Monday, August 31, 2015
What burden is the hospice Chaplain to assume? There are many burdens hospice Chaplains like every other type of Chaplain assumes. Most are personal and independent of chaplaincy. The topic to which I am referring is hospice oriented only. What burdens do patients carry when they are in hospice care? If they are lucid and able to communicate, we may learn they carry burdens related to relationships, the need for reconciliation, fear of dying, the afterlife, and concerns for the welfare of their loved one after they die, to name just a few. They come to us with these burdens. Best practice in chaplaincy means the Chaplain is able to listen and identify these burdens and be a part of the healing ministry that supports the patient through the hospice journey. What burdens do the patients’ loved ones bear? Their burdens can relate to anger with God, wrestling with the “why” of it all, the need for reconciliation with their loved one, it might mean reconciliation with a clergy person or faith community as a funeral looms in the immediate future. How do these burdens find relief and lifting and what role does the Chaplain play in all of this? Let me answer this question by providing a bulleted list that hopefully gives a starting point for the Chaplain to begin. • When providing care for a patient who is lucid, the Chaplain uses the power of active and reflective listening. Giving the patient a Safe Haven, as Bowlby suggests, is a great starting place. It may be that the patient before the Chaplain has never unburdened his or her soul to anyone and now that death is near, the time may be ripe for this to occur. • When providing care for a patient who is minimally or non-responsive, the Chaplain may find him/herself in a quandary as to what to do next. Best practice answers the quandary. After the Chaplain provides spiritual care for the patient, the Primary Caregiver is contacted by phone and a brief summary of the Chaplain’s visit is provided. The Chaplain always thanks the PCG for the privilege they have given said hospice organization to provide care for this patient. Leaving a business card and not contacting the PCG after the visit adds an additional burden to the PCG to contact the Chaplain. If you think about it, why would you even think for a moment of adding an additional burden to an already burdened person? Is that not a form of arrogance rather than servant-hood that suggests that if they want to speak to me, then they can just call me? The Chaplain is to exude a servant-mindedness. Expecting a burdened family member to contact him or her is just not a good mindset. And, really, that is the point of this article. The Chaplain communicates his or her attitude with body language and tone of voice. The Chaplain’s attitude conveys all the family member(s) need to hear. If you leave a card, great. But, make the phone call. It’s just Best Practice, plain and simple.
Thursday, August 27, 2015
A Hospice Chaplain is a difference-maker. Being a difference-maker, however, doesn’t happen all by itself. Difference-making takes place when there is activity involved. In reading Forbes: Entrepreneurs I came across this article: “How 'Difference Makers' Think -- The Single Greatest Secret to Personal and Business Success”. (http://www.forbes.com/sites/groupthink/2013/06/04/how-difference-makers-think-the-single-greatest-secret-to-personal-and-business-success/) A portion of the article reads: A comprehensive set of new studies from OC Tanner Institute (including research we’ve conducted with Forbes Insight that we’ll be issuing shortly) shows a fundamental shift in the mindset of people who achieve groundbreaking results. The mindset is this: Great difference makers shift from seeing themselves as workers with an assignment to crank out, to seeing themselves as people with a difference to make. You, Hospice Chaplain, have a difference to make in the life of each of your patients and their family members. It is your calling. It is your destiny! Here are 3 ways you can make a difference by taking the initiative. I am sure you can think of many more, but consider these thought-starters. 1. Make a difference in the life of the patient. a. By actively listening. b. By a non-anxious presence. c. By advocating for them and their needs in a long-term care facility, home setting, or hospital. d. By assisting them to finish life well. 2. Make a difference on your IDT a. With your encouraging words and positive presence b. By helping without being asked to do so c. By working with your leadership to solve problems 3. Make a difference in your Inpatient Units. a. Do not wait to be told to do something. Take action: Meet, Greet, Move boxes, Do what is necessary, but do the unexpected. b. Support the staff with special seasonal rituals. c. Support the patients and families by giving extraordinary care. Chaplains who take existing job expectations—or job descriptions—and expand them to suit their desire to make a difference find great satisfaction and do great ministry for their patients/families and their company. Do what’s expected (because it’s required) and then find a way to add something new to their work. Do something that delights, something that benefits the souls on your caseload and those who work with.
