What does the Chaplain do when “The Sky is Falling?”

There will be times in an IDT meeting when a team leader will not be in their place due to a death in the family, an illness, or some other pressing matter.  A substitute is assigned to lead the meeting and all should be well…right?  Well, not always.

 

ç Looks like a fun IDT meeting or “Is the sky falling? ç   “Oh, dear, what shall I do?”   ç

                      

 

In re-reading this folk tale, I recalled the interesting names of the characters: Chicken Little, Cocky Locky, Ducky Lucky, Goosey Loosey, Turkey Lurkey and Foxy Loxy.  The first 5 are the good guys; Foxy Loxy is the bad guy.  Since this story has a moral we can have a little fun with the story. 

Chicken Little apparently was having one of those days.  I mean if a little chicken can’t eat the corn laid out for it without an acorn hitting her in the head, what’s wrong with the world?  Her response was one of utter hysteria. That seems like a very real human thing to do.  She gets her friends all stirred up and they head out to see the King to tell him the sky is falling.  Now, the friends don’t enquire as to why Chicken Little believes the sky is falling, they just accept the premise because they know Chicken Little.  So, off they go.  Unfortunately, they meet up with Foxy Loxy who is a bit slyer than any of them ever thought to be.  The upshot of the story is Foxy Loxy eats the entire cohort except for Chicken Little who runs home.  Drama, drama, drama.

 

My point?  There are times when things in an IDT’s life cycle look confused and disorganized.  The reasons are many and varied.  You can fill in a few I’m sure.  When that happens, what is your response as a Chaplain?  What are your options?  Let’s lay them out:

1.  You can join in with the leader of the drama and scream along, “The sky is falling!"
2.  You can ask the leader of the drama why the sky is falling and agree that “Yes, the sky really is falling!”   Oh, Dear.  In #’s 1 and 2 the faith leader of the IDT is showing no strength of faith and surrenders to the drama leader’s assertion that the sky IS falling.
3.  You might also ask the drama leader why the sky is falling and kindly but firmly state that whatever the IDT is facing is short-lived and will be corrected and there is no need to upset the rest of the Team.   

Moral of the story:  There is always someone on the IDT with the personality style of Chicken Little…one thing out of place or several things out of place the reaction is the same, “The sky is falling”.  Most IDT’s know who that individual is.  The Chaplain cannot engage in drama…ever.  It’s beneath the dignity of our calling to do so.  We point people’s gaze upward and inward, not downward. 

So, the next time your IDT is in a tizzy that life in the IDT is not perfect, take the lead and squelch the drama with your own inimitable style.   

A blessing to share...

Here is a blessing that came my way. 

https://cshospice.org/2532-2/

A Few Reflections ...

I’ve been very busy putting together our CPE program to launch on October 24 from    1-5PM…so busy that I just haven’t had the time to invest in writing.

 

But, I want to invest in you today by relating several admission visits I’ve participated in. I have a few reflections that continue to shape my outlook and heart for hospice.

 

• The ‘existential slap’ is real.  It is evidenced by the shock of realizing life will soon be over.  Observing the nervousness, lack of focus, and sorrow in the lives of these new hospice patients was heart rending.  Ram Dass once said, “We are just walking one another home.”  How true a statement; however, the type of walking we do with a new hospice patient is often seen by our placing their arm around our shoulders as we support them on their journey. 
• Negotiating with God and/or man seems to be part of the process for some.  The cancer patient would get well if only she could be part of a transplant program.  This can’t be happening, I’m too young.  I’ll have to get better.  I think I can do that.  Is this negotiating or is this denial?  In the final analysis I’m not sure it matters as this person is suffering deep existential pain which becomes spiritual pain…heart-rending once again.
•  Admitting the end is near is part of the process for others.  I’m not sure which is more painful to hear.  What I do know is that the cavalry is on its way.  Cornerstone Hospice has what patients need: the physical, the pharmacia, the nursing, medical, and all that goes with it, the social services, and the spiritual.  Amazing how a family nearly breaks down with tears of relief that finally help is on the way.  For me to be a part of such an institution as hospice fills me at once with tears of joy and also a determined focus to provide a team of Chaplains that are known for their loving and practical spiritual support.
   
