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Faith & Medicine At The
Bedside: Caring For The Caregiver
SHERRY-ANN BROWN, MD, PHD
NARDIA MCFARLANE, MD
MARK NYMAN, MD
Pa...
Outline
 Jesus, Healer
 Faith in America
 Need for a Spiritual component
 The Needs of the Caregiver
 Power Tools for...
Mathew 9:35
Jesus went through all the towns and villages, teaching in their
synagogues, proclaiming the good news of the ...
Jesus, Healer
St Francis Xavier Major Seminary, http://sfxms.blogspot.com
@drbrowncares
drbrowncares@gmail.com
Jesus, MD
Archdiocese of Washington, http://blog.adw.org/2010/02/the-diagnosis-is-dire-but-the-doctor-is-in/
@drbrowncares...
Jesus, Bedside
http://www.ely.anglican.org
@drbrowncares
drbrowncares@gmail.com
Jesus, Power
http://draltang02.blogspot.com/
@drbrowncares
drbrowncares@gmail.com
Faith in America
 According to an online poll of 2,455 U.S. adults by
Harris Interactive in November 2007:
 __% of adult...
Faith in America
 According to an online poll of 2,455 U.S. adults by
Harris Interactive in November 2007:
 82% of adult...
http://www.gallup.com
Organized Religious Preferences in the
United States, 2012 (Gallup poll)
@drbrowncares
drbrowncares@...
The Need for a Spiritual
Component
 In a study at the Dana-Faber Cancer Institute:
 __% patients/nurses/physicians felt ...
The Need for a Spiritual
Component
 In a study at the Dana-Faber Cancer Institute:
 80% patients/nurses/physicians felt ...
The Needs of the Caregiver
 Patient Story: I Cannot Die Tonight
@drbrowncares
drbrowncares@gmail.com
The Needs of the Caregiver
 1.4 million cancer diagnoses in 2006 in USA
 Similar number of family/primary caregivers
 C...
The Needs of the Caregiver
 Caregiver’s life radically altered by diagnosis
 Profound spiritual needs
 Wrestle with fai...
The Needs of the Caregiver
 Females with private prayers/spiritual conversations
 Successfully cope
 Find meaning
 Loo...
The Needs of the Caregiver
 More religious family members
 feel more positively about role as caregivers
 get along bet...
The Needs of the Caregiver
 “To cure sometimes, relieve often, comfort
always”
 Spiritual strength: strength which gives...
Stress-buffering hypothesis
of spirituality
Kim et al, Support Care Cancer 2007 15:1367-1374
@drbrowncares
drbrowncares@gm...
Kim et al, Support Care Cancer 2007 15:1367-1374
(p<0.001)
Stress-buffering hypothesis
of spirituality
@drbrowncares
drbro...
The Needs of the Caregiver
 Psychological distress from increased caregiver stress can
be attenuated by maintaining faith...
Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98
Stress-buffering hypothesis
of spirituality
@drbrowncares
drbr...
The Needs of the Caregiver
 Maintaining faith/finding meaning buffer[s]
adverse effect of caregiving stress on mental
hea...
The Needs of the Caregiver
 Caregivers who felt that the caregiving role was
meaningful, perceived themselves to be healt...
Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98
Stress-buffering hypothesis
of spirituality
@drbrowncares
drbr...
Stress-buffering hypothesis
of spirituality
Commentary:
The previous slide indicates that we need to interpret these studi...
The Needs of the Caregiver
 Female caregivers:
 Use spiritual resources more than men
 More likely to experience negati...
The Needs of the Caregiver
 Medicine needs to further integrate these scientific findings
into clinical practice to promo...
Assessing/Addressing
Spiritual Needs
Meeting
Caregiver’s
Spiritual Needs
Caring For
The
Caregiver
Power Tools:
Key
Concept...
Power Tools – Key Questions
SIDNEY AC
1. Has faith or spirituality been of support as you face your loved one’s
illness?
2...
