spiritual care [compatibility mode]
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8/11/2019 Spiritual Care [Compatibility Mode]
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Toward National Consensus onSpiritual Care
Dr. dr. Sagiran, Sp.B., M.Kes
RS Nur Hidayah Bantul DIY RS PKUMuhammadiyah Yogyakarta FKIK
UMY
DISAMPAIKAN DALAM RANGKA
SEMINAR NASIONAL 'PEMENUHAN SPIRITUAL PASIEN',1DI AKPER KAB.PURWOREJO SABTU 1 JUNI 2013
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The NCP Guidelines Address Eight Domains of Care:
• Structure and Processes;
• Physical Aspects;
• Psychological and Psychiatric Aspects;
• Social Aspects;
• Spiritual, Religious, and ExistentialAspects;
• Cultural Aspects; •
Imminent Death; and •
Ethical and Legal Aspects.
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Conference Recommendations
Recommendations for improving spiritual care aredivided into seven keys areas:
I. Spiritual Care Models
II. Spiritual Assessment
III. Spiritual Treatment/Care Plans
IV. Interprofessional Team V.
Training/Certification
VI. Personal and Professional Development
VII.Quality Improvement
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I. Spiritual Care Models
Recommendations
• Integral to any patient-centered health care system
• Based on honoring dignity
• Spiritual distress treated the same as any othermedical problem
• Spirituality should be considered a “vital sign” •
Interdisciplinary
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Human
• Physics
•
Spiritual
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Inpatient Spiritual Care Implementation Model
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Outpatient Spiritual Care Implementation Model
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The Biopsychosocial-Spiritual Model of Care
From Sulmasy, D.P. (2002). A biopsychosocial-spiritual model for the care of patients at the endof life. Gerontologist, 42 (Spec 3), 24-33. Used with permission.
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II. Spiritual Assessment of Patients and Families
Recommendations• Spiritual screening
• Assessment tools
• All staff members should be trained to recognizespiritual distress
• HCPs should incorporate spiritual screening as a partof routine history/evaluation
• Formal screening by Board Certified Muslim Clergy
• Documentation
• Follow-up• Response within 24 hours
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Spiritual Diagnosis Decision Pathways
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Spiritual Assessment Examples
Diagnoses (Primary) Key feature from history Example Statements
Lack of meaning / questions meaning about one’s own“My life is meaningless”
Existential existence / Concern about afterlife / Questions the meaning
“I feel useless” of suffering / Seeks spiritual assistance
lack of love, loneliness / Not being remembered / No “God has abandonedme” Abandonment God or others
Sense of Relatedness “No one comes by anymore”
Displaces anger toward religious representatives / InabilityAnger at God or others “Why would God take my child…its not fair”
to Forgive
Concerns about relationship withCloseness to God, deepening relationship “I want to have a deeper relationship withGod”
deity
Verbalizes inner conflicts or questions about beliefs or faithConflicts between religious beliefs and recommended
Conflicted or challenged belieftreatments / Questions moral or ethical implications of “I am not sure if God is with me anymore”
systems therapeutic regimen / Express concern with life/death
and/or belief system
Hopelessness about future health, life “Life is being cut short” Despair / Hopelessness
Despair as absolute hopelessness, no hope for value in life “There is nothing left for me to live for”
Grief is the feeling and process associated with a loss of “I miss my loved one so much” Grief/loss
person, health, etc “I wish I could run again”
Guilt is feeling that the person has done something wrongGuilt/shame “I do not deserve to die pain-free”
or evil; shame is a feeling that the person is bad or evil
I need to be forgiven for what I didReconciliation Need for forgiveness and/or reconciliation of self or others
I would like my wife to forgive me
“Since moving to the assisted living I am not able toIsolation From religious community or other
go to my church anymore”
Ritual needs / Unable to practice in usual religiousReligious specific “I just can’t pray anymore”
practices
Loss of faith and/or meaning / Religious or spiritual beliefsReligious / Spiritual Struggle SEMINAR NASIONAL “What if all that I believe is not true”
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Religious Coping
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III. Formulation of a Spiritual Treatment Care Plan
Recommendations
• Screen & Access
• All HCPs should do spiritual screening •
Diagnostic labels/codes
• Treatment plans• Support/encourage in expression of needs and beliefs
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Hu Care Window
Quick Screening Acceptance (-) Acceptance (+)
Worship obedient (-) SORROW GUIDE
Worship obedient (+) REVIVE NIRVANA
(Sagiran, 2013, Palliative Care Using Husnul-Khatimah Concept at IslamicHospitals, Doctorate Thesis, MUY.)
