healthcare :: Page 2 :: Carla Cheatham Consulting Group

Archive for healthcare – Page 2

Nine Weeks of Must-Read Books for Professional Care Providers: Week 4–Healthcare Ethics

Posted by Carla Cheatham on Friday, January 27th, 2017 in Spiritual Care Integrity and Excellence, Uncategorized

Nine Weeks of Must-Read Books for Professional Care Providers

Week 4—Healthcare Ethics

In honor of the highest-selling month for books, and the cold weather during which it’s more tempting to curl up and read, I’m posting those books and videos I most recommend to caring professionals in practice and to which I refer in my trainings.

Healthcare Ethics

Mama Might Be Better Off Dead, Laurie Kaye Abraham

I probably would not have read this book had I not been made to by one of my favorite professors in my doctoral program. A reporter from the Chicago Sun Times followed 4 generations of an economically poor African American family as one of its members, Jackie Banes, tries to hold it all together.

With several major medical issues in the family, this was easier said than done. Navigating insurance, healthcare, and all the other systems designed to care for persons involves creativity to keep from falling into the massive cracks in their design. It was my first glimpse of the fact that many persons are not opportunistic or crooked or lazy, as some assert, but are simply working to survive a system more akin to a jungle than a safety net.

This straightforward text will make you think, make you re-think, and likely soften your edges and open your eyes.

The Immortal Life of Henrietta Lacks, Rebecca Skloot.

I love this book! This best seller describes the history behind the HeLa cells used in research and the development of life-saving medications and bought and sold for enormous sums of money. The catch is they were taken from a poor, black, tobacco farmer in 1951 without her knowledge or permission.

With persons in medicine making money off of this woman’s cells, her family saw none of it. Secrecy, medical ethics, race, class, and many other factors bob and weave around the personal grief of a family who felt betrayed and the conflicts that can arise when some seek the greater good at the expense of what it right.

It will jar you, challenge you, shock you, and open a world about which you probably have never even heard. Don’t miss wrestling with this story.

Healing at the Speed of Sound: How What We Hear Transforms Our Brains and Our Lives, Don Campbell & Alex Doman.

Drawing on over 10 years of brain research provides information, practical tips, and even exercises to help us understand and make positive use of the sounds that constantly surround us, and can impact our world for better or worse.

Insightful, useful for individuals and professionals seeking to support others, and even fun. You’ll love this book and how it informs your ability to make use of sound even in your work.

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, Anne Fadiman.

I’m itching to get my hands on this book and looking for a window of time to get it off of my nightstand and into my hands! Having not yet read it, I will defer a description to that provided on Amazon:

“The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia’s parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy.

Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadiman’s compassionate account of this cultural impasse is literary journalism at its finest.

The current edition, published for the book’s fifteenth anniversary, includes a new afterword by the author that provides updates on the major characters along with reflections on how they have changed Fadiman’s life and attitudes.”

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to End of Life Healthcare. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Nine Weeks of Must-Read Books for Professional Care Providers: Week 3–Boundaries, Family Dynamics, and Team Health

Posted by Carla Cheatham on Friday, January 20th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 3—Boundaries, Family Dynamics, and Team Health

Boundaries, Family Dynamics, and Team Health

We professional care providers deal with persons and families who are often in crisis, which is when all of their best and worst defense mechanisms and even most dysfunctional patterns can arise, tapping into our own!

The more we understand these dynamics, the better we can notice and heal them in ourselves, keep our own stuff from entering unhealthily into the situation before us, and even be healthier members of our teams and own families.

If we are hesitant to explore and consider these things, we must ask ourselves from where is our resistance coming? Why would we want to avoid the healing journeys we encourage those persons with whom we work to engage in?

These books will empower you to be better and healthier in every arena of your life, so the discomfort of what you might find if you start looking is definitely worth the price of admission!

Generation to Generation: Family Process in Church and Synagogue, Edwin Friedman. This helpful classic helps not just faith leaders but clinicians and leaders of any group to recognize family systems dynamics that can arise when we humans gather with all of our imperfections. The more we are aware of these dynamics, the more likely we will be to recognize them and avoid getting in the nasty middle of them.

With its simple, straightforward language, it helps even non-counselor types gain important knowledge, insight, and skills. Just read this. Trust me!

The Five Dysfunctions of a Team: A Leadership Fable, Patrick Lencioni. Written in an engaging story-telling style, this latest work from Lencioni portrays hurdles teams commonly face that hold them back from being cohesive and effective, as well as action plans for overcoming them. Any member of a team can benefit from having their eyes opened to the dynamics that can tear teams apart and the ideas that may help them pull together to success. A helpful read!

