Thank you...

Thank you to all who have visited Embraced. We now have over 7,000 visitors to the site. I am well aware that this is a small-niche site designed for hospice chaplains (although chaplains of all markets could benefit, as well).  The fact that there are followings from around the world indicate that Embraced is meeting needs.

I am always happy to receive your comments and feedback.  If there is a topic you would like me to address, just let me know and I will be happy to give it a go.  

Chaplain Colleagues, I honor and respect your work.  It is sacred and absolutely necessary in the healthcare environment.  Thank you, once again.

Please…don’t say these things

At times we all say the dumbest things to patients because of a lapse of thought.  This article is just to remind us of the care we need to take in our conversations with hospice patients.

 

1. “When God shuts a door. He opens a window.”  Have you ever thought that from the patient’s perspective that yes, a door has shut, but there is no window?  This statement obviously is religious graffiti with no basis in thoughtfulness.  It might be a good exercise to read Job 2:11-13 to gain some insight into how to suffer with another human being:
   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.
   What did these three friends do?  Correct.  They sat in the ashes with Job and said not a word because they saw his greatness of suffering.  Our western culture hates silence to the point that people feel like they have to interrupt the silence with inane words.  We have to better than that.  We continue…
    
2. “If you pray hard enough…”  Oh, how this incites many emotions within me.  Why don’t we just say to the terminally ill person, “Look, this cancer (or whatever is claiming this person’s life) is all your fault.  If only you had been more religious this wouldn’t have happened.”  I would not expect a professional Chaplain to say something so outrageous as this, but it calls us to remember that our words have the power to support and encourage and to crush.  Let’s be very sure we support and encourage.
    
3. “God is in charge…”  True, but your patient is experiencing life on the emotional side of things and is not really concerned with systematic theology at the moment. 
4. “God will never give you more than you can handle.”  Again, true, and again this is not New Testament survey, this is life.

 

The above are usually stated by those who intellectualize suffering.  If they can put a cliché to their religious thought then they believe everything will be alright and they can drop these statements on unsuspecting, dying patients.  I simply ask you to swap places with the dying and answer how  you believe you would feel is someone laid such guilt trips on you as you lay searching to make congruence out of your suffering and your faith.

 

Here are a couple of other statements that can pierce a soul much like the iceberg pierced the Titanic:

1.  “You can fight this.”  No comment needed.
2.  “God must need you in Heaven.”  Pulling my hair out on this one.  Another variation is “God must have needed another angel when you baby died.”
    
   Why not something like this:
   “I’m so sorry you’re dealing with this.  I love you.”
   “You are so loved.”
   “You are not alone.”
    
   Chaplain Colleagues, we will hear well-meaning people say the worst things to our patients.  Please educate and assist them to speak words of peace and comfort.  Not an easy assignment, but yet, it is one of blessed tasks.

 

 

 

 

Positive and Negative, more than just opposite poles on a battery...

What side of a problem do you usually take?  The problem side or the solution side?

If you take the problem side, chances are you are a Master of the Obvious.  You point out what everyone else knows, there is a problem.

If you take the problem side, chances are your personality is more negative than positive.  Some folks are born that way, I suppose, but if you’re going to be a difference maker you’re going to have to work on that.

If you take the solution side, chances are your focus is on what can be done to change the situation.

If you take the solution side, chances are your personality is positive which influences people and circumstances and makes a difference.

What does this have to do with chaplaincy?  A lot.  If you want to have an influence on your IDT, be on the solution side of a problem.  Problems arise from time to time.  It is easy to join the Fraternity or Sorority of the Negative.  Is that really what the IDT needs?  When changes are made is being negative what the IDT needs?  The fact is your IDT looks to you for leadership.  While they may feel and express negativity your lead will help put oil on the troubled waters. 

Besides the above, isn’t your personal happiness and well-being fostered by a more positive outlook than negative?  Our persona and reputation go before us.

