Bullet Point Spiritual Assessment

Gordon J. Hilsman, D.Min. Franciscan Health System

Tacoma WA

Objectives

Focus on documenting spiritual assessments as professionally collaborative

Value spiritual assessment as a major, perhaps the primary component of patient oriented health care experience

Consider bullet points as a style of charting spiritual assessments

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To Assess or to Sedate? Sedere – to sit, remain, take a seat, perch

Sedare – settle, allay, calm down, (sedate, sedative, sedation)

Ad – next to, right up close (adjust, adorn, adhesion)

Assess - Ad+sedeo= to sit next to, to consider together – implies depth

Rapport- First Three Minutes

Creatively establishing

a helping relationship

in ways that are: Beyond social Time/space-creating Transcendence

allowing Profoundly accepting Earthily engaging

Communicating about Spiritual Care

The art of Combining:

Creativity regarding human perspectives

Substance, worth reading/considering by other clinicians

Usefulness to colleague chaplains and interdisciplinary teams, for patient care

Clinician (Greek – clinos = bed)

A professional prepared to use direct observation, developed frameworks of understanding, and pertinent data in order to fashion interventions of assistance to people in serious need.

2 - Assessment

3 - Care (Function)

4 - Documentation

5 - Continuing Ed.

6 - Consultation

1 - Rapport

Spiritual Clinician

Becoming (and remaining) a Spiritual Clinician

Why Bullet Points?

The day of a physicianThe day of a nurseThe day of a social workerThe day of a chaplain

Types of Listening

Diagnostic

Personal / Pastoral

Collaborative

Intimate Love

Bullet points are efficient, focused, useful, easy to comprehend and the most likely way to slice through to the human side of other interdisciplinary team members who are intensely engaged in completely different professional missions and assessment frameworks.

Bullet points are: Efficient Focused Useful Easy to comprehend Effectively penetrating for other IDT members

Narrative and 3 or 4 Bullet Points

Intro narrative: Why did you converse with this patient / family? Who is this patient/family (Capture the soul)? How did this patient/family relate to you?

Assessment: 2 to 4 bullet point issues that surfaced in the conversation?

Functions: What did you do to help this person/family?

Plan: What do you plan to do to help this person/family?

Assessment

What issues surfaced or were dealt with in the conversation?

“Without agenda???”

This is not your first unit of CPE!!!

Spiritual Assessment Framework

A basic structure with which to organize spiritual care work for enhancing patient care through interdisciplinary and intra-disciplinary communication

Professional vs. Interdisciplinary Assessment

Assessment frameworks for certification

Assessment frameworks for data collection

Assessment frameworks for interdisciplinary teamwork

Paragraph chart note:I saw this patient at the request of her father who I had

met in the hallway. She is a 57 year old widowed Philippine woman with a daughter in California and a son that lives in town. She spoke in sad tones about her nagging knee pain leading to tomorrow’s surgery and her mother who died in February. She has been crying this morning, somewhat overwhelmed by her inability to lift her grandson and by her grief over her mother’s death. I listened, facilitated her grieving and prayed with her, though she is currently not practicing her Catholic heritage. I will suggest the evening chaplain drop in on her for further support. She declined my offer of her being visited by a priest.

JACHO Ready Spiritual Assessment Form

What are the needs?

What did we provide?

What is the plan of care?

Chaplain Focused Bullet Point Note

57 year old widowed Pilipino woman with a supportive father and a son living here, and a daughter in California

Teary today, open and verbal with me about her life situation. Pt aware of surgery and its implications, fairly hopeful of a favorable outcome to improve her life.

Mother died in February, knee pain prevents her from lifting her grandson. We began grief work.

Appreciates prayer though she is currently not practicing her Catholic heritage. Declined being visited by a priest.

I will continue grief work tomorrow and suggest the evening chaplain drop in on her for further support.

IDT Bullet Point Assessment

Saw pt. on suggestion of her father in the hallway. She is a 57 year old widowed Pilipino woman with a son living here, and a daughter in California. She is teary today, open and verbal with me about her life situation.

Pt fairly hopeful of a favorable surgery outcome Active grief issues, mother died in February, knee pain prevents

her from lifting her grandson. Appreciates prayer, currently not practicing her Catholic

heritage. Declined being visited by a priest.

Chaplain began grief work, prayed with patient, and supported.to be continued tomorrow

Chaplain to continue grief work and support after surgery

Reduce Defensive Entries

Excess verbiage Unnecessary Rationalizations Pedantic Over-explaining Superfluous Self reference Annoying redundancy Subtle image enhancement Justifications for your worth Critique of other professionals’ care

Questions about

Bullet Point Assessment?

One Assessment Framework

Franciscan Health System – Tacoma WA

Four Axes of Spiritual Needs Assessment

Emotional SupportLoss/AdjustmentReligion/SpiritualityAdvocacy/Referral

1. What does this person need from me emotionally right now?

2. What losses, recent and previous, has this person experienced that continue to surface painfully at times?

3. How does this person nurture her/his own human spirit, relative to established religious traditions and apart from them?

4. What does this person need that I can’t provide?

Bullet Point Issue Recording

Saw pt. on suggestion of her father in the hallway. She is a 57 year old widowed Pilipino woman with a son living here, and a daughter in California. She is teary today, open and verbal with me about her life situation.