The Gentle Art of Verbal Self-Defense, Elgin Suzzette Haden. This is still a classic. Over 25 years ago, I was 19 and in college, dealing with a very challenging loved one with mental illness who knew no boundaries. A wise therapist recommended this book to me and it helped change my life. Subtle and not-so-subtle put downs come at us on a daily basis, and we likely make them ourselves. This practical, easy to grasp book is full of tools you can use from tone of voice, assertive scripts, body language, and more to help you recognize and navigate challenging conversations. A must read for caring professionals.

Please Understand Me: Character and Temperament Types, David Keirsey & Marilyn Bates. This easily accessible explanation of 16 different personality types includes a self-test to learn your 4-letter type (ENTJ, for example) and includes a great explanation of each types strengths, challenges, and ways of showing up in relationships. When we understand that the way our colleagues, clients, and even friends and loved ones act as they do as part of who they are, it can be easier to speak their language and be more patient with their unique way of being in the world. This is an important piece that will help you professionally and personally in more ways than you can begin to understand until you read it and the lightbulbs begin to go off!

How Al-Anon Works for Families & Friends of Alcoholics, Al-Anon Family Groups. Professionals in all capacities would benefit from even a basic understanding of the impact the family disease of alcoholism can have on all of its members. Issues of trust, esteem, boundaries, control, and so much more can arise for persons who have been impacted by addiction and being aware of them can help professionals notice and navigate these dynamics in their work. Besides, who amongst professional caregivers wouldn’t benefit from a reminder to maintain healthy boundaries and loving detachment in their work?! Prepare to have your eyes opened in ways you never expected.

Facing Codependence: What It Is, Where It Comes From, and How It Sabotages Our Lives, Pia Melody. Many people roll their eyes at the very word, which became incredibly over-used in the 1980s. Nonetheless, it does exist and makes life harder than it needs to be for many, even if they only have small traits of this way of engaging in relationships, as most of us do! Using a simple framework, Melody helps persons identify such patterns, including 5 symptoms and early roots of the behavior and helpful information for healing those patterns. This book will surprise many with its insights and gentleness.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to General Healthcare. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Nine Weeks of Must-Read Books for Professional Care Providers: Week 1–Centerings & Meditations

Posted by Carla Cheatham on Tuesday, January 3rd, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 1—Centerings for Team Meetings & Personal Meditations

When I first got into writing and publishing, I was surprised to learn that December was not the biggest month for book sales; it’s January, when everyone is redeeming their gift-certificates! My guess is that it also doesn’t hurt that it’s cold and dreary in many places, which is an even better time to curl up with a good book.

I’ll be spending the next several weeks providing recommendations of books I believe are helpful for professional caregivers, and anyone really, to read for their personal and/or professional development. Some are old classics while others you will likely be new to you.

These aren’t intended to be in-depth, critical reviews nor are they exhaustive lists. I’ll simply be describing some of the books, and even videos, that have been most helpful to me in my practice and the books I draw from and refer to when I train professional caregivers. I’ll describe what I like about each and why, as well as how I use it in my practice.

I’ll cover the following categories over the next 9 weeks:

Centerings for Team Meetings & Personal Meditations
Personal & Professional Formation
Boundaries, Family Dynamics, and Team Health
General Healthcare
End of Life Care
Spirituality and Multi-faith Care
Grief & Meaning
Dementia
Wrap Up and Suggestions from Readers

For today, here are the books I use and recommend both to get the team centered at the beginning of meetings and for my own personal use for daily meditations.

Centerings at Team Meetings & Personal Meditations

Many agencies use this as a time for bonding amongst team-members, checking in to see how everyone is doing, debriefing tough cases, honoring those who’ve died (i.e., on hospice services), and having time for team members to receive care from someone else.

I recommend keeping it short; 5-minutes for the reading and any discussion of it and 5-minutes for debriefs, reading of names, and other check-ins.

I also recommend being mindful of the faith traditions around the table. Everyone should feel welcomed, included, invited, and not coerced into listening to material that runs counter to their own beliefs. This isn’t about being politically correct; it’s about being mindful, respectful, practicing hospitality and cultural humility.

Talk openly as a group about materials that do and don’t work for everyone. When folks know you’re trying to honor and make room for everyone, they’re usually pretty gracious about it and open to stretching a bit outside their comfort zone to join the team.

1.) The Book of Awakening, Mark Nepo. After going through his own experience of cancer, Nepo experienced an awakening that he poetically shares with others, encouraging us to also wake up fully to our lives. Each day’s reading is poignant, succinct, and is followed by reflection questions that I sometimes use and other times do not.

Excerpts are available on Nepo’s website.

2.) The Invitation, Oriah Mountain Dreamer. I first heard the opening words to this book when my favorite professor in seminary read them to us. I was hooked immediately. Oriah writes gently and beautifully with powerful insights that are simple but moving. I read excerpts at team meetings with great feedback.

After being at a party where the conversation seemed superficial and empty, she went home and wrote a piece that began, “It doesn’t interest me what you do for a living. I want to know what you ache for and if you dare to dream of meeting your heart’s longing…” From there, the book was born.

