2 pages
Britney Foster
SpiritualCaregivingChapter3.pdf
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Envisioning the Ideal
As healers we have to receive the stories of our fellow human
beings with compassionate hearts, hearts that do not judge or
condemn but recognize boundaries within which the often
painful past can be revealed and the search for a new life can
find a start.
—Henri Nouwen, Ministry and Spirituality
What do healthcare professionals think is necessary to make the environment “spiritually healthy”? What would an ideal healthcare environment look like? How would we function in such an environ- ment? Is there any existing healthcare system that comes close to the ideal? Is the hope for a healthcare system that embraces the spirit of all just a fanciful notion, or could it be a reality?
This chapter describes a vision for such a healthcare system, exam- ines how the roles of healthcare providers would operate in such a sys- tem, elaborates on the ways patients and families would benefit from it, and presents examples of healthcare systems that embody aspects of the vision.
C o p y r i g h t 2 0 0 4 . T e m p l e t o n P r e s s .
A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .
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We asked participants, “What would you like to see done in the workplace that supports your personal efforts at bringing spirituality into healthcare?” The responses reflected a number of common con- cerns, but the primary theme was a need for leadership that embodies spiritual values, supports spiritual care for patients and families, and pro- vides spiritual support for the caregiver.The comments of our respon- dents demonstrate their recognition of the power of one person to make a difference to a patient, a group, and even a culture. Many expressed a strong desire for more kindness, compassion, acceptance of differences— including religious differences—and better communication.
Beyond these behaviors, participants recognized that what is needed is a system change of such magnitude that it would require focused intention, long-term commitment, and an acceptance of spiritual values that cherishes individuals and recognizes the significance of the work done by care providers. We have organized the text in this chapter to first examine the leadership issues.Then we address the changes needed to provide support for the spiritual care of patients. Last, we address sug- gestions for supporting the spirituality of the healthcare provider. In addition to these areas of focus, we include two responses that reflect totally different perspectives on the question,“What would you like to see done in the workplace that supports your personal efforts at bring- ing spirituality into healthcare?”
Leadership Issues
Quite a few of our participants commented on the importance of leadership in changing the healthcare culture. Dr. Gunnar Christiansen says,“The development of an environment in the workplace that fosters spiritual growth is dependent on the example of one employee for another and particularly by those in management. This will not come out by regulations or suggestions. It will occur only through demon- stration of love for one another, which requires appreciation of each person and being sensitive to his or her needs and feelings.”
Patricia Camp contends that the value of spiritual care must be not
Envisioning the Ideal
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only recognized but required by hospital administra- tors if this is to become a reality. In full agreement, Dr. Karen Soeken observes, “It is essential for manage- ment to have spiritual values. It is too bad it’s not a job requirement for management level!”
From the perspective of a healthcare administra- tor, Martha Loveland makes several very specific sug- gestions for the leadership of a healthcare organiza- tion.
I’d like to see corporate objectives set which are based on rea- sonable resources.Workload data should be shared/published so senior managers would have an objective base for making resource allocation decisions. I’d like all levels of senior man- agement to participate in every level of employment in the company.This would assist upper management to more accu- rately perceive, understand, and then manage the human issues that relate to the job.The employee must be valued and the employee must know he or she is valued in every feasible way. I’d like to see family needs recognized better with flexible scheduling, paid paternity leave, more paid vacation, and a workday not to exceed eight hours. Single parenting and blended families exert extreme pressure on the
whole family in trying to cope with communication and decision issues. The employee must be understood as having other interests and responsibilities beyond the work place.
* In what ways does the leadership of your healthcare organization support spiritual care? Spiritual well-being of employees?
* What would you like management to do to make your workplace environment more spiritually supportive to patients, families, and caregivers?
The development of
an environment in
the workplace that
fosters spiritual
growth is dependent
on the example of
one employee for
another and partic-
ularly by those in
management.This
will not come out
by regulations or
suggestions. It will
only occur through
demonstration of
love for one another,
which requires
appreciation of each
person and being
sensitive to his or her
needs and feelings.
—Dr. Gunnar
—Christiansen
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* Is it possible for spirituality to flourish if the leadership does not sup- port it? What about if the leadership is laissez-faire in regard to spir- ituality?