Tuesday, August 18, 2015
Basic Practice in Chaplaincy 1. Make contact with each new patient on your Team. You have a 5-day window to contact each new patient. Document each phone call in Allscripts. 2. Complete the Initial Spiritual Care Assessment. Document this in Allscripts. 3. Documentation of Initial and Routine visits will be completed the day of your visit. If the visit is late in the day, you have 24 hours to complete the documentation. 4. Synchronize in the morning and evening of each work day. 5. The following provides a primer on functioning with best practices in the facilities. Please keep in mind that each facility has its own nuances. Your professional presence will assist you to comply with the nuances of the facility. Checking In 1. Upon your arrival at the facility, check in at the front desk. Explain who you are, who you represent. Have your badge prominently placed on your blouse or shirt. 2. Ask for the room number of the patient(s). 3. Thank the person who assisted you. Entering the Patient’s Room 1. Remember that the patient’s room and bed are their personal space while they are in the facility. a. Knock before entering the room or, even, on the wall near the bed before crossing the line of a curtain that defines that patient’s particular area. b. If the curtain is completely drawn around the bed, speak outside the curtain and be sure you have the patient’s/family’s permission before stepping inside the curtained-off area. c. Announce yourself by name, with Cornerstone Hospice, and role and ask if it is OK to come in. For example, “Hello, my name is Rich; I am your Chaplain with Cornerstone Hospice. May I come in for a moment?” d. Respect for the humanity, privacy, and situation of each patient and the patient’s family are essential to what we do. Positioning Yourself in the Patient’s Room 1. Position yourself in a sensitive manner. a. Examples, depending upon patient and situation: If the patient is at all physically exposed because of gown, equipment, etc., seek a facility staff member to cover patient. Do NOT do this yourself. Perhaps the patient is hard of hearing; position yourself and speak clearly to maximize the patient’s ability to hear you and/or read your lips. Perhaps the patient has a sight deficiency; position yourself accordingly and use your voice and/or touch to ensure the patient knows you are there and that you have identified yourself, as the patient may not otherwise be able to recognize you from a previous visit. Sit in a chair, if possible, so that you are eye-level with the patient; however, do not immediately sit, because that might signal to the patient that you intend to stay for a while – make sure you have determined with the patient/family that an extended visit at that time is appropriate and welcomed. (Do not sit on the bed.) If the Patient Indicates He/She Does Not Wish a Visit 1. Do not stay if the patient does not desire a visit. We do take “no” for an answer! 2. Leave a Spiritual Care Services brochure with them for further information and later contact. Touch 1. Be cautious with physical touching. a. It is often natural for us to want to touch a patient: To hold hands or place a hand on the head, for example, while praying; b. To lay a hand on an arm or shoulder as an expression of comfort or reassurance. 2. However, touch can be a “touchy subject”. a. The patient may be in physical pain that even a little pressure might exacerbate. b. The patient’s personal history and/or personal temperament may make touch unwelcome or threatening. c. The patient may misunderstand the intent of the touch, especially if their condition in any way decreases their understanding and perception. d. Whenever possible, if you wish to touch a patient, ask the patient’s permission first. What We Do and Don’t Do 1. Remember, we emphasize listening. Our first concern, always, is simply TO BE WITH patients/families. o To listen. o To let them lead any conversation where they want/need it to go. o To be a quiet presence, if that is what is needed and possible. 2. We seldom or never: Give advice. Try to convince anyone of anything. Proselytize (try to win converts to our religious beliefs and communities) – this one is a NEVER. Communicate with the patient’s faith community to provide a pastor, priest, Imam, Rabbi, or other religious leader to assist with your work with the patient. 3. We may pray with patients/families. a. We will pray: If they request it. If they agree to our suggestion/offer to pray. After clarifying if they want us to pray with them, then and there, or for them, in our own time, perhaps back in the sanctuary. After clarifying what prayer means to them and what style of prayer is appropriate for them. (We do not assume prayer using a particular religious form or language, unless it is clear from the patient/family that is what they want and expect and if we ourselves are comfortable with that kind of prayer.)
