december 1, 2011 mgh chaplaincy 2 — caring headlines — december 1, 2011 jeanette ives erickson...

CaringDecember 1, 2011

Headlines

The newsletter for Patient Care ServicesM a s s a c h u s e t t s G e n e r a l H o s p i t a l

Patient Care Services

Annual Blessing of the Hands honors the work our hands do to supportthe healing and hope of so many.

MGH ChaplaincyMGH Chaplaincya hands-on approach to spiritual carea hands-on approach to spiritual care

See related storiesthroughout this issue of

Caring Headlines

See related storiesthroughout this issue of

Caring Headlines

— Caring Headlines — December 1, 2011

Jeanette Ives Erickson

continued on next page

Jeanette Ives Erickson, RN, senior vice presidentfor Patient Care and chief nurse

Nation al Patient

Safety Goals, which

are updated annually,

describe specifi c

actions organizations

are expected to

take to prevent

medical errors,

miscommunication

among caregivers,

unsafe use of

equipment, and

improper medication

administration.

s many of you are aware, Na- tional Patient Safety Goals were established by The Joint Commission in 2002 to help accredited healthcare organizations improve care by pro- actively addressing quality and safety issues. In order to earn or maintain accreditation, organizations must demonstrate through documentation and on-site visits that they have the policies and practices in place to protect patients from specifi c healthcare errors. Nation- al Patient Safety Goals, which are updated annually, describe specifi c actions organizations are expected to take to prevent medical errors, miscommunication among caregivers, unsafe use of equipment, and im-proper medication administration.

National Patient Safety Goals are determined through a collaborative process. A panel of patient-safety experts, called the Patient Safety Advisory Group, advises The Joint Commission on how to address emerg -ing patient-safety issues. This panel is comprised of nurses, physicians, pharmacists, risk managers, clinical engineers, and others with real-life experience in the healthcare setting. With input from clinicians, pro-vider organizations, consumer groups, and other stake-holders, The Joint Commission determines the high-est-priority patient-safety issues, and they become the designated National Patient Safety Goals for that year.

The National Patient Safety Goals that we focus on at MGH are not sequentially numbered. That’s be-cause, in addition to hospitals, The Joint Commission issues safety goals for ambulatory, behavioral, labora-

tory, and home-care practices. We focus strictly on the goals established for the hospital setting.

2011 Joint CommissionNational Patient Safety Goals

Goal 1: Improve the accuracy of patient identifi cation: • Use at least two patient identifi ers when pro-

viding care, treatment, and services • Eliminate transfusion errors related to patient

mis-identifi cationGoal 2: Improve the effectiveness of communication

among caregivers: • Report critical results of tests and diagnostic

procedures on a timely basisGoal 3: Improve the safety of using medications: • Label all medications, medication containers,

or other solutions on and off the sterile fi eld in perioperative and other procedural settings

• Reduce the likelihood of patient harm associ-ated with anticoagulant therapy

• Maintain and communicate accurate patient medication information (effective 7/1/11)

AA

National Patient Safety Goals

National Patient Safety Goals

When it comes to Excellence Every Day,there’s no such thing as compromise

When it comes to Excellence Every Day,there’s no such thing as compromise

December 1, 2011 — Caring Headlines —

Jeanette Ives Erickson (continued)

In this IssueMGH Chaplaincy.................................................................1

Jeanette Ives Erickson .......................................................2• National Patient Safety Goals

Respiratory Care Week ..................................................4

Chaplaincy Retreat .............................................................6

A Day in the Life of an MGH Chaplain .................8

Clinical Narrative ............................................................10• Patti Keeler, Staff Chaplain

Clinical Pastoral Education: Then and Now ............................................................12

CPE: Collaborative Care .............................................14

Recycling in the OR .......................................................16

Professional Achievements ........................................17

Fielding the Issues ...........................................................18• New Patient & Family Advisory Council

Announcements ..............................................................19

Sacred Space, Sacred Pace Labyrinth .................20

I think of

National Patient

Safety Goals as

valuable tools

that help iden tify

potential dangers

before they can

result in harm to

patients. I think of

National Patient

Safety Goals as

working together

with The Joint

Commission to

ensure the highest

quality care for

patients and families.

Be cause when it

comes to Excellence

Every Day, there’s

no such thing as

compromise.

Goal 7: Reduce the risk of healthcare-associated infections: • Implement evidence-based practices to prevent

healthcare-associated infections due to multiple drug-resistant organisms in acute-care hospitals

• Implement best practices or evidence-based guide-lines to prevent central-line-associated blood-stream infections

• Implement best practices for preventing surgical-site infections

Goal 15: Identify safety risks inherent in patient popula-tions:

• Identify individuals at risk for suicide

Universal Protocol

• Conduct a pre-procedure verifi cation process

• Mark the procedure site

• Perform time out

At a recent meeting of the Staff Nurse Advisory Commit-tee, we were fortunate to hear from Keith Perleberg, RN, director of the PCS Offi ce of Quality & Safety, and staff specialist, Carol Camooso Markus, RN, who shared infor-mation about how National Patient Safety Goals are evalu-ated at MGH. They described how Joint Commission sur-veyors assess compliance using one or more of the following methods. They:

• observe practice

• review a patient’s medical record

• interview staff

• interview a patient

One staff nurse shared her experience during the recent Joint Commission laboratory survey when the surveyor tracked a unit of blood from the MGH Blood Bank to the patient care unit where she worked. She proudly explained how the surveyor had witnessed a proper two-person verifi -cation as she verifi ed the blood transfusion with another nurse on the unit.

To gauge the group’s readiness for a regulatory visit, Camooso Markus threw out some impromptu, mock survey questions. I’m happy to report, not a single incorrect answer was given.

The Joint Commission has approved one new Na tional Patient Safety Goal for 2012 that fo-cuses on catheter-associated urinary-tract infec-tion. It states: “Implement evidence-based prac-tices to prevent indwelling catheter-associated urinary-tract infections.”