* Reread Martha Loveland’s suggestions. Are there additional sugges- tions you might make? If you were in leadership, which, if any, of her suggestions would you adopt? If you are in leadership, what do you do to make the workplace spiritually healthy?
Support for Spiritual Care
Overwhelmingly, the participants in this project believe that spiri- tual care is essential, and they each shared the ways they go about pro- viding that care. Many also expressed frustration, however, about the lack of support for spiritual care. Much of this frustration is focused on the perception that today the margin is much more important than the mission in healthcare.
Pediatric nurse Carole Richards says, “I would like to see as much focus put on the patient as is put on money. I would like to see a greater commitment to meeting spiritual needs and a greater recognition that the nurse makes an important contribution to this care.”
Dee Brooks explains that a stronger and more direct approach regarding spiritual care is needed:“From the beginning of the admission process we should ask patients what they desire for spiritual care.Then we need to follow up to make sure these needs are met and then we need to evaluate whether or not we were able to satisfy the spiritual needs of patients.”
Dianne Smith agrees but observes that a stronger and more direct approach must be taken regarding expectations of competency for staff
in providing spiritual care:“The focus on spirituality must be more than a brief mention during staff orientation. It must flow through every aspect of the healthcare experience.” She believes that if spiritual care were truly valued, then financial support would be made available to staff for attending conferences and in-services as a way of increasing competence in this area. Dianne’s suggestion is in line with a new stan- dard mandated by the Joint Commission on the Accreditation of
Envisioning the Ideal
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Healthcare Organizations requiring a spiritual assessment on all patients admitted to a general hospital, all psychiatric patients, patients in long- term care, and patients receiving homecare services.1
A few respondents identified a need for greater support for spiri- tual interventions such as prayer and talking about a patient’s relation- ship to God. Joyce Kinstlinger would like to see “a more open attitude for encouraging spirituality.This would include allowing staff to suggest to open and willing patients that bringing their problems to a Higher Power might be helpful.We should also be able to encourage patients to use churches, synagogues, and mosques as resources. And we should be allowed to encourage prayer in our patients’ lives without fear of retri- bution.”
Charity Johansson clarifies the difficult position that healthcare providers find themselves in when trying to balance agency policy with the responsibility to meet spiritual needs:
In the hospital, where I see patients once a week, as opposed to the educational setting, where I am the other days, I wish I would be given permission to spend some of my physical therapy minutes responding to a patient’s spiritual needs. Right now I clock my minutes very specifically, for example, : to :. Because I feel guilty spending any of these minutes on spiritual issues, I count any time spent responding to spiritual needs as nonbillable, nonproductive time. You know, not every patient wants a visit from the chaplain, and yet they may need some spiritual response every day.This part of care needs to be recognized as important.
“Respect for all persons is essential,” adds Sandra Brown. “Patient- focused care needs to be supported in reality, not just in word.This sup- port needs to include a thorough assessment of spiritual needs as well as provision of time and resources in the plan of care for meeting the spiri- tual needs of the patient. I believe that when a patient is in the hospital, it is essential that there be a designated spiritual leader who assesses the spiritual needs of patients every day and sees to it that those needs are met.This would include mobilizing the support systems that the patient values.”
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Occupational therapist Jay Brashear shares his dream for a spiritually centered home health agency: “I have a dream of starting my own home healthcare agency made up of clinicians and staff that are devot- ing their lives to the Lord.At our case conferences, we would pray for patients as well as discuss them. Somehow I would like this agency to challenge the current system nationally that makes accountability less documentation-driven. I would like to see the care of the patient take precedence over the care of the chart.”
Nancy Shoemaker, who works in a clinic of a large private nonprofit hospital system, would like to see “a visible presence of interdenominational clergy, such as chaplains, making rounds in the patient and staff areas. I remember when I was hospitalized to deliver my children, I was in a Catholic hospital, and nuns stopped by every shift to say hello. I was very comforted by their presence. I believe that patients and staff alike would benefit from increased accessi- bility to people who have dedicated their lives to spir- itual values.”
Kay Hurd says that although she is greatly sup- ported in her workplace, “I would like to see the chapel more accessible to patients, families, and staff. I also would like nursing education to instill a sense of ‘caring for’ patients and not just ‘taking care of ’ patients. Many nurses are not taking care of the same patients every day, so that interconnectedness and relationships cannot be established. If one could work out a schedule so that nurses could care for the same patients, I believe it would help not only the nurse but the patient as well.”
