Spiritual Care Crises: Who do I see first?

One thing the hospice Chaplain will soon discover is that handling crises is part the work of spiritual care. Whether the Chaplain visits patients in their home, facility, or hospice house managing crises will test the mettle of the Chaplain. Wisdom and information are two key elements in the process of triaging patients and their families. It would not be unusual for the Chaplain to receive emails or phone calls from the Case Manager Nurse informing the Chaplain that a certain patient has transitioned to actively dying and the family needs the Chaplain by their side … NOW. Add to that emails and calls from other CMs and even family members and the Chaplain’s day is now filled with crises. The Chaplain must then prioritize and triage based upon the following: acuity and intensity. Regarding acuity, the following questions seem to assist the Chaplain to develop a triage list of priority: What do I already know about the patient? When did I last see this patient? What is happening with the patient? family? What did I glean from my collaboration with the Nurse? Is this a difficult case that requires quick response? The concept of intensity is subjective, but that does not marginalize or minimize its importance. What did the Chaplain understand from the tone of the conversation with the Nurse? with the family member? When the Chaplain asked questions for clarity as to the acuity level (the Chaplain would never use that word with the family member) what was the response? At this point the Chaplain has enough information to make a decision on where on his/her visitation list this patient/family in crisis will fall. As the Chaplain works through the crises it will be naïve to think that a day filled with crisis will not tax the Chaplain emotionally and spiritually. At this point, the idea of self-care takes front and center stage in the Chaplain’s life. Many Chaplains come into the hospice environment from the parish pastorate. Often in the parish scene a pastor will not practice healthy self-care because of the demands of the congregation or their disdain for the pastor having need for self-care. Unpacking emotions with a colleague or manager is always a good first step. Some IDT’s have a debriefing session to support one another. Chaplains and other IDT members who follow the sage advice that reads, “We must care for one another. If we don’t take care of one another, how can we take care of our patients and families?” Hospice is built upon compassion, understanding, patience, support, encouragement and many other such concepts. We need one another in the IDT. There is no room for a “lone-ranger” attitude. The “lone ranger” will soon burn out. Triaging based upon the acuity and intensity will assist the Chaplain to develop a strategy to meet both patient and family crisis. Self-care will prevent attrition of the staff and build a deep bond of trust and strength within the IDT. Do you have examples of how you were overwhelmed with crises and how you handled it? Together, we can offer great ideas to support one another.