In the U.S. on any given day, from 900,000 to a million people - - PDF document
5/29/2014 NA NACC WEBINAR: CC WEBINAR: SUMMAR SUMMARY POINT CHARTING F Y POINT CHARTING FOR R INTERDISCIPLINARY EFFECTIVENESS INTERDISCIPLINAR Y EFFECTIVENESS Gordon J. Hilsman, D. Min. June 5, 2014 ghilsman@gmail.com 253-565-4992
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NA NACC WEBINAR: CC WEBINAR:
SUMMAR SUMMARY POINT CHARTING F Y POINT CHARTING FOR R INTERDISCIPLINAR INTERDISCIPLINARY EFFECTIVENESS Y EFFECTIVENESS
Gordon J. Hilsman, D. Min.
June 5, 2014 ghilsman@gmail.com 253-565-4992
www.spiritualclinician.com
THERE WILL BE PEOPLE IN THOSE BEDS….
In the U.S. on any given day, from 900,000 to a million people occupy hospital beds
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INVEST:
Collaboration with health care teams requires work – constantly improving excellence of spiritual caregiving – not merely entitlement to be taken seriously by physicians and nurses
Invest:
robes of an office or
form Vestire – to wear
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A GUIDING CONVICTION
Writing in the medical record is a primary way of improving a chaplain’s functioning as an integral member of an interdisciplinary team.
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WRITE
Even if you have difficulty conversing face to face with physicians’ authority, you can have a real influence on patients by what you write in the medical record
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OBJECTIVES: PARTICIPANTS WILL -
Rev
Review ew t the cont context fo for c chart n note tes
(pr
(professional, humanistic, cl ssional, humanistic, clinical, dedicat inical, dedicated, busy busy, , highl highly f focused and “pu cused and “pushed hed”)
Enrich t
ich their uniq eir unique, e ue, ever er- evolving, fr lving, frame amework f
r spiritual assessment spiritual assessment and char and charting ting habits habits
Consider tr
Consider trying a ying a narrativ narrative + bulle bullet point point appr approach
to char charting spirit ting spiritual care ual care
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CHARTING: BEYOND THE BASICS
PART I:
Orientation Input – Narrative Writing Exercise Q & A Summary Homework Assignment Intro to Part II
PART II
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RELEVANT NACC STANDARDS
303.8 Communicate effectively orally and in writing 304.6 Formulate and utilize spiritual assessments in order
to contribute to plans of care.
305.1 Promote the integration of Pastoral/Spiritual Care
into the life and service of the institution in which it resides. 305.5
305.5 Document one’s contribution of care effectively in the
appropriate records
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305.2 Establish and maintain professional and interdisciplinary relationships.
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CLINICAL
From the Greek klinikos meaning “of the bed”
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CLINICAL – “OF THE BED”
The term “clinician” suggests that when a person becomes unable to stand up, a knowledgeable and
be able to help, while others stand helpless.
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CLINICIAN SPIRITUAL CLINICIAN
A professional who
uses direct
developed frameworks
complex systems, and factual data (lab/imaging) to provide interventions
in serious need.
A professional who uses direct observation, careful listening, personal encounter, and established frameworks
phenomena of religion and spirituality to assist persons caught in situations in which their human spirit is being seriously challenged.
www www.spiritualclinician.com .spiritualclinician.com
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(Function)
4.Documentation
Spiritual Clinician
Becoming (and remaining) a Spiritual Clinician
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CHARTING WITH RAPPORT
Rappor Rapport: a uniquely engaging relationship in
which serious human concerns flow easily between a person who needs and a person who actively cares.
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LISTENING AS RAPPORT BUILDING
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TWO PARTS TO A QUALITY CHART NOTE
the current soul” of an individual in writing, including values and sometimes attitudes
spiritual needs, attitudes, and a plan After a caregiving conversation….
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A PERSON (HEALTHCARE VIEW)
Soul
Mind
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THE HEALTH CARE CULTURE AS CHARTING CONTEXT … …includes several characteristics that help give direction to spiritual care notes.
