Measuring Outcomes in Communitybased Spiritual Care Revd Dr

Measuring Outcomes in Community-based Spiritual Care Revd Dr Helen Wordsworth, RN, RM, RHV, (tutor) RNT, MTh, DMin, QN.

2 “When we touch on the essence of humanity at our core – the very spirit that accompanies the body in each care encounter, we reveal boundless opportunities to positively impact the overall health of each individual and the communities we serve. Source: Jason A. Wolf, Ph. D. , President, The Beryl Institute in “The Critical Role of Spirituality in Patient Experience", The Beryl Institute, and Health. Care Chaplaincy Network, 2015 Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

3 How would you define Spiritual care? Spiritual care: The practical expression of presence, guidance, and interventions, individual or communal, to support, nurture, or encourage an individual’s or group’s ability to achieve wholeness; health; personal, spiritual, religious, and social well-being; integration of body, mind, and spirit; and a sense of connection to self, others, and a higher power (ANA/HMA, 2017) Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

4 How would you define Spiritual Care? “Spiritual care is care, which recognizes and responds to the needs of the human spirit when faced with trauma, ill health, or sadness and can include the need for meaning, for self-worth, to express oneself, for faith support, perhaps for rites or prayer or sacrament, or simply for a sensitive listener. Spiritual care begins with encouraging the human contact in compassionate relationship, and moves it whatever direction need requires. ” National Health Service Education for Scotland [NES], (2010). Spiritual Care Matters: An Introductory Resource for all NHS Scotland Staff. NES, Edinburgh. P. 6. Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

5 How have you assessed Spiritual Care needs? Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

6 What models can be used for assessing Spiritual care needs? FAITH: Do you have a spiritual belief? Faith? Do you have spiritual beliefs that help you cope with stress/what you are going through/ in hard times? What gives your life meaning? INFLUENCE: Are these beliefs important to you? How do they influence you in how you care for yourself? COMMUNITY: Are you part of a spiritual or religious community? Is this of support to you and how? ACTION: How would you like your healthcare provider to address these issues with you? Puchalski, CM: https: //smhs. gwu. edu/urgentmatters/sites/default/files/Feb%202011%20 Spirituality%20 in%20 Medicine. pdf Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

7 What models can be used for assessing Spiritual care needs? H Sources of hope, strength, comfort, meaning peace love and connection: eg. How do gain hope and comfort? O The role of organised religion: eg. Does worship have a place in you or your family’s way of life? P Personal Spirituality and practices: e. g. do you have any spiritual beliefs or practices that are important to you? E Effects on care and end of life decisions: e. g. Would your personal beliefs affect your management if there was a health crisis? Anandrajah G, Height E, Spirituality and Medical practice. American Family Physician 2001; 63: 81 -89 Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

8 Have you used these models? If so, how did they work? Were you able to devise a Spiritual care plan as a result? What interventions were you able to make? What was the outcome? Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

How would you define Spiritual care? Professor Arndt Büssing of Witten/Herdecke University suggests that although they may use different terminology, most researchers define Spiritual care in four domains: The search for peace, Connection with others, Meaning and purpose in life, and Relationship with a higher being.

10 Büssing’s Spiritual care assessment Uses questions relating to all four domains Focuses on unmet needs May form the basis of a care plan Possible interventions may be agreed with the serviceuser Outcomes can be recorded along with suggestions for further interventions Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

Assessment 11 Planning Implementation Evaluation Date Need Aim Planned interventions Action taken and date Outcome Next steps Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

Assessment Date Need 12 N 22 Planning Implementation Evaluation Aim Planned interventions Action taken and date Outcome To develop trusting relationships and reduce anxiety levels over next six months Appropriate referral to a Counsellor Review in three months Referral made January Person reports 2019 feeling more at Reviewed April 2019 peace and appears less stressed. Ticked “slight” on questionnaire today (April 2019) To read three Identify reading style and Book selection and April 2019 spiritually preferences notebook delivered Discussion around helpful books Arrange for loan of January 2019 book topics. in next six appropriate books Phonecall February Asked for more months Suggest she makes notes 2019 to check if reading material as she reads for discussion appropriate selection at next visit Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Next steps Monitor stress levels every three months. Supply 3 books every three months 11/27/2020