As healthcare providers, we understand the importance of maintaining a safe environment for patients. It’s a responsibility we all share. I think of National Patient Safety Goals as valuable tools that help iden tify potential dangers before they can result in harm to patients. I think of National Patient Safety Goals as working together with The Joint Commission to ensure the highest qual-ity care for patients and families. Be cause when it comes to Excellence Every Day, there’s no such thing as compromise.


ctober 17, 2011, marked the beginning of National Respir- atory Care Week. Since its introduction in 1982 by President Ronald Reagan, this annual event has provided an occasion to recognize respiratory therapists’ contributions to patient care. At MGH, Respiratory Care Services employs more than

90 registered respiratory therapists. Members of the de-partment are local and national leaders through the their work with the American Association for Respir-atory Care and the Massachusetts Society for Respira-tory Care. Many MGH respiratory therapists complete specialized training to qualify for expanded roles, in-cluding transporting critically ill infants from outlying institutions to the MGH Newborn Intensive Care Unit and attending the deliveries of high-risk infants.

Since 1986, respiratory therapists have provided extracorporeal life sup-port under the medical direction of MGH pedi-atric surgeons.

Respiratory therapists are familiar faces through-out the hospital, wher-ever you fi nd patients. In intensive care units, they are primarily involved in the assessment and man-agement of patients who need continuous ventila-tory support. On general medical and surgical units, they follow patients with tracheostomies, provid-ing airway care, and oxy-gen and humidity ther-apy. When patients’ con-ditions improve, they re-place their trach tubes with smaller ones apply-ing special valves that al-low them to speak, de-spite a tracheostomy.


Respiratory therapist,Kim Brown-Tyndall, RRT, a member of the NICU

Transport Team, (pictured with Medfl ight pilot), stabilizes critically ill

newborn transported from community hospital

to Level III NeonatalICU at MGH.

Respiratory Care

OO

(Photos provided by staff)

Respiratory CareRespiratory Carean integral part of patient care

across the spectrum of healthcare settingsan integral part of patient care

across the spectrum of healthcare settings— submitted by Respiratory Care Services


For many patients, the need for a tracheostomy is only temporary. Respiratory therapists partner with col-leagues in Speech-Language Pathology and Nursing to transition patients back to their natural airways as soon as clinically indicated.

Respiratory therapists manage a large volume of patients who use nocturnal CPAP (Continuous Posi-tive Airway Pressure, a treatment that utilizes mild air pressure to keep airways open) to help with sleep apnea or to provide assistance breathing using non-

invasive ventilation. Respiratory thera-pists deliver a variety of aerosolized medi-cations using special nebulizers. Many of these drugs are designed to treat patients with chronic pulmonary diseases such as cystic fi brosis or manage chronic pulmo-nary hypertension that many patients with long-term pulmonary disease develop. Respiratory therapists are an essential part of the Code Team and the Rapid Response Team in addition to assisting nurses and medical staff in managing aerosolized drug- and oxygen-delivery. Respiratory therapists assist with bronchoscopies and hyperbaric oxygen-therapy treatments at the MEEI.

As our founding fathers so presciently observed back in 1811, “In times of dis-tress every man is a neighbor.” Respiratory therapists play an active role in disaster re-lief here in the United States and interna-tionally. Many therapists are members of the International Medical Surgical Relief Team (IMSurT) as well as the hospital’s Hazard ous Material (HAZMAT) team, a multi-disciplinary team that responds to hazardous-environment situations and the decontamination of patients exposed to hazardous materials.

As a profession, Respiratory Therapy is an integral part of patient care across the spectrum of healthcare settings. Look for respiratory therapists providing care, edu-cating patients and staff, and collaborating with the healthcare team in almost every patient-care location.

For more information on the services provided by respiratory therapists at MGH, call 4-4493.

Respiratory Care (continued)

As a member of the InternationalMedical Surgical Relief Team (IMSurT), respiratory therapist, Carlos Heymann, RRT, provides breathing assistance to young childin Haiti after the 2010 earthquake.


a meeting of minds for the healing of souls— by Michael McElhinny, director, MGH Chaplaincy

a meeting of minds for the healing of souls

Chaplaincy

n September 28, 2011, the MGH Chaplaincy came together for a day-long retreat of strategic planning, team- building, and self-awareness activities. The theme was, ‘Pulling together: ensuring we’re all rowing in the same direction.’ We were fortunate to be joined by executive director of PCS Operations, Marianne Ditomassi, RN, and professional development manager, Rosalie Tyrrell, RN. Tyrrell administered the Myers-Briggs Type Indica-tor to attendees, which revealed some important nu-

ances about who we are, how we approach our minis-try, and how we might better function as a team.

We took a close look at present reality, considering our strengths, weaknesses, opportunities, and threats to current practice. Each chaplain had been asked to benchmark chaplaincy services at other hospitals, and sharing this information with the group generated helpful ideas for strategies that might be of use in our own department.

We began the important work of crafting a vision statement. This effort is ongoing and has brought us closer together as a team. By the end of the retreat, three areas of focus had emerged as strategic goals for the Chaplaincy:

• schedule visits with equity, effi ciency, and best use of resources

• improve communication within the department

• implement a productivity measurement tool

We’ve begun to share clinical narratives with one another and benefi tted from the lessons learned by our colleagues. These narratives highlight our skill and in-tervention techniques and are an excellent tool for sharing best practices. Professional development man-ager, Mary Ellin Smith, RN, is assisting us in this work.

During National Pastoral Care Week, October 24–28th, the Chaplaincy offered an educational booth in the Main Corridor to provide information and spiritual resources to staff and visitors of all faith traditions and those of no religious affi liation. On display was the ever-popular prayer tree, a video presentation high-lighting the services provided by the department, and soothing harp music from a Gentle Muse.

The annual Blessing of the Hands took place in the MGH Chapel and, by request, on many patient care

Members of the MGH Chaplaincy at recent

strategic planning retreat


OOChaplaincy retreat:Chaplaincy retreat:


Chaplaincy

units. And the Sacred Space, Sacred Pace Labyrinth was available for spiritual meditation in the MGH Chapel.

We ask clinicians to help us help patients and fami-lies get the spiritual care they need.

Consult a chaplain when a patient:• is newly diagnosed with a terminal or serious illness• wants to explore treatment options• wants to talk about advance directives • has diffi culty making sense of a health crisis• draws on spirituality or religion to cope• feels abandoned or punished by God• agrees to re-direct care• is being resuscitated • has been hospitalized for more than fi ve days• is considered for organ donation• has a specifi c religious request• requests a family meeting• needs a listening ear • feels dis-spirited or discouraged by a lengthy hospi-

talization or diffi cult course

Consult a chaplain when a family member:• would benefi t from spiritual support in time of crisis• is asked to make decisions on behalf of a loved one• has a specifi c religious request• would like a spiritual perspective on critical illness• has requested to transition care to comfort measures

Consult a chaplain when a staff member:• faces a personal challenge in caring for a patient• has a question about religious teachings that affect

medical decisions

• experiences compassion fatigue or moral distress

For routine requests, call 6-2220, or enter requests in Provider Order Entry. For emergency, urgent, or pre-op requests, page the chaplain on call at pager # 2-7302.

