Friday, April 29, 2016

A Deeper Dive Into the Interventions, Part 3

A Deeper Dive Into the Interventions, Part 3


“Listen to patient’s story/life review” is an intervention that requires the Chaplain to be in the moment and all there.  It seems to me that when a patient is trusting enough to open their innermost beings to the Chaplain, this servant of God is most anxious and receptive to hear.  Consider personalizing this scenario for a moment: What happens when you get a prognosis that you are dying? In my case, if I were told today that I have three months to live, it means that because this is end of April 2016, I would die in the in August 2016. It means, Christmas 2015 was my last Christmas and Thanksgiving was my last Thanksgiving, although I didn’t know it at the time. I won’t see another summer again. It means what I planned to do and the places I was going to go next fall will all be canceled. The vacation I had planned going to Georgia to see the changing of the leaves? Gone! Everything I had planned, gone! It means I have three months left to live! Me. I am going to die at 62!


This is what flashes through a person’s mind when they get the news. They hear, see, envision, twelve weeks left. Twelve more Mondays, Tuesdays, etc. Right in the middle of living my life, this brick wall stands right in front like an insurmountable obstacle. Non-negotiable! The End! You can’t go over it. You can’t go under it. You can’t knock it down. You won’t wake up from this bad dream. Finished!  And, they need to talk about it.


On one occasion I was invited to visit with a patient who said she was Wiccan.  She was extremely hesitant to allow me to visit, but chanced it anyway.  After the ice was broken and conversation seemed to open up, I asked her to share her story with me if she felt at ease to do so.  And, so she began to share why she became a Wiccan.  It seemed that when she was a little girl her mother took her and her siblings to church on a regular basis.  Her father did not attend as he had no use for the church. The time came when he got sick and died.  After the funeral, church people came to her, hugged her, and told her they were so sorry her father…went to hell.  I about fell out of my chair.  How cruel of them to crush the heart of a child who was grieving the loss of her father!  She stated she went on a spiritual quest to find a religious system that did not have hell as a doctrine.  She found it in Wicca.  I must say that because I gave her my full attention a relationship of trust developed.  It was on the basis of that trust that healing pastoral care took place.  People need to be heard.  Listening is our strongest characteristic.  It shows we care, that the patient (or whoever we are with) matters, that we are truly concerned about the patient and not about ourselves and what visit we have to make next.  Much is revealed about the patient’s life in a life review.  It can form the foundation of great pastoral conversations.  Fear, anxiety, despair, and even physical pain frequently diminish when the person feels heard, understood, and accepted.  Personhood, self-worth, and dignity are affirmed. Feelings of isolation decrease.  Persons find their own answers in the new milieu of affirmation.



Wednesday, April 27, 2016

A Deeper Dive into the Interventions: Part 2

A Deeper Dive into the Interventions: Part 2


“Offer reassurance”…sounds simple enough…say a few kind words and all is accomplished…or is it?


Offering reassurance is like a many faceted diamond.  Assuring a patient they are forgiven by God is one example.  Another example is offering reassurance to a patient with dementia who responds to “God loves you”, “You matter”, “You are safe”, or other affirmations of personal worth.  Words filled with encouragement and support are what we mean by offering reassurance.


Let’s face it, our patients are near their last day, last hour, last minute of life.  Some are fearful, anxious, troubled, guilty, shame-filled, in need of kind words.  A hospice patient goes through a lot before they become a hospice patient.  They have been ill for some time, they haven’t felt well, and to top all of this off, like a wrecking ball comes the terminal diagnosis from the physician that they have 6 months to live.  The reaction of the patient to this devastating news is called “the existential slap.”  In the International Journal of Palliative Nursing (November 2004, Vol. 10 Issue 11, p520) Nessa Coyle pens an article that focuses on the psychology of patients when a physician discloses the diagnosis of a life-threatening illness. The usual habit of allowing thoughts of death to remain in the background is now impossible. Death can no longer be denied. This awareness precipitates a crisis for most individuals, who are suddenly faced with addressing and most likely rearranging, their priorities in the time they now anticipate is left. The "existential slap," occurs when the reality and inevitability of one's own personal death sinks in. (Abstract to the article)

