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Using Spiritual Assessment to Facilitate Spiritual Care

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Ritual as comfort in times of pain or anxiety ... The role of rituals. The place of mystical events and understandings of divine intervention ... – PowerPoint PPT presentation

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Title: Using Spiritual Assessment to Facilitate Spiritual Care


1
Using Spiritual Assessment to Facilitate
Spiritual Care
Caring for the Spiritual Lives of Seniors
Presenter Rev. James W. Ellor, Ph.D., D. Min.,
LCSW, ACSW, BCD, DCSW, CGP, CSW-G Professor
School of Social Work, Baylor University Editor
Journal Of Religion, Spirituality and
Aging Parish Associate First Presbyterian Church
of Waco
2
Planning Teams -1 (10 minutes)
  • Find a group of 4-6 persons that you can work
    with as a team throughout the day. Consider
    finding people that you do not know ahead of
    time.
  • Discuss together what your goals are for today.
    What do you want to get from today?
  • You have 10 minutes for this exercise

3
Discuss with the group the tools you hope to
assess
  • Religion
  • Spirituality
  • Faith
  • Faith Development
  • Faith Development
  • Spiritual Coping
  • What else?

4
Theoretical Issues
5
Why do assessment?
  • Offers voice to spiritual needs
  • Enhances inter-disciplinary cooperation
  • Mandated by Joint Commission for Long Term Care
    and Hospice

6
Joint Commission
  • Minimum Standards
  • Determine the patients denomination
  • Beliefs
  • What Spiritual Practices are important
  • Hope, Despair, views of death
  • Is the patients spiritual practice helpful in
    coping with suffering and life in general?
  • All Joint Commission Standards are intended to be
    integrated with other logical standards, such as
    Behavioral Health

7
Where to find Joint Commission Standards
  • The Joint Commission directly requires Spiritual
    Assessment in
  • Long Term Care
  • Hospice
  • The Hospice Standards offer a fuller reflection
    of the thinking of the commission

8
Spiritual Assessment
Definitions are the first step then
  • Definition
  • Assessment
  • Treatment
  • outcome ?

9
Constructing a new wholistic paradigm
10
The Person
11
A Matter of Perspective
  • Theology
  • Theo centric
  • Anthro centric
  • Psychology
  • Paradigms
  • Philosophies
  • And More

12
Anthro centric
  • Starts from understanding that humanity can not
    fully understand God
  • Therefore it is understood that humanity can only
    view God through human eyes. In other words,
    humanity looks up at God
  • Key is role of revelation

13
An Anthrocentric perspective
Thibault, Jane M., James W. Ellor, and F. Ellen
Netting. "A Conceptual Framework for Assessing
the Spiritual Functioning and Fulfillment of
Older Adults in Long-Term Settings." Journal of
Religion and Aging 7, no. 4 (1991) 29-46.
14
Fowlers Stages
  • Pre-stage Infancy Undifferentiated Faith Stage
  • Stage 1 Intuitive-Projective Faith
  • Stage 2 Mythic-Literal Faith
  • Stage 3 Synthetic-Conventional
  • Faith
  • Stage 4 Individuative-Reflective
  • Faith
  • Stage 5Conjunctive Faith
  • Stage 6 Universalizing Faith
  • James W. Fowler, 1995, Stages of Faith, San
    Francisco Harper and Row.

15
Coping Model Based on the work of Ken Pargament
Interrelations of Stress Buffers
  • Social Support
  • Coping Skills
  • Perception of stressor and coping ability
  • Sources of Meaning
  • Biological resilience
  • Hartz, G. W. (2005). Spirituality and mental
    health Clinical applications. Binghamton The
    Haworth Press.