Humanist
Humanistic ic
Pr
Pragmatic agmatic
Decisiv
Decisive
Busy
Busy
Driven by
en by o
zational ( al (finan ancial) p cial) pres essure
Div
Diverse rse with int with inter-depend nden ent care-giving dis t care-giving discip ipline lines
Awash
ash with with ad administ ministrativ rative f focus on me s on measure asurement
Incre
Increasingly singly t techno chnologica logical
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NURSING NURSING
Born out of mother-empathy in the caves (comfort, relieve,
assist, facilitate natural healing, optimize wellbeing)
2,824,641 RNs in US today, 91% female Overworked, beleaguered by paperwork and organizational
procedures
Frustrated by meager time to connect emotionally with
patients and families
Understaffed and quietly (mostly), angry about it Persistently dedicated to direct care of people, their comfort,
their treatment regimens and their self care
The most trusted profession of all
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PHY PHYSICIANS ICIANS
Origin and Development: Born out of remembering what worked
previously in human crisis – what substances, actions, rituals, and words, ancestors used successfully to help the body heal
Separated from Religion: Greeks separated medicine from religion,
creating “clinical”, now “evidence based” practice (valuing
Gender Makeup: ~ 900,000 in US today, 2/3 male with increasing
female practitioners and influence
Attitudes: Chronically beleaguered by loss of practice autonomy,
Fo
Focus: in what helps them improve patients’ medical conditions and their own patient satisfaction scores
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INTERDISCIPLINARY CONTEXT
For N r Nurses: es: Chart…
What alerts them to the current support and
concerns of this person’s human spirit;
Issues regarding unknown discomfort of the
patient;
Whatever may be interfering with “compliance”, self
care or the natural healing process.
How the patient/family related to you
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INTERDISCIPLINARY CONTEXT : FOR PHYSICIANS
The patient and
patient and family e mily experience (Meaning!!) perience (Meaning!!)
Attitudes and
ttitudes and kno knowledge ledge re: present condition
Int
Integration gration and acceptan acceptance.
limitations of health care)
Specifi
Specifics; ( ; (concise statements attract busy team members.)
Chart what will em what will emphasize: phasize:
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Ne Never use conf r use confidentiality as identiality as an an excuse cuse no not t t to writ write point e pointedly! dly!
The purpose of confidentiality is to promote open personal
disclosure within a specific professional context
Within the circle of confidentiality use the “need to know” test
to root out gossip
Other clinicians need access to your relevant knowledge If you withhold pertinent information you fail to join the circle
Generalize about private “confessional” material while
conveying it’s essential importance to “getting” the patient/ family situation.
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USE YOUR JUDGMENT ABOUT RELEVANCE If a spiritual clinician’s note does not include discovered major aspects of a patient’s situation, other clinicians lose confidence and respect of that writer, but generally retain politeness anyway. (they won’t directly critique your notes, except on the level of legality.)
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THE PRACTICAL PLACE OF RELIGION IN SPIRITUAL CARE
Spirituality All that an individual values, practices, believes, and decides in
enjoy, and find meaning in what cannot be controlled Religion Combined human- Divine activity intended to assist people in developing and maintaining their human spirits
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PRACTICAL RELIGION - DEFINITION
Human efforts to bolster, enhance, heal and rejuvenate the human spirit’s capacity to cope with and enjoy what it cannot control, including one’s own beliefs, values and practices as well as those one has incorporated from the evolving traditions of such classic religious geniuses as Moses, Jesus, Buddha, and Muhammad.
