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Promises and Perils of Spiritual care assessment: with special references to religious/cultural perspectives

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Title: Promises and Perils of Spiritual care assessment: with special references to religious/cultural perspectives


1
Promises and Perils of Spiritual care assessment
with special references to religious/cultural
perspectives
  • Philip Crowell, PhD, MA, MDiv.
  • Chaplain and Director, BC Childrens and Womens
    Hospitals, Vancouver, BC

2
Promises Perils
  • The reality - we need to do it
  • Great benefit when it is done right
  • The need for competency in order to do it
    appropriately
  • Assessment, interpretation, evaluation,
    measurement is part of our culture with respect
    to another person/family and their culture

3
The Art of Spiritual Assessment
  • Is there an art, science and skill involved that
    goes beyond the assessment questions?
  • The value of the inner wisdom and self-awareness
    of the assessor?
  • How important is the arete, skill, virtue and
    competency of the assessor and interpreter? The
    art of questions.
  • What do we see when we enter a hospital room?

4
From Illness and Healing Images of Cancer by
Robert Pope
  • Cancer in older people carries with it a tacit
    acknowledgement of inevitability, but in children
    we are surprised, and uncomprehending.
  • In this drawing, Erica, with hair gone from the
    treatments, touches the pump that administers her
    chemotherapy.

5
Perils and Promises
  • In using tools we are able to take a measure
    at a moment in time
  • A toolkit of supplies JPCC vol. 59,nos 1-2
    Spring-Summer, 2005, Thomas St.James OConnor,
    Kathleen ONeill, Grace Van Staalduinen,
    Elizabeth Meakes, Carol Penner, and Katherine
    Davis, Not Well Known, Used Little and Needed
    Canadian Chaplains Experiences of Published
    Spiritual Assessment Tools

6
Tools
  • Spiritual Assessment Tools
  • Religious Attitude Inventory
  • W.E. Broen, Personality Correlates of Certain
    Religious Attitudes, Journal of
  • Consulting Psychology, 1955, vol. 19, p. 23
    David Foy, James D. Lowe, Lee K. Hildman, Keith
    Jacobs, Reliablity, Validity and Factor Analysis
    of the Religious Attitude Inventory Southern
    Journal of Educational Research, 1976, Vol 10,
    pp. 235-241.

7
tools
  • Gordon Allport and James Ross, Personal
    Religious Orientation and Prejudice, Journal of
    Personality and Social Psychology, 1967, Vol. 5,
    pp. 432-443
  • Michael J. Donahue, Intrinsic and Extrinsic
    Religiousness The Empirical Research, Journal
    for the Scientific Study of Religion, 1985, Vol.
    24, pp. 418-423. Ralph W. Hood, The
    Conceptualization of Religious Purity in
    Allports Typology, Journal for the Scientific
    Study of Religion, 1985, vol. 24, pp. 413-417

8
And even more tools
  • R.W. Hood, The Construction and Preliminary
    Validation of a Measure of Reported Mystical
    Experience, Journal for the Scientific Study of
    Religion, 1975, Vol. 14, pp. 29-41.

9
The last of the tools. There will be more
  • C. Daniel Batson, Religion as Prosocial Agent
    or Double Agent, Journal for the Scientific
    Study of Religion, 1976, Vol. 15, pp. 29-45.
  • Keith Edwards, Religious Experience
    Questionnaire, Dissertation Abstracts
    International, 1976, Vol. 36.
  • The God Questionnaire
  • Anna-Maria Rizzuto, The Birth of the Living God
    A Psychoanalytic Study (Chicago, ILL The
    University of Chicago, 1979).

10
Fitchett
  • 7x7 Model of Spiritual Assessment
  • George Fitchett, Assessing Spiritual Needs A
    Guide for Caregivers (Minneapolis, MN Augsberg
    Fortress Press, 1993) also see, G. Fitchett and
    J. Russell Burch, A Multi-Dimensional Functional
    Model for Spiritual Assessment, The Caregiver
    Journal, 1990, vol. 7, pp. 43-62.
  • Mental, Physical and Spiritual Well-Being Scale
  • Dianne Vella-Brodrick and Felicity Allen,
    Development and Psychometric Validation of the
    Mental, Physical, and Spiritual Well-Being
    Scale, Psychological Reports, 1995, Vol. 77,
    pp. 659-674.

11
Assessment and interpretation
  • Spiritual Self-Assessment Form
  • Lyn Brakeman, Theology as a Diagnostic Tool in
    Assessing Spiritual Health, The Journal of
    Pastoral Care, 1995, Vol. 49, pp. 29-38.
  • Spiritual Assessment Inventory
  • Todd Hall and Keith Edwards, The Initial
    Development and Factor Analysis of the Spiritual
    Assessment Inventory, Journal of Psychology and
    Theology, 1996, Vol. 24, pp. 233-246 Todd Hall
    and Keith Edwards, The Spiritual Assessment
    Inventory A Theistic Model and Measure for
    Assessing Spiritual Development, Journal for the
    Scientific Story of Religion, 2002, Vol. 41, pp.
    341-357.