Bless you, Chaplain Colleagues, yours is a key position that has many facets.  May your personality’s facet shine and glimmer like a Tiffany diamond.  Maybe the Knot Prayer is for you.  It is for me.

10 Highly Effective Habits of Hospice Chaplains

Over the years I have attempted to practice effective strategies and habits.  They helped me carry ridiculously high caseloads and at the same time provided me a platform for beneficial pastoral care.  Let me list several and perhaps you can add a few of your own:

1.       Stay spiritually centered.  The work we do demands our best, a clear head, a clean heart, a strong inner person. 

2.       Keep relationships strong at home.   If you leave home and you’re all emotionally in turmoil from an argument with your spouse or children, your day can be doomed.  Instead, as much as is possible, keep harmony in your relationships.  Find a way to release the turmoil before you see your first patient if something does happen.

3.       Organize your work.  At Cornerstone Hospice we have a piece of our electronic charting to make out a daily/weekly schedule.  Know where you’re going.  Caseloads these days are higher than they have ever been.  Don’t expect that to change.

4.       Document your work.  At Cornerstone Hospice we are required to document at the bedside or shortly thereafter.  Do not allow your charting to grow stale.  I promise you will miss something important.

5.       Build relationships of trust with your patients and families.  You may be the one to officiate at the funeral and your background with the patient and family will hold you in good stead.  The surviving family members will appreciate you for it.

6.       Work with the patient to achieve the Goals/Expected Outcomes.  Help them to leave this world with as many loose ends tied up as possible.

7.       Take time to assist a new Chaplain.  Show him/her the ropes.  Teach them good habits to practice.  Introduce them to your IDT members.  Always hold them in high regard among your colleagues.

8.       Give a listening ear to IDT members that are going through difficult times.  You will endear yourself to the Team and that is something very important.

9.       Stay abreast of the chaplaincy world.  Learn all you can and share it.

10.   Become the go-to expert on matters spiritual and religious on your IDT.  Ask your Team Manager for time to teach and train your Team.  You will be the beneficiary of the Team’s high regard. 

These are 10 highly effective habits.  What would you add?

Staying motivated, positive, and hopeful...keys to your career

What is it that keeps you motivated?  What keeps your engine running at an optimum rpm?  What keeps you going even when all around you is not going well at all?  In this post I will open my life to you and let you see what keeps me motivated, positive, and hopeful.  

First, I want you to know that I cultivate spirituality deep in my heart and soul.  The Bible provides inspiration.  Prayer provides a place of confession, forgiveness, direction, assurance, confidence, and peace.  Together Bible reading and prayer form a solid foundation for my inner life.

Proverbs 22:29 (NIV) reads, “Do you see a man skilled in his work? He will stand before kings; he will not stand before obscure men.”  There are so many skilled hospice Chaplains that I have learned from and who continue to do their work with excellence.  They invested time and information in my life.  The least I can do is put that information to use and go several steps farther and gain insight of my own.  Giving my best effort, doing a good job, exhibiting confidence and demonstrating my own strengths and abilities are all facets of the beautiful diamond I call, “Excellence in Spiritual Care”.   An unknown thinker wrote, “One of the greatest sources of energy is pride in what you are doing.”  Every hospice Chaplain should be a student of the profession.  Getting into a rut of doing the same thing with each patient is a dangerous place to be.  After all, a rut is defined as a grave with both ends kicked out.  Make time to read about hospice chaplaincy.  Buy yourself a subscription to professional journal such as Plainviews.  You will be informed and challenged by what you read.  You will grow.  And, it must be remembered that soon you and your staff colleagues must do the work of top 10% hospice Chaplains or your hospice might not receive its full re-imbursement.  While it is not all on the Chaplains to excel, certainly, the Chaplains should lead the way to excellence.

