Meeting People Where They’re At:Taking Spiritual Assessment

Rev. Bobbi Virta, The United Church of Ferndale, WA, & Rev. Tessie Mandeville, Palliative Care Chaplain, PeaceHealth St. Joseph Med Ctr, Bellingham, WA

https://www.youtube.com/watch?v=cx2Sps9aMcY

Tip #1: Practice the art of connecting, not projecting

Tip #2: Practice the art of listening

The word ‘listen’ contains the same letters as the word ‘silent’.

Listening to the patient’s personal story.

Who was this patient before they became sick?

Who are they now when they are not sick? What accomplishments are they most proud

of in their life? From where do they draw strength during

challenging times? How does their faith inform the decisions

they are trying to make? What gives them meaning and purpose?

When we understand who this person and family is, what is important to them and why, we find that they are more likely to hear and accept the recommendations for treatment that we make because they feel they not only have been listened to but heard. This builds trust (an action and emotion) and they feel respected and cared for when they know we see them as a whole person, not just their disease or symptoms.

Tip #3: Practice the art of meeting people where they’re at

There is an increasing awareness in healthcare that we are treating the whole person—body, mind, emotions, and spirit.

Studies have shown that a holistic model of care increases both patient satisfaction and cost effectiveness.

Spiritual care is increasingly being promoted as an essential part of holistic care.

Religious and spiritual beliefs and practices have been shown to be a major component of how patients cope with serious illness.

Studies have shown that care that includes the spiritual dimension increases patient and family satisfaction and contributes to decreases in the extraordinary cost of excessive medical interventions at the end of life.

However, what we’re noticing is that the spiritual care needs of our patients are not always seen as a priority.One study found that physicians

—the central figures in treatment decisions—are less likely than all other hospital disciplines to believe it to be important to refer patients to chaplains.

Other research showed that 72 percent of the patients with cancer surveyed said their spiritual needs were minimally or not at all supported by the medical system.

People don’t care about how much you know until they know how much you care.

Recognize that emotional intelligence (EI) is equally as important as IQ (and maybe more so during these types of conversations).

In 1990, during the days when the preeminence of IQ as the standard of excellence was unquestioned, psychologists Mayer and Salovey offered the first formulation of a concept they called “emotional intelligence”, an additional way of looking at intelligence. Goleman expanded on this concept by reviewing reports from both psychology and neuroscience that gave us insight into our “two minds”—the rational and the emotional—and how they work together to shape who we are.

In mastering communication with seriously ill patients, the critical task for clinicians is to find a way to integrate complicated biomedical facts and realities with emotional, psychological, and social realities that are equally complex but not very well represented in the language of medicine. Working with life-threatening illness is a cross-cultural experience. As a clinician, you need to understand both the biomedicine and the personal story, and you need to be able to speak both languages.

Chaplaincy CareCare provided by a board certified

chaplain or by a student in an accredited clinical pastoral education program. Examples of such include emotional, spiritual, religious, pastoral, ethical, and/or existential care.

Care performed by professional chaplains.

Pastoral Care This phrase comes out of the Christian tradition and

developed within the socially contracted context of a religious or faith community where the ‘pastor’ or faith leader is the community’s designated leader who oversees the faith and welfare of the community and the community submits to or acknowledges the leader’s overseeing. The ‘faith’ they share is a mutually received and agreed upon system of beliefs, actions, and values.

Pastoral care may form part of the care provided by a chaplain.

Care performed by chaplains and other religious

professionals, usually with persons of their own faith

tradition.

Spiritual CareInterventions, individual or communal, that

facilitate the ability to express the integration of the body, mind, and spirit to achieve wholeness, health, and a sense of connection to self, others, and/or a higher power.

Forms part of the care provided by a chaplain.

The overarching category representing a domain of care comparable to “emotional care” that can and should be performed to a greater or lesser degree by all health care professionals.

Spiritual Care, cont’dA realm of care shared not only by the treatment

team but by whomever the patient considers important in their life (i.e. a friend, co-worker, family member)

In the setting of the hospital, spiritual care becomes a responsibility of all team members but the chaplain is the spiritual care expert and is able to have both a body of knowledge to share and demonstrate what we add to the care process.

Ways to Assess Spiritual Distress

Spiritual Screening

Spiritual History

Spiritual Assessment

Spiritual ScreeningA quick determination by any

health care professional of whether a person is experiencing a serious spiritual/religious crisis and therefore needs an immediate referral to a professional chaplain.

Spiritual HistoryA process of interviewing patients, asking

them questions about their lives in order to come to a better understanding of their needs and resources. These questions are usually asked as part of a comprehensive exam by the clinician who is primarily responsible for providing direct care or making referrals to specialists, such as professional chaplains.

FICA tool (handout)

Spiritual AssessmentA more extensive [in depth, ongoing] process of

active listening to a patient’s and family’s story as it unfolds in a relationships with a professional chaplain and summarizing the needs and resources that emerge in that process. The summary includes a spiritual care plan with expected outcomes which should be communicated to the rest of the treatment team.The assessment requires the training of the

professional chaplains and should only be done by someone with that training.

A Basic Overview of Spiritual Assessment:

Relationships and Connectivity—To identify the relationships and connections that are significant in this person’s life. This includes not only family and friends but also with God or a sense of the sacred as understood by the person.

A Basic Overview of Spiritual Assessment,

Cont’d:

Meaning and Purpose—To identify what relationships, values, activities, interests, or beliefs provide a sense of meaning and purpose for the person. It’s important to remember that the person’s values and beliefs may be in a state of flux and/or may need to be re-evaluated in light of a new situation.

A Basic Overview of Spiritual Assessment,

Cont’d:

Degree of Understanding and Congruence of Response—To identify whether the person understands her/his current medical condition and is able to apply their values and beliefs to that medical condition in a mature fashion.

All of these would be summarized into a spiritual care plan with expected outcomes which should be communicated to the rest of the treatment team.

Tip #4:

Practice the art of spiritual care

Remember Tips #1-3:Practice the art of connecting,

not projecting.

Practice the art of listening.

Practice the art of meeting people where they’re at.

Becoming a Non-Anxious Presence

Edwin Friedman, a Jewish Rabbi, family therapist, and leadership consultant expounded on Murray Bowen’s classic phrase “non-anxious presence” and helped differentiate between a person who has an anxious presence and one who does not, with the goal that one can become a non-anxious presence and thereby facilitate a healing relationship.

Meeting People Where They’re At: The Heart of the Matter

We have to find ways to meet people where they are at because they can be nowhere else in that moment. The spiritual care provider meets them in that space, shares that space with them, and shines a light on hope—helps them identify latent sources of hope.

Effective spiritual care recognizes the central place emotion plays in spirituality.

We have to help people re-imagine what hope looks like for them.