12
Spiritual assessment 1 Fitchett
  • Problems with a medical model
  • Assessment is both a statement of perception and
    a process of information gathering and
    interpreting.
  • I use the term assessment as a noun and a verb.
    Because it is both process and content, it is
    inherently a dynamic concept. George Fitchett,
    Assessing Spiritual Needs, p,17

13
Continued - 2
  • Multi-focused assessments are often guided by
    questions such as what does this person want?
  • What do I think he needs? Do I feel qualified to
    help her?
  • What kind of help is expected or required of me
    in the institutional context of this assessment
    (compare the patients hospital room and the
    parish pastors office)?

14
Assessment -3
  • What are the likely consequences if I elect to do
    more or to do less than expected?
  • What other departments or services will also be
    involved in the patients care?
  • What additional resources will be need to help
    this person or to help me help him?
  • Are those resources available? If not, is it
    better to postpone any intervention until they
    are?

15
Assessment 4
  • When is the best time to make an assessment?
  • A chaplain in Fitchetts survey was careful not
    to make an assessment until he had gotten to know
    a patient, during a second visit at the earliest.
  • However, one sizes up a situation as soon as you
    enter a room, i.e., am I welcome here today or
    not?

16
Spiritual Care/Pastoral Counselling Core
CompetenciesJanuary 2010 / March 2010
  • This document is a first attempt to summarize the
    core competencies (knowledge, skills, attitudes,
    behaviours) that are required for the practice of
    Spiritual Care/Pastoral Counselling. These
    competencies can be observed, demonstrated,
    evaluated and assessed.
  • The following nine competency categories were
    derived from the National Validation Survey
    (2008) which included competencies identified
    through the DACUM project (2006). The actual
    competency statements validated through the
    survey are grouped under these main categories.

17
A top ten list
  • Spiritual Assessment
  • Self-Awareness
  • Spiritual and Personal Development
  • Multi-dimensional Communication
  • Brokering Diversity
  • Ethical Behaviour
  • Collaboration Partnerships
  • Facilitating Learning
  • Leadership
  • Research

18
Spiritual Assessment (includes the development of
care plan, implementation and evaluation of
outcomes)
  • A.4 Create spiritual care plan.1
  • B.2 Utilize evidence-based practice.3
  • B.4 Identify person's sense of purpose1
  • B.5 Help person evaluate role and function of
    spiritual religious identity in their life.1
  • B.7 Invite clients to draw upon their spiritual
    and religious resources.1
  • B.10 Employ a variety of intervention techniques
    to achieve care plan goals (or therapy goals and
    objectives).1
  • B.12 Engage in reflection and dialogue on
    spiritual issues of significance to the client.1
  • B.13 Allow client to tell his / her story as a
    way to seek for meaning / purpose.1

19
Continued -Compiled by Becky Vink, January 11,
2010Modified by Margaret Clark, March 1, 2010
  • B.14 Engage with client's experiences of (trauma,
    distress) pain, suffering and dying.1
  • B.15 Acknowledge the sacred in human experience.1
  • B.16 Assist persons in their own creative
    expression of spirituality.1
  • B.17 Offer guidance for spiritual growth.4
  • B.18 Engage in prayer where appropriate.4
  • B.19 Enable reconciliation (e.g. conflict
    management forgiveness, relationship).5
  • B.20 Provide and facilitate rituals, rites and
    ceremonies.2
  • B.24 Function as primary therapist / clinician /
    spiritual counsellor as required.3
  • E.1 Assess the dynamics of the culture, resources
    and community.3

20
Assessment on assessment 5
  • In medicine, the patient has an admitting
    diagnosis, a subsequent assessment confirmed or
    revised diagnosis/ assessment that guides the
    therapy
  • For example, In DSM IV the diagnosis of
    Schizophrenia requires that continuous signs of
    the illness have been present for at least six
    months.

21
Assessment 6 over-time
  • In psychoanalytic treatment of narcissistic
    personality or behavior disorders, according to
    H. Kohut, it is necessary to wait to see if one
    of the characteristic narcissistic transferences
    develops before one makes a definitive diagnosis.

22
Importance of spiritual assessment
  • Foundation for action
  • Foundation for communication
  • Foundation for contracting
  • Foundation for evaluation
  • Foundation for personal accountability
  • Foundation for quality assurance
  • Foundation for research
  • Assessment as the touchstone for professions
    identity

23
7 X 7 Model for Spiritual Assessment - assumptions
  • Each of us is a whole person
  • Our spirits are not separate from our bodies, our
    emotions, and our thoughts
  • There are two major divisions and 7 dimensions
    within each

24
Holistic Dimensions -7
  • Medical context dimensions
  • Psychological state dimensions
  • Psychosocial dimension
  • Family system dimensions
  • Ethnic and cultural dimensions
  • Societal issues dimensions
  • Spiritual dimensions

25
The Spiritual Dimensions (7pts)
  • 1. Beliefs and Meaning- stories religious
    symbols literal, broken myth, and restored myth
    noting the inconsistencies of the stories
    meaning from caring for others for her husband
  • 2. Vocation and consequences duties called to
    fulfill able to fulfill? Impasse?
  • 3. Experience and Emotion what experiences of
    peace in life have been experience? Or joy?