You can read the full poem, “The Invitation” and learn more about Oriah and her other works through her website.

3.) The Four Agreements, Don Miguel Ruiz. Many know this short, simple yet profound book about how the way we think and see the world impacts our whole lives. It comes from the tradition of Toltec wisdom and focuses on the following:

Be impeccable with your word

Don’t take anything personally

Don’t make assumptions

Always do your best

Get this one for yourself, and read excerpts with your team. It’s definitely worth it! Learn more through the four agreements website.

4.) The Language of Letting Go, and More Language of Letting Go, Melodie Beattie. When I first start reading from these brief daily meditation books that come from the 12-step recovery tradition and focus on codependence, teams often raise a hairy eyebrow, confused about why I’m sharing something like that with them.

When I smile and ask, “Can any of us as professional caregivers honestly claim not to have at least a LITTLE bit of co-dependence in us?” They laugh and go, “Oh, yeah! Go ahead…”

Wanting to please people and pursue perfection and care for others aren’t bad traits. It’s when they go amuck that we have problems. Beattie offers honest reflections from her own journey and hard-gained wisdom to help keep us more centered and healthy, as well.

Learn more about her work and access these books via paperback and also through itunes through her website.

Hopefully something here has been helpful. Be looking for the next post on books I suggest for personal and professional formation!

Peace,

Carla

How “Thank you for all you do!” Can Backfire

Posted by Carla Cheatham on Thursday, October 27th, 2016 in The Power of Presence

How “Thank You For All You Do” Can Backfire

by Carla Cheatham

A couple of years ago, I led a presentation for a room full of hospice and palliative care managers and administrators. The topic was compassion fatigue, but it wasn’t your typical “Put up appreciation boards” or “Send out cartoon clips each day” kind of talk.

Instead, I approach compassion fatigue from the stance of boundaries, resilience, noticing the stories we are telling ourselves, and focusing on our own behavior rather than blaming everyone else (even though that’s a LOT more fun!)

It’s definitely the grad school version of get real, get honest, and make real changes, but it’s always cool to see participants REALLY go there and open up to a different way of working. By the time they leave, their shoulders are pulled down away from their ear lobes and they say they feel empowered to go back and immediately implement a new way of leading.

At one point, when I was speaking about what they could do to promote healthier teams, my slide read, “Appreciation beyond rote statements…” I described noticing a trend at an organization where I once worked in which managers all started to write, “And thank you for all that you do” at the end of their emails and texts.

“At first”, I said, “we thought, ‘Aaawwww, how nice!’ Then it happened a second time, and we thought, ‘Oh, ok. They must be serious about wanting to acknowledge and thank us’. But by the 5^th or 6^th or 12^th times, it felt trite and rehearsed and made us want to throw up in our mouths a little bit!”

As I spoke, I saw that classic, “Woops, we’ve been doing that!” look. So I said, “It’s like all of you went to the same leadership seminar where they told all of you at the same time to end everything with, ‘And thank you for all you do!’”

At this, the room absolutely erupted in acknowledging laughter. They admitted that they actually HAD been taught to do exactly that.

“Well, STOP it!” I laughingly said, to more laughter from them. And then, more seriously, I said, “When it becomes rote, we stop believing you and feel like it’s just a campaign slogan. It feels kinda like we’re being played or duped into feeling appreciated, especially if nothing else in the organization actually changes other than your signature line to us. It just doesn’t feel good when it begins to seem automatic rather than something you’ve actually thought about, which I completely trust is NOT your goal, at all.”

They nodded with feeling, affirming that this wasn’t at all what they wanted.

I encouraged them, instead of global or generic phrases, to take an extra 15-30 seconds to think of something specific the person or team had said or done in the previous week or two, or even something that you admire and respect about who they are, and use that, instead:

“By the way, Sarah, I couldn’t help but notice how gentle and calm you were with Mr. Smith last week, even when he was really angry and taking it out on you. Thanks for being so compassionate and understanding with the patients with whom we work. It inspires me to want to be even more like that, myself, in work and in life. Thank you for that reminder.”

“Hey gang, I know it’s been extra stressful lately as we’ve been short-staffed. We’re working on it, I promise. But please know that, while we do, I really see how hard each of you are working to pull together, have each other’s backs, get the job done, while also taking good care of yourselves during a tough time. It truly means a lot to me and I could not be more proud of you guys. I wanna be y’all when I grow up!”

“Brian, before I close this note, I want to make sure to tell you, I heard what you said the other day about wanting to stay above board and not cut corners on our contracts. Thanks for keeping us true to our mission, and reminding me to not lose sight of the kind of person I want to be. I appreciate your presence on our team and in my life.”

“Trish, you were spot on with your comments in the meeting yesterday. Your wisdom and insight never ceases to amaze me. Thanks for letting us benefit from that brilliant brain of yours.”

