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To celebrate the Spiritual Care Association's rapid growth in six months to more than 1,000 members and offices in nine countries, we are pleased to announce these two special offers:

1. Half-price membership in the Spiritual Care Association for the three membership categories for the first year of membership. This limited-time offer is available through October 31 and exclusively for people who are not already members. Join the more than 1,000 people who have already taken advantage of the considerable benefits of membership. To view the annual benefits, the normal annual membership fee, and to join, click here and insert discount code OCTOBER during payment for the membership category for which you qualify.

2. Half-price application fee for Path 1 or 2 Board certification in the Spiritual Care Association. This limited-time offer requires that you submit your application no later than October 31 and requires becoming a SCA member. This offer is available both for SCA new members and current members. Download the application form in the Certification section of the SCA website. Applications must be postmarked no later than October 31.

For certification requirements, click here. Members can access the application by logging in and clicking "Apply Now" on the Board Certification page of the SCA website.

If you have any questions or comments, please contact us at info@spiritualcareassociation.org.
Thought for Today ----    An Imperative for the Chaplaincy Profession
Concerns raised by thought leaders for decades about gaps in the field of spiritual care are taking on increased urgency. Without evidence-based tools as a framework for care ----    specifically, measurable quality indicators and set of competencies, the field is hard pressed to validate the contribution spiritual care makes to quality health care. Without consistent training and certification based on demonstration of clinical competencies, it is difficult to identify chaplains who can provide the most effective care.
New Fall/Winter Catalogue of Spiritual Care Educational Offerings
In line with the above thought, HealthCare Chaplaincy Network (HCCN) and the Spiritual Care Association (SCA), HCCN's affiliate multidisciplinary professional membership organization, offer high quality educational offerings to enhance professional practice and to advance the field of spiritual care. You may be aware of some of these resources but perhaps not the full array:
The Spiritual Care Association Learning Center's Seven Benefits:
  1. Features 16 online courses created by experts
  2. The most comprehensive, evidence-based curriculum in the spiritual care field
  3. Each course created to lead to quality outcomes because each is based on standardized, evidence-based quality indicators and scope of practice developed by expert panels 
  4. Convenient ─ Easily accessible plus learn online at your own pace
  5. Cost-effective: Individual online course price for Spiritual Care Association members is $295 and $495 for non-members.
  6. Earn certificate and continuing education hours upon completion
  7. Is for spiritual care specialists and generalists: Chaplains, NursesSocial Workers, Physicians, Administrators, other health care professionals, Religious/Spiritual/Existential Leaders, Clergy, and Seminarians
16 Courses Now Online + More to Come
  1. Building and Maintaining a Chaplaincy Department
  2. What to Do with Information: HIPAA and Confidentiality
  3. Talking about What Matters: Advance Directives and Planning
  4. What We Do Matters: Continuous Quality Improvement within Chaplaincy and Health Care
  5. What We Hear and Say: Spiritual Assessment and Documentation
  6. More than Listening: Counseling Skills
  7. When Care is Tough: Supporting the Interdisciplinary Team
  8. Values, Obligations and Rights: Health Care Ethics
  9. Powerful Communication Techniques
  10. Living with Heartbreak: Grief, Loss, and Bereavement
  11. Far Too Soon: The Anguish of Perinatal Loss
  12. Cultural Competence, Inclusion, and Vulnerable Populations
  13. Caring for the Smallest: Pediatrics
  14. The Challenge of Memory: Alzheimer's and Other Dementias
  15. Delivery and Continuity of Care for Chaplaincy Care
  16. When It's Time to Say Goodbye: Introduction to Spiritual Care at the End of Life
Typical Praise for Online Learning Center
A pediatrics chaplain at a major academic medical center who completed the pediatric course has said:
"I love all the resources (especially the charts that made some of the child development stuff more accessible in a quick fashion), and I passed along a few articles to our bereavement coordinator. I also appreciate the quick response to my questions and concerns."
   September 2016     Issue No. 13
Patient-Centered Care News
The other day I read this description of Patient-Centered Care which I wish to share as I think it sums it up well: "In patient-centered care, the patient is the source of control for their care. The care is customized, encourages patient participation and empowerment, and reflects the patient's needs, values and choices. Transparency between providers and patients, as well as between providers, is required. Families and friends are considered an essential part of the care team."
We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----   An Imperative for the Chaplaincy Profession
One of the best practices that chaplaincy has long resisted is establishing standard practice. Chaplains are used to operating on intuition or "just being." Part of the resistance is that many chaplains have a misunderstanding of what standard practice is and is not. What it is not is giving up the art of chaplaincy or using the training that teaches us to respond to the other as an individual. Standard practice means that everyone knows how something is done and does not have to guess. It also means that everyone outside the chaplaincy department knows what to expect when they interact with a chaplain. Standardized practice can also mean that the chance of a process going wrong will be reduced or eliminated. It is time to move forward.
Spirituality and Health Care

Spiritual Advice for Surviving Cancer and Other Disasters (Washington Post)
An oncologist briskly walks into the consultation room, greets me and my wife, double-checks his chart and pulls up a computer image.