Mary’s story (parts 1, 2, 3)
The Needs of the
Caregiver: SIDNEY AC
What feelings/ processes did Mary experience?
 shock, ...
Power Tools – Key Questions
SIDNEY AC
1. Has faith or spirituality been of support as you face your loved one’s
illness?
2...
The Needs of the
Caregiver: SIDNEY AC
 Mary…
 Believes in a personal, loving God
 Clearly aware of spirituality in her ...
The Needs of the
Caregiver: SIDNEY AC
 Caregivers of clinic patients TOP 10
 Hope for the future
 Strong faith in God
...
Meeting
Caregiver’s
Spiritual Needs
Caring For
The
Caregiver
Power Tools:
Key
Concepts
PLiWA
Power Tools:
Key
Resources
Tr...
Power Tools – Key Concepts
PLiWA
Presence
• Being fully in the room with the caregiver – mind, body, and spirit
Listening ...
The Needs of the
Caregiver
 Caregivers…who had questioned their faith or felt distant
from or angry with God, reported hi...
The Needs of the Caregiver:
SIDNEY AC, PLiWA
 Patient story: Brokenness
@drbrowncares
drbrowncares@gmail.com
The Needs of the
Caregiver
 Spiritual needs
 To feel connected to others
 To be listened to
 To be able to question an...
The Needs of the
Caregiver
 Caregivers sometimes need encouragement to:
 Express needs
 Accept help
 Stay connected wi...
Meeting
Caregiver’s
Spiritual Needs
Caring For
The
Caregiver
Power Tools:
Key
Concepts
PLiWA
Power Tools:
Key
Resources
Tr...
The Needs of the
Caregiver: Triple C
• Patient stories: One Day At A Time
Stepping Aside, Letting Go
@drbrowncares
drbrown...
The Needs of the
Caregiver: Triple C
• Teamwork among:
• Health professionals (caring nurses),
• chaplains, and
• communit...
The Needs of the
Caregiver:
SIDNEY AC, PLiWA
 Patient story: Because He Lives
@drbrowncares
drbrowncares@gmail.com
Developing Your Toolbox
1. What are your sources of hope, strength
and comfort?
2. What helps to get you through the
diffi...
High Yield Points
 Interest in caregiver as a whole person
 Caring respectable manner
 Assess and meet caregivers’ spir...
Quotes to consider
“I think, therefore I am.” ~ Rene Descartes, French
philosopher, writer, and mathematician
“I AM; there...
Quotes to consider
 “God will be in that hospital room with you…
There will be times when you can heal, though
you cannot...
References
 Balboni et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients...
Questions?
@drbrowncares
drbrowncares@gmail.com
Faith & Medicine At The
Bedside: Caring For The Caregiver
SHERRY-ANN BROWN, MD, PHD
NARDIA MCFARLANE, MD
MARK NYMAN, MD
Pa...
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Faith & medicine at the bedside - caring for the caregiver

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Faith and Medicine at the bedside. Caring for the Caregiver. #faith #medicine #caregiver #health #healthcare @drbrowncares

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Faith & medicine at the bedside - caring for the caregiver

  1. 1. Faith & Medicine At The Bedside: Caring For The Caregiver SHERRY-ANN BROWN, MD, PHD NARDIA MCFARLANE, MD MARK NYMAN, MD Painting from www3.stcamilluscenter.org @drbrowncares drbrowncares@gmail.com Please see ‘Women in Medicine & Dentistry’ @ www.cmda.org for an MP3 of the talk available for purchase online.