At right: Reverend Angelika Zollfrank staffs

educational booth in the Main Corridor

Below left: Father Tom Mahoney performs the

Blessing of the Hands outside the MGH Chapel.

Below right: Michael McElhinny, director of

the Chaplaincy, performs Blessing of the Hands

with clinicians on apatient care unit.


Chaplaincy

ave you ever wondered what it’s like to work in the MGH Chaplaincy? No two days are alike, and every day brings new rewards, new challenges, and valuable insights into the lives and experiences of our patients and families. The following compilation of daily interactions may give you some sense of the activities that make up a ‘typi-cal’ day and night in the MGH Chaplaincy.

6:30amOffi ce manager/program manager, Gina Murray, arrives in

the Chaplaincy offi ces on Founders 6.“Every day for more than twelve years, I have hit the ground

running to oversee the logistics of the multi-faceted, day-to-day operations of the 15-person Chap laincy Department and the coordination of our 45 amazing volunteer Eucharistic minis-ters.”

8:00amStaff assistant, Jim Fitzgerald, begins his day by checking

phone messages and patient referrals in the Provider Order Entry system.

“Every day is different. At any given time I could be coordi-nating patient referrals, planning Chaplaincy events, or sched-uling interviews for Clinical Pastoral Education (CPE) students.”

8:15amDirector of Chaplaincy, Michael McElhinny, spends a mo-

ment in the MGH Chapel.“While we often see patients on the worst day of their lives,

visiting the chapel is an opportunity to experience grace, com-passion, and spiritual care. We are privileged to be here”

9:15amRabbi Ben Lanckton makes his fi rst call.“I’m called to the Neuroscience Unit where I visit a mother be-

ing treated for a brain tumor. Soon, I’m paged to another unit to see a 30-year-old patient who’s non-responsive. His wife, who is ag-nostic, is distraught. Later, I’m paged to the Cardiac Care Unit by the family of a Jewish man to offer a blessing of healing for a pa-tient on life support.”

10:00amDaphne Noyes, chaplain for Cardiac Surgery, prepares to make

rounds in the Cardiac Surgical ICU.“A woman wearing a hijab sits weeping outside a patient’s

room. I bring her some water and tissues. Her husband is just out of surgery, and her emotions are raw. I accompany her and her son to the Masjid adjacent to the MGH Chapel so they can offer prayers.”

11:20amPediatric chaplain Ann Haywood-Baxter is paged to the Labor

& Delivery Unit. “A mom anticipating the arrival of a healthy baby asks me to

say a blessing for a safe delivery. I pray for this mom, baby, family, and the members of the Labor & Delivery team. Having witnessed many heartbreaks already today, I am renewed by the hope that comes with a new baby. I will treasure this memory as I remem ber the gratitude expressed by mom and the nurse.”

12:35pmOncology chaplain, Katrina Scott, leads the 12:15 chapel ser-

vice. Afterward, she pauses to refl ect.“Hand-holding, tear-wiping, listening, affi rming, sacred-space-

holding, sharing stories, compassionate companioning, gentle hu-mor, and empathic presence.”


HHA day in the life of an

MGH chaplain— by Daphne Noyes, staff chaplain

A day in the life of an MGH chaplain


Chaplaincy (continued)

3:00pmReverend Angelika Zollfrank, CPE supervisor and chaplain, heads for the

weekly group she facilitates on the Psychiatric Unit.“Everyone in the group feels hopeless. I turn to JT, a young man who has

been silent. ‘JT, do you want to put anything into the group before we end for today?’ He pauses. ‘I can’t say nothing about hope. I can only sing about it.’ With that he starts to sing a beautiful gospel tune about hope in God, even in dark times. Every member of the group leaves with a smile.”

7:00pm–7:00amFather Martin Okwir begins his overnight shift.“I am paged at 8:00, 11:00, and 3:00am. One call concerns an 86-year-old

man who is dying. His large family is present and very emotional. I spend time with them providing comfort and spiritual support. I wrap up my shift by head-ing to the Same Day Surgical Unit at 5:45am for several pre-op visits.”

A full docket, indeed. Perhaps next time you hear an MGH chaplain say, “It’s all in a day’s work,” you’ll have a better understanding of what that really means. For more information, call the MGH Chaplaincy at 6-2220.

1:05pmFather Tom Mahoney is paged to the Neuro ICU.“A Roman Catholic patient has transitioned to comfort

care after removal of ventilator support. His wife of 56 years, four daughters, son, daughter-in-law, and home health aide join in offering the Rite of Anointing of the Sick. I invite them to offer individual blessings after joining in the laying on of hands then offer prayers of fi nal commendation and blessing.”

2:10pmInterfaith chaplains, Patti Keeler and John Kearns, are

paged to an ICU.“We listen as ‘John’s’ parents and boyfriend share his spiri-

tual pain at being rejected from his church and society. John had sought comfort in alcohol and relief in attempted sui-cide. With our hands and hearts unit ed, we pray: ‘You are surrounded by God’s love. Let God’s love heal you.’ ”

In the Pediatric Intensive Care Unit, pediatric chaplain, Ann Haywood-Baxter, sits with 11-year-old patient, Teddy McGowanto talk abouta spiritualcare plan.


Clinical Narrative


Patti Keeler, staff chaplain

y name is Patti Keeler, and I have been a staff chaplain at MGH for four years. Re- cently, I received a page stating: “We need a priest on Ellison 4, stat.” I arrived in the Surgical ICU within minutes. I was unable to get a clear look at the patient because of the many cli-nicians surrounding his bed and rushing in and out of his room. I was told that Mr. M had suffered a massive crushing injury, had just been admitted to the SICU post-operatively, and that death was imminent. A large gathering of family members was ‘waiting for the priest’ in the conference room.