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AWE AND DREAD: HUMAN NEEDS AS SPIRITUAL
Develop a capacity to describe human needs that
are personal, interpersonal, transcendent, and
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Common aspect of
Common aspect of human living human living
Mysterio
eriously co usly comple mplex
Highly I
ly Influential uential
Ma
May be influenced y be influenced but ne but never contr r controlled lled
Beautifully
utifully f fulf lfilling, (w illing, (with e ith extraor traordinar inary success y success)
Potentially painful, e
ntially painful, even de en devastating stating
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PRIMAR PRIMARY ARENAS OF THE HUMAN SPIRIT Y ARENAS OF THE HUMAN SPIRIT
SOUR SOURCES OF MEANI S OF MEANING (EV G (EVOKI KING A NG AWE AND DREAD) E AND DREAD)
Definition
Common Common aspect of human living aspect of human living My Myster eriously co iously comple mplex High Highly Infl Influe uent ntial ial Ma May be influence y be influenced but ne but never contr r controlled lled Can be Can be beautifully fulf beautifully fulfilling illing Po Pote tentially p painful, (e
(even de n devastating)
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Self-regard Physical Self Care Emotional self Care Work Sexuality Development/Aging Materiality Nesting Athletics/Dance Hobbies Intimate Loving Parenting “Childing” Siblings Friending Learning Elders Grand-parenting Helping Help Getting Nature Losses Mortality Personal Deity Religion Creating Art Enjoying Art Cosmic Harmony Family of Origin Ethnic Heritage Neighborhood Gender Group Peer Groups Faith Groups Nation Human Community Pe Personal Spirit Spirituality Int Interpersona nal l Spirit Spirituality Tr Transcendent Spirit Spirituality Com Communal al Spirit Spirituality
36 Primar 36 Primary Arenas of the Human Spirit y Arenas of the Human Spirit
See video See video on
utube at : t : “spiri “spiritual arena arenas vide video”
http://www.youtube.com/results?search_query=spiritual%20arenas&sm=12
See descriptions at www.spiritualclinician.com
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(Two to four sentences that “capture the current soul” of the person)
(Two to five summary points that give practical focus to specific, current spiritual needs and plans)
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First to chart after admission Referred by staff High Acuity Comprehensive unit assignment Significant chaplain-recognized issue
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Creating a brief narrative summarizing a person’s unique, current humanity and life situation
Even (especially) in electronic charts
Checked Boxes in charting formats are organizationally necessary for data collection but almost always ignored by IDT members.
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HOW TO CAPTURE THE SOUL
Fashion in descriptive writing an intuitive grasp of which of the primar primary spiritual y spiritual arenas of the human spirit arenas of the human spirit are currently most operant for this person
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This is a 49 year old married construction worker with two fractured wrists, one complicated, inflicted in a workplace fall. Pt. spoke today about his two teenage daughters, one whose birthday is today, and his wife’s worry about her. He also mentioned the family income, medical costs, and the recent strain in their marriage relationship. Pt. is quite confident in the surgery scheduled for tomorrow, and is apparently aware of its potential
Catholic, declining visit from a priest.
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OPERANT SPIRITUAL ARENAS
This is a 49 year old (development) married (intimate loving)
construction worker (work) with two fractured wrists suffered (physical self care) in a workplace fall. He spoke openly today about his two teenaged daughters, (parenting) one whose birthday is today, and his wife’s worry about her, the family income (materiality), medical costs, and the recent strain in their marriage relationship. Pt. is quite confident in the surgery (help getting) proposed for tomorrow, being apparently aware of its potential consequences. Pt. calls himself an “inactive” Catholic, declining visit from a priest. (religion, faith group).
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NARRATIVE SENTENCES TO CONSIDER FOR RELEVANCE
Key first sentence – “This is a …. How the patient/family related with you (lexicon) Moods, attitudes, values A quote – “What’s on his mind/heart right now?” Relationships of support and concern (Who loves him
and what disturbs him?)
Brief religious comments if relevant (minimal jargon)
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LEXICON – HOW PT. RELATED TO YOU
Guarded Chatty Grumpy Aggravated Sullen, taciturn, Suspicious Forthright Warmly Openly Gratefully Critically Eagerly ____________ _____________ _____________ _____________ _____________ 39
PATIENT/FAMILY ATTITUDE/BEHA TITUDE/BEHAVIOR VIOR
Resigned Appreciative Very anxious Conflicted Divided Quiet Angry Resigned Accepting Knowledgeable Religious Animated Reminiscing Arguing Grieving openly Questioning Mutually Supporting Strategizing Calmly waiting Praying Hoping _______________ _______________ _______________ 40
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NARRATIVE AND BULLET POINT CHART
Pt. spoke openly today about his family and financial concerns Pt. is quite confident in the surgery scheduled for tomorrow,
being apparently aware of its potential consequences.
