Wednesday, December 31, 2014
In reading the Hospice Foundation of America December 2014 e-newsletter, I was captivated by the article "A Resolution Worth Exploring". I hope you will be, too! A Resolution Worth Exploring As you ponder resolutions for 2015, taking better care of yourself professionally should be close to the top of the list. Ronald Epstein, MD, professor at the University of Rochester School of Medicine and Dentistry, practicing palliative care doc, and published researcher on self-care, says such things as getting rest, eating well, getting exercise, taking vacations, and spending time with family are great to do but don't necessarily translate into better care for patients. Instead, Epstein suggests learning skills that promote mindfulness. What does Epstein mean by mindfulness? "I guess you would say mindfulness is an attitude of mind and mindful practice is what you do in everyday work," he says. "If you are practicing mindfully, you are aware of your own reactions, you are aware of the dynamics in the family, you are aware of how this is affecting you, you are able to monitor the way that you react and also to regulate your own reactions to stressful circumstances so that actions are better aligned with your values." This informs hospice chaplaincy in that if we are practicing our discipline mindfully, we will be self-aware, aware of the family dynamics around us, how our work affects us (positively and negatively), and how we respond to the stressful circumstances surrounding the hospice environment. Living and practicing our ministry means we do not deny our emotions or reactions and seek feedback from colleagues when we feel a bit off balance. I urge hospice Chaplains to practice not just good self-care but 'mindful' self-care. Our work is too demanding to do anything less. May 2015 be your best and most rewarding year in your hospice career.
Monday, December 29, 2014
Last week I had the opportunity to read an article in AACN Advanced Critical Care, Volume 18, Number 1, pp.19–30 © 2007, AACN, that had to do with the The Reina Trust & Betrayal Model. This article used as its focus “a difficult case study involving repeated health crises and irreversible organ dysfunction [that] illustrates the challenges critical care professionals face in caring for patients and their families. In such cases, trust is especially fragile, and coexists with its counterpart, betrayal. The Reina Trust & Betrayal Model defines 3 types of Transactional Trust. The first, Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient’s choices, and express compassion. The second, Contractual Trust, or the Trust of Character, demands that clinicians keep agreements, manage expectations, establish boundaries, and encourage mutually serving expectations. The third, Communication Trust, or the Trust of Disclosure, must be rooted in respect and based on truth-telling. Particularly in life-and death situations, communication requires honesty and clarity. Each type of trust involves specific behaviors that build trust and can guide critical care professionals as they interact with patients and their families. In reading this article with its case study I came to the conclusion that the three types of transactional trust fit what a hospice Chaplain does in his/her relationship with a patient and family. In hospice, every patient is in a health care crisis and, indeed, trust is fragile. The first and most important task of the Chaplain is to win and build trust with the patient and family. This illustrates the Competence Trust. By nature a Chaplain conveys humility, honors the patient’s choices, and expresses compassion. When a Chaplain’s competence is established in the relationship, a bond of trust, though newly established, begins to form. The next transactional trust is that of Contractual Trust. The relationship can crumble: 1. If the Chaplain cannot keep agreements (is late for appointments, does not call to reschedule, forgets names of patient and family members, is cold and aloof, for examples); 2. If the Chaplain tramples on boundaries by trying to rush the conversation toward converting the patient or violates confidentiality. The third trust is the Communication Trust. While the Chaplain will not deal with the medical side of the patient’s experience, it is absolutely fundamental that the Chaplain will respect the patient’s autonomy. I urge the reader to look for this article and superimpose upon it the role of the hospice Chaplain. Friends, you are a clinician and hold a revered place on the IDT. Blessings, Chaplains, for your work!
Thursday, December 25, 2014
In 2015 I want to explore with a subject that will enhance your chaplaincy ... Providing Spiritual Care According to Disease Process. As you know, I do not believe in a "one size fits all" style of spiritual care. In this study, we will look at the most common disease processes patients present with in hospice care, and look at common spiritual characteristics associated with those disease processes and how to address them. Until then, finish out 2014 giving your best to the patients and families who look to you for comfort and strength.
Wednesday, December 24, 2014
Welcome to those from France who visited this blog yesterday. I would enjoy getting to know your approach to chaplaincy. Please feel free to comment on any of the posts. The way to do that is to click "No Comments" (I know that is an odd way to invite Comments, but it is simply how this blog works). My blog statistics indicate that there were more visits by those from France than anywhere else in the world including the US. Blessed Christmas and New Year to all!
Tuesday, December 23, 2014
Twas the night before Christmas and all through the house no one was stirring but the hospice Chaplain in Grandpa’s room. The family was bowed low by the chimney in prayer, in hopes that God’s intervention would soon be there. The grandchildren were nestled all snug in their beds, with visions of life without Grandpop coursing through their troubled heads. And Mamma with her ‘kerchief, and I in my cap, wished we could settle our brains for a nap. When from the bedroom there arose such a clatter, we sprang from our knees to see what was the matter. The Chaplain sat holding Grandpop’s hand as he said, “Yes, Lord, I am coming home.” I knew in a minute he must be leaving and headed to Heaven. We wept, we hugged, we thanked the Chaplain for her care. Death comes to all, hospice is there. On Nurse, on Physician, on Social worker, on Home Health Aide, on Chaplain, on IDT, “We care. We love. We serve.”
Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless.
Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless.
Thursday, December 18, 2014
In many cases a Chaplain documents a narrative style describing what happened in a visit. That is fine as far as it goes, but it can leave out gaps of information that are essential: pain score and scale used; observations of decline; and interventions employed to reach the Goal/Expected Outcome. I have been ok with Chaplains using a narrative style, but have grown uncomfortable with continuing with that simply because of the demands of auditing firms that review hospice charts. Years ago I learned to document using the FAIERS template. F=Focus or purpose of the visit; A=Assessment of patient; I=Interventions used; E=Education presented to patient; R=Response of patient to the visit; S=Subsequent visit information. I mulled switching to this tool, but can’t through such things as Assessment and Education. A Chaplain is not licensed to perform an Assessment. A Chaplain may only observe or record such things as pain levels and decline. As far as Education is concerned, this seems to be intertwined with the Interventions we use and would be a waste of valuable time on the part of the Chaplain. While one can pronounce this acrostic of FAIERS, it seems inadequate for our use. Instead, I wrote the following to more fully describe what happens when a Chaplain visits a patient or a family member/caregiver: Purpose of the visit—The Chaplain can state that this was a routine visit to comply with the terms of the Plan of Care or state that this was an On Call visit or a Return visit due to an emergency or whatever description that fits the circumstance of the visit. Observation—Again, Chaplain do not assess, they observe. A. Pain level/scale B. Decline—MAC C. Spiritual concern(s) Intervention(s) A. What interventions did you use to address the spiritual concern(s)?—The Chaplains have 21 possible Interventions from which to choose for this section. They should have already have chosen one or two from the Initial Spiritual Assessment (this is the only place Assessment can be used). B. What evidence can you give that this helped the patient?— Response of the patient/family-- I will provide our Chaplains with plenty of examples of verbiage to use to document this piece. Subsequent visit—This section should be brief and summed up in one sentence. A. To fulfill the terms of the POC B. Within 30 days Your comments are welcome. This is not an easy process and one I approach lightly. Bless you, Chaplains, for your fine work. You are God’s hands of peace and support.
Wednesday, December 17, 2014
In my reflections about this Holy Day, holiday season, the hymn “I Heard the Bells on Christmas Day” came to mind. Why? It seems to be juxtaposed with some of the goings on in our nation and world. We look at the relics of Ferguson, Missouri, and other cities that have been torn apart by rioters. We hear cries to kill police officers. We see and hear of the barbarism of Pakistani terrorists. Can we help but say with Henry Wadsworth Longfellow in verse 3: “And in despair I bowed my head: "There is no peace on earth," I said, "For hate is strong and mocks the song ‘Of peace on earth, good will to men.’" It leads to a simple prayer of “Kyrie among all nations”. Would you join me in this prayer at this juncture in history, please?
“Along unfamiliar paths I will guide them…” In the Old Testament book of Isaiah 42:16, we read “Along unfamiliar paths I will guide them; I will turn the darkness into light before them and make the rough places smooth. These are the things I will do; I will not forsake them.” Note the words ‘unfamiliar paths’, ‘darkness’, ‘rough places’, ‘I will not forsake them’. Hospice patients and families are traveling very unfamiliar paths. This is a fact that sometimes gets lost among us who are hospice professionals. Death seems almost commonplace to us. But, it isn’t for our patients and their loved ones. Their ‘path’ is fraught with darkness and rough places. They may even feel forsaken by the Almighty. Our work is one of comfort. In the previous chapter of Isaiah, there is a cry from God to, “Comfort ye my people!” Being a comforting presence will go a long way to helping our patients and families on their journey through ‘unfamiliar places’. Perhaps you might read this verse to those who are open to it. May this beautiful passage bless you as you bless those you serve. May the wellspring of compassion be opened in you as you reach out in care. May soothing words find a home in you. May tenderness bless you as you reach out to comfort body, mind and spirit. In the midst of fear and frustration may courage be given to you. When difficult decisions confront you, may wisdom inspire you. May patience keep vigil with you and may peace of mind calm you. May your heart find a song to sing, even when you are weary. May abundant life lift you and gratitude bless you as you live the mission of care entrusted to you. Amen, so be it. Pat Bergen, CJS
Monday, December 15, 2014
Musings on a Monday Morning … The need to laugh … In my line of work as a manager of spiritual care in a large hospice, very often stress is palatable. You can feel it, sense it, and hopefully deal with it. I must say that stress can diminish one’s sense of humor. You can know for certain when you are running low on humor … you get irritated at the people you love the most, you get irritated with people you work with, you just get irritated … period. I find that laughter cuts the stress down to size. It puts things into perspective and cheers my soul. I don’t know about you, but I need stress cut down to size and a happy soul. For instance, at church one recent Sunday night the choir was presenting their Christmas musical. The place was packed with people. The pastor took a moment to greet those in attendance and asked us to greet one another. My wife and I shook hands with several people close to us and then a sweet, little lady came up to me and welcomed me as if I were a guest. My eyes met my wife’s and I just smiled and told her how glad I was to be present for this musical presentation. My, my, my … Just grin and laugh. With the joy of the season comes sad and distressing situations … Have you noticed that life gets complicated at the absolute worst times of the year. I’m not sure I understand why that it, it just happens. What holds things together at work? When chaos strikes, embracing the mission, embracing my call, and embracing my colleagues works for me. What holds things together at home? This is a one word answer … love. Love for my wife keeps the relationship strong. I try to tell her frequently that I love her and show it so she sees by my actions that my words are true. What are you chewing on this Monday?