"It's cancer," he says.

As the shock starts to wear off, I cry. My oncologist tries to engage me in small talk. "What is it you do for a living?" he asks. I inform him that I'm a college professor and that I do disaster research.

After a slight pause, he replies, "Looks like you're in for your own personal disaster."
Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit (ATS Journals)
Background: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. Objective: To describe how family members and clinicians experience and express spirituality during the dying process. Setting: 21 bed medical-surgical ICU Methods: Reflecting the care of 70 dying patients, we conducted 208 semi-structured qualitative interviews with 76 family members and 150 clinicians participating in the 3 Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by 3 investigators using qualitative interpretive description.
Patient Experience
A Nurse Writes ----     4 Ways Nurses Can Indirectly Influence Patient Experience (HealthLeaders Media) 
  1. Acknowledge Patients' Suffering
  2. Create 'Radical Convenience'
  3. Apply the '90/5' Rule
  4. Appreciate Your Staff
A Physician Writes ─ 5 Ways to Improve  Physician-Patient Relationships (H&HN-Hospital & Health Networks)

Improved efficiency and effective patient engagement are often treated as if they are mutually exclusive. But through my experience as a physician and instructor, I have seen the power that several simple but fundamentally important skills can have on the physician-patient relationship. Rather than being an inevitable casualty of the changing health care environment, patient engagement is the road to improved efficiency, quality, safety and financial stability. Equipping everyone with the skills needed for success will improve culture, quality, patient experience, and provider and staff satisfaction as well as reduce physician burnout.

Your health care team members need five skills to restore relationships in their own practices:
  1. Presence and mindfulness.
  2. Reflective listening.
  3. Information gathering and agenda setting.
  4. Recognizing and responding to emotion.
  5. Gratitude and appreciation.
Taking the time to listen leads to better outcomes.

Palliative Care

Palliative Care Targets Quality of Life (Kiplinger)
This is an excellent overview article to give to those unfamiliar with palliative care facts and benefits. Includes perspective from cancer patient Amy Berman of The Hartford Foundation ("Palliative care is the best friend of the seriously ill."), Dr. Diane Meier, director of the Center to Advance Palliative Care ("Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment."), and Judith Skretny, director of palliative care for the National Hospice and Palliative Care Organization ("Palliative care can be given to people anywhere.")
New Edition of Pediatric e-Journal Focuses on Communication (National Hospice & Palliative Care Organization & e-Hospice USA e-newsletter)

Communications with children and families is the theme of the new edition of the pediatric e-journal produced by NHPCO's Children's Project on Hospice/Palliative Services. This PDF resource is available free of charge online.

These articles included in this edition of the e-journal offer suggestions for and examples of engaging in this important aspect of providing pediatric palliative/hospice care.

Early Palliative Care Recommended for Cardiovascular Disease and Stroke Patients (AAHPM SmartBrief and tcdmd)
Patients with advanced cardiovascular disease and stroke should receive early palliative care, the American Heart Association and American Stroke Association said in a policy statement in the journal Circulation. The report included 28 recommendations to facilitate use of palliative care, covering reimbursement for services, the identification of patients who need palliative care, the creation of quality measures, the development of standards for hospital palliative care and education and certification for practitioners.
Systematic Palliative Care Provides Greater Improvement in Quality of Life for Patients with Pancreatic Cancer (Oncology Nurse Advisor)

Quality of life is significantly improved for patients with pancreatic cancer when systematic palliative care is administered vs on-demand palliative care, a study published in the European Journal of Cancer has shown.

Early palliative care (EPC) is proven to have a positive impact on clinical outcomes for oncology patients; therefore, researchers sought to determine optimal timing for EPC activation in a prospective, multicenter randomized study. 

Read more
End-of-Life Care
A Physician Writes ----   Mission Creep Doesn't Benefit Patients at the End of Life (Washington Post)

When my father was 88 and the picture of health for his age, he taught me, an experienced physician, an unexpected lesson.