  2. 2. Outline  Jesus, Healer  Faith in America  Need for a Spiritual component  The Needs of the Caregiver  Power Tools for your Toolbox  Patient Stories @drbrowncares drbrowncares@gmail.com
  3. 3. Mathew 9:35 Jesus went through all the towns and villages, teaching in their synagogues, proclaiming the good news of the kingdom and healing every disease and sickness. @drbrowncares drbrowncares@gmail.com
  4. 4. Jesus, Healer St Francis Xavier Major Seminary, http://sfxms.blogspot.com @drbrowncares drbrowncares@gmail.com
  5. 5. Jesus, MD Archdiocese of Washington, http://blog.adw.org/2010/02/the-diagnosis-is-dire-but-the-doctor-is-in/ @drbrowncares drbrowncares@gmail.com
  6. 6. Jesus, Bedside http://www.ely.anglican.org @drbrowncares drbrowncares@gmail.com
  7. 7. Jesus, Power http://draltang02.blogspot.com/ @drbrowncares drbrowncares@gmail.com
  8. 8. Faith in America  According to an online poll of 2,455 U.S. adults by Harris Interactive in November 2007:  __% of adult Americans believe in God.  __% of the public believe in miracles.  __% believe in the existence of heaven. @drbrowncares drbrowncares@gmail.com
  9. 9. Faith in America  According to an online poll of 2,455 U.S. adults by Harris Interactive in November 2007:  82% of adult Americans believe in God.  79% of the public believe in miracles.  75% believe in the existence of heaven. @drbrowncares drbrowncares@gmail.com
  10. 10. http://www.gallup.com Organized Religious Preferences in the United States, 2012 (Gallup poll) @drbrowncares drbrowncares@gmail.com
  11. 11. The Need for a Spiritual Component  In a study at the Dana-Faber Cancer Institute:  __% patients/nurses/physicians felt providing spiritual care was important AND appropriate  __% patients frequency of spiritual care provided  __% patients positive impact of spiritual care  Spiritual care training for physicians, OR:  _x more likely to provide spiritual care  _% had received prior training Balboni et al, J Clin Oncol 2013 1;31(4):461-7 @drbrowncares drbrowncares@gmail.com
  12. 12. The Need for a Spiritual Component  In a study at the Dana-Faber Cancer Institute:  80% patients/nurses/physicians felt providing spiritual care was important AND appropriate  15% patients frequency of spiritual care provided  100% patients positive impact of spiritual care  Spiritual care training for physicians, OR:  7x more likely to provide spiritual care  14% had received prior training Balboni et al, J Clin Oncol 2013 1;31(4):461-7 @drbrowncares drbrowncares@gmail.com
  13. 13. The Needs of the Caregiver  Patient Story: I Cannot Die Tonight @drbrowncares drbrowncares@gmail.com
  14. 14. The Needs of the Caregiver  1.4 million cancer diagnoses in 2006 in USA  Similar number of family/primary caregivers  Caregiver vital for trajectory of disease  Spouses typically primary caregivers  ¾ caregivers in USA are women  Female - independent risk for poor well-being Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 Ferrell et al, Seminars in Oncology Nursing 2012 28(4):256-261 @drbrowncares drbrowncares@gmail.com
  15. 15. The Needs of the Caregiver  Caregiver’s life radically altered by diagnosis  Profound spiritual needs  Wrestle with faith  Witness pain and suffering  Struggle to maintain hope  Spiritual needs key for whole-person support Ferrell et al, Seminars in Oncology Nursing 2012 28(4):256-261 @drbrowncares drbrowncares@gmail.com
  16. 16. The Needs of the Caregiver  Females with private prayers/spiritual conversations  Successfully cope  Find meaning  Look beyond immediate burden  Finding meaning  may explain positive outcomes  can produce spiritual growth Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  17. 17. The Needs of the Caregiver  More religious family members  feel more positively about role as caregivers  get along better with those they care for  Providing care for the caregiver  Equips caregiver to address patient’s needs Weaver et al, Southern Medical Journal 2004 97(12):1210-1214 Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  18. 18. The Needs of the Caregiver  “To cure sometimes, relieve often, comfort always”  Spiritual strength: strength which gives the ability to face difficulties & overcome adversities  Meaning of life: a sense of purpose to life or that life is part of a greater plan or mission O’Connor and Skevington, Br J Health Psychology 2005 10 (pt 3):379-398 Wessel,Conn Med 1980 44(2):111-2 @drbrowncares drbrowncares@gmail.com
