Spiritual Assessment: A Manager Friendly Framework NACC Presentation April 6, 2008

Introductions:  Rose Shandrow, M.Div. Director, Spiritual Care Services Franciscan Health System Tacoma, WA  Gordon J. Hilsman, D.Min. Manager of CPE St. Joseph Medical Center Tacoma, WA

Integration of Spiritual Care  Catholic Health Initiatives: Measures of Chaplain Performance and Productivity: Task Force Report published June 2002 Develop a common language to articulate what chaplains do and the value added Develop tools for managing performance and productivity Promote the professionalism of chaplains and the integration of spiritual care

4 Soul Mind Body Person (Healthcare View)

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6 Objectives 1.Framework of Spiritual Assessment 2.Chaplain Functions 3.Spiritual Care Outcomes 4.Benefits of Framework

Assumptions- Spiritual Care 1. Recordable 2. Establish Rapport first 3. Needs Focus (ad sedio) 4. Partnering Endeavor 5. Continued Learning

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Assumptions- Spiritual Care 1. Recordable 2. Establish Rapport 3. Needs Focus (ad sedio) 4. Partnering Endeavor 5. Continued Learning

Rapport First

Assumptions- Spiritual Care 1. Recordable 2. Establish Rapport 3. Spiritual Needs(ad sedio) 4. Partnering Endeavor 5. Continued Learning

Spirituality All that an individual values, practices, believes, and decides in order to cope with and enjoy what can’t be controlled, including relationships with oneself, other people, Transcendence and communities of importance

Ministry to Spiritual Need  A ministry event consists of a person functioning as a caregiver addressing the spiritual need of another person experiencing a difficult life situation.  Spiritual needs are seriously unsettling challenges to the human spirit of a given individual.

Assumptions- Spiritual Care 1. Recordable 2. Establish Rapport 3. Needs Focus (ad sedio) 4. Partnering Endeavor 5. Continued Learning

Basic Axis Questions  What does this person need emotionally right now?  What has this person lost, recently and historically?  What are the ways this person maintains and nurtures her own human spirit?  What does this person need that may be beyond my relationship with him?

Axis One: Emotional Support What does this person need emotionally right now, (from me)? 17

1. The Crisis Need for Stabilizing EMOTIONAL SUPPORT 2. The Expression Need to Engage and Share 3. The Anxious Need of Waiting Too Long 4. The Bewildering Need for Basic Information 5. The Regression Need to be Empowered

2. The Expression Need to Engage and Share Needing to cry, yell, share, or just tell somebody how you feel about what is happening to you

20 2. An Expressing person Supportive Validating Talks openly Expresses Feelings Cries Relaxes Considers Resources Function Desired Outcomes

W a i t i n g Upset feelings from waiting too long in an important situation

22 4. A person who is waiting too long Presence & Networking Expresses situation Prays Acknowledges limitations Thankful Calm Function Desired Outcomes

Axis Two: Loss and Grief What has this person lost, recently and historically, that still disturbs her/him at times? 23

24 Major Losses 6.Acute Grief (in past 48 hours) 7.Prior Grief (Lost earlier) 8. Dying 9. Huge Life Adjustment

Prior Grief Major past loss being currently grieved

26 7. Prior Grief Grief Counseling Mentions previous loss Expresses emotion Receives validation Shares reminiscences Cries while talking about the lost loved one Receives referral for further grief assistance Expresses greater hope Function Desired Outcomes

Grief Counseling Outcomes (%)

Axis Three: Spiritual Resources How does this person maintain and nurture her own human spirit? 28

29 Religious/ Spiritual Care 10. Instruction 11. Religious Support 12. Spiritual Support 13. Spiritual Counsel 14. Self Forgiveness 15. Estrangement

11 - Religious Support The Need to feel the immediate positive presence of Transcendence 30

31 Person who is needing God Religious Support Sacrament/ spiritual ritual Spiritual leader of choice Religious questions/problems Prays Desired Outcomes Function

Estrangement Need to re-connect with separated loved ones

33 A person regretting estrangement Function Desired Outcomes Reconciling Talks about an estranged relationship Agrees to receiving contact with an estranged person Agrees to take initiative to contact an estranged person Accepts the adequacy of one’s efforts at reconciling

Axis Four: Advocacy and Referral What does this person need that may be beyond my relationship with her/him?

35 Referral/ Ethics 16. Medical Ethics Concerns 17. Family Conflict 18. Advocacy 19. M. Health/ Addiction Concerns 20. Family Dysfunction Concerns 21. Love Life

Mental Health/Addictions Need to explore concerns about one’s mental health or mood altering chemical abuse

37 19.Person with mental illness or addiction concerns Function Desired Outcomes Referral Concern verbalized Feelings expressed Calm conversation Accepts consultation

Love Life Pain Need for listening, advice or referral about one’s love life

39 Intimate Spirituality: The Catholic Way of Love and Sex by Gordon J. Hilsman Available from Sheed & Ward, a subsidiary of Rowman and Littlefield Or

Benefits of the Spiritual Assessment Framework  Documentation  Training Resource  Measurement Source

Spiritual Assessment Form What are the needs? What did we provide? What is the plan of care?

Data Collection Tool

Pastoral Care Encounters Department Able to identify the workload of the chaplains

Types of Referrals

Spiritual Care Needs Addressed

Types of Functions to Address Needs

Chaplain to Department Comparisons Chaplain Ima NunDepartment

Chaplain to Chaplain Comparisons Chaplain Ima Nun Chaplain Andy Wokswitme

Year to Year Comparisons Chaplain Sean Deaconery

Students to Chaplains Comparisons Loss and Adjustment StudentsChaplains

Per Diem to Staff Chaplain Comparisons Religious and Spiritual Support Staff ChaplainPer Diem Chaplain

Facility to Facility Comparisons

Spiritual Care Needs Clinical Area

Spiritual Care Needs Staff

A Means for Identifying Areas for Growth/Development of chaplain skills  What is my pattern of practice?  If it is so different from my colleagues, what can I learn about their perspective in order to enhance my own?  What further training do I need?

A Means for Examining Effectiveness of Spiritual Care Functions  What are the desired outcomes for rendering a chaplain function?  To what degree do I see the desired outcomes from the services I provide?

Data Collection Tool

Summary of Observable Outcome

Results Gained from Spiritual Assessment Framework  Improved care to the patient/family/staff  Improved documentation  Identifiers for Growth and Development of Chaplains  Facilitated discussions in depth by staff chaplains regarding each of the Chaplain functions  Interdisciplinary Education  Community/Patient Education

Questions?  Thank you for your attendance and participation in our break-out session.