Wednesday, September 24, 2014

7 Essential Skills Every Hospice Chaplain Needs to Develop

Recently I taught as class for Spiritual Care Volunteers. As sessions normally proceed questions arise about the hospice Chaplain. One question was: “What is the difference between a parish pastor and hospice Chaplain?” Without taking much time from the main presentation I replied, “A hospice Chaplain is much like a medical specialist. Chaplains are specially trained in end-of-life spiritual care. The parish pastor is a generalist who knows a lot about many issues, but will refer to specialists who are more able to counsel people in marriage crisis, or financial crisis or in end-of-life crisis. When I had knee surgery I went to a specialist, an orthopedist, who knew what the problem was and how to fix it.” My plan for this article is list 8 essential skills a hospice Chaplain excels in to provide effective spiritual care. The list is not in order of priority. Skill One: Empathetic Presence. We looked at the topic of empathetic listening in the August 12, 2014, post. Endlink Resource for End of Life Care Education suggests that empathetic presence involves the following: “Active listening; Relaxed yet engaged body posture; Eye contact (when culturally appropriate); Reassuring touch (when culturally appropriate); Listening beyond or beneath the literal words said by a person to the deeper emotions, meaning, and needs; Empathetic presence may also involve a metaphorical “holding someone’s pain” as you are open-hearted but do not become overwhelmed emotionally; It may also ask you to laugh, be joyous, and not focus on illness, pain, or dying; In the face of comments such as “why is God making me suffer so?” or “I just wish this were over, I can’t stand it anymore” empathetic presence might include: Acknowledging their suffering; Saying you are sorry you don’t have the answer or solution; Providing reassurance of your (or the team’s) ongoing care.” Skill Two: Assist patients and families to adjust to their “new normal”. Regardless of the disease process, at end-of-life patients and families experience internal chaos of confused emotions, anticipatory grief, and spiritual pain. The hospice Chaplain can greatly assist through affirming that their experience is normal and expected. Further, the Chaplain can offer reassurance that the entire hospice care team will be there for them. Their “new normal” is a familiar experience to the care team and all that can be done to be supportive will be done. Skill Three: Dignity therapy. Max Chochinov developed this approach to providing a life review for patients. The We Honor Veterans program has a similar life review called the Veteran’s History Project. Both of these formal venues can place in the hands of the family and caregivers a powerful life review of their loved one. A life review can also be done in a more informal manner through a pastoral encounter. Whatever method the Chaplain uses to guide the patient through the life review the key is that the patient can express the highs and lows of life and any expression of regret or satisfaction with life. Skill Three: Meaning making. One of the vital issues patients at end-of-life work through is meaning making. What gave my life meaning when I was healthy? What gives my life meaning, now? These are powerful questions the scream for answers. You will be amazed at what a patient will say to these questions. Some answers will bring the Chaplain to tears. Skill Four: Hope/strength/comfort. These three values I placed together because they play off of one another. When a patient thinks through what gives hopes to their lives, they often receive new strength for their suffering and thus, comfort. There may be others who have entered their lives at some point in the past who made such a profound impact on them that a call, an email, or a letter will provide great strength and comfort. As a Chaplain, I looked for ways I could bolster hope in the lives of those I served. By contacting a university’s sports program, I was able to assist a patient who held the sport’s team and coach in high regard. In another case, a patient received a fishing trip which he talked about during the weeks preceding his death. We must have hope to live when healthy. We need hope to live when we are facing death. Skill Five: Helping the patient see things in a new light. This is a brief definition of reframing. Suffering brings about its own emotional trauma. The skilled hospice Chaplain can greatly benefit the patient by reframing the circumstances. For instance, a patient in an initial visit may be very shocked that his physician has told him that there is nothing else that can be done and hospice is the only option left. A sensitive Chaplain may reply to this by saying, “Your doctor may have told you there is nothing left to do for your illness, but we will do everything we can to bring meaning and hope to your life.” Compassion and common sense are keys to reframing. I read a passage in Mark Twain’s, Tom Sawyer, which makes me both smile and laugh at Tom’s brilliance at reframing a punishment he had rightly earned. He was given the task to whitewash 30 yards of fence on a Saturday while his friends all went to the local swimming hole. Tom’s friend, Ben, began to taunt him with his having to work. Tom’s reply is classic reframing. “What do you call work?” “Why, ain’t that work?” Tom resumed his whitewashing and answered carelessly: “Well, maybe it is, and maybe it ain’t. All I know is, it suits Tom Sawyer.” “Oh come, now, you don’t mean to let on that you like it?” “Like it? Well, I don’t see why I oughtn’t to like it. Does a boy get a chance to whitewash a fence every day? That put the things in a new light…” (Twain, 1970, [1876], p. 18) Skill Six: Perpetuating religious rituals. Most hospice patients have been out of their churches, synagogues, temples, or other place of worship for quite some time. Their souls long for ritual. The hospice Chaplain recognizes that and makes provision to either meet the ritual needs herself or will call upon a local Pastor, Rabbi, Priest, Monk, Imam, or other spiritual leader to assist. Skill Seven: Communicating with patients with a dementia. This is a topic dear to my heart as I have developed a means to do just that. John Zeisel wrote, “I’m Still Here: A New Philosophy of Alzheimer’s Care”. Having done my research and application of theory, I can attest that the patient’s being is still there. My perspective is simple, if the patient is still there, it’s our moral duty to go and find them by learning techniques to reach them. Each of the above skills has to be sharpened and practiced. These skills do set the hospice Chaplain apart from the parish pastor or even other types of Chaplains. These skills characterize the work of the hospice Chaplain affirming the unique contributions they make to healthcare. Bless you, Chaplains, as you provide comfort and care to those you serve.

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