Three ways to safely navigating through the holidays … The holiday season is in full force. Have you noticed how unbelievably busy life has become in such a short while since Thanksgiving? There are some things that I know have not changed one bit: 1) Your caseload and the needs of the patients has probably gotten larger and more complex; 2) The patients’ families are as stressed if not more so because this will probably be the last Christmas/Chanukah/Kwanzaa their loved one will be here; 3) The changes that Medicare is bringing make your work that much more complex. So … what can you do to keep your head squarely on your shoulders and get good spiritual care done? First, do not get behind. If you get behind in your visits, it will be incredibly difficult to catch up. No doubt, you are already penciled in for PTO and as we all know, staying in compliance is a monthly challenge, but never has the challenge been greater than this month. Second, honor the spirituality of your patients as never before. I get phone calls from nurses and home health aides wanting to know how to help their patients celebrate Christmas and Chanukah. Their biggest concern is not to offend the patient. Here are at Cornerstone Hospice, we are accredited by the National Institute for Jewish Hospice and as part of the accreditation we receive a Jewish Holiday information sheet which gives sage advice on how to assist our patients with Chanukah. On Sunday I sent out the information sheet to our entire staff. They are now equipped to assist our Jewish patients. Regarding Christian patients, reading the nativity passages from Matthew and/or Luke is usually well-received. Third, practice wise self-care. You are pressing to get your entire caseload visited before PTO. You are attending church or faith community functions. Things happen that keep you awake at night. Life presses forward whether you are ready or not. I urge you to practice smart self-care. Getting rest, eating right, exercising, being able to say “No” to just one more invitation, and so forth are all pieces of the puzzle at holiday time. Be safe on the road. Take time to love your family. Do what you feel you can and no more. Remember the days when you were a parish pastor and drove hard through the month of December and then wondered where the wonder of the holidays went? You missed the wonder because you were too busy helping everybody else experience it. You are no longer a parish pastor, so slow down and enjoy it. If you’re a Type A personality, you may feel you just HAVE to do more of this or that. Baloney! Relax! To your holiday celebration, I say be blessed!
Thursday, December 4, 2014
I had the privilege to speak at one of our Celebrations of Life programs in Sebring and presented what I hoped would be a comforting, healing message. This passage might seem a bit odd for a memorial type of program, but I really believe it speaks to the many issues of grief and bereavement. First, a bit of background on my life. When I was 10, my father died. He had a coronary thrombosis. The whole sequence of event surrounding his death sent our family into a terrible tailspin. Hospice care was not even a flicker in America at that time (1964). Hospice care was 20 years away at that time. So, families were left to their own ways to handle grief. My grief ‘counsel’ was “Brave boys don’t cry”, and “You are now the man of the house”. What a heavy burden to place on a 10 year old’s shoulders! It took me until I was 30 to come to grips with the mourning aspect of my father’s death. As Alan Wolfelt reminds us, mourning is grief gone public. I never mourned, never wept over his death. In fact, by the time I was 30 my emotions were so bound up with pain when the month of May came that I wished that the 24th could be erased from the calendar. So, I met with a counselor friend of mine who advised that I write a letter to my father expressing whatever came to mind. What an awkward thing that was … at first. I remember beginning the letter, “Dear Dad”… But, I also remember how I closed the letter, “I give you permission to die.” I then went to my home and read the letter aloud to my wife and as I did, the grief and pain gushed forth from within me like a tidal way. The little boy, who was told to be brave, was now a man who did cry. What a necessary catharsis this was for me. After 30 more years of life, I honor my father’s life and his contributions to the family and to me. With this background in mind, I shared my thoughts on Isaiah 35:1. The desert experience reminds me of our grief experience in several ways: a. The desert is a place of Exhaustion. The journey of grief is exhausting mentally, emotionally, physically, and spiritually. b. The desert is a place of Thirst. As people thirst for water to quench this need for hydration, those in grief thirst for comfort, peace, and normalcy. c. The desert if a place of Mirage. People in a desert see things that aren’t there. In the grief experience there are times when we think we see the end of our pain only to experience what Wolfelt calls a grief bomb. And, we are reminded of the challenges in our journey. Thankfully, in 2014 we have hospice to provide support during the patient’s illness and after the patient’s death to provide bereavement support. Hospice’s time is now. People are hurting. We are here to lend a hand of support.
Tuesday, December 2, 2014
Upon reading the following story found at http://www.passionprovokers.com/blog/the-woodcutter-how-to-embrace-the-presence, I found there was great truth in the fable. I hope you are made to think and identify with the Woodcutter ... The Woodcutter: How to Embrace the Present By Jami Keller Long ago, there was once a wise Woodcutter who lived in a small village. He would go out each day looking for wood to bring back to village, prepare it for carpentry, and sell it to his fellow Villagers. While out on one of of his wood finding exhibitions, he sees the most beautiful stallion he has ever seen in a nearby field. Oddly, the stallion boldly comes towards him without fear. As the Woodcutter continued on his work, the stallion continued to follow him all the way back to the village. Over the next several weeks, the stallion allows him to ride him, and soon he makes his daily trips with his new friend. The horse becomes a great help, and the Woodcutter is soon able to triple the amount of wood he can prepare in a day. The villagers come to the woodcutter to praise him for this great blessing that is this horse. They in fact benefit from this as well, in the form of cheaper wood and better building materials. The Villagers began visiting regularly to admire the stallion, and to each compliment the Woodcutter would respond "I don't know, is it a good thing or a bad thing? I like the horse and having the companionship, plus the advantages that this horse brings to us all." The Villagers would often agree to his face in admiration, and later question his response. Of course it was a good thing! It was nothing but great, was it not? The Woodcutter must have been a man who had vision. Vision is having a bigger picture of himself, and those around him, in order to realize the value of good communication. This was useful to him in that he was able to understand his role and value in the community. To gain this vision, he first had to see the value in all living things. The Woodcutter did not let his feelings rule his life, but was able to feel the full measure of feelings and navigate his choices with full awareness of his feelings. He was able to actively choose to not let what happened to him dictate his outlook on life. He was aware that his happiness was dependent on his own choices, not strokes of (what the Villagers thought were) luck. News spread about this horse, and one day the King came to visit. The King was so impressed with this majestic animal that he offered the Woodcutter half of the gold in the kingdom because "This stallion needs to be the stud of my stables." The Woodcutter was shocked and told the King "Your Majesty, I am honored that you like the horse, but I regret to tell you that I can not sell you the horse. He is a friend, and not a possession that I have the right to sell." The King was very impressed that a villager could turn down such an offer while having a respectable reason to do so. The King agreed with the Woodcutter and went on his way. The Villagers were were angry and frustrated. "Why would you not take the gold? We could have all been rich. What is wrong with you? You are a fool!" The Woodcutter responded. "I do not know, is it a good thing or bad thing? I have kept my honor and my friend the horse." Time passed and one day the Woodcutter went out to collect wood and found that the horse was missing. The Villagers noticed and confronted the woodcutter: "Not only do you not have the gold the King offered you, now you have no horse!" The Woodcutter replied, once again, "I do not know, is it a good thing or a bad thing?" The Villagers walked away shaking their heads mumbling that the Woodcutter may not be fit to be in their village. When this kind of loss happens, there has to be a foundation of joy in our hearts that prevails even when there would be no reason for joy. These lessons are never easy, and require a level of wisdom that not everyone will allow themselves to achieve. Not long afterword, the horse reappeared, along with 20 other horses. The stallion had gone out and won the leadership as the heard of horses. Now, the Woodcutter had 21 horses and was scrambling to care for them. Word spread like it does in a community, and most of the village came to help and witness the unusual circumstance. The Villagers went to the Woodcutter, hats in hands, hopeful to benefit from the new fortune. "Forgive us most wise Woodcutter, this is a huge blessing to you and all of us." The Woodcutter, who now was responsible for feeding and shoveling up after the horses, told them once again: "I don't know, is this a good thing or a bad thing? I am glad to have my horse back but this is overwhelming." Because of the value of the horses and the need for them to be trained, the Woodcutters only son began training the horses with him. Tragically, the Woodcutters son was thrown off a horse and broke both his legs. It was unlikely that he would walk again or be able to continue to Woodcutters lineage. The Villagers brought food and helped with chores, while giving their condolences about this terrible thing. The villagers kept telling him how unlucky his son was, and how unlucky it would be to not see his name continue. The Woodcutter was full of gratitude that his son lived, and replied to the villagers comments by saying "I don't know, is it a good thing or a bad thing?" The Woodcutter gives us insight for when tragedy happens. Finding hope in these times is often the difference between becoming bitter and working towards being fully present. The loss of the ability to walk, especially in this long ago time, was vital to all life. The son would need care for as long as he could not walk, and the Woodcutter was willing and ready to do this care with gratitude for the service; Loving what is means being present to the miracle of all life. Shortly after his sons accident, the King returns to the village. He is there to recruit all the able bodied young men to fight in a gruesome war. Most do not return from the war, and those that did were never the same. Many mothers and fathers of the sons who did not make it would often visit the Woodcutter's son, always commenting on how lucky the Woodcutter was to still have his son. The Woodcutter and his son lived their lives as an example of what is truly good. They continued to have many hardships, but also had much success. I've been telling this story for many years, and each time I am reminded of just how well it captures several of Passion Provokers core beliefs, to name a few: 1. The Villagers in our lives rarely know what is really going on and almost always have their own agenda. Be wary of the Villagers in your life, because they will always have an opinion that is based on their needs, not necessarily yours. 2. No matter how positive or negative something may seem, you always have a choice in how you feel and respond. 3. Be present to all the relationships you have, because love is the only reason for life. ________________________________________
Monday, December 1, 2014
This inspiring verse written by Steve Maraboli fits in well with what we teach in CPE ... focus on "being" and not so much "doing". I hope you are blessed by it. “Dare to Be” When a new day begins, dare to smile gratefully. When there is darkness, dare to be the first to shine a light. When there is injustice, dare to be the first to condemn it. When something seems difficult, dare to do it anyway. When life seems to beat you down, dare to fight back. When there seems to be no hope, dare to find some. When you’re feeling tired, dare to keep going. When times are tough, dare to be tougher. When love hurts you, dare to love again. When someone is hurting, dare to help them heal. When another is lost, dare to help them find the way. When a friend falls, dare to be the first to extend a hand. When you cross paths with another, dare to make them smile. When you feel great, dare to help someone else feel great too. When the day has ended, dare to feel as you’ve done your best. Dare to be the best you can – At all times, Dare to be!” ― Steve Maraboli, Life, the Truth, and Being Free
I live in the Tampa Bay area of Central Florida. Yesterday was another Sunday with another loss by the Tampa Bay Buccaneers. If you live in the Cincinnati area, you are pleased with the win even if it was by a point. The papers and, especially the comment section of the papers, as well as the independent bloggers online are saying the same thing ... the modern game of football in the NFL has passed Coach Lovie Smith and he is but an "old school fossil." That is quite a damning statement considering the Coach spent one year out of the NFL (last year). Is this coded language to indicate that he perhaps is too set in his ways to accept change or too stubborn about how he manages the team? I really don't know, but my point is this... Can a Chaplain or Chaplain Manager/Supervisor come to the point when he or she is so set in their ways that new ideas of ministry or management can find only resistance? Can a Chaplain or Chaplain Manager/Supervisor be so old school that methodologies that really help a patient are simply missed. I have no problem with sticking by the tried and true, but I always want to be open to new ideas and perhaps even develop one myself so that the ministry of hospice spiritual care can go forward with greater effectiveness. In these current days, Chaplains will be looked to for providing guidance to their IDTs in how to respond to current cultural crises ... Ebola and the aftermath of Ferguson. Chaplains' pride and prejudices will have to be worked through to provide a coherent message for reconciliation, hope, and inner healing. I would like to wish those of other faith persuasions the best and most joyous of holy day celebrations: Ashura (Muslim); Bodhi Day (Buddhist); Hannukah (Jewish); Boxing Day (Canadian); Kwanzaa (African-American). To my Christian community, Merry Christmas. Bless you, Chaplains, as you carry out God's good work.
