Meeting People Where They Are: Taking Spiritual Assessment – Tessie Mandeville, Reverend & Bobbi Virta, Reverend Presented at the 2015 Palliative Care Summer Institute conference at Bellingham Technical College

1. Meeting People Where They’re At:
Taking Spiritual Assessment
Rev. Bobbi Virta, The United Church of Ferndale, WA, &
Rev. Tessie Mandeville, Palliative Care Chaplain,
PeaceHealth St. Joseph Med Ctr, Bellingham, WA

2.  https://www.youtube.com/watch?v=cx2Sps9aMcY

3. Tip #1:
Practice the art of
connecting, not
projecting

4. Tip #2:
Practice the art of
listening

5. The word ‘listen’
contains the same
letters as the word
‘silent’.

6.  Listening to the patient’s personal story.
 Who was this patient before they became sick?
 Who are they now when they are not sick?
 What accomplishments are they most proud of in
their life?
 From where do they draw strength during
challenging times?
 How does their faith inform the decisions they are
trying to make?
 What gives them meaning and purpose?

7.  When we understand who this person and
family is, what is important to them and why,
we find that they are more likely to hear and
accept the recommendations for treatment
that we make because they feel they not
only have been listened to but heard. This
builds trust (an action and emotion) and they
feel respected and cared for when they
know we see them as a whole person, not
just their disease or symptoms.

8. Tip #3:
Practice the art of
meeting people where
they’re at

9.  There is an increasing awareness in
healthcare that we are treating the
whole person—body, mind, emotions,
and spirit.
 Studies have shown that a holistic
model of care increases both patient
satisfaction and cost effectiveness.

10. Spiritual care is increasingly being
promoted as an essential part of
holistic care.
Religious and spiritual beliefs and
practices have been shown to be a
major component of how patients
cope with serious illness.

11. Studies have shown that care that
includes the spiritual dimension
increases patient and family
satisfaction and contributes to
decreases in the extraordinary cost
of excessive medical interventions at
the end of life.

12.  However, what we’re noticing is that the
spiritual care needs of our patients are
not always seen as a priority.
 One study found that physicians—the
central figures in treatment
decisions—are less likely than all
other hospital disciplines to believe it
to be important to refer patients to
chaplains.

13. Other research showed that 72
percent of the patients with
cancer surveyed said their
spiritual needs were minimally
or not at all supported by the
medical system.

14. People don’t care about
how much you know
until they know how
much you care.

15.  Recognize that emotional intelligence (EI) is equally as
important as IQ (and maybe more so during these
types of conversations).
 In 1990, during the days when the preeminence of IQ
as the standard of excellence was unquestioned,
psychologists Mayer and Salovey offered the first
formulation of a concept they called “emotional
intelligence”, an additional way of looking at
intelligence. Goleman expanded on this concept by
reviewing reports from both psychology and
neuroscience that gave us insight into our “two
minds”—the rational and the emotional—and how they
work together to shape who we are.

16.  In mastering communication with seriously ill patients,
the critical task for clinicians is to find a way to integrate
complicated biomedical facts and realities with
emotional, psychological, and social realities that are
equally complex but not very well represented in the
language of medicine. Working with life-threatening
illness is a cross-cultural experience. As a clinician,
you need to understand both the biomedicine and the
personal story, and you need to be able to speak both
languages.

17. Chaplaincy Care
 Care provided by a board certified chaplain or
by a student in an accredited clinical pastoral
education program. Examples of such include
emotional, spiritual, religious, pastoral, ethical,
and/or existential care.
 Care performed by professional chaplains.

18. Pastoral Care
 This phrase comes out of the Christian tradition and developed
within the socially contracted context of a religious or faith
community where the ‘pastor’ or faith leader is the community’s
designated leader who oversees the faith and welfare of the
community and the community submits to or acknowledges the
leader’s overseeing. The ‘faith’ they share is a mutually
received and agreed upon system of beliefs, actions, and
values.
 Pastoral care may form part of the care provided by a chaplain.
 Care performed by chaplains and other religious professionals,
usually with persons of their own faith tradition.

19. Spiritual Care
 Interventions, individual or communal, that facilitate the
ability to express the integration of the body, mind, and
spirit to achieve wholeness, health, and a sense of
connection to self, others, and/or a higher power.
 Forms part of the care provided by a chaplain.
 The overarching category representing a domain of
care comparable to “emotional care” that can and
should be performed to a greater or lesser degree by
all health care professionals.

20. Spiritual Care, cont’d
 A realm of care shared not only by the treatment team
but by whomever the patient considers important in
their life (i.e. a friend, co-worker, family member)
 In the setting of the hospital, spiritual care becomes a
responsibility of all team members but the chaplain is
the spiritual care expert and is able to have both a body
of knowledge to share and demonstrate what we add to
the care process.

21. Ways to Assess Spiritual Distress
 Spiritual Screening
 Spiritual History
 Spiritual Assessment

22. Spiritual Screening
 A quick determination by any health care
professional of whether a person is
experiencing a serious spiritual/religious
crisis and therefore needs an immediate
referral to a professional chaplain.

23. Spiritual History
 A process of interviewing patients, asking them
questions about their lives in order to come to a
better understanding of their needs and resources.
These questions are usually asked as part of a
comprehensive exam by the clinician who is primarily
responsible for providing direct care or making
referrals to specialists, such as professional
chaplains.
 FICA tool (handout)

24. Spiritual Assessment
 A more extensive [in depth, ongoing] process of active
listening to a patient’s and family’s story as it unfolds in
a relationships with a professional chaplain and
summarizing the needs and resources that emerge in
that process. The summary includes a spiritual care
plan with expected outcomes which should be
communicated to the rest of the treatment team.
 The assessment requires the training of the
professional chaplains and should only be done by
someone with that training.

25. A Basic Overview of Spiritual
Assessment:
 Relationships and Connectivity—To
identify the relationships and
connections that are significant in this
person’s life. This includes not only
family and friends but also with God or a
sense of the sacred as understood by
the person.

26. A Basic Overview of Spiritual
Assessment, Cont’d:
 Meaning and Purpose—To identify what
relationships, values, activities, interests,
or beliefs provide a sense of meaning and
purpose for the person. It’s important to
remember that the person’s values and
beliefs may be in a state of flux and/or may
need to be re-evaluated in light of a new
situation.

27. A Basic Overview of Spiritual
Assessment, Cont’d:
 Degree of Understanding and Congruence of
Response—To identify whether the person
understands her/his current medical condition and is
able to apply their values and beliefs to that medical
condition in a mature fashion.
 All of these would be summarized into a spiritual
care plan with expected outcomes which should be
communicated to the rest of the treatment team.

28. Tip #4:
Practice the art of
spiritual care

29. Remember Tips #1-3:
Practice the art of connecting, not
projecting.
Practice the art of listening.
Practice the art of meeting people
where they’re at.

30. Becoming a Non-Anxious
Presence
 Edwin Friedman, a Jewish Rabbi, family
therapist, and leadership consultant
expounded on Murray Bowen’s classic
phrase “non-anxious presence” and helped
differentiate between a person who has an
anxious presence and one who does not,
with the goal that one can become a non-
anxious presence and thereby facilitate a
healing relationship.

31. Meeting People Where They’re At:
The Heart of the Matter
 We have to find ways to meet people where they are at
because they can be nowhere else in that moment.
The spiritual care provider meets them in that space,
shares that space with them, and shines a light on
hope—helps them identify latent sources of hope.
 Effective spiritual care recognizes the central place
emotion plays in spirituality.
 We have to help people re-imagine what hope looks
like for them.