If any of this makes you roll your eyes because it’s too fuzzy woo-woo, that’s fine. Find what feels right in your environment in your voice given your personality and your team’s. But find something!

Gratitude is one of the greatest hallmarks of resilience, for individuals AND teams, while experiencing a lack of reward, community, and fairness are some of the well-documented precursors of burnout. When we feel truly seen for real, sincerely felt, tangible reasons, it makes all the difference in the world. It increases compassion satisfaction and can make enduring challenging seasons in the workplace a lot easier.

Besides, leaders set the tone for a team, for good or for ill, and that kind of intentional, genuine noticing and naming of the good we see in others can be contagious. You can’t afford to NOT take the few extra moments to build them up.

Thank you for being willing to stretch, spend a little extra time, and find new ways each day to make sure your team knows exactly the what and why behind your words of appreciation. You make more of a difference in their daily lives and how they feel about their work than you’ll ever really know.

Peace,

Carla

Rev. Dr. Carla Cheatham began her career in social services with an MA in Psychology and certification in crisis counseling. After earning her PhD in Health and Kinesiology and an MDiv, she served faith communities and led an interfaith non-profit supporting working justice. Carla then went on to work for 10 years in hospice as a chaplain and bereavement coordinator. Now she is a national keynote speaker teaching professional caregivers about presence, healthy teams, boundaries, compassion fatigue, ethical care, spiritual and existential support for all, and much more. She is the author of Hospice Whispers: Stories of Life and also Sharing Our Stories: A Hospice Whispers Grief Support Workbook available through Amazon. Learn more at CarlaCheatham.com

How Physicians Maintain Their Humanity

Posted by Carla Cheatham on Wednesday, August 31st, 2016 in Spiritual Care Integrity and Excellence

While attending college in my undergraduate years, I had a significant and painful medical issue that required multiple specialists over the course of a year.

Young, scared snotless, with very little support on the journey, I got a crash course in navigating the medical system, medical advocacy, and interacting with physicians and other medical personnel. Many were absolutely amazing! Others, well, not so much.

As afraid and overwhelmed as I was, physically as well as mentally, my emotions were already on the ragged edge. I was also in a small, rural area where respect for women, especially young and outspoken and educated ones, was not at it’s peak in the late 80’s.

To be blunt, misogyny was a daily experience, especially with some of the physicians. Finding my voice was necessary to make certain I got the care and answers I needed. It was awful. And I’m eternally grateful.

I learned a lot about what did and did not work well for me when any medical staff person walked into the exam or treatment room.

I quickly noticed the mannerisms and ways of engaging that made me relax, feel safe and seen and heard; which ones felt condescending, dismissive, shaming, and made me want to finally burst into the tears that were always brimming in my shell-shocked 19 year-old eyes; and which ones felt respectful, reassuring, and filled me with hope and confidence in myself and my provider.

My major was psychology, so I did what I knew to do as a fledgling research geek–I dove into the literature. I found myself studying Norman Cousins’ book, Anatomy of an Illness, the works of Selye, Ader, Cohen, and Felten. I started learning more about the mind-body connection and the burgeoning field of psycho-neuro-immunology. I was hooked. The data was proving what we already instinctively knew. Among other things…

The way a clinician interacts with a patient can be just as healing, or detrimental, as the treatment provided.

For those medical staff who saw me, heard me, and treated me with dignity blended with tenderness and patience, “Thank you” is not a big enough word! As I look back now on that barely-a-young-adult me who could now be my own child, I am filled with gratitude for those who showed up well for me during such a trying time.

One of my greatest lifelines became the pharmacist at the local grocery store. She took time to answer all my questions, helped translate physician instructions that had gone over my deer-in-the-headlights psyche, and was always so gentle and caring. She understood when her kindness finally broke the dam on my hold-it-all-together shell and released my tears.

Over 26 years later, I just teared up while writing this in appreciation for how much of a difference she made in my experience. She probably has no idea how much she meant to me. (Her bosses did. I wrote a letter to corporate thanking them for having someone so compassionate working for them!)

No matter what your role in the medical field, never underestimate how healing your presence can be to someone overwhelmed, in fear, and in pain.

A few years ago, a dear friend invited me to dinner and asked me to consider applying as the chair of the Department of Humanities at the medical school where she worked. I asked her for the 20-second job description. She answered:

“Teaching doctors to be human”

I had never heard a better way of explaining what I feel called to do. Thankfully, it’s what I get to do as I travel to train and equip healthcare staff to show up well when someone is suffering.

The soft skills of caregiving can be taught, and we MUST teach them for the sake of healing, whether a cure is possible or not.

The word “humanism” has gotten a bad rep in some circles as being about an over-focus on humanity to the exclusion of divinity. But those in academia understand a far different definition–the very one my friend gave about the humanities chair position.

It’s simply about being human.