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III. Formulation of a Spiritual Treatment Plan (cont’d)
• Spiritual care coordinator
• Documentation of spiritual support resources
• Follow up evaluations
• Treatment algorithms •
Discharge plans of care •
Bereavement care •
Establish procedure
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Intervention - HCP / Pt. Communication
• Compassionate presence • Reflective listening/query about
important life events
• Support patient sources ofspiritual strength
• Open ended questions •
Inquiry about spiritual beliefs,
values and practices
• Life review, listening to the
patient’s story• Targeted spiritual intervention
• Continued presence and follow upSEMINAR NASIONAL
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Intervention - Simple Spiritual Therapy
• Guided visualization for
“meaningless pain” •
Progressive relaxation •
Breath practice or
contemplation
• Meaning-oriented-therapy •
Referral to spiritual care
provider as indicated •
Narrative Medicine
• Dignity-conserving therapy
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Intervention - Patient Self-Care
•
Massage• Reconciliation with self and/or others
• Join spiritual support groups •
Meditation
• Religious or sacred spiritual readingsor rituals
• Books
• Yoga, Tai Chi •
Exercise
• Engage in the arts (music, art, danceincluding therapy, classes etc) •
JournalingSEMINAR NASIONAL
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IV. Interprofessional Considerations: Roles and Team Functioning
Recommendations
• Policies are needed
• Policies developed by clinical sites • Create
healing environments • Respect of HCPs
reflected in policies • Document assessment of
patient needs • Need for Board Certified
Chaplains • Workplace activity/programs to
enhance spirit
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V. Training and Certification
Recommendations
• All members of the team should be trained in spiritualcare
• Team members should have training in spiritual self-care
• Administrative support for professional development
•
Spiritual care education/support
• Clinical site education
• Development of certification/training •
Competencies
• Interdisciplinary models
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VI. Personal and Professional Development
Recommendations
• Healthcare settings/organizations shouldsupport HCP’s attention to self -care/stressmanagement
>training/orientation
>staff meetings/educational programs
>environmental aesthetics
• Spiritual development
>resources
>continuing education
>clinical context
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VI. Personal and Professional Development (cont’d)
•
Time encouraged for self-examination• Opportunities for sense of connectedness and
community
>interprofessional teams
>ritual and reflections
>staff support
•Discussion of ethical issues
>power imbalances
>virtual based approach
>opportunity to discuss
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VII. Quality Improvement
Recommendations
• Domain of spiritual care to be included in QI plans
• Assessment tools
• QI frameworks based on NCP Guidelines
• QI specific to spiritual care
• Research needed
• Funding needed for research and clinical services
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Conclusion
• Spiritual care is an essential to improving quality
palliative care as determined by the NationalConsensus Project (NCP) and National QualityForum (NQF)
• Studies have indicated the strong desire of patientswith serious illness and end-of-life concerns to havespirituality included in their care
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Conclusion (cont’d)
• Recommendations are provided for the implementation of spiritualcare in palliative, hospice, hospital, long-term, and other clinical
settings• Interprofessional care that includes board-certified chaplains on
the care team
• Regular ongoing assessment of patients’ spiritual issues
• Integration of patient spirituality into the treatment plan with
appropriate follow-up with ongoing quality improvement
• Professional education and development of programs
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Conclusion (cont’d)
• Clinical sites can integrate spiritual care models into their
programs
• Develop interprofessional training programs
• Engage community clergy and spiritual leaders in the care ofpatients and families
•
Promote professional development that incorporates abiopsychosocial-spiritual practice model
• Develop accountability measures to ensure that spiritual careis fully integrated into the care of patients
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