Following this diagnosis a recommendation to hospice is made.  In a flurry of activity the patient and family is met by an Admissions Nurse for a 3 hour meeting to enroll the patient in hospice followed by the Case Manager/Nurse, Social Worker, and Chaplain all within a 5 day Medicare mandated window.  Is it any wonder that one of the key personality traits we look for in hospice Chaplains is compassion?  The patient is reeling from the diagnosis of 6 months to live and is thrown into an environment they are totally new to and may never have heard of before or at least not understood. 


Without question, our patients need reassurance. 

Apathy—The Death knell of Spiritual Care Leadership

Apathy—The Death knell of Spiritual Care Leadership


The sage wisdom of the great philosopher Jimmy Buffet speaks to our topic:

‘Is it ignorance or apathy? Hey, I don't know and I don't care.”


We are on the precipice of what I understand as a crisis in hospice spiritual care leadership.  The healthcare world is changing at a rapid pace.  Hospice has been changing at a whirlwind pace.  I don’t see stability on the horizon, but more change.  Much of the change will have to do with money and management.  Already there is a new model for re-imbursement for hospice providers.  The U-shaped model affects Chaplains in that their presence with the transitioning hospice patient is required on a more frequent basis, particularly the last week of life.


In addition to this is the new wave of evidenced-based chaplaincy.  Chaplains are on center stage to prove their worth.  That’s right, prove their worth… At Cornerstone Hospice our guiding philosophy positions our Chaplains very well for this new wave.  We have as our guiding philosophy Outcome Oriented Chaplaincy which has as its core the following core elements: Accountability, Best Practice, and Collaboration.  The Chaplains at Cornerstone were hired because of their skills and background education and experience for the field of hospice chaplaincy.  We require 3 units of Clinical Pastoral Education and a Master’s degree in Divinity, Counseling, or a related field. 


Our Chaplains are informed and reminded that this is not the pastorate, this is chaplaincy.  There are requirements: a daily goal of visiting 4-6 patients; participation in and adding value to the IDT meetings; meeting all standards of iCare, performance issues, and personal/professional growth.  To summarize, hospice chaplaincy at Cornerstone is for ministers who live out their calling by serving with excellence the needs of our patients, families, and staff.  They recognize they earn hours for PTO, not just take a day off without telling anyone.  They receive annual evaluations for their performance.  They are open to corrective action.  It’s called accountability.  The hospice cannot bill Medicare for Chaplain Service.  Chaplaincy is an unfunded mandate that the hospice provides as a service to patients and families.  It is incumbent that the Chaplain understands this and lives out a work ethic befitting this economic issue.  To buck at accountability is the height of arrogance and reflects a lack of understanding of what hospice care is about.


Regarding spiritual care leadership, as the Spiritual Care Program Manager, I do not have the option of coasting since I have “made it” to management.  There is a great deal expected and required of me…externally by Cornerstone and internally by my own passion and commitment.  The Chaplains I serve need inspiration, instruction, and support.  Those three elements move me to be my best and do my best.  Like the Chaplains, I realize that spiritual care is on an unfunded mandate.  Therefore, my leadership is designed to so develop and maintain the highest standards of spiritual care possible; to develop the pastoral care skills of our Chaplain team; to design a methodology for the Chaplains to document their visits; and, to be a resource for the entire hospice.  Providing a webinar for the Association of Professional Chaplains on the topic of Communicating Spirituality to Patients with Alzheimer’s Disease and Other Dementias; conducting a workshop at the annual conference for Healthcare Chaplaincy Network; and, having the dementia care webinar on the front burner for Trinity Health in November of 2016 are evidences of my commitment to the field of hospice chaplaincy. 


