Spiritual Care In Physical Rehabilitation Medicine: A Chaplain’s Work & Experience

1. Spiritual Care InPhysical Rehabilitation Medicine: A Chaplain’s Work & Experience Arlene E. Grace, M.Div. Chaplain Spirituality, Religion & Health Interest Group @ HUP April 1, 2015

2. Spiritual Care In Rehabilitation Medicine: A Chaplain’s Work & Personal Experience Today’s Presentation will Focus on: • The Penn Medicine/Good Shepherd Rehabilitation Network Partnership • An Overview of Penn Medicine @ Rittenhouse and the Penn Institute for Rehabilitation Medicine • Spiritual Care in Physical Medicine and Rehabilitation • My Personal Experience as a Rehabilitation Patient

3. The Making of Good Shepherd Penn Partners: The Penn Medicine/Good Shepherd Connection PM&R at Penn Medicine • Penn Medicine’s Physical Medicine and Rehabilitation (PM&R) program has been in existence for more than 100 years. • In 2004, PM&R embarked on a new strategy to improve and expand its clinical, education and research programs, while strengthening relationships with Penn Medicine’s clinical departments and outside organizations. Source: Pennpartners.org

4. PM&R at Penn Medicine • One of the department’s main objectives was to coordinate post-acute care throughout the Penn Medicine System. • As post-acute care existed in earlier years, each of the system’s acute-care hospitals offered independent rehab. services. • The need for a consistent clinical approach to rehabilitation care throughout the Penn Medicine system was the driving force behind the formation of Good Shepherd Penn Partners. Source: Pennpartners.org

5. Good Shepherd Rehabilitation Network • Penn Medicine’s PM&R department sought out expertise – a partner with post-acute care management and outstanding patient outcomes. • Good Shepherd Rehabilitation Network (GSRN), based in Allentown, PA, was selected over several organizations because of its expertise in long-term acute care and rehabilitation and for its successful experience with healthcare partnerships. Source: Pennpartners.org

6. Good Shepherd Rehabilitation Network (GSRN)

7. The Formation of Good Shepherd Penn Partners • Combining the respected research and clinical expertise of Penn Medicine with GSRN’s more than 100-year tradition of evidence-based rehabilitation care resulted in the optimization of post-acute care for patients in the Philadelphia region. • With similar core values, the two organizations were able to come together to work through a complex start-up at Penn Medicine @ Rittenhouse and align post-acute care throughout the Penn Medicine system. Source: Pennpartners.org

8. The Formation of Good Shepherd Penn Partners Good Shepherd Penn Partners opened its doors on July 1, 2008, bringing together two nationally respected healthcare organizations to provide the region with a continuum of post-acute care that includes inpatient and outpatient rehabilitation and a long-term acute care hospital.

9. Good Shepherd Penn PartnersPenn Medicine @ Rittenhouse

10. Penn Medicine at RittenhouseOffers the Following Services Outpatient Therapy Inpatient Rehabilitation Long-term Acute Care Acute Care Therapy Penn Hospice at Rittenhouse (separate entity)

11. The PIRM at Penn Medicine at Rittenhouse(Penn Institute for Rehabilitation Medicine) The staff of the PIRM provides care for individuals with limited function caused by a range of medical conditions including: • Stroke • Traumatic brain injury • Spinal cord injury • Orthopedic injury • Amputation • Multi-trauma injury

12. The PIRM at Penn Medicine at Rittenhouse(Penn Institute for Rehabilitation Medicine) The PIRM holds accreditations for the following programs: • Comprehensive Rehabilitation Program • Inpatient Stroke Rehabilitation Program • Brain Injury Inpatient Rehabilitation Program • Amputee Inpatient Rehabilitation Program Source: pennpartners.org

13. The PIRM at Penn Medicine at Rittenhouse(Penn Institute for Rehabilitation Medicine) Patients at the PIRM typically receive at least three hours of rehabilitation therapy per day. A specialized team of expert clinicians provides comprehensive, 24 hour care. The care team includes: • Physiatrists • Rehabilitation nurses • Physical, occupational and speech therapies • Care managers • Psychologists • Spiritual Care • Recreational therapists

14. The PIRM at Penn Medicine at Rittenhouse(Penn Institute for Rehabilitation Medicine)Meet the Chaplain Chaplain Arlene Grace • HUP CPE Residency • Hospice Chaplain (Caring Hospice) • ER Chaplain (Mercy) • Chaplain at PM@R 2008 – Present HUP/GSPP: • PM&R, Long-term Acute Care & Palliative Care

15. Meeting the Spiritual Needs of Physical Rehabilitation Patients

16. Meeting the Spiritual Needs of Physical Rehabilitation Patients Four Major Themes of Spiritual Needs • Belonging/Acceptance • Power/Control • Purpose/Value/Meaning • Love

17. Belonging/Acceptance • Like all of us, the rehab. patient wants to have a sense of belonging and acceptance. • According to research interviews, this (belonging/acceptance) was nurtured in relationships with family, friends, therapists and patients with similar injuries (Trice, Chally, Watkins, 2007).

