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Caring for the Whole Person, Together. A Discussion with Regional Nursing Leadership Providence Health & Services Oregon Region Tim Serban. Our Key Message:. We affirm the tremendous contributions of nurses to the spiritual dimensions of patient care. Period. Our Ask of ONLC.

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caring for the whole person together

Caring for the Whole Person, Together

A Discussion with Regional Nursing Leadership

Providence Health & Services

Oregon Region

Tim Serban

our key message
Our Key Message:

We affirm the tremendous contributions of nurses to the spiritual dimensions of patient care. Period.

our ask of onlc
Our Ask of ONLC
  • Endorse a common and coordinated approach (screening-assessment)to address the spiritual needs of patients.
  • Engage nursing in use of a spiritual screening tool and a process to implement it.
key questions
Key Questions:
  • What is a “Model of Spiritual Care”?
  • What is the difference between “screening” and “assessing?”
consensus conference recommendations
Consensus Conference Recommendations

“Spirituality should be considered a patient vital sign. Just as pain is screened routinely, so should spiritual issues be a part of routine care.”

-Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference, 2009

consensus conference recommendations1
Consensus Conference Recommendations

“All patients should receive a simple and time-efficient spiritual screening at the point of entry into [and at transitions through] the health care system and appropriate referrals as needed.”

-Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference, 2009

spiritual screening
Spiritual Screening

“…a quick determination of whether a person is experiencing a serious spiritual crisis and therefore needs an immediate referral to a board-certified chaplain [for assessment]. Spiritual screening helps identify which patients may benefit from an in-depth spiritual assessment.”

-Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference, 2009

patient experience metrics
Patient Experience Metrics
  • “Degree to which all staff treated me with compassion”
  • “Nurses listened to me”, etc.

Strongly correlated with overall scores

providence wellbeing scale
Providence Wellbeing Scale

why peace and support
Why “Peace” and “Support”?
  • Quantitative: Thresholds for action, and/or comfort function goals
  • Simplicity
  • Evidence-based
  • Non-religious
  • These are “connecting questions”
a partnership
A Partnership:
  • Chaplains to coach and mentor nurses.
  • Nurses to conduct screening and document scores.
  • Chaplains to provide assessments and collaborate on spiritual needs that don’t require a chaplain.
our ask of nursing
Our Ask of Nursing
  • Endorse a common and coordinated approach (screening-assessment)to address the spiritual needs of patients.
  • Engage nursing in use of a spiritual screening tool and a process to implement it.
developing a spiritual distress screening tool for saint thomas health

Developing A Spiritual Distress Screening Tool for Saint Thomas Health

Chaplain Kim Sheehan, M.Div., BCC

Saint Thomas Midtown Hospital

Nashville, TN

June 11, 2014

what is spiritual distress
What is Spiritual Distress?


“The aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”

- National Consensus Project for Quality Palliative Care Guidelines

Spiritual Care:

“Spiritual care refers to issues of ultimate meaning, values, and relationship with a higher power or the transcendent or sacred.”

- Pulchalski, Christina M., & Ferrell, Betty. (2010) Making Healthcare Whole

Spiritual Distress:

“The disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biological and psychosocial nature.”

- North American Nursing Diagnosis Association (2001)

provides holistic reverent care
Provides Holistic, Reverent Care

“Since a Catholic health care institution is a community of healing and compassion, the care offered is not limited to the treatment of a disease or bodily ailment but embraces the physical, psychological, social, and spiritual dimensions of the human person…For this reason, Catholic health care extends to the spiritual nature of the person.”

- Ethical and Religious Directives for Catholic Health Care Services

improves patient outcomes
Improves Patient Outcomes

“Anxiety, depression, and other poor outcomes are found to be common among patients with unmet emotional needs.”

“Studies found that psychosocial interventions reduced mortality rates among cancer patients.”

- From the Joint Commission Journal on Quality and Safety, December 2003

improves patient satisfaction
Improves Patient Satisfaction

“Unmet emotional needs have been associated with desires to discontinue patronizing a specific hospital as patients ‘become disillusioned about the services provided.’”

- From the Joint Commission Journal on Quality and Safety, December 2003

improves hcaps
Improves HCAPS

Press Ganey Survey Responses Highly Correlated with “Degree to which Staff Addressed Emotional/Spiritual Needs”:

  • Response to concerns/complaints
  • Staff effort to include you in decisions about your treatment
  • Staff sensitivity to the inconvenience that health problems and hospitalization can cause
  • How well staff worked together to care for you
  • Staff concern for your privacy.

From: Press Ganey Knowledge Summary: Patient Satisfaction with Emotional and Spiritual Care, 2004.

accreditation requires screening
Accreditation Requires Screening

Phase in for 2015.

Standard 3.2 Psychosocial Distress Screening:

The cancer committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care.

The purpose of this standard is to develop a process to incorporate the screening of distress into the standard care of oncology patients and provide patients identified with distress with resources and/or referral for psychosocial needs.