  Yes, it’s been a good experience.  I have been following the many patients I saw come into our service.  And, again…yes, our Chaplains are doing what they do best.  For the patients and families I am pleased.

Cornerstone Hospice & Palliative Care, Inc. Launches Clinical Pastoral Education

Clinical Pastoral Education/Training is theological learning through experience in a clinical setting, under the supervision of a certified teacher-practitioner of pastoral ministry.  CPE/Training provides a process for integration of various aspects of theological education into a personal theology and professional style of ministry.  The goal of CPE/Training is to give opportunities to function as ministers, while receiving guidance to render pastoral care.  In the process, one’s own unique gifts in ministry are called forth, recognized, and strengthened.

The main educational purposes of this program are to provide opportunities to render pastoral care to individuals under stress in multi-institutional settings, to develop pastoral identity, and to master a body of interpersonal skills and academic materials related to pastoral care functions.  In the process of fulfilling these purposes, the student/ trainee will be able to set individualized learning goals and evaluate theological and pastoral presuppositions and procedures within the context of relationships with a chaplain supervisor, student colleagues, potentially staff chaplains and professionals from other disciplines.  Rich Behers, DMin BCC CFHPC, Spiritual Care Program Manager will lead the CPE process.

 

Class begins October 24, 1-5 PM at the Southridge office of Cornerstone Hospice located at

4215 CR 561, Tavares, FL 32778

For an application or questions, please contact Rich Behers, DMin BCC CFHPC at rbehers@cshospice.org

Chaplain Position Opening--Full Time

Full Time

Sebring, FL

Posted 2 weeks ago

This is a full time  position providing support to patients and families predominately in Hardee & Highlands counties and on an as needed basis Polk county.
Description:  Assists, educates, and provides support to patients and families with spiritual concerns.
Qualifications:
-Master’s degree of Divinity from a Seminary accredited by the American Association of Theological Seminaries, or Bachelor’s degree and a minimum of three units of CPE in a hospital or hospice setting. -Five years of experience as either a pastor or chaplain.
-Knowledge and Abilities:
a) Demonstrated knowledge and commitment to the Hospice philosophy of care and the Hospice team concept.
b) Able to assess data reflecting the patient’s status and interpret the appropriate information needed to identify each patient’s requirements relative to their spiritual needs.
c) Ability to work comfortably in a non-denominational or multi-denominational environment.
-Knowledge of multi-cultural beliefs and practices and ability to work with patients and families from diverse backgrounds, including, but not limited to, race, religion, ethnicity, or sexual orientation.
-Valid Florida driver’s license and required auto liability insurance.




Please go to cshospice.org to apply.

Omincompetence…Something to think about.

This morning I was reading Chapter 7 in Helping the Helpers (Foskett, John and Lyall, David; New Library of Pastoral Care, page 107) and came across a very fascinating word, omnicompetence.   Here is the exact quote: “…each ministry demands its own training and expertise, and it is unrealistic to expect omnicompetence…”

I looked this word up and found varying definitions.  In defining omnicompetence I discovered several clear descriptions:  able to handle any situation; competent in every area; the ability to do everything.  And, I had to wonder if that is not what is expected of the parish pastor or the hospital chaplain or even the hospice Chaplain.  It is unreasonable to expect of any human, regardless of religious calling, to have the ability to handle every crisis situation with ease or to implement administrative skills perfectly, or to do everything on the job description without faltering even a tiny bit.  What is expected by the use of this word is the fundamental necessity of education and mentored training. 

At Cornerstone Hospice & Palliative Care, Inc., we have a high census of patients with dementia; therefore, we train our Chaplains and Volunteers in “Communicating Spirituality to Patients with Alzheimer’s Disease and Other Dementias.”  We have many other patients suffering from diseases such as: HIV:AIDS, COPD, Cardiac Disease, Cancers of all sorts, as well as other life-limiting disease processes.  Therefore, we educate our Chaplains using the module, “Providing Spiritual Care According to Disease Process.”  I recognize that our Chaplains like to read after hours to gain more information about chaplaincy, so I provide http://www.embracedbytheheartofhospice.blogspot.com.  We recognize that there are chaplains in the community and highly motivated lay persons that have a desire to deepen their ministry skills.  We offer Clinical Pastoral Education to meet those needs.