Envisioning the Ideal
Patient-focused care
needs to be sup-
ported in reality, not
just in word.This
support needs to
include a thorough
assessment of
spiritual needs as
well as provision of
time and resources in
the plan of care for
meeting the spiritual
needs of the patient.
I believe that when a
patient is in the hos-
pital, it is essential
that there be a
designated spiritual
leader who assesses
the spiritual needs of
patients every day
and sees to it that
those needs are met.
This would include
mobilizing the
support systems that
the patient values.
—Sandra Brown
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* In what ways is spiritual care to patients and families supported in your workplace?
* What would you like to see in your workplace to support the pro- vision of spiritual care?
* What are your thoughts about praying with patients? When, if ever, is this acceptable?
* How do you give spiritual care to patients and families?
Support for Spiritual Care of Staff
Although all our participants identified the many ways that they nurture their own spirits, many of them also felt that the current health- care system challenges their spirituality. Many of our respondents indi- cated that there is a need for a “culture” change regarding how people treat each other. Commenting on the importance of this, internist Her- man Brecher contends,“There is nothing that needs to be done in the physical environment.What is crucial lies in the quality of the interper- sonal relationship. It is in the interpersonal relationship that spirituality or belief is or is not created.”
Family physician Bernita Taylor believes that improved communi- cation at every level of healthcare would go a long way toward enhanc- ing the spiritual climate. Carole Richards commented on the lack of mutual support that exists between co-workers and between supervis- ory staff and those who they supervise.
A common response among our respondents was the need for recognition of how important their work is. The current culture in healthcare with its focus on economic issues not only devalues patients but caregivers as well. Everything seems to be subordinate to the bot- tom line. Psychiatric nurse specialist Vicki Germer believes that health- care workers need to hear more about the meaning of their work and a lot less about the financial concerns. Carol Story would like to be val- ued for the work that she does as a nurse, to be recognized and affirmed by those who are challenged to grow and succeed in their ministry as a result of her work.
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A few respondents shared their frustration when their spiritual values and beliefs seem to be disre- garded as unimportant. Harriet Coeling, on the nurs- ing faculty of Kent State University, wishes that oth- ers would recognize her desire to put God first and to interpret things from God’s perspective. She believes that her Christian faith tradition is not respected. Psychiatric nurse specialist Evelyn Yapp wants those in her work environment to show understanding rather than indifference to the importance of her spirituali- ty:“I want them to look beyond the surface and rec- ognize another person’s internal qualities. I want them to make thoughtful decisions without greed in provi- sion of healthcare to the people of God.”
Several people identified the need for a quiet place to retreat to during the day. Nurse Elizabeth Page “would like to see a place set up so that people of all religions could go in and pray privately during the day.”Vicki Germer commented that her facility had recently added a prayer-meditation room, and that it is a wonderful addition. Kelly Preston cited the need for “spiritual renewal days” that she believes could be sponsored by the chaplaincy department. Similarly, Charity Johansson adds, “There needs to be more openly sanctioned time for renewal of body and soul, less productivity expectations, and less committee time.” Karen McCauley offers this observation regarding the impact of deadlines and productivity standards: “In homecare, everything is driven by deadlines and quotas. People tend to rush into the office from making visits in order to make the deadline and fail to take time to smell the roses. Less hectic schedules would go a long way to creating a spiritual environ- ment.”
From a parish nurse perspective, Catherine Lick adds:
I work in a church, but I feel that more could be done for and with the staff
to create and foster relationships and support. This could be done through staff retreats that focus on personal care and concern, as well as on the real-
Envisioning the Ideal
What is crucial lies
in the quality of the
interpersonal
relationship. It is in
the interpersonal
relationship that
spirituality or belief
is or is not created.
—Dr. Herman Brecher
*
There needs to be
more openly sanc-
tioned time for re-
newal of body and
soul, less productivity
expectations, and less
committee time.