. It was at a conference entitled "Empathy, Altruism and Agape: Perspective on Love in Science and Religion – A Research Symposium," she gave the evening dinner talk, entitled "Why I Can Never Retire." She pointed out that while she was 83 years of age, she still goes into St. Christopher’s hospice in London every morning and changes bedpans for an hour with the nurses before spending at least several hours sitting on the ends of beds and listening attentively to dying individuals as they might wish to speak of their lives and situation. She said that attentive listening is a form of love, and it makes people feel that their lives are significant, even if there is just a short while left before they pass on. Dame Cicely always included chaplains and pastoral care on her hospice teams, and that became the model worldwide as she trained all the leaders of the modern hospice movement. She stated with some emotion that while “In the nursing and social work text books they talk about me as the woman who founded hospice, they talk about what I did, but not why I did it. I did it for God and to help dying people to be absorbed in God’s love.” Dame Cicely often spoke of compassion. What does “compassion” add to “care”? It adds an element of stronger affective response and deeper awareness of the concrete reality of the patient’s “illness” experience. Bernard Lown, MD, one of the greatest cardiologists of our time, the inventor of the defibrillator, and recipient of the Nobel Peace Prize for founding and developing International Physicians for the Prevention of Nuclear War, wrote a classic book entitled The Lost Art of Healing: Practicing Compassion in Medicine (Houghton Mifflin, 1996, Ballantine Books, 1999). It is a powerful statement about how compassionate care, often in the form of attentive listening, creates a “healing relationship” with patients that improves diagnostic clarity, patient outcomes, patient adherence with treatment, and brings immense gratification to the professional as well. It also makes healthcare systems successful. In our system of hospice care, each of us is personally responsible to nurture a culture of compassionate care in which: • patients will not experience humiliating insensitivities or rudeness, but rather compassion, respect, hospitality and attentive listening; • interactions with patients are uniformly recognized as having the significance of any other important clinical intervention; • physicians, nurses and all staff will find patient care more gratifying and meaningful; and, • benevolent and respectful interactions between members of the healthcare team will be understood as establishing the secure base from which the compassionate care of patients unfolds. There is a beautiful passage in the book of Isaiah, chapter 35, verse 1, “The desert shall rejoice and blossom like a rose.” Let your work be guided by this idea. Patients and families experience many deserts, burning deserts, scorching deserts that leave them empty of meaning, empty of content, empty of substance. Help them to sing Hallelujah in a new key, and to be witnesses to the transforming power of love. When you are in the desert, plant a rose… a rose of peace, a rose of reconciliation, a rose of faith, hope and love. And the desert will blossom. You, as a clinician, will blossom, patients will blossom, whole hospitals and facilities and homes will blossom. And as the Psalm reads, “Those who refresh others will themselves be refreshed.” Never forget that the affirmation of the patient’s significance is profoundly important in times of severe illness. In the words of E.E. Cummings: “We do not believe in ourselves until someone reveals that something deep inside us is valuable, worth listening to, worthy of our trust, sacred to our touch.”
Wednesday, November 26, 2014
We have now enjoyed over 1,500 visitors to this site. I remind our readers that we are a niche site promoting Hospice Chaplaincy. Hospice Chaplaincy is what energizes my soul. The Chaplain staff here at Cornerstone Hospice is one of the best if not the absolute best corps of chaplains. I pour myself into their work with the intent of developing a top 10% quality group. Your comments and questions are always welcome. If you would like a consult, please let me know.
Flying to Newark, New Jersey, to attend the NIJH Annual Conference is a highlight in my year. This year was especially good as the leadership was trying a new approach by including a breakout session. Mrs. Lamm, now the out-front spokesperson for the organization called me a week prior to the conference and asked if I would be a facilitator for the Chaplains. I accepted not knowing how incredibly blessed I would be to do so. From the beginning of the conference to the end, the conferees were exposed to the nuances of Judaism that were simply unknown to us. The breakout session was illuminating as our group was comprised of Rabbis and non-Jewish Chaplains. The theme was how we all benefited from the type of information we received at this conference. Rabbis and Chaplains have at least one thing in common__we like to talk… and, not always about the subject! And, that is what made the breakout group so fascinating. I was so very impressed by the professionalism and skill of both Rabbis and Chaplains. We agreed that we needed one another. I believe that in those short moments we were together a bond formed based on mutual respect. Beyond that we agreed that knowledge of Judaism enhanced our ability to serve our Jewish patients. Our Rabbi Chaplains sensed they could better serve their non-Jewish patients through similar events where knowledge was shared. The beauty of the discussions was in the expressed desire on everyone’s part to not be religiously offensive to the patients and families that we serve. And, that is where we came together to agree that we need each other. I was so glad I went to this my third conference. Of course, my generous and spiritually open hospice, Cornerstone Hospice & Palliative Care, Inc. received its re-accreditation from the NIJH. In 2015 we intend to further develop our relationships with Rabbis and synagogues. Building bridges of understanding and mutual respect is a wonderful project. I hope you have to the opportunity to engage in this most worthy effort!
My little grandson, Mason, is just two, but he has learned how to celebrate an accomplishment. It always makes me smile when I hear him say "I did it!" as he throws his arms up in jubilation. Well, that is sort of how I feel as I share with you that I had a great experience this past Saturday. As an exclamation point to my weight loss, I entered and ran in the Pets and Vets 5K. This race was sponsored by my hospice. The weather was less than nice as it was drizzling, windy, and chilly. But, "I did it!" I ran my first 5K ever and came in second place in my age group. To say that I was elated is an understatement. Self-care cannot be something we tacitly acknowledge as necessary. It is something we embrace and practice. I lost the weight through dieting and exercise. I trained for this 5K for several months and "I did it!" Blessings to you all this Holiday and Holy Day Season!
