Tuesday, January 27, 2015
Providing Spiritual Care According to Disease Process: Cardiac
Providing Spiritual Care According to Disease Process: Cardiac Heart failure patients are a rapidly emerging hospice population. While cancer patients still comprise the largest disease group in hospices, they account for less than 50% of patients while a rapidly growing population is the group with heart disease (Caffrey C, Sengupta M, Moss A, Harris-Kojetin L, Valverde R. Home health care and discharge hospice care patients: United States, 2000, 2007. National Health Statistics. 2011;38:1–28). Cardiac disease is the second most prevalent medical diagnosis, accounting for 14% of hospice admissions nationwide, with heart failure being the most common designation (National Hospice and Palliative Care Organization (NHPCO) NHPCO Facts and Figures Hospice Care in America, 2012). Research indicates patients experience sustained symptoms of shortness of breath, edema, dry mouth, fatigue, pain, anxiety, sadness (Zambroski CH, Moser DK, Bhat G, Ziegler C. Impact of symptom prevalence and symptom burden on quality of life in patients with heart failure. European Journal of Cardiovascular Nursing. 2005;4(3):198–206) and depression that adversely impact quality of life (Bekelman DB, Nowels CT, Allen LA, Shadar S, Kutner JS, Matlock DD. Outpatient palliative care for chronic heart failure: A case series. Journal of Palliative Medicine. 2001;14(7):815–821). Importantly, depression is a common co-morbidity among heart failure patients that is frequently overlooked (Ferrell BR, Coyle N. Oxford Textbook of Palliative Nursing. New York: Oxford University Press; 2010). These salient points were brought together by Johanna Wilson, MSN, PhD Student and Susan McMillan, Ph.D., ARNP, FAAN in their article, Symptoms Experienced by Heart Failure Patients in Hospice Care, located in the Journal of Hospice and Palliative Nursing, February 1, 2013; 15(1): 13-21. The prepared Chaplain will listen for clues to indicate the patient is suffering from a depressed mood, anxiety, and/or sadness. From my experience with cardiac, hospice patients that tears often are part of a pastoral encounter. It seems that the patient experiences an intensification of negative or regretful events in his or her life. This can be termed guilt or shame. The wise Chaplain will use the expression of these feelings to explore what is behind the deep sense of remorse or guilt and seek to assist the patient to find absolution or resolution of the guilt. Since cardiac patient can feel isolated and have a need to be around people, the people most closely associated with the patient, the family, need to be educated by the Chaplain about the emotional and spiritual challenges the patient is experiencing. This education is to provide the family with understanding for what their loved one is going through that they may provide a strong support system. Should the Chaplain be called upon to pray for the patient, prayers dealing with the themes of hopefulness, well-being, the presence of God in the midst of suffering, God’s love, God’s mercy, God’s forgiveness, God’s taking our guilt and shame are all sources of comfort and encouragement to the cardiac patient. Listen, love, and enlighten both the patient and the family and your hospice chaplaincy will be blessed with this growing segment of the hospice population.