The Healing Power of Presence Malcolm L. Marler, D.Min., BCC Director, Pastoral Care

A Story of Presence “She slowly dipped a cloth in the soapy water, squeezed it out and showed me how to gently remove the debris. Then she dipped a fresh cloth in the water, squeezed it out, and handed it to me. “That’s right Mama.” She cooed as I swabbed my 6’4” baby.”

Overview Strategies and resources for meeting emotional and spiritual needs How to be sensitive to the spiritual needs of someone different than your own. Understanding Presence Why questions are more important than answers.

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number 12 Press Ganey’s “Patient Satisfaction Survey” Literature review of over 100 studies. Evidence reveals parallels between spiritual and emotional needs (needs intermingle) Caring for both includes: support, empathy, comfort, affirmation, attentiveness to patients’ unique needs.

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Are patients’ emotional and spiritual needs important? 2. Are hospitals effective in addressing these needs? 3. What strategies should guide improvement in the near future and long-term?

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Are emotional, spiritual needs important? (“Degree to which hospital staff addressed your emotional/spiritual needs”) Patient satisfaction is significantly correlated with Staff response to concerns/complaints Staff effort to include patients in treatment decisions Staff sensitivity to the inconvenience of hospitalization Impact on health outcomes Impact on hospital finances Emotional distress accompanies hospitalization

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Are hospitals effective in addressing these needs? Patients experience emotional distress in hospitalization Patients’ and/or families’ needs are handled in a timely, considerate, and empathetic way All tests, interventions, and treatments are explained in emotionally sensitive and supportive decision-making process Staff demonstrably provide empathetic emotional support

Press Ganey - “Degree to which hospital staff addressed your emotional needs” 81.6 mean (1347 responses) 9th percentile vs. UHC, 2nd Quarter mean, 1342 responses 54th percentile vs. UHC, 2nd Quarter 2012

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Suggestions for improvement Basic emotional and spiritual care resources Books, multimedia, support groups, music Meal choices for each religion Quiet secluded space (chapel, meditation) Chaplain/Pastoral Care Team Community outreach to faith groups, volunteers Nurses trained to provide prayer

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Suggestions for improvement Multidisciplinary Emotional and Spiritual Care Quality Improvement Team Coordinate resources Organizational learning of communication skills Senior leadership must empower the team to carry out organization wide improvements Structured interventions, relaxation techniques, stress management education, counseling, yoga, meditation, massage therapy, access to internet

Joint Commission Journal on Quality and Safety December 2003, Volume 29 Number Suggestions for improvement Standardized Elicitation of Emotional and Spiritual Needs Require spiritual screening to identify needs Responses to Patients’ Concerns/Complaints Staff’s efforts to include patients in treatment Staff sensitivity to patients’ hopes, dreams, likes, loves, family, roles.

What Do Patients Mean by Spiritual? Baylor Health Care System, Mark Grace, VP of Mission and Ministry, 2011 We had always asked the question, “Staff worked to meet your spiritual needs.” Spirituality is a critical element of the wellness equation; a holistic, patient centered approach. Asked patients in a random telephone survey, diverse population from 15 units of hospital

What Do Patients Mean by Spiritual? To be treated with dignity and respect To be treated with compassion and kindness To be valued as a person For staff to be sensitive to my feelings about my illness and hospitalization An environment that encourages hope Baylor Health Care System

What Do Patients Mean by Spiritual? Baylor Health Care System Begins with the care patient receives, extends beyond religion Including patients in treatment decisions Responding to emotional needs Responding to patient concerns, complaints Safe and secure environment, privacy Interdisciplinary

Focused Priorities Baylor Health Care System, 2011 Focus on facilitating a dialogue with patients related to spiritual needs. Learning to convey compassion, empathy, and how to recognize spiritual distress. Removed “spiritual needs question,” identified three top priorities that influence Meeting emotional needs Responding to concerns and complaints Include patients in decisions about treatment

What is Presence? Henri Nouwen, Catholic priest, psychologist ( ) When someone comes to us in pain, something in us wants to reassure the other and to move away from the pain. Real healing is overcoming this mutual avoidance and being together where it hurts. Sharing pain. Trust becomes possible when someone stays with us in the pain. Allow the question to be there.

What is Presence? Margaret Guenther, PhD, MDiv. Episcopal priest, author of Holy Listening, Spiritual Director ( ) We often confuse healing with curing Curing - often do something Healing - a certain passivity, willing surrender Hope, not foolish optimism Listen, listen, listen Accept the comfort of silence Avoid fixing, go where we are led Willingness to be touched, vulnerability

What is Presence? Karen Stanley, RN, MSN, AOCN, FAAN Palliative Care Nursing Consultant Requires knowing oneself Affirmation and valuing Acknowledging vulnerability Intuition Being in the moment Serenity

Discussion When have you experienced someone being “present” to you? Or when you have observed another being present to someone? What was different about this experience from routine encounters with others? What was “healing” in the encounter?

Discussion “Managing Up” -- Who are persons you know at UAB Hospital who are a healing presence to others?

Follow Up Powerpoint and other references for this presentation can be found by the end of the today at: Click on the “Employees” tab, then choose “Psychosocial Spiritual Grand Rounds.”