In this particular post, I clearly identify my theological stance as Christian. If this offends you, I am sorry. In times of chaos, we all embrace that which makes sense to us. My faith makes sense to me and is my strength at this time. Also, this post may come across as political. It is not meant to be. It is a clarion call to peace. Peace transcends politics. I am sure each of us holds an opinion about what is happening in our country right now. The core of the problem is spiritual. Please indulge me as I share a story I hope you will find enlightening. In today's America we need not one but many persons like the character in this true story. May God raise up a corps of Telemachus'. It is said that in the year 402 AD, the young monk felt called to leave the monastery and head out into the pagan world to not only learn what the world had to offer, but to spread the message of Christ to all who would listen. One day in prayer, Telemachus felt called by God to leave immediately and head to Rome. If monastery’s were the hub of a local community’s society, Rome was considered the hub of the world. This was the center of society during this time. Not sure what he would find, or why God had called him on his mission he headed from the monastery and began his trek. Upon arriving in Rome, he was immediately caught up in the crowd. The crowd was immense and excited. Soon Telemachus found himself giddy with the contagious excitement of those around him. He wasn’t sure where he was headed but he knew whatever it was, it had to be great, and there was no way he was going to miss out on it. Within a few moments he found himself deep in the seating area of the Roman Coliseum. Asking those around him, he learned that the Romans had just defeated the Goths, and the emperor had commanded a circus to be held for the celebrating crowd. As he took his seat, he couldn’t have missed the emperor sitting in his seat of honor. He most certainly would not have missed the arrival of the gladiators into the coliseum. As the gladiators lined up below the emperors seat, together they stood and yelled out: “We, who are about to die, salute you”. It was the traditional greeting of the gladiators to their emperors, and in that instant he knew exactly what he had stumbled upon. The Bishops and leaders of the church had spoken out about the gladiator games in Rome, yet most believed it legend. In that moment, Telemachus realized it all was true. Soon the gladiators pulled their weapons and the bloody brawl began just a few hundred yards away from him. The grotesque nature of the sport appalled him. Worse yet, was the reactions of those around him. The spectators where in a blood thirsty ecstasy over what they were seeing. Telemachus was sickened and shocked. In that instant he realized that it must stop. From his seat, he yelled out to the warriors: In the Name of Jesus Stop… But no one heard. Without thinking he jumped over the wall and into the battle arena of the fighters. The gladiators surprised by the unexpected guests momentarily stopped their fights and stared at the monk. “IN THE NAME OF JESUS STOP!” he yelled over and over again. After a few moments, the silence turned to chuckles and outright laughter. One of the gladiators, with a sick enjoyment, took a swing at Telemachus with his sword, just barely missing him. With that the others began to draw their swords. Soon they were chasing this man, across the field of battle to the laughter of the crowd. Most who witnessed the spectacle thought he was a clown or there for comic relief. That was until they heard what he was yelling; For the love of Christ, Stop!… He ran, jumped, dodged and ducked, and with each passing moment his words grew clearer and louder; In the name of Jesus, Stop. In the name of Jesus Stop. IN THE NAME OF JESUS STOP! Eventually the gladiators surged and when the dust cleared, there laid Telemachus on the ground with a sword in the center of his chest. There was silence in the crowd. It was said in that moment, that his words still echoed in the coliseum; In the name of Christ Stop. After what seemed like an eternity, one man got up from his seat, and left in silence. Then another… Then another… Until everyone got up from their seat and left in silence and disbelief. I shout to the community destroyers, "In the name of Jesus STOP!" Will you join me?
Wednesday, November 19, 2014
It will happen to every Chaplain. There will come the “evil day” (using the Biblical idea found in the Bible book of Ephesians). It may involve health, finances, family, or something deeply personal. The issue I want to address has to do with how the Chaplain handles these types of situations and maintains his or her reputation. I am not for a moment suggesting or advocating for stoicism or grin and bear it response. I am advocating for a response to serious stress that will prevent the Chaplain from losing the most valuable possession in all that he or she has …reputation. I want to suggest 5 Keys to maintaining one’s reputation: 1. Develop a support system that will be there for such a time as this. I recall a number of years ago when I was a senior pastor. It was obvious to me that I made a terrible mistake in moving my family across the state to this new place of service. The church was in disarray and in no way ready to even think of becoming a witness to the community. There were factions upon factions. I called upon the local denominational leader and spoke to him about my assessment of the situation. He agreed with my assessment and then told me it was much worse. That was not what I wanted nor needed to hear. Time proved he was correct. I then asked him a question that he scoffed at. I asked if there were a safety net of sorts for such a situation so that I could move from that place. I learned something of great value from that experience. The lone ranger style of life and leadership will leave the pastor or Chaplain with no resources at a time of crisis. I began to build a network of like-minded ministers who I could call or meet to unload the pain I was enduring. There is almost a syndrome among ministers to go it alone, to be a lone ranger. Build a network of colleagues who will encourage you and support you. 2. Watch your emotions. It is very easy to express emotions that will border on bitterness, but will definitely express anger or rage. Lay persons will never understand the level of stress you are experiencing as a Chaplain. The work of chaplaincy is something all to itself. If you express the depth of your emotions, which probably are valid, but way too strong at the moment, you will leave your colleagues and managers wondering about what really is happening with you. Of course, you haven’t told them the entire story, so they only hear what they hear and see what they see. Be very careful at this point. It is not wise to unpack your emotions with colleagues. Unpack emotions within your network of close friends, instead. 3. As you counsel those you visit and provide spiritual support, seek to deepen yourself spiritually. Use your well-developed spirituality to find inner peace. Pray, read your Sacred Texts, journal, ponder, meditate, and promise yourself you will keep the emotions between you and God. If need be, seek counsel from your Pastor, Priest, or other Faith-community Leader. Getting it out often helps reduce the stress level for a time. 4. If you choose to speak to someone up the leadership chain, choose your words carefully. Be careful that you do not come across as assigning blame on them for your plight. That will not turn out well for you. It’s not that they are too busy to hear you out, they need to understand what is happening and what it is you would like them to do to help. Again, I caution, choose your words, your tone of voice and attitude carefully. 5. When you come through the crisis (as you will) approach any and all you spoke to and assure them that their listening ear was helpful to you. Exude humility and genuine gratitude. Be gracious in expressing how much the time they took with you meant to you. That will go a long way to solidifying your relationships. Crises happen. It’s a fact of life. Ruining your reputation over the crisis is rarely the first choice of the Chaplain. Do your best to maintain your poise and dignity. Tears are fine and understandable. Emotional outbursts in front of the wrong audience will have lasting negative results. Bless you as you endure.
Monday, November 17, 2014
Carl Rogers, Kathleen Rusnak, and Douglas Smith… only one of those names may be familiar to you. Yet, for the hospice Chaplain, I urge that Rusnak and Smith be much more a household name. What is that these three say that is similar and foundational for pastoral care relationships? Rogers identifies 3 essential attitudes in providing client centered therapeutic relationships: 1.Unconditional positive regard; 2.Empathic understanding; and, 3.Congruence. Rusnak identifies 7 attributes of the pastoral care relationship: 1. Why a Brick Wall?; 2. Loss of Future; 3. Grieving; 4. Life Review and Change; 5. Vulnerable; 6. Authentic; 7. Paranormal/Symbolic. And, Smith adds 1. Eliminating relationships of dominance, and humility training. So, who are these people and what are they trying to bring to the Chaplain and pastoral care? Carl Rogers, the creator of client-centered therapy and counseling, student-centered education, and person-centered approaches to human relations and community building, is arguably the most influential American psychologist of the 20th century. While some may dispute this, pointing to the domination within academic psychology of the behaviorism of B.F. Skinner, if the view is widened beyond the academy to include the entire sphere of influence, the fact is indisputable that Rogers' profoundly humanizing psychology of human potential has been embraced by not only American culture but by much of the developed world. Those spheres include education, organizational consulting, health care, psychotherapy and counseling, community action and social agency, adult development, communications training, parenting education, and pastoral care. (By Maureen O’Hara, http://www.carlrogers.info/aboutCarlRogers.html). Kathleen Rusnak is an ordained Lutheran pastor with a doctorate in Psychology and Religion. She has been the pastor of three Lutheran congregations, a hospice chaplain in two hospices, the director of spiritual care and bereavement at The Connecticut Hospice (the first hospice in the United States), and lived and worked in Israel for over two years as the director and study coordinator of the theological department at a post-Holocaust Christian European kibbutz in the Galilee, which focused on repentance and renewal towards the Jewish people. She is an internationally known speaker and writer on the topic of end-of-life issues. Her Brick Wall2 is an outstandingly clear presentation on the experiences of persons who have just received the notification that they have 6 months to live. Douglas Smith is a professional speaker, trainer, consultant and counselor. He has worked in hospitals, hospices, and social service agencies. He is the author of several books, including The Tao Of Dying, Caregiving: Hospice-Proven Techniques For Healing Body And Soul, Being A Wounded Healer, and The Complete Book Of Counseling The Dying And The Grieving. His manner of speaking is far different than Dr. Rusnak and his approach to writing is different than that of Dr. Rogers. However, his message is very clear as are the messages of Dr. Rusnak and Carl Rogers. Each of these educators is passionate about treating the client as someone who matters and communicating that fact. They urge us as therapists, pastoral counselors, and chaplains to accept people where they are, be gentle with those at end-of-life and explore with them such things as meaning-making, emotional/existential pain, and communicate in a manner that does not set up a relationship of dominance. I ask you as a reader, have you been to Dr. Rusnak’s website or Douglas Smith site? I am sure you have read Rogerian theory. So, I extend an invitation to you to expand you knowledge to include http://www.dougcsmith.com/workshops.html and http://www.thebrickwall2.com/ I am grateful for all three of these educators in pastoral care. May you be blessed as well.
