Presentation on theme: "Bullet Point Spiritual Assessment"— Presentation transcript:
1Bullet Point Spiritual Assessment Gordon J. Hilsman, D.Min.Franciscan Health SystemTacoma WA
2ObjectivesFocus on documenting spiritual assessments as professionally collaborativeValue spiritual assessment as a major, perhaps the primary component of patient oriented health care experienceConsider bullet points as a style of charting spiritual assessments
4To Assess or to Sedate?Sedere – to sit, remain, take a seat, perchSedare – 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
5Rapport- First Three Minutes Creatively establishinga helping relationshipin ways that are:Beyond socialTime/space-creatingTranscendence allowingProfoundly acceptingEarthily engaging
6Communicating about Spiritual Care The art of Combining:Creativity regarding human perspectivesSubstance, worth reading/considering by other cliniciansUsefulness to colleague chaplains and interdisciplinary teams, for patient care
7Clinician (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.
11Types of Listening Diagnostic Personal / Pastoral Collaborative Intimate Love
12Bullet 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.
13Bullet points are:EfficientFocusedUsefulEasy to comprehendEffectively penetrating for other IDT members
14Narrative 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?
15What issues surfaced or were dealt with in the conversation? AssessmentWhat issues surfaced or were dealt with in the conversation?
16This is not your first unit of CPE!!! “Without agenda???”This is not your first unit of CPE!!!
17Spiritual Assessment Framework A basic structure with which to organize spiritual care work for enhancing patient care through interdisciplinary and intra-disciplinary communication
18Professional vs. Interdisciplinary Assessment Assessment frameworks for certificationAssessment frameworks for data collectionAssessment frameworks for interdisciplinary teamwork
19Paragraph 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.
20JACHO Ready Spiritual Assessment Form What are the needs?What did we provide?Talking PointsBefore our chaplain’s notes were subjective narratives depending on the writing style of the individual. Survey on chaplain notes did not provide satisfactory results—did not always find information to be useful.Using our framework, we improved our documentation from subjective narratives to a more formal way to documentSpiritual care needs of the patientServices providedPlan of careOur policy is that anytime chaplains are called upon to provide assistance, we will document in the patient’s medical record in the progress notes using this form.Our framework gives us common language on spiritual care services to use in our conversations among:Chaplains, with CPE students: More focused dialogue among themselves regarding the services they provide. (Will show more specific examples shortly)Interdisciplinary colleagues Able to explain services and relate it to the need they are addressing.IMPROVEMENT: Able to articulate from “I can’t describe it, but you will know it when you see it.”What is the plan of care?
21Chaplain Focused Bullet Point Note 57 year old widowed Pilipino woman with a supportive father and a son living here, and a daughter in CaliforniaTeary 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.
22IDT 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 outcomeActive 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 tomorrowChaplain to continue grief work and support after surgery
23Reduce Defensive Entries Excess verbiageUnnecessary RationalizationsPedantic Over-explainingSuperfluous Self referenceAnnoying redundancySubtle image enhancementJustifications for your worthCritique of other professionals’ care
24Bullet Point Assessment? Questions aboutBullet Point Assessment?
25One Assessment Framework Franciscan Health System – Tacoma WA
26Four Axes of Spiritual Needs Assessment Emotional SupportLoss/AdjustmentReligion/SpiritualityAdvocacy/Referral
271. 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?
28Bullet 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 outcomeActive 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
30Axis One: Emotional Support What does this person need emotionally right now, (from me)?(Mad, Sad, Glad, Hurt, Afraid, Ashamed)30
31EMOTIONAL SUPPORT 1. The Crisis Need for Stabilizing 2. The Expression Need to Engage and Share5. The Regression Need to be EmpoweredEMOTIONAL SUPPORT4. The Bewildering Need for Basic Information3. The Anxious Need of Waiting Too Long
32Helping people pull themselves together 1 - Stabilizing - Personal support when familiar patterns are disrupted by crisis eventsHelping people pull themselves together
332. 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
34Supportive Validating 2. An Expressing person Function Desired OutcomesTalks openlyExpresses FeelingsCriesRelaxesConsiders ResourcesSupportiveValidatingChaplains can help you be ok with your crying or your angry feelings and can listen to how this new situation feels to you.Supportive Validating - Chaplains show :EmpathyKnowledgePersonal availabilityBroad frameworks of understanding peopleA calming presence thathelp people work through anger, fear, sadness or regret.OutcomesTalks openly about a serious personal issueExpresses one or more of the named primary feelings, i.e., anger, fear, sadness, or regret.CriesAppears more relaxedRequests further resources34
353-Information Need for basic information Informingin the wilderness of healthcare systems
36Presence and Networking W a i t i n g Upset feelings from waiting too long in an important situationPresence and Networking
374. A person who is waiting too long FunctionDesired OutcomesExpresses situationAcknowledges health care system limitationsPraysExpresses GratefulnessCalmPresence & NetworkingPresence & Networking –Chaplains companions with waiting people with:calm supportrealistic understanding of the limitations of healthcareserving as an information liaison anda non-anxious presence thathonors the importance of this unique healthcare needOutcomesA waiting person:Expresses the importance of the situation and the exasperationIs able to pray, alone or with a caregiverAcknowledges awareness of the limitations of health careExpresses appreciation for the companionshipAppears more calm.37
385-Empowering - Need to find and use your own best ways of 5-Empowering - Need to find and use your own best ways of dealing with difficult timesHelping people extricate themselves from regressing after being overwhelmed
39Axis Two: Loss and Grief What has this person lost, recently and historically, that still disturbs her/him at times?
