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Transformational Spiritual Care: An Interprofessional Team Approach


According to Weinberger et al. nurses are more likely to refer to spiritual ... experienced role ... Chaplain in Interdisciplinary Team Collaboration. – PowerPoint PPT presentation

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Title: Transformational Spiritual Care: An Interprofessional Team Approach

Transformational Spiritual CareAn
Interprofessional Team Approach
  • Presented by
  • Donna Mann, MTS
  • Maureen Quinn, MScN NP-Adult
  • Waterloo/Wellington CCAC

Community HPC Initiativein Waterloo/Wellington(W
  • This initiative is funded by the WWLHIN
  • A partnership of Palliative Care Physicians,
    WWCCAC, Acute Care Centers, Family Health Teams,
    Hospice Organizations, The Waterloo Wellington
    Hospice Network and WWLHIN
  • Funding initiated October 2009

The Cambridge HPC Team
  • Planning and development commenced February 2010
  • Located at Cambridge Memorial Hospital in the
    Medical Day Clinic
  • The program began April 2010
  • Approximately 125 patients and families have
    received care

What is a Community HPCTeam?
  • A geographically based inter-professional team of
    specialized care providers who work together with
    primary health care providers to develop and
    implement a plan of care to facilitate the
    delivery of end-of-life care for patients and
    their families

Who is the HPC Team?
  • The team consists of
  • Palliative Care Physician Consultants
  • A Nurse Practitioner
  • A Clinical Resource Nurse
  • A Spiritual Care Provider
  • Administrative Support

What is the Purpose of the Team?
  • To enhance palliative care in the home or
    community clinic setting by providing expert
    consultative services
  • To facilitate seamless transitions from one care
    setting to another
  • To build capacity within the palliative health
    care system

  • Diagnosis of a life threatening illness Would
    you be surprised if this person were to die in
    the next 12 months?
  • Require symptom management for end-of-life issues
    (physical, psychosocial, spiritual care)

The Dimension Of Spiritual Care In Palliative Care
  • The Archstone Foundation of Long Beach,
    California sponsored a Consensus Conference in
    2009 focused on the role of spirituality in
    palliative care. Leaders in all relevant
    healthcare disciplines were invited to work
    together to formulate a consensus report on the
    issues, barriers and recommendations for
    spiritual care in hospice and palliative care.

  • The definition of spirituality agreed upon by
    this inter-professional group is as follows
  • Spirituality is the aspect of humanity that
    refers to the way individuals make and express
    meaning and purpose and the way they experience
    their connectedness to the moment, to self, to
    others, to nature, and the significant or
  • (Journal of Palliative Medicine, 2009)

The Dimension Of Spiritual Care In Palliative Care
  • Among the many recommendations made in this
    inter-professional groups report are these
  • Spiritual distress or religious struggle should
    be treated with the same intent and urgency as
    treatment for pain or any other medical or social
  • Patients should be encouraged and supported in
    the expression of their spiritual needs and
    beliefs as they desire and this should be
    integrated into the treatment or care plan and
    reassessed periodically.
  • In order to integrate information from a
    spiritual assessment into a patients care plan,
    an appropriate process would include screening
    and assessing the spiritual needs, identifying
    spiritual goals, and determining, implementing
    and evaluating the appropriate spiritual

Spiritual careThe value
  • The field of palliative care is well served
    when attention is paid to the physical as well as
    the spiritual dimensions of the end of
    life(Sinclair, S., 2010)
  • Spiritual and religious beliefs can also create
    distress and increase the burdens of
    illness(Puchalski, C. et al 2009)
  • Kenneth Pargament emphasizes the importance of
    addressing spiritual struggles in psychological

Integrating Spiritual Care into Health Care and
into HPCThe challenge
  • It is important to understand perspectives of
    other people on the interdisciplinary team.
  • one study reported that physicians with no
    experience with spiritual care feared that the
    chaplains would ignore patients concern and
    disrespect patients beliefs (Fitchett,G.,
    Rasinski,K., Cadge,W., Curlin,F. 2009)
  • According to Weinberger et al. nurses are more
    likely to refer to spiritual care providers but
    have some discomfort in addressing spiritual care
    matters directly.