Thursday, November 13, 2014
A hospice patient goes through a lot before they become a hospice patient. They have been ill for some time, they haven’t felt well, and to top all of this off, like a wrecking ball comes the terminal diagnosis from the physician that they have 6 months to live. The reaction of the patient to this devastating news is called “the existential slap.” In the International Journal of Palliative Nursing (November 2004, Vol. 10 Issue 11, p520) Nessa Coyle pens an article that focuses on the psychology of patients when a physician discloses the diagnosis of a life-threatening illness. The usual habit of allowing thoughts of death to remain in the background is now impossible. Death can no longer be denied. This awareness precipitates a crisis for most individuals, who are suddenly faced with addressing and most likely rearranging, their priorities in the time they now anticipate is left. The "existential slap," occurs when the reality and inevitability of one's own personal death sinks in. (Abstract to the article) Following this diagnosis a recommendation to hospice is made. In a flurry of activity the patient and family is met by an Admissions Nurse for a 3 hour meeting to enroll the patient in hospice followed by the Case Manager/Nurse, Social Worker, and Chaplain all within a 5 day Medicare mandated window. Is it any wonder that one of the key personality traits we look for in hospice Chaplains is compassion? The patient is reeling from the diagnosis of 6 months to live and is thrown into an environment they are totally new to and may never have heard of before or at least not understood. The Rev. Dr. Kathleen Rusnak references how her new patients described their reaction to the Existential Slap. The first time I heard a patient say, “When the doctor told me I had less than six months left to live, it felt like “I hit a brick wall,”-- I didn’t hear it. The second time a patient said that to me, I heard it the first time. And then I read this metaphor in a hospice nurse-practitioner’s thesis on suffering. The interviewed patient stated that she felt like she “hit a brick wall” when the doctor told her she had six months left to live. Metaphors are very powerful. They express in symbolic language the depth of raw feeling and emotions that cannot be directly expressed in words. (www.thebrickwall2.com) For now, as there is so much more to be explored in the Existential Slap, I want to do a deeper dive into what Dr. Rusnak so candidly wrote when she described her response to the patient, “I didn’t hear it.” If there is one regret I have as a Chaplain, it is that like Dr. Rusnak, I didn’t hear or at least didn’t “get” what the patient was actually trying to communicate. Could this be what Heidegger refers to as “the forgetfulness of being?” We, the IDT, the Chaplains as a group are so incredibly busy that we often are thinking ahead to the next patient, the next this, the next that that we are not in the moment, but in the next moments! And, we forget. We forget that before us is a new patient who has just started the hospice journey and is about to have the most daunting experience of a lifetime that will conclude with the end of life on this planet. Which among us has died before and lived to tell about it? I’m not talking about near-death experiences. I’m speaking of the real experience of death. With that clarification, the answer is simple, none of us. Can we grasp the magnitude of what this new hospice patient is attempting to process? It’s pretty hard, isn’t it? In this article, I simply want to urge my fellow Chaplains to do whatever is necessary to be in the moment with your patients. We who are living fall prey to the “forgetfulness of being” while the patient we serve is moving rapidly to the stage of the “mindfulness of being.” Simply put, the mindfulness of being is encapsulated in the long hours of self-reflection where the patient pours over life searching for answers to these questions and more: “Who am I? What was my purpose? Did I have a purpose? Did I waste my life? Did I love? Was I greedy? Did people love me? Will I be remembered? Did I make a difference?” (Rusnak) I am sure you recognized that these questions are core issues to spirituality. And, that is why we are present with them as hospice Chaplains. Blessings to you my Colleagues.
In yesterday’s article I shared some vital information about how to get a hospice Chaplain career position. Today, I want to share how to keep it and excel in your hospice Chaplain career. First of all, let me state unequivocally, getting a hospice Chaplain career position is not easy. Therefore, when you are offered a position and begin your career, I urge you to cherish it. Here are 5 ABSOLUTES to excelling in your career. 1. Keep a positive ATTITUDE. There will be highs and lows in hospice chaplaincy. You will love the face to face work with patients and families. Most Chaplains enjoy serving people. However, there will be that “2x4 to the head” moment when nothing you do will satisfy a patient or family. Also, there will be changes in the way you document, changes in what is expected in documentation, additional information required, changes, changes, changes. In 2014 this is the norm. Your IDT colleagues may grouse and complain among one another and even to you as they ask your opinion. Do not fall into that trap of negativity. Remain positive. Trust your leadership to navigate the very difficult maze of Medicare demands. Create a brand for yourself as being Mr. or Ms. Positive. That will take you a long way in chaplaincy. 2. Embrace the highest in ethical standards. Your time is your own to create your work day. At Cornerstone Hospice our day begins at 8AM and concludes at 4:30PM. Most field staff begin their day in their home making phone calls setting appointment, it is expected that we all put in a full day’s work. With that said, I urge our Chaplains to make 2 visits in the morning and 2 in the afternoon. If at all possible they are to complete their charting in their computers after each visit, so they can finish their day at 4:30PM and then be with their families. We have a mandate to visit our caseload 1-2 times in every 30 day cycle. The verbiage in the computer may state, “per month”, but it is 30 days. Beyond staying in compliance, it is expected that Chaplains will maintain confidences within the IDT. Once you break a confidence, everyone will know. Your reputation is blown and you have gained a very negative brand. So, work hard, stay in compliance, advocate for your patients, and keep your word and all confidences. 3. Make yourself available for projects. Chaplains are busy with patients and families. That is a given. However, from time to time there will be special projects that need a Chaplain. Be the first to volunteer. Your willingness will be appreciated, particularly when you make vital contributions to the work team. 4. Increase your skills and knowledge base. As I wrote that sentence, I heard voices of complaint and dissatisfaction, because there is usually no added compensation for degrees and certifications. However, the nature of our work demands highly skilled pastoral care clinicians. Becoming Board Certified from a nationally recognized organization will help excel in your work. Taking Continuing Education courses will assist your skill development. Here is my attitude … The better prepared I am to do my work, the better care I will provide a patient at their most vulnerable moments in the course of their hospice journey. In addition, my skill level will greatly benefit family members. Please do not succumb to the temptation to be satisfied with where you are. Growth is an imperative in our field of service. I am sure I could write much more on this vital topic, but I’ll leave it at what I wrote. When you have your annual performance evaluation, your personal brand or reputation will precede you. Your excellent work will be noted. You just may receive a merit increase in pay as a result.
Wednesday, November 12, 2014
How to get hired as a hospice Chaplain ... Recently, we have interviewed for a couple of PRN Chaplains. This experience reinforces what I am about to write. There are ways that you will get an interview and ways to interview that will at least get you a second look and even make you a finalist and, further, get you hired. 1. When you respond to a posting for a Chaplain position, be sure to complete the application in as detailed a manner as possible. 2. When you send in a resume, the following are absolute MUSTS: Choose a format. Word for Windows has several. Be detailed. Dates and where you worked previously are necessary. Why you left the position is helpful. We understand if you were to say, “It was not a good fit.” I prefer a list of at least 3 references. Since this is hospice chaplaincy, a cover letter that explains your calling to chaplaincy, your experience in chaplaincy, the reason you want to work at a hospice, if you are moving from another venue of chaplaincy to hospice tell us why. If you cannot clearly state a sense of calling, that may be a red flag. 3. Should you be selected for a face to face interview, please follow these guidelines: Have an ‘elevate’ speech detailing who you are. It should take 3 minutes. When answering questions take a moment to reflect on what you are about to say, then say it. The way you respond to a difficult question will give us some insight into how you will respond to a difficult situation in a hospice pastoral care scenario. Give real life anecdotes to illustrate your points. Do NOT ever use racial, ethnic, or gender slurs. That will immediately disqualify you even though the interview may proceed. Smile … appear relaxed. Again, this will let us know how you will respond in a pastoral care scenario. 4. After the interview, send a “Thank you” email. That will let us know that you have manners and are professional in your business dealings. After all, no one owes you an interview. 5. If you are invited for a second interview, we are looking for even more of a professional manner of response. We are looking for further clarity on issues. It could be that there are one or two matters that are unsettled in our minds and we are looking to you for more information. 6. And, finally, throughout the process we are looking for someone polished, gracious, professional, and skillful. And, if you follow the above, you have a great chance of getting a chaplaincy career position. If you have any questions about resume writing, cover letter writing, or guidance in how to interview, please contact me at firstname.lastname@example.org.
Monday, November 10, 2014
It is rare that I will write something about myself, but I thought today would be a good day to do it. As you know, I am a huge believer in self-care. I try to keep it simple and understandable, but also, real. I've read and I'm sure you have read many articles about self-care that give complex and complicated directives about taking care of yourself. I prefer something a bit more simple: eat right, excercise, pray, worship with others at your faith community, get the rest you need, enjoy your relationships, take nothing and no one for granted, express appreciation, be positive, serve others. These are just a few priorities that keep my life centered. With that said, I want to share with you my ever present goal ... to run and finish my first, ever 5K. Cornerstone Hospice is hosting a Vets and Pets 5K Run/Walk on November 22. If you are interested in this event please visit: www.signmeup.com/100962 The fact is I've never run a 5K. I have been working up toward this and think I can get it done. What are you attempting that you've never done? Let's share our hopes and ambitions for self-care. It will make us better Chaplains!
Friday, November 7, 2014
Since we are hosting quite a high number of international guests to Embraced By The Heart of Hospice, please email me or leave a comment to inform me on topics of particular interest to you and your work. This blog was created to enhance the work of chaplaincy across the world. It seems to be attracting a great audience. Thank you for visiting. Let's develop a great relationship!
Thursday, November 6, 2014
As we are headed for the holidays, many families and caregivers will the pain of the loss of their loved one. There will be one less chair at the table. Emotions will be frayed. The holidays have the potential for emotional setbacks. Sue Wintz, Editor of PlainViews, gives practical thoughts on Getting Through the Holidays… Getting Through the Holidays: What About Spiritual Distress? By Sue Wintz Any holiday can be a difficult one for a variety of populations, and this season of the year with so many holidays happening close to each other can be especially so. • For those who are grieving, This Emotional Life on PBS.org has an article written by those who are bereaved; the MISS Foundation has a page devoted to "Transforming the Holidays and Holidaze" with articles and suggestions. • Cancercare provides information for family caregivers of those living with cancer on how to cope and adjust one’s expectations during holidays and special occasions. • The Alzheimer’s Association provides downloadable holiday tips for caregivers while ElderCare Link has "10 Tips for Coping with Caregiver Blues During the Holidays." • Discovery Health’s mental health section focuses on "How to Get Through The Holidays Stress-Free With Your Family." • Social Work Today has a 2011 archived article, "Divorce and the Holidays – Putting Children First," while PRWeb has "5 Tips for Surviving the Holidays When Going Through a Divorce." • Keeping You Well provides advice for diabetics, and WebMD offers tips on those who are seeking weight loss. Of course there are many more sites, and many more populations that would likely benefit from a quick, practical checklist of ways to manage the emotions that arise during the holiday season. But while they all hint at ways to find new ways to prepare for and endure the holiday season, I found little that specifically addressed the spiritual issues that arise. For example: • How does one who is grieving find a sense of meaning when joyful holiday songs are being played everywhere they go? • How does someone whose holiday ritual is attending religious services cope when they are hospitalized and unable to participate? • When diagnosed with a life-threatening or terminal illness, what are ways that person and their loved ones confront and discuss the fact that it might be their last holiday season? • What ways can caregivers of dementia patients who are wrestling with the memories of how their loved ones used to be before their illness seek hope in the present reality? As chaplains and health care providers, what are the ways that we manage these situations that often reveal deep spiritual distress? Do we simply hand out “Making It Through The Holidays” lists that others have prepared, or do we create ones that directly address the spiritual needs that occur? As the holidays approach, this is a project that can be valuable to chaplaincy practice and how departments prepare for a clear and specific way of providing care to those who are in their setting. What list would you create?