Further, there is the “other half” of hospice chaplaincy—documentation in the electronic record.  For that, the Chaplain has resources such as, “Algorithms for Spiritual Care”, the “Users’ Guide”, and “Documentation Template” to assist in the process.  The goal is to educate the Chaplain so that in the midst of meeting his caseload of patients with their unique personalities and responses to their life limiting illnesses, the Chaplain not only will be flexible in his approach to meeting the patients, but also, intelligently flexible as he/she provides the appropriate spiritual care for these patients.

Caring is just not enough.  Quoting from Helping the Helpers (pages 104-105):

“Heije Faber in his classic study Pastoral Care in the Modern Hospital compares the role of the minister (Chaplain) in hospitals with that of a clown in a circus.  The clown has his own unique and essential role in the circus introducing a dimension of humanity amidst the amazing feats of the lion-tamers and the trapeze artists.  Similarly a minister (Chaplain) in a hospital can be seen as another human being with whom patients can identify in the midst of all the high technology. ‘If the minister (Chaplain) is to be compared with the clown, he is not to overlook how Grock, one of the greatest of the clowns, would study his act almost daily, frequently giving it fresh slants, and taking care to notice the reactions of the audience.  He realized that the clown had to be professional. The pastoral ministry is also a trade one has to learn and make one’s own by study and training.’”  And, that is why I put so much emphasis on educating our Chaplain Team.  At this time of year, the National Football League training camps are in full swing.  Since I live in the Tampa Bay area of Florida, I follow the Tampa Bay Buccaneers.  I listened to a sports report about the Bucs quarterback.  He was eating his lunch alone and was studying his iPad so he could know the offensive plays so well, he didn’t have to think about what to do.  His decisions would be second nature.  To become a hospice Chaplain with great pastoral care skills it takes more than a heart.  Heart is an assumed quality of a hospice Chaplain.  Gaining skills in providing excellent and comforting spiritual care takes time, study, and practice.  It just doesn’t happen on its own.  I don’t expect any Chaplain to be omnicompetent, but I do expect the Chaplain to trend upward in his/her pastoral care skills.

Interesting word: omnicompetence…

Taking Special Responsibility...

“A leader is a person who must take special responsibility for what’s going on inside himself or herself, inside his or her consciousness, lest the act of leadership create more harm than good.”  Parker Palmer, Leading from Within

 

I have read quite a number of statements about leadership, but this one has arrested my attention like few others.  Chaplains are leaders.  If you were to use “Chaplain” in place of “leader” that statement would read: “A Chaplain is a person who must take special responsibility for what’s going on inside himself or herself, inside his or her consciousness, lest the act of chaplaincy create more harm than good.”  How true is that!

 

There are some Chaplains who have slipped through the CPE process without being scathed by a deep and bold personal inventory and have wandered into chaplaincy stubborn, indifferent to the needs of patients, and reckless in their application of spiritual care.  They are still the parish pastor with all the brashness that goes with that.

 

However, the Chaplains that makes a difference in the lives of patients and families has taken the time and effort to do a fearless personal inventory of what’s going on inside of him/herself so that the act of chaplaincy benefits all involved.  There is sensitivity to the religious beliefs held by patients and families.  There is a humble application of spiritual care without rushing the issue.  There is a deep interest in the lives of patients and families and it shows.

 

I call upon all who go by the moniker of Chaplain to hold oneself accountable and take special responsibility for what’s going on inside so that the act of chaplaincy is unhindered and beneficial.

Henri Nouwen on Reframing

We are often tempted to “explain” suffering in terms of “the will of God.” Not only can this evoke anger and frustration, but also it is false. “God's will” is not a label that can be put on unhappy situations. God wants to bring joy not pain, peace not war, healing not suffering. Therefore, instead of declaring anything and everything to be the will of God, we must be willing to ask ourselves where in the midst of our pains and sufferings we can discern the loving presence of God.