Pt fairly hopeful of a favorable surgery outcome Active grief issues, mother died in February, knee

pain prevents her from lifting her grandson. Appreciates prayer, currently not practicing her

Catholic heritage. Declined being visited by a priest.

Chaplain began grief work, to be continued tomorrow

ASSESSING

6.Grief Support7.Grief Counseling8. End of Life Care9. Adjustment Counseling

16. Ethics Consulting17. Family Systems Facilitating18. Advocacy19. Mental Health/Addictions Consult20. Family Behavioral Concerns21. Love Life Consulting.

10. Instructing 11. Religious Support12. Spiritual Support13. Spiritual Counseling14. Self- Forgiveness15. Healing Estrangement

Screening for Spiritual Pathologies

Loss / Adjustment

Spiritual / Religious Support

Advocacy /Referral /Ethics

Establishing Rapport

Emotional Support

•Careful Listening•Empathic Reflecting•Gentle Querying•Insightful Interpreting

1. Crisis Ministry2. Supportive/Validating3. Informing 4. Presence and Networking5. Empowering

Axis One:

Emotional Support

What does this person need emotionally right now, (from me)?

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(Mad, Sad, Glad, Hurt, Afraid,

Ashamed)

1. The Crisis

Need for Stabilizi

ng

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

1 - Stabilizing - Personal support when familiar patterns are disrupted by crisis events

Helping people pull themselves

together

2. The Expression Need to Engage and Share

Supportive validating (listening) - the Need to cry, yell, share, or just tell somebody how you feel about what is happening to you

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2. An Expressing person

Supportive

Validating

•Talks openly

•Expresses Feelings

•Cries

•Relaxes

•Considers Resources

FunctionFunction Desired OutcomesDesired Outcomes

3-InformationNeed for basic information

Informing

in the wilderness of healthcare systems

4 - W a i t i n gUpset feelings from waiting too long in an important situation

Presence and

Networking

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4. A person who is waiting too long

Presence &

Networking

•Expresses situation

•Acknowledges health care system limitations

•Prays

•Expresses Gratefulness

•Calm

FunctionFunction Desired OutcomesDesired Outcomes

5-Empowering - Need to find and use your own best ways of dealing with difficult times

Helping people extricate

themselves from regressing

after being overwhelmed

Axis Two: Loss and Grief

What has this person lost, recently and historically, that still disturbs her/him at times?

9-Life Adjustment

8.Dying

7-Prior Grief

6-Acute Grief

(Past 48 hrs)

Loss

6 - Current Grief Major loss in previous 48 hours

Facilitating saying

goodbye to somebody

recently lost

7 - Prior Grief Major past loss being currently grieved

Recognizing current warm-sad memories and facilitating the past loss grief that enkindled them

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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

FunctionFunction Desired OutcomesDesired Outcomes

Grief Counseling Outcomes(%)

0

10

20

30

40

50

60

70

80

90

1

Mention of the Loss

Observable Emotion

Receives Validation

Reminisces

Shows Tears

Considers Referrals

Signs of New Hope

8 - Dying Dealing with the goodbyes of the dying process

Helping people say goodbye when they’re

dying

9-Life adjustment Making peace with a major change in appearance or function

Getting used to the new way things will be

Axis Three: Spiritual-Religious Care

How does this person maintain and nurture her own human spirit?

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15. Estrangement

14. Self Forgiveness

13. Spiritual Counsel

12. Spiritual Support

11. Religious Support

10. Instruction

Religious/ Spiritual

Care

11 - Religious Support - Needing to feel the immediate positive presence of Transcendence

“I want to feel God all around me!”

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Person who is needing God

Religious Support

•Sacrament/ spiritual ritual

•Spiritual leader of choice

•Religious questions/problems

•Prays

Desired OutcomesDesired OutcomesFunctionFunction

“Let me tell you about what I do and believe that deeply feeds me personally!”

“What I want to know is ….”

“What really turned me off ….”

“I couldn’t believe it when….”

“I did that and I’ve never told anyone!”

Wanting to get back together with somebody you love.

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A person regretting estrangement

FunctionFunction Desired OutcomesDesired Outcomes

Reconciling

•Talks with emotion about an estranged relationship •Agrees to receive 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 What does this person need person need that may be that may be beyond my beyond my relationship relationship with her/him?with her/him?

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21. Love Life

20. Family Dysfunction

Concerns19. M. Health/

Addiction Concerns

18. Advocacy

17. Family Conflict

16. Medical Ethics Concerns

Referral/Ethics

Begin the process of using professional help to sort out options when there is no clear best care direction

17 - Family Conflict – Needing help with upset feelings among family members

Facilitating healing/referral of family conflict

Feeling neglected

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

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19.Person with mental illness or addiction concerns

FunctionFunction Desired OutcomesDesired Outcomes

Referral

•Concern verbalized

•Feelings expressed

•Calm conversation

•Accepts consultation

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21. Love Life PainNeed for listening, advice or referral about one’s love life

Recap

Rapport firstCreativity & imaginationIdentify issues in bullet pointsFramework for assessmentAugment electronic chartingReduce defensive chart entries

FINIS