Sunday, August 16, 2015
It is almost comical when I read qualifications for Hospice Chaplains. 1 Unit of CPE, Bachelors Degree, 1 year of experience in pastoral care...Seriously? What exactly are you expecting of this person you call Chaplain? Have you no idea what issues a Chaplain will encounter? Are you not aware that Hospice CAHPS will determine your reimbursement? Even with our high qualifications we spend time training our Chaplains to provide excellence in spiritual care. We assume nothing and seek to build a team of Chaplains that will make a difference in the life of the patient and their families. The issues hospice Chaplains face require experience and skill. Makes me wonder if the lack of qualifications is simply a financial issue rather than anything else. Something to think about when the results of the CAHPS come rolling in.
Thursday, August 13, 2015
Best Practice for Chaplains Serving in Hospice Houses (an excerpt from the training guide) Basic Hospice Philosophy • Always remember patient care comes first. • This work is not about us as Chaplains, but about our patients and families. Before the Chaplain Enters a Facility Serving in a Hospice House will challenge you spiritually, emotionally, and physically. The stress of the position requires the Chaplain to address his or her inner person. Being spiritually centered before you enter the facility is an absolute necessity. You need to not only be there, you need to be ALL there. A healthy 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.” Before you enter the facility, if you are feeling seriously stressed, write down your stressors, your emotional pain, or whatever might be a distraction and purpose to deal with it later. You must be clear in your thinking, your sensing, your speaking, and your spirit. The needs of the patients are priority needs. Again, they need you there and ALL there. Basic Practice in Chaplaincy Because both patient and family members are going through extreme emotional and spiritual pain, I am asking that you follow this action plan to ensure high quality spiritual care in the Houses: 1. Check on each patient daily. Complete all Initial Assessments the day the patient arrives at the Hospice House. Complete a Routine Assessment for patients that are lucid or have family members present for whom you opened a Care Plan (Spiritual Care [Family]). Document a Clinical Note when no one is present and the patient is either sleeping or is actively dying. 2. If family members are NOT present at the time you are at the House, contact them by phone and write a Clinical Note. 3. Should the family members or patient request a Priest or other religious leader make every effort to contact that faith leader and document your efforts. This is the Chaplain’s responsibility, not the Nurse’s. 4. Respond as soon as possible to any request by the Nurse(s) for spiritual concerns. Be supportive of all staff at the House. 5. Make yourself available to provide support to the staff when you are not in direct patient care. 6. Serve as a Hospice Ambassador to ALL who are visiting in your House. Seek out ways to provide care for families that are new to the Hospice House, i.e. getting them coffee, or other beverage; providing information about the House; introducing them to key leaders in the House that they might interact with. Remember, this may be routine for us as we are familiar with all the systems in the House, but this is their first journey into a Hospice House. Please help make this stressful journey one they will remember in a positive manner. Always be alert to a family member who is seated alone and looks distressed. Be a friend and confidant. Be Chaplain of the entire facility.
Thursday, August 6, 2015
I’m not much on verbosity when brevity can be the better teacher. This is the case in writing on the subject of words that heal. The words that hurt deserve a long and painstaking explanation because those types of words are the product of a lack of thought and knowledge on the part of the speaker. I mentioned the friends of Job in my last posting. At the beginning of their time with Job, they were sensitive and caring. And, then, they got the idea that they needed to provide explanations to Job for his suffering. Human nature is such that we must fill the silence with something. This is not a good thing. So, here are a few scenarios and examples of words that heal… Remember your CPE Training and be present in the moment, listen more than talk, let your body language speak that you care and are with the patient. The patient says, “I think it’s more than a little unfair that I have this and that I’m going to die so young.” Your response: Think about it. What will you say? How will you say it? What will your body language tell this patient…your facial expression, your posture? If you say something, it might be something like this: (with outreached hand, hold the patient’s hand) “I am so sorry. It must be awful/painful/sad or whatever one word fits.” As you speak look the patient in the eyes and let your being speak to theirs. Have you thought that at the beginning of the conversation three thoughtfully and sensitively framed questions might guide the patient? “How are you doing physically?” “How are you doing emotionally?” How are you doing spiritually?” Of course, these questions are used when you have an established relationship of trust. Said slowly, waiting for response is the best approach. I am sure you have your own style, but whatever your style I think we can agree that we must be sensitive, carry no agenda, seek not to explain, openly desire to support and comfort. The humble spiritual caregiver you are will speak with a language no words can describe. Bless you, Chaplain Colleagues, in your efforts to express a heart of comfort.