Integrating Spiritual Care into Health Care and
into HPCHow To Integrate into the team?
  • Educating the interdisciplinary team is
  • 1/3 of chaplains reported they have experienced
    role conflict, predominately with social work.
    (Wittenberg-Lyles et al 2008)
  • gently provide literature and education to your
  • Create a quick reference screening tool

Integrating Spiritual Care into Health Care and
into HPC
  • Create an environment of support and of
  • Wittenberg-Lyles et al. reported in their survey
    that 73 of the chaplains report that other team
    members look to them for guidance and are labeled
    the encourager
  • Create rituals for the team to acknowledge a loss
    of a patient and to highlight the teams successes

Interfacing with the Other Members of the Health
Care Team
  • Screen your content and condense it before you
    communicate with other health care professionals
    be translators (Wendy Cage, 2010)
  • Recognize that everyone in health care is busy
    and this will only get worse.

Creation of a screening tool.A stroke of
  • Spiritual Care Working Group of area hospital
    chaplains and the three WWCCAC Spiritual Care
  • A pocket tool developed to help care providers
    in recognizing a need for their patients/clients
    to receive spiritual care support

Spiritual Care Pocket Tool
  • Front of Pocket Tool Back of Pocket Tool

Front Of Pocket Tool Identifying A Spiritual
  • Service Providers Inter-Professional Team
    Members ask yourself the following three
  • Is the client struggling to find relief from
    physical symptoms, feelings of abandonment,
    conflict, despair, fear, anger or guilt?
  • Is the client asking, Why is this happening to
    me? or, How much longer will this go on? or,
    How will I be remembered?
  • Does the client talk about being a spiritual or
    religious person and/or want spiritual or
    religious practices at home?
  • If you answered yes to ANY of the above, then
    the client would benefit from contact by your
    local Spiritual Care Provider.

Front of Pocket Tool Referral Process
  • Do you know whom to contact when a client
    expresses a spiritual need?
  • Is there a designated Spiritual Care Provider for
    your organization and do you know how to contact
    that person?
  • If there is not, then whom do you contact when a
    client has spiritual needs?

Back Of Pocket Tool What Is Spiritual Care?
  • Your local Spiritual Care Provider is a source of
    comfort and support for clients and families who
  • Asking questions such as, Why is this happening
    to me? How much longer with this go on? How
    will I be remembered?
  • Feeling lonely, discouraged, anxious or
  • Struggling with a sense of well-being
  • Wanting to discuss faith, hope or meaning in the
    midst of illness
  • Needing assistance in contacting a local faith
    community or having spiritual and/or sacred items

  • declaration of verbal permission from the
    families of both patients in these case studies
  • their hope that these stories would support the
    ongoing integration of spiritual care in Hospice
    Palliative Care provision

Transformational Spiritual Care The Art and the
  • Cage, W. (2010). Hospital Chaplains Listening
    to What They Say and Watching What They Do.
    Association of Professional Chaplains Annual
    Meeting (Invited Lecture).
  • Elman, L.B., Houghton, M.P.H. et al. (2007).
    Palliative Care in Amyotrophic Lateral Sclerosis,
    Parkinsons Disease, and Multiple Sclerosis.
    Journal of Palliative Medicine,
  • Vol. 10, No. 2, 433-457.
  • Exline, J.J. Martin, A. (2005) Anger toward
    God A new frontier in forgiveness research. In
    E.L. Worthington (Ed.) Handbook of Forgiveness
    (pp. 73-88). New York, NY Routledge.
  • Fitchett, G., Rasinski, K., Cage, W. Curlin, F.
    (2009). Physicians experience and satisfaction
    with chaplains A National Survey, Arch Intern
    Med, Vol. 169, No. 19.

