facing the questions…. partnering with health professionals in providing spiritual-cultural care...
TRANSCRIPT
Facing the Questions….
Partnering with Health Professionals in providing Spiritual-Cultural Care in Healthcare SettingsJanet Stark, Spiritual Care Manager and Multifaith Chaplain, Brockville General Hospital
Objectives To address the concept of “Culturally- Appropriate
Care” in the provision of religious, spiritual and cultural care
BGH Spiritual Care Nursing Survey will be discussed
A Spiritual Care Assessment Tool will be shared Connecting with Allied Health Practitioners Participants will be invited to share questions,
barriers and what they have found works well in their practice
Understanding the concept
Spiritual care is often poorly addressed in health organizations. We may profess to provide holistic care - body, mind and spirit - but are we all on the same page when it comes to “spirit” care? If we are not all on the same page, how can we provide ‘spirit’ care to a consistent standard?
Nurses First!
The 2011 nursing survey
A Nurse’s Perspective
Results from 121 nursing surveys at Brockville General Hospital in 2011 identified the vast differences in understanding nurses have for what constitutes best practice spiritual care.
A key finding is that often the terms ‘spiritual care’ and ‘religious care’ are misunderstood. The term ‘culturally-appropriate’ care seems better understood in the current Canadian environment of inclusiveness and tolerance.
A Nurse’s Perspective
…..Vast range of educational backgrounds when it comes to spiritual health…
On a nursing team there may be:
An older nurse who was trained by the Catholic nuns
A nurse with Aboriginal roots who feels that often traditional medicine is at odds with his customs and practices
A young nurse who proudly claims to be an atheist
A middle-age nurse who is an evangelical Christian and attends every worship service held in the hospital.
On a nursing team there may be:
A nurse who is of oriental background and Buddhist in practice
A nurse who seems angry at the ‘church’ and fights against any personal connection with organized religion
A nurse who is very spiritual and finds strength in sports and nature
Spiritual Care Nursing Survey Where are you at?
RN RPN PSW
1. What is the difference between Religious and Spiritual care?
2. What is spiritual strength fostered by?
3. What is spiritual distress fostered by?
4. Do you have a developing spirituality of your own?
Spiritual Care Nursing Survey What is your role?
1. Is spiritual care within your scope of practice?
2. Are you comfortable providing a spiritual assessment?
If not, why? 3. Do you currently refer patients to the
spiritual care department? 4. Do you currently call a patient’s own
clergy when needed?
Spiritual Care Nursing Survey What do you need?
In order to improve your knowledge, skills, and comfort level with assessing & providing spiritual care, I need:
____short in-services ____half-day workshops____full day workshops____pastoral care course____brochures, books & websites____mentoring____other: _____________________________________
Findings:
Some nurses are well-informed but not comfortable
Some nurses are not well-informed and not comfortable
Some nurses are well-informed and comfortable
Research Shows
Health professionals are often inadequately prepared to provide spiritual care
Penman et al 2009
Nurses tend to equate “spirituality” with “religion” Oldnall, 1996
Nursing assessment has been dominated by the medical model (physical needs)
Baldacchino, 2006
Research Shows
87% of patients consider spirituality to be important in their lives
Between 51% and 77% consider religion to be important in their lives
Edwards et al 2010
Outcomes of spiritual care is that patients: can count their blessings, achieve inner peace and explore coping strategies
Baldacchino 2006
A Nurse’s Perspective
Spiritual Care is most often consulted at end-of-life
Palliative Care nurses seem to have the most comfortable relationship & practice
with psycho-social-spiritual needs
Canadian Nursing Association Position – Spirituality, Health and Nursing Practice
The CNA expects registered nurses to be respectful of and sensitive to diversity in spiritual beliefs, to support spiritual preferences and to attend to spiritual needs
CNA Position
When planning for and providing care, nurses have an ethical responsibility to be aware of and adjust for an individual’s spiritual beliefs as a component of a holistic nursing assessment and practice.
Nurses are uniquely situated to ensure that an individual’s spiritual values, beliefs and experiences are taken into account
Broadening the Perspective
Religious Care
“Are you kidding?”