I urge my colleagues who are Directors and Managers to join me in these days of change to inspire their ranks to highest levels of spiritual care and to design programs of value that will educate the Chaplains.  Proving our worth and value is no small task.  It requires our absolute best in focus and hard work.

Monday, April 25, 2016

A Deeper Dive into the Interventions

A Deeper Dive into the Interventions


A major part of the Spiritual Care Algorithms is the Interventions section.  If you do not have this document, please request it at  I presented on the Spiritual Care Algorithms at a workshop at the Healthcare Chaplaincy Network annual conference April 11 in San Diego.  There are 21 interventions Chaplains can use in their work.  I thought it would be instructive to look at these and highlight what the point of the selected intervention is.


Today we will look at “The Chaplain provides an empathetic presence.”  It was the annual conference of the National Institute for Jewish Hospice in 2013.  I sat there in rapt attention as Rabbi Maurice Lamm gave the opening address.  His speech started out like this: “My Friends, do not tell me you have empathy.  Show me you have empathy.  Empathy is something you do, not something you talk about.”  What a powerful statement!  What he was referring to was an empathetic presence.  The effective Chaplain knows how to project empathy and compassion without saying a word…thus, empathetic presence!


Carl Rogers gives us instruction through these statements on empathetic listening:  “We think we listen, but very rarely do we listen with real understanding, true empathy. Yet listening of this very special kind is one of the most potent forces for change that I know.”  In Experiences in Communication, Rogers goes on to say “I hear the words, the thoughts, the feeling tones, the personal meaning, even the meaning that is below the conscious intent of the speaker. Sometimes too, in a message which superficially is not very important, I hear a deep human cry that lies buried and unknown far below the surface of the person. So I have learned to ask myself, can I hear the sounds and sense the shape of this other person's inner world? Can I resonate to what he is saying so deeply that I sense the meanings he is afraid of, yet would like to communicate, as well as those he knows?”  Are those not questions we need ask ourselves as Chaplains?

There is much to be said about empathetic listening.  Let’s start with the basics: Empathetic listening helps people feel heard and not alone.  What is the cry of the heart that is fearful, anxious, distracted?  Is it not for someone to listen with interest? with concern? with compassion?  Secondly, empathetic listening involves many skills and components: 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. What may seem contradictory, empathetic listening may also ask you to laugh, be joyous, and not focus on illness, pain, or dying.  After all, it is the patient or caregiver we are listening to.  They are our focus.  And the results?  In this day of outcomes oriented chaplaincy we need to be clear on the benefits of empathetic listening: Fear, anxiety, despair, and even physical pain frequently diminish when the person feels heard, understood, and accepted.  Personhood, self-worth, and dignity are affirmed. Feelings of isolation decrease.  Persons find their own answers in the new milieu of affirmation.

Tuesday, April 5, 2016

Healthcare Chaplaincy Network Annual Conference

I am getting excited about the workshop: Quality Improvement: Hospice Chaplaincy Philosophy and Clinical Documentation Strategies.  I understand that there will be 69 persons attending my workshop.  This should be a fun experience.  I will let you know how the workshop went and all the great details.  I will be in San Diego April 10-13.  Your prayers are requested.

Saturday, April 2, 2016

Important Post, Your Feedback Requested

As I am planning the future of Embraced By The Heart of Hospice, I am requesting your feedback. My passion for hospice chaplaincy motivates me to develop an accredited program of instruction in this aspect of chaplaincy.

1.  This will not be CPE though it will be CPE congruent.
2.  The focus will be strictly hospice chaplaincy...very thorough hospice.
3.  There will be expectations of each learner: research, career assistance and counseling, writing assignments, practicums.
4.  This will be a one year program and will include international learners.
5.  A full curriculum and syllabus provided at a later date.

Your thoughts ....