When a priest is requested in a critical situation such this, the most important fi rst step is to ascertain whether it’s a Roman Catholic priest who’s been re-quested, and if so, whether the patient has received the Sacrament of the Sick. I learned, as I walked to the conference room, that a Roman Catholic priest had been summoned and had administered the sacrament to the patient in the operating room.

The conference room was fi lled with men and women, several seated at the table, others huddled in corners, one leaning against the wall with his head in his hands. Some were sobbing, some were holding hands, some stared blankly, some spoke softly.

“My name is Patti. I’m the chaplain on-call,” I said as I walked into the room.

A man identifi ed himself as Mr. M’s brother. He got up from his seat and took my hand. “Thank-you so much. We are so glad you’re here.” He led me to the chair he’d just vacated.

Before I sat, while I was in full view of everyone or could pivot to make eye contact, I shared my shock and sadness at the events of the morning. I recognized in the body language of all present that their shock, grief, and ability to process were as unique as each of them. I knew it would be important to honor that. I as-sured them that Father Martin had been with Mr. M prior to surgery and administered the Sacra ment of the Sick. Because they ranged in age from young to old, I explained that the Sacrament of the Sick, or anointing with oil, was an outward sign of God’s inward, invisible love and was preparation for Mr. M’s journey to meet God face to face.

I sat next to Mrs. M and held her hand. With a grip that tightened with each word, she described their 46-

I was told that

Mr. M had suffered

a massive crushing

injury, had just

been admitted to

the SICU post-

operatively, and that

death was imminent.

A large gathering

of family members

was ‘waiting for

the priest’ in the

conference room.

MM

Chaplain brings voice of Chaplain brings voice of experience and compassion to experience and compassion to

tragic situationtragic situation


Clinical Narrative (continued)

year marriage as “blessed.” I heard stories of a deeply faithful and loving husband, grandfather, father, uncle, and friend. I heard stories of a man passionate about boating, his hometown, and being of service to others. As family members introduced themselves, they shared their love and fond memories, including teaching his nephew how to swim and being a compassionate care-giver to his wife after her heart attack. The stories all had a similar theme, “There wasn’t anything Mr. M wouldn’t do for someone. He had been doing a favor for a friend at the time of the accident.” As memories were shared, people came closer to sit at the table. All except the man with his head in his hands.

Perhaps the most diffi cult story was from Mr. M’s nephew and his fi ancée. They were to be married in fi ve days in the same church where the family was now talking about having Mr. M’s funeral. The rehearsal, which most of those present would be attending, was three days away. Mr. M’s brother whispered to me, “We’ll be burying [Mr. M] and celebrating their wed-ding on the same day.” Some in the room had come from far away, already gathering for the wedding, and more would be arriving in the next few days.

I asked if we could pray together. I stood and mo-tioned to the lone man, inviting him to join us. Mrs. M took my right hand, the lone man took her other hand, and Mr. M’s brother took my left hand. As we all held hands, I said. “Let us begin by looking around this circle and seeing all whom God has gathered together by His divine intention.” Mrs. M and her brother-in-law squeezed my hands tighter as eye contact was made around the circle. “Let us be in the spirit of prayer. God of our journeys, we give you thanks for gathering us to-gether in this circle, for the life of [Mr. M], and for the privilege of having walked with him in his journey upon this earth. May our hands held together be a source of courage and strength as we pray our good-bye. May we remember in times of fear, doubt, insecu-rity, loneliness, and sadness, God’s calling us together to hold each other in our grief. May this circle also be a reminder to celebrate and remember the joy of loving and being loved by [Mr. M].”

Our circle was interrupted by a member of Mr. M’s clinical team inviting us back to his room. “If you want to be with him,” she said, “it would be good to come now.” Only a few people got up to leave.

“I believe she’s telling us that Mr. M’s time is near,” I said. I accompanied them to Mr. M’s room. We gath-ered around his bed with Mrs. M holding one of his hands and his brother holding the other as Mr. M drew

his last breath. We continued to pray with the Lord’s Prayer and Psalm 23.

I followed the psalm with a prayer of commenda-tion of Mr. M’s soul to God’s tender care and con-cluded with a Celtic prayer that I’ve memorized and adapt for the appropriate religious or spiritual situation:

“Lord, so strange to us this doorway labeled death. A door of darkness still closed to protect us from the brilliance of eternal life; a fi nal obstacle to the fullness of Your presence. We stand together at the threshold, [Mr. M] and we who pray this prayer for him, Your child. Give courage Lord, for this uncharted journey, peacefulness at parting from all that must be left be-hind, and an inner vision of invitation for all that is better that awaits. We must release [Mr. M] from our own fl awed embrace to Your precious and perfect pres-ence. Soon enough, we too must follow, placing our footsteps in those of Christ Himself. Amen.”

I remained with the family until they were ready to leave, then accompanied them to the White Lobby. We hugged. I offered blessings upon their journey and reminded them of Mr. M’s light and love that still burned within each of them. I encouraged them to re-fl ect that light back to each other again and again. And I reminded Mr. M’s nephew and his wife-to-be that Mr. M loved them and blessed their marriage. “Hold that blessing close to your hearts.”

The man who hadn’t said a word throughout our two hours together hugged me and said, “He was my best friend — my brother-in-law, but my best friend.” Several weeks later, I received a phone message from him, thanking us all at MGH for holding this family together at such a diffi cult time and for the prayer cir-cles. He said the memory continued to sustain him and especially his son and daughter-in-law, “whose wedding was beautiful.”

Comments by Jeanette Ives Erickson, RN,senior vice president for Patient Care and chief nurse

Patti came to the aid of this wounded family so abrupt- ly thrust into crisis. With compassion, understanding, empathy, and strength, she guided them through the shock and emotional trauma of their sudden loss. Patti was truly an instrument of healing as she nurtured this family with prayer, reminiscences, and the comfort of her presence. As we see from the follow-up phone call from ‘the lone man,’ Patti’s caring intervention made a lasting impression.

Thank-you, Patti.

I offered

blessings upon

their journey and

reminded them

of Mr. M’s light

and love that still

burned within

each of them.

I encouraged

them to refl ect

that light back to

each other again

and again. And I

reminded Mr. M’s

nephew and his

wife-to-be that

Mr. M loved them

and blessed their

marriage.