416 - Current Grief Major loss in previous 48 hours Facilitating saying goodbye to somebody recently lost
427 - Prior Grief Major past loss being currently grieved Recognizing current warm-sad memories and facilitating the past loss grief that enkindled them
437. Prior Grief Grief Counseling Function Desired Outcomes Mentions previous lossExpresses emotionReceives validationShares reminiscencesCries while talking about the lost loved oneReceives referral for further grief assistanceExpresses greater hopeGrief CounselingGrief Counseling –Chaplains respond withcareful listening &gentle questionsthat promote reminiscingto further integrate the loss into that person’s lifeOutcomeMentions previous lossExpresses emotionReceives validationShares reminiscencesCries while talking about the lost loved one, orReceives referral for further grief assistanceExpresses greater hope43
4910 – Religious and Spiritual Instruction Need to learn religious/self care modalities
50“I want to feel God all around me!” 11 - Religious Support - Needing to feel the immediate positive presence of Transcendence“I want to feel God all around me!”Needing to feel God all around youWhen you are really scared, sad or confused, you might want somebody to pray with you or talk with you about God. Chaplains help you pray or find the minister, pastor or other spiritual leader you know and that you want to be there with you.50
51Person who is needing God FunctionDesired OutcomesSacrament/ spiritual ritualSpiritual leader of choiceReligious questions/problemsPraysReligious SupportReligious SupportChaplains provide:prayerritualSacrament orliaison with the patient’s valued spiritual leader.OutcomeParticipates in a sacrament or other spiritual ritualIs contacted by a spiritual leader of his/her choiceOpenly discusses religious questions or problemsPrays with chaplain or support person51
5212 - Spiritual Support - Need to share unique ways one nurtures one’s human spirit “Let me tell you about what I do and believe that deeply feeds me personally!”
5313 - Spiritual Counseling - Mulling – The Need to discuss ultimate matters, and/or heal old religious wounds“What I want to know is ….”“What really turned me off ….”“I couldn’t believe it when….”
5414. Self-Forgiveness Need for relief from guilt or shame “I did that and I’ve never told anyone!”
5515 – Estrangement - Need to re-connect with relationally separated loved ones Wanting to get back together with somebody you love.
56A person regretting estrangement FunctionDesired OutcomesTalks with emotion about an estranged relationshipAgrees to receive contact with an estranged personAgrees to take initiative to contact an estranged personAccepts the adequacy of one’s efforts at reconcilingReconcilingReconciling –Chaplains serve as transitional facilitators of re-connection, and if possible, healing, of previously strained relationships.OutcomeTalks about an estranged relationshipAgrees to receiving contact with an estranged personAgrees to take initiative to contact an estranged personAccepts the adequacy of one’s efforts at reconciling56
57Axis Four: Advocacy and Referral What does this person need that may be beyond my relationship with her/him?
5916 - Ethics Questions - Need to understand or 16 - Ethics Questions - Need to understand or discuss treatment outcome concernsBegin the process of using professional help to sort out options when there is no clear best care direction
6017 - Family Conflict – Needing help with upset feelings among family members Facilitating healing/referral of family conflict
6118 – Advocacy Need for support in finding appropriate care Feeling neglected
6219 - Mental Health/Addictions - Need to explore concerns about one’s mental health or mood altering chemical abuse62
6319.Person with mental illness or addiction concerns FunctionDesired OutcomesConcern verbalizedFeelings expressedCalm conversationAccepts consultationReferralReferral - Chaplains recognize the need for forms of care other than a patient or family is receiving, and work towards referral to:counselingpsychotherapypsychiatric assessmentalcoholism/ drug abuse assessmentOutcomeConcern verbalizedFeelings expressedCalm conversation about mental health symptoms or consequences of addictive behaviorAccepts consultation with a specialist on addiction/mental health.63
6420 - Family Mental Health/Addiction Concerns Need to address concerns about behavior of a family member
6521. Love Life Pain Need for listening, advice or referral about one’s love life 65
66Recap Rapport first Creativity & imagination Identify issues in bullet pointsFramework for assessmentAugment electronic chartingReduce defensive chart entries