16
Hierarchy of Sources of Meaning
Marginal Sources of Meaning
Secondary Sources of Meaning
Foundational Sources of Meaning
Hartz, G. W. (2005). Spirituality and mental
health Clinical applications. Binghamton The
Haworth Press.
17
Religious Coping Methods
  • Spiritual Support and collaborative Coping
  • Belief that one is receiving support and guidance
    from God God is seen as another member of the
    support network.
  • Congregational Support
  • Helpfulness of clergy, lay leaders, and fellow
    congregants in times of stress
  • Benevolent religious reframing
  • Attributing the stressful event to the will of
    God or to a loving God

Hartz, G. W. (2005). Spirituality and mental
health Clinical applications. Binghamton The
Haworth Press.
18
Four Reliable Aspects of Religion and Spirituality
  • Prayer helps
  • People use their beliefs in coping, particularly
    with tragedy
  • Religion seems to influence
  • Immune
  • Endocrine
  • Nervous systems
  • Ritual as comfort in times of pain or anxiety
  • Community Support come from Faith Based
    Community Services
  • Provides values and answers basic life questions

19
Outcome Examples (So what!)
  • If you learn that the senior employs religion as
    a coping mechanism, how will that impact working
    with the person when she/he is anxious?
  • If you learn that she/he is Presbyterian, how
    will that impact services, such as referral to
    chaplaincy or the selection of a pastor to come
    talk with the senior?
  • If you learn that the person is oriented toward
    mysticism, how will that impact the way you
    understand their discussions of future events or
    anxieties?

20
Coping Defined
  • Coping refers to efforts to master conditions of
    harm, threat, or challenge when a routine or
    automatic response is not readily available.
  • Monat, A. and R. S. Lazarus (1977). Stress and
    Coping An Anthology. New York, Columbia
    University Press.

21
Coping Mechanisms
  • DenialKeeping negative events from conscious
    awareness
  • Sublimation Aggressive impulses are diverted
    into prosocial behaviors
  • Projection
  • Attributing to someone else ones own thoughts
    or feelings.
  • Displacement Deflecting feelings from their
    original target to someone else
  • Reaction formation
  • Unacceptable wishes or impulses are transformed
    into their opposite
  • Intellectualism/rationalization
  • Symptom Conversion
  • Planning
  • Restraint
  • Reframing
  • Use of social support
  • Acceptance
  • Use of humor

22
Coping
  • Most common mechanism involving religion is
    reframing
  • 3 natural Mechanisms
  • A system of beliefs Mental attitudes
  • Increased social support
  • Focus on others (transcendence)

23
Mechanisms for Optimism Hope
  • Positive Hymns
  • Positive Theologies pervasive within congregation
  • Prayer in times of trouble (We are never alone)
  • The concept of a loving, forgiving Devine partner
    in life

24
Social Support
  • Congregational Care giving
  • Congregational support for families
  • Congregational Information and Referral
  • Clergy most likely turned to in times of crisis

25
Assessment Keys
  • The nature of God
  • Is God approachable…if so how?
  • The on going role of, or presence of God in the
    life of the client/patient
  • The role of humanity in the on-going creation of
    our environment
  • The role of rituals
  • The place of mystical events and understandings
    of divine intervention
  • The nature of and need for critical elements of
    participation in the faith community, such as
    worship, prayer, anointing, etc.

26
Team Meeting 3 (20 minutes)
  • This is a time to brain storm with your team.
  • What types of topics do you need to cover in your
    assessment?
  • How will this fit into the other types of
    assessments being done, either by you, or by
    colleagues?
  • What outcomes do you expect from this assessment?
    (This may be a good question to start your
    discussion with!)
  • Be prepared for a brief popcorn feedback session
    with the entire group by offering some ideas back
    to the group

27
Assessment Technology
  • The nuts and bolts of getting it done

28
Steps in Assessment
  • Determine what is to be assessed. Definition is
    critical
  • Determine the how, and by whom, the data will be
    used
  • Determine who will do the evaluation
  • Develop an approach
  • Implement and constantly reevaluate process
  • Risk Factors

29
Possible Formats
  • Open ended Questions
  • Structured Questions
  • Targeted content with clear categories of
    response
  • Still open
  • Closed questions
  • Full Psychometric design
  • Eco-mapping

30
Eco Map for Spiritual Assessment
31
Topics for Inclusion
  • Now that you have the big picture, what are the
    specific items that you want to put into your
    assessment tool?