Tuesday, November 4, 2014
A key element to productive, healthy interpersonal relationships is communication. Communication encompasses both listening and speaking. Someone wisely said, “God gave us two ears and one mouth.” Learning to listen is one of the greatest challenges we will face in our work as Clinical Chaplains. Learning what to say is a close second. This chapter is designed to be interactive, as well as, informative. Let’s tackle listening first. Through my days in CPE I was taught much about listening… active listening and interactive listening. Distinguishing between them was not particularly difficult. What was difficult was clearing my mind so I could hear what was being said. What are some barriers to listening? Michael Webb presents “Eight Barriers to Effective Listening”. We will look at five of these barriers: 1. Knowing the Answer--"Knowing the answer" means that you think you already know what the speaker wants to say, before she actually finishes saying it. You might then impatiently cut her off or try to complete the sentence for her. Can you imagine the reaction of a spouse suffering with anticipatory grief who has longed to unpack painful feelings only to be cut off? Pastoral care will suffer greatly. 2. Trying to be Helpful--Although trying to be helpful may seem beneficial, it interferes with listening because the listener is thinking about how to solve what he perceives to be the speaker's problem. Consequently, he misses what the speaker is actually saying. One of the primary purposes of active listening is to discern the “question behind the question” or the “pain behind the statement”. A Chaplain cannot discern anything if he/she is trying to come up with a solution to a perceived problem. 3. Treating discussion as competition—Have you been in a conversation (apart from your work) and spoke about a time of illness or surgery? You were trying to make a point, but the other person interrupted and shared their story. It appeared they were playing a game of ‘one-upmanship’. You said one thing and they were going to see your story and up the ante by telling you theirs. The point you were trying to make got totally lost. You were left wondering why you even brought it up. We are not in competition with our patients. Hospice Chaplaincy is about the patient and family, not about us. We go in to the patient with a blank slate and let them fill it in. 4. Trying to influence or impress--Because good listening depends on listening to understand, any ulterior motive will diminish the effectiveness of the listener. Examples of ulterior motives are trying to impress or to influence the speaker. A Chaplain who has an agenda other than simply to understand what the patient is thinking and feeling will not be able to pay complete attention while listening. Since one of the goals a Chaplain has in a pastoral encounter is to be ‘present’ with the patient, letting the mind wander trying to come up with a cogent come-back destroys the essence of listening. 5. Reacting to ‘red flag’ words—One of the key differences between a Chaplain and a parish Pastor should be/needs to be found at this point. We, as Chaplains, are not the keepers of the faith. We are not called to correct, but to support. When a Wiccan speaks of “Sunnyland”, we don’t react. When a Buddhist says, “We do not believe that this world is created and ruled by a God," we don’t’ react. When a Muslim expounds the Five Pillars, we don’t react. When a Catholic or Presbyterian or Methodist or Baptist or Episcopalian patient shares their view of the after-life and it differs with your beliefs, the Chaplain does not react. The Clinical Chaplain recognizes that the journey of the patient is his or her own journey. The patient’s belief system is just that… the patient’s belief system. Our agenda is simple… to serve the patient. The Clinical Chaplain does not suffer from religious counter-transference which fills the pastoral encounter with the Chaplain’s own anxiety. How does a Chaplain keep from stumbling over the barriers to effective communication? In short, the Clinical Chaplain is self-aware. If the Chaplain struggles with ego issues, he/she might fall prey to “trying to influence or impress”. If the Chaplain struggles with insecurity, he/she might fall prey to “reacting to red flag words”. If the Chaplain struggles with a competitive personality, he/she might fall prey to “treating discussion as competition.” Getting oneself out of the way so that listening becomes a reality is every Clinical Chaplain’s challenge. I was taught an analogy in CPE called “The Window.” This lesson provided a simple means to evaluate myself and where I was emotionally. I used this simple tool prior to the work day and, in some cases, prior to spiritual care visits. I hope you find it useful, too. The Window The Window is an analogy designed to provide insight into our feelings/emotional state. Let’s examine the parts of a window. There are window panes, one of which can be raised and lowered. Have you noticed that the windows in your house often attract smudges? The same thing happens with our emotions. We take on smudges when we have an argument with our spouse, when finances cause stress, when our children have problems, when someone criticizes us, when someone is rude to us, when another driver cuts us off or flips us off. Each day our Window gets smudged. As we can’t see clearly through a glass window, a smudged personal Window prevents us from “seeing” what a patient is saying. Look at your personal Window. What smudges are on it? Clean them off. How? You have options. Use them. Not to have a clean Window means you carry into every pastoral encounter a distracted presence. You can’t “see” what the patient is saying. You’re distracted. Your insight is blurred by the “stuff” of your own life. An effective Clinical Chaplain self-assesses so that his/her visits are devoid of “stuff”. In addition to the smudges, is your Window up or down? Just as an ‘up’ window at home allows a free flow of air, an ‘up’ Window allows a free flow of ideas and communication. As a ‘down’ window at home limits air flow, a ‘down’ Window limits communication. What will cause a ‘down’ Window? Such things as intolerance of others’ belief systems, hidden anger toward other religious systems, bitterness at life or God or someone else, and any other dysfunction that remains unhealed. So, check your Window before you attempt a pastoral encounter. The beneficiary of your self-assessment will be the patient, as well as, yourself. I emphasize, communication is the key that unlocks the door to deep and meaningful pastoral encounters. Becoming a skilled communicator takes work and a growing understanding of the field of communication.
What are the issues behind conflict? •A conflict is more than just a disagreement. It is a situation in which one or both parties perceive a threat (whether or not the threat is real). •Conflicts continue to fester when ignored. Because conflicts involve perceived threats to our well-being and survival, they stay with us until we face and resolve them. •We respond to conflicts based on our perceptions of the situation, not necessarily to an objective review of the facts. Our perceptions are influenced by our life experiences, culture, values, and beliefs. •Conflicts trigger strong emotions. If you aren’t comfortable with your emotions or able to manage them in times of stress, you won’t be able to resolve conflict successfully. •Conflicts are an opportunity for growth. When you’re able to resolve conflict in a relationship, it builds trust. You can feel secure knowing your relationship can survive challenges and disagreements. I have observed that most people do not like the pain of conflict. But, who is responsible for attempting to resolve the conflict? Pride often gets in the way of conflict resolution. The picture that comes to mind is of two people with arms crossed separated from each other by more than just several feet. They are separated emotionally. They glance at one another hoping the other would offer an olive branch. However, neither does and the conflict deepens until at some point what initiated the conflict is no longer even remembered. This cannot happen in a work environment. If a Chaplain is in conflict with a co-worker, there are expectations the co-worker has of him or her. There is the expectation that because the Chaplain is a minister that a minister will be the first to attempt resolution. Right or wrong, that is the perception. People have great expectations of ministers, don’t they? Unfair? Perhaps, but that is the general feeling among non-ministers. There are values that ministers share: Love for people; Desire to serve people; Passion for our work; We love to please others; We do not like conflict. While hardly an exhaustive list, these are part of a core set of ministerial values. I state this with the intention of presenting an approach to conflict resolution: The Win-Win Approach. The Win-Win Approach to Conflict Resolution Is the person with whom you are having conflict your opponent or your partner in the cause of hospice? The win-win approach says, “I want to win and I want you to win.” This statement is not easy to come to when in a high stakes conflict. However, if there is to be a win-win, then several things must be present in your demeanor: •Self-awareness/Emotional Intelligence—What emotional baggage am I influenced by in this conflict? Is there unresolved conflict that is influencing my emotions? Is there other ‘stuff’ influencing me at this moment? •Needs—What are my needs in this conflict? Must I win at all cost? Do I own any of this conflict or am I a victim of the other person’s need for power and control over me? Your answer to that question will determine if you really want a win-win or win-lose outcome. •Big picture—What is the bigger picture? Am I and my need to win this conflict bigger than the bigger picture? The answer to that will determine if conflict resolution is even possible. What are the needs of the person with whom I am in conflict? Have I considered his or her needs? It’s a good thing to do if you desire a win-win outcome. •Target of attack—In approaching conflict, the target is key. Recently, I came upon a prosecuting attorney who told me that before each trial, she had to develop a hatred for the accused in order to be convincing to the jury. I found that odd as this person described herself as a deeply devoted Christian. However, when there is a conflict, those involved seem to take a similar posture. Hopefully, they don’t hate each other, but certainly there is enough personal attack to go around. The win-win approach has as its target the problem, not the person. “Solve the problem at hand, salvage the relationship if at all possible” is the motive behind the win-win approach. There are other approaches to conflict resolution, but the win-win approach seems to fit the focus of this study. Humility, ownership of responsibility, and integrity on the part of the Chaplain will go a long way to resolving conflict. Does this suggest a “happily ever after” outcome? Absolutely not! There are situations when a conflict has deteriorated a relationship to the point that a working relationship is no longer possible and one of two options exist: re-assignment or resignation. Re-assignment brings relief, albeit, temporary relief because there will be new people and new conflicts. The key benefit of re-assignment is that is gives time for healing and rekindling of passion to succeed in the work of chaplaincy, and it also brings the sense of reality in that there is an awareness that no one can go from one re-assignment to another to another. That type of thing leads to the belief that conflict resides with the person re-assigned. Resignation ends the relationship permanently with no hope of resolution. This is a last resort measure. Resignation fosters the following: victim mentality, self-righteousness, avoidance of responsibility, future problems with relationships, let alone unemployment. No, resignation is not the best solution. If you are in a conflict, seek resolution. The work of the hospice Chaplain is too important to have the anchor of unresolved conflict pulling it down. Conflict drains you of necessary emotional energy. If you can’t resolve it, seek assistance from your manager or HR representative. Whatever you do, do not build a cadre of supporters who will choose up sides. That is unprofessional and simply wrong. Carry yourself as the minister you are and keep your reputation unsullied.