  19. 19. Stress-buffering hypothesis of spirituality Kim et al, Support Care Cancer 2007 15:1367-1374 @drbrowncares drbrowncares@gmail.com
  20. 20. Kim et al, Support Care Cancer 2007 15:1367-1374 (p<0.001) Stress-buffering hypothesis of spirituality @drbrowncares drbrowncares@gmail.com
  21. 21. The Needs of the Caregiver  Psychological distress from increased caregiver stress can be attenuated by maintaining faith and spirituality  Caregivers who are low in spirituality need help to derive faith and meaning in the context of cancer care Carson, Sem Onc Nurs 1997 pp271-274 Kim et al, Support Care Cancer 2007 15:1367-1374 Colgrove et al, Annals Behav Med 2007 33:90-98 @drbrowncares drbrowncares@gmail.com
  22. 22. Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 Stress-buffering hypothesis of spirituality @drbrowncares drbrowncares@gmail.com
  23. 23. The Needs of the Caregiver  Maintaining faith/finding meaning buffer[s] adverse effect of caregiving stress on mental health  Mortality rates higher for stressed caregivers Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 @drbrowncares drbrowncares@gmail.com
  24. 24. The Needs of the Caregiver  Caregivers who felt that the caregiving role was meaningful, perceived themselves to be healthier than those caregivers who saw little or no purpose in the caregiving role  Spirituality helps caregivers find meaning in their role, leading to improved health Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  25. 25. Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 Stress-buffering hypothesis of spirituality @drbrowncares drbrowncares@gmail.com
  26. 26. Stress-buffering hypothesis of spirituality Commentary: The previous slide indicates that we need to interpret these studies with caution. The figure is from a cross-sectional, retrospective study with self-reported data. As with any cross-sectional data, there is no overt determination of causality or directionality. This means that the data could be interpreted in at least two ways: • It has been suggested that caregivers who are more spiritual may embrace love, faithfulness generosity, and selflessness. They may view caregiving as a spiritual duty leading to positive appraisal and fulfilling their spiritual calling, while neglecting self-care. • Conversely, the data could suggest that caregivers who in general experience a greater decline in physical health pursue more spiritual coping mechanisms, regardless of their baseline spirituality.
  27. 27. The Needs of the Caregiver  Female caregivers:  Use spiritual resources more than men  More likely to experience negative effects  Stress-buffering effects same for both sexes Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 @drbrowncares drbrowncares@gmail.com
  28. 28. The Needs of the Caregiver  Medicine needs to further integrate these scientific findings into clinical practice to promote better patient care Weaver et al, Southern Medical Journal 2004 97(12):1210-1214 @drbrowncares drbrowncares@gmail.com
  29. 29. Assessing/Addressing Spiritual Needs Meeting Caregiver’s Spiritual Needs Caring For The Caregiver Power Tools: Key Concepts PLiWA Power Tools: Key Resources Triple C Power Tools: SIDNEY AC Key Questions @drbrowncares drbrowncares@gmail.comBrown, 2015, SMJ 108(1):67