From: Commission on Cancer Accreditation, American College of Surgeons

“The National Comprehensive Cancer Network Guidelines for Distress Management recommend that each new patient be rapidly assessed in the office or clinic waiting room for evidence of distress using the Distress Thermometer and Problem List as an initial rough screen.” - NCCN Guidelines 2013, Distress Management
deficits to current model
Deficits to Current Model
  • Does not specifically address distress
  • Not quantifiable
  • Not a mandatory box
  • Actually several questions in one; not as user-friendly for nurses.
barriers to using current model
Barriers to Using Current Model
  • Time constraints on nurses
  • Level of the nurse’s comfort with addressing spirituality with patients
  • Lack of continuous, consistent nursing education:
      • How to present the question
      • How to interpret the variety of checkboxes
      • How to observe patient/family behavior
      • How to make an immediate referral
example of current problem
Example of Current Problem

“Routine Visit” Referrals

Often may be a patient who “wouldn’t mind if the chaplain came by.” Typically the patient has his/her own pastor or faith community involved in care and values spiritual care but is not experiencing any acute spiritual distress or needs.

clarifying our needs
Clarifying Our Needs
  • Need for the tool to specifically address distress.
  • Need for clear wording of questions, making it user-friendly for nurses to administer.
  • Need for clear, concise response options to facilitate quick documentation.
  • Need for the tool to be evidence-based so that we are confident that it is identifying patients experiencing distress.
researching the literature
Researching the Literature

A committee of chaplains researched articles related to spiritual screening and spiritual distress to find evidence-based models for spiritual screening.

Notable models:

  • Rush Protocol (Fitchett & Risk, 2009)
  • “Are You At Peace?” (Steinhauser, et. al., 2006)
  • Providence Wellbeing Scale (Providence Health Services)
creating our own tool
Creating Our Own Tool

Developed a Draft

Formulated questions that incorporated the Likert scale scoring, similar to the Providence Scale.

Solicited Feedback

Met with all our chaplains to vet the questions, revised based on their feedback.

Met with nurse managers to vet the questions, revised more based on their feedback.

Developed a Validation Study for the Tool

This is our current phase in the process - beginning the study this summer.

benefits to new screening tool
Benefits to New Screening Tool
  • Will Collect Quantitative Data
    • Will allow us to measure what percentage of patients are experiencing distress
    • Will open up the possibility to measure outcomes at discharge.
  • Will Utilize Evidence-Based Methods
  • Will Simplify Nurses’ Screening Process
  • Will Improve Patient-Centered Care
chaplain as educator screening tool and identifying spiritual needs

Chaplain as Educator Screening Tool and Identifying Spiritual Needs

June 11, 2014

Art W. Maddock, MDiv, BCC, Mercy Springfield

role of educator with clinic team
Role of Educator with Clinic Team
  • What does it look like?
  • How does it feel?
  • What have you learned?
role of educator with clinic team1
Role of Educator with Clinic Team

What Does It Look Like?

  • Different from hospital setting
  • Assist to recognize and screen emotional & spiritual needs
  • Formal and informal training
role of educator with clinic team2
Role of Educator with Clinic Team

How does it feel?

  • Adjustment in educating clinicians
  • Prolonged realization of chaplain

availability and involvement.

  • Restructuring approach for clinic culture
role of educator with clinic team3
Role of Educator with Clinic Team

What have you learned?

  • Value of informal training
  • Value of effective language
  • Value of leading leadership
  • Build on what is present
current focus screening tool
Current Focus: Screening Tool

Initial Screening Tool Objectives

  • Need rather than support centered
  • Clinician user-friendly
  • Introduction to promote holistic care
  • Clinician approach—“Tell me your concerns”
  • Spiritual distress indicators included
  • 2+ indicators marked = Referral
  • Eventual placement in EHR
current focus screening tool1

Current Focus: Screening Tool

“Our team is committed to the well-being of the

whole person. Are there any current concerns that are affecting your emotional or spiritual well-being?”

If “No”: “If that happens to change please let us

know, our clinic chaplain is available for support.”

If “Yes" Ask: “Tell me what your concerns are.”

current focus screening tool2
Current Focus: Screening Tool

Mark Boxes That Apply

  • New Diagnosis/Health Concerns
  • Grief/Loss Issues
  • Significant Relational Problems
  • Stress/Moderate to Severe Anxiety
  • Sadness/Hopelessness
  • Loneliness/Isolation
  • Spiritual Direction
  • Limited Support System
current focus screening tool3
Current Focus: Screening Tool

Results of Screening Tool Pilot

  • Proved clinician friendly
  • Increased referrals
  • Increased awareness of unmet emotional and spiritual needs
  • Revealed commonality of spiritual distress needs identified
  • Need ongoing evaluation of number of indicators marked
lessons learned

Lessons Learned


Recognized the difference between screening and assessment

Continue to evaluate distress indicator terminology for clinician use

Continue to evaluate appropriate groups of patients to be screened