How do I know what to do?

1. How do I know what to do? Pastoral Care for Non-Responsive Patients in an ICU Setting. Prepared for the 2016 Caring for the Human Spirit Conference by Chaplain Walter Dixon, M.Div., BCC Chaplain Linda S. Golding, MA, BCC.

2. Tools of listening and presence Familiar New

3. Learn about the specific needs and concerns in the ICU.

4. Learn about the specific needs and concerns in the ICU. • Recognize and affirm the full humanity of the non-responsive patient.

5. Learn about the specific needs and concerns in the ICU. • Recognize and affirm the full humanity of the non-responsive patient. • Collaborate with ICU nurses as they care for non-responsive patients.

6. Learn about the specific needs and concerns in the ICU. • Recognize and affirm the full humanity of the non-responsive patient. • Collaborate with ICU nurses as they care for non-responsive patients. • Acquire skills with which to engage with non-responsive patients.

7. Plan

8. Why now?

9. Action Plan: CPE Supervisors. Patient Care Directors. Individual Nurses.

10. Pre-Visit Questionnaire • What kinds of concerns do you have when visiting non-responsive pts?

11. When visiting non-responsive patients with family present? • Without family present?

12. Some responses from you:

13. Some responses from the students: • Is there anything to do besides pray? • Are others watching or listening to me? • How long should I stay ? • Consent – how do I know that they want to see me? They can’t tell me to stay or leave. • What do I talk about? Can I talk about, say, God, when I don’t know what their belief system is?

14. Feeling self-conscious in front of family – are they judging me? • Talking about the non-responsive patient. Can he/she hear us? How do I include the patient? • Should the focus be on the family or the patient?

15. Being self-conscious, making the patient worse. • Reminds me of visiting babies in the NICU – how can I provide pastoral care to infants who can’t talk back. • I don’t go in. Don’t understand the moment. I may pass by and say “Lord bless.”

16. Chaplains as teachers and models.

17. Chaplains as learners.

18. Nurses as teachers and models: Resources Actions Conversation

19. The nurses showed the chaplains: Introductions Talking Touching Caring Themselves

20. Patient alone.

21. Pastoral Presence. Introduction to Patient and purpose of visit. Take in the room. Connect with patient. Close the visit.

22. Family present. What is the same, what is different?

23. Pastoral Presence. Introduction to Family and purpose of visit. Then Patient. Take in the room. Connect with patient, modeling for the family. Speak of the patient in first person. Keep family in healing realm. Close the visit.

24. Case Study and Role Play

25. Post-Visit Questionnaire • What are some of the specific skills you observed or learned?

26. Were there spiritual aspects to these visits?

27. What are the remaining obstacles?

28. Students learned to: • Speak normally.

29. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients.

30. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients. • Skills around touching.

31. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients. • Skills around touching. • Always acknowledge the person in the room.

32. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients. • Skills around touching. • Always acknowledge the person in the room. • Notice if the Patient’s heart rate changes when you are close/touch/speak as if they were conscious.

33. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients. • Skills around touching. • Always acknowledge the person in the room. • Notice if the Patient’s heart rate changes when you are close/touch/speak as if they were conscious. • Keep him/her informed of what is happening outside.

34. Speak normally. • Turn to nurses as valuable sources of information about non-responsive patients. • Skills around touching. • Always acknowledge the person in the room. • Notice if the Patient’s heart rate changes when you are close/touch/speak as if they were conscious. • Keep him/her informed of what is happening outside. • To be careful about speech and timbre. An awareness that we might startle them.

35. “The visits provoked a lot of curiosity about how I interact with patients who can't respond to me.”

36. Spiritual? • An act of faith. • Bridging the gap. • Every patient is a spiritual being. • More than a conscious, waking self. • Full humanity and personhood. • No visible signs. • Trusting witness.

37. “It was clear that the nurses saw their patients as full persons and not just as bodies in a bed. This way of seeing the patients was particularly surprising and moving.”

38. Obstacles? • Being able to speak and pray with a patient when nursing is also present. • Feeling anxious that I am with non-responsive patients when alert, responsive ones may need me. • Being more informed.

39. Develop a more embodied way of communicating with unresponsive patients. • How to interpret what nonresponsive patients’ spiritual and emotional needs. • Becoming comfortable with family presence.

40. Additional feedback: “For me, the permission was the strongest encouragement in changing my behavior. “

41. “It made me realize that there is wide open space for thinking creatively and critically about ministering to non-responsive patients and left me eager to learn more.”

42. Questions?

43. Thank you