Wednesday, February 25, 2015
At Cornerstone Hospice & Palliative Care, Inc. we use Spiritual Care Volunteers to provide extra support for our patients and families. We established this program of care because of the need and availability of our volunteers. It was obvious that many of our volunteers wanted further training so they could do their job better with patients. The training they requested had to do with spiritual care. At this time, we have over 40 trained SCV’s. What do they do? Here is a listing of their responsibilities: •Visit patients as assigned •Complete appropriate documentation •Maintain patient confidentiality •Confirm the religion and/or local church of patients (if applicable) •Call churches/clergy as needed •Provide Spiritual Care Services brochure to patient or family •Provide literature at the request of the patient or family •Meet the spiritual needs of patients •Provide referrals and other information for the Chaplain •Attend department training classes and meetings •Follow Policy and Procedures for hospital, hospice house, ALF, nursing facilities, and other facilities in which hospice patients are receiving care The training comprises 2 hours with a PowerPoint presentation. One of the issues that comes to the surface has to do with evangelism and proselyting. I remind our volunteers that there is a team of clinical staff, including a Chaplain, that is working with the patient. The Chaplain has been working with the patient and has a relationship of trust built. Should the patient have questions about the afterlife, the Chaplain would know and address the matter. Another issue that sometimes occurs has to do with counseling. Some volunteers fancy themselves as lay counselors who want to “fix” the patient prior to death. Again, this is not what we ask SCV’s to do. In one training class I led, there was a gentleman who had charts and algorithms he developed to counsel people. He did not have the educational background nor licensure to counsel. Our Volunteer Coordinator eased him out of our program. When you enlist the right people for the task, the blessings they provide are second to none. If you need help establishing this group, feel free to contact me at firstname.lastname@example.org.
Tuesday, February 24, 2015
When I was thinking of this topic, the first title that came to mind was “How are your phone skills?” A question like that begs for dumb answers. Instead, I want to provide a checklist of sorts with guidance that will help you build your caseload and build relationships with your patients and their families. 1. Preparing to call your new patients, your routine visit patients, or family members: a. Know by name who it is you are calling. Have the information in front of you. You have a number of people to call, so be certain. Be as certain as you can that the patient you are calling is still living. b. Find a location that is distraction free. Try not to call from a cube as you have no privacy. Never call at a restaurant or other public place. You will be violating HIPPA law. 2. Convey caring by, a. Your tone of voice. Does your voice smile? b. Providing a non-anxious voice presence 3. Expect a positive response a. Whatever you do, don’t talk yourself out of seeing the patient. b. Use this scripted approach: “Hello. May I please speak to Mrs. Jones? (Pause for response) , Hello Mrs. Jones, I am Rich Behers. I am calling as a member of the care team at Cornerstone Hospice. My role is to provide emotional and spiritual support. I would like to drop by later this afternoon to visit with you. Is 3 PM a good time for you?” You can break the sentences up or pause for any response as you need to. Whatever you do, speak slowly. There will be at least one more article on phone style. For now, practice these and your caseload will grow. Blessings to you, Chaplain Colleagues! Your work is sacred.
Monday, February 23, 2015
Managing a large caseload might very well rank as the largest source of frustration in hospice chaplaincy. It often seems that there are more patients at the end of the 30 days than there are days to see them. Being out of compliance is not an option. What is a hospice chaplain’s strategy? First, it begins within the Chaplain. Whatever the number of patients is, the Chaplain must have a can do attitude. A hospice Chaplain must grasp the reality that regardless of the size of the territory or number of patients there is a lot at stake. There is no doubt the task is daunting with new admits and death calls to make both of which narrow the time allotted to making the routine visits. It not only can be done, but must be done. Second, develop a strategy. The hospice Chaplain will find it workable if he or she will target a large caseload based upon geographical proximity. Putting it simply, find the clusters of patients each nurse is caring for. Find out when the nurse is visiting the patients and make your visits on a different day. It is never advisable to crowd the patient with more than one visit per discipline per day. Third, work your plan. If you are a home team Chaplain you must be determined to accomplish your goal. Visit the clusters of patients and do not get away from that. Certainly, there will be occasional emergencies, meetings, and funerals. But, that is the exception and not the rule. Stay with it. The facility Chaplain will park his or her car at the facility and make as many visits as time allows. Then off to another facility on the next day. For the Chaplain who has both home and facility patients, plan out your week with a good mixture of both. I recognize that the home Chaplain and home and facility Chaplain will struggle from time to time with a family “not cooperating” with your plan. It’s a part of the job that we will have to adapt to. This is the part that makes hospice chaplaincy so challenging. Fourth, see as many patients as possible at the beginning of the month and as many patients as possible through Wednesday of each week. I am sure you can understand the value of this. If your caseload is 55 patients and you are a home team Chaplain, seeing 40-45 patients in the first two weeks of the month will ensure you will have success in staying within compliance. Fifth, don’t go to seed on the quantity/quality debate. Some Chaplains argue that the quality of spiritually care is directly related to the quantity of time spent with a patient. That may or may not be the case. Regardless of the outcome of any debate, your task is to provide compassionate support for each patient. Spending over an hour consistently with each patient is somewhat excessive. Use your time wisely. Bless you Chaplain Colleagues in your work. You have a lot on your plate.