Two years ago, I came across a research article that I hope will get even more airtime called “Attitudes and Habits of Highly Humanistic Physicians” by Carol M. Chou, MD and colleagues (Journal of the Association of American Medical Colleges, Sept 2014). A summary can be accessed here

In short, the study authors interviewed internal medicine residents to find out which physicians they felt best exemplified humanistic patient care. They then interviewed those professionals to identify the habits that contributed to their patient-focused attitudes and their practice of high quality care.

They found that self-reflection, being in a teaching role, and practicing mindfulness were common habits of these exemplary physicians. Even more significant contributors to these clinicians’ effectiveness were maintaining a healthy work-life balance and actively working to develop a meaningful connection with the patient.

The authors also found that not only did the connected relationship help the patient, it helped reduce burnout for the clinician!

Clinicians can be taught, and can improve their ability, to show up well for patients, creating a relationship that is truly healing for all involved. Now, let’s give them the training, and the time, to do just that!

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice as a chaplain and bereavement coordinator. She now trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish Fall 2016. Follow Carla’s writings through her website blog, her guest blog on hospicetimes.com and also on Facebook or on Twitter @CarlaCheatham.

When They’re Holding Out for a Miracle: Healing Conversations

Posted by Carla Cheatham on Tuesday, July 26th, 2016 in Spiritual Care Integrity and Excellence

In the May 2014 issue of Journal of Oncology Practice I was excited to read an article authored by an interdisciplinary team from John Hopkins titled, “AMEN in Challenging Conversations: Bridging the Gaps Between Faith, Hope, and Medicine”. (Cooper, Ferguson, Bodurtha, & Smith, 2014). It’s brief at just under 3 1/2 pages, so I hope you’ll take a moment to read it. I shared it with my hospice team and they loved it!

What do you do when the patient’s prognosis is medically grim but the patient and family are “holding out for a miracle”? The authors discuss a respectful and easy model for all disciplines to use in handling such conversations using the mnemonic “AMEN” (see below).

I’m especially excited to see the chaplain, Rhonda Cooper, as the lead author! We spiritual care counselors often complain about not feeling respected as a valued member of the Interdisciplinary Team.

But respect is to be found as we empower and equip ourselves to support the team in performing their jobs by sharing our unique skill set.

We must BE the chaplain whom they see as clinically relevant and to whom they want to refer.

AMEN stands for Affirm, Meet, Educate, No matter what and is a conversational tool meant to give the provider an outline to remember to affirm the feelings, meet the patient/family where they are, educate about the medical issues, and assure them of the team’s presence and commitment to them.

It is a “Yes, AND” approach rather than “Yes, BUT” and can meet the needs of the patient and family by honoring their feelings, respecting their beliefs, and guaranteeing the provider will be with them every step of the way. We can do this while also upholding the ethical responsibility to deliver the medical facts of the moment and discuss the next steps in the plan of care.

The hospice team with which I work and I had the opportunity to utilize this approach with a beautiful, talented, precious young teenage woman whose family became increasingly desperate for a miracle as the glioblastoma taking over her brain and body was clearly on its way to ending her life. Asking anyone to face their grief and face medical reality is challenging enough when the patient is older, but when it’s a child…UGH!!

We did not want to deny them the faith that was holding them together and meant so much to them. We did not want to disrespect them by pushing and we did not want to disrespect her by not advocating for her comfort and final wishes. It was a dance no one wanted to do and, frankly, it scared the snot out of all of us.

But we did it, even though her mother was completely furious with us for even hinting at the things about which we were ethically required to educate the family. Several of us were “kicked out” one by one until finally it was only the RNCM and CNA who were allowed to cross their threshold.

The whole team communicated and coordinated care and shared ideas and support behind the scenes as these two women walked into a minefield each day. Thankfully, we had an incredibly mature team who was able to not take things personally and was able to avoid pathologizing their emotional and spiritual pain, labeling them as “resistant” or “crazy”, no matter how hard things became (you can follow the link to another post about handling grief that appears as conflict and anger).

We affirmed their feelings and beliefs. We met them wherever they were each visit. We educated gently but clearly and firmly (that was the hardest part). And we reassured them that they would not have to do this alone because we would be with them every step of the way. And we were, as much as they would allow us.

Almost 2 years after this sweet child died, I ran into her mother in the frozen foods section grocery store shopping for what was needed to make Christmas dinner. I realized I was holding my breath as she tried to place me (in running cap and and clothes, I look a little different!), wondering how she would respond. She asked how she knew me. I finally, softly, reminded her. Her arms flew around my neck as she grasped me and gushed her heartfelt thanks for our patience and unfailing love throughout a sticky, to say the least, situation.

Listening to her share her heart and what it was like to be her on the receiving end, hearing her describe that it was important we kept slowly and gently saying the things that needed to be said, no matter how angry she became, while also affirming her faith and feelings, was a miraculously healing moment for us both.

She had the opportunity to extend thanks she could not at that time. I had the opportunity to lay to rest the one case that had hung over my head for 2 years, wondering if we had done the right thing. It was my favorite present that year.