Pt. calls himself an “inactive” Catholic, declining visit from a
Chaplain will assess pt.’s need for counseling after surgery
This is a 49 year old married construction worker with two fractured wrists suffered in a workplace fall. He has a wife and two teenaged daughters at home.
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Paragraph chart note: I saw this patient at the request of her father who I had met in the
daughter in California and a son that lives in town. She spoke in sad tones about her nagging knee pain leading to tomorrow’s surgery and her mother who died in February. She has been crying this morning, somewhat overwhelmed by her inability to lift her grandson and by her grief over her mother’s death. I listened, facilitated her grieving and prayed with her, though she is currently not practicing her Catholic heritage. I will suggest the evening chaplain drop in on her for further support. She declined my offer of her being visited by a priest.
Another Example
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What are the needs? What did we provide? What is the plan of care?
JACHO Ready Spiritual Assessment
And increasingly: “Was the plan of care followed?”
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IDT BULLET POINT ASSESSMENT
Saw pt. on suggestion of her father in the hallway. She is a 57 year old widowed Pilipino woman with a son living here, and a daughter in
situation.
Pt fairly hopeful of a favorable surgery outcome Active grief issues, mother died in February, knee pain prevents her
from lifting her grandson.
Appreciates prayer, currently not practicing her Catholic heritage.
Declined being visited by a priest.
Chaplain began grief work, prayed with patient, and supported, to
continue grief work and support after surgery
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SURVEY DATA SHEET FOR CHART NOTE EVALUATION
Q – 1 On a scale of 1-5, how often do you read Chaplain chart entries when you
see them?
Q – 2 On a scale of 1–5, how legible do you find them to be? Q – 3 On a scale of 1–5, how often do you see Chaplain chart notes as
contributing to patient care?
Interviewer _________________________ Date___________ #
Unit ID Q -1 Q – 2 Q – 3 Notes
1
ICU RN/MD Read them?Eligible? Substantive?
2
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Assess Assessment
Referral for visit: Referred by self.
Type of visit: Follow up.
Patient expressed experiences of:
Ritual Rituals/ s/Prayer/Sac acra rame ments: s: Pt. and family appreciate prayer and feel comforted by it..
Obser Observations of
patient:
frustrated and anger about being "abandoned" by the Medical Team.
Bill feels that the team's idea of comfort care is not enough for the Pt. Bill and his children would like more time and feel that the medical team is shortening that time by not giving blood to the Pt. Bill stated that he knows that the Pt. is in God's hands, but Bill also feels that they shouldn't give up.
Asses Assessment -
piritual al lif life resou resource ces/ s/ba barri rriers ers:
Life/losses/death/end-of-life: Bill still wants to fight for more time with the Pt. and is not willing to talk about her
I spoke with Bill about what God's will means to him.
Plan of Plan of Care Care
Next Steps:
Patient/family request follow-up visits.
Follow Up Visits
Spiritual Care will continue to follow.
Amount of time of visit: 20 minutes. 46
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Sylvia shared her childhood history as a child survivor of the Holocaust. There are many tears that were not shed at the time in order to survive, and the pain and the terror of that time still surfaces. Even still, her outlook is positive, and she chooses happiness in spite of immense grief that is deeply held. Her Jewish heritage is deeply meaningful to her, however, she has lived her adult life as a Christian, having been raised in a Christian orphanage in Germany. She finds strength in doing good for
When the time is right, Sylvia would like to try to share her narrative of the Holocaust. She fears the immense pain that it will bring her, but she desires that her history be told and recorded. I will follow up with the Holocaust Center in Seattle to see what resources may be able to support her in this and will follow Sylvia while she is here. Provided connection to her Jewish heritage, pastoral presence, prayer and blessing. We reflected on her life as a Proverbs 31 “woman of valor”.
Sylvia
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HOMEWORK ASSIGNMENT
Take 15 minutes to interview a peer or
interdisciplinary colleague about that person’s current life situation, and write two to four sentences attempting to “capture the current soul”
arenas)
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PROJECTS – PREPARE FOR NEXT WEEK
“Capture the current soul” of a colleague E-mail your paragraph to ghilsman@gmail.com View the website sections on “spiritual needs” at:
www.spiritualclinician.com
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