26
Spiritual dimension 7 x 7
  • 4. Courage and Growth courage to be to enter
    the dark night of the soul living wake the
    possibility of new beliefs? Has growth been slow
    or sudden?
  • 5. Ritual and Practice
  • 6. Community RC parish, her partner is the
    community as resource for the patient?
  • 7. Authority and Guidance will the patient
    allow the chaplain to help, support, and offer
    guidance when struggling?

27
A case Mrs. Gabatino
  • facing her own death and cancer
  • Reflecting on her faith, partner, the death of an
    infant - SIDs, no other children, 7 foster
    children, Italian background,
  • Anxiety absent, grateful, joyful, angry,
    exhausted, timid, worthless, and guilty.

28
What is our approach in contrast to genetic
counseling assessment?
  • Genetic testing and information often raises
    issues that are existential, having to do with
    illness, suffering, loss, choices and death
  • Spiritual and religious values will influence how
    some people respond to genetic information
  • (Religious and Spiritual Concerns in Genetic
    Testing and Decision Making An Introduction for
    Pastoral and Genetic Counselors Journal of
    Clinical Ethics, Summer 2006)

29
Ethical decisions
  • They may reconsider their feelings about being
    induced or abortion and worry about how their
    family, friends, and religious communities may
    react
  • Spectrum- from anacephaly to trisomy 21
  • They may worry about what the future might bring
    for the child, knowing that life, at some level,
    is always a struggle, but harder for those who
    are disabled

30
Genetic and spiritual care counselors
  • Can be a tremendous help to parents grappling
    with these questions.
  • Help identify their social, psychological and
    spiritual resources
  • Seek to dispel any misperceptions about the cause
    or effects of a genetic abnormality and minimize
    negative thought patterns (blame/guilt)

31
The basics
  • assessing various traumatic situations so we can
    respond
  • Spiritual care may include the ability to make a
    spiritual assessment and to follow up - and/or to
    conduct rituals, helping people to draw on the
    positive elements of their faith-beliefs, or
    rituals of lament/sorrow

32
Integration
  • Park Ridge Center for Health, Faith and Ethics
    (2004) study encourages genetic counselors to
    learn about different religious frameworks and
    language to effectively assess patients
    spiritual needs
  • Caution about any directive counseling
    assessing other counselors involved
  • Will some want guidance and affirmation?

33
The Balance
  • the danger of stereo-typing vs. not knowing
    their basic cultural/religious assumptions
  • What to ask? The same questions will mean very
    different things to different individuals because
    of their cultural lens

34
The spiritual/ethical questions in context
E.o.L. settings, inductions, palliative care
  • What is a good life? What is our responsibility
    to limit human suffering? To allow natural death?
    To have a D.N.A.R.?
  • What is the place of hope?
  • Will it be better to be born then not to be born?
    Will I be the same person if I make a
    termination decision? What will it be like, since
    I have never experienced a loss or death of
    someone close?

35
Our questions
  • Do you have the time, or skills to assess and
    attend to their spiritual needs?
  • The perils and the possibilities of spiritual
    care triage

36
A consultation - assessment
  • The Case newborn, rare genetic condition,
    respiratory failure, soft-bones, constrictive
    ribs, heart-surgery necessary, resuscitation
  • 2 months later H1N1
  • Aboriginal family, Catholic and traditional way
  • Modes of communication

37
Pediatric case
  • Perinatal diagnosis 8 months pregnancy
  • Large mass discovered on the throat of baby
  • 1) wait delivery and immediate surgery risk of
    oxygen debt
  • (2) wait delivery and go palliative
  • (3) exit surgery
  • The couple not religious but spiritual with
    background in the UCC.

38
Spiritual Assessment in Genetic Counseling
  • Journal of Genetic Counseling, vol.16, No. 1 Feb.
    2007
  • 60 in a group of 127 genetic counselors,
    reported they had performed a spiritual
    assessment within the past year, however, 8 of
    these counselors assessed spirituality in more
    than half of their sessions

39
Barriers to spiritual assessment
  • Lack of time, insufficient skills, uncertainty
    regarding the role of spiritual assessment within
    genetic counseling
  • This study suggests a need for increased training
    regarding the methods for and relevance of
    spiritual assessment in g.c.

40
Back to holistic care
  • Harold Koenig stated, neglecting the spiritual
    dimension is just like ignoring a patients
    social environment or psychological state, and
    results in failure to treat the whole person.
    (2002, p.6)

41
Spirituality in Patient Care, by Harold
Koenig, p. 44)
  • Single Question Spiritual History
  • Do you have any spiritual needs or concerns
    related to your health?

42
Fear and Hope
  • The suffering human being needs a place where
    he/she can rest, a place which breathes genuine
    hospitality, where fear and hope are permitted to
    exist side by side a place where the naked face
    appeals for compassion and finds response.
    (Eriksson Lindstrom, 2003)
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