1. Spiritual Care in the 21 st Century Challenges and Opportunities May 16, 2012 Presenters Rose Shandrow, System Director Dept. of Mission Operations & Spiritual Care Services Rev Dr. Garrett Starmer, BCC Clinical Pastoral Education Manager

2. Opening Prayer Lord, Eternal God, we are about to begin our webinar and we do so with the awareness that without Your Divine Presence, here at the center of our gathering and also within ourselves—our work will be empty. We thank you for the privilege of belonging to organizations that are committed to service. May the spirituality we share grow and develop ever more fully by the power of your Holy Spirit among us. We ask that our work be a vessel for us to serve one another and You. Guide us as we serve through our health care ministries Grace us with Your Wisdom and Vision; gift us with Holy Humor and Humility so that not only this gathering, but all our lives may be a meeting place for Your Kingdom. We ask this through our Lord, Jesus Christ, who lives with You in the unity of the Holy Spirit, now and forever. Amen

3. CHI’s Environmental Assessment and Key Drivers of Change Aging Chronic Disease Physician Dynamics Payment / Financial Trends Catholic Identity Health Care Reform Treatment & Technology Talent Rural Challenges Consumerism 3

4. Matthew 16: 13-16

5. Who do we say we are as chaplains? What roles have and will chaplains play in advocating for change that creates a better health care system? Who are our stakeholders? Who do they say we are?

6. Spiritual Care in the 21 st Century Challenges and Opportunities Objectives Recognize challenges and opportunities from a clinical perspective Recognize challenges and opportunities from a business perspective Consider options that are available to address some of the challenges and opportunities

7. Future Clinical Needs 1. INTERNAL VIEW- Our self identity as Chaplains a. Who are we? b. What do we do? c. How do we do it and what difference does it make? d. When do we do it? e. Where do we do it? 2. EXTERNAL VIEW- WHAT WE NEED TO BE DOING a. Acute Care Setting b. Community Settings

8. Crisis in HealthCare DANGER: OPPORTUNITY:

9. Spirit back into Healthcare’s Body, Mind & Spirit “Health care in the US is evolving from an exclusive concentration on the physical dimension of illness to a more holistic model.” (Meader, 2007 77, Meador, K.G. (2004). Jankowski, Handzo & Flannelly 2011 abstract

10. The medical profession itself is leading the charge! Puchalski & Ferrell’s book: Making Health Care Whole makes the point. Spirit is the missing piece of the puzzle in health.

11. Spiritual affects healing Evidence grown since 1990’s that: Spiritual and religious struggle negatively effects mental and physical healing and well being. Pargament 2001: Fitchett, et al 2004: Nelson & Becker 2006:

12. Research needs “Testing the Efficacy of Chaplaincy Care” Jankowski, Handzo, & Flannelly ; Journal of Health Care Chaplaincy 17, nos. 3-4 2011: 100-125 Studied the patient outcomes research in the US.

13. They described three major trends in healthcare: 1. Increased emphasis on palliative care 2. Greater use of electronic documentation, into which spiritual interventions and outcomes will be integrated 3. People identifying themselves as spiritual but not religious or with no religious affiliation.

14. They underscored the need for the development and validation of the following concepts: -measures of spirituality, -spiritual risk -spiritual struggle

15. They described the need for additional study in the areas of: “What chaplains do that is unique to chaplaincy practice How what they do relates directly to patient health outcomes Which practices are best for which kinds of patients in what patient settings” Jankowski, Handzo, & Flannelly

16. DEFINE WHO WE ARE AS PART OF THE MEDICAL / HEALTHCARE TEAM – Spiritual Care Providers -Chaplain’s Traditional Emphasis Spiritual Experts Spiritual Healers Spiritual Educators Spiritual Leaders Spiritual Bridge Builders / Partners

17. Being Present Engaging Story Listening Feelings & Emotions Feelings & Emotions Empathy Spiritual Assessment Determine need and timing of visit. What is the person’s need? Self-Awareness of what I bring to the situation. Attend to the person’s needs, rather than only our own thoughts, feelings, or our need to help/minister/fix. Finding a relational way to connect with the patient, family member or associate. Two-way engagement with an awareness of what I bring to the relationship. Engaged/active listening. Assisting the person in choosing, from their perspective, an appropriate “next step” supporting their needs/desires/resources. Focus, follow, and ask open questions around the person’s story. Explore the content and emotions presented. Revealing, sharing and expressing empathy. Identifying the persons emotions and feelings. Using your understanding of the situation, story and empathy to enable the person to begin identifying, naming and accepting their feelings and emotions. Bringing empathy and understanding to the situation. Withholding judgment. Being self-aware and reacting appropriately. Bringing a compassionate objectivity for both the individual/family and the care givers. Assessing the person’s needs, desires & resources within the context of Meaning, Hope, Relationship/community and Holy. With the person’s “consent,” develop a plan of care. (Spiritual & religious support; Ethics, advocacy & referral support; Change, adjustment & loss support; Emotional support, and Leadership & advocacy) Identifying the results of your full-circle spiritual care and what the two of you have accomplished. Chart persons assessment and outcome. Rapport Building Assessment Inter venti on Outcomes Showing Up Spiritual Outcomes Spiritual Intervention Spiritual Care Plan What’s Next? Adapted from Steve Gomes’ stair step concept within Centura Health’s Full-circle chaplaincy Plan Rapport Maintaining Full Circle Spiritual Care