 

Henri Nouwen

Show Me The Way

Crossroad Publishing Co., 1992

 

 

One day, I was sitting with Rodleigh, the leader of the troupe, in his caravan, talking about flying. He said, "As a flyer, I must have complete trust in my catcher, The public might think that I am the greatest star of the trapeze, but the real star is Joe, my catcher. He has to be there for me with split-second precision and grab me out of the air as I come to him in the long jump."

 

"How does it work?" I asked.

 

"The secret," Rodleigh said, "is that the flyer does nothing and the catcher does everything: when I fly to Joe, I have simply to stretch out my arms and hands and wait for him to catch me and pull me safely over the apron behind the catchbar."

 

"You do nothing!" I said, surprised.

 

"Nothing," Rodleigh repeated. "A flyer must fly, and a catcher must catch, and the flyer must trust, with outstretched arms, that his catcher will be there for him."

 

When Rodleigh said this with so much conviction, the words of Jesus flashed through my mind: "Father into your hands I commend my Spirit." Dying is trusting in the catcher. To care for the dying is to say, "Don't be afraid. Remember that you are the beloved child of God. He will be there when you make your long jump. Don't try to grab him; he will grab you. Just stretch out your arms and hands and trust, trust, trust."

 

Henri J. M. Nouwen

A Roman Catholic Priest

Our Greatest Gift: A Meditation On Dying And Caring

Communication Skills

The key element to productive, healthy interpersonal relationships is communication.  Communication encompasses both listening and speaking.  Someone wisely said, “God gave us two ears and one mouth.” 

 

Learning to listen is one of the greatest challenges we will face in our work as Clinical Chaplains.  Learning what to say is a close second.  This chapter is designed to be interactive, as well as, informative. 

 

Let’s tackle listening first.  Through my days in CPE I was taught much about listening… active listening and interactive listening.  Distinguishing between them was not particularly difficult.  What was difficult was clearing my mind so I could hear what was being said.

 

What are some barriers to listening?  Michael Webb presents “Eight Barriers to Effective Listening”.  We will look at five of these barriers:

 

1. Knowing the Answer--"Knowing the answer" means that you think you already know what the speaker wants to say, before she actually finishes saying it. You might then impatiently cut her off or try to complete the sentence for her.  Can you imagine the reaction of a spouse suffering with anticipatory grief who has longed to unpack painful feelings only to be cut off?  Pastoral care will suffer greatly.
2. Trying to be Helpful--Although trying to be helpful may seem beneficial, it interferes with listening because the listener is thinking about how to solve what he perceives to be the speaker's problem. Consequently, he misses what the speaker is actually saying.  One of the primary purposes of active listening is to discern the “question behind the question” or the “pain behind the statement”.  A Chaplain cannot discern anything if he/she is trying to come up with a solution to a perceived problem.
3. Treating discussion as competition—Have you been in a conversation (apart from your work) and spoke about a time of illness or surgery?  You were trying to make a point, but the other person interrupted and shared their story.  It appeared they were playing a game of ‘one-upmanship’.  You said one thing and they were going to see your story and up the ante by telling you theirs.  The point you were trying to make got totally lost.  You were left wondering why you even brought it up.  We are not in competition with our patients.  Hospice Chaplaincy is about the patient and family, not about us.  We go in to the patient with a blank slate and let them fill it in.
4. Trying to influence or impress--Because good listening depends on listening to understand, any ulterior motive will diminish the effectiveness of the listener. Examples of ulterior motives are trying to impress or to influence the speaker.  A Chaplain who has an agenda other than simply to understand what the patient is thinking and feeling will not be able to pay complete attention while listening.  Since one of the goals a Chaplain has in a pastoral encounter is to be ‘present’ with the patient, letting the mind wander trying to come up with a cogent come-back destroys the essence of listening.
5. Reacting to ‘red flag’ words—One of the key differences between a Chaplain and a parish Pastor should be/needs to be found at this point.  We, as Chaplains, are not the keepers of the faith.  We are not called to correct, but to support.  When a Wiccan speaks of “Sunnyland”, we don’t react.  When a Buddhist says, “We do not believe that this world is created and ruled by a God," we don’t’ react.  When a Muslim expounds the Five Pillars, we don’t react.  When a Catholic or Presbyterian or Methodist or Baptist or Episcopalian patient shares their view of the after-life and it differs with your beliefs, the Chaplain does not react.  The Clinical Chaplain recognizes that the journey of the patient is his or her own journey.  The patient’s belief system is just that… the patient’s belief system.  Our agenda is simple… to serve the patient.  The Clinical Chaplain does not suffer from religious counter-transference which fills the pastoral encounter with the Chaplain’s own anxiety.