Chaplaincy

Clinical Pastoral t may surprise you to know that MGH has contributed to the development of thousands of ministry students since MGH’s Dr. Richard Cabot fi rst published, A Plea for a Clinical Year, in 1925. Cabot believed that patients, families, nurses, and physicians had a lot to teach clergy about health crises. Cabot collaborated with Reverend Russell Dicks, also of MGH, to create the fi rst Clinical Pastoral Education (CPE) program in a general hospital. Dicks pioneered the ‘verbatim,’ approach as a tool for peer consultation. CPE programs around the world continue to use verba-tim reports as a primary learning tool in addition to newer methods devel-oped later. For example, the CPE program collab-orates with the Norman Knight Nursing Center’s Simula tion Lab to use role-playing and video recording as teaching tools.

Throughout the his-tory of the program, graduate level theologi-cal students have come

to MGH to complete a 400-hour clinical rotation at the hospital. Those seeking to be-come professional health care chaplains participate in additional rotations. This pro-vides an opportunity to practice critical-thinking skills, metaphor and narrative facil-ity, interpretation of religious texts, leadership skills, and understanding of human motivations and behaviors. CPE students encounter the real-life paradoxes that humanity has faced through the ages: Why is there suffering? Where do we come from? What is the purpose of human existence? What is the Divine? How is human life related to the ultimate reality?

The photographs on these two pages show the 1951 CPE class at MGH and today’s CPE alumni. Notice the white coats. Some believe they wore white coats because the program was an extension of Cabot’s conviction that chaplains should


I

Clinical Pastoral Education class circa

1951. Reverend Thomas Lehmann (back row,

fourth from the right), is the father of Reverend

Daphne Noyes, chaplain in the Cardiac Surgery

ICU and the Cardiac Surgical Unit.

then...


Education:Education:Chaplaincy (continued)

be included as part of medical group practice. Some think the white coats were worn because chaplains of that day worked as orderlies before taking on the role of spiritual caregivers. Neither practice is true today: chaplains don’t wear white coats, nor do they serve as orderlies. And if you look closely, you’ll see that all students in the 1951 photo wore crosses on their lapels, a strong indication that they were all Christian.

The photo below, taken in 2011, refl ects to-day’s religious, spiritual, and cultural diversity. No matter what their own religious backgrounds, MGH

chaplains minister to patients, families, and colleagues of diverse belief systems, religious expressions, and spiritual practices. MGH chaplains and CPE interns are as diverse as our patient population, serving people of all faiths and of no particular faith tradition. Members of the Chaplaincy team draw on their own individual sources of meaning and hope as they provide spiritual support to patients, families, and staff in times of crisis.

Religious and spiritual leaders continue to reach out to those who are suffering, as they have for generations. In CPE, chaplain interns learn to develop a spiritual care plan based on each individual patient’s beliefs. They learn to support and intervene through conver-sation, prayer, meditation, rituals, and worship. Chap lains collaborate with the inter-disci-plinary healthcare team and spiritual leaders throughout the Boston area. They contribute to spiritual literacy as they help individuals move toward improv ed religious and spiritual coping. Cabot’s philosophy continues to guide the practice of the MGH chaplaincy:

“Every human be-ing — man, woman, and child, hero and convict, athlete and invalid — needs the blessing of God through these great channels: responsibil-ity, recreation and af-fection, work, play, and love. With these, any life is happy in spite of sorrow and pain, successful de-spite the bitterest failure.”

CPE alumni circa 2011. Chaplain, Daphne Noyes, (back row, fourth from the right), is seen in the same seat her father, Reverend Thomas Lehmann, occupied in photo on opposite page.

and nowand now— by Angelika Zollfrank, Clinical Pastoral Education supervisor


Chaplaincy

hen ‘Paul’ was fi rst diagnosed with sar- coma, chemotherapy and surgery success- fully eradicated the cancer. Several years later, he developed leukemia. It was thought that a stem-cell transplant was successful in eliminating that, but four months later he relapsed. Paul and his wife, ‘Jane,’ were devastated. They had found each other late in life and lived for one another. Jane was at Paul’s bedside as much as possible. They hoped for a miracle, proof that God was with them.

Paul’s nurse, Sarah Brown, RN, had long observed that religion and spirituality can be useful resources for coping. Patients often want the healthcare team to ad-dress their spiritual needs. While chaplains bring spe-cial expertise to spiritual care, trained healthcare pro-viders can also identify instances where spiritual care is needed. At MGH, nurses, social workers, physicians, and chaplain interns have the opportunity to partici-pate in an inter-disciplinary Clinical Pastoral Educa-tion (CPE) program. Brown enrolled in this program to learn spiritual assessment, deeper listening skills, and information about different belief systems.

Paul and Jane were originally Roman Catholic but had recently joined an evangelical Protestant Church. Paul believed God had given him signs that he would get better. Brown thought, if his treatment didn’t work, Paul might feel let down, not only by his healthcare team, but by God.

Brown brought those concerns to her CPE clinical supervisor, Reverend Angelika Zollfrank. Zollfrank en-couraged her to monitor Paul’s progress and involve

chaplain, Darcy Roake. Roake was an intern in the CPE program and the chaplain assigned to Brown’s unit.

Roake performed a comprehensive spiritual as-sessment. She acknowledged Jane’s wish for a mira-cle and asked God for strength in uncertainty. Roake confi rmed Brown’s sense that Paul and his wife struggled with what they perceived as God’s in-tervention in Paul’s treatments. She, too, was con-cerned about the couple’s spiritual struggle. Brown and Roake collaborated on a spiritual care plan that focused on helping Paul develop a sense of God’s presence separate from his treatment outcomes.

Roake talked with Paul and Jane about their fears. She helped Paul express his feelings about what would happen to Jane in the event his treat-ment failed. Jane began to think about life without Paul. They celebrated their love for one another even in the midst of uncertainty. In Roake’s pres-ence, they could talk openly about dying, and Paul was able to make his wishes known.

A few weeks later, Paul and Jane were relieved and grateful to learn that Paul’s treatment had been successful. They observed that they had become more hopeful and intentional in their support of one another. “What we’ve learned about each other will carry us no matter what lies ahead,” said Paul.

Working together as nurse and chaplain intern, Roake and Brown came away with a new awareness of how illness, spirituality, and culture intersect in the delivery of patient care. Their participation in the Clinical Pastoral Education program and their understanding of existential and spiritual issues had a positive impact on this patient’s hospital experi-ence.