—Charity Johansson
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ization that ministry “burns” people out and we have to continually be filling our lamps. I came upon a quote from Mother Teresa that speaks what I am try- ing to say:
“Don’t think that love, to be true, has to be extraordinary.What is necessary is to continue to love. How does a lamp burn if it is not by the continuous feed- ing of little drops of oil? When there is no oil, there is no light.l.l.l. Dear Friends, what are our drops of oil in our lamps? They are the small things from every day life, the joy, the generosity, the little good things, the humility, and the patience, a simple thought for someone else. Our way to be silent, to listen, to forgive, to speak and to act, they are the real drops of oil that make our lamps burn viv- idly our whole life. Don’t look for Jesus far away. He is not there. He is in you, take care of your lamp and you will see him.”
This is what needs to be practiced in the workplace, whether a church, hos- pital, or factory.
There is research that supports many of the suggestions made by our respondents.Writing about Catholic institutions, Bazan and Dwyer call for healthcare organizations to address the spiritual needs of managers, physicians, nurses, and other employees who may be experiencing deep pain about the meaning and purpose of life.2 The authors suggest prayer support and compassion as effective spiritual interventions but also pro- pose that healthcare organizations can alter their structure and culture to provide environments that invite and support employees in address- ing their spiritual issues. Organizations can develop specific programs to address the spiritual yearnings of employees. Such programs could include availability of private spiritual direction, formal mentoring, renewal days or retreats, and spirituality programs for professionals.They emphasize how important it is that spirituality be considered in every activity undertaken by the organization—including recruiting. Re- sources should be allocated for expanded spiritual services; quiet places for reflection, meditation, and related classes; traditional retreats; and qualified personnel to address spiritual needs.
Graber and Johnson advocate additional strategies for healthcare organizations desiring to integrate spirituality.3 These include the use of focus groups to identify core or common values, ethics, and a philoso-
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phy of care.Any program sponsored by the healthcare organization must respect the views of nonreligious staff and patients and establish guide- lines regarding the extent and nature of spiritual support for patients.
* What do you need in the workplace to support your own spiritual well-being?
* Reread Catherine Lick’s comments on pages –. How do you keep your lamp filled?
* What impact do the demands of your job have on your spirituality?
Positive Responses
Not everyone had suggestions for change in the workplace. Nurse Beatrice Rosen feels supported in her workplace.“Part of my spirit is to look at life and my job with optimism,” she says. “My boss appreciates this, as there tends to be enough pessimism to go around. I also am aware that my immediate supervisors have a personal relationship with God—their compassion for others is evident, and that supports me in what I do and think.”
Physician Jack Hasson observes,“Most times, in the heat of battle, we do not appreciate how fortunate we are to be in situations to help oth- ers on a daily and hourly basis. I see this when I bring others with me on rounds who are not in the healthcare arena. To a man or woman, they tell me how rewarded they felt to experience what we experience daily and take for granted.We should have ways to remind ourselves of this fact.”
We researched existing healthcare organizations to determine if there were any that embody what our participants are looking for.There are probably many, but we report on three models.We learned about the first one from one of the participants in this project, Eileen Altenhofer.
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Eileen volunteers at Highline Community Hospital, the only Planetree facility in the state of Washington.4 In , Highline Community Hospital was named one of the nation’s top fifteen “hospitals with a heart” in the American Association of Retired Persons’ July/August Modern Maturity magazine. For the past nine years, Highline Com- munity Hospital has been working to bring the Planetree philosophy to life within the healthcare system.
The Planetree Model
Planetree was founded in as a nonprofit organization with a mission to personalize, humanize, and demystify the healthcare experi- ence for patients and families.The organization is dedicated to cultivat- ing healing in a pleasant, caring environment and is focused on patient- centered rather than provider-centered care, recognizing that each patient is a unique individual with physical, emotional, and spiritual needs. Because of this uniqueness, patients have a voice in the care pro- vided.They are encouraged to ask questions, to make suggestions, and to participate in their care.
The Planetree Alliance currently consists of forty-seven innovative hospitals and healthcare institutions located across the United States and in Canada.These organizations are dedicated to implementing Planetree programs and developing, with Planetree and other alliance members, new and increasingly effective programs.
The Planetree philosophy at Highline Community Hospital is evi- dent in a variety of ways. For instance, patient education is viewed as critical to demystifying medical care. Patients have access to informa- tion about their medical condition and available treatments through the Planetree Health Library and Family Education program. Eileen Altenhofer volunteers at the library to do research for patients and fam- ilies and to compile the research findings into a useful reference for them.
