slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
The Role of Assessment in Patient-Centered Pastoral Care Chaplain John Ehman 12/5/11 PowerPoint Presentation
Download Presentation
The Role of Assessment in Patient-Centered Pastoral Care Chaplain John Ehman 12/5/11

Loading in 2 Seconds...

play fullscreen
1 / 58

The Role of Assessment in Patient-Centered Pastoral Care Chaplain John Ehman 12/5/11 - PowerPoint PPT Presentation


  • 228 Views
  • Uploaded on

The Role of Assessment in Patient-Centered Pastoral Care Chaplain John Ehman 12/5/11. The purpose of this presentation is not to prescribe a particular assessment but to explore a framework appropriate to patient-centered pastoral care -- into which you may place the

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Role of Assessment in Patient-Centered Pastoral Care Chaplain John Ehman 12/5/11' - mea


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

The Role of Assessment in

Patient-Centered Pastoral Care

Chaplain John Ehman

12/5/11

slide2

The purpose of this presentation is not to

prescribe a particular assessment but to

explore a framework appropriate to

patient-centered pastoral care

-- into which you may place the

particulars of your own assessment

practice that you will develop over time.

slide3

Assessment here refers to all the ways that we,

as pastoral professionals, try intentionally to

understand a present situation in order to

get our bearings on how to work with

that situation moving forward,

for the patient’s benefit.

slide4

Assessment here refers to all the ways that we,

as pastoral professionals, try intentionally to

understand a present situation in order to

get our bearings on how to work with

that situation moving forward,

for the patient’s benefit.

Assessment is part of a

chaplain’s professional discipline.

slide5

From your experience providing pastoral care

and your reflection through verbatim work,

what kind of assessments do you tend to

make during visits to get your bearing

on how to work with patients?

slide6

From your experience providing pastoral care

and your reflection through verbatim work,

what kind of assessments do you tend to

make during visits to get your bearing

on how to work with patients?

Which of these are issue-oriented assessments,

and which are process-oriented assessments?

slide7

Attention to process is important

in patient-centered pastoral care…

…because patients are invited to take the lead,

tell their story, and find help and healing

through aninteractive experience

with a chaplain.

slide8

When a chaplain interacts with a patient,

the chaplain isn’t the only person in

the room making assessments.

See handout:

slide9

What Is the Frame for Patient-Centered

Pastoral Assessment Practice?

Not simply…

Issues Assessment

(“Spiritual Assessment”)

slide10

What Is the Frame for Patient-Centered

Pastoral Assessment Practice?

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

slide12

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

slide13

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

slide14

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

slide15

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

slide16

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

What is the patient’s style of communicating and

“testing” whether or not he/she is being heard?

slide17

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

What is the patient’s style of communicating and

“testing” whether or not he/she is being heard?

Are other people in or near the room?

slide18

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

What is the patient’s style of communicating and

“testing” whether or not he/she is being heard?

Are other people in or near the room?

How may role expectations be structuring the interaction?

slide19

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

What is the patient’s style of communicating and

“testing” whether or not he/she is being heard?

Are other people in or near the room?

How may role expectations be structuring the interaction?

Is the chaplain feeling uneasy or distracted?

slide20

Pastoral Process Assessment: Some Basic Elements

Is the patient able & willing to indicate informed consent?

Is the patient empowered to take the lead?

Are there special, practical circumstances complicating

clear communication (including cultural diversity)?

How is the patient engaging cognitively and emotionally?

What is the patient’s style of communicating and

“testing” whether or not he/she is being heard?

Are other people in or near the room?

How may role expectations be structuring the interaction?

Is the chaplain feeling uneasy or distracted?

How much leading is the chaplain doing, and why?

slide21

The degree of leading that a chaplain does during a visit may be a critical indicator of how much the interaction is really following a patient-centered pastoral care approach.

See “Types of Leading” handout:

slide22

An example of how process assessments

may figure into pastoral visits:

I am called by a nurse who reports that a patient "wants to see a chaplain." When I ask the nurse if she's aware of any particular circumstances surrounding the request, she says, "She's going to have to have both legs amputated, and she's been crying."

slide23

An example of how process assessments

may figure into pastoral visits:

I am called by a nurse who reports that a patient "wants to see a chaplain." When I ask the nurse if she's aware of any particular circumstances surrounding the request, she says, "She's going to have to have both legs amputated, and she's been crying."