Working

together as

nurse and

chaplain intern,

Roake and

Brown came

away with a

new awareness

of how illness,

spirituality, and

culture intersect

in the delivery of

patient care.

CPE adds another dimension to collaborative care

— by Angelika Zollfrank, Clinical Pastoral Education supervisor

CPE adds another dimension to collaborative care

WW


Chaplaincy

<— Thanks to a generous donation from theLadies’ Visiting Committee, the Clinical Pastoral Education program acquired three new computers and a new workspace counter-top. Paula O’Keefe, Kathy Rehm, Elaine Kwiencen, Virginia Needham, Lois Cheston, and Rose McCabe represented the Ladies’ Visiting Committee at an afternoon tea in appreciation of their ongoing support for the MGH Chaplaincy.

The Chaplaincy gives thanks to the devoted —>Eucharistic ministers who volunteer throughout the

hospital offering the Sacrament of Holy Communion, prayers, or a quiet presence to patients, families and

staff. Known by many as, “the angels in pink,” almost 50 Eucharistic ministers give more than 400 hours of service

each month. Recently, they were honored as volunteer champions for their many years of service. Pictured (l-r):Robert Dunn (38 years), Robert Fitzsimmons (22 years), Joan DeGuglielmo (28 years), Margo Quinlan (22 years),

Ken Quinlan (22 years), and back row: Gina Murray, Chaplaincy Offi ce/Program Manager, and Dr. Peter Slavin.

Not pictured: Nancy Buckley (39 years); EllenConnell (20 years); Joyce Ciffolillo (17 years);

and Roberta Nelson (16 years).

As a way of welcoming new pediatric —>residents and as a visual reminder of the

presence of Chaplaincy, pediatric chaplain, Ann Haywood-Baxter, invited her Chaplaincy colleagues to decorate the door of her offi ce with hand-shaped cut-outs containing words of blessing, encouragement, and appreciation. Her offi ce on the Ellison 17 Pediatrics Unit is seen by many people coming to and leaving the unit. Says Haywood-Baxter, “I asked the

chaplains to be creative and offer words that would remind people that they’re loved.”

(Top photos provided by staff)


Going Green

ed bags, blue bags, white bags, green bags. It’s all trash, but different bags contain different stuff, go to different places, comply with different regulations, and ultimately cost MGH a different amount of money to dispose of. (Money: the other green we want to conserve). MGH began recycling paper in 1990. By 2007, we had added cardboard, glass, and metal to the mix. And in 2008, plastic joined the list of re-cyclables at MGH. In the four years that Environmental Ser-vices has been keeping track, MGH has recycled upwards of 8,140,000 pounds, (that’s 10% of the disposal burden for that time frame), which saved the hospital between $500,000 and $1,000,000. Not only is recy-cling free, some facilities now provide fi nancial incentives to recycle certain materials.

In the Operating Rooms, the recycling initiative began more than ten years ago but really took off in 2007 when the OR Recycling Task Force was created, led by associate chief nurse, Dawn Tenney, RN. Accord ing to an organization that helps healthcare organizations adopt environmentally sustain-able practices, ORs are typically responsible for 20–30% of a hospital’s total waste, which in 2010, was 2,874 tons at MGH.

In the OR setting, we’ve brought attention to the use (and mis-use) of red bags (bags containing hazardous waste). Through education and awareness, we’ve changed our practice to ensure that only hazardous waste is deposited in red bags, keeping our costs down and our impact on the environment low. On the heels of that success, we’ve turned out attention to other recy-clables. We discuss the issue at staff meetings, give presenta-tions, utilize statistics, participate in America Recycles and

Earth Day events, and publish articles in the OR newsletter, Connections, as well as Hotline and Caring Headlines. We attend meetings of the Rais ing Environ mental Awareness League, led by Edwin Andrews, administrative manager of the General Clini cal Research Center, and Bill Banchiere, director of Environ mental Services. We have consultative relationships with John Messervy, director of Capital and Facility Planning and found er of Partners Sustainable Initiatives program; Elisabeth Wilson, environmental safety offi -cer; and Fred Hawkins, RN, infection control practitioner.

On Saint Patrick’s Day, 2008 (appropriately), we began using green bags in the OR for plastic, glass, and metal; we continue to recycle paper in blue bins, cardboard in designated containers, and batteries in white pails. Our ef-

forts extend to the legacy (pre-Lunder) ORs, the post anesthesia care units, an-esthesia workrooms, and the Same Day Surgical Unit, and the new Lunder Build-ing ORs, workrooms, PACUs, and Bio-med ical Engin eering. In April, we received one of three Partners Sustainable Cham -pion Awards for our continuing efforts to contribute to the greening of MGH.

The key to our success has been rec-ognizing the need to reduce waste and receiving the support we need to de-velop appropriate solutions — including the time, supplies, and equipment necessary to do this work in a clinical setting.

As healthcare providers we’re concerned with public health and compli-ance with regulatory standards. We are accountable to our patients, our hos-pital, and society to be the best we can be. Minimizing our impact on the en-vironment is central to our core values and has the added benefi t of being cost- and resource-effective.

In most settings, recycling is a ‘grass-roots’ effort. It relies on someone tak-ing the initiative to raise awareness, establish communication networks, and put systems into effect. I urge everyone at MGH who cares about the envi-ronment and wants to contain costs to be proactive in helping the hospital go green. For more information or help getting started, e-mail Ida Aiken, RN.

RRIn the four years that Environmental Ser vices has

been keeping track, MGH has recycled upwards of

8,140,000 pounds of disposables, saving the hospital

between $500,000 and $1,000,000.

RecyclingRecyclingsaving money and minimizing our impact

on the environment— by Ida Aiken, RN, staff nurse

saving money and minimizing our impacton the environment


Professional Achievements

Kim certifi edGeorgia Kim, RN, staff nurse, became certifi ed in Infusion Therapy by the

Infusion Nurses Societyin September, 2011.

Cox presentsErin Cox, RN, clinical nurse

specialist, Vascular Unit, presented, “Interactive Case Presentation: Complex

Wound Management,” at the Vascular Interventional Advances Conference, in

Las Vegas, October 17, 2011.

Harmon Mahonypresents

Carol Harmon Mahony, OTR/L, occupational therapist, presented,

“Functional Assessment of Movement,”at the 34th annual meeting of the

American Society of Hand Therapists,in Nashville, September 23, 2011.