I often speak about the “sweet spot” between pushing too far and doing too little, neglecting our duties with patients and families in healthcare, especially related to spiritual care. (That series can be found under Guest Articles at HospiceTimes.com). I’m grateful to increasingly hear the “soft skills” of healthcare promoted to (and by) all team members, assisting us in utilizing the research-proven approach of patient-centered communication.

When persons feel heard, validated, understood, and accepted then disagreement about perspectives are much easier to bear.

Connect with my heart and I can more easily accept you disagreeing with my brain.

It can be easy to forget this, and easy to overlook simple techniques that we can all use to connect with patients and families in this way. In a field designed around diagnosis, it can be way too easy to pathologize that which makes us uncomfortable, we do not understand, or for which we feel we do not have time. We may write off patients “praying for a miracle” as delusional or in denial, and it is natural to feel uncomfortable when someone is grieving but acting it out via angry confrontations with staff.

We, the ones with the badges, titles, and uniforms, often forget that we are also human and our own discomfort or “baggage” can get in the way of our truly SEEING the persons with whom we work. Our perception can get cloudy as we label persons in grief as “crazy”, “resistant”, “defiant”, “combative”, etc.

If we can instead see them as well-intentioned humans processing challenging and painful information the best way they can as quickly as they can, and as fellow human beings who deserve our patience, respect, affirmation, and honest connection that still tells the truth, it is the single most ethical, compassionate, and healing thing we could ever do as professionals.

It is a delicate line, but it is possible, and chaplains are well-suited to help lead the way for our colleagues in maintaining that balance.

And so may it be…AMEN.

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice. She trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish August 2016. Follow Carla’s writings through her website blog and also on Facebook or on Twitter @CarlaCheatham.

Do Physicians Die Differently?: A Missing Peace

Posted by Carla Cheatham on Tuesday, July 19th, 2016 in Spiritual Care Integrity and Excellence

Do Physicians Die Differently?: A Missing Piece Peace

There’s been a lot of excitement lately about research articles that some say indicate physicians die differently than do the rest of us. Certainly, there are some differences.

One recent study in the Journal of the American Geriatrics Society for instance, demonstrated that physicians do appear to utilize hospice significantly more often than non-physicians in the last 6 months of life (Matlock et al, May 2016).

But as I’ve read these recent reports, I’ve worried that perhaps we are making a bit more of the results than is completely fair, or even accurate.

We end of life professionals and advocates want very badly to prove what our gut tells us is true–that those who understand the comfort, dignity, and quality of life hospice can provide will choose our services rather than pursue unnecessarily aggressive “hail Mary” treatments in their final days and hours.

The study authors even wrote,

“Because physicians are intimately familiar with the health care arena, they are uniquely aware of potential benefits and limitations of modern medicine…Their medical knowledge allows for a better understanding of prognosis. As a consequence, it was hypothesized that physicians would approach their own death and dying differently than someone without the same level of understanding and experience.”

It’s easy to make this assumption, and understandable that we want it to be true. But we do everyone a disservice when we forget that it’s not that simple. Knowledge alone doesn’t always help us make wise decisions.

While found to use hospice more often, the physicians studied were also found to receive hospital care as much as the rest of us and used the ICU and critical care even MORE than non-physicians in their final days!

So they don’t die quite as differently as we had hoped.

Perhaps those physicians studied who opted for hospital and critical care services in the last 6 months of life instead of hospice were among the large number of docs who still don’t really understand who we are, what we do, and what life and death with hospice support can look like. That would point us in the direction of even more education in medical schools and beyond.

But there’s another possibility we must consider.

Could it be that, even if physicians do understand hospice care and hold a positive view of what we can provide for them and their families, they are just as susceptible to the trappings of grief and fear as the rest of us?

We like to think that we make decisions logically, but we truly don’t. Our mammalian brain can be taught the facts all day long, but until our limbic system (seat of emotions) is calmed and reassured, little effective change occurs.

For example:

Theories of health behavior and predictors of behavior change postulate that attitudes play a significant role in our health choices, and that attitudes are comprised of both affective (feelings of comfort vs. discomfort) and cognitive (stereotypes and knowledge) components.

I teach about this a lot when I train healthcare staff in the ethical and competent care of persons of all cultures, backgrounds, and belief systems—discomfort with an outgroup (someone different than us) is only minimally impacted by instruction that increases our knowledge about that outgroup.

(Check out my “Sweet Spot” blog series at hospice times. I’ll be addressing this topic there, soon)

Prejudice research demonstrates that our attitudes are most impacted by the number of close, positive, personal connections we have with a member of an outgroup by increasing our comfort (the affective component) and debunking our stereotypes (a portion of the cognitive component).

In short, no amount of education can make our guts feel better about a decision.