  30. 30. Power Tools – Key Questions SIDNEY AC 1. Has faith or spirituality been of support as you face your loved one’s illness? 2. Is spirituality important to you, as you provide support for your loved one? 3. Is your spirituality similar or different from your loved one’s spirituality? 4. Have you encountered spiritual needs that you have as a family caregiver? 5. What has this caregiving experience been like for you? 6. Have you been able to find meaning in your caregiving experience? 7. Do you have a faith community, minister, or clergy available to you? 8. Has your spirituality changed since your loved one became ill? SIDNEY AC: Support, Important, Different, Needs, Experience, You, Available, Changed @drbrowncares drbrowncares@gmail.com QuestionsadaptedfromFerrelletal,2012,SemOncNurs Brown, 2015, SMJ 108(1):67
  31. 31. Mary’s story (parts 1, 2, 3) The Needs of the Caregiver: SIDNEY AC What feelings/ processes did Mary experience?  shock, denial, sadness, anger, acceptance  bargaining with God  intense pain with grieving  need to know loving/sustaining God Carson, Sem Onc Nurs 1997 pp271-274 Patient and caregiver may be out of synchrony @drbrowncares drbrowncares@gmail.com
  32. 32. Power Tools – Key Questions SIDNEY AC 1. Has faith or spirituality been of support as you face your loved one’s illness? 2. Is spirituality important to you, as you provide support for your loved one? 3. Is your spirituality similar or different from your loved one’s spirituality? 4. Have you encountered spiritual needs that you have as a family caregiver? 5. What has this caregiving experience been like for you? 6. Have you been able to find meaning in your caregiving experience? 7. Do you have a faith community, minister, or clergy available to you? 8. Has your spirituality changed since your loved one became ill? SIDNEY AC: Support, Important, Different, Needs, Experience, You, Available, Changed @drbrowncares drbrowncares@gmail.com QuestionsadaptedfromFerrelletal,2012,SemOncNurs Brown, 2015, SMJ 108(1):67
  33. 33. The Needs of the Caregiver: SIDNEY AC  Mary…  Believes in a personal, loving God  Clearly aware of spirituality in her life  Relies on spirituality to cope with caregiving Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  34. 34. The Needs of the Caregiver: SIDNEY AC  Caregivers of clinic patients TOP 10  Hope for the future  Strong faith in God  Caregivers of hospice patients TOP 10  Prayers from others  Strong faith in God Carson, Sem Onc Nurs 1997 pp271-274 Harrington et al, 1996 @drbrowncares drbrowncares@gmail.com
  35. 35. Meeting Caregiver’s Spiritual Needs Caring For The Caregiver Power Tools: Key Concepts PLiWA Power Tools: Key Resources Triple C Power Tools: SIDNEY AC Key Questions Assessing/Addressing Spiritual Needs @drbrowncares drbrowncares@gmail.comBrown, 2015, SMJ 108(1):67
  36. 36. Power Tools – Key Concepts PLiWA Presence • Being fully in the room with the caregiver – mind, body, and spirit Listening deeply • Hearing intention behind caregivers’ words • Uncovering underlying needs Bearing witness • Accompanying caregiver on journey • Sitting with caregiver in the midst of suffering Acts of compassion • Tangible responses that aid caregiver in feeling spiritually supported PLiWA Presence, Listening deeply, Witness, Acts of Compassion @drbrowncares drbrowncares@gmail.com ConceptsadaptedfromFerrelletal,2012,SemOncNurs Brown,2015,SMJ108(1):67
  37. 37. The Needs of the Caregiver  Caregivers…who had questioned their faith or felt distant from or angry with God, reported higher levels of depression as caregiving burden increased Carson, Sem Onc Nurs 1997 pp271-274 Colgrove et al, Annals of Behavioral Medicine 2007 33:90-98 @drbrowncares drbrowncares@gmail.com
  38. 38. The Needs of the Caregiver: SIDNEY AC, PLiWA  Patient story: Brokenness @drbrowncares drbrowncares@gmail.com
  39. 39. The Needs of the Caregiver  Spiritual needs  To feel connected to others  To be listened to  To be able to question and ask ‘why?’ Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  40. 40. The Needs of the Caregiver  Caregivers sometimes need encouragement to:  Express needs  Accept help  Stay connected with others  Continue to engage in spiritual activities Carson, Sem Onc Nurs 1997 pp271-274 @drbrowncares drbrowncares@gmail.com
