1. Welcome to the Phoenix Area Interactive Learning Session

2. Donice Hoopaugh, MSN/MHA, CCM, RN donice.hoopaugh@ihs.gov Cathy Witte, RPh, MDiv, MS Bioethicscatherine.witte@ihs.gov

3. Spiritual Care in Healthcare  Supported by the Indian Health Service mission to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.  Recognized by The Joint Commission and CMS

4. AI/AN Statistics/Demographics (US Census Bureau)  Over 350 tribes in the United States, many have relocated to our area. American Indians and Alaska Natives speak more than 250 languages. Some live on rural or remote reservations, in villages and pueblos, and on Rancherias and tribal trust lands; but according to the census 2000 the majority (66 %) live in urban areas. 1  36% (684,000/1.9 million of the IHS service area population resides in non- Indian areas, and 600,000 ARE SERVED IN URBAN CLINICS. 1 1) U.S. Census Bureau 2010

5. Phoenix Indian Medical Center

6. 22 federally recognized Arizona tribes

7. CULTURAL CONTINUUM TRADITIONAL  Non-English speaking  Close-knit family  Minimal involvement with non-Native society URBANIZED  English speaking only  No tribal ties  Full acculturation into non-Native society

8. Diversity of spiritual needs and expressions

9. Chaplaincy and Traditional Care at PIMC  Diverse faith and tribal affiliations  Traditional practitioners and chaplains available when services are requested for prayer.  If request is for specific tribal practitioner or religious representative, PIMC will attempt to assist.  In-house chapel / prayer room  Sweat lodge

10. Important Cultural/Religious Legislation for American Indians The American Indian Religious Freedom Act (1978)  Resolved certain conflicts between Indian religious beliefs and practices and federal laws that restricted the exercise of Indian beliefs including use of sacred lands and artifacts Indian Sacred Sites, 1996, Clinton admin. executive order  Accommodate access to and ceremonial use of Indian sacred sites by religious practitioner and avoid adversely affecting the physical integrity of such sacred sites  …needs only be carried out to the extent practical, permitted by law and not clearly inconsistent with essential agency function

11. Traditional Cultural Advocacy Program (TCAP) Established in 1994 under IHS director, Dr. Trujillo, affirmed the agency’s commitment to  “protect and preserve the inherent right of all American Indians and Alaska Natives to believe, express, and exercise their traditional religions…”  IHS staff must inform patients of their right to practice native religions and healing practices, and when a patient or family member requests the services of a TIM, every effort will be made to address this request.

12. Traditional Cultural Advocacy Committee (TCA) at PIMC  In 1989, community members, hospital administrators and healthcare providers collaborated to form the TCA.  Membership comprised of American Indian Spiritual practitioners, PIMC employees and community members. Currently, 15 members attend regularly.  Reports to the hospital’s Medical Executive Committee  Purpose is to proactively recognize opportunities for use of American Indian Spiritual Practitioners

13. Activities of Traditional Cultural Advocacy Committee  Makes Traditional AI /NA cultural spiritual ceremony observance available such as Sweat Lodge Ceremonies, Traditional prayers and Blessings  Makes recommendations concerning policies, procedures, and standards of practice for AI/NA healing methods in the organization  Participates in the design, implementation and evaluation of traditional care and integrated services  Educates staff in areas of Traditional care  Assists in providing and/or contacting a Traditional practitioner to meet spiritual needs expressed by the patient

14. PIMC Sweat Lodge  Established late 1990’s in response to client’s identified needs for healing and recovery; as part of the Behavioral Health program.  Remains on-site to this day, and continues as an integral part of health and spiritual healing for many people – Native and non-Native

15. PIMC Volunteer Chaplains Association  In 1979, the hospital administration asked an American Indian pastor serving in Phoenix to work with the Volunteer Director to organize a group of local clergy to provide on-site pastoral care to patients  Group became more formalized over the years, policies and procedures developed and requirements set forth for chaplain volunteers to function in hospital setting  Currently, 9 chaplain volunteers from various faith affiliations