We know this. If we think about it, we get it. End of life care decisions are not just about our knowledge of the medical options and an understanding of the cost-benefit analysis between quality vs quantity of life.

We know that sometimes, even when everything indicates it’s time to finally allow life to unfold to a natural end, even the most intelligent and well-informed can still demand to fight for dear life. We’ve seen it happen too many times.

In those moments, and there are many we see in our line of work, we know that unresolved grief, fears, baggage, relationship ruptures, spiritual distress, etc. can be a tremendous factor in whether or not we are ready to let life happen, which includes allowing natural death.

So I’m curious if we’re forgetting to notice a huge part of the equation in this whole conversation about whether and how and by how much physicians really do or do not die differently than the rest of us.

Even knowledge can’t over-ride the heart when it is unprepared, issues are unresolved, relationships are unrepaired, and when we are afraid.

If that is the case, and I strongly suspect that it may be, then we have a whole new path of “education” to pursue–preparing our hearts to catch up with our brains; teaching ourselves to have the hard but liberating conversations about our fears and our grief; giving room for our vulnerable feelings to be spoken aloud so they need not fester alone in silence.

Suppressed grief suffocates, it rages within the breast, and is forced to multiply its strength. ~Ovid, Tristium, V, 1, 63.

I do not mean to imply in any way that physicians are any less evolved, emotionally mature, or spiritually aware than the rest of us. I just wonder if we’re missing a piece of the picture, here, when we make it purely about what they know in their heads.

If we treat physicians as if they “should know better”, we fail in our calling to provide patient-centered care, because we do not SEE them–as men and women who are children and parents and siblings and spouses and friends who are intelligent and talented and capable of fear and grief and anger and uncertainty.

Certainly, we must educate healthcare professionals and lay persons about the benefits of hospice in providing the end of life most of us say we want—in our homes with our loved ones and no bells or whistles.

But we must also increase our grief literacy, so we are not baffled when knowing the “facts” about medical decisions doesn’t result in what we believe to be wise decisions.

In this industry we tend to speak of death as being very much like the process of birth. There’s waiting and expectation, struggle and labor, then stillness and peace as something new has occurred.

There are things we can do to prepare ourselves to cope more easily with labor pains at the end of life that have to do with so much more than a comfort kit of medications!

As we push for better awareness and practices to decrease the physical symptoms before death, may we not forget to allow social workers, spiritual care counselors, and bereavement counselors to also prepare our hearts so our grief and fears and doubts will not be unnecessarily complicated, either.

Wise teachers have been talking about this need for readiness for death so we can fully live, for some time. It isn’t new.

I think perhaps we just need to remember to take it into account when we so easily slide into looking at knowledge as being only about our education and brain cells.

We have much to teach ourselves, and each other, about what hospice can provide at the end of life. Let us not forget the soft skills that can help us prepare now for the deep breathing that will help us through our anticipatory grief, our relationship struggles, and spiritual angst…

And find a truly different way for all of us to die.

Peace…

Rev. Dr. Carla Cheatham is a hospice chaplain and bereavement coordinator in Austin, Texas, an adjunct professor at the Seminary of the Southwest, the Section Leader for the Spiritual Caregivers Section through the National Hospice and Palliative Care Organization, and a weekly guest blogger for Hospice Times.

She is the lead speaker for Carla Cheatham Consulting Group, LLC and the author of “Hospice Whispers: Stories of Life”. Her next book, “Sharing Our Stories: A Hospice Whispers Grief Support Workbook” is scheduled to publish September 2016. Learn more at carlacheatham.com or on her Hospice Whispers Facebook Page.

The “Sweet Spot”: Ethical Interdisciplinary Spiritual Care–Week 2

Posted by Carla Cheatham on Tuesday, March 15th, 2016 in Spiritual Care Integrity and Excellence

This is the second in a series of posts based on my presentation called “The Sweet Spot: Ethical Interdisciplinary Spiritual Care” (c)2014. This work is copyrighted and all rights are reserved, however, please feel free to share it electronically or even in print with proper credit provided. I want this material to reach as far as possible to help professionals, and the field, as much as possible.–Carla

Last week, in the “Sweet Spot”…

For Week 1 of the Sweet Spot series (click here to read), I wrote about the importance of all members of the healthcare team being prepared to screen for and respond to spiritual distress in the moment, when necessary.

I then shared my own ways of administering, or asking the questions for, Puchalski’s FICA screening tool.

I also spoke of the importance of referring to the trained, clinical spiritual care counselor (aka, “chaplain”) to perform the clinical spiritual assessment, develop the spiritual plan of care, and perform interventions to respond long-term to that spiritual distress.

Last week’s post was the “How”, but some may not yet be clear about the “Why”, and wonder what in the heck makes spiritual care so vital to competent, patient-centered care. Others may fully believe that impeccable spiritual care is crucial, but are not quite able to articulate the “Why”.

