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Working Collaboratively to Provide for the Spiritual Care of Trauma Patients

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Title: Working Collaboratively to Provide for the Spiritual Care of Trauma Patients


1
Working Collaborativelyto Provide for the
Spiritual Care of Trauma Patients
  • A Trauma Surgeons Perspective
  • David L. Acuna, DO, FACOS
  • Wesley Medical Center

2
(No Transcript)
3
Purpose
  • Spiritual care of trauma patient
  • Perspectives of a trauma surgeon
  • Describe
  • trauma team organization and objectives
  • trauma population
  • patterns and severity of injury
  • Spirituality impact on trauma care
  • Chaplain as trauma team member

4
Definition of Trauma
  • Any inflicted injury
  • Physically
  • Emotionally

5
Define Level of Trauma
  • Level I
  • Highest level of surgical care, 24/7 availability
    of full compliment of specialists, educational
    outreach, research
  • Level II
  • Has most components of Level I without the
    research component
  • Level III
  • Does not have full availability of specialists
  • Level IV
  • Able to provide initial evaluation and
    stabilization

6
Trauma Team
  • Trauma surgeon
  • Mid-level provider
  • Trauma nurse x 2
  • Radiology technician
  • Respiratory therapist
  • Pharmacologist
  • Chaplain
  • Level dependent
  • Anesthesiologist
  • Orthopedic resident
  • Pediatric nurse

7
General Trauma Description
  • Wide variance
  • Degree of injury/illness
  • Patient personality
  • Resuscitative in nature
  • Time dependent
  • Short-term interaction
  • Follow-up care by specialty service
  • Primary care
  • Rehabilitation
  • Long term acute care
  • Can be emotionally charged (family)

8
Trauma Growth Adults and Pediatrics
9
Cause of Injury
10
Adult Cause of Injury by Year
11
Pediatric Cause of Injury by Year
12
Injury Pattern
  • Blunt Trauma
  • Penetrating Trauma
  • Burns
  • Other (hanging/drowning)

13
Adult Injury Severity by Year
14
Adult Trauma Activation by Year
15
Pediatric Trauma Activation by Year
16
Pediatric Injury Severity by Year
17
Alcohol Related Trauma Activation
18
Positive Drug Screen (Adult Ped)
19
Trauma Care
  • Surgeon/patient ratio
  • Prioritization of care is based patient
    physiology
  • Time dependent (Golden Hour)
  • Wide variation in physiological needs
  • Urgent spiritual/religious issues
  • Blood products
  • Medications

20
Case Report
  • Motor vehicle accident
  • Elderly couple
  • Husband injury
  • Wife injury
  • Medical intervention
  • Spiritual care

21
Indications for Spiritual Care Provision by the
Surgeon
  • Approach
  • Chaplain or personal clergy not available
  • Emergent spiritual need
  • Patient
  • Family
  • Defer
  • Chaplain or personal clergy not available
  • Time constraints

22
Requests for Spiritual Care
  • Prayer
  • Intercessory
  • Corporate
  • Event related
  • Test
  • Surgery

23
Palliative Care
  • Severe head injuries
  • High-level spinal cord injuries (quads)
  • Self-inflicted injuries
  • Severe complications of trauma
  • Severe co-morbid conditions plus the trauma

24
End of Life
  • Comfort care decisions
  • Management of
  • Pain
  • Anxiety
  • Conflict between
  • Physiological care
  • Comfort care
  • Life prolonging vs non-life prolonging

25
Transplant
  • Beliefs
  • Family request
  • Transplant team
  • Conflict of interest by resuscitating team

26
Death
  • Anticipating death
  • Advanced Directives
  • Definition of Death vs Brain Death
  • Testing for Brain Death

27
Family
  • Unit of care
  • Spiritual
  • Emotional
  • Cultural
  • Family dynamics

28
Pediatric Population
  • Emotionally intensified
  • Cause of injury
  • Potential abuse neglect
  • Inter-family dynamics
  • Staff-family dynamics