Tuesday, February 17, 2015
As I look back over the 100 or so postings, I am reminded that finesse in ministry can come only after a series of other things are firmly in place. One of those is a strong theology of ministry. My theology of ministry has its roots in the Person and Work of the Holy Spirit. Three words come to mind in my theology of ministry: Comfort, Counsel, and Companioning. These three components of my theology seem so necessary in hospice chaplaincy. My patients and their family members need comfort; at times they need counsel; and, always, need my companionship on their hospice journey. Do I dare to think that my Person and Work has the same authority as that of the Holy Spirit? I would be foolish to think so. Yet, I feel equipped to provide these aspects of spiritual care as a mature and seasoned Chaplain. Because I am settled and secure in my own faith journey, I am able to provide spiritual support to those of other faith groups. I do not compromise my belief system in order to do my work. Therefore, I am able to provide spiritual care to Christians, Jews, Muslims, Buddhists, Hindus, atheists, agnostics, Wiccans, and those who have other belief systems that are more secular. In reading Professional Spiritual & Pastoral Care, edited by Rabbi Stephen B. Roberts, Skylight Paths Publishing: Woodstock, Vermont, 2013, I came upon an illuminating article by Rev. Dr. Martha R. Jacobs. Her article is titled “Creating a Personal Theology to do Spiritual/Pastoral Care”. She states, “My theology has to be large enough to accept the theology of those whom I serve, where they be Christian, Buddhist, Jewish, Muslim, Sikh, Catholic, Humanist, or Atheist. If I cannot support a patient (or family member or staff person) in his or her theology, then I cannot serve as a multifaith chaplain, I need to be secure in my own belief system. I also need to be able to be open to understanding and interpreting [my patients’ theology] or that of family members, or staff persons with whom I come into contact. I have to be open to other people’s theology and help them through using their belief system, not my own.” Have you put to pen and ink your theology of pastoral care? Those of us who have gone through the rigors of Board Certification can reflect upon the hours of work spent thinking through and reflecting upon this subject and then putting those thoughts and reflections on paper. I urge you to take the time for this project. You and those you serve will benefit greatly from it.
Tuesday, February 10, 2015
I really appreciate your reading these articles. It's your turn now to share your views on the series "Providing Spiritual Care According to Disease Process." Simply click on "No Comments" and a window will pop up for you to write your comments. Thank you!
Friday, February 6, 2015
Providing Spiritual Care According to Disease Process: Cancer Some of the types of cancer hospice patients present with and which the hospice Chaplain will become acquainted are: lung, colorectal, prostate, female breast, bladder, pancreatic, gastric, liver, head and neck, and brain. This list is not meant to be exhaustive. When it comes to the emotional and spiritual needs of the cancer patient, there is a general term used to describe the patient’s suffering: distress. The National Comprehensive Cancer Network developed the NCCN Distress Thermometer for patients. Quoting the introductory remarks on the NCCN Distress Thermometer site, http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf, “Distress is an unpleasant emotional state that may affect how you feel, think, and act. It can include feeling of unease, sadness, worry, anger, helplessness, guilt, and so forth. Everyone with cancer has some distress at some point of time. It is normal to feel sad, fearful, and helpless.” When the Chaplain enters the dynamic of the patient’s environment he or she may identify from where the distress is manifesting itself. It will prove instructive for the Chaplain to review the actual Distress Thermometer at this location, http://www.nccn.org/patients/resources/life_with_cancer/pdf/nccn_distress_thermometer.pdf. The Chaplain may have the patient complete the Distress Thermometer assessment so he/she can get a better sense of where the patient is emotionally and spiritually. Two cases highlight the emotional distress cancer patients’ experience. I had the privilege of providing spiritual care to a gentleman stricken with prostate cancer. Without belaboring the medical aspect, the cancer metastasized and he was nearing end of life. He prided himself of his independence. Indeed, he was a painter and had many of his works in studios in various parts of the world. He was a traveler having taken many trips overseas. But, now, his world was his apartment at an ALF. There came a time when he hit the brick wall of realizing his life was short and his activities outside of his apartment would be curtailed. I was present when the hospice DME delivery service dropped of a walker, a cane, a wheelchair, and a potty chair. This patient was devastated. The Existential Slap (please locate this essay from the November 13 posting) hit him hard. He went into a depression. What brought him out of