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Chaplaincy in Palliative Care Settings

Next Reply: Re:Assessment tools
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Post Assessment tools
Author: Chapdavid
Date: May 30, 2008 9:06 am
I am a new palliative medicine chaplain. I am looking for an assessment tool that is currently being used widely and effectively. Can anyone send me suggestions?
Replies: order by [Date] [Author] [Subject]
- Re:Assessment tools (by Angel on 05/30/2008)
Here is an assessment I use:

-----------------------------------------------
PALLIATIVE CARE SPIRITUAL ASSESSMENT
-----------------------------------------------
- CHAPLAIN VISIT REQUESTED BY:
Palliative Care Consultation Team requested
Spiritual Care Consult,
Primary Care Team requested Spiritual Care Consult,
Admission to Palliative Care,
Other:

- REASON FOR CHAPLAIN VISIT:
Patient terminally ill,
Patient with non-terminal intractable symptoms,
patient with diagnosis pending,
Other:

- PATIENT'S DEMEANOR:
PATIENT is receptive to chaplain visit,
receptive but too fatigued for interview at this time,
polite but unreceptive,
unreceptive,

Comment:

-
PATIENT'S RELIGIOUS/SPIRITUAL BACKGROUND:

Adventist,
Assembly of God,
Baptist,
Brethren,
Buddhist,
Catholic,
Christian Scientist,
Church of Christ,
Church of God,
Disciples of Christ,
Eastern Orthodox,
Episcopalian,
Evangelical Covenant,
Friends,
Islam,
Jehovah's Witness,
Jewish,
Latter-Day Saints,
Lutheran,
Methodist,
Native American,
Nazarene,
Pentecostal,
Presbyterian,
Protestant,
No Denomination,
Reformed,
Salvation Army,
United Church of Christ,
Unitarian Universalist,
Unknown/no preferences,
Other:


- SPIRITUAL PRACTICES:

Prayer,
Meditation,
Home ritual,
Community worship,
Fasting,
Music,
Bible Study,
Communion,

Comments:

a) How does the practice help the patient?

Peace giving,
Calming,
Comforting,
Sense of God's presence for them,
Reduces tension,
Helps patient focus on strength in God/Higher Power,
Helps patient feel secure in facing their death,
Helps patient to cope with separation from family,
Patient finds no help from beliefs,

Comments:

b) Patient's Perception of God/Higher Power:

positive,
negative,
neutral,
judgmental,
punitive,
merciful,
compassionate,
faithful,
wrathful,
supportive,
source of strength,
other:

- FREQUENCY OF PRACTICE:

daily,
once a week,
once a month,
occasionally,
only in a crisis,
special occasions,
major holidays

- SPIRITUAL ASSESSMENT:

a. Are you affiliated with a religious community?
Yes
No
b. Is your religious community aware of your hospitalization?
Yes
No
c. Would you like us to contact him/her?
Yes
No
If yes, name of person:

- PATIENT'S SPIRITUAL HISTORY AND CONDITION AT PRESENT TIME:

a) The patient's feelings about their present situation including
Spiritual Injury:

shock,
denial,
anger,
bargaining,
depression,
acceptance,
spiritual suffering,
fear of dying,
fear of being dead,
fear of what will happen after death,
fear of abandoning loved ones,
fear of being abandoned,
fear of uncontrolled pain,
fear of loss of independence,
fear of loss of functioning,
grief and bereavement,
loss of self,
loss of important relationships,
loss of meaning,
withdrawal from previous roles and activities,
suicidal ideation,
forgiveness,
sharing,
reconciliation,
integration of dying
experience with pt's belief system,
guilt and remorse,

Comments:

b) Effects of illness on their God relationship:

unchanged,
improved
relationship,
raised question about relationship,
surfaced anger towards God,
unexamined,

Comments:

c) Effects of illness on spiritual practice:

increased need for practice,
provides comfort,
allays fears and anxiety,
consolation,
decreased desire for practice,
ceased practice in light of present crisis,
no impact,
no change,

Comments:

- PASTORAL ASSESSMENT OF SPIRITUAL NEEDS OF PATIENT

ASSESSMENT/IMPRESSION OF THE IMMEDIATE RELIGIOUS/SPIRITUAL NEEDS OF THE
PATIENT:
+ Re:Re:Assessment tools (by GPutnam on 05/30/2008)
When you do this assessment do you go down the questions or do you have a narrative conversation with the patient? This is specificly on religious practice, do you also ask questions about meaning or about family support, physical issues, other issues?
Re:Assessment tools (by ghandzo on 05/31/2008)
Unfortunately, there is not yet consensus within the pastoral care community on the parameters that need to be included in a spiritual assessment or spiritual history. However, if one looks at a number of these tools, one sees many common elements. (1)the frequency and importance of religious practices for the patient and how well those practices are working now. (2) the person's relationship to a higher power and how the person sees that relationship impacting on their illness. (3) the person's relationship to community broadly defined. Within all of these is the issue of how the person makes meaning. Art Lucas from St. Louis has pulled these together under the categories, "Needs, Hopes, and Resources" which many people have found helpful. The convergence is also evident in the FICA instrument written by Christian Puchalski at the George Washington Institute for Spirituality and Health (www.gwish.org) and he FACT tool written by Mark Laroca-Pitts and available in the Resource Room of the Association of Professional Chaplains website (www.professionalchaplains.org).

