Monday, June 30, 2014
From time to time, a Chaplain will have a case that is complex. This is one reason why I am adamant that a hospice Chaplain have a minimum of 3 and hopefully 4 units of Clinical Pastoral Education. CPE prepares a Chaplain for the rigors of hospice chaplaincy. For many hospices one unit of CPE will suffice. In my opinion, that does an injustice to the patients and families. What, then, is CPE? CPE is a hands-on experience that incorporates such matters as pastoral formation and pastoral reflection in order that the Trainee develops a methodology of ministry that will provide spiritual care to persons of all faiths or no faith. The issue of religious countertransference is often an issue that requires hard work for the Trainee. CPE is a process. For this reason, there are four units of CPE required as a minimum for a Trainee to seek Board Certification. Each unit is comprised of 400 hours of supervised study and clinical practice under the guidance of the CPE Diplomate or Supervisor in Training or CPE Supervise (the language is unique to various cognate groups). The end result of CPE is a Chaplain who knows him/herself and has the means to identify those issues of his or her that could jeopardize the pastoral encounters with patients and families. Further, the CPE trained Chaplain possesses the ability to read what Anton Boisen, the founder of CPE, called the "living human document." One of the key reasons I endeavored to attain Board Certification, even though hospices do not require Board Certification or even more than 3 units of CPE, was to develop the skills necessary to benefit the patients and families I would serve. My Board Certification was earned through the Association of Professional Chaplains and the College of Pastoral Supervision and Psychotherapy. At this point, I find it valuable to state in a more detailed fashion what pastoral formation and pastoral reflection include. Pastoral Formation enables the Trainee to articulate an understanding of the pastoral role that is congruent with their pastoral values, basic assumptions, and personhood (312.1); demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a non-anxious and non-judgmental presence, and clear and responsible boundaries (312.6) Pastoral reflection enable the Trainee to establish collaboration and dialogue with peers, authorities and other professionals (312.7; demonstrate awareness of the Spiritual Care Collaborative Common Standards for Professional Chaplaincy (312.8); demonstrate self-supervision through realistic self-evaluation of pastoral functioning (312.9). Over the course of 1,600 hours of clinical work and classroom supervision, a Chaplain's theory and theology of pastoral care is very well developed. Therefore, based upon the preparation a Board Certified Chaplain has undergone he or she becomes able to work with the complex cases with other members of the care team as a fully participating partner all for the patient's good. In posts to come will be examples of my understanding of pastoral formation and pastoral reflection.
Friday, June 27, 2014
One of the great challenges a hospice Chaplain will meet is with the caregiver who is totally worn out. Patients suffering from dementia, Parkinson Disease, and any other debilitating illness require quite a bit of attention and care. Every spouse or family caregiver I have met is dedicated to providing the absolute best they can offer to their loved one. The demands placed upon caregivers sometimes wear the caregiver out. Caregiving expert Patricia Smith states, "Every day in our caregiving role we empty out in order to be present to those in our care. If we continue to empty out without filling up again, we place ourselves in harm’s way. Caregivers often misinterpret their need for selfcare as selfishness or self-centeredness." When this type of fatigue sets in a domino effect of emotions takes place: anger, frustration, and guilt do their deep damage to the heart and soul of the caregiver. Is there an answer? Yes and No. Every hospice is required to provide volunteers to meet a number of different needs: sitting with a patient for a few hours while the caregiver gets out of the house to run errands or just to get out to breathe in fresh air; to meet special needs spiritually, or to provide a sounding board for the caregiver, to name a few. Believe me, volunteers do a tremendous amount of work. Hospices could not function without volunteers. So, that is the Yes answer or at least a piece of it. The No answer has more to do with dysfunction and denial. There are caregivers who refuse the offer of a volunteer and feel that they alone are the only ones who can provide the care their loved one needs. Other caregivers refuse to make the time for their own doctor appointments and their health suffers. Their commitment of time is solely devoted to the needs of their loved one. Any offers of support group activities or the provision of respite care (another wonderful benefit of hospice) are denied. The members of the care team often collaborate on these more difficult cases in order to prevent further caregiver fatigue and health decline of the caregiver. According to Smith, caregivers can still be "healthy caregivers" by creating strong personal boundaries, adapting stress into relaxation and learning to practice daily self-care. They can also be empathetic and supportive of others' suffering without taking on the pain as their own. This is called "empathetic discernment:" the art of knowing personal and emotional boundaries, as well as making choices about what to care about. If you are a caregiver on the verge of burnout or if you know of a caregiver in such a situation and would like to discuss this, please contact me for a compassionate response.