18. Spiritual Experts –Name what is Spirituality –Name what is Spiritual distress –Name what is Spiritual Coping/healing –Conversant in Mind, Body & Spirit Connections and healing

19. Lucas & VandeCreek: The Discipline of Pastoral Care Giving Foundations for Outcome Oriented Chaplaincy Needs, Hopes & Resources Spiritual Assessment… Concept of the Holy Meaning Hope Community Educate healthcare team in what we do. Language that is understandable, intuitive, connects the dots of the body, mind and spirit: From “woo” “woo” (and little sharing with staff) to clear observable language including Spiritual Assessment: The assessment, interventions and outcomes clearly charted

20. Spiritual Expert – Spiritual Care Charting EMR: Electronic Medical Record –What do we chart? –Who reads it? –How easy is it to get to the Spiritual Care Chart? –How does staff refer to chaplain? Charting needs to be intuitively understood.

21. SPIRITUAL INTERVENTIONS INTERVENTIONS: Advanced Directive Information provided: (Single) __Yes __No Advanced Directive Comment: (Free text) __________________________________________________________________________________________________ EMOTIONAL SUPPORT: (Multi) __Anxiety reduction initiated __Emotional Health Education provided__Empathic Companioning __ Empowered patient __Established Trust __Family/ Significant Other supported __Guided Imagery provided __Hope” strengths identified__“Hope” struggles identified __Information provided __“Meaning” strengths identified__“Meaning” struggles identified __“ Relationship” strengths identified __“Relationship” struggles identified __Other Emotional Comment (free text)____________________________________________________________________ CHANGE, ADJUSTMENT AND LOSS (Multi) __ Change, adjustment, loss education provided __End of life discussion/care __“Hope” with loss addressed __Life review facilitated __Loss & Grief (current) support provided __Loss and Grief (prior) support provided __Meaning” of the loss discussed__Referral provided __Relationships/Community/Support system discussed__Other Change, Adjustment and Loss Comment (Free text) ____________________________________________________________________________________

22. SPIRITUAL INTERVENTIONS SPIRITUAL AND RELIGIOUS multi) __Anointing of the Sick__ Baptism provided __Beliefs/Values explored __Blessing/Ritual provided __Communion provided__Confession/Reconciliation provided __Ed. on Spiritual/Rel. issues provided__Forgiveness addressed __God/the spiritual strengths identified__God/the spiritual struggles identified __Holy texts/Scripture read/provided __Religious leader/community consulted __ Rosary shared/provided __Prayer shared __Spiritual/Religious life explored __Other Spiritual and Religious Comment (Free text) __________________________________________________________________________________________________ ETHICS, ADVOCACY AND REFERRAL(Multi) __Addiction discussed/referral/support made __Advocated for patient __Care now and/or in the future discussed__Ethical issues discussed __Ethics Committee called __ Ethics, advocacy or referral education provided __Family Conference facilitated __Healthcare team-Pt./Fam. communication facilitated __Referral provided __Resources provided __Relationship issues/conflict addressed __Other Ethics, Advocacy and Referral Comment (Free text) __________________________________________________________________________________________________ Intervention Comment/Summary Points (Free text) _________________________________________________

23. Built in bias in medical Opening Screen: Cerner SBAR Interdisciplinary Plan of Care –Problems –Consults Narrative charting: check point charting

24. Spiritual Healers Know what we do Know how what we do effects the patient’s outcomes (Jankowski, Handzo, Fannelly)

25. Spiritual Educators Educate about spirituality Hope, Meaning, Holy, Community/Relationships Spiritual Distress Spiritual Coping How the spiritual is essential to healthcare outcomes- body, mind, spirit How they can staff meet spiritual needs When to call a chaplain

26. Spiritual Educators Educate local Faith leaders re: health care Educate local Faith group leaders re: positive connection between positive faith and healing Offer Religious leaders list of social services - be a bridge with healthcare functions

27. Spiritual Educators Expand understanding of healthcare’s financial pressures Become conversant in business language Become conversant in balance sheets Become conversant in organizational processes Become conversant in showing cost-savings of spiritual care. Polish Presenting skills

28. Spiritual Leaders Care for Medical team Care with the Medical Team Care based on ERD’s Care based on Mission and Values- Lead team in workplace spirituality

29. Spiritual Bridge Builders/Partners What types of collaborative processes can we engage in with local religious leaders? Collaborate with local faith group leaders for health of congregation members Team with Parish Nurses for coordination of congregants- patients as move into the community Team with CPE in education of Church Leaders

30. External View Outpatient settings Community offering of care Connect with homecare agencies Work with Social Service Agencies –Catholic Community Services –Catholic Charities –Salvation Army

31. Technology Skype type communication Remote communication Education

32. Cultural/Religious Expertise Spiritual but not Religious Multi-cultural/faith society

33. Research Foundational Essential

34. Business Case in support of Spiritual Care Services Challenges & Opportunities

35. Catholic Health Association Spiritual Care Advisory Committee Objective: Become a national voice to educate/advocate for roles and benefits of professional chaplaincy, and the value of spiritual care as core to Catholic health care’s identity

36. Clinical Team When seeking assistance from spiritual care and professional chaplaincy, what are your asking for? As a nurse, when would you refer a patient and why? What is your understanding of professional chaplaincy and what more do you need to know better about the role of chaplains?