Monday, November 3, 2014
It is inevitable that you will experience conflict with someone close to you. Conflict happens at home with your spouse, your children, in-laws, or other family members. At work you might lock horns with a manager, colleague, and, perhaps, a patient or family member. The purpose of these posts is to explore conflict and suggest means to resolve it. Part One is about the basics of conflicts. I am sure you will identify with much of what is written. Conflict arises from differences, both large and small. It occurs whenever people disagree over their values, motivations, perceptions, ideas, or desires. Sometimes these differences appear trivial, but when a conflict triggers strong feelings, a deep personal need is often at the core of the problem. These needs can be a need to feel safe and secure, a need to feel respected and valued, or a need for greater closeness and intimacy. The culture of 2014 is filled with tension and fear. People today fear failure, losing their job, and societal issues (such as, healthcare or lack thereof; the economy; terrorism). Your colleagues come to work every day carrying emotional baggage from any number of sources. Perhaps it was an argument with a spouse or teenaged child, or awareness that their personal finances are not doing well, or a concern that their car might not make it through the day and repairs are unaffordable, or from some other stressor. They are emotionally vulnerable. It would not take much to push them over the edge. You’ve noticed they are distant or at least not like themselves. Their words are few, their sentences short. They don’t make eye contact much if at all. When they talk about the company it is negative. Nothing is good. It is all bad. Their perception is that no one cares about them. And, then, it happens. The wrong thing is said or something is said with a tone that conveys a harsh message. Their defenses shred. And, they react. A conflict is birthed. Part Two will focus on the issues involved in conflict and an approach that hopefully will result in a win-win resolution.
Friday, October 24, 2014
Christy Matta, M.A., writes with clarity about stress reduction and stress management. Her insights on the 5 Signs of Emotional Exhaustion at Work caught my eye. The work of the hospice Chaplain is heavily emotional. A Chaplain that does not practice self-care is a sitting duck for emotional exhaustion. Chaplains MUST engage in self-care or fall prey to a potentially career ending crash. http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=48310&cn=117 o Negative Feelings: Frustration and irritation at work are common when you're emotionally exhausted. Your frustration might be focused on parts of the job, coworkers behavior, or job politics and bureaucracy. o Feeling Pressured and Out of Time: When we're emotionally exhausted we don't have the resources to handle the pressures of the job. You might find yourself feeling pressure to succeed, without time to finish your work or do a good job or without time to plan for your day and proactively deal with work demands. o Negative Thoughts: Our thoughts are closely linked to our feelings. When we're feeling bad, we're also often thinking negative thoughts. Thinking "I'm alone," having overly judgmental thoughts towards your co-workers or the organization or thinking harsh thoughts about yourself are all common signs of emotional exhaustion. Thoughts that "I shouldn't have to deal with this" "this is unfair" or "my coworkers/supervisors/management are incompetent" are judgmental thoughts that might be a sign of emotional exhaustion. o Strained Relationships: Feelings of isolation and negative thoughts about coworkers, supervisors and administrators can leave you with strained relationships at work, adding to feeling isolated and unappreciated. o Counterproductive Work Behaviors: When you're emotionally exhausted, you may feel drained or depleted and find that you are more emotional at work. When you're emotionally exhausted, you may lose the ability or desire to resist temptation. As a result, you may end up acting in ways you otherwise wouldn't. Do you find yourself acting in ways that undermine your colleagues or the company for which you work? Examples might include anything from stealing, or fraudulent behavior to purposeful tardiness and avoiding safety measures. Steps to healthy self-care: 1. Recognize you are in the throes of emotional exhaustion. 2. Talk to someone you trust about it. 3. Make any adjustments you can. 4. Take a few days off. 5. Evaluate how you spend your off hours. 6. Do something that gets your mind off of work. 7. Feed your spirit. 8. Talk to someone you trust. (not a repetition, just an emphasis) 9. Get your body moving. 10. Learn to relax. Most Chaplains don’t know how to do this well at all. Blessings, Chaplain friends. My model for ministry is Jesus Christ. He said to his weary disciples in Mark 6:31, “Then, because so many people were coming and going that they did not even have a chance to eat, he said to them, “Come with me by yourselves to a quiet place and get some rest.” When your work is such that you meet yourself coming and going, it is time to rest and to eat. For the glory of God and the inner healing of man …blessings upon you.
Tuesday, October 21, 2014
Spiritual Care Week Recognizing the Work of Hospice Chaplains Great Chaplains are reliable, dependable, proactive, diligent, great leaders and great followers... they possess a wide range of easily-defined—but hard to find—qualities. A few hit the next level. Some Chaplains are remarkable, possessing qualities that may not appear on performance appraisals but nonetheless make a major impact on performance. Here are five qualities of remarkable Hospice Chaplains: 1. They subscribe to the “whatever it takes” philosophy in getting their work completed. Yes, caseloads are high. Yes, patient and family needs are pressing. Yes, driving distance never gets shorter. Yes, there are new Medicare mandates for documentation. Yes, their time is continually requested for projects, committees, and such. But, they get it done … whatever it takes. 2. They’re eccentric… As some have said, they are the “God Squad”. Their personalities are unique. Their value systems are well defined. Their manner of living is their own. Their sense of humor is dry, happy, funny. They are wonderful. 3. They publicly praise… Because they do great work, they receive praise. However, they also recognize the work of others. They speak words of admiration and respect at IDT and in other public settings where their words have added significance. 4. And they privately complain. Words have power… to build and destroy. Chaplains recognize their standing in the IDT. They complain privately which maintains their reputation as a builder. 5. They advocate. They advocate for patients when no one else will. They advocate for ethics, peace, IDT unity … There is so much more that makes up a great Chaplain. The above are the nuances of great chaplaincy. I am honored to be their leader at Cornerstone Hospice & Palliative Care, Inc.
Wednesday, October 8, 2014
Peter Marshall was an amazing Presbyterian minister who was the U.S. Senate Chaplain from 1946-48 during the presidency of Harry Truman, and died in 1949. He was born in Scotland and was known for his passionate preaching and deep conviction. All of his sermons were written out so that we have the original texts he created and can appreciate and once again be stirred by his intense love of God. The Keeper of the Springs Once upon a time, a certain town grew up at the foot of a mountain range. It was sheltered in the lee of the protecting heights, so that the wind that shuddered at the doors and flung handfuls of sleet against the window panes was a wind whose fury was spent. High up in the hills, a strange and quiet forest dweller took it upon himself to be the Keeper of the Springs. He patrolled the hills and wherever he found a spring, he cleaned its brown pool of silt and fallen leaves, of mud and mold and took away from the spring all foreign matter, so that the water which bubbled up through the sand ran down clean and cold and pure. It leaped sparkling over rocks and dropped joyously in crystal cascades until, swollen by other streams, it became a river of life to the busy town. Millwheels were whirled by its rush. Gardens were refreshed by its waters. Fountains threw it like diamonds into the air. Swans sailed on its limpid surface, and children laughed as they played on its banks in the sunshine. But the City Council was a group of hard-headed, hard-boiled businessmen. They scanned the civic budget and found in it the salary of a Keeper of the Springs. Said the Keeper of the Purse: “Why should we pay this romance ranger? We never see him; he is not necessary to our town’s work life. If we build a reservoir just above the town, we can dispense with his services and save his salary.” Therefore, the City Council voted to dispense with the unnecessary cost of a Keeper of the Springs, and to build a cement reservoir. So the Keeper of the Springs no longer visited the brown pools but watched from the heights while they built the reservoir. When it was finished, it soon filled up with water, to be sure, but the water did not seem to be the same. It did not seem to be as clean, and a green scum soon befouled its stagnant surface. There were constant troubles with the delicate machinery of the mills, for it was often clogged with slime, and the swans found another home above the town. At last, an epidemic raged, and the clammy, yellow fingers of sickness reached into every home in every street and lane. The City Council met again. Sorrowfully, it faced the city’s plight, and frankly it acknowledged the mistake of the dismissal of the Keeper of the Springs. They sought him out of his hermit hut high in the hills, and begged him to return to his former joyous labor. Gladly he agreed, and began once more to make his rounds. It was not long until pure water came lilting down under tunnels of ferns and mosses and to sparkle in the cleansed reservoir. Millwheels turned again as of old. Stenches disappeared. Sickness waned and convalescent children playing in the sun laughed again because the swans had come back. Do not think me fanciful, too imaginative or too extravagant in my language when I say that I think particularly of our Chaplains as Keepers of the Springs. The phrase, while poetic, is true and descriptive. They spread spiritual warmth…its softening influence…and however difficult the ministry to patients and families might be, they do their labor of love selflessly. Bless you, Chaplain Friends, as you keep the springs of hope, love, comfort, and peace alive in the hearts of those at the end of life.
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Adaptability: The #1 Characteristic Most Needed in the 21st Century Without question, change is the mantra of the 21st century. There have been major changes in hospice regulations: decrease in re-imbursement rates, higher demands for documentation from Medicare, regulations galore, and pressure to perform and survive. These types of changes have brought incredible stress to the leadership of hospices across the nation. Some hospices have not been able to survive. In fact, the myths associated with hospice have taken on a life of their own. From physicians to potential patients and their families, poor information is winning the day. In the IDT meetings the stress of regulatory oversight is taxing nurses with more documentation than they have had to deal with in previous days. And, more is expected of Chaplains regarding documentation and performance standards. In the not too distant future hospices will be reimbursed based on their scores on a family satisfaction survey. The scrutiny is unlike at any time in American hospice history. The IMPACT Act will require hospices to be surveyed once every three years to make sure the organization is competent and efficient. The Chaplain is the soul and conscience of the IDT. I have noticed that as the Chaplain’s demeanor goes, so goes the Team. That is a very broad statement but I believe it is true. The Chaplain has the power of influence. He or she usually opens an IDT meeting with an inspirational presentation and prayer (in many cases). The Team looks to the Chaplain for stability and strength. Our Chaplains are doing a great job supporting their Teams by actively caring for the Team members and through ancillary actions such as The Blessing of the Hands, Celebrations of Life, Memorial Wreath, and the daily work which highlights their clinical skills. The underlying element that makes the Chaplain so effective with the IDT is the characteristic of adaptability. When change is announced or experienced, adaptability requires a calm demeanor as evidenced by a relaxed facial expression and body language. If there is a need for a decision, the Chaplain will remain poised and use his or her wisdom in making a decision. In conclusion, change is upon us. This is not a new phenomenon. The question boils down to "will you be flexible and adaptable?" Bless you, Chaplain Friends, in your great work.