The patient-centered philosophy is expressed through the Healing Arts program, the environment, the respect and dignity afforded each patient and family, and the overriding belief that the patient is so much more than an illness. The patient is a whole person with emotional,
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physical, and spiritual needs who is member of a family, of a communi- ty, and of a culture.
Through the hospital’s Healing Arts program, patients have access to chaplaincy services and the use of music, massage, warm-water therapy, relaxation techniques, aromatherapy, and other healing measures that result in greater comfort, less anxiety, and increased satisfaction for patients and families.The physical atmosphere of the facility is nurtur- ing and as homelike as possible.The healing gardens at Highline offer a peaceful and beautiful sanctuary for patients, families, and staff.
In addition, Highline’s patient care areas are designed to provide comfortable and homelike surroundings for patients and their guests. One of the wings of the hospital includes a spacious family area where families and friends can gather and relax and even make a meal in one of its full-size kitchens. Patients are cared for in private rooms with dec- orated woodwork, artwork, and large windows that foster a healing environment.
Medical-Religious Partnerships
A second model we found was developed by Daniel Hale and Richard Bennett in central Florida.5 This model combines healthcare and spirituality in a different way than does Highline Community Hospital. Dr. Hale and Dr. Bennett have created partnerships between religious and healthcare organizations that build healthier communities. In contrast to the example of Highline Community Hospital, which incorporates the sacred into the secular healthcare arena, this project incorporates secular healthcare into the sacred arena of the church.
In these partnerships, the clergy speak from the pulpit to remind church members about the importance of maintaining health and seek- ing out quality healthcare for themselves and their families.When health is spoken about in the context of the church, health becomes more than a physical matter—it is a spiritual matter clearly linked to an individual’s responsibility to honor the body as a temple of God’s Spirit. Following the clergy’s introduction of the importance of health as a relevant con- cern of the church, the congregation receives visits from doctors and other health professionals to provide education on important health
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issues such as cancer, hypertension, depression, and medication manage- ment. Additionally, the healthcare professionals provide training to church-based lay health educators and patient advocates. Hale and Bennett report that this model is so popular that it has spread beyond Christian congregations to Jewish synagogues and Muslim mosques.
Daughters of Charity Model
A third model, similar to Highline Hospital but with a religious foundation, is found in many of the hospitals that are part of the Daughters of Charity National Health System (DCNHS). In , the leaders of the DCNHS-East Central region decided to explore the spir- ituality that was foundational to their ten facilities. They convened a study group made up of the top DCNHS-EC leaders and representa- tives of other DCNHS regions and ministries.They met quarterly for one year to explore the distinction between religion and spirituality, the difference between human development and human formation, the pri- macy in Western culture of the functional dimension of human life over the transcendent dimension, and the importance of beholding the mys- tery of life rather than trying to control or manipulate it.6
They completed their sessions in and summarized their find- ings.The leaders of each DCNHS-EC facility were encouraged to read, understand, and support the findings. The vice presidents for mission services were encouraged to integrate spirituality and spiritual forma- tion in their work. Since that time, the DCNHS-EC facilities have inte- grated spirituality into the workplace by sponsoring spirituality com- mittees, retreats, renewal days, and pilgrimages.
Let’s take a look at one of those facilities, St.Vincent Hospitals and Health Services in Indianapolis, to see what it means when an institu- tion integrates spirituality.
St.Vincent Hospitals and Health Services in Indianapolis is a tertiary hospital serving over , patients a year.The hospital is committed to treating the whole patient—body, mind, and spirit—and recognizes that healing cannot take place unless all aspects of the person are in- cluded in the care.The mission of the hospital extends beyond the walls of the institution to provide care for the poor and those whom the rest
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of society ignores.The hospital envisions itself as a catalyst for collabo- rative community action to provide a full range of preventive, social, spiritual, and educational services.
The hospital is the home of the Indiana Heart Institute, which is the state’s largest cardiac center and one of the largest cardiac programs in the United States. In addition to the cardiac specialty, St.Vincent pro- vides treatment for many other specialties such as cancer, sleep disorders, orthopedics and sports medicine, maternity care, neurology and neuro- surgery, ophthalmology, hand and microsurgery, laser surgeries, mini- mally invasive surgeries, occupational health, stress centers, senior serv- ices, and community development. Additionally, an outreach service through St.Vincent Health provides healthcare to people who live in rural communities.