Let me tell you what your manager is looking for when your annual review comes do.  The manager is looking at the big picture of your chaplaincy.  The big picture is comprised of many small actions.  Together they make up the whole.  Such things as attitude, commitment to the hospice philosophy, productivity, documentation excellence, and healthy relationships with staff are some of the matters a manager looks to in completing a yearly evaluation.  I am not looking for our Chaplains to be perfect. I am looking for them to be consistently excellent.  Our bar is high at Cornerstone.  So far, our Chaplains are reaching it a good bit of the time.  They are aware of two things: first that I must be a top 10% manager and, second, they must be top 10% Chaplains.  While these are daunting goals, they are not out of reach.  In fact, as Robert Frost put it, “Two roads diverged in a wood and I - I took the one less traveled by, and that has made all the difference.”  I may be wrong, but don’t think so, when I say that I believe that many more people are looking to travel an easier road.  Therefore, I choose the road less traveled.  Yes, it will be harder and more challenging, but the rewards are far greater. 

Yesterday, my pastor said to me, “I don’t know how you do it. You work with people with so little hope.” At first glance, that statement has a ring of truth to it. But, when you think of it, our patients have every reason to hope… to hope for reconciliation with a loved one and, perhaps, to God; to tie up the loose ends of their lives in the time that remains; to find forgiveness; to extend forgiveness; to realize that life was, indeed, worth living; to celebrate a life well lived; to bless those who need to know that they were and are loved and appreciated; to affirm the depth of love for a spouse; to review life with a spouse and/or children (adult or younger).  Hope lives in hospice. 

So, Blessed Chaplain Colleagues, I urge you to give your all in service to your patients and their loved ones.  Be motivated, be positive, be strong, and be faithful.

Applying Body Language Clues

I think it important to state at the beginning of this article that I am not suggesting you analyze your patients or family members.  This is not what hospice chaplaincy is about.  We work daily with living human documents.  My purpose is to provide you with clues and cues to assist you in your approach to pastoral care.  This affects your emotional intelligence which will also affect your pastoral care relationship with patients and family members.

 

With that stated, I want to provide clues and cues dealing with your observation of eyes, mouth and voice, posture, and touching.

 

EYES

While direct eye contact is good and shows interest, if you as the Chaplain become too intense with your eyes you will send a message of dominance and intimidation.  Don’t do that.  If the person you are working with does not keep eye contact or looks away frequently, you have lost them.  Stop what you are talking about and regroup.  Change the subject to something they do have interest in.  You have heard of the term “brow-beat”?   Don’t ever continue to talk about a subject in pastoral care because you feel they “must” hear what you are saying.  Pastoral care is much more patient than that.

 

MOUTH AND VOICE

If the person you are talking to presents with lips that are pursed or tight, it may mean they disapprove of what you are saying or at least not trust what you are saying.  If the person you are talking to is loud, it may be they are angry, frustrated, upset, or stressed out.  May this call to mind your training on suffering.  Loud is often what suffering sounds like.  If they are talking softly, it could be they are uncomfortable, embarrassed, or even shy.  Be mindful that if someone asks you a question and answers it themselves they are definitely telling you something about themselves. Be sure to listen and hear.

 

POSTURE

These comments have as much to do with your posture as to the posture of the one you are speaking with.  Arms crossed and legs turned away from you is a closed posture which means you have work to do to overcome a barrier or two.  If you see the person hunched over with hands supporting the head, that person might be emotionally weary and in need of your support.

 

TOUCHING

Touching is a “touchy” subject.  Be cautious.  It is a natural thing for a Chaplain to reach out to touch a patient or grieving/upset family member.  Keep in mind that a touch might not be welcome.  The patient or family member may misunderstand the intent of the touch, especially if the patient’s condition in any way decreases their understanding and perception.  It is advised to ask before you touch a shoulder or hold a hand.  And, you have to set boundaries about people touching you.  Please read the informative site http://www.livescience.com/20801-personal-space.html. 