We were discussing treatment options promoted by his primary-care physician and other doctors for an aortic aneurysm - a ballooned segment of blood vessel at risk for dangerous rupture in his abdomen. He turned to me and asked, "Why would I want to fix something that is going to carry me away the way I want to go?"

My father had the generally accurate impression that if his aneurysm ruptured, he could demand pain medicine, decline emergency surgery and be dead from internal bleeding within a few hours or, at most, a day or two.

With his unexpected question, he directly challenged the assumption that a doctor's advice is always in a patient's best interest, particularly regarding a medical problem late in life. This proposition had been my general belief, but after more than two decades as an internist and gastroenterologist, he had prompted me to reconsider it.

Furthermore, Dad was making an important distinction, between care at the end of life (in this case, palliative care for pain) and treatment (aneurysm repair). He was also suggesting a natural exit strategy. Not suicide, to which he had a moral objection, and not physician-assisted suicide, which was not a legal option in his home state of Wisconsin.

Despite his generally decent health, we both thought that he was too old for a major surgical repair, so I suggested he undergo an outpatient procedure to insert a stent to prevent the ballooning artery from worsening - that would at least postpone the threat of rupture. My reasoning was that with the stent, he was likely to enjoy the birth of his first great-grandchild and that without it, he would probably never know her.

My father lived five more years and met 12 great-grandchildren. Three of those years were good ones, but two of them were not.

I have asked myself, "Was it worth it?" I know that he asked himself that, too. His mantra for the last two years of his life was "I have lived too long."

Four Things Dying People Agree are as bad as or Worse Than Death 
(AAHPM SmartBrief and Quartz) 

Among seriously ill patients asked to consider dying or living with limitations, 69% said being incontinent would be as bad or worse than death, while 67% cited needing a breathing machine, 56% listed having a feeding tube and 54% said it was requiring constant care. Researchers noted in JAMA Internal Medicine that none of the patients had those limitations and it was possible they overestimated how difficult it would be to live with them.

Read more
"More At Peace": Interpreters Key to Easing Patients Final Days (National Hospice & Palliative Care Organization, e-Hospice USA e-newsletter and Kaiser Health News)
Interpreters routinely help people who speak limited English ----     close to 9 percent of the U.S. population, and growing ----     understand what's happening in the hospital. They become even more indispensable during patients' dying days. But specialists say interpreters need extra training to capture the nuances of language around death.

Many doctors and nurses need the assistance of interpreters not only to overcome language barriers but also to navigate cultural differences. Opportunities for miscommunication with patients abound. Words don't always mean the same thing in every language.

Medical staff, already nervous about delivering bad news, may speak too quickly, saying too much or too little. They may not realize patients aren't comprehending that the team can no longer save their lives.

"That's when it gets interesting," Maldonado said. "Does the doctor understand that the patient isn't understanding?"
Read more
Important Webinars Coming Up In September-October

September 15th and October 19th: Free Live Q&A Forums About the New Spiritual Care Association hosted by prominent health care chaplains the Rev. Sue Wintz, BCC and the Rev. George Handzo, BCC
Register for October 19th Forum

October 25th: "Advocacy for Spiritual Care in a Changing Political Environment" presented by Washington, DC expert M. Todd Tuten ─ Senior Policy Advisor, Akin Gump Strauss Hauer & Feld LLP 

October 27th: "Reforming Chaplaincy Training" presented by The Rev. David Fleenor, BCC, ACPE Supervisor, Director of Clinical Pastoral Education, Mount Sinai Health System 
Board Certified Chaplains: September 15th Is Deadline to Purchase at Reduced Price the New Standardized Clinical Knowledge Test

Three New Online Professional Education Courses Now Available at the Spiritual Care Association Learning Center

   August 2016     Issue No. 12
Patient-Centered Care News
While all of the articles selected for this issue address an aspect of patient-centered care, I wish to draw your attention to four in particular that directly speak to spirituality in health care:
  • A Physician Writes: How Spirituality Can Help Motivate Patients
    (from KevinMD)
  • A Chaplain Writes: A Mindfulness Prayer to Begin Interdisciplinary Team Meetings (from Pallimed)
  • Profile of a Hospice Nurse: A Tender Hand in the Presence of Death
    (The New Yorker)
  • Profile of a Hospital Chaplain Who Serves Both a Hospital in Oregon and a Clinic That He Founded in Uganda (KATU-TV)
Chaplains, who deal with stressful situations, practice spiritual self-care for their own well-being. Recently, I was prompted to write in The Huffington Post about how spiritual self-care ─ in whatever way is personally meaningful ─ can be important for any of us. The link to that article is included here, too.