Part of St.Vincent’s mission is to build better communities.The hos- pital offers a full range of community services. Let’s examine just two areas where community contributions are made. In the area of the spir- itual environment, St.Vincent’s believes it is essential that the values, col- laborations, and actions of individuals and communities reflect their beliefs and ethics, as well as a sense of being part of something bigger. They provide pastoral care counselors who strive to be conduits of God’s love and peace for those who are confronted with life’s struggles. Chaplains are available to provide comfort and guidance to patients and families while at the same time respecting individual faith preferences.
The hospital built the Seton Cove Spirituality Center as a place for spiritual growth.This interfaith center is available to St.Vincent staff for the purpose of spiritual formation and renewal. Spiritually focused pro- grams are offered that provide insights into the spiritual significance of work and family life. In addition, St.Vincent physicians have received John Templeton Spirituality in Medicine grants in recognition of their efforts to integrate spirituality into resident programs and standards of care.
The hospital’s commitment to the natural environment is evident in several ways. St. Vincent’s Meditation and Fitness Trail is open to St. Vincent staff, patients, and the community at large.The trail provides a peaceful natural setting that fosters mental, physical, and spiritual well-
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being.The Reflection Garden is located in a quiet courtyard of the St. Vincent Hospital in Indianapolis and is dedicated to those in need of peace and spiritual strength to overcome the challenges of life. The Robert E. Colvin Simplicity Garden was donated by the family of a for- mer St.Vincent staff member who provided the hospital with twenty- four years of loyal and dedicated service.The garden is surrounded by the walls of St.Vincent Hospital and includes a statue of St. Francis of Assisi to welcome visitors.
The hospital’s commitment to education is evident in the Pediatric Asthma program, which provides a respiratory therapist to bring asth- ma education and therapies directly to school children suffering from asthma and other respiratory problems. St.Vincent’s provides graduate, undergraduate, and continuing education opportunities to physicians, residents, and medical students with approved training in internal med- icine, family medicine, obstetrics/gynecology, and geriatric medicine. Because St. Vincent recognizes that caring for the soul is essential to healing, it provides education and pastoral care residency programs in the Stress Center, hospice, cardiology, ICU, and family life areas. Other trained seminarians, clergy, and laypeople provide pastoral care in clini- cal areas throughout the hospital. St.Vincent has shared clinical pastoral education with hospitals in several adjacent communities.And lastly, St. Vincent collaborates with the University of Indianapolis and Marian College to sponsor registered nurses in a parish nurse course.This effort supports many denominations in the community in an effort to im- prove the health of all citizens.This is a healthcare system that has truly committed itself to the integration of spirituality in every aspect of its operations.
* Review the three models presented. In what ways do they integrate spirituality?
* How does your workplace integrate spirituality? * What can you do to bring spirituality into the workplace?
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Let’s end this chapter with a bit of a fantasy excursion.We have heard about our participants’ “wish list” regarding what they think would make the workplace more spiritual. We have examined three models that approximate elements of the ideal. Now, let’s imagine the ideal. Allow the story of Pleasantville, a make-believe community, spark your imagination. Allow yourself to dream about what it would be like to work in Pleasantville Community Hospital or to provide healthcare ser- vice within the surrounding Pleasantville community.
Ten years ago the leadership in Pleasantville Community Hospital, desiring to differentiate itself from that of the other hospital systems in Pleasantville, conducted a large survey of the community. They were interested in knowing what factors influenced patients’ choices regard- ing which healthcare facility and healthcare providers to use.The results of the survey indicated overwhelmingly (but not surprisingly) that respondents identified competence of healthcare providers as the most important factor in choosing a provider and/or a hospital. But in addi- tion to provider competence, respondents identified other “soft factors” as almost equally important. The need to be treated with compassion and dignity, to be consulted on their care, and most of all to have their stories heard—all of these weighed heavily in respondents’ healthcare choices. The hospital followed this large survey with focus groups to better understand what respondents wanted and how the hospital could ensure that these needs were met.The focus groups identified as spiri- tual issues these “soft factors” of patients being heard and feeling that they were not only receiving care but also being cared for.
