When Never Happens
Presented by: Chaplain Jeremy Hudson
St. Luke’s Hospice
Cedar Rapids, IA
319/369-7744
www.stlukescr.org/hospice
What are “Never Happen”
events?
• Stressful unanticipated events in life
• Events that don’t fit in our plan for life
• Stretch even the healthiest individuals, families, and
communities
• The impact may be cumulative
Never Happen Events
• Death of spouse or
child
• Death of a close family
member (parent or
sibling)
• Major change in living
conditions
• Major change in church
or spiritual activities
• Major change in health
of family member
• Major change in
financial state
• Death of a close friend
• Violence/Abuse
• Revision of personal
habits
• Major change in social
activities
(Holmes & Rahe Social Readjustment
Rating Scale)
What is Spirituality?
Spirituality has many definitions, but at its core
spirituality helps to give our lives context. It's not
necessarily connected to a specific belief system or
even religious worship. Instead, it arises from your
connection with yourself and with others, the
development of your personal value system, and your
search for meaning in life.
“Spirituality and stress relief: Make the connection”
By Mayo Clinic Staff
What is Spiritual Distress?
• Spiritual distress “a disruption in the life principle that
pervades a person's entire being and that integrates
and transcends one's biological and psychological
nature.” (North American Nursing Diagnosis Association (NANDA), 1999, page 67)
• A person’s present experience is in conflict with
personal beliefs
My Story
Signs of Spiritual Distress
•
•
•
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•
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Questioning the meaning of life
Loss of purpose
Being afraid to fall asleep at night
Anger at God/higher power
Feelings of being abandoned by God/higher power
Questioning their own belief system
• “What good are they?”
Adapted from the Hospice and
Palliative Nurses Association
Signs of Spiritual Distress
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•
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Feeling a sense of emptiness/direction
Loss of hope
Impaired ability to cope
Questioning the meaning of suffering
• Is this punishment?
• Pain and other physical symptoms can be expressions
of spiritual distress
Adapted from the Hospice and
Palliative Nurses Association
Spirituality and Patient
Outcomes
Spirituality and Patient
Outcomes
Spirituality and Patient
Outcomes
No One is Immune
What is a Spiritual Assessment?
• An in-depth look at the patient’s spirituality
• Continuous process
• Multi-Dimensional – should deal with beliefs, behavior,
emotions, relationships, meaning and purpose and
practices. (Fitchett, G. (2002). Assessing spiritual needs: A guide for caregivers.)
• Results in a spiritual care plan that includes appropriate
interventions and a way to measure effectiveness
(The Discipline for Pastoral Care Giving: Foundations for Outcome
Oriented VandeCreek & Lucas, 2001)
What is a Spiritual Screening?
• Different than assessment
• Generally uses one or three static questions
• Aimed at determining the patient’s faith affiliation
and whether the patient has special religious and/or
cultural needs, such as diet, observances, and/or
restrictions (e.g., blood products)
• One dimensional
(Fitchett, G. & Risk, J. (2009). Screening
for spiritual struggle. Journal of Pastoral
Care and Counseling, 63, 4.1-12. )
Spiritual Assessment Examples:
7X7
• Medical (Biological)
• Psychological Dimension
• Family Systems
Dimension
• Psycho-Social Dimension
• Ethnic, Racial, Cultural
Dimension
• Social Issues Dimension
Spiritual Dimension
• Dimension Beliefs and
Meaning
• Vocation and Obligations
• Experience and Emotions
• Courage and Growth
• Rituals and Practice
• Community
• Authority and Guidance
(Fitchett, G. (2002). Assessing spiritual needs: A
guide for caregivers.)
Spiritual Assessment Examples:
7X7 Karen
• Medical (Biological) - Terminal CA, blood transfusions no longer
effective, having pain crisis due to not taking pain meds.
• Psychological Dimension – Struggles with self worth.
• Family Systems Dimension – Single mother of 3 children, youngest
is caregiver, anger from her childhood relationship with mother.
• Psycho-Social Dimension – Few friends, very close to son and
grandchildren, little support outside of family, successful career.
• Ethnic, Racial, Cultural Dimension – Caucasian Catholic American
raised in the Midwest.
Spiritual Assessment Examples:
7X7 Karen
• Social Issues Dimension – reports feeling unwanted by society
because of age.
• Spiritual Dimension
• Beliefs and Meaning – believes that God wants her to suffer
because she is a bad person. The Family Systems dimension
revealed that her relationship with her mother informed her image of
God and how God viewed her.
• Vocation and Obligations – Mother and grandmother, family is a
gift from God she is to care for, now threatened by illness and death.
Spiritual Assessment Examples:
7X7 Karen
• Experience and Emotions – reports that she tries hard to be close
to God but feels distant yet. Strong desire to be accepted by God.
• Courage and Growth – Strong desire to practice her faith and
“finally arrive” at a place of peace.
• Rituals and Practice – Scripture study, prayer, rosary, communion,
scared music, sitting on her patio in the morning (her sacred place).
• Community – Loosely connect to her youngest son’s parish.
• Authority and Guidance – Scripture, Catholic Church, Clergy, Her
Mother
FACT
F – Faith (or Beliefs): What is your Faith or belief? Do you
consider yourself a person of Faith or a spiritual person?
What things do you believe that give your life meaning and
purpose?
A – Active (or Available, Accessible, Applicable): Are you
currently Active in your faith community? Is support for your
faith Available to you? Do you have Access to what you need
to Apply your faith (or your beliefs)?
LaRocca-Pitts, M. (2008b). FACT: Taking a spiritual history in a
clinical setting. Journal of Health Care Chaplaincy 15, 1-12.
FACT
C – Coping (or Comfort); Conflicts (or Concerns): How are you
Coping with your medical situation? Is your faith (your beliefs)
helping you Cope? How is your faith (your beliefs) providing
Comfort in light of your diagnosis? Do any of your religious
beliefs or spiritual practices Conflict with medical treatment?
T – Treatment plan: If patient is coping well, then either support
and encourage or reassess at a later date as patient’s
situation changes. If patient is coping poorly, then 1) provide
direct intervention: spiritual counseling, prayer, Sacred
Scripture, etc., 2) encourage patient to address these
concerns with their own faith leader, or 3) make a referral to
the chaplain/spiritual care coordinator for further assessment.
LaRocca-Pitts, M. (2008b). FACT: Taking a spiritual history in a
clinical setting. Journal of Health Care Chaplaincy 15, 1-12.
Barriers to Spiritual Assessment
• Discomfort of Person Assessing
– Can cause avoidance in doing a proper assessment
– Skip assessment
– Loss of confidence by patient in the provider
• Timing
– Pain
– Fatigue
– Others present
Barriers to Spiritual Assessment
• Wording in the assessment
• Patient/Family unable or unwilling
• Knowledge of spirituality
Spiritual Assessment Helps
• Use your experts
– Board Certified or Board Certification eligible Chaplain
– Patient’s Clergy/Spiritual Caregiver
• Practice, Practice, Practice
• Association of Professional Chaplains
– www.professionalchaplains.org
Questions?