We hope that you find this complimentary monthly e-newsletter informative. Below are short summaries of each selected item with links to the entire pieces. Also included is a downloadable PDF version for readers who prefer that format.
Please feel free to send any questions or comments to comm@healthcarechaplaincy.org.
Rev. Eric J. Hall
President & CEO
HealthCare Chaplaincy Network & Spiritual Care Association
Thought for Today ----    An Imperative for the Chaplaincy Profession
Professional health care chaplains, while caring for the emotional and spiritual needs of individuals regardless of religion or beliefs, are laser-focused on upholding the humanity of the patient. Now more than ever, they must also look beyond the bedside. In today's health care environment, they must consider the expectations of health care settings ----    most of all, mounting pressure on all disciplines to contribute to metrics such as patient satisfaction, patient experience, medical outcomes, and cost savings. Value derived from quality outcomes is paramount. These facts of contemporary medicine place professional chaplaincy at a critical crossroads. It is time to move forward.
A Physician Writes: How Spirituality Can Help Motivate Patients (KevinMD)
Recently, I was asked to give a talk on spirituality and its importance in health care. I found myself thinking about how I have spent the last few years focusing on the "easy" fixes with my patients such as diet, sleep, and exercise. Now, I am not saying that these things are truly easy to fix.

However, when it comes to a physician addressing these topics with a patient, talking about the evidence on how certain foods can contribute to or prevent disease and giving specific recommendations based on current science, is much easier than talking to a patient about spirituality and how it can also contribute to or prevent disease.

A Chaplain Writes: A Mindfulness Prayer to Begin Interdisciplinary Team Meetings (Pallimed)

I am a hospice chaplain working in Central Ohio and am asked in that role to provide a prayer at the beginning of our interdisciplinary team meetings. I want the prayer to be truly interfaith and non-denominational, but even more importantly, I want the prayer to meet the team where it is in the moment, and to inspire them in their work. I use a mindfulness bell to set the tone for the prayer and to create a space in the day.
Hospice and Palliative Care
Profile of a Hospice Nurse: A Tender Hand in the Presence of Death (The New Yorker)

The daily work of a hospice nurse, who treats the physical, psychological, and spiritual needs of people at the most vulnerable point of their lives. 

Heather Meyerend is a hospice nurse who works in several neighborhoods in South Brooklyn-Sheepshead Bay, Mill Basin, Marine Park, Bensonhurst, Bay Ridge. She usually has between sixteen and twenty patients, and visits each at home once a week, sometimes more. Some patients die within days of her meeting them, but others she gets to know well, over many months. She sees her work as preparing a patient for the voyage he is about to take, and accompanying him partway down the road. She, like most hospice workers, feels that it is a privilege to spend time with the dying, to be allowed into a person's life and a family's life when they are at their rawest and most vulnerable, and when they most need help. Some hospice workers believe that working with the dying is the closest you can get on earth to the presence of God.

Campaign Seeks to Increase Palliative Care Conversations, Referrals (AAHPM SmartBrief & Healio)

The National Institute of Nursing Research's Palliative Care: Conversations Matter campaign is aimed at increasing the number of pediatric palliative care conversations and referrals earlier in the treatment process, said director Patricia Grady. The campaign offers written materials about palliative care for families of seriously ill children.

The 11 Qualities of a Good Death, According to Research (Quartz)

A recent study published in the American Journal of Geriatric Psychiatry, which gathered data from terminal patients, family members and health care providers, aims to clarify what a good death looks like. The literature review identifies 11 core themes associated with dying well, culled from 36 studies:
  • Having control over the specific dying process
  • Pain-free status
  • Engagement with religion or spirituality
  • Experiencing emotional well-being
  • Having a sense of life completion or legacy
  • Having a choice in treatment preferences
  • Experiencing dignity in the dying process
  • Having family present and saying goodbye
  • Quality of life during the dying process
  • A good relationship with health care providers
  • A miscellaneous "other" category (cultural specifics, having pets nearby, health care costs, etc.)
In laying out the factors that tend to be associated with a peaceful dying process, this research has the potential to help us better prepare for the deaths of our loved ones-and for our own.

A Doctor Focused on Dying Finds Lessons for Better Living (e-Hospice International and Stat)
Dr. BJ Miller, senior director of the Zen Hospice Project in San Francisco, knows most people regard hospice and palliative medicine with a sense of dread, instead of possibility. Hospice and palliative medicine specialists frequently speak about their field needing an image makeover. He is poised to deliver it.
Fast Food-Style Palliative Care Consults Found Ineffective, May Cause PTSD (Geripal)
Why were PTSD symptoms WORSE with the palliative care intervention?