Spiritual Care
“What’s that?”
Culturally-Appropriate Care
“Ah… we get it!”
Culturally-Appropriate Care
Open, sensitive & inquiring
Proactive and not Reactive
Exploring early on-- being aware of, and adjusting to a person’s own spiritual-religious culture.
All part of “patient-centred care”
Culturally-Appropriate Care
A person or family’s lifestyle— Education Economic background Sexual orientation Ethnicity Religion Local culture Family tradition
What is Culturally-Appropriate Care?
Understanding the patient’s living environment
Being open and sensitive to diverse beliefs and practices
Leaving personal bias’ at the door Not making assumptions Knowing where to find resources
Clinical Disciplines- Allied Health
Therapeutic Recreation Discharge Planning Social Work Psychology Ethics Committee Palliative Care
Barriers to being consulted
Personal bias or negativity
Not understanding what spiritual
care has to offer
Poor past experience/discomfort
Thinking that “patient must be dying” for the chaplain to show up
Spiritual-Cultural Assessment
Patient/Client/Resident: ___________________________________
Faith Group/Religion/ Ethnic Background:____________________
Spiritual Contact:_______________________Phone ___________
Spiritual-Cultural History:Do you have a faith practice or religion?
_____________________________________________________
How would you describe your culture?_________________________
Do you have any rituals you wish to practice?____________________
Spiritual-Cultural Assessment
What spiritual practices gave you support in the past?(sometimes concrete examples need to be suggested: prayer,
nature, reading, pets, art, music, worship services, visits from family, clergy etc) ___________________________________________________
Who gives you support? ___________________________________________________
Tell me about your family__________________________________
Is there anyone else who should be involved in making decisions about your care?______________________________________
Spiritual-Cultural Assessment
Goals of Care:
What is really important and meaningful to you right now?______
Is there anything the care team needs to know about health practices or restrictions important in your culture/faith group?_________________________
What do you believe about your illness? ________________________________
Spiritual-Cultural Assessment
Spiritual Distress:
Is there anything bothering you right now?___________________
Is there anything you are afraid of?__________________________
How are your loved ones coping right now?___________________
What would help?_________________________________________
How can we include this in the hospital setting?________________
Are there any other concerns you would like to share with me?________________________________________________________
Helpful Strategies
Communication
Relationship with Staff
Team Concept
Education
What can help?
Be sure nurses realize that you have the patient’s (& family) permission to be part of their care team
Permission does not have to be in writing
Gain permission of the patient to include their own personal clergy-
person if desired
What can help?
Be sure nurses can observe spiritual care at the bedside. Seeing the interaction, developing relationship and the positive response can result in an informal mentoring opportunity
Gain the support of the nursing manager—make sure he/she totally “gets it”
Ask for occasional moments to speak at nursing staff meetings
What can help?
Be sure clinical staff know that you are available to help provide spiritual care, bereavement care and stress mgt for them personally
Make the referral process easy!
Find opportunities to ‘debrief’ nurses when something has worked well/not well
What can help?
Plans for mandatory annual education sessions to improve the healthcare provider’s comfort and skill in providing appropriate bedside spiritual care.
Have up-to-date area clergy contacts lists available in all nursing areas
Compliment nurses on specific interactions that are helpful
What can help?
Doing a really good job of explaining the role of spiritual care during new staff orientation education.
Attending multidisciplinary patient rounds and having a voice at the table.
Rarely saying “no” to requests
Having a good after-hours “on-call” system
What can help?
Show the value of including spiritual care volunteers in patient care
Offer to assist/facilitate family meetings
Get to know and build rapport with physicians
Brainstorm Session!What works well in your practice?
Questions
1. Why do spiritual care providers act as an advocate for patient-centred care?
Questions
2. How can we achieve respect on the multi-disciplinary team?
Questions
3. How can our toolkit of spiritual interventions merge with other therapy programs?
Questions
4. What have been our successes?
Our Barriers? (in providing spiritual-cultural care?)
Questions
5. How to help meet the personal spiritual needs of staff