this depression was a short phrase in a conversation he and I had about a popular movie, The Bucket List. Since this man’s personality would not allow him to be held hostage to depression he began to make his bucket list. One of the events he wanted to initiate was a family meeting where he would have his adult grandchildren pull out the boxes of 35mm slides (for our current techie generation, slides were in vogue for many years prior to the digital camera) and reminisce about their overseas trips with ‘Grandpa’. The plan sounded good. On Christmas Eve I stopped by the ALF, knocked on this patient’s door, was greeted by his son and welcomed in. What I saw would make any heart glad. Slides were scattered on the floor, granddaughters laughing and telling stories as they held the slides up to catch the light. And, there he was… my patient seated in his chair, hands on his lap, eyes glued to the scene unfolding before him. He looked at me, nodded approvingly and welcomed me to the party. It was not too long after that Christmas Eve that his life ended. The keys to spiritual care with him involved empathetic presence, interactive listening, pastoral counsel, and a pet therapy dog. In regards to the pet therapy dog that visited the patient, further explanation should validate the value of this mode of care. In a recent study found in THE JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY,¬ January 2015, which can easily be accessed at http://www.oncologypractice.com/fileadmin/content_pdf/co/JCSO_Jan_2015_22_Fleishman.pdf the following gives credibility to the use of pet therapy dogs: Nonscientific qualitative responses to the intervention focused on 2 areas: the unconditional love that pets were seen as providing and the friendly dedication on the part of the pet owners. One patient was quoted saying, “Every dog visited me in the past few treatments and makes me feel good. It is such a good program.” Another patient had suggested that the AAVs [Animal Assisted Visits] be extended to others outside of the study: “It is such a great thing, it should be offered to everyone in the waiting room, not just to individual patients.” As patients became increasingly uncomfortable over the course of radiation therapy, experiencing pain, fatigue, skin lesions, and the inability to eat, swallow solid food, or to speak, the therapy dogs remained happy to see them, not seeming to notice any alteration in appearance. Patients also commented on the value of the human visitors. One patient said that she greatly looked forward to and relied on the support she received from the owners of the therapy dogs, but said, “People couldn’t have just come alone without their dogs – that would have been awkward and silly.” Another patient stated, “I greatly benefitted from the presence of the dogs. They dispelled my worries while I was waiting for my treatment.” My conclusion is that if your hospice has pet therapy dogs trained for this type of patient care it should be embraced as a part of your spiritual care. The second instance has to do with my sister who died of colorectal cancer. Her journey through this disease was fraught with debilitating nausea after each chemotherapy treatment and general malaise with intense pain. From diagnosis until death she had only a few months of life. It is unfortunate that she was not referred to hospice. She journeyed through this disease with just her spouse providing support. At the time, I was living and working over 1,000 miles away. She and I had at times long telephone calls that focused on her inner well-being and overall spiritual life. I visited with her a few times prior to her death. What I gleaned from this experience includes: hospice care should be made available to all patients faced with end-of-life diagnoses; spiritual care can be provided by family members; the spouse or other caregiver must be vigilant to advocate for the patient as there is not a hospice Team present to do that; and follow-up with the surviving spouse is utterly necessary. In the case of my brother-in-law, he grieved himself to death almost one year after my sister’s death. I would also counsel my Chaplain colleagues that officiating at the funeral of one of your family members may not always be the wisest things to do… courageous and compassionate, yes; wise, not always. I did conduct her funeral service. For me, deferring would have provided me the opportunity to grieve and mourn without the concerns of developing a funeral sermon and all that goes with that. In reflecting on the Distress Thermometer and my sister’s experience, she would have scored fairly high as she was deeply concerned about the finances, treatment decisions (she ultimately declined further chemotherapy because she said, “it was killing me faster than the cancer”), and the many physical problems she faced as the cancer progressed. In conclusion, I urge my Chaplain colleagues to gain insight into the type of cancer your patients are suffering with and to use the Distress Thermometer as an aid to understanding the issues they are facing. Your skills as a clinical chaplain will come into play as you provide Interventions which will provide them the comfort and assurance they need.