Doug White writes a terrific accompanying editorial outlining several possible explanations for these findings. The main one I want to highlight is this: "The intervention was not a full palliative care consult, which typically involves more frequent encounters with palliative care practitioners, active management of patients' symptoms, and involvement of social workers and chaplains."

Exactly. With all due respect to the outstanding palliative care clinicians at Mt. Sinai and Duke, these were not full palliative care consults. They were "In-N-Out fast food-style" palliative care consults (Google In-N-Out, East Coasters).

An average of 1.4 encounters, and on the very first encounter you cover prognosis and goals of care? I do that every once and awhile, but my primary goals in the first encounter are usually (1) to introduce the idea of palliative care; and (2) to form a relationship with the patient or surrogate: Who are you? Where do you come from? How are you?

I try very hard not to get into the heavy stuff of discussing prognosis until I know the person and have formed a relationship. I try to encourage people to involve palliative care early in the process, prior to 7 days on a ventilator, as a great deal of the important work (and sometimes misinformation) has already happened.

And when I'm consulted about one of these patients, I work together with the ICU team, often meeting with family in conjunction with the ICU residents, fellows, attendings, social workers, and chaplains. I'm part of a team, and it's important for patients and family members to see it that way. In this study, the ICU docs hardly ever saw surrogates together with the palliative care intervention group (less than 10% of the time).
Profile of a Hospital Chaplain Who Serves Both a Hospital in Oregon and a Clinic That He Founded in Uganda (KATU-TV)
Father Freddy Okun is the Director of Spiritual Care at Providence St. Vincent Medical Center in Portland, Oregon. He came to the hospital by way of Nebbi, Uganda, where he lived until the turn of the millennium.

"[Patient] stories are very powerful to people going through losses," he said. "I had losses in my family so hearing their stories makes me feel the losses that I had in my own life as well."

When Father Freddy was young, his father and sister both contracted malaria and died.

In 2009 Father Freddy helped open a clinic in Nebbi, the only one in that part of the country equipped to treat serious illnesses.

"Still people die of malaria [in Nebbi], but there are so many wonderful stories of people who have been healed due to that clinic," Father Freddy said.

Teams from Providence have played a major part in that healing. Father Freddy has helped bring doctors and nurses from Providence to Uganda to both train medical staff there and see patients, sometimes hundreds of them in a matter of days.

Read more
Patient Experience
Customer Service vs. Patient Care (Patient Experience Journal & The Beryl Institute)

In a competitive market where financial resources are limited, many of the popular approaches to improving the patient experience involve large capital investments in such things as hotel style amenities and expensive technology. The author argues that marketing based on a model of the patient as a traditional 'customer' is ill conceived and contributes unnecessarily to the high cost of healthcare while lacking a true understanding of, or an appropriate response to, the most basic needs of hospitalized patients that lead to patient satisfaction.

Read more
Taking Time Out for Spiritual Self Care (The Huffington Post)

While walking along Broadway in Lower Manhattan recently, I noticed a group of young adults handing out booklets and inviting passersbys to a prayer station set up on the sidewalk. Some people stopped and engaged in conversation, while others avoided contact by crossing to the other side of the street. I was intrigued by this and wondered, "How do people view spiritual care? What feels comfortable -or uncomfortable - about something we all need?" The fact that many people did stop at the prayer station certainly indicates a strong need.

Read more

New Online Professional Continuing Education Course 
Added to the Spiritual Care Association Learning Center
What We Do Matters: Continuous Quality Improvement (CQI) within Chaplaincy and Health Care
This course is designed to enable learners to be a full participant in CQI processes and to establish and sustain a CQI program for a chaplaincy or spiritual care service using Lean and Six Sigma. Participants will learn the basic language in order to recognize CQI's underlying assumptions, language, and processes. The course will teach assumptions and language that are pretty much universal to all CQI systems and the language particular to Lean Six Sigma which is the most widely used system. Participants will learn how to set up and run simple Lean or Six Sigma projects and be able to avoid the most common mistakes in this process. Examples from hospital practice will be provided. (Course Author: The Rev. George Handzo, BCC, CSSBB) 

Health Care Providers: Show the World That You 
Deliver Excellent Spiritual Care

Chaplaincy Job Opportunities in Israel

Kashouvot, a pioneer organization in Israel that is advancing multifaith spiritual care, seeks Christians or Muslims for paid chaplaincy work in Israel. For more information contact Rabbi Miriam Berkowitz at kashouvotmiriam@gmail.com.