29
Chaplain Care
  • Availability (very good)
  • Quality
  • Experience
  • Cultural
  • Ethnic

30
Chaplain Care (Ideal)
  • Liaison to family
  • Information gathering
  • Patient Support
  • Delivery of information
  • 1-1 personal and private
  • Emotional
  • Spiritual
  • Family Support
  • Coordinated delivery of information
  • Patient health
  • Logistics
  • Emotional
  • Spiritual

31
Improvements
  • Follow-up in ICU
  • Patient
  • Family
  • Increased Communication
  • Charting (notes in medical record)
  • Rounding

32
Needs
  • Trauma team
  • Highly emotional
  • Self-care
  • Personal plan
  • Avoidance

33
Thank you.
34
Working Collaborativelyto Provide for the
Spiritual Care of Trauma Patients
  • A Chaplains Perspective
  • Rev. Shannon Borchert, M.Div.
  • Pastoral Care Education
  • Wesley Medical Center

35
Program Description
  • Clinical Pastoral Education Program
  • ACPE accredited
  • Educators
  • 2 ACPE Supervisors
  • 2 Board Certified Staff Chaplains
  • 1 Administrative Assistant
  • Students
  • 5 Residents
  • 21 Extended students

36
Religious Affiliations
37
Religious Affiliations
38
Configuration of the Trauma Team
P.A.
Respiratory Therapy
P.A
Trauma Control Nurse
R.N.
Radiology
Trauma Surgeon
Chaplain
39
Chaplain as Trauma Team Member
  • Multi-disciplinary team
  • Primary need
  • Physical resuscitation (stabilization)
  • Unit of care
  • Patient
  • Family
  • Friends
  • Medical team

40
Spiritual Triage or Assessment
  • Severity of injury
  • Emotional dynamic of injury
  • Mechanism and nature of injury
  • Age of patient
  • Emotional and family dynamics

41
Objectives of the Spiritual Care Provider
  • Trauma Liaison
  • Communication
  • Spiritual/Religious care
  • Patient
  • Family
  • Medical team
  • Emotional care
  • Hospitality
  • Safety
  • Privacy
  • Comfort

42
Spiritual Case Study
43
Trauma Liaison
  • Communication between medical team and family
  • Facilitating family visitation
  • Protecting the needs of the patient
  • Comfort to family members in time of anxiety

44
Communication
  • Patient family/friends
  • Details of trauma
  • Condition of patient
  • Medical procedures
  • Time frames
  • Goal
  • Keep the family informed without giving specific
    medical diagnosis.

45
Spiritual Care
  • Healing
  • Guiding
  • Sustaining
  • Reconciling
  • Clebsch, W. A., Jaekle, C. R. (1975). Pastoral
    Care in Historical Perspective. New York Jason
    Aronson, Inc.

46
Care for Clinical Staff
  • Immediate staff care
  • Express concern
  • Emotional Support
  • Listening
  • Prayer
  • Long term staff care
  • Formal CISM debriefing

47
  • Thank you.

48
Working Collaborativelyto Provide for the
Spiritual Care of Trauma Patients
  • A Researchers Perspective
  • Gina M. Berg-Copas, PhD
  • Kansas University School of Medicine
  • Wesley Medical Center

49
Objectives
  • How collaboration began
  • Evidence based care
  • Collaborative research at our facility
  • Trends in S/R publishing in trauma/critical care
  • Can the trauma population be segmented for
    spiritual care?

Kansas University School of Medicine
50
History of Research Requirements
ACS RESEARCH REQUIREMENTS
51
Model Prepared by Gina M. Berg-Copas, PhD
52
Examples of New Collaborative Networks Within
Wesley Medical Center
Model Prepared by Gina M. Berg-Copas, PhD
53
Research Collaboration
54
Evidence Based Medicine
  • the conscientious, explicit and judicious use of
    current best evidence in making decisions about
    the care of individual patients

Centre for Evidence-Based Medicine
55
Evidenced Based Spiritual Care
  • What is the evidence of spiritual care?
  • What is it?
  • Who wants it?
  • Who should assess it how should it be assessed?
  • What does it look like?
  • Is it effective?
  • Who provides it?
  • Why isnt it provided?

