presented by

Jae Bum Kim Chaplain Resident

3. RESEARCH METHOD

Two months experiment

-From 2/1/15 to 3/31/15

-On Monday and Friday

Confined to TCU (Total 20 beds)

Referrals sources restricted to nurses, PCT’s and So-cial Workers.

-Limited two (2) referrals per day : 21 out of 24 re-sponded

Chaplain prioritized cold visits

-Limited two (2) visits per day : 25 out of 26 re-sponded

Chaplain consulted with unit director, nurses, PCT’s and Social Workers for this research.

Using SDAT (Spiritual Distress Assessment Tools) to score patient’s spiritual risks in number.

Data Analysis:

-Use T-Test two independent samples

P Value <0.05

4. SDAT (SPIRITUAL DISTRESS ASSESSMENT TOOL)

1. Meaning

The need for life balance and the need to be able to cope with illness.

2. Transcendence

The need for connection with the patient’s existential foundation.

3. Values Acknowledgement

The need for health professionals to know and respect the patient’s values

4. Maintain Control

The need to understand the patient’s need to feel included in decision-making process and to be associates with health professionals’ decisions and actions.

5. Psycho-social identity

The need to be loved, to be heard, to be rec-ognized, to have a positive image of oneself and to feel forgiven.

1. INSPIRATION

My Schedule

Covering 3 clinical works and others:

Day Surgery, TCU, Palliative Care, On-call, CPE

Early shift (6:15 a.m.- 3:30 p.m.)

In times of high census

Inquisitive mind (self-motivation)

Enhancing research literacy

Practicing experimental research

2. RESEARCH GOALS

Evidence of need-based visitation

(Referral Based Visit vs. Cold Visit)

Find a distinctive spiritual risk in TCU

A Case study for need-based visitation

INTRODUCTION

Page 1/11 J-term Research Project Jae Bum Kim

5. SCORING PROCESS

6. Structure of the Spiritual Needs Model and the Spiritual Distress Assessment Tool

SPIRITUAL NEEDS MODEL SPIRITUAL DISTRESS TOOL (SDAT)

PATIENT INTERVIEW INTERVIEW ANALYSIS Spiritual dimension Need associated with the

spiritual dimension Set of questions for patient interview Questions for analysing the interview

and identifying unmet spiritual need Scoring of unmet spiritual

need

(range from 0 to 3*) MEANING

Overall life balance

NEED FOR LIFE BALANCE - need to maintain and/or rebuild an overall life balance - need to learn to “live with” an illness or disability

Does your hospitalisation have any repercussions on the way you live usually? Is your overall life balance disturbed by what is happening to you now (hospitalisation, illness)? Are you having difficulties coping with what is happening to you now (hospitalisation, illness)?

How does the patient speak about his or her need for life balance? Is the overall life balance of this pa-tient disturbed?

To what degree does the Need for Life for Life Balance remain unmet?

0 0

0 1

0 2

0 3

TRANSCENDENCE

Anchor point exte-rior to the person

NEED FOR CONNECTION - need for Beauty - need to be connected with the personal existential anchor

Do you have a religion, a particular faith or spiritu-ality? Does what is happening to you now change your relationship to God /or to your spirituality? (closer to God, more distant, no change) Is your religion / spirituality / faith challenged by what is happening to you now? Does what is happening to you now change or disturb the way you live or express your faith / spirituality / religion?

How does the patient speak about his or her need for connection? Is his or her need for connection disturbed?

To what degree does the Need for Connection remain unmet?

0 0

0 1

0 2

0 3

VALUES

System of values that determine goodness and trueness for the person; the system is made apparent in the person’s actions and life choices

NEED FOR VALUES AC-KNOWLEDGEMENT - need that caregivers under-stand what has value and significance in his or her life NEED TO MAINTAIN CON-TROL - need to understand and be involved in caregivers’ deci-sions and actions

Do you think that the health professionals caring for you know you well enough? Do you have enough information about your health problem, and on the goals of your hospitali-sation and treatment? Do you feel that you are participating in the decisions made about your care? How would you describe your relationship with the doctors and other health professionals?

