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Patient-Centered Care E-Newsletter August 2016

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   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.


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