Hopefully, you gained some insight into cues and clues.  Don’t overdo it and over-analyze people.  Just know that there are behaviors and postures that can give you a bit of understanding where people are in their emotions.  Be yourself, be open, and be compassionate.  That communicates well and we know that people on a hospice journey need Chaplains who care.  Blessings!

 

How you shake someone’s hand …

There is a gentleman at my church (yes, I attend church and even teach a class) that shakes hand like a vice.  I’m not sure what his point is in doing that but he does_every week.  How you as a Chaplain shake hands, speak, and express yourself facially and with your body will dictate the success or failure of your visit.

 

Here are a few of the more notorious types of handshakes:

 

•  The Vice Grip—As I mentioned above this is a hand crushing type of handshake.  Ultimately its purpose is to show dominance, strength, and even intimidation.  These qualities are the last things a Chaplain wants to express to his patients and their family members.
•  The Lobster—This handshake has this moniker because the dominant person simply grasps the other person’s fingers, but does not grasp the hand.  Again, this is along the lines of dominance and superiority and not a handshake a Chaplain should employ.
•  The Sweaty Handshake—If you’ve ever experienced this handshake you know that your hand is perfectly dry, but the other person’s hand is sweaty, giving a yucky feeling.  This is not atypical for a hospice patient or family member to be nervous when they greet you. If their hand is sweaty, so be it.  Do not allow your facial expression to look surprised or dismayed or shocked. 
•  The Dead Fish—Chaplain, know thyself.  If your personality style is passive or reserved, do not allow that to come across in the way you shake hands.  A handshake begins the visit, as does your tone of voice and your facial expression.  You just can’t sabotage yourself with a dead fish, limp handshake.
•  The embraced handshake—This is a very acceptable handshake if it matches your facial expression and tone of voice.  A handshake where you embrace the other person’s hand with your hands conveys warmth and caring.  Be sure all about you agrees with warmth and caring.
•  The firm handshake—I saved this one for last simply because there is a difference between it and the vice grip.  Firm, but not crushing.  Firm, but not intimidating.  Firm but brief so as not to linger trying to out shake the other person.  Facial expression and tone of voice convey your level of engagement with the person.  

 

Chaplain Colleagues, the way you begin your visit cannot be undervalued.  Your smile, you kind words of greeting and your handshake will put your patients and their families at ease.  Providing a non-anxious presence will serve as a catalyst to many a positive and healing discussion.

How you say it ...

In the last post, I wrote about body language.  How we present ourselves to our new patients and their families and our ongoing caseload of patients will lay the foundation for effective pastoral care visits.  Coupled with body language is our speech.  

 

Professor Albert Mehrabian has pioneered the understanding of communications since the 1960s. He received his PhD from Clark University and in l964 began an extended career of teaching and research at the University of California, Los Angeles.  Mehrabian's findings were:

• 7% of message pertaining to feelings and attitudes is in the words that are spoken.
• 38% of message pertaining to feelings and attitudes is paralinguistic (the way that the words are said).
• 55% of message pertaining to feelings and attitudes is in facial expression.
  As you know, in hospice chaplaincy how you say your words is just as important as what words you say.  You convey your meaning non-verbally with your body language and amplify that with your voice. 
  It is helpful to have examples so we can actually hear how a voice should sound.  The Guardian has an instructive site that provides examples of what someone should sound like to engage, to calm and to soothe.  These are three of the many tasks a Chaplain performs in pastoral care chaplaincy.  Please go to https://www.theguardian.com/science/blog/2015/apr/16/is-your-voice-trustworthy-engaging-or-soothing-to-strangers to listen to the examples.
   
  I hope you are gaining insight regarding the skills required to convey our meanings to our patients and their families.  This will help us to connect with them quickly and start the spiritual care relationships on a solid foundation. 
   

