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Screening for Spiritual Struggle. Judith Blanchard, D.Min., B.C.C. – Chaplain Clinical Leader. A Quality Improvement Initiative at Maine Medical Center, Portland ME Winter-Spring 2011 Judith Blanchard, D.Min., B.C.C. Chaplain Clinical Leader

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Screening for spiritual struggle

Screening for Spiritual Struggle

Judith Blanchard, D.Min., B.C.C. – Chaplain Clinical Leader

Screening for spiritual struggle

A Quality Improvement Initiative at Maine Medical Center, Portland ME

Winter-Spring 2011

Judith Blanchard, D.Min., B.C.C. Chaplain Clinical Leader

Douglas Allan Dunlap, Ed.M., Ed.D, M.Div., Chaplain Resident

Screening for spiritual struggle



– Learn how one might engage nursing staff in screening for religious/spiritual struggle.

Screening for spiritual struggle


–Gain familiarity with a quality improvement project for in-patient spiritual care.

Screening for spiritual struggle

Importance of Religion to Cancer Patients

N=230 patients with advanced cancer.

From Balboni et al, J of Clinical Oncology, 2007

Screening for spiritual struggle

Religious/spiritual struggle

  • may compromise recovery

  • may increase risk of mortality

  • compromises emotional adjustment to illness and quality of life

    Fitchett, 2012

Screening for spiritual struggle


“I am told that God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.” Newsweek 9/3/07

Screening for spiritual struggle

Addressing Spiritual Struggle/Distress means:

“…to help create an environment where what is fundamental, natural, and indigenous to the human psyche can most easily do its own work of bringing about integration, balance, and wholeness.”

Michael Kearney (2000)

Screening for spiritual struggle

Nursing recruitment from:

  • Nursing Director recommendation

  • Chaplain Invitation

  • Peer Referral

  • Personal Interest – Self Referral

Screening for spiritual struggle

Current Nursing Questions:

Interdisciplinary Screens:

Any spiritual practices that

may affect your care? No Yes


Chaplain X2951

Screening for spiritual struggle

Spiritual Screening Tool

Patient Admitted: Our team is committed to the whole person.

Do you have a belief, spiritual or otherwise, that is important to you?



Is that helping you now?

Was there a time when you did?









BELIEFNot Helpful




Thank you. We do wish to be supportive of you.

[Make SCM Pastoral Care Consult Order or call 662-2951 with referral. Note which Track patient on.]

Screening for spiritual struggle

10 Nurses Recruited and Trained

1 – Injured and unavailable

3 – No referrals (1 nurse said she had made a couple but no record)

2 – made one referral

3 – made two referrals

1 – made six referrals

14 Referrals made in six weeks

Screening for spiritual struggle

Results of 14 Nursing Referrals

#1 Belief Helpful N = 7

#2 Belief Not Helpful N = 3

#3 Belief in Past N = 1

#4 No Belief N = 3

Screening for spiritual struggle


  • Nurses are interested in their patients’ spiritual well-being

  • Nurses will volunteer to contribute to a project addressing SS/SD

  • Nurses observe spiritual distress in their patients

  • Protocol enabled more RN e-referrals

Screening for spiritual struggle

Participating nurses reported

  • the screening protocol provided terminology and a procedure that they found helpful in discussing the spiritual domain with their patients.

Screening for spiritual struggle and aims for quality improvement
Screening for Spiritual Struggle and Aims for Quality Improvement

Screening for spiritual struggle

Follow up by chaplains

Findings and plans for the future

Screening for spiritual struggle

We are all in this together!

Questions and Answers