18. Power/Control • We all want to be in control of our lives. It’s no different with rehab. patients. Because of their injuries, they’ve lost control of many of their physical functions. With acceptance, hard work and support of professional staff, family and friends, they are able to move on to gaining control over other aspects of their lives.

19. Purpose/Value/Meaning • Many rehab. patients experience a deep sense of grief over loss of their limb(s) and/or function, as if losing a loved one. In some cases, they don’t understand they are grieving. Patients suffering loss should be introduced to the stages of grief so they are able to move forward in their healing.

20. Purpose/Value/Meaning • It’s human nature for us to have purpose, value and meaning – it’s part of our make-up. For the rehab. patient, this often means a change in personal perspective and discovering how purpose, value and meaning can be re-imagined for his/her life.

21. Love • We want to be loved. As human beings, it’s a basic need. Like all of us, the rehab. patient wants to be loved as friends, as lovers, as those who have realized a purpose in life; whether that love comes from God/a higher power or from others who hold a place of importance in their lives. • Some patients wrestle with this issue for years. Through constant reassurance from family and others that they are loved, and gentle reminders that they are supported, the rehab. patient can continue their journey toward spiritual and emotional healing and wholeness.

22. Three Coping Strategies forSpiritual Well-Being • Seeking help through religious/spiritual guidance • Hope • Striving for independence and self-care

23. Seeking Help Through Religion/Spirituality • Religion/Spirituality, for some people, plays an important part in quality of life, coping, and the search for meaning in crises. Researchers have found that spiritual well-being and physical well-being are related. • Activities such as attending religious meetings, meditating and praying, helping others through volunteer work, and being part of a support group or network are all related to positive emotional and physical health. • Guided Imagery & Life Review

24. Seeking Help Through Religion/Spirituality:Guided Imagery • A relaxation technique which intentionally “redirects” thoughts in order to achieve a positive, desired outcome (i.e. Relaxation, Stress, Pain Relief, Inner Peace, etc.) (Tusk, 2011). • Guided Imagery (GI) incorporates all of the body’s senses (sight, smell, touch, sound, taste) to create an intense “emotional connection” between mind, body and spirit. • Research has shown that GI can dramatically counteract effects of fear, anxiety, helplessness and loss of control and enhance one’s coping skills.

25. Seeking Help Through Religion/Spirituality:Life Review • In general terms, Life Review refers to the process of looking back to the past in order to inform and/or bring pleasure to the present (Life Review Project, 2007). • Such activities as personal story-telling, oral history, reminiscing, and life history interviewing are all examples of Life Review. Chaplains often engage their patients in one or more of these activities during an initial assessment or follow-up. • Life Review is especially useful to rehab. patients experiencing a sense of loss (due to decline in physical function or amputation). It helps them recall their life before their loss, integrating the past with the present, in the hope they can approach their future in a positive light.

26. Hope • Hope has been shown to be one of the most important coping strategies among rehab. patients. It’s also the motivating force for other coping strategies, including: sense of trust, acceptance, and striving for independence. • Family, loved ones, friends and medical care givers all play an integral role in sustaining hope in patients for continued healing and recovery (Yousefi and Abedi, 2011).

27. Striving for Independence and Self-care • Needing to depend on family and professional care-givers for the most basic needs, rehab. patients strive to become independent and self-sufficient. • With love, support and professional guidance, patients are often able to re-evaluate and re-define their social and occupational objectives. • Strategies may include: • Striving for more physical movement • Setting objectives for self-care • Education • Research

28. Striving for Independence andSelf-care • The presence of family, friends, and other loved ones during the movement from initial disability to independent living may well be the support that one needs. • Within the context of spirituality, faith as a vital part of the journey is often the difference between one merely coping with what has happened and someone actually thriving in the family and living in society (Kyllo, 2008).

29. "If I regarded my life from the point of view of the pessimist, I should be undone. I should seek in vain for the light that does not visit my eyes and the music that does not ring in my ears. I should beg night and day and never be satisfied. I should sit apart in awful solitude, a prey to fear and despair. But since I consider it a duty to myself and to others to be happy, I escape a misery worse than any physical deprivation." – ~Helen Keller~