Facial Expressions and the Chaplain

My goal on the topic of body language has been to get the facts and present those that are most pertinent to the hospice chaplain.  Today, I will present a topic of great interest to successful interaction with patients and their families.  There are few things that irk me more when I am with a patient that is in the throes of an illness that leaves the patient with an odor or some physical deformity and someone comes into the room and  makes a facial expression of horror or some such thing.  The chaplain must not surrender pastoral care decorum to odors or deformities.  Facial expressions speak volumes to the patient and to their families.  There are 6 emotional facial expressions.  Can you list them?  I will assist you by providing a letter or two or three for each one.  In coming articles I will address the components of facial expressions.  For now, we just want to identify the expressions that we use, as well as, those of patients.

 

H- - p - - - - s

S - - - - - -

F - - -

D - - g - - t

S - - - r - - e

A - - - - r

 

A chaplain must be proficient in conveying several vital cues through facial expression:

• Empathy
• Interested listening
• Hopefulness
• Affirmation
• Acceptance
• Concern
• Compassion
• What other facial expressions can you think of? 
   
  In future articles we will examine practical tips on how to express these vital emotions.
   
   

Body Language Skills (Pre-test)

Body Language Skills  (Pre-test)

 

Match the following from the left column to the interpretation of the behavior in the right column.  This is a good start at understanding how your non-verbal language speaks as loud, if not louder, than your spoken language.  “Edward T. Hall (1959), a well-recognized social anthropologist, maintained that in a normal conversation more than 65 percent of social meanings are transmitted through the non-verbal channel.” (Kris Rugsaken in body-speaks, Clearinghouse Academic Advising Resources)  If that remains the case in 2016 then the Chaplain has to pay attention to the matter.  The answers to the pre-test are below the exercise.

 

1.    Sitting with legs crossed, foot kicking slightly	a.    Open, relaxed
2.    Arms crossed on chest	b.    Readiness, aggression
3.    Sitting, legs apart	c.    Rejection, doubt, lying
4.    Hand to cheek	d.    Apprehension
5.    Locked ankles	e.    Doubt, disbelief
6.    Head resting in hand, eyes downcast	f.     Evaluation, thinking
7.    Touching, slightly rubbing nose	g.    Boredom
8.    Rubbing the eye	h.    Defensiveness

 

There are many more non-verbal behaviors, but the above tend to occur in a pastoral care encounter.  How did you do?  Will you be more self-aware of your non-verbal communication?  Did you notice that two of the above have the same answer?  Why do you suppose I included two non-verbals with the same interpretation?

 

Answers: 1, g; 2, h; 3, a ; 4, f; 5, d ; 6, g; 7, c; 8, e

3 Powerful Thoughts on Forgiveness

As we work with patients and families and seek to facilitate forgiveness when that issue arises, it is always good to have to have reference points that give you as the Chaplain a means to offer guidance.  As a foundational starting point, explore these thoughts.  More posts on forgiveness will follow.


…When we dare to look at the myriad hostile feelings and thoughts in our hearts and minds, we will immediately recognize the many little and big wars in which we take part.  Our enemy can be a parent, a child, a "friendly" neighbor, people with different lifestyles, people who do not think as we think, speak as we speak, or act as we act.  They all can become "them."  Right there is where reconciliation is needed. Reconciliation touches the most hidden parts of our souls.  God gave reconciliation to us…

~Henri Nouwen

The Judeo Christian Scriptures affirm that the chief end of sacred writ is to guide us into love. A road block to that destination is the incessant search for what is wrong with our community, co-workers, friends, family, neighbors and the world. We get lost in this and become part of the problem. How can I claim to love God, if I do not love people? Perhaps we should strive to welcome people and give them a measure of unmerited favor.  This is the evidence of love; this is our guiding principle: the healing presence of GOD.-Guillermo Escalona

“As I walked out the door toward the gate that would lead to my freedom, I knew if I didn't leave my bitterness and hatred behind, I'd still be in prison.” ― Nelson Mandela

How do these statements inform your chaplaincy? 

Awareness: of Self, of the Dynamics that surround us and how it all affects us

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 [the new year], 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 2016 be your best and most rewarding year in your hospice career

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.