37. Executive Team As CEO, what do you understand as the purpose and value of spiritual care and professional chaplaincy? As CFO, in view of the budget shortfalls in healthcare, what additional information do you need to have about the value added of spiritual care and chaplaincy to feel comfortable in your decision- making?

38. Process After the Catholic Health Association Assembly, an online survey will be made available through mission leaders requesting participation from executives and clinical team members. Survey will be available for three weeks- June 11-29, 2012 Results will be collated and studied by the CHA Spiritual Care Advisory Council Information received will aid in developing and communicating messages for respective audiences.

39. Division of Mission Operations/Spiritual Care Direct Care Encounters by both Chaplains & CPE Residents/Interns n=16,638

40. Sources of Referrals-Combined Fiscal Year to Date

41. Categories of Spiritual Care Needs Addressed-Combined Fiscal Year to Date

44. Division of Mission Operations/Spiritual Care Spiritual Care Interventions-Combined Fiscal Year to Date n=60,778

46. Franciscan Health System How Spiritual Care Supports Holistic Care and Healing in our Health Care System Spirituality Groups Retreats Guest preaching Invocations Benedictions Blessings Spirituality Groups Retreats Guest preaching Invocations Benedictions Blessings Interdisciplinary Teams Patient care conferences Patient rounds Ethics conferences Advance Directives Palliative Care Teams Interdisciplinary Teams Patient care conferences Patient rounds Ethics conferences Advance Directives Palliative Care Teams Support Groups Bereavement Pre and post transplant Chronic illness Perinatal and neonatal Cancer Cardiac Pulmonary Pain Mental health Care for caregivers Support Groups Bereavement Pre and post transplant Chronic illness Perinatal and neonatal Cancer Cardiac Pulmonary Pain Mental health Care for caregivers Community Service/Outreach Ministerial alliances Interdenominational networks Diocesan relationship Parish volunteer training/ministry formation Educational resources Community service projects Community Service/Outreach Ministerial alliances Interdenominational networks Diocesan relationship Parish volunteer training/ministry formation Educational resources Community service projects End-of-Life Care Comfort care Organ procurement support Ethical decisions around end-of-life care Spiritual and cultural education Spiritual issues End-of-Life Care Comfort care Organ procurement support Ethical decisions around end-of-life care Spiritual and cultural education Spiritual issues Special Services Mass/worship Sacraments Holy seasonal services and rituals Ecumenical prayer services Special Services Mass/worship Sacraments Holy seasonal services and rituals Ecumenical prayer services Associate Support New staff orientation Spiritual counseling Blessings Critical incident Stress Management (CISM) group support Associate memorials /funerals/ retreats Associate Support New staff orientation Spiritual counseling Blessings Critical incident Stress Management (CISM) group support Associate memorials /funerals/ retreats Volunteer Programs Eucharistic volunteers Spiritual Care volunteers Special program volunteers Volunteer Programs Eucharistic volunteers Spiritual Care volunteers Special program volunteers Leadership Strategic initiatives and long-range planning Workplace Spirituality Parish Nurse Leadership teams and formation Operations meetings Mission Integration Department meetings Service recovery Education Boards Leadership Strategic initiatives and long-range planning Workplace Spirituality Parish Nurse Leadership teams and formation Operations meetings Mission Integration Department meetings Service recovery Education Boards Patient/Family Ministry Crisis ministry/management Assessing and working with diverse family dynamics Spiritual/religious/cultural assessment Spiritual and emotional support Bereavement care Prayer, blessings and rituals Facilitation of ethical decision-making Patient/Family Ministry Crisis ministry/management Assessing and working with diverse family dynamics Spiritual/religious/cultural assessment Spiritual and emotional support Bereavement care Prayer, blessings and rituals Facilitation of ethical decision-making Committees Ethics Palliative Care Critical Care Perinatal Loss Trauma Care Bereavement Institutional Review Boards Committees Ethics Palliative Care Critical Care Perinatal Loss Trauma Care Bereavement Institutional Review Boards Clinical Pastoral Education Clinical faculty for program Create didactic presentations for learning Mentor residents, interns and externs Clinical resource for program participants Clinical Pastoral Education Clinical faculty for program Create didactic presentations for learning Mentor residents, interns and externs Clinical resource for program participants Documentation Technology Develop electronic tools for documentation Document spiritual assessments, interventions and care plans Generate HIPPA compliant patient lists for volunteers Documentation Technology Develop electronic tools for documentation Document spiritual assessments, interventions and care plans Generate HIPPA compliant patient lists for volunteers

47. To wish for change will change nothing; To make the decision to take action right now will change everything. Nick Vujicic

48. Questions??