Collaborative Goal
56
Trends in S/R Publications
  • Comprehensive literature search of (1965-2008)
  • Databases PubMed, CINAHL, Expanded Academic,
    PsychInfo
  • Keywords pastoral care, trauma, injured,
    critical, family, psychological, end of life,
    spirituality, religion.
  • Inclusion criteria
  • spiritual(ity), religion(osity), prayer, faith,
    or pastoral/chaplain/clergy.
  • Methodology
  • Experimental, Non-experimental, Lit Reviews,
    Commentaries
  • Author Credentials
  • Medical Physician, Nursing, Pharmacy
  • Behavioral Psychology, Social Work, Counseling
  • Theological Chaplain, Divinity, Theology

Kansas University School of Medicine - Wichita
57
Author Credentials
Kansas University School of Medicine - Wichita
58
Article Types by Credentials
Kansas University School of Medicine - Wichita
59
Spiritual Care What is it?
  • Spiritual care
  • Find meaning purpose
  • Maintain relationships
  • Transcend immediate moment
  • Religious care
  • Expression of self in religious themes
  • Maintain belief systems
  • Worship practices

Kociszewski, 2002
60
Spiritual Care Who wants it?Patient Attitudes
and Needs
  • Majority patients want awareness of S/R
  • respectful inquiry
  • offer of prayer
  • 45 stable health S/R influence medical decision
    making
  • Older or sicker patients
  • greater self-perceived S/R
  • want physician to inquire about S/R beliefs
  • pray for/with patient at approaching death

Wesley et al. 2004 MacLean et al., 2003
Corrigan et al., 003 Mackenzie et al.,
2000 Berery, et al., 2002 Savage et al., 1999
Wallace et al., 2003 Todres et al., 2005
61
Spiritual Care Who wants it?
  • In trauma, responses vary widely
  • Religious function is means of coping
  • Meaning traumatic events
  • Abandon faith
  • Family satisfaction in end of life decision
    making
  • Higher when spiritual needs are discussed

Harris et al, 2008 Gries et al., 2008
62
Spiritual How should it be assessed?
  • Spiritual inventories
  • Self-reported
  • Highly subjective
  • Check boxes
  • Religious inventories
  • Documentation of preference
  • Involvement/Attendance
  • Cultural

63
Spiritual Care What does it look like?
  • Restore patient and/or family comfort
  • Relieve fears
  • Respect patient needs
  • Manage pain
  • Atmosphere of compassion
  • Listen to patient and/or family
  • Religious component
  • Rituals
  • Prayer

64
Spirituality Is it effective?
  • Weak associations
  • Measurement
  • Religious importance Lifestyle factors
  • No associations to health
  • Negative religious coping or struggle
  • Experimental prayer

Koenig et al. 1998 Sloan et al., 1999
65
Spiritual Care Who should provide it?Physician
Attitudes and Practices
  • Tend to
  • report lower degree of spirituality than patients
  • refer patients to chaplains
  • Do not
  • conduct spiritual histories
  • feel comfortable praying with patients
  • Higher self-ranked S/R
  • more likely to pray with EOL patient
  • correlated with belief that faith
  • role in healing
  • enhances clinical relationship
  • Monroe, 2003 Siegal, 2002 Ellis 1999, Gallup,
    1994 Maugans 1991

66
Spiritual Care Who should provide it?Nurses
Attitudes and Practices
  • Religious belief is effective therapy
  • Willing to consider prayer with patients
  • Barriers
  • Lack of evidence of efficacy
  • Inadequate teaching skills
  • Often primary provider

Halcon, 2003
67
Spiritual Care Who should provide it?Physical
Therapists Attitudes and Practices
  • Acknowledge
  • importance of S/R
  • Report
  • lack of skill to address issues