How does the patient speak of his or her need that caregivers understand what has value and significance in his or her life? How does the patient speak of his or her need to understand and be in-volved in caregivers’ decisions and actions?

To what degree does the Need for Values Acknowledgement remain unmet?

0 0

0 1

0 2

0 3

To what degree does the Need for to Maintain Control remain unmet?

0 0

0 1

0 2

0 3 PSYCHO-SOCIAL IDENTITY

The environment (society, caregiv-ers, family, close relations) that maintain the per-son’s particular identity.

NEED TO MAINTAIN IDENTITY - need to be loved, to be recognised - need to be listened to - need to be in contact (in particular with the person’s faith community and other people) - need to have a positive self-image - need to feel forgiven, to be reconciled

Do you have any worries or difficulties regarding your family or other persons close to you? How do people close to behave with you now? Does it correspond with what you expected from them? Do you feel lonely? Could you tell me about the image you have of yourself in your current situation (illness, hospitali-sation)? Do you have any links with your faith community?

How does the patient speak of his or her need to maintain identity?

To what degree does the Need for Maintain Identity remain unmet?

0 0

0 1

0 2

0 3

0 = no evidence of unmet spiritual need; 1 = some evidence of unmet spiritual need; 2 = substantial evidence of unmet need; 3 = evidence of severe unmet spiritual need


(1) Cold Visit per Own Triaging Skills

Meaning Transcendence Values Psycho-Social Identity

Total Scores Life Balance Need for Connection Acknowledgement Maintain Control Maintain Identity 1 2 1 3 3 2 11 2 1 1 1 1 1 5 3 1 1 2 2 1 7 4 1 1 1 1 1 5 5 1 1 1 1 1 5 6 1 2 1 1 1 6 7 2 1 3 3 2 11 8 1 1 1 2 1 6 9 2 1 1 1 2 7

10 2 1 1 1 1 6 11 3 1 2 2 1 9 12 2 1 2 2 0 7 13 1 1 1 1 0 4 14 1 1 1 1 1 5 15 1 1 0 0 1 3 16 1 1 1 1 0 4 17 1 1 0 0 0 0 18 1 0 2 2 1 6 19 1 1 1 1 0 4 20 1 1 0 0 1 3 21 1 1 0 1 1 4 22 1 1 2 2 1 7 23 1 1 2 2 1 7 24 1 1 2 2 1 7 25 1 0 1 1 0 3

Average (Mean) 1.3 1.0 1.3 1.4 0.9 5.7

(2) Referral Visit per Staff’s Referral

Meaning Transcendence Values Psycho-Social Identity

Total Scores Life Balance Need for Connection Acknowledgement Maintain Control Maintain Identity 1 1 3 3 3 1 11 2 3 3 3 3 1 13 3 1 2 2 2 1 8 4 2 1 2 2 2 9 5 1 3 2 2 1 9 6 3 2 3 2 2 12 7 2 2 2 3 1 10 8 3 3 2 2 1 11 9 2 1 2 2 3 10

10 3 1 2 2 0 8 11 1 1 3 3 2 10 12 3 2 3 3 2 13 13 2 2 3 3 2 12 14 1 1 1 2 1 6 15 1 1 1 1 1 5 16 3 1 3 3 1 11 17 3 2 3 3 3 14 18 3 2 2 2 3 12 19 3 2 3 3 1 12 20 1 1 3 3 1 9 21 1 1 2 2 2 8

Average (Mean) 2.0 1.8 2.4 2.4 1.5 10.1

7. DATA COLLECTION


Spiritual Risk Mean Score

Difference t stat p value Cold Visit Referral Visit

Need for Life Balance 1.3 2.0 0.7 3.363 <0.05

Need for Connection 1.0 1.8 0.8 4.411 <0.05

Need for Values Acknowledgement 1.3 2.4 1.1 4.938 <0.05

Need to Maintain Control 1.4 2.4 1.0 5.137 <0.05

Need to Maintain Identity 0.9 1.5 0.6 3.004 <0.05 Total Spiritual Risk Scores 5.7 10.1 4.4 6.306 <0.05

T-TEST: TWO INDEPENDENT SAMPLES (Cold Visit vs. Referral Visit)

Unequal Variances – Two Tail

Unmet needs in referral based visit shows significantly higher scores than those of cold visit.