Thursday, June 26, 2014
I grew up in a day when heroes and heroines were all the rage. There was John Wayne, the man's man. The man everyman wanted to become. Mother Teresa taught the world servanthood among the world's poorest. There are many other men and women I admire as great people, world changers. So, heroes and heroine's are part of the fabric of my life. There is a woman who I identify as the Heart of Hospice--Dame Cicely Saunders. I have been in hospice work nearly 10 years and one of my concerns is that since we have transitioned from a hospice movement to a hospice industry, we might be guilty of forgetting our roots. Dame Cicely is the mother of the modern hospice movement. I admire her for her compassion, her faith, her commitment to the most vulnerable among us, her indefatigable effort to advocate for the care of patients at the end of life. A story is told of how she went from being a nurse, to a social worker, to a physician. As a nurse she advocated for her patients at the end of life to the physicians. She was not heard by the physicians. She then put in the time and effort and became a physician herself. Her voice roared for the cause of patients and she founded St. Christopher's Hospice in 1967. Under Dr. Saunder's leadership hospice provided a holistic approach for caring for a patient's physical, spiritual and psychological well-being. This marked a new beginning, not only for the care of the dying but for the practice of medicine as a whole. Dame Cicely coined the term "total pain." This new term identified spiritual, existential, and psychological pain as part of the plan of care. In modern hospice care, the patient receives excellent medical care that will keep them out of physical pain. In addition, a degreed social worker and a skilled Chaplain provide care for the spiritual and existential pain from which the patient suffers. It is a total team effort to provide pain relief on every level. The entire hospice care team, called the Interdisciplinary Team, focuses on the needs of the patient. What a wonderful concept! As I reflect upon my many interactions with hospice patients I am so grateful for the privilege to serve patients at the most sensitive and vulnerable times of the lives. Were it not for the historic work of Dame Cicely Saunders hospice would not exist. Yes, Dame Cicely Saunders is a heroine for her work and for who she was a human being. .
Wednesday, June 25, 2014
One of my passions is to find ways to communicate with patients with AD and other dementias. For over 5 years I have researched methods and techniques to communicate spirituality to these patients. In future posts I will examine the role of the hospice chaplain as he or she interacts with the patient afflicted with a dementia. In preparing for a nation-wide webinar, "Communicating Spirituality to Patients with Alzheimer's Disease and Other Dementias", for the Association of Professional Chaplains, my study led to me to some staggering statistics published by the National Council of Certified Dementia Practitioners. These facts led me to conclude that dementia of all types will be the disease of the 21st century. The findings are as follows: By 2050, 11.5-15 million Americans will have a dementia-related condition. Currently, 24 million people world-wide have a dementia-related condition. By 2040, it is projected that 84 million persons will have a dementia-related condition. These figures arrest our attention. This informs my work as a spiritual care leader to recognize this disease is not going away and spiritual care providers must develop skills in communicating with these persons. One of the common themes in conversations with hospice chaplains when it comes to working with dementia patients centers on frustration in not knowing how to communicate. I have developed a toolkit,The Communication Care Kit , which contains the multi-sensory tools to enhance a spiritual care visit. There will more to say about this in future blogs. In conclusion, dementia is being diagnosed at a rapid rate. It is absolutely incumbent that the hospice chaplain learn how to communicate with these souls.
Tuesday, June 24, 2014
In a collaborative effort on the subject of the spiritual dimension of patient care, Drs. Christina Puchalski and Sharon K. Hull were joined by Robert Vitillo and Nancy Reller to publish an article in the Journal of Palliative Medicine (Volume 17, Number 6, 2014). The purpose of the article was to present a picture of events surrounding two international conferences that worked toward consensus on approaches to integrate spirituality into healthcare systems with a view to develop strategies to create more humane and compassionate systems of care. Because of the length of the article I am going to provide several quotes that highlight the value of spiritual care. “Data indicate that a focus on spirituality improves patients’ health outcomes, including quality of life. Conversely, negative spiritual and religious beliefs can cause distress and increase the burdens of illness.” These data inform our clinical spiritual care in that a hospice Chaplain approaches a patient with no agenda of his or her own, but actively listens to the patient with discernment for spiritual concerns. It is the patient, not the Chaplain that sets the agenda for the visit. “Too often individuals visiting health care facilities are seen as a disease that needs to be fixed quickly and cheaply rather than as human beings with complex needs, including those of a spiritual nature.” Chaplains often hear patient concerns of feeling overwhelmed, powerless, and anxious (to name but a few). Chaplains engage the patient at the point of pain. “During the 2013 International Consensus Conference, participants also were asked to review a Call to Action that was developed by the Fetzer Institutes Health Advisory Council. The purpose of the Call to Action was to start a platform from which to create a coalition to develop healthcare systems that are spiritual and compassionate.” My response to this: “Welcome to the great world of hospice!” It is hospice that has embraced Dame Cicely Saunders’ concept of total pain and build a system of medical care, social care, and spiritual care around it to alleviate the suffering of humanity at the end-of-life. I found this article energizing and encouraging because this is who we are as hospice.