How does a Chaplain keep from stumbling over the barriers to effective communication?  In short, the Clinical Chaplain is self-aware.  If the Chaplain struggles with ego issues, he/she might fall prey to “trying to influence or impress”.  If the Chaplain struggles with insecurity, he/she might fall prey to “reacting to red flag words”.  If the Chaplain struggles with a competitive personality, he/she might fall prey to “treating discussion as competition.”  Getting oneself out of the way so that listening becomes a reality is every Clinical Chaplain’s challenge.  I was taught an analogy in CPE called “The Window.”  This lesson provided a simple means to evaluate myself and where I was emotionally.  I used this simple tool prior to the work day and, in some cases, prior to spiritual care visits.  I hope you find it useful, too.

 

Managing Your Time

Without time management skills, a hospice Chaplain is without focus and will invariably miss face to face visits with several patients each month.  That highlights the reality that time management and patient care go hand in hand.

 

Hospice Chaplaincy is governed by several realities and expectations:

1.  All patients must have an initial comprehensive spiritual assessment completed by the 5th day after admission. (the day of admission counts as the first day.)

2.  If the patient/family requests deferring the assessment visit, you must document this in Clinical Notes.

3.  If the patient is being readmitted and has had an initial comprehensive spiritual assessment completed within the last 14 days and no significant change in the patient spiritual status has occurred; you do not need to repeat the assessment.

 

Based on these Medicare requirements, it is absolutely incumbent that the Chaplain have direction and focus in his/her work; thus, the need for time management skills.

 

In addition, some Chaplains are responsible for more than one team.  Management of these caseloads demands the type of focus time management brings.

 

Our day begins at 8 AM and concludes at 4:30 PM.  We take 30 minutes for lunch, so that leaves us with 8 hours to do our work which includes documentation. 

 

There are various ways to manage your caseload and the time involved to see each patient.  Our goal is to visit 20 patients per week. 

 

Since 20 patients is our goal, then we need to map out a strategy.  Use your Scheduler function on Allscripts for two weeks at a time.  This will help your strategy to take form.

 

• List the patients you for whom you are providing spiritual care. 
• Place them on your Scheduler for the next two weeks.  Keep in mind your productivity goal of 20 per week.  Patient care is primary that is why we see them 1-2 times per month.
• As you are building your calendar, leave room for IDT, calling new admits and scheduling visits for them and other meetings as they come up.  The calendar is not to be seen as something rigid, but rather as a fluid document that accommodates change. 
• Realities:  There will be days a patient declines a visit.  Simply pull a patient from another day to fill in.  There will be visits that go long.  Call the next patient and explain you are running late and provide a time you believe you will be at their home.  There will be times when a facility patient is out of their room for some activity or other reason.  Make other visits in the facility and come back to that one.  The idea is to maximize your time at each facility.
• Geographically locate your patients and focus on seeing patients from that area on a particular day or two. 
• Monitor your time.  Many patients and caregivers are up by 9 AM.  Use the 8-9 AM hour to organize your schedule.  Begin calling at 9 AM and set your visits for the day.  If you have both facility and home patients, schedule the facility patients in the morning as they could be more alert in the morning hours.  Schedule home patients in late morning and throughout the afternoon.  Do your best to have your documentation completed by 4:30 PM so you can enjoy your family and have a pleasant evening.
   
  Time management will provide you with a sense of accomplishment and fulfillment.  You will look back over the week and see what great work you have done in providing quality spiritual care to your patients and their caregivers.