4.4 points higher in total

Need for Life Balance

0.7

Need for Connection

0.8

Need for Values Acknowledgement 1.1

Need to Maintain Control 1.0

Need to Maintain Identity

0.6

* P Value < 0.05

8-1. DISTINCTIVE SPIRITUAL RISK IN TCU


5.7

10.1

High

Moderate

Mild

Low

Cold Visit Referral Visit

Spritual Risk Scores(unmet needs)

15

Values Acknowledgement and Maintain to Control show higher scores than other spiritual risks in both of referral based visit and cold visit

It is related to the matter of Medical Information and Medical Treatment.

1.3

1.4

1.3

1

0.9

2.4

2.4

2.0

1.8

1.5

0 0.5 1 1.5 2 2.5 3

Acknowledgement

Maintain Control

Life Balance

Transcendence

Psycho-Social Identity

5 Spiritual Risks Scores

Referral Visit

Cold Visit

Personal Observation -Delayed visits from medical doctor -Lack or no enough medical information provided to patients -Patient’s lower involvement in treatment options

Research Articles

-Satisfaction with medical care by patients has become increasingly important in today’s health care climate for many reasons.

-Gaps in understanding and communication between patients and medical doctors could result in decreased quality of care.

8-2. DISTINCTIVE SPIRITUAL RISK IN TCU


9. COMMUNICATION DISCREPANCIES BETWEEN MD and PT *

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S

*Adapted from Douglas P. Olson, MD; Donna M. Windish, MD: Communication Discrepancies Between Physicians and Hospi-talized Patients, Arch Intern Med/VOL 170 (NO. 15), AUG 9/23, 2010

A. Did a doctor/medical staff provide new medicine information? B. Did a doctor/medical staff provide medicine’s side effects information?

Higher percentage of NEVER from patients vs. higher percentage of SOMETIMES from doctors

C. Did a doctor/medical staff invite patient to involvement in treatment options?

Higher percentage of NEVER from patients vs. higher percentage of SOMETIMES from doctors

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S

NE

VE

R

SO

ME

TIM

ES

USU

ALLY

ALW

AY

S


A. Did a doctor provide medical information in respectable way? Higher percentage of NEVER from patients vs. higher percentage of SOMETIMES from doctors

B. Did a doctor explain medical information in understandable way?

C. Did a doctor discuss about any Anxieties or fears about patient’s condition or treatment? Higher percentage of NEVER from patients vs. higher percentage of SOMETIMES from doctors

10. PATIENT’S RATING OF MEDICAL CARE *

Standard Care vs. Intervention Group The perceived length of stay (LOS) was significantly shorter

(92.6 vs. 105.5). The proportion of patients who

rated the ED staff physician as “excellent” or “very good” was sig-nificantly higher in the intervention group (Bedside: 87.1% vs. 80.5 % / Technical Skills: 86.8 % vs. 80.1 %)

Periodic personal interaction and provision of clinically based infor-mation in ED is thought to improve patient’s

perceived LOS, efficiency, and clinical skills of Emergency Physicians after ED visit.

The amount of information provided to patient and periodic updating of process and medical information to patient have effect on patient’s perception of care positively.