Highfield, 2003
68
Spiritual Care Who should provide it? Social
Workers Attitudes and Practices
  • Report
  • Most comfortable approaching patients about S/R
  • Skills to do so
  • Less S/R than patients

Wesley, 2004 Sheridan, 2002
69
Spiritual Care Why isnt it provided?
  • Barriers
  • Incompatible personal beliefs
  • Cross-cultural issues
  • Lack of familiarity with non-Judeo-Christianity
  • Conflicting values on controversial issues
  • Practical limitations of time
  • Pressure to make correct technical decisions

Power, 2006 Wesley, 2004 Angelucci, 1999
Timmins Kelly, 2008
70
Guideline Recommendations
  • Recommendation 1 (C)
  • Assess patient S/R
  • Incorporate into plan of care
  • Recommendation 2 (D)
  • Physicians review ancillary reports
  • Incorporate insights into patient condition
  • Recommendation 3 (C)
  • Practitioner training in S/R
  • Assessment incorporation
  • Recommendation 4 (D)
  • Practitioner pray at patient request

American College of Critical Care Medicine Task
Force Clinical Practice Guidelines
71
Evidence Conclusions
  • Training
  • Care for whole person
  • S/R assessment
  • Incorporate findings in plan of care
  • Prayer at patient request
  • Format
  • Clinical setting
  • Academic course work

American College of Critical Care Medicine Task
Force Clinical Practice Guidelines
72
WMC/KUSM-W Research
  • Who in the trauma population considers chaplain
    care to be important?

Kansas University School of Medicine - Wichita
73
Importance of Chaplain Visit in Trauma Population
  • Methods
  • Telephone survey
  • Consenting level I and II trauma patients
  • October 2007 October 2008
  • Interest
  • Importance of Chaplain visit
  • Satisfaction with Chaplain visit
  • Demographics and clinical characteristics

Kansas University School of Medicine - Wichita
74
Importance of Chaplain in Trauma Pop
  • 291 (67 response consenting patients)
  • Patient Demographics
  • Age Mean 44 years (SD 16.8)
  • Sex 56 males
  • Race 92 White
  • Education 65 non-college graduate
  • Income 52 Below 40k
  • Religion 85 Christian or Catholic

Kansas University School of Medicine - Wichita
75
Importance of Chaplain in Trauma Pop RESULTS
  • Importance of Chaplain Care
  • Moderately important (mean 4.0, SD2.0)
  • Satisfaction with Chaplain Care
  • Importance of and satisfaction with Chaplain care
    r .426 p lt .001
  • Chaplain satisfaction and trauma care
    satisfaction r .292 p lt .001

Scale 1not important at all, 6very
important Scale 1very dissatisfied, 6very
satisfied
Kansas University School of Medicine - Wichita
76
Importance of Chaplain Care
  • No significant differences
  • Demographics age, sex, race, education, income
  • Significant difference
  • Religion (p.002)
  • Greater proportion of Other or No religion
    reported not important than Catholics and
    Christians (non-Catholics)

1not important, 2important
Kansas University School of Medicine - Wichita
77
Importance of Chaplain Care
  • No significant correlations
  • Glasgow Coma Score (GCS)
  • Injury severity score (ISS)
  • Self-reported
  • injury severity
  • stress level
  • health status

Kansas University School of Medicine - Wichita
78
Importance of Chaplain Care
  • Patients who value Chaplain care are not
    identifiable by demographic or clinical
    characteristics.
  • It is important to offer Chaplain services to all
    patients and families.

Kansas University School of Medicine - Wichita
79
Emerging Impacts of Collaboration
  • Better understanding of trauma population
  • Expanded critical thinking
  • New perspectives
  • Better practitioners (both clinicians and
    pastoral)
  • Cultural change regarding research
  • Positive attitude
  • Increased awareness of research opportunities
  • New collaborative networks
  • Trauma and Pastoral Care Education

80
New Collaborative Networks
81
Take Home Points
  • Spirituality in Trauma Population
  • Evidence
  • Lack thereof
  • Low grade for guidelines
  • Not authored by spirituality or religious experts

82
Thank you.
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