The hospital administration followed the survey and focus groups with an investigative group charged with examining research literature in the area of patient satisfaction.These efforts led to the identification of a growing body of research pointing to the positive relationship between faith and health.The hospital decided to embark on a plan to systematically address spiritual issues as part of its mission to the Pleasantville community.The plan involved multiple steps, including:
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. Defining a new mission statement . Engaging all employees within the system to share the vision
and to provide their input into implementation of the vision . Discovering what employees identify as essential supports for
their own spiritual wholeness . Enlisting the support of hospital chaplains to plan a spiritual
training program .Training existing employees as well as orienting new employees
to this holistic approach . Modifying written materials used in all aspects of care, from
admission to discharge, to reflect the holistic focus of the institution . Evaluating the environment to ensure that it supports spiritual
well-being . Reaching out to the surrounding faith communities to collabo-
rate on the development of congregational health ministries, including parish nurses and well-trained lay volunteers
. Applying for a research grant to evaluate the effectiveness of these changes
. Making a commitment that the Pleasantville Hospital and sur- rounding faith communities would be a center of excellence for spiri- tual research and holistic healthcare
. Planning how these changes would affect day-to-day operations
Each of these steps is described. The mission statement. The first step involved redefining the mission
statement of the hospital.This process took six months to complete.The goal was to create a mission statement that was ecumenical in nature, that could capture the hearts and minds of the employees within the hospital system, and that would send a powerful message to the sur- rounding community that the hospital had indeed heard what people were asking for and was committed to providing not only competent healthcare but spiritual care as well. The following mission statement represents the culmination of these efforts:
We are a community of caregivers dedicated to service, respecting the religious and spiritual values of all who seek our services, bringing wholeness to patients and
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families who come to us for care, facilitating wholeness in those who provide care, and making a difference through service to the community at large.
Involving staff in implementing the vision. Step two of the hospital’s transformation involved engaging all employees within the Pleasantville Hospital system to share the vision and to seek their input into the implementation of the vision.This process took another six months and involved small-group discussions. The participants included chaplains, physicians, nurses, therapists, social workers, nursing assistants, and unit secretaries, as well as housekeeping, maintenance, admitting, billing, lab- oratory, dietary, and radiology employees—in fact, everyone who had any interpersonal contact with patients and families.The administration of the hospital assumed responsibility for sharing the results of the earli- er investigative work. That research uncovered what patients wanted from the hospital, supporting the importance of integrating spiritual care into the total package of care and the importance of each employee in making this commitment to holistic care a reality. Out of these small- group discussions, the administration achieved “buy in” from the em- ployees, who also provided suggestions regarding what was needed to support their own spiritual well-being.
Spiritual supports for staff. Step three involved discovering what em- ployees believed were necessary spiritual supports for them.The sugges- tions made by employees included provision of places for quiet reflec- tion, availability of ecumenical worship services throughout the day on all shifts, support of prayer groups, and spiritual retreats.
Development of training materials. Step four involved engaging the chaplains, the “spirituality experts,” in developing training materials for existing employees as well as for new employees being oriented to the hospital system. The training included information about the im- portance of spiritual care; the relationship between religion and spiritu- ality and how to respect each; how to recognize spiritual needs and implement spiritual care; how to fully integrate hospital chaplains and community-based clergy into the care delivery system; the importance of volunteerism; and what it means to be a good steward of limited resources.
Envisioning the Ideal
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Implementation of training. Step five commenced with the first train- ing session provided to hospital personnel. Initially, chaplains used a “train the trainer” approach to provide instruction to personnel who were interested in becoming trainers.This approach decreased the bur- den on chaplains and greatly expanded the number of personnel with expertise in spiritual care.The training sessions were offered at a variety of times on all shifts to ensure that everyone was included.The training sessions were designed to be not just an exchange of information but rather a positive spiritual experience where participants shared their sto- ries and learned from each other. The groups were small and always began with a prayer led by one of the participants. Refreshments were served, and participants left with a prepared booklet providing concrete examples of patient situations that exemplified spiritual care.