Lee presentsSusan Lee, RN, nurse scientist,

presented, “Research and Evidence in Nursing Maturation in Practice,” and, “Strength of Evidence: When is it Suffi cient for Practice Change?” at the 2011 Sanford Nursing Research,

Evidence-Based Practice and Performance Improvement

Conference, at Sanford Healthin Sioux Falls, South Dakota,

September 30, 2011.

Kaufman presentsJoanne Kaufman, RN, nursing

director, Clinical Care Management Unit/Case Management, presented,

“Patient Care in a High-Risk Medicare Population: a Primary-Care-Based Model

for Transitions, Communication,and Continuity,” at the Connecticut chapter meeting of the AmericanCase Management Association

in Uncasville, Connecticut,in October, 2011.

Aceto certifi edKatherine Aceto, RN, staff nurse,

became certifi ed in Plastic Surgical Nursing by the Plastic SurgicalNursing Certifi cation Board

in October, 2011.

Brown presentsCarol Brown, RN, staff nurse,Cardiac Unit, presented, “ECG Interpretation, Part I,” and ECG

Interpretation, Part II,” at the Continuing Education Program at Boston College

School of Nursing, September 26,and October 3, 2011.


Carol Harmon Mahony, OTR/L, occupational therapist, presented, “Fracture Management,” at Tufts

University, October 3, 2011.Harmon Mahony, also presented,

“Wrist Injuries,” at Tufts,October 17, 2011.

Jeffries appointedMarian Jeffries, RN, clinical nurse

specialist, Thoracic & Laryngeal Surgery, was appointed a member of the Clinical Nurse Specialist Content Expert Registry

for 2011–2015, by the AmericanNurses Credentialing Center

in October, 2011.

Inter-disciplinary team presents

Physical therapists, Ann Jampel, PT, and Mary Knab, PT, and occupational

therapist, Karen Turner, OTR/L, presented,“A Social Construction of Knowledge Through Group Refl ection on Stories of Clinical Practice,” at the Educational

Leadership Conference of the American Physical Therapy Association,

in Clearwater, Florida,October 2, 2011.

Orencole and Parkspublish

Mary Orencole, RN, nursepractitioner, Cardiac ArrhythmiaService, and Kimberly Parks, MD,

authored the article, “The MGH Heart Failure Device Monitoring Clinic,”

in EP Lab Digest,October, 2011.

Roche presentsConstance Roche, RN, nurse

practitioner, Surgical Oncology,presented, “10 Things You Should

Know About Breast Cancer,” at the Nurse Practitioner Associates for Continuing Education, in Boston,

October 6, 2011.

Lowe presentsColleen Lowe, OTR/L, occupational

therapist, presented, “Functional Movement Assessment, Analysis, and

Implications for Treatment,” at the 34th annual meeting of the American

Society of Hand Therapists, in Nashville, September 23, 2011.

Lowry presentsPatricia Lowry, RN, nurse

practitioner, Cardiac InterventionalUnit and Hypertrophic Cardiomyopathy

Program, presented, “Updates in Hypertrophic Cardiomyopathy and

Sudden Cardiac Death,” at theNational Primary Care

Conference, held in Boston,October 6, 2011.

Rinehart presentsTodd Rinehart, LICSW, clinical

social worker, Palliative Care Service, presented, “Don’t Take it Personally: Responding to ‘Diffi cult’ Patients and Challenging Behaviors at End of Life,” at the Barbara McInnis House, Boston

Healthcare for the Homeless,October 18, 2011.

Dahn certifi edJenna Dahn, RN, staff nurse,

became certifi ed in Plastic Surgical Nursing by the Plastic SurgicalNursing Certifi cation Board

in October, 2011

Maxam presentsBarbara Maxam, LSW, Social

Services, presented, “Caregiver Issues in Alzheimer’s Disease,” at the Boston

Chinatown Lecture Series,October 19, 2011.


Carol Harmon Mahony, OTR/L, occupational therapist, presented,

“Cheiroarthropathy Study,” at the annual conference of Epidemiology of Diabetes

Interventions and Complications,in Chicago, October 20, 2011.

Townsend presentsElise Townsend, PT, physical

therapist, presented, “Managing the Physical Therapy Needs of Boys with

Muscular Dystrophy: a Team Approach,” at the annual meeting of the American

Physical Therapy Association, in Providence, Rhode Island,

October 25, 2011.

Inter-disciplinary team presents

Ellen Robinson, RN; Pamela Grace, RN; Martha Jurchak, RN; and, Angelika Zollfrank, presented, “Clinical Ethics Residency for Nurses: Allying ASBH

Clinical Ethics Consultation Education Guide with Professional Goals to Transform Practice,” at the annual meeting of the American Society

of Bioethics and Humanitiesin Minneapolis,

October 14, 2011.


Question: I heard there’s a new Patient and Family Advisory Council. Can you tell us about it?

Jeanette: Unlike existing patient and fam-ily advisory councils, this new council is not disease- or population-specifi c. It is broadly based and includes patients and family mem-bers with a variety of healthcare issues and ex-periences. It will complement existing coun-cils by exploring and sharing best practices, seeking opportunities to promote patient and family involvement in committees, and serv-ing as an advisory resource for staff, physi-cians, administrators, and the community. The new Patient and Family Advisory Council (PFAC) met for the fi rst time on October 25, 2011.

Question: Who are your members?

Jeanette: Staff on the council include rep-resentatives from the Offi ce of Patient Advo-cacy, Service Improvement, Social Services, Hospitalist Service, PCS Offi ce of Quality & Safety, nursing directors, and staff from the Emergency Department and Pediatric clinic. Patient and family members are a diverse group of men and women from different backgrounds and healthcare situations. They are energetic, motivated, and thoughtful, and fully commit-ted to promoting patient- and family-centered care.

Question: Are you still recruiting new members? What is the criteria for membership?

Jeanette: Yes, we are still recruiting patient and family mem-bers. To become a member you must:

• be a current patient or be related to a current patient at MGH

• possess a willingness to work in an advisory capacity

• have good listening skills

• have the ability to interact well with people

• have the ability to attend monthly council meetings (and po-tentially support sub-committee efforts)

For more information, go to [email protected].

Question: How did the fi rst meeting go?