I approach the room and notice a contact isolation placard. A curtain is drawn across the doorway. I gown and glove, then knock on the open door. "Ms. B., I'm the chaplain, may I come in?" "Yes, please do," a woman's voice replies.

slide24

An example of how process assessments

may figure into pastoral visits:

I am called by a nurse who reports that a patient "wants to see a chaplain." When I ask the nurse if she's aware of any particular circumstances surrounding the request, she says, "She's going to have to have both legs amputated, and she's been crying."

I approach the room and notice a contact isolation placard. A curtain is drawn across the doorway. I gown and glove, then knock on the open door. "Ms. B., I'm the chaplain, may I come in?" "Yes, please do," a woman's voice replies.

I see a woman in the bed with her head raised. She is adjusting her gown up around her shoulders. She appears middle-aged, obese, and her hair is somewhat unkempt. There is no immediate sign from her face that she'd been crying. She looks eagerly at me and smiles. On each side of the room are two men. They are silent and make no obvious action to engage me (e.g., no eye contact, no move to shake my hand). Both seem to be sitting at a maximum distance from the patient.

slide25

I walk to the patient, and she shakes my hand. "My name is John Ehman. I'm the chaplain for the hospital. Your nurse just told me that you wanted to see a chaplain, and so I wanted to see how I might be of help to you. Let me also just say hello to… [and I go over to each of the men and shake their hands --they appear to engage me at the most minimal level].

slide26

I walk to the patient, and she shakes my hand. "My name is John Ehman. I'm the chaplain for the hospital. Your nurse just told me that you wanted to see a chaplain, and so I wanted to see how I might be of help to you. Let me also just say hello to… [and I go over to each of the men and shake their hands --they appear to engage me at the most minimal level].

I say to the patient: "I don’t mean to interrupt your visit, so I'd be happy to come back in a few minutes if that works better for you." "Oh, no," she says. "I want to see you"; and she holds out her hand. I go to her and take her hand. She pulls me close to the bedside. I now have my back to one of the men, and the other I notice (out the corner of my eye) is looking at the floor.

slide27

I walk to the patient, and she shakes my hand. "My name is John Ehman. I'm the chaplain for the hospital. Your nurse just told me that you wanted to see a chaplain, and so I wanted to see how I might be of help to you. Let me also just say hello to… [and I go over to each of the men and shake their hands --they appear to engage me at the most minimal level].

I say to the patient: "I don’t mean to interrupt your visit, so I'd be happy to come back in a few minutes if that works better for you." "Oh, no," she says. "I want to see you"; and she holds out her hand. I go to her and take her hand. She pulls me close to the bedside. I now have my back to one of the men, and the other I notice (out the corner of my eye) is looking at the floor.

The patient looks me directly in the eyes and says, "I need you to talk to me about God." She closes her eyes tightly, takes a deep breath, and suddenly appears to be holding back emotion. I smile slightly and say, "We can surely talk about God. Tell me what's on your heart and mind."

slide28

I walk to the patient, and she shakes my hand. "My name is John Ehman. I'm the chaplain for the hospital. Your nurse just told me that you wanted to see a chaplain, and so I wanted to see how I might be of help to you. Let me also just say hello to… [and I go over to each of the men and shake their hands --they appear to engage me at the most minimal level].

I say to the patient: "I don’t mean to interrupt your visit, so I'd be happy to come back in a few minutes if that works better for you." "Oh, no," she says. "I want to see you"; and she holds out her hand. I go to her and take her hand. She pulls me close to the bedside. I now have my back to one of the men, and the other I notice (out the corner of my eye) is looking at the floor.

The patient looks me directly in the eyes and says, "I need you to talk to me about God." She closes her eyes tightly, takes a deep breath, and suddenly appears to be holding back emotion. I smile slightly and say, "We can surely talk about God. Tell me what's on your heart and mind."

Emotion wells in her face. She says rather rapidly, "They want to cut off my left leg and my right foot, and I just don't believe that God wants me to lose my legs. I know that God can heal anything, and God doesn't want them to do this. I'm not ready to lose my legs. I know God has something more for me." She pauses, looking intently at me. I allow a few seconds of silence as we look at one another and then say, "Yes. I hear you. Can you tell me more?"

slide29

She begins a long monologue looking constantly at me (never at the others in the room), except for moments when she shuts her eyes in emotion. She periodically cries as she speaks. The two men appear extraordinarily still and silent. She talks about how she is a very faithful person, how God means everything to her, how she loves to pray all the time, and then how she doesn’t want to lose her legs, how she's done everything she could for the past two years to get her legs to heal and how that effort has meant staying inside all the time with her feet up and keeping them wrapped; how she's done nothing for the past two years but concentrate on her legs.

