1 SPIRITUAL SCREENING AND SPIRITUAL ASSESSMENT DIFFERENT TOOLS
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1 SPIRITUAL SCREENING AND SPIRITUAL ASSESSMENT: DIFFERENT TOOLS TO SERVE A COMMON END PART 2 Patricia E Murphy RSCJ, Ph. D, BCC National Association of Catholic Chaplains April 16, 2015 Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL Patricia_Murphy@rush. edu based on a presentation by George Fitchett, DMin, Ph. D Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, IL
2 Outline v. When Do We Do Spiritual Assessment v. Why Is Spiritual Assessment Important v. Inquiry about Spiritual Life v. Research v. Clinical Practice v Spiritual screening v Spiritual history-taking v Spiritual assessment v. Next Steps in Spiritual Assessment
3 Screening, History Taking, Assessment Fitchett & Risk, 2009 FICA Puchalski et al. , 2009 Fitchett, 1993
4 Publications about Spiritual Assessment Pub. Med, 1015
5 When Do We Do Spiritual Assessment? There is no spiritual care that doesn’t have an assessment. Every chaplain does spiritual assessment in every patient encounter. The issue is intentional vs intuitive spiritual assessment.
6 Why is Spiritual Assessment Important? Pastoral diagnosis is: • The touchstone of our identity • A distinct contribution to interdisciplinary care (Paul Pruyser, 1976)
7 Why is Spiritual Assessment Important? Spiritual assessment is foundation for: § caring § communicating § evaluating § educating (Naming the pain and guiding the care, D Denton, 2008)
8 Why is Spiritual Assessment Important? STANDARD 1: ASSESSMENT Assessment: The chaplain gathers and evaluates relevant data pertinent to the patient’s situation and/or bio-psychosocial-spiritual/religious health.
9 Why is Spiritual Assessment Important? STANDARD 1: ASSESSMENT - INTERPRETATION Assessment is a fundamental process of chaplaincy practice. Provision of effective care requires that chaplains assess and reassess patient needs and modify plans of care accordingly. A chaplaincy assessment in health care settings involves relevant biomedical, psycho-social, and spiritual/religious factors, including the needs, hopes, and resources of the individual patient and/or family. A comprehensive chaplaincy assessment process includes: Gathering and evaluating information about the spiritual/religious, emotional and social needs, hopes, and resources of the patient or the situation Prioritizing care for those whose needs appear to outweigh their resources
10 Spiritual Assessment: Positive Attitudes Among Canadian Chaplains v. Aid communication with other department chaplains v. Aid communication with interdisciplinary team v. Establish chaplains as equal members of team Study of CAPPE chaplains: survey, n=90, focus groups, n=15. O’Connor et al, JPCC, 2005
11 Discipline for Pastoral Care Giving – Arthur Lucas, 2001 Profile • Concept of Holy • Meaning • Hope • Community
12 “What Do Chaplains Contribute? ” “Chaplaincy is not always understood by other clinicians, or the understanding is actually a misunderstanding. ” “Our medical director talks in terms of educating the parade. There always new faces, there always new dynamics, and so as a result you can’t count on history to support you. ”
13 Why is Spiritual Assessment Important: JCAHO Standard Q: Does the Joint Commission specify what needs to be included in a spiritual assessment? A: Spiritual assessment should, at a minimum, determine the patient's denomination, beliefs, and what spiritual practices are important to the patient. This information would assist in determining the impact of spirituality, if any, on the care/services being provided and will identify if any further assessment is needed. The standards require organization's to define the content and scope of spiritual and other assessments and the qualifications of the individual(s) performing the assessment. (JCAHO Website; January, 2004)
14 Three Levels of Clinical Inquiry about Spirituality and Religion
15 3 Actions: 1. Refer for spiritual assessment re: possible RS struggle. 2. Spiritual care requested, make referral. 3. No action: no indication of RS struggle, no interest in spiritual care. Fitchett & Risk, 2009
16 FICA--Taking a Spiritual History F--Faith and Belief "Do you consider yourself spiritual or religious? " or "Do you have spiritual beliefs that help you cope with stress? ” I--Importance "What importance does your faith or belief have in our life? Have your beliefs influenced how you take care of yourself in this illness? C--Community "Are you part of a spiritual or religious community? Is this of support to you and how? A--Address in Care "How would you like me, your healthcare provider, to address these issues in your healthcare? " Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Pall Med 2000; 3: 129 -37. Copyright, Christina M. Puchalski, MD, 1996. Also see: www. gwish. org
17 Guidelines for Pastoral Diagnosis - Paul Pruyser, 1976 Awareness of the Holy what if anything is sacred, revered Providence what has God promised me Faith affirming vs negating stance in life Grace or Gratefulness kindness, generosity, the beauty of giving and receiving Repentance feelings of contrition, remorse, regret Communion feelings of kinship with the whole chain of being Sense of Vocation willingness to be a cheerful participant in creation
18 Discipline for Pastoral Care Giving – Arthur Lucas, 2001 Profile • Concept of Holy • Meaning • Hope • Community
19 The 7 x 7 Model for Spiritual Assessment Published in 1993, Augsburg Press Reprinted 2002, Available from Academic Renewal Press, Lima, Ohio www. arpress, 1 -800 -537 -1030
20 The Challenges of Evidence-based Spiritual Assessment* Characteristics (Alternative) Quantifiable (Narrative) Valid (Invalid) Rationale Identify degrees of R/S distress and R/S resources in order to inform care plan Describe change in R/S distress or other sx in response to chaplain spiritual care Psychometric validity of instrument as measure of R/S issues relevant to patients with this diagnosis Acceptable to patients Useful (Waste of time) Acceptable to chaplains: helpful guide to spiritual care; consistent with identity and education Provides information valued by other clinicians Inclusive (Pathologizes) Universal (Local) Inclusive and respectful of diverse R/S beliefs and practices The same model is used by all chaplains working with patients with this condition *assume condition-specific models for spiritual assessment, e. g. , PTSD
21 Evaluating Current Practice in Spiritual Assessment Example Quantifiable Valid Useful Inclusive Universal 7 x 7 no unknown possibly unknown Rush Screening Protocol yes partial unknown FICA no unknown hopeful Spiritual Pain Scale yes partial unknown
22 What About the Electronic Medical Record? • Could eventually be a source for research, but not easy to get the data downloaded, currently. • Could influence how chaplains “assess” patient.
23 What do chaplains at Rush do? • EPIC dropdown menu • Assessment • Patient seems to be… • Patient described… • Sources of Emotional Support • Level of Support • Source of Emotion • Use at least 50% of 7 x 7 • Yes all but 1 person • No, due to short LOS • Influenced by drop down menu • Yes – 1 and 1 somewhat • No – most • What do you do after introduction, any regular behavior?
24 When Do We Do Spiritual Assessment? There is no spiritual care that doesn’t have an assessment. Every chaplain does spiritual assessment in every patient encounter. The issue is intentional vs intuitive spiritual assessment.
25 What do you do? • Do you screen for religious or spiritual struggle? Yes or no • Do you use at least 50% of the categories in the 7 x 7 in your listening to do an assessment?
26 What do you do? • Does the dropdown menu influence you? • What do you do after introduction? Any regular question or behavior?
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