Incorporating Spiritual Humility In The Practice Of ... · PDF file• 90% of the US population practices spiritual or ... Are there any beliefs important to you that ... plays in

Incorporating Spiritual Humility In The Practice Of Medicine: Understanding How Spiritual Practices Of

Patients And Families Relate To Our Practice Of Medicine

Amanda D. Osta, MD, Ann E. Burke, MD, Annamaria Church, MD, Albina Gogo, MD, Dena Hofkosh, MD, Megan E. McCabe, MD, Janet R. Serwint, MD

Disclosures

• We have no financial disclosures

This work has been published by the American Academy of Pediatricshttp://www2.aap.org/sections/palliative/ResilienceCurriculum.html

http://www2.aap.org/sections/palliative/ResilienceCurriculum.html

Objectives

1. Recognize the importance of religion/spirituality in the lives of patients and families

2. Take a spiritual history using tools such as FICA and SPIRIT

3. Apply spiritual humility to the practice of medicine

4. Identify opportunities to incorporate spiritual humility in personal practice and training program

Agenda Time Topic

0-10 minutes Introduction to the workshop and overview of the curriculum

10-20 minutes

Role of Spiritual Humility in the Practice of Medicine

20-35 minutes

Journaling followed by Pair : Share

35-45minutes

Taking a Spiritual History Using FICA or Spirit

45-60minutes

Role play demonstration of spiritual history taking

60-75 minutes

Spiritual history practice

75-90minutes

Application of Spiritual Beliefs to the Care of Children

Rationale for Resilience in the Face of Grief and Loss Curriculum

• Request from AAP Section of Medical Students, Residents, and Fellows (Now Section on Pediatric Trainees)

• Need to address their grief and loss during training

• Expanded to address the maintenance of wellness and resilience

• Included section on spiritual humility

Components of the Resilience in the Face of Grief and Loss Curriculum

• Part A: Understanding Grief and Loss

• Part B: Communication with Families about Critical Incidents and Life Altering Diagnoses

• Part C: Adaptive Behaviors and Coping; Mechanisms for Health Care Providers

• Part D: Introduction to Personal Wellnesshttp://www2.aap.org/sections/palliative/ResilienceCurriculum.html


Part A: Understanding Grief and Loss

• Knowledge of grief and loss reactions

• Ethical considerations in end of life decision making

• Common religious and spiritual traditions used by families



Join Poll Everywhere

Text AMANDAOSTA359 to 37607 to join, then text your message

Presenter

Presentation Notes

Poll Title: How comfortable do you feel asking patients and families about their spiritual beliefs?https://www.polleverywhere.com/multiple_choice_polls/3mSVMuzdfrOM030

Presenter

Presentation Notes

Poll Title: What are the barriers that you have faced engaging with patients and families about their beliefs?https://www.polleverywhere.com/free_text_polls/ukG4UZpTXZgKkp1

Questions Families Often Ask: Implicit Spiritual Themes

• Why is this happening?

• Is this a punishment for something I have done?

• Is this part of a bigger or divine plan?

• Is there some greater good I can obtain from this?

Part A: Understanding Grief and Loss in Children and Their Familieshttp://www2.aap.org/sections/palliative/ResilienceCurriculum.html

Presenter

Presentation Notes

Why is this happening? Is my child’s illness (death) a failure on the part of me as a parent to protect my child adequately? Is my child’s illness a punishment for something I have done? Is my child’s illness (death) part of a bigger or divine plan? Is there some greater good in relation to which my child’s death becomes more acceptable? (organ donation, research options to help others)


Background • Spiritual beliefs may serve as a support and comfort.

• 90% of the US population practices spiritual or religious traditions (Robinson 2006)

• Clinicians should support and respect these beliefs

• Attempt to implement traditions or explain why they cannot be done.


Presenter

Presentation Notes

Spiritual beliefs may serve as a comfort and help ground a family in their grief at times of illness and death. Every attempt should be made to implement traditions that are essential or explain why they cannot be done in the health care setting.


Background (continued)

• Understand the individual spiritual beliefs of patients and their families.

• Parents and children may have different beliefs as well.

• Offer to include clergy from the family’s tradition(s).