She tells of going to another hospital last week and being told that her legs would have to be amputated, how she insisted on coming to Penn for a second opinion, and how she had just been told again that amputation was necessary.

Her story takes on more particular detail as we approach the present moment, and she tells of a doctor saying to her, "The surgeon will be in on Friday, so let's just do it then." She expresses outrage at the perceived casualness of that doctor, saying, "These are my legs, and he's just saying let's do it because it's convenient for the surgeon! God doesn't want me lose my legs!" She becomes quiet, looking intently at me, appearing to expect my response.

slide30

In light of what you have

heard and assessed so far,

what might you do next?

slide31

So, how did this play out?

CHAPLAIN: You've said a great deal with deep meaning --about your faith and how hard you've worked for years to get your legs to heal, how for over two years you haven’t been able to do anything else in your life because of your legs, how constantly you've carried that burden and prayed for guidance. And, how much it hurt to have a doctor seem to treat all of this so casually.

slide32

So, how did this play out?

CHAPLAIN: You've said a great deal with deep meaning --about your faith and how hard you've worked for years to get your legs to heal, how for over two years you haven’t been able to do anything else in your life because of your legs, how constantly you've carried that burden and prayed for guidance. And, how much it hurt to have a doctor seem to treat all of this so casually.

PATIENT: He never should have said that. Walk in here and just schedule to cut my legs off for people's convenience. After all I've done. [Pause.] I've suffered for these legs. It's my decision.

slide33

So, how did this play out?

CHAPLAIN: You've said a great deal with deep meaning --about your faith and how hard you've worked for years to get your legs to heal, how for over two years you haven’t been able to do anything else in your life because of your legs, how constantly you've carried that burden and prayed for guidance. And, how much it hurt to have a doctor seem to treat all of this so casually.

PATIENT: He never should have said that. Walk in here and just schedule to cut my legs off for people's convenience. After all I've done. [Pause.] I've suffered for these legs. It's my decision.

CHAPLAIN: I want to honor your faithfulness through years of suffering. I can’t begin to guess your experience through it all, but I sense the magnitude of it. I also want to honor what it means to be faced now with a decision about whether the way ahead for healing might be a way through loss, a loss you've tried so hard to prevent.

slide34

So, how did this play out?

CHAPLAIN: You've said a great deal with deep meaning --about your faith and how hard you've worked for years to get your legs to heal, how for over two years you haven’t been able to do anything else in your life because of your legs, how constantly you've carried that burden and prayed for guidance. And, how much it hurt to have a doctor seem to treat all of this so casually.

PATIENT: He never should have said that. Walk in here and just schedule to cut my legs off for people's convenience. After all I've done. [Pause.] I've suffered for these legs. It's my decision.

CHAPLAIN: I want to honor your faithfulness through years of suffering. I can’t begin to guess your experience through it all, but I sense the magnitude of it. I also want to honor what it means to be faced now with a decision about whether the way ahead for healing might be a way through loss, a loss you've tried so hard to prevent.

PATIENT: I did everything I could. [Looks back and forth to each of the two men – for the first time – and then closes her eyes, with tears.]

slide35

CHAPLAIN: You've been guided by your love of God through it all. That is a powerful witness. Whatever you decide I'm sure will also be a witness to your faith.

slide36

CHAPLAIN: You've been guided by your love of God through it all. That is a powerful witness. Whatever you decide I'm sure will also be a witness to your faith.

PATIENT: [Looks up at me.] Two years I suffered. I haven't been able to do anything else. [Pause. Deep breath.] I know God wants me to do more with my life. [Pause.] I know what I have to do. I know God doesn’t want me to sit home like this forever. I don’t want to lose my legs, but He didn’t bring me this far for this to be "it." [Pause.] Thank you. I'm ready.

slide37

CHAPLAIN: You've been guided by your love of God through it all. That is a powerful witness. Whatever you decide I'm sure will also be a witness to your faith.

PATIENT: [Looks up at me.] Two years I suffered. I haven't been able to do anything else. [Pause. Deep breath.] I know God wants me to do more with my life. [Pause.] I know what I have to do. I know God doesn’t want me to sit home like this forever. I don’t want to lose my legs, but He didn’t bring me this far for this to be "it." [Pause.] Thank you. I'm ready.

