Friday, October 24, 2014

Self-care is NOT an Option

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. 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

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

A Message of Appreciation to Hospice Chaplains

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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The #1 Characteristic Most Needed in the 21st Century

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

5 Keys to Excellence in Documentation

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 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

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: 3 Benefits for Chaplains

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: 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

We are now over 1,000 visits!

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!