Tuesday, October 7, 2014
I can remember the days when I first started in hospice chaplaincy. No one taught me how to document my visit. While we used the FAIERS note, I didn’t know what was expected. In Toward Excellence In Spiritual Care, the Chaplain handbook I wrote for our hospice, I left nothing to chance. In the current Medicare environment every discipline must write a Clinical Note that defines the visit. The Note must paint the picture and explain what happened in the visit. There are 5 Critical Keys to Excellence in documentation: 1. Document pain. What did you observe about the patient and pain? What did the patient say her pain level was? Be sure to document the number out of 10 on the VAS scale. If the patient is not a dementia patient but is non-verbal use the FLACC scale. If the patient is a dementia patient, use the PainAD. 2. Document decline. Be sure to use “The Big MAC”. If you don’t know what that is, please see previous postings as it is fully explained. If you still need assistance please use the Comment section or for further consultation please contact me at firstname.lastname@example.org. 3. Document collaboration. Collaborating with the patient’s caregiver, facility staff member, hospice nurse or other discipline, becomes part of the record. One thing a minister/Chaplain will struggle with if he or she came into hospice from the pastorate is documenting collaboration. Pastors can be lone rangers and not collaborate as the Pastor/leader. In hospice care, the team concept is the philosophy. 4. Document the patient’s or caregiver’s response to visit. This piece memorializes the visit and can be used as part of your understanding of the patient’s spiritual or existential pain. After several visits you may notice a pattern that will greatly assist you in providing proper care. 5. Document your subsequent visit time frame. It is best to set a time frame with the patient or caregiver at the close of the visit. Remind them that you will call to confirm the next visit with them. Being forward looking provides hope for the patient and reassurance for the caregiver. One thing never to do is to forget a visit. Call if you will be late, but never forget a visit. Use your Scheduler as your daily guide to who you visit. These keys will hold you in good stead with the patient and family. Bless you, Chaplain Friends, for your hard work.
Friday, October 3, 2014
3 Commitments the Hospice Chaplain Makes The fundamental foundation of Outcome Oriented Chaplaincy is built upon three commitments: 1. Accountability—Never has this commitment been more important than now. Hospice, in general, is in the midst of the throes of multiplied changes in the Medicare re-imbursement structure. More is being required of all disciplines. Chaplaincy is not excluded. Therefore, accountability must take the forefront in the ministry of the Chaplain. Holding ourselves accountable means we make a commitment to our employer. Our employers have a right to expect the Chaplain to make a positive difference in the lives of patients and families. For this reason alone, I re-wrote our Spiritual Plan of Care so the Chaplains may find success in identifying spiritual concerns, goals and expected outcomes of their work, and a plethora of interventions to make these pastoral encounters meaningful. 2. Best Practice—The hospice Chaplain is charged with the responsibility of knowing best practices to make his or her work effective and efficient. Caseloads are larger and expectations are higher these days. There is no such thing as a one-size fits all methodology to hospice spiritual care. The Chaplain must take the initiative to grow in the field by reading, attending events, and personally interfacing with other Chaplains to discover better ways and means to serve patients and families. 3. Collaboration—The basis of collaboration is invitation. The hospice Chaplain invites the IDT to discover the fundamentals of hospice chaplaincy. This is done in a number of settings: the IDT meeting where the Chaplain is an active participant and educator of the staff; personal interactions with the staff when engaged with a patient; and in telephone conversations with staff members alerting them of potential crises. The Chaplain’s personal manner will go a long way to make collaboration a key component of his/her work. Collaboration is a piece of the Clinical Note the Chaplain writes these days, so this is not just a theoretical concept, it is one that is measured. Blessings, Chaplain Friends, as you conduct your ministry. You have a great responsibility. Carry it out faithfully.
Thursday, October 2, 2014
Emotional Intelligence is a newer term that has absolutely grabbed hold of the human resources world and business world. And, it makes sense as EI or EQ whichever you prefer has a good bit to do with how an employee perceives him/herself as well as others. It is built upon the concept of self-awareness. You, as a Chaplain, ought to be very familiar with the concept of self-awareness since having up to 1,200 or 1,600 hours of supervised clinical training through Clinical Pastoral Education. A lot of CPE is based on self-awareness. Self-discipline and discernment are also key elements of EI. A fun EI test to discover your level of emotional intelligence is found at this site: http://www.queendom.com/tests/access_page/index.htm?idRegTest=3037. I completed it and found that while I had a high level of EI, there was much I could do to grow. This ‘test’ would make a good discussion starter in Chaplain meetings. There are three benefits a Chaplain will gain from improving EI: 1. Emotional Intelligence helps us to “read a room”. How many times have you been in a patient’s hospital, facility, or other room with family and friends in it and the dynamics were both subtle and obvious. What were you learning about those persons surrounding the patient? What did you think was happening with the dynamics? Did this information assist you in relating in a more effective manner with the family? The hospice Chaplain must be keen in this skill. 2. Emotional Intelligence helps the Chaplain to be aware of his or her own emotions and not let them ruin a visit. There will be those times when it would be very easy for the Chaplain to get caught up in an emotional situation and lose effectiveness. As I interviewed a candidate for a position, I noticed that in discussing the loss of his father, he broke down and wept. It was clear his mourning was not complete. This really could get in the way of his work with family members who were in the process of losing their father to death. A Chaplain must be aware of his emotions or risk losing his ability to serve. Now, I am not saying that a Chaplain cannot weep with those who weep. I am saying that transference and projection are not acceptable for the Chaplain. 3. Emotional Intelligence helps the Chaplain understand the emotions of the patient and family/caregiver(s). People need to feel understood. People, at times, exhibit strange emotions. People at end-of-life are allowed to exhibit challenging emotions. If the Chaplain cannot understand the patient or the family caregiver, then an opportunity to assist these folks is lost and their inner peace is at risk. The hospice Chaplain has a lot riding on her connection with the patient or family member. When the Chaplain connects and conveys understanding and shows it with appropriate body language, the patient feels able to unburden a potentially deeply burdened soul. As you can tell, we have barely scratched the surface of this topic. I encourage you to do your own study and exploration of this topic. It is broader and deeper than I imagined. And, Chaplain Friend, bless you as you live out your ministry.
Wednesday, October 1, 2014
Please celebrate with me the milestone of 1,000 visits to Embraced By The Heart of Hospice. This work is my effort to place the focus on the great work of hospice chaplains and hospice chaplaincy in general. Thank you so very much for your visits to this blog!
Monday, September 29, 2014
Whenever I teach a session on Outcome Oriented Chaplaincy, there are the incredulous who think that this takes the ‘heart’ out of hospice care. Nothing could be farther from the truth. What’s at the heart of Outcome Oriented Chaplaincy is spiritual care that is both insightful and high quality. The following are three great benefits of Outcome Oriented Chaplaincy: 1. OOC provides a Spiritual Plan of Care that identifies the spiritual concern(s) of the patient AND family/caregiver. At Cornerstone Hospice, a very progressive and highly successful organization, the Spiritual Plan of Care is OOC. The Chaplains identify the spiritual concern, and then discuss the outcome or resolution that the patient is seeking. The Chaplain uses his/her professional experience to select the proper interventions to use that will assist the patient to meet resolve the spiritual concern as much as possible. Likewise with the family/caregiver. Cornerstone is the only hospice I am aware of that has this dual focus on providing a Spiritual Plan of Care for patient and family/caregiver. The electronic record has the Chaplain complete the Care Plan for the patient in one section and the family/caregiver in a completely separate section of the Assessment. 2. OOC wins the approval of the IDT. In any IDT or in some cases, the IDG, is composed of highly trained participants: a physician (some certified in hospice and palliative care); a social worker (some are licensed, some are also counselors); volunteer specialists, bereavement counselors (some with a Master’s degree, others with a PhD); nurses (some with advanced degrees and now all must be certified in hospice and palliative care); and, CNA’s. The Chaplains at Cornerstone Hospice are required to have a Master’s degree in an appropriate field of theology and 3 units of Clinical Pastoral Education. As I understand the trending of requirements, at some point hospice chaplains will need to become Board Certified like our hospital counterparts. I say all of this to indicate that OOC promotes highly educated and skilled spiritual clinicians. Further, a hospice committed to OOC will have didactics to re-enforce the concepts that make OOC such an effective philosophy of care. 3. OOC develops skilled clinicians. Long gone are the days when a pastor would volunteer his/her time visiting the sick of a hospice. Hospice Chaplaincy is a recognized field of spiritual care by a number of cognate groups that have a specialty certification in Hospice and Palliative Care. If the goal is to assist patients to have a ‘good’ death, then it is fundamental to consider that the Chaplain must have the skills to identify and resolve spiritual/existential issues as much as possible prior to the patient’s death. The same applies to resolving the family/caregiver’s spiritual concerns. You can find more information about OOC in “Professional Spiritual & Pastoral Care” edited by Rabbi Stephen B. Roberts. This book is a classic for chaplaincy and is a collection of outstanding contributions by recognized leaders in chaplaincy service. Bless you, Chaplain Friends, as you make full proof of your ministry.