Tuesday, August 4, 2015
Powerful Article from Which We May Learn What Not to Say What you are about to read is one of the last blog entries from Lisa Bonchek Adams. She had cancer and she died March 3, 2015. Her words are gripping. The stupid things people say to those with cancer & their families February 27th, 2013 There are always eyebrow-raising things people say to those with cancer and/or their families. Maybe not everyone would find each of the comments listed below to be offensive but they’ve been submitted by readers as ones they wish they hadn’t heard. I like to revisit this topic every so often to allow people to post comments and add to the list. Some of these come from the comments the last time I discussed this topic (here). At the bottom you will find a link to the post I did on suggestions about what TO say and how to help a friend with cancer or other illness. I’m not going to respond to each of the statements below. I’m just going to list them for your consideration. Some are just strange. Some miss the mark. Some are downright rude. They weren’t all said to me, but they were said. Gee, that almost makes me want to have an award for the most offensive one listed below… **please make sure to see the link in red at the bottom of the page for a post of things that are recommendations of what to say …………………………………………………………… “It will all be okay, I just know it.” “Someday you will put this all behind you” (to a stage IV patient) “Don’t worry, things will get better.” (to a stage IV patient) “So when will you be all better?” (to a stage IV patient) “When will your cancer be gone?” (to a stage IV) “But you don’t look sick.” “Lance Armstrong cured his stage IV cancer. You can too.” “But I thought you had chemo and surgery last time. How could it be back? This is why people shouldn’t do chemo.” “Do you think it was a waste to do chemo last time?” “Live in the moment.” “Be strong.” “Fight hard.” “Keep your chin up.” “Don’t give up.” “Attitude is everything.” “We just need a miracle for you.” “If anyone can beat this, you can.” After telling someone I had stage IV: “Wow. I’m going to miss you.” “Is it terminal?” “What’s your prognosis?” “It could be worse, you know.” “Everything happens for a reason.” “It’s all part of a larger plan.” “You’re only given what you can handle.” “All you need to do is think positive.” “Half the battle is the mindset. Be determined to beat cancer and you will.” “Now that you’ve been through this you’re due for some good things to happen.” “I’m sure it’s fine/I’m sure it’s nothing.” “Well, you’ve been needing a vacation for a while and now [during chemo] you get to lie around and read books all day. What could be better?” “Well, do they think [the chemo] is going to do any good?” “At least it’s not on your face where everyone could see the scars, besides you don’t really need your breasts anyway.” “A new-agey friend asked me if I had been really angry about anything 7 years before my diagnosis that I had repressed. (What had I done to cause my DCIS?)” “I was advised to write a letter to my husband detailing how much I loved him so he could have something when I died. [My husband] was standing next to me as I was being given this little chestnut.” “One said to me the day after my malignant melanoma diagnosis: ‘Maybe this will help you evaluate all the things you need to change in your life.’ ” “Last year I had part of my cervix removed surgically for PRE-cancerous cell growth. I was at home recovering from surgery and still had days to await the results of whether or not I had clear margins, etc. Those days that drag on and you just wonder and hope. My mother in law came over with dinner (nice) and then proceeded to stand there and tell me about every person she knew with cancer, how they died, and how their families went on.” “When my mother was diagnosed with breast cancer, I was a wreck. My (now ex) husband got tired of it really fast and made a rule to confine my sadness to one day per week: “you are only allowed to cry about this on Fridays.” If I felt like I absolutely had to cry Sat-Thur, I had to do it in private.” “The worst thing said to me was right before I was to have a new lump checked out. I was a 7 yr breast cancer survivor at the time, with 3 children ranging from 14-8 yrs old. When I told a pastor’s wife I was worried about the lump, but was most worried about my children if I got bad news, she responded, ‘Oh, they will get over it. You’d be surprised how quickly. I know I got over my dad dying in a year, and I was about their age.’ ” “Gosh, I thought chemo was supposed to make you lose weight” “Nearly every person I told about my mother’s death felt the need to tell me about some relative of theirs that had passed away and how awful their death was.” “The very stupidest thing was said to me recently, a few months after treatment ended for a recurrrence. I was out to eat with my youngest son, now 16, and ran into an acquaintance. She said she’d given it a lot of thought, and wanted me to know that there were “perks” to dying at early age, in case I did. I’m 47. (and feeling fine by the way, and had just told her so.) But she proceeded to tell me 3 of “the perks” if I were to die early. One “perk” was that I wouldn’t be the grieving spouse, another was that I had already parented “through the fun years” and wouldn’t have to see my kids make bad life choices, and the other one….oh, I wouldn’t have the aches n pains that came with old age like she was experiencing. She was “sincere” and had “thought about it,” and is a nurse!! Just blew my mind.” 1. Random stranger on the street: Do you have cancer? Me: Yes. RS: How long do you have? Me: – 2. On telling peripheral people (e.g. hairdresser, or friend of a friend) of my diagnosis, they proceed to tell you that their uncle/cousin/friend’s mother had cancer and then that they died. I guess they are trying to make a connection and it’s the first thing that pops into their head, but I really did not want to hear about death at that time. 3. An email from a friend of a friend (a homeopath) telling me that breast cancer is caused my a negative relationship with your own mother. This is definitely not the case! 4. People asking me if I knew how I got my cancer (and then offering me something to read about some “natural” therapy they have heard about or are selling). 5. I fully got sick of hearing the words “positive” and “strong”; so much so that I banned my family and friends from saying them. “People choose their sicknesses. He chose to have cancer by not managing his negative energy and he chose to die by not fighting.” “Someone I know has pancreatic cancer. She didn’t suffer too many adverse effects throughout chemo which was fortunate for her. Her daughter, who knows I went through chemo all a year earlier, made a comment that her mother must have a particularly strong constitution because she didn’t have trouble with side effects. Ya, unlike like the rest of us weak wussies who who were knocked out by chemo! I knew that she was grasping at any tiny sign that her mom might experience a full recovery so I kept my mouth shut.”
Monday, August 3, 2015
Words that Hurt, Words that Heal In preparing for this series of articles, I did a painful review of comments made to persons suffering with cancer, those suffering loss of loved ones, and those facing end-of-life issues in hospice care. I suppose most people simply don’t know what to say, but seem to feel a need to say something to dispel the silence. Looking at a Biblical model for speaking to one suffering, I turn to the early chapters of the book of Job. By the end of chapter 2, Job has experienced deep losses. The pain of his suffering altered his physical appearance. His friends, upon seeing him, wept. “When Job’s three friends, Eliphaz the Temanite, Bildad the Shuhite and Zophar the Naamathite, heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him; they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was.” (Job 2:11-13) The wisest thing these friends did was to sit in the dust with Job and suffer with him and not say a word. It was not until they tried to explain things and link suffering to God’s judgment on Job that things got ugly. There was a time when I was serving as a church pastor that a tragedy occurred. An infant was accidentally shot by an older sibling. The infant was taken to a local hospital for care. A few days later the child died. Added to the pain of this tragedy was the fact that a member of the church I served felt it her responsibility to inform the child’s mother that if she had faith the child would heal and live a normal life. What pain that mother felt at the loss of her child and what added pain was hers as she thought it was her fault because she didn’t have enough faith to save her little one’s life. Words can hurt, even crush someone who is suffering. Chaplains can ill-afford to be emotionally unaware of what is happening around them as they support the suffering. An ill-timed word or phrase can complicate the pastoral care relationship and make suffering so much worse. Persons suffering with cancer, HIV/AIDS, cardiac, and other high profile disease processes are vulnerable to comments that will make their suffering worse. In the coming days I will provide a singular focus on one disease process at a time in hopes that this review will provide both warning and instruction. Bless you, Chaplain Colleagues, as you communicate to your patients and families.
Great News! It is my pleasure to inform you that an invitation was extended to me by Healthcare Chaplaincy to present my work on Best Practice in Hospice Chaplaincy. The national conference is April 11-13, 2016, in San Diego, CA. As the time for the conference gets closer, I will fill you in on all the topics to be presented. Bless you, Chaplain Colleagues, for your work. It is sacred and without doubt exceptionally necessary.