Screening for Spiritual StruggleScreening for Spiritual Struggle

Judith Blanchard, D.Min., B.C.C. – Chaplain Clinical Leader

A Quality Improvement Initiative at Maine Medical Center, Portland ME

Winter-Spring 2011

Judith Blanchard, D.Min., B.C.C. Chaplain Clinical Leader

Douglas Allan Dunlap, Ed.M., Ed.D, M.Div., Chaplain Resident

Objectives

NURSING COLLABORATION

– Learn how one might engage nursing staff in screening for

religious/spiritual struggle.

QUALITY IMPROVEMENT

– Gain familiarity with a quality improvement project for in-patient spiritual care.

N=230 patients with advanced cancer.From Balboni et al, J of Clinical Oncology, 2007

Importance of Religion to Cancer Patients

Very important

68%

Somewhat important

20%Not

important12%

Religious/spiritual struggle

may compromise recovery may increase risk of mortality compromises emotional adjustment

to illness and quality of life

Fitchett, 2012

“I am told that God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.” Newsweek 9/3/07

SPIRITUAL DISTRESS

Addressing Spiritual Struggle/Distress means:

“…to help create an environment where what is fundamental, natural, and indigenous to the human psyche can most easily do its own work of

bringing about integration, balance, and wholeness.”

Michael Kearney (2000)

Nursing recruitment from:

• Nursing Director recommendation• Chaplain Invitation• Peer Referral• Personal Interest – Self Referral

Current Nursing Questions:

Interdisciplinary Screens:Any spiritual practices thatmay affect your care? No Yes________________________

Chaplain X2951

Was there a time when you did?

Yes No

Is that helping you now?

Yes No

Thank you. We do wish to be supportive of you.[Make SCM Pastoral Care Consult Order or call 662-2951 with referral. Note which Track patient on.]

#1BELIEFHelpful

Spiritual Screening Tool

Yes No

#2BELIEF

Not Helpful

#3BELIEF

in Past

#4No

BELIEF

Patient Admitted: Our team is committed to the whole person.Do you have a belief, spiritual or otherwise, that is important to

you?

10 Nurses Recruited and Trained 1 – Injured and unavailable 3 – No referrals (1 nurse said she had

made a couple but no record) 2 – made one referral 3 – made two referrals 1 – made six referrals 14 Referrals made in six weeks

Results of 14 Nursing Referrals

#1 Belief Helpful N = 7

#2 Belief Not Helpful N = 3

#3 Belief in Past N = 1

#4 No Belief N = 3

Conclusions:• Nurses are interested in their patients’

spiritual well-being• Nurses will volunteer to contribute to a

project addressing SS/SD• Nurses observe spiritual distress in their

patients• Protocol enabled more RN e-referrals

Participating nurses reported

• the screening protocol provided terminology and a procedure that they found helpful in discussing the spiritual domain with their patients.

Screening for Spiritual Struggle and Aims for Quality Improvement

AimAim Screening ProtocolScreening Protocol

Aim #2: Care is Effective Aim #2: Care is Effective (evidence-based)(evidence-based)

A) The protocol is based on research A) The protocol is based on research indicating the harmful effects of spiritual indicating the harmful effects of spiritual struggle. B) Other studies show the struggle. B) Other studies show the effectiveness of the protocol.effectiveness of the protocol.

Aim #3: Care is Patient-Aim #3: Care is Patient-CenteredCentered

Use of the protocol increases the likelihood Use of the protocol increases the likelihood that patient's preferences for spiritual care that patient's preferences for spiritual care services are respected.services are respected.

Aim #4: Care is TimelyAim #4: Care is Timely

The protocol reduces the time between The protocol reduces the time between admission and referral for spiritual care or admission and referral for spiritual care or assessment.assessment.

Aim #5: Care is EfficientAim #5: Care is Efficient

The protocol makes efficient use of non-The protocol makes efficient use of non-chaplain healthcare staff to reduce the time chaplain healthcare staff to reduce the time chaplains spend in patient identification.chaplains spend in patient identification.

Aims for quality improvement from the Institute of Medicine 2001 report, Aims for quality improvement from the Institute of Medicine 2001 report, Crossing the Crossing the Quality ChasmQuality Chasm. . The protocol does not explicitly address Aim #1: Care is Safe, or Aim #6: Care is Equitable.The protocol does not explicitly address Aim #1: Care is Safe, or Aim #6: Care is Equitable.A summary of the report is available at A summary of the report is available at http://iom.edu/CMS/8089/5432/27184.aspx. . Fitchett, 2012Fitchett, 2012

Follow up by chaplains

Findings and plans for the future

We are all in this together!We are all in this together!

Questions and Answers