SPIRITUAL LEADERSHIP: THE ART OF FACILITATING ADVANCED CARE PLANNING (ACP) Kathleen Blanchfield, PhD, FCN, RNJanice M. Smith PhD, RNLewis University CONHP Faculty Advocate Healthcare Network NurseCoordinator Parish Nurse Program

“How does one live spiritually in hope of dying well?” (Sheehan, 2000)

Advanced Cared Planning (ACP) Process that allows an individual to make their wishes known regarding care for incapacitating health states or end of life

ADVANCED DIRECTIVES Living Will –a document that lists instructions for how the person desires to be treated if they are incapacitated or are at the end of their life Health Care Power of Attorney (HCPOA) –designates a person to act as a decision maker if the individual cannot make decisions regarding their care (Crisp, 2007) Practitioner Orders for Life- Sustaining Treatment (POLST, 2013) more detailed than conventional living wills or other advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes 5 Wishes (Aging with Dignity) –A living will that talks about your personal, emotional, and spiritual needs as well as your medical wishes

Spiritual Leadership Viewed Through the Nine Characteristics of Nursing Servant Leadership Listening with the Heart Giving of Yourself Doing Ministry Assessing Needs Becoming an Advocate Discerning Decisions Making a Difference Being there to Serve Embracing a Higher Purpose (O’Brien, 2011, p.331)

Spiritual Opportunities Listening with the Heart

Listening with the Heart I just hope I will go to sleep someday and not wake up. This is all so confusing and maybe it is against the church teachings. Why should my wife and I fill out Advanced Care Directives? I can’t deal with this. Let the kids figure it out. They should know me and what I would want. I have plenty of time to deal with this later.

Spiritual Leadership Sacred Interactions

Praying together about the process of ACP Arrange for the ministers to clarify the moral teaching of the faith community that supports or limits ACP Connect individuals and congregational members for support and witness to the necessity of ACP Small group educational programs Individual discussions in Parish Nurse office, home visits, wakes, funeral gatherings, church parking lot and narthex Refer to legal, physician, nurse practitioner, minister, social services, for further assistance. Provide anticipatory guidance regarding necessity to openly discuss ACPs with family and friends Answer questions and assist with completing the Advanced Directive Documents Church Bulletin articles on ACP Homilies and witnessing on ACP

Lived Experience of the Parish Nurse Regarding ACP

Witness to the sacredness of the end of life journey with parishioners Prioritize connection and conversation over completion of forms, especially with family members Allow time for open conversations Recognize the fear that is an underlying presence that is best dealt with spiritually Respect personal preferences and beliefs Be prepared for conflict resolution and opportunities for reconciliation Recognize that the process is ongoing, and ever changing between family members, friends, and generations The best place to have this sacred process is in the congregational setting

Discussion