  • Harvey, J., Barnett, K. Rupe, S. (2006).
    Posttraumatic Growth and Other Outcomes of Major
    Loss in the Context of Complex Family Lives. In
    L.G. Calhoun R.G. Tedeschi (Eds.), Handbook of
    Posttraumatic Growth Research and Practice (pp.
    100 117). New York Lawrence Erlbaum
  • Kirkpatrick, L.A. Shaver, H. (1992). An
    attachment-theoretical approach to the psychology
    of religion. International Journal for the
    Psychology of Religion, 2, 336-51.
  • Lanoix, M. (2009). Palliative care and
    Parkinsons disease managing the
    chronic-palliative interface. Chronic Illness
    2009, 5, 46.
  • Lawrence, R.T. (1997). Measuring the image of
    God The God Image Inventory and the God Image
    Scales. Journal of Psychology and Theology, 25,

  • Liben, S., Papadatou, D. Wolfe, J. (2008).
    Paediatric palliative care challenges and
    emerging ideas. The Lancet, Vol. 371, No. 9615,
  • McWilliams, N. (1994). Psychoanalytic diagnosis
    Understanding personality structure in the
    clinical process. New York The Guilford Press.
  • Moriarity, G. (2006). Pastoral Care of
    Depression Helping Clients Heal Their
    Relationship with God. Binghamton, NY Haworth
  • Pargament, K.I., Desai, K.M. McConnell, K.M.
    (2006). Spirituality A Pathway to Posttraumatic
    Growth or Decline? In L.G. Calhoun R.G.
    Tedeschi (Eds.), Handbook of Posttraumatic
    Growth Research and Practice (pp. 121 137).
    New York Lawrence Erlbaum Associates.

  • Puchalski, C., Ferrell, B., Virani, R. et al.
    (2009). Improving the Quality of Spiritual Care
    as a Dimension of Palliative Care The Report of
    the Consensus Conference. Journal of Palliative
    Medicine, Vol. 12, No.10, 885-904.
  • Rees, J., OBoyle, C., MacDonagh, R. (2001).
    Quality of life impact of chronic illness on the
    partner. J R Soc Med 2001 94563-566.
  • Rizzuto, A.M. (1979). The birth of the living
    God. Chicago University of Chicago Press.
  • Rodnitzky, R. (2010) Parkinson disease dementia.
  • Schrag, A., Hovris, A., Morley, D., Quinn, N.
    Jahanshahi, M. (2006). Caregiver-burden in
    parkinsons disease is closely associated with
    psychiatric symptoms, falls, and disability.
    Parkinsonism Related Disorders 20061235-41.

  • Sinclair, S. (2010). Impact of death and dying
    on the personal lives and practices of palliative
    and hospice care professionals. CMAJ,
  • Snow, K.N (2010). Resolving Anger Toward God
    Lament as an Avenue Toward Attachment.
    Unpublished doctoral dissertation, George Fox
  • Thomas, S. MacMahon, D. (2004). Parkinsons
    disease, palliative care and older people.
    Nursing Older People, 16, 1, 22-27.
  • Weinberger-Litman, Muncie, M., Flannelly, L.
    Flannelly, K. (2008). Holistic Nursing Practice,
    Vol. 24, No. 1

  • Wittenberg-Lyles, E. et al. (2008).
    Communication Dynamics in Hospice Teams
    Understanding the Role of the Chaplain in
    Interdisciplinary Team Collaboration.
  • Journal of Palliative Medicine, Vol. 11, No. 10,
  • Zornow, G.B. (2001). Crying out to God
    Uncovering prayer in the midst of suffering.
    Unpublished manuscript.

Contact Information
  • Donna Mann, Spiritual Care Provider
  • Maureen Quinn, Nurse Practitioner