The Rev. George Handzo, BCC
Vice President
Pastoral Care Leadership & Practice
The HealthCare Chaplaincy
New York, NY
+ Re:Assessment tools (by ElizabethValera on 06/09/2008)
Coming out of the home care hospice world, into inpatient palliative care, I developed a spiritual assessment that resembles what we used in hospice and focusses on identifying sources of spiritual pain and sources of spiritual comfort for the patient and family members. I would be glad to share it, if you are interested.
+ Re:Assessment tools (by ElizabethValera on 06/10/2008)
Here is the spiritual assessment I mentioned above. I will also send copies directly to your e-mail (for those who requested) which is easier to read, print, etc. Since we use a computer charting system, I have this assessment on-line and then I just delete the parts that don't apply to that particular assessment. I am interested in creating an updated version of this, now that I have been using this form for a year. Comments and suggestions are welcome.

Palliative Care Spiritual Assessment

Current Support System
Faith Group:
Name of Community:
Name of Spiritual Leader:
Family:
Friends:
Others:

Particular cultural or religious practices to be observed:
________________________________________________

Sources of Spiritual Pain:
Guilt__ Denial of Reality__
Meaninglessness__
Need for Reconciliation__
Fear of Death__ Isolation__
Powerlessness__ Grief__
Anticipatory Grief__ Anger__ Other__

Sources of Spiritual Comfort:

Acceptance of Reality__ Afterlife Beliefs__
Spiritual Practices__
Music__ Hope__ Forgiveness/Reconciliation__
Life Review__ Nature__
Sense of strength or empowerment__
Other__


Narrative Description of pt’s sources of spiritual pain and/or comfort: (if needed)
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
____________________________________

What are patient’s and/or family’s hopes/needs/concerns in regard to the above?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______

Interventions/Plan of Care for Spiritual Support:
______________________________________________________________
______________________________________________________________
____________________
________________________________________________
Re:Assessment tools (by SharolHerr on 06/10/2008)
WOW! What awesome tools being shared. It is wonderful to be a part of a community of palliative care givers and not have to reinvent the wheel. I would encourage anyone who is developing services to refer to the "National Consensus Project". This is a compendium of quality standards for palliative care that were created by a group of national leaders including representatives from NHPCO, CAPC, etc. The document consists of domains and standards for palliative care. Domain 5 of the "Clinical Practice Guidelines" is Spiritual, Religious and Existential Aspects of Care. It outlines key components of spiritual care provision in palliative care including assessment. There are also some references cited at the end of the domain. I think this can be a wonderful resource to you. Sharol Herr, RN, MSED; Nurse Clinician/Education Coordinator; Mt. Carmel Health Palliative Leadership Center; Columbus, Ohio.
+ Re:Assessment tools (by ghandzo on 06/11/2008)
Thanks to those who have shared assessment tools. I find it very helpful to see what others have done. I think we would do much better if this happened more as opposed to each person doing something new. Through this process we might come to some concensus on what the most effective tool might be. I do often wonder about the logic each person uses to decide what data they will collect. I think the basic question should be, how does collecting this particular piece of information assist in providing the client with helpful pastoral care? If there is no answer, the question should be excluded. For instance, I've often wondered about the utility of faith tradition- except in broad categories (Jewish, Christian, etc). I would be interested in more discussion about pieces of assessment information that people have found particulary helpful clinically, or particularly unhelpful.

The Rev. George Handzo, BCC
Vice President
Pastoral Care Leadership & Practice
The HealthCare Chaplaincy
New York, NY
Re:Assessment tools (by ghandzo on 06/14/2008)
This is a very interesting discussion and the kind that I think moves us forward because it examines some of our assumptions. As Chaplain Valera has correctly pointed out, asking patients their faith tradition has been an assumed piece of most assessments without much question about what it means clinically. Chaplain Putnam's comment reminds me of a system I learned from Chaplain Larry Burton. This system divides believers into three types- Traditional, Negotiating, and Individualistic. The traditionalists rely on outside sources like scripture or clergy to make decisions. The negotiators (most of us) blend outside sources with our own internal wisdom. The individualists rely solely on their own wisdom. In this system, whether one is Christian, Jewish, or Muslim is less important than whether one is on the "conservative" or "liberal" side of the spectrum in each. Thus, the conservative or traditional Jew will think and act more like the traditional Muslim than they will act like a liberal Jew in areas like medical decision making. It is this place on the spectrum that tells us how this person is going to make end-of-life decisions. I also tend to agree that the religion of a person's youth may be more salient than their current affiliation especially if the religion of their youth was more traditional.

The Rev. George Handzo
Vice President
Pastoral Care Leadership & Practice
The HealthCare Chaplaincy
New York, NY

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