A Resolution Worth Exploring

In reading the Hospice Foundation of America December 2014 e-newsletter, I was captivated by the article "A Resolution Worth Exploring". I hope you will be, too! A Resolution Worth Exploring As you ponder resolutions for 2015, taking better care of yourself professionally should be close to the top of the list. Ronald Epstein, MD, professor at the University of Rochester School of Medicine and Dentistry, practicing palliative care doc, and published researcher on self-care, says such things as getting rest, eating well, getting exercise, taking vacations, and spending time with family are great to do but don't necessarily translate into better care for patients. Instead, Epstein suggests learning skills that promote mindfulness. What does Epstein mean by mindfulness? "I guess you would say mindfulness is an attitude of mind and mindful practice is what you do in everyday work," he says. "If you are practicing mindfully, you are aware of your own reactions, you are aware of the dynamics in the family, you are aware of how this is affecting you, you are able to monitor the way that you react and also to regulate your own reactions to stressful circumstances so that actions are better aligned with your values." This informs hospice chaplaincy in that if we are practicing our discipline mindfully, we will be self-aware, aware of the family dynamics around us, how our work affects us (positively and negatively), and how we respond to the stressful circumstances surrounding the hospice environment. Living and practicing our ministry means we do not deny our emotions or reactions and seek feedback from colleagues when we feel a bit off balance. I urge hospice Chaplains to practice not just good self-care but 'mindful' self-care. Our work is too demanding to do anything less. May 2015 be your best and most rewarding year in your hospice career.

3 Key Transactional Trusts a Chaplain Builds

Last week I had the opportunity to read an article in AACN Advanced Critical Care, Volume 18, Number 1, pp.19–30 © 2007, AACN, that had to do with the The Reina Trust & Betrayal Model. This article used as its focus “a difficult case study involving repeated health crises and irreversible organ dysfunction [that] illustrates the challenges critical care professionals face in caring for patients and their families. In such cases, trust is especially fragile, and coexists with its counterpart, betrayal. The Reina Trust & Betrayal Model defines 3 types of Transactional Trust. The first, Competence Trust, or the Trust of Capability, requires that clinicians practice humility, engage in inquiry, honor the patient’s choices, and express compassion. The second, Contractual Trust, or the Trust of Character, demands that clinicians keep agreements, manage expectations, establish boundaries, and encourage mutually serving expectations. The third, Communication Trust, or the Trust of Disclosure, must be rooted in respect and based on truth-telling. Particularly in life-and death situations, communication requires honesty and clarity. Each type of trust involves specific behaviors that build trust and can guide critical care professionals as they interact with patients and their families. In reading this article with its case study I came to the conclusion that the three types of transactional trust fit what a hospice Chaplain does in his/her relationship with a patient and family. In hospice, every patient is in a health care crisis and, indeed, trust is fragile. The first and most important task of the Chaplain is to win and build trust with the patient and family. This illustrates the Competence Trust. By nature a Chaplain conveys humility, honors the patient’s choices, and expresses compassion. When a Chaplain’s competence is established in the relationship, a bond of trust, though newly established, begins to form. The next transactional trust is that of Contractual Trust. The relationship can crumble: 1. If the Chaplain cannot keep agreements (is late for appointments, does not call to reschedule, forgets names of patient and family members, is cold and aloof, for examples); 2. If the Chaplain tramples on boundaries by trying to rush the conversation toward converting the patient or violates confidentiality. The third trust is the Communication Trust. While the Chaplain will not deal with the medical side of the patient’s experience, it is absolutely fundamental that the Chaplain will respect the patient’s autonomy. I urge the reader to look for this article and superimpose upon it the role of the hospice Chaplain. Friends, you are a clinician and hold a revered place on the IDT. Blessings, Chaplains, for your work!

Merry Christmas

May the miracle of Christmas warm your hearts this blessed day.

Coming in 2015

In 2015 I want to explore with a subject that will enhance your chaplaincy ... Providing Spiritual Care According to Disease Process. As you know, I do not believe in a "one size fits all" style of spiritual care. In this study, we will look at the most common disease processes patients present with in hospice care, and look at common spiritual characteristics associated with those disease processes and how to address them. Until then, finish out 2014 giving your best to the patients and families who look to you for comfort and strength.

To those in France ...

Welcome to those from France who visited this blog yesterday. I would enjoy getting to know your approach to chaplaincy. Please feel free to comment on any of the posts. The way to do that is to click "No Comments" (I know that is an odd way to invite Comments, but it is simply how this blog works). My blog statistics indicate that there were more visits by those from France than anywhere else in the world including the US. Blessed Christmas and New Year to all!

Twas the night before Christmas ... (not what you think)

Twas the night before Christmas and all through the house no one was stirring but the hospice Chaplain in Grandpa’s room. The family was bowed low by the chimney in prayer, in hopes that God’s intervention would soon be there. The grandchildren were nestled all snug in their beds, with visions of life without Grandpop coursing through their troubled heads. And Mamma with her ‘kerchief, and I in my cap, wished we could settle our brains for a nap. When from the bedroom there arose such a clatter, we sprang from our knees to see what was the matter. The Chaplain sat holding Grandpop’s hand as he said, “Yes, Lord, I am coming home.” I knew in a minute he must be leaving and headed to Heaven. We wept, we hugged, we thanked the Chaplain for her care. Death comes to all, hospice is there.  On Nurse, on Physician, on Social worker, on Home Health Aide, on Chaplain, on IDT, “We care. We love. We serve.”


Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless. 

A new template for hospice Chaplains to use...Your thoughts?

In many cases a Chaplain documents a narrative style describing what happened in a visit. That is fine as far as it goes, but it can leave out gaps of information that are essential: pain score and scale used; observations of decline; and interventions employed to reach the Goal/Expected Outcome. I have been ok with Chaplains using a narrative style, but have grown uncomfortable with continuing with that simply because of the demands of auditing firms that review hospice charts. Years ago I learned to document using the FAIERS template. F=Focus or purpose of the visit; A=Assessment of patient; I=Interventions used; E=Education presented to patient; R=Response of patient to the visit; S=Subsequent visit information. I mulled switching to this tool, but can’t through such things as Assessment and Education. A Chaplain is not licensed to perform an Assessment. A Chaplain may only observe or record such things as pain levels and decline. As far as Education is concerned, this seems to be intertwined with the Interventions we use and would be a waste of valuable time on the part of the Chaplain. While one can pronounce this acrostic of FAIERS, it seems inadequate for our use. Instead, I wrote the following to more fully describe what happens when a Chaplain visits a patient or a family member/caregiver: Purpose of the visit—The Chaplain can state that this was a routine visit to comply with the terms of the Plan of Care or state that this was an On Call visit or a Return visit due to an emergency or whatever description that fits the circumstance of the visit. Observation—Again, Chaplain do not assess, they observe. A. Pain level/scale B. Decline—MAC C. Spiritual concern(s) Intervention(s) A. What interventions did you use to address the spiritual concern(s)?—The Chaplains have 21 possible Interventions from which to choose for this section. They should have already have chosen one or two from the Initial Spiritual Assessment (this is the only place Assessment can be used). B. What evidence can you give that this helped the patient?— Response of the patient/family-- I will provide our Chaplains with plenty of examples of verbiage to use to document this piece. Subsequent visit—This section should be brief and summed up in one sentence. A. To fulfill the terms of the POC B. Within 30 days Your comments are welcome. This is not an easy process and one I approach lightly. Bless you, Chaplains, for your fine work. You are God’s hands of peace and support.