13 Assessment Date Need N 12 N 21 Planning Implementation Evaluation Aim Planned interventions Action taken and date Outcome The person will feel more peaceful about life after death With permission, contact priest or chaplain of person’s choice to arrange visit. Follow up visit Appointment made, March 2019. Follow up visit April 2019 Next steps Encourage person to write thankyou note to chaplain or priest To participate Determine person’s choice Volunteer recruited to Person Contact in a religious and barriers to attendance take to local Methodist would like Methodist service Recruit volunteer to help service to go once church for Research availability of List of service times on a month suitable times televised/online services. radio/television given and arrange Offer recorded servic Recorded services transport. delivered once a month. Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Person no longer saw this as a need. 11/27/2020

14 Think of a conversation with a recent patient/client/service-user. What unmet needs do you think they would have ticked? Which of these would be most strong? Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

15 Go back to the questionnaire Look at the unmet needs that were felt most strongly. List them by their number on your blank care plan, second column from left. N 3 N 20 Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

16 Now identify some hoped for achievable outcomes in the third column from left To have two church visitors per week To learn how to pray at home Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

17 And now fill in some planned interventions and the action you hope to have taken To have two more visitors per week To learn how to pray at home Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

18 And then fill in some planned interventions and the action you hope to have taken N 3 To have two church visitors per week Gain Contacted permission, April 2019 Contact visiting team N 20 To learn how to pray at home Offer written prayers Take holding cross Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Supplied April 2019 11/27/2020

19 Finally, fill in outcomes and next steps N 3 To have two church visitors per week Gain permission, Contact visiting team N 20 To learn how to pray at home Offer written prayers Supplied Take holding cross April 2019 Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Team contacted April 2019 Regular visits Monitor in place, feels more cared for Prays regularly now Take prayer book 11/27/2020

20 1. Talk with your partner about how you felt in that activity. 2. How do you think the patient/client/service-user might feel? Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

21 Nurse’s responses to using this tool. We offered this tool at a UK conference to 12 groups of Parish nurses, to use as if they were working with an imaginary patient. Most managed and liked the questionnaire, although we had to change the title from “in the past week have you felt the following needs” to “in the past week have you felt the following unmet needs” to “in the past week have you felt that the following needs were unmet” The care plan produced ideas for interventions but of the twelve groups, only three progressed to evaluation. Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

Single line of care plan with a bed bound patient with heart failure, on oxygen 22 therapy. Assessment Date Need Aim N 14 To feel she is making a valuable contribution Planning Implementation Planned interventions Action taken and date Outcome Next steps PN discusses ways to help others, e. g. writing cards, knitting Knitting patterns and wool supplied for orphanage. Notecards and address book sourced. Feels more useful, Has written some cards, enjoys knitting but finds fine wool difficult. Is going to try chunky knitting Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Evaluation 11/27/2020

Single line of care plan with a male aged 50 facing poor prognosis 23 Assessment Date Need N 2 Planning Implementation Aim Planned interventions Action taken and date To feel more Baseline anxiety scale Safe space and Provide a safe space to time arranged identify and prioritise over three visits fears and worries March/ April 2019 at peace about fears and worries. Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing Evaluation Outcome Next steps Anxiety scale showed marked improvem ent Call monthly to monitor 11/27/2020

24 Nurse’s responses to using this tool. We also offered this tool to UK Parish nurses in the UK, to use with their patients and had some limited uptake. From some there was a tendency to fill in the achievable aim from the nursing perspective rather than that of the patient The planned interventions they suggested were imaginative and relevant Not all of those who responded managed to complete the implementation and evaluation columns. Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

25 Nurse’s responses to using this tool. Two nurses gave comments: 1. “I really enjoyed using the questionnaires. They certainly highlighted needs that I wouldn’t have realised were there. Definitely a useful tool to discover and action upon the less obvious needs” Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020

26 Nurse’s responses to using this tool. 2. “The outcome of using this questionnaire was much more profound than expected. It deepened the trust I developed with the client. It helped me to see just how much influence these unmet needs were having on the client’s health. And treating them opened a way to see and address other needs. ” Copyright, Helen Wordsworth , Westberg institute for Faith Community Nursing 11/27/2020