Revision of paperwork. The sixth step was tedious to complete. The administration recognized that creating a spiritual environment where wholeness could be achieved meant that every aspect of what the hos- pital did, including the forms and variety of paperwork used, needed to reflect this commitment. Beginning with the admission packet and moving though each piece of the record, every item of written mate- rial was scrutinized; much of it was changed. For instance, the following statement was added to letters sent to patients detailing what to expect during admission:
Pleasantville Hospital, in conjunction with a variety of faith communities, is ded- icated to providing holistic care that includes meeting spiritual needs. Patients and families can expect that at least one person on the care team—a physician, nurse, chaplain, or social worker—will do a spiritual assessment/history and ask in what ways the patient can be supported spiritually during his/her hospital stay.
Structured assessment tools used by various healthcare providers were modified to include the spiritual aspect of care. Another critical decision was made to place plaques proclaiming the mission statement strategically throughout the hospital.
Environmental modification. Step seven involved an evaluation of the environment to determine whether it was conducive to spiritual well- being.This evaluation led to a decision to modify all areas of the hospi-
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tal to be in line with the existing birthing center, where rooms were warm and inviting, and to designate “quiet reflection places” through- out the hospital where employees, patients, families, and other visitors could retreat for brief periods for spiritual recharging. Decisions were made to repaint all areas of the hospital in soothing colors and to play soft background music to create a peaceful ambience. The changes to the environment were phased in as part of a four-year capital improve- ment plan.
Inviting the community to participate. The eighth step ran concurrently with many of the earlier steps and focused on reaching out beyond the hospital boundaries to surrounding faith communities, business leaders, and other community-based health providers.This step was undertaken to expand the notion of a healing community from the hospital system to encompass the whole community.The Pleasantville Hospital system offered to fund a full-time position for a parish nurse coordinator. Faith communities were encouraged and offered support in developing con- gregational health ministries under the leadership of a parish nurse, who would be supported by the hospital-based parish nurse coordinator. Business leaders were encouraged to lend financial support to faith communities in their development of the parish nurse position as well as the congregational health ministry. Community-based healthcare providers were invited to participate actively in the unfolding of the hospital’s vision, including attending the training sessions being offered.
Funding and research. The ninth and tenth steps were intricately linked. Pleasantville applied for and received a large research grant to evaluate the effectiveness of these system-wide changes. It sought the expertise of an internationally recognized medical researcher to provide leadership for the research efforts and made a commitment that the hos- pital, in conjunction with the surrounding community, would be a cen- ter of excellence in whole-person care.
Restructuring patient care. The eleventh step led to a major restructur- ing of how patient care was delivered. To provide the type of care to which the hospital had committed itself, additional resources were needed, and a new model of care was formulated. For instance, the essential role of the chaplain as the spiritual leader was recognized, but
Envisioning the Ideal
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the hospital didn’t have enough chaplains to provide the amount and type of support needed. Not only did the hospital undertake a major recruiting effort to hire more full-time chaplains, but it also made a commitment to establish Pleasantville Community Hospital as a chap- laincy training institution.
Another structural change involved inviting clergy from the sur- rounding community to provide religious services in the hospital chapel.These services were videotaped and could be accessed on closed- circuit television throughout the hospital.The chaplains interacted with patients, families, and all the staff who so desired.
A weekly care-planning meeting was added to each unit’s schedule. This meeting included everyone who had contact with patients and families—physician, chaplain, nurses, social workers, therapists, nursing assistants, the parish nurse from the patient’s faith community, and some- times the housekeeping personnel. The focus of this meeting was to determine what the patients needed medically, emotionally, and spiritu- ally, how those needs would be met, who on the team could best address specific needs, and what would be needed upon discharge to continue to move patients towards wholeness.
Usually any change is confronted with resistance; change is difficult and moves people out of their comfort zone. But at Pleasantville Community Hospital, where the changes were more than cosmetic and targeted the very culture of the hospital and surrounding community, change was embraced and applauded. The response of patients was so positive that there were waiting lists for admission for elective proce- dures. There was no nursing shortage at Pleasantville Community Hospital. In fact, nurses from all over the state applied for positions.The hospital served as a magnet for extraordinary practitioners in all fields who desired to work in an environment where the patient was the bot- tom line. Finances were not an issue either.The surge in patient revenue, together with donations from wealthy benefactors from the business community and a number or private foundations, supported the hospi- tal’s efforts.
Too good to be true? Perhaps, but maybe .l.l.
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