NA NACC WEBINAR: CC WEBINAR: SUMMAR SUMMARY POINT CHARTING F 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 2
INVEST: Collaboration with health care teams requires work – constantly improving excellence of spiritual Vestire – to wear caregiving – not merely entitlement to be taken Invest: seriously by physicians - to clothe in the official and nurses robes of an office or - to give one's capital a new form 3
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. 4
WRITE The pen remains mighty 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 5
OBJECTIVES: PARTICIPANTS WILL - Rev Review ew t the cont context for char r chart no t notes (pr (professional, humanistic, clinical, dedicat ssional, humanistic, clinical, dedicated, busy d, busy, , highly f highly focused and “pushed”) cused and “pushed”) Enrich their uniq Enrich their unique, e ue, ever er- evolving, frame lving, framewor ork f k for r spiritual assessment spiritual assessment and char and charting habits ting habits Consider tr Consider trying a ying a narrativ narrative + bulle bullet point t point appr approach oach to char charting spiritual care ting spiritual care 6
CHARTING: BEYOND THE BASICS PART II PART I: Review Summary Orientation Input - Spiritual Needs Input – Narrative Bullet Point Exercise Writing Exercise Charting taboos Q & A Q & A Summary Wrap-Up Homework Assignment Intro to Part II 7
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 8
305.2 Establish and maintain professional and interdisciplinary relationships. 9
CLINICAL From the Greek klinikos meaning “of the bed” 10
CLINICAL – “OF THE BED” The term “clinician” suggests that when a person becomes unable to stand up, a knowledgeable and objective person taking a careful look, a clinician, may be able to help, while others stand helpless. 11
SPIRITUAL CLINICIAN CLINICIAN A professional who uses A professional who direct observation, careful uses direct observation, listening, personal encounter, developed frameworks and established frameworks of understanding of understanding the complex complex systems, and phenomena of religion and factual data spirituality to assist persons (lab/imaging) to caught in situations in which provide interventions their human spirit is being of assistance to people in serious need. seriously challenged. www www.spiritualclinician.com .spiritualclinician.com 12
1. Rapport 2. Assessment 6. Consultation Spiritual Clinician 3. Care 5. Continuing Ed. (Function) 4.Documentation Becoming (and remaining) a Spiritual Clinician 13
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. 14
RAPPORT FIRST RAPPORT FIRST 15
LISTENING AS RAPPORT BUILDING 16
After a caregiving conversation…. TWO PARTS TO A QUALITY CHART NOTE 1. A two to five sentence narrative that “captures the current soul” of an individual in writing, including values and sometimes attitudes 2. Two to five bullet points identifying spiritual needs, attitudes, and a plan 17
A PERSON (HEALTHCARE VIEW) Soul Mind Body 18
THE HEALTH CARE CULTURE AS CHARTING CONTEXT … …includes several characteristics that help give direction to spiritual care notes. Humanistic Humanistic Pragmatic Pragmatic Decisiv Decisive Busy Busy Driv Driven b en by organizational (f organizational (financial) pressure inancial) pressure Div Diverse with int e with inter-dependent care-giving disciplines dependent care-giving disciplines Awash with administrativ ash with administrative f focus on measurement cus on measurement Increasingly t Increasingly technological chnological 19
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 20
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 observation and scientific understanding over belief and ritual) Gender Makeup: ~ 900,000 in US today, 2/3 male with increasing female practitioners and influence Attitudes: Chronically beleaguered by loss of practice autonomy, organizational pressures, time consuming electronic charting. Fo Focus: in what helps them improve patients’ medical conditions and their own patient satisfaction scores 21
INTERDISCIPLINARY CONTEXT Fo For N Nurses: 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 22
INTERDISCIPLINARY CONTEXT : FOR PHYSICIANS - Char Chart what will em t what will emphasize: phasize: The patient and patient and family e mily experience (Meaning!!) perience (Meaning!!) Attitudes and kno titudes and knowledge ledge re: present condition Int Integration gration and acceptance. acceptance. (the “human condition” and the limitations of health care) Specifics Specifics; ( ; (concise statements attract busy team members.) 23
Ne Never use confidentiality as an r use confidentiality as 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 of confidentiality and risk increasing irrelevance Generalize about private “confessional” material while conveying it’s essential importance to “getting” the patient/ family situation. 24
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.) 25
THE PRACTICAL PLACE OF RELIGION IN SPIRITUAL CARE Spirituality Religion All that an individual Combined human- values, practices, Divine activity intended believes, and decides in to assist people in order to cope with, developing and enjoy, and find maintaining their human meaning in what cannot spirits be controlled 26
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. 27
AWE AND DREAD: HUMAN NEEDS AS SPIRITUAL Develop a capacity to describe human needs that are personal, interpersonal, transcendent, and communal. Consider a framework of Primary Arenas of the Human Spirit. 28
Common aspect of human living Common aspect of human living Myst Mysteriously com eriously comple lex Highly Influential Highly Influential Ma May be influenced but ne y be influenced but never contr r controlled lled Beautifully fulf Beautifully fulfilling, (with e illing, (with extraor traordinar dinary success) success) Potentially painful, e ntially painful, even de en devastating stating 29
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