* Adapted from T. Paul Tran, MD; Warren P. Schutte, BS: Provision of Clinically Based Information Improves Patients’ Perceived Length of Stay and Satisfaction with EP, Section of Emergency Medicine, Depart-


* By chance, I had a conversation with a physician whom I knew since last year. The doctor was very proud of her specialty as a physician. I have shared with her about my personal experimental research outcome. I told her that I found out there was one distinctive unmet spiritual risk in TCU. I remarked that patient expressed their unmet needs caused by lower quality of medical care from medical doctors. I told her that the cause of unmet spiritual risks from medical service are as follows:

Delayed visit from medical doctors No detailed/clear/understandable medical information from medical

doctors Few chances of patients’ involvement in medical decision making

process The doctor agreed what I found out, but she shared the following per-spectives from her clinical experience. There is zero patient’s responsibility as a whole medical system

- “No return from patient” - Physicians frustrated a lot because of patient’s complaint regardless

of their detailed information provided. For example, “You never told me,” in response to “Did you read it.”; “Why angiogram now,” in re-sponse to the procedure schedule; “I never know I have a kidney problem,” even though doctor explained it a day ago.

- Physicians has “mad lists” on the desk. - The doctor illustrated one palliative care patient’s daughter who

strongly denied DIALECTICS even though she explained it in detail two days ago.

The doctor concluded patients need to be EDUCATED as life class to lessen their unreasonable complaints. From this conversation, I understand there are huge discrepancies be-tween the perception of patient and that of medical doctors because of various reasons.

11. A MEDICAL DOCTOR’S PERSPECTIVE


When a person is admitted to a hospital, (s)he must wear a gown, sleep in an unfamiliar bed and take on the identity of the “patient.”

Physician, as leader of the healthcare team, have a professional and moral obligation to ensure that patients feel welcome/comfortable/being cared for in their new surrounding.

12. VALUE (MEDICAL CARE) RELATED SPIRITUAL

46-47%


Spiritual Distress Assessment Tool (SDAT) Spiritual

Dimension

unmet spiritual need identified Unmet spiritual need

1st visit (10) Last visit (6)

Meaning

-She is experiencing difficulty in breathing (demoralized).

-She needs to learn to live with new condition at Manor care facility.

-She lost her sister a month ago.

-Patient may experience difficulty from smoking withdrawal.

□ 0

□ 1

X 2

□ 3

□ 0

X 1

□ 2

□ 3

Transcen-dence

-She is religious, faithful Catholic

-She values faith tradition (sacrament)

-She practices prayer every night

-She loves to hold rosary

-She loves to recite Hail Mary

-She is affiliated with local church

□ 0

X 1

□ 2

□ 3

X 0

□ 1

□ 2

□ 3

Values

-She is experiencing physical distress in spite of medical treatment.

-She expresses her concern to Dr. R.

-She expresses her desire to allow her body to decline naturally.

□ 0

□ 1

X 2

□ 3

□ 0

X 1

□ 2

□ 3 -She kept on complaining about her breathing problem.

-She delegates most of medical treatment options to POA.

-She did not know POA’s intention beyond decision about Manor care option itself.

□ 0

□ 1

X 2

□ 3

□ 0

□ 1

X 2

□ 3

Psycho-Social Identity

-She is proud of self-supportive life counting on pension.

-She denied support from her niece.

-She lost her sister a month ago.

-She welcomes chaplain’s visit.

-She needs to be reconnected to her son in spite of her disinterest.

-Her sons are not involved in her medical treatment decision making.

□ 0

□ 1

□ 2

X 3

□ 0

□ 1

X 2

□ 3

13. CASE STUDY Spiritual risks changed from moderate (scores= 10) to mild (scores=6)

0 5 10 15

1st visit

3rd visit

Case Study (Palliative Patient)

1st visit

3rd visit

Patient’s unmet spiritual needs decreased

from 10 to 6 (Moderate Mild) following 3 times palliative spiritual care visits.

-Meaning (210)

-Transcendence (10) -Acknowledgement (21) -Maintain Control (22) -Identity (32)


Owner

Sticky Note

One person’s experimental research Lack of Objectivity Small number of samples

oold iisit Patients (25) eeferral iisit Patients (21)

No Analysis of Demographic Factors

Close professional relationship with other team members

Distinctive spiritual risks in TCU Values (Acknowledgment / Maintain Control) Medical Information/Communication Important

Evidence of need (referral) based visit

Chaplain as a juggler to handle multitask works

14. LIMITATION OF RESEARCH

15. FINDINGS OF RESEARCH


Documents

research-J.Kim