Adaptability: The Most Necessary Trait for 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.

 

Test Your Knowledge of Terms Describing Limitations of Dementia Patients

In the list below, match the term on the left with the description on the right.  The answers are at the bottom of the page.  I would be interested to know how you did. Please comment.

Aphasia	Number problems
Apraxia	Writing disorders
Anomia	Body image disorders
Alexia	Movement disorders
Agraphia	Impairment of language
Visual Agnosia	Inability to recognize familiar people
Spacial Agnosia	Inability to recognize writing and pictoral material as a whole_only parts
Simultanngagnosia	Difficulty finding words
Prosopagnosia	Inability to find one’s way around familiar place
Anosognosia	Inability to name or use an object without touching it
Acalcula	Reading difficulties

Answers:

1. e
2. d
3. h
4. k
5. b
6. j
7. i
8. g
9. f
10. c
11. a 

 

How did you do? 

10-11—You’re an Expert  7-9 You’re Advanced  5-6 You’re New To This

The Role of Clinical Chaplaincy

The Role of Clinical Chaplaincy

 

From time to time, great articles are written that need world-wide distribution.  This article by George Hankins Hull is one of those articles.  It stands juxtaposed with my article titled, “Seriously, you want Chaplains to do what?”

 

Thank you, George Hankins Hull for a definitive statement on the work of the clinical chaplain.  May we all embrace these truths.

 

November 12, 2013

ELEMENTS OF CLINICAL PASTORAL ASSESSMENT: The Role of the Clinical Chaplain By George Hankins Hull

 

Clinical Chaplaincy is relational, neutral and non-judgmental. It is a patient centered approach in keeping with the person centered model as advocated by Carl Rogers, integrating the arts and sciences relative to psychodynamic theory in pastoral practice.

Around any illness is a collection of stories. The chaplain endeavors to be present to the patient as a fellow human being, as the patient’s stories unfold; bearing witness to the patient’s dilemma- not judging the patient for what they say or how they choose to express themselves. This narrative approach places the chaplain in the unique role as the interpreter of metaphors, assisting the patient in making the connections to their story.

At times these stories are confessional in nature, as a patient, through narrative seeks to reconcile themselves with the life that they have lived. At other times, the stories they relate represent more a review of their life inextricably interwoven with finishing the business of living.

Consequently, clinical chaplaincy is a patient centered narrative approach. Integral to that, is the patient’s family. Working with the stories that patients and families share, the clinical chaplain can begin to assess how the family approaches illness, and in particular, this hospitalization.

The Clinical Chaplain also assesses how the patient utilizes their religious experience or their philosophy of life as a means of support as they seek to come to terms with their diagnosis and its attendant ambiguities of living each day.

Extensive clinical training and a proactive integration of the social sciences, especially in the fields of counseling and psychotherapy is essential to the work of the Clinical Chaplain.

George Hankins Hull, Dip.Th, Th.M.

Director of pastoral care and clinical pastoral education at UAMS Medical Center. He is a Diplomate in the College of Pastoral Supervision & Psychotherapy and a board-certified clinical chaplain.

 

 

 

 

 

Seriously, you want Chaplains to do what?

Seriously, you want Chaplains to do what?

The role of the Chaplain has changed in some hospices nationwide.  The reasons vary, but one of the key reasons is financial.  It is more affordable to have a Chaplain perform certain duties than an RN.  For instance, there are Chaplains who are being directed to pronounce patients.  In Florida, I am told this is perfectly legal.  Interesting… 

This raises an ethical conundrum.  Just because a Chaplain is legally allowed to do something, is it the right thing to do in the dynamic of hospice care?  Having attended hundreds of deaths, there were clear-cut roles defined by hospices I served.  The hospice nurse attended the dying patient, the chaplain attended the grieving family.  Somehow, that was a strategy that worked very well for all involved.  The family members expected the medical issues, including pronouncing, to be the role of the medical professional, not the spiritual care professional.  What exactly is a hospice trying to accomplish by assigning this medical duty to a chaplain.  If it is to save money, then that is an ethical issue that that hospice will have to wrestle with.  If, as so many hospices trumpet, patients and families come first, why would any hospice blur the clear distinctions between the disciplines of medical and spiritual care?  And, further, what are the repercussions on the chaplains who are required to do this?  I cannot answer the first question, but I can answer the second.  In fact, if a spiritual care manager from one of the hospices requiring pronouncing of its chaplains wants to know, then I suggest they enquire of their chaplaincy staff.  If you still can’t find an answer, let me share this with you, on a weekly basis I receive calls from Chaplains who do pronouncements who are concerned they are doing something they are grossly unqualified to do and thus in their un-comfortability in this task, are seeking other places of service. 

Looking forward to a great 2016

There are two particular topics I am working on now and hope to bring to you in the first few months of 2016: body language and the clinical use of prayer.  Body language has at least two aspects: that of the person we are speaking to and our own body language.  There is much to learn about this that will make us more perceptive and effective in our work.  Prayer as a clinical intervention must be explored for its clinical effectiveness.  I invite you to study this along with me.

Have a blessed New Year and growth in your work.

I will be back at the blog the first week of January.

Merry Christmas!

To all of you who have taken the time to read this blog, Thank you.  A Merry Christmas to all.  You are a wonderful gift of compassion and service to your patients.

To Our Staff Working on Christmas

First of all, “Thank you.”  Hospice care is a 24/7/365 operation.  Illness does not call a truce for the holidays.  It marches on.  Your commitment to patient care is one of most noble commitments known.  You have my admiration and deep respect.  To my Chaplain Colleagues, you who will be on call during the day will seek to bring comfort and peace to troubled families.  As I was driving to work this morning, I noticed 5 police vehicles at a residence.  What could be happening?  I doubt the people were having a breakfast for this group of officers.  You may be called to a death or another type of spiritual emergency.  I know you will provide what that family needs.  I have great confidence in you.  To all of my Colleagues who are working on Christmas, peace and best blessings.