Presenter

Presentation Notes

It is important to understand the individual spiritual beliefs of patients and their families, because not everyone in a spiritual tradition believes ALL of the teachings Parents and children my have different beliefs as well, so inquire Include clergy from the family’s tradition(s) as early in the illness as possible


Understanding the Family’s Perspective

• Rely on their spiritual beliefs to understand and accept difficult news.

• 60-80% of families had unmet spiritual needs (Feudtner 2003)

• Four explicit themes are critical (Robinson 2006)• Prayer• Faith• Access to and support of clergy• Belief in the endurance of the parent-child relationship beyond death


Presenter

Presentation Notes

Parents state they may rely on their spiritual beliefs to understand the meaning of their child’s health care experience and accept difficult news.


Spiritual Humility

• Health care providers need to embrace spiritual humility.

• Spiritual generalist – insightful about need for spirituality

• Clergy or spiritual specialists – who can help guide and support families

• Access to multi-denominational chapel and services

Part A: Understanding Grief and Loss in Children and Their Families http://www2.aap.org/sections/palliative/ResilienceCurriculum.html

Presenter

Presentation Notes

Health care providers need to embrace spiritual humility, as no one can understand all the religious or spiritual traditions in the world. Medical provider as a spiritual generalist – insightful about need for spirituality Access to clergy or spiritual specialists – who can help guide and support families Access to multi-denominational chapel and services for place to pray and reflect


Perspective of Health Care Professionals

• Inquiring and respecting another’s spiritual belief

• We cannot possibly know all there is about another individual beliefs

• Spiritual humility allows us to acknowledge that we don’t know, but seek to understand


Presenter

Presentation Notes

Inquiring and respecting another’s spiritual belief is not being unfaithful to one’s own beliefs. Rather, it is being secure enough in one’s own belief to allow others to follow their beliefs


Journaling Exercise Followed by Pair: Share

1. Can you describe an experience in your own practice where knowing more about the family’s spiritual beliefs may have been helpful?

2. Describe a time that personal spirituality conflicted with or contributed to a patient interaction?

Taking a spiritual history

• Allows families a mechanism to access resources.

• Receipt of support from spiritual community.

• Incorporate spiritual practices into hospital setting.

• Need not make assumptions.


Presenter

Presentation Notes

Allows families a mechanism to access resources that are critical element of care. Receipt of support from spiritual community. Incorporate spiritual practices into hospital setting. Need to not make assumptions. Don’t assume the two parents or the parent and child have the same spiritual beliefs.


Open the Discussion

What role does spirituality or religion play in your and your child’s life? (Sulmasy 2002)



Taking a Spiritual History: FICA

• Faith and beliefs

• Importance

• Community

• Addressed

Taking a Spiritual History: FICA

• Faith and Beliefs: Is there a particular faith(s) that you and your family are members of?

• Importance: How would you rank the importance that spirituality plays in your life?

(Astrow 2001)

(Puchalski, Larson, Post 2000)


Presenter

Presentation Notes

Faith and Beliefs: Is there a particular faith(s) that you and your family are members of? Are there any beliefs important to you that you would like to share? Importance: How would you rank the importance that spirituality plays in your life (Very Important/Important/Not Very Important)? Another way of asking the Importance Quesition: Is faith or spiritually important in your life?


FICA (continued)

• Community: Describe your connection to a spiritual community.

• Addressed: How can the healthcare team support your child and family in your faith and spirituality at this time?

(Astrow 2001)

(Puchalski, Larson, Post 2000)Part A: Understanding Grief and Loss in Children and Their Familieshttp://www2.aap.org/sections/palliative/ResilienceCurriculum.html

Presenter

Presentation Notes

Community: Describe your connection, if any, to a spiritual community. How do you see this community supporting you in times of challenge? Addressed: How can the healthcare team support your child and family in your faith and spirituality at this time? Are there any issues about this that you would like addressed? Another way of asking Community and Addressed portions of FICA Are you part of a faith community? Are there ways I can support you in your faith as you are coping with illness?


Taking a Spiritual History: Spirit

• Spiritual belief system

• Personal spirituality

• Integration with spiritual community

• Ritualized practices and restrictions

• Implications for medical care

• Terminal events planning

Taking a Spiritual History: SPIRIT (continued)

• Spiritual belief system:• A particular faith or sense of spirituality that is a part of your life?

• Personal spirituality: • Personally express your spirituality/connection to something

greater than yourself?