Process assessments help chaplains offer a pastoral interaction that is in tune with patients' felt needs and empowering for patients' self-help. This may bring benefits even before the chaplain is able to gain a good sense of specific issues.

slide38

The process assessment often slightly precedes -- and

then runs along side of -- an issues assessment,

and can support communication about issues.

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

slide39

The process assessment often slightly precedes -- and

then runs along side of -- an issues assessment,

and can support communication about issues.

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

What should be the elements of an issues

assessment, a “spiritual assessment,” in

your own practice of pastoral care?

slide40

Strategy for Building Your Own Practice

of “Spiritual Assessment”

1) Start from what you naturally pay attention to in visits.

2) Consider how these indicators may limit your sense of

a patient, or be misleading under some circumstances.

3) What values and assumptions are implicit in your

assessment items? What theory and theology is

behind them?

4) Periodically list your most salient assessment items

and think of how they can be rounded out.

5) Write verbatims of difficult visits to spur your thinking.

6) Consult the research and professional literature on

“spiritual assessment” for new ideas to incorporate.

slide41

Examples of Popular “Spiritual Assessments”

in the research and pastoral literature:

FACIT-Sp FICA 7x7 Model

(facit.org) (Puchalski) (Fitchett)

Brief RCOPE Spirituality Scale Spiritual Needs

(Pargament) (Delaney) (Galek)

See handouts:

slide42

Periodically write out a list of the most salient

assessment items in your own practice:

For an example, see handout:

slide43

What sets up, and what follows from,

the Process and Issues Assessments?

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

slide44

What sets up, and what follows from,

the Process and Issues Assessments?

Pre-Visit Information Gathering

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

slide45

Pre-Visit Information Gathering

SOURCES: the medical record, care team members

(especially the primary nurse), family members

ADVANTAGE: this “background” information can help

identify special issues and can give context for

understanding/assessing the patient’s situation

DISADVANTAGE: it can suggest an agenda for the

visit and can skew the chaplain’s perception

and assessment of the patient

slide46

What sets up, and what follows from,

the Process and Issues Assessments?

Pre-Visit Information Gathering

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

End-of-Visit Assessment

slide47

End-of-Visit Assessment

Are there any loose ends to be addressed?

(--especially practical matters that might have pulled the

visit off course if pursued earlier in the conversation)

What is the patient’s expectation for follow-up?

A before-leaving-the-room check:

Is there anything else that you can do or get for the patient?

Is all that the patient might reach for (e.g., call button) within reach?

Is the overhead light, window shade, and curtain OK?

Are there safety issues apparent (e.g., falls hazards or

patient expressions of pain or breathing difficulty)?

slide48

Note about SPECIAL ASSESSMENTS that extend

beyond spiritual issues:

When encountering issues like abuse or intent to

harm, follow institutional policies and make referrals

to institution-identified specialists where necessary.

Assess how the disclosure of sensitive information

and the involvement of third parties affects

the patient-chaplain relationship as you

continue to offer pastoral care.

slide49

What sets up, and what follows from,

the Process and Issues Assessments?

Pre-Visit Information Gathering

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

End-of-Visit Assessment

Communication of Assessment

and Pastoral Planning

slide50

Communication of Assessment

and Pastoral Planning

The challenge of documentation:

Documentation often requires you to translate a subtle understanding of a patient into a clinical language that “pigeonholes” information.

Thinking about the task of documentation can cause you to impose the requirements of that task onto the course of the patient visit.

The challenge of pastoral planning:

Your total assessment of a visit helps you plan for follow-up, but

it also may lead you to take an agenda into the next visit.

slide52

Frame for Patient-Centered

Pastoral Assessment Practice

…takes into account how a “spiritual assessment”

does not occur in isolation

Issues Assessment

(“Spiritual Assessment”)

slide53

Frame for Patient-Centered

Pastoral Assessment Practice

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

slide54

Frame for Patient-Centered

Pastoral Assessment Practice

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

End-of-Visit Assessment

slide55

Frame for Patient-Centered

Pastoral Assessment Practice

Pre-Visit Information Gathering

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

End-of-Visit Assessment

slide56

Frame for Patient-Centered

Pastoral Assessment Practice

Pre-Visit Information Gathering

Process Assessment

Issues Assessment

(“Spiritual Assessment”)

End-of-Visit Assessment

Communication of Assessment

and Pastoral Planning