16. Volunteer Pastoral Care Services  Visit patients in the inpatient and outpatient settings  Provide religious/spiritual resource materials  Conduct weekly non denominational service in hospital chapel /meditation room  Provide coverage 24/7 through on call pager to address urgent/emergent pastoral care concerns (i.e.. End of life- death, fetal demise and crisis interventions)  Coordinate with TCA members when requests involve Traditional care

17. Staff Chaplain Pastoral Care Services Oncology Center of Excellence  In 2001, funding made available to support the work of a chaplain to develop a spiritual care program through a National Cancer Institute grant (NCI #5 UO1 CA 86122-02) to specifically address cancer care disparities.  The PIMC chaplain works in partnership with the Southwest American Indian Collaborative Network (SAICN), the Volunteer Chaplains’ Association, TCA, and members of the medical center’s oncology staff to specifically address the spiritual care needs of those seeking cancer care

18. Dis-ease and Illness  Can provoke fear and uncertainty  Can prompt questioning and discovery of deeper meanings, values and beliefs  Seeking care has many challenges physically financially emotionally and spiritually Cultural diversity reflects diverse spiritual understandings  Patients and families seek guidance from elders, traditional healers, pastors or ministers  Often seek guidance from more than one group Chaplains, Traditional Practitioners, and Elders  Assist with spiritual interventions- prayers, blessings  Address spiritual questions and concerns

19. Individual Spiritual Care Assessments documented in electronic health record Common Spiritual Needs  Grief/loss  Fear/anxiety  Powerlessness  Anger  End of life concerns Common Interventions  Presence  Prayer  Active listening  Anxiety reduction  Coping enhancement  Verbalizing spiritual/emotional issues  Spiritual/religious reflection  Rituals and Ceremonies

20. “...healthcare providers should spend less time talking about the intricacies of cancer and its treatment and more time looking at, listening to, and trying to understand how cancer and its treatments affect the everyday lives of the people and families we treat.” (Pelusi and Krebs, 2005) “So this is how I help people. Even though they are at the end of their days, on the verge of leaving Mother Earth, there are ways to help that individual, and that’s my job, my duty.” Traditional Indian Healer (Carrese & Rhodes, 2000, p.95)

21. Next steps for spiritual care provider roles within IHS and USPHS Goal: Spiritual care be represented as functional/formal component in the provision of healthcare at facilities serving AI/AN  Foster discussion and collaboration across IHS, tribes, community agencies and academic institutions that are aimed at sustaining a presence of spiritual and cultural well being for AI/AN patients  Advocate for professional role in USPHS Commissioned Corp that addresses spiritual care (chaplain) commensurate with the other uniformed services.

22. Recommended Reading Working with Aboriginal Elders: Understanding Aboriginal Elders and Healers and the Cultural Conflicts involved in their work in Health Care Agencies and Institutions, Ellerby, J. (1999), Earth Concepts and Biomedical Communications, Winnipeg, Canada. Sweat Lodges: A Medical View, Berger, L., Rounds, J., The IHS Primary Care Provider, Clinical Support Center, June 1998, Vol. 23, no. 6. Where the Lightning Strikes: The Lives of American Indian Sacred Places, Nabokov, P. (2006), Penguin Books. Spiritual Care within Oncology Care: Development of a Spiritual Care Program at an Indian Health Service Hospital, Witte, C., Begay, T. & Coe, K, J of Health Disparities Research and Practice, (2011) 4 (3), 54-60. Professional Chaplaincy: Its Role and Importance in Healthcare, A White Paper, eds. VandeCreek, L., Burton, L, J of Pastoral Care, Spring 2001, Vol. 55, No. 1. Understanding Cancer – Understanding the Stories of Life and Living, Pelusi, J., Krebs, L. (2005), J of Cancer Education. 20(1 Suppl):12-16. Bridging Cultural Differences in Medical Practice: The Case of discussing negative Information with Navajo Patients, Carrese, J. & Rhodes, L. (2000), J of General Internal Medicine, 15. 92-96.

23. Questions?

24. Next Webinar Session: Topic: Understanding Contract Health Services Date: March 20, 2013 Time: 10:00 a.m.-11:00 a.m.