Jeanette: Two patient and family members from existing PFACs joined us to share their wisdom and experience. Ongoing collaboration among all PFACs will be critical to our success. Some ideas that were generated for improving the healthcare experience at MGH included: looking at patients as members of the team; helping families understand the process of care; mak-ing sure everyone knows what’s expected. Staff felt privileged to be engaged in this effort.

Question: What other PFACs exist at MGH?

Jeanette: MGH has been partnering with patients and fami-lies for many years. The Mass General Hospi tal for Children PFAC was established in 1999, the Cancer Center PFAC in 2001, and the Heart Center PFAC in 2007.

For more information, call 6-3370.

Fielding the Issues

Unlike existing

patient and

family advisory

councils, this

new council is

not disease- or

population-

specifi c. It is

broadly based

and includes

patients and

family members

with a variety of

healthcare issues

and experiences.

A new Patient and Family Advisory Council

A new Patient and Family Advisory Council


Announcements Published byCaring Headlines is published twice

each month by the department of Patient Care Services at

MassachusettsGeneral Hospital

PublisherJeanette Ives Erickson, RN

senior vice presidentfor Patient Care

Managing EditorSusan Sabia

Editorial Advisory BoardChaplaincy Michael McElhinny, MDiv

Disability Program Manager Zary Amirhosseini

Editorial Support Marianne Ditomassi, RN Mary Ellin Smith, RN

Materials Management Edward Raeke

Nutrition & Food Services Martha Lynch, RD Susan Doyle, RD

Offi ce of Patient Advocacy Robin Lipkis-Orlando, RN

Offi ce of Quality & Safety Keith Perleberg, RN

Orthotics & Prosthetics Mark Tlumacki

PCS Diversity Deborah Washington, RN

Physical TherapyOccupational Therapy Michael Sullivan, PT

Police, Security & Outside Services Joe Crowley

Public Affairs Emily Lemiska

Respiratory Care Ed Burns, RRT

Social Services Ellen Forman, LICSW

Speech, Language & Swallowing Disorders and Reading Disabilities Carmen Vega-Barachowitz, SLP

Training and Support Staff Stephanie Cooper Tom Drake

The Institute for Patient Care Gaurdia Banister, RN

Volunteer Services, Medical Interpreters, Ambassadors,and LVC Retail Services Paul Bartush

DistributionUrsula Hoehl, 617-726-9057

SubmissionsAll stories should be submitted

to: [email protected] more information, call:

617-724-1746

Next PublicationDecember 15, 2011

New Ostomy Support Group

New Ostomoy Support Group meets on the third Thursday of

each month. Next meeting:December 15, 2011

4:00pmWACC 455

All colostomy, ileostomy and urostomy patients and families

are welcome.

For more information,call 6-2760

Choosing Child CarePartners Employee Assistance

Program and Partners Child Care Services are offering a roundtable

discussion for those new to parenting and childcare.

Allison Lilly, LICSW, will explore: child care options, costs, and how

to fi nd and evaluate care.

Sheryl Lauber Weden, director of Partners Child Care Services will talk about internal resources for

center and back up care.

Wednesday, December 7, 201112:30–1:30pm

Haber Conference Room

For more information,call 6-6976

Monthly Eldercare Discussion GroupSponsored by the Employee

Assistance Program

December 13, 2011 12:00– 1:00pmYawkey 7-950

facilitators:Janet T. Loughlin, LICSW, and Barbara Moscowitz, LICSW.

Group discusses subjects relevant to elder care-giving.

All are welcome! Feel free to bring a lunch.

For more information,call 6-6976.

Clinical Recognition Program

The Clinical Recognition Review Board and Steering Committee are happy to announce a new

initiative by which clinicians applying for recognition at the advanced clinician and clinical scholar levels can submit their

portfolio for a preview prior to formal submission. This voluntary,

anonymous process gives clinicians an opportunity to receive

feedback on their portfolios from former review board members.

Reviewers will provide feedback on specifi c areas identifi ed by

clinicians, leadership, and review board members based on past

experience.

For more information, e-mail questions or portfolios to

MGH PCS Clin Rec(in the Partners directory).

Attention clinical research nurses

The International Association of Clinical Research Nurses (IACRN)

is looking for clinical research nurses interested in participating

in a new local chapter.

The IACRN is an international organization dedicated to

promoting the role of clinical research nurses and providing a forum for research nurses,

research nurse practitioners, and others to discuss issues common

to this specialized practice.

Membership in the Boston chapter is open to all interested research nurses in New England.

Meetings are held three times per year. Next meeting:

March 8, 20126:00pm

location TBA

For more information, contact Mary Larkin, RN, at 4-8695, ore-mail [email protected].

Annual Chaplaincy Holiday Songfest

Thursday, December 15, 201112:00–1:00pmMain Corridor

Come and join in the festivities.Holiday attire is encouraged. Award will be given for “Best

Dressed!”

For information, call 6-2220.

New disability indicator in PATCOM

Effective November 1, 2011,the patient registration process under Admitting & Registration

Services includes a disability indicator. Including information about a patient’s permanent disability in our registration system, helps staff be more

proactive in meetingspecial needs.

For more information, call Zary Amirhosseni at 3-7148.

Blum Center EventsShared Decision Making:

“Understanding the Prostate Specifi c Antigen (PSA) Test”

Wednesday, December 7, 201112:00–1:00pmpresented by

Mary McNaughton-Collins, MD

Healthy Living:“When Holidays Aren’t Happy”

Wednesday, December 14th12:00–1:00pmpresented by

Reverend Daphne Noyes, staff chaplain

Programs are free and open to MGH staff and patients.No registration required.

All sessions held in the Blum Patient & Family Learning Center.

For more information,call 4-3823.


Chaplaincy

Labyrinths have been around for thousands of years in just about every major religious tradition. Used for refl ection, meditation, prayer,and comfort, labyrinths are inherently powerful, helping individuals feel a greater sense of ‘oneness’ and a connection with their spiritual center.

Sacred Space, Sacred Pace Labyrinth at MGH

Sacred Space, Sacred Pace Labyrinth at MGH

CaringHeadlinesDecember 1, 2011

Returns only to:Bigelow 10 Nursing Offi ce,

MGH, 55 Fruit StreetBoston, MA 02114-2696

First ClassUS Postage PaidPermit #57416

Boston, MACaring

december 1, 2011 mgh chaplaincy 2 — caring headlines — december 1, 2011 jeanette ives erickson...

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