1. Bullet Point Spiritual Assessment
Gordon J. Hilsman, D.Min.
Franciscan Health System
Tacoma WA

2. 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

3. 3

4. 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

5. Rapport- First Three Minutes
Creatively establishing
a helping relationship
in ways that are:
Beyond social
Time/space-creating
Transcendence allowing
Profoundly accepting
Earthily engaging

6. 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

7. 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.

9. Why Bullet Points? The day of a physician The day of a nurse
The day of a social worker
The day of a chaplain

11. Types of Listening Diagnostic Personal / Pastoral Collaborative
Intimate Love

12. 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.

13. Bullet points are:
Efficient
Focused
Useful
Easy to comprehend
Effectively penetrating for other IDT members

14. 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?

15. What issues surfaced or were dealt with in the conversation?
Assessment
What issues surfaced or were dealt with in the conversation?

16. This is not your first unit of CPE!!!
“Without agenda???”
This is not your first unit of CPE!!!

17. Spiritual Assessment Framework
A basic structure with which to organize spiritual care work for enhancing patient care through interdisciplinary and intra-disciplinary communication

18. Professional vs. Interdisciplinary Assessment
Assessment frameworks for certification
Assessment frameworks for data collection
Assessment frameworks for interdisciplinary teamwork

19. 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.

20. JACHO Ready Spiritual Assessment Form
What are the needs?
What did we provide?
Talking Points
Before 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 document
Spiritual care needs of the patient
Services provided
Plan of care
Our 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?

21. 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.

22. 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

23. 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

24. Bullet Point Assessment?
Questions about
Bullet Point Assessment?

25. One Assessment Framework
Franciscan Health System – Tacoma WA

26. Four Axes of Spiritual Needs Assessment
Emotional Support
Loss/Adjustment
Religion/Spirituality
Advocacy/Referral

27. 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?

28. 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

30. Axis One: Emotional Support
What does this person need emotionally right now, (from me)?
(Mad, Sad, Glad, Hurt, Afraid, Ashamed) 30

31. EMOTIONAL SUPPORT 1. The Crisis Need for Stabilizing
2. The Expression Need to Engage and Share
5. The Regression Need to be Empowered
EMOTIONAL SUPPORT
4. The Bewildering Need for Basic Information
3. The Anxious Need of Waiting Too Long

32. Helping people pull themselves together
1 - Stabilizing - Personal support when familiar patterns are disrupted by crisis events
Helping people pull themselves together

33. 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. Supportive Validating 2. An Expressing person Function
Desired Outcomes
Talks openly
Expresses Feelings
Cries
Relaxes
Considers Resources
Supportive
Validating
Chaplains 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 :
Empathy
Knowledge
Personal availability
Broad frameworks of understanding people
A calming presence that
help people work through anger, fear, sadness or regret.
Outcomes
Talks openly about a serious personal issue
Expresses one or more of the named primary feelings, i.e., anger, fear, sadness, or regret.
Cries
Appears more relaxed
Requests further resources 34

35. 3-Information Need for basic information
Informing
in the wilderness of healthcare systems

36. Presence and Networking
W a i t i n g Upset feelings from waiting too long in an important situation
Presence and Networking

37. 4. A person who is waiting too long
Function
Desired Outcomes
Expresses situation
Acknowledges health care system limitations
Prays
Expresses Gratefulness
Calm
Presence & Networking
Presence & Networking –
Chaplains companions with waiting people with:
calm support
realistic understanding of the limitations of healthcare
serving as an information liaison and
a non-anxious presence that
honors the importance of this unique healthcare need
Outcomes
A waiting person:
Expresses the importance of the situation and the exasperation
Is able to pray, alone or with a caregiver
Acknowledges awareness of the limitations of health care
Expresses appreciation for the companionship
Appears more calm. 37

38. 5-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 times
Helping people extricate themselves from regressing after being overwhelmed

39. Axis Two: Loss and Grief
What has this person lost, recently and historically, that still disturbs her/him at times?

41. 6 - Current Grief Major loss in previous 48 hours
Facilitating saying goodbye to somebody recently lost

42. 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 Function Desired Outcomes
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
Grief Counseling
Grief Counseling –Chaplains respond with
careful listening &
gentle questions
that promote reminiscing
to further integrate the loss into that person’s life
Outcome
Mentions previous loss
Expresses emotion
Receives validation
Shares reminiscences
Cries while talking about the lost loved one, or
Receives referral for further grief assistance
Expresses greater hope 43

44. Grief Counseling Outcomes (%)

45. 8 - Dying Dealing with the goodbyes of the dying process
Helping people say goodbye when they’re dying

46. Getting used to the new way things will be
9-Life adjustment Making peace with a major change in appearance or function
Getting used to the new way things will be

47. Axis Three: Spiritual-Religious Care
How does this person maintain and nurture her own human spirit? 47

48. 48

49. 10 – 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 you
When 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

51. Person who is needing God
Function
Desired Outcomes
Sacrament/ spiritual ritual
Spiritual leader of choice
Religious questions/problems
Prays
Religious Support
Religious Support
Chaplains provide:
prayer
ritual
Sacrament or
liaison with the patient’s valued spiritual leader.
Outcome
Participates in a sacrament or other spiritual ritual
Is contacted by a spiritual leader of his/her choice
Openly discusses religious questions or problems
Prays with chaplain or support person 51

52. 12 - 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!”

53. 13 - 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….”

54. 14. Self-Forgiveness Need for relief from guilt or shame
“I did that and I’ve never told anyone!”

55. 15 – Estrangement - Need to re-connect with relationally separated loved ones
Wanting to get back together with somebody you love.

56. A person regretting estrangement
Function
Desired Outcomes
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
Reconciling
Reconciling –
Chaplains serve as transitional facilitators of re-connection, and if possible, healing, of previously strained relationships.
Outcome
Talks about an estranged relationship
Agrees to receiving contact with an estranged person
Agrees to take initiative to contact an estranged person
Accepts the adequacy of one’s efforts at reconciling 56

57. Axis Four: Advocacy and Referral
What does this person need that may be beyond my relationship with her/him?

58. 58

59. 16 - Ethics Questions - Need to understand or
16 - Ethics Questions - Need to understand or discuss treatment outcome concerns
Begin the process of using professional help to sort out options when there is no clear best care direction

60. 17 - Family Conflict – Needing help with upset feelings among family members
Facilitating healing/referral of family conflict

61. 18 – Advocacy Need for support in finding appropriate care
Feeling neglected

62. 19 - Mental Health/Addictions - Need to explore concerns about one’s mental health or mood altering chemical abuse 62

63. 19.Person with mental illness or addiction concerns
Function
Desired Outcomes
Concern verbalized
Feelings expressed
Calm conversation
Accepts consultation
Referral
Referral - Chaplains recognize the need for forms of care other than a patient or family is receiving, and work towards referral to:
counseling
psychotherapy
psychiatric assessment
alcoholism/ drug abuse assessment
Outcome
Concern verbalized
Feelings expressed
Calm conversation about mental health symptoms or consequences of addictive behavior
Accepts consultation with a specialist on addiction/mental health. 63

64. 20 - Family Mental Health/Addiction Concerns Need to address concerns about behavior of a family member

65. 21. Love Life Pain Need for listening, advice or referral about one’s love life65

66. Recap Rapport first Creativity & imagination
Identify issues in bullet points
Framework for assessment
Augment electronic charting
Reduce defensive chart entries

67. FINIS