(Maugans 1996)

Presenter

Presentation Notes

Spiritual belief system: Do you have a particular faith or sense of spirituality that is a part of your life? Personal spirituality: How do you personally express your spirituality/connection to something greater than yourself?


Taking a Spiritual History: SPIRIT (Continued)

• Integration with a spiritual community: • A spiritual community that you are a part of? • Regular religious or spiritual practices?

• Ritualized practice and restrictions: • Any restrictions or laws/rituals that you follow as a part of your faith?

(Maugans 1996) Part A: Understanding Grief and Loss in Children and Their Familieshttp://www2.aap.org/sections/palliative/ResilienceCurriculum.html

Presenter

Presentation Notes

Integration with a spiritual community: Is there a spiritual community that you are a part of? Are there any regular religious or spiritual practices you are a part of through this community? Ritualized practice and restrictions: Are there any restrictions or laws/rituals that you follow as a part of your faith?


Taking a Spiritual History: SPIRIT (Continued)

• Implications for medical care: • A role for spirituality in what you are facing with your child now? • Wish to incorporate a particular practice/have a member of your community

come in?

• Terminal events planning: • In the event that someone dies, what rules or beliefs/rituals should be

carried out?

(Maugans 1996)


Presenter

Presentation Notes

Implications for medical care: Can you see a role for spirituality in what you are facing with your child now? Do you wish to incorporate a particular practice/have a member of your community come in to provide a practice for your child? Terminal events planning: In the event that someone dies, what are any rules or beliefs/rituals that should be carried out?


Role Play Demonstration

Large Group Discussion

• What went well?

• What could have been done differently next time?

Taking Spiritual History at Your Table(FICA)

• Faith and Beliefs: Is there a particular faith(s) that you and your family are members of? Are there any beliefs important to you that you would like to share?

• Importance: How would you rank the importance that spirituality plays in your life (Very Important/Important/Not Very Important)?

• Community: Describe your connection, if any, to a spiritual community. How do you see this community supporting you in times of challenge?

• Addressed: Can you comment on a time that spirituality was important to you in healthcare?

Large Group Discussion

• What was easy about taking a spiritual history? What was difficult?

• Do you think that you could teach your learners to do this?

Case 1 (In Small Groups)

Your patient is a 6yo Middle-Eastern American boy whose family’s faith is important to them. The child is dying from a progressive neurological disease for which there is no treatment. The family hasn’t felt comfortable with their child dying in their home, so they request that their child be admitted to the hospital. However they want their spiritual leader to perform the death rituals in the hospital. How would you approach this request?



Case 1: Points to Consider

1. What discussion would you want to have with the family?

2. What information would be important to know?

3. What resources could you access to assist with their request?

4. How would you navigate this request with the different disciplines involved with the child’s care- parents, nursing staff, child life, and chaplain?



Case 2 (In Small Groups)

You are working in the PICU and a child is declared dead after a motor vehicle accident resulting in severe head trauma. The mother is distraught and states that in their Judaian religious beliefs, a family member must remain with her child’s body until taken to the funeral home.



Case 2: Points to consider

1. How might you approach this request?

2. What would be your reaction?

3. What resources would you want to access within the hospital setting to try to honor this request?



Wrap Up

• What are some barriers to implementation of this in your program?



• Megan McCabe (Montefiore)

• Maggie Moon (Johns Hopkins U)

• Amanda Osta (U of Illinois-Chicago)

• Deborah Rana (UC- San Diego)

• OJ Sahler (U of Rochester)

• Keely Smith (U of Missouri-Kansas City)

• Florence Rivera (AAP administrative staff)

• Connie Baldwin (Editorial Expertise)

• Janet Serwint (Johns Hopkins U)

• Susan Bostwick (Weill-Cornell College)

• Ann Burke (Wright State U)

• Annamarie Church (Naval Medical Center)

• Albina Gogo (UC-Davis)

• Dena Hofkosh (U of Pittsburgh)

• Marta King (Saint Louis U)

• Jenni Linebarger (U of TX-Houston)

Authors of Resilience Curriculum

Presenter

Presentation Notes

14 authors/institutions AAP, APA, APPD, COMSEP represented

Documents

Incorporating Spiritual Humility In The Practice Of ... · PDF file• 90% of the US population practices spiritual or ... Are there any beliefs important to you that ... plays in