32
Common Elements in Spiritual Assessment
  • Doug Olson, building on the work of the Fetzer
    Foundation in his study of common variables used
    in spiritual assessment found the following eight
    variables to be commonly found in all of the
    religious and spiritual research instruments
    gathered for their research These variables are
  • Olson, Doug, In press, Religiosity and
    Spirituality Assessment Approaches and Tools, in
    Robert and Rosalie Kane Assessing Older Persons.
    Oxford University Press.
  • Fetzer Working Group (1998). Brief Measure of
    Religiousness and Spirituality, Jointly sponsored
    by NIA and Fetzer. Kalamazoo, Michigan.

33
Variables
  • Dependent
  • Relationship
  • Religious History
  • Organizational Practice
  • Degree of Commitment
  • Independent
  • Private Daily Experience
  • Value Systems and Ethical Precepts
  • Spiritual and Religious Beliefs
  • Spiritual Development

34
Fetzer Institute 12 Domains
  • Daily Spiritual Experience
  • Religious/Spiritual coping
  • Private religious practices
  • Religious/spiritual history
  • Organizational religiousness
  • Religious preferences

35
Fetzer Institute 12 Domains, continued
  • 7. Meaning
  • 8. Commitment
  • 9. Forgiveness
  • 10. Values
  • 11. Beliefs
  • 12. Religious Support

36
Possible Elements
  • Spiritual History
  • Denominational history
  • Oral History
  • Coping
  • Meaning
  • Pathology Assessment
  • Activities
  • View of death and Afterlife
  • Important or Meaningful Symbols
  • View of God
  • Role of Prayer
  • Motivation for health or Wellness
  • Spiritual reminiscence
  • Eco mapping

37
Constraints
  • Time/Staff
  • Need
  • Cognition on the part of the senior
  • Assess to family or other key informants
  • History

38
Confidentiality
  • New Laws on confidentiality
  • Need Client/patient permission
  • Work out with supervisor and administration

39
How and by whom will data be used?
  • Chaplains office
  • Clinical Assessment
  • Interdisciplinary Team
  • Statistical Reporting
  • Community Liaison
  • Nursing Assessment

40
Determining who will do the assessment
  • Chaplain
  • Volunteer
  • Social Service
  • Nursing
  • Activities

41
Team Meeting- 4 (15 minutes)
  • Who will do it?
  • What format will you use?
  • Paper and pencil
  • Interview
  • Small group
  • What do you want to get out of it?
  • How will it interface with other assessments
  • How will it be used?
  • What Elements do you want in your assessment tool?

42
Intervention Examples
  • Different interventions require different
    assessment strategies

43
Role related construction for example Parish
Nurse or Chaplain Interventions
  • Spiritual Mapping
  • Spiritual Crisis Intervention
  • Counseling
  • Grief Support

44
Task Oriented Assessment Spiritual Crisis
Intervention
  • Religion as coping mechanism
  • Spiritual community support
  • Ritual as comfort in times of pain

45
Task Oriented Assessment Counseling
  • Wholistic assessment to include the spiritual
  • Spiritual Crisis Intervention
  • Spiritual wellness or strengths
  • Religious community support

46
Task Oriented Assessment Grief Support
  • Comfort in times of loss
  • Religion as coping
  • Community support

47
Task Oriented Assessment Community Liaison
  • Assessment of residents in order to build bridges
    with community congregations
  • Knowledge data base for programming
  • Data base to bridge with needed faith communities.

48
Team Meeting 5
(30Minutes) Putting it all together
  • Work with your team to develop your own
    assessment tool

49
Building your own assessment - Goal
  • What is your goal
  • Basic assessment for brief intervention
  • May not want a paper and pencil tool, rather a
    short memorizable instrument
  • Short portable tool
  • Written tool that can be placed into a chart
  • Depth assessment to bridge with interdisciplinary
    team

50
Developing the tool
  • Demographic Questions
  • Assessment of the spiritual
  • Assessment of the need for or types of
    intervention
  • Assessment interface with psychology

51
Finalize approach
  • Finalize tool
  • Field test tool
  • Employ tool
  • Reevaluate tool

52
Where to go from here
  • Design a Spiritual Strategy
  • Discovery Assessment
  • Insight Team meeting
  • Action Intervention

53
Final Team Meeting - 6
  • Put it all together
  • Who?
  • Will do what?
  • To whom?
  • For what purpose?
  • How will it be evaluated?
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