  41. 41. Meeting Caregiver’s Spiritual Needs Caring For The Caregiver Power Tools: Key Concepts PLiWA Power Tools: Key Resources Triple C Power Tools: SIDNEY AC Key Questions Assessing/Addressing Spiritual Needs @drbrowncares drbrowncares@gmail.comBrown, 2015, SMJ 108(1):67
  42. 42. The Needs of the Caregiver: Triple C • Patient stories: One Day At A Time Stepping Aside, Letting Go @drbrowncares drbrowncares@gmail.com
  43. 43. The Needs of the Caregiver: Triple C • Teamwork among: • Health professionals (caring nurses), • chaplains, and • community clergy. @drbrowncares drbrowncares@gmail.com ConceptsadaptedfromWeaveretal,2004,SMJ Brown, 2015, SMJ 108(1):67
  44. 44. The Needs of the Caregiver: SIDNEY AC, PLiWA  Patient story: Because He Lives @drbrowncares drbrowncares@gmail.com
  45. 45. Developing Your Toolbox 1. What are your sources of hope, strength and comfort? 2. What helps to get you through the difficult times in your life? 3. Would you like someone to pray with you? @drbrowncares drbrowncares@gmail.com
  46. 46. High Yield Points  Interest in caregiver as a whole person  Caring respectable manner  Assess and meet caregivers’ spiritual needs  Develop toolbox  Ease patient suffering @drbrowncares drbrowncares@gmail.comBrown, 2015, SMJ 108(1):67
  47. 47. Quotes to consider “I think, therefore I am.” ~ Rene Descartes, French philosopher, writer, and mathematician “I AM; therefore I think…” • inspiration to exhort patients • wisdom to encourage caregivers @drbrowncares drbrowncares@gmail.com
  48. 48. Quotes to consider  “God will be in that hospital room with you… There will be times when you can heal, though you cannot cure.” Kushner, Medicine and Caring: Thoughts on Compassionate Care and a Religious Worldview, Medical Grand Rounds, Mayo Clinic 2012 @drbrowncares drbrowncares@gmail.com
  49. 49. References  Balboni et al. Why is spiritual care infrequent at the end of life? Spiritual care perceptions among patients, nurses, and physicians and the role of training. J Clin Oncol. 2013 1;31(4):461-7.  Borrell-Carrio et al. The Biopsychosocial Model 25 years later: Principles Practice and Scientific Inquiry. Ann Fam Med. 2004; 2:576-582.  Carson. Spiritual care: the needs of the caregiver. Semin Oncol Nurs. 1997;13(4):271-4.  Colgrove et al. The effect of spirituality and gender on the quality of life of spousal caregivers of cancer survivors. Ann Behav Med. 2007;33(1):90-8.  El Nawawi et al. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care. 2012 Jun;6(2):269-74.  Ferrell et al. Deriving meaning and faith in caregiving. Semin Oncol Nurs. 2012;28(4):256-61.  Kim et al. Psychological distress of female cancer caregivers: effects of type of cancer and caregivers' spirituality. Support Care Cancer. 2007;15(12):1367-74.  MacLean et al. Patient Preference for Physician Discussion and Practice of Spirituality. J Gen Inter Med. 2003; 18:38-43.  Phelps et al. Addressing spirituality within the care of patients at the end of life: perspectives of patients with advanced cancer, oncologists, and oncology nurses. J Clin Oncol. 2012 30(20):2538-44.  Post et al. Physician and Patient Spirituality: Professional Boundaries Competency and Ethics. Ann Intern Med. 2000;132: 578-583.  Rumbold. A Review of Spiritual Assessment in health care practice. MJA. 2007;186:S60-62.  Steinhauser et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000 284(19):2476-82.  Weaver et al. The role of religion/spirituality for cancer patients and their caregivers. South Med J. 2004;97(12):1210-4.  Wessel. To cure sometimes, to relieve often, to comfort always. Conn Med. 1980 44(2):111-2. @drbrowncares drbrowncares@gmail.com
  50. 50. Questions? @drbrowncares drbrowncares@gmail.com
  51. 51. Faith & Medicine At The Bedside: Caring For The Caregiver SHERRY-ANN BROWN, MD, PHD NARDIA MCFARLANE, MD MARK NYMAN, MD Painting from www3.stcamilluscenter.org @drbrowncares drbrowncares@gmail.com

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