So here goes…

Episode 2 of the Sweet Spot series–the “Why” of Ethical Interdisciplinary Spiritual Care

My first point in making the case for ethical spiritual care is, well, the ethical one! I believe all persons deserve access to the benefits spiritual/existential care may provide without fear of judgment, abandonment, or coercion.

I speak about this regularly and wrote about it recently in a post on Hospice Times called, “Manifesto for Competent Spiritual Care: 7 Things That Matter” (click the title to give it a quick read. It’s fairly short!) So, I won’t belabor that point here.

My second point in the case for exquisite spiritual/existential care is based on empirical data and best practices, which I’ll discuss below. Research into spiritual care in healthcare is sorely lacking. Operationalizing the ethereal, making the aesthetic more concrete, can be more than a challenge.

Religion, spirituality, existentialism–these are weighty and heady issues shrouded in much mystery that often feel simply overwhelming to address. For some, this mystery is comforting and peaceful; for others, it can be a mild headache or even grounds for an all out post-traumatic involuntary eye–twitch.

Thankfully, we’re slowly getting more comfortable with the topic of spirituality in healthcare and are developing the empirical data to back it up!

But great strides have been made in recent years thanks to grants from the Templeton Foundation, the work of the Healthcare Chaplaincy Network, publications by Christina Puchalski and Betty Ferrell (one of which I referenced last week), and numerous others.

Even the National Consensus Project for Quality Palliative Care, which lists the 8 Domains necessary for competent palliative care, gave Spiritual, Religious, and Existential Aspects of Care its own whole domain (Domain 5). Instead of being just a paragraph or text box blurb in the midst of some other domain, it got it’s own place in the show and it’s even cross-referenced across multiple other domains in the document (“Clinical Practice Guidelines for Quality Palliative Care, Third Edition”, 2013, https://www.hpna.org/multimedia/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf

We are making tremendous progress in understanding the importance of quality, professional spiritual care in healthcare, but we have a long way to go.

What we’ve learned is that spiritual pain, described as “a pain deep in your soul (being) that is not physical” (Mako, Galek, & Poppito, 2006) appears to be common in healthcare patients and is significantly associated with lower self-perceptions of spiritual quality of life (Delgado-Guay, Hui, et al, 2011).

As I stated last week, the data indicates patients want to talk to their providers about their religious and spiritual concerns, but most often do not get to (Williams, 2011).

When we fail to respond adequately to patients’ spiritual distress, we find depressed mood and a decline in quality of life with persons beginning to wonder whether, for instance, God has abandoned them or even still loves them (Pargament, et al, 2001, 2004).

I call this failure on our part spiritual neglect, one extreme of what I call spiritual malpractice. When I first used this term with a dear and respected friend, who is an M.D., she said, “Don’t use that term in the medical community! It’s a big word that will turn us off an shut us down.”

But I argued that the goal isn’t to incite fear, it’s to make clear that not tending to persons’ religious, spiritual, and/or existential needs is a VERY big deal and one to which we must pay serious attention. An here’s more of “Why”.

When we DO address spiritual distress, we find higher patient and family satisfaction (Astrow, et al, 2007; Daaleman, et al, 2008; Wall, et al 2007), lower rates of hospital deaths (Flannelly, et al, 2012), higher rates of hospice enrollments and patients being less likely to pursue unnecessarily aggressive treatments (Balboni, et al, 2010; Balboni, et al, 2011; Flannelly, et al, 2012).

All of this means that when we tend to their spiritual distress, persons are more likely to die exactly where all the surveys say we want to die–at home surrounded by our things and pets and loved ones with familiar sights and sounds and smells and NOT connected to tubes and wires and beeping machines.

Now, don’t get me wrong…tubes and wires and beeping machines sometimes save our lives. I’m not against them, at all. In fact, I’m a left-handed red-headed Aries, so I know a thing or two about hanging on stubbornly and fighting against the odds. But sometimes we fight far too long and far too much to our detriment, in terms of our dignity and quality of life and the wear and tear it puts on our bodies and our families and our resources.

Surveys also consistently find that our greatest fear isn’t death, it is how we will die that scares the snot out of us. We do not want to be in pain, lose our dignity, or be a burden to our families. I’ll refer you to the amazing work of Dr. Monica Williams-Murphy and her book “It’s OK to Die” for more on this topic, lest this rabbit run too far off the trail.

This whole issue brings me to a point I mentioned last week, and promised to circle back to and address. It can be easy to assume that if a person declares a religious faith and connection (to a church, synagogue, sangha, mosque, etc.) that spiritual care from the healthcare team is redundant and therefore not necessary.

But one critical finding in the research indicates this is not only false, but a possibly dangerous proposition. In the cancer studies performed by Balboni and colleagues listed above, the findings initially showed that those patients who identified as highly religious were MORE likely to pursue aggressive end of life treatments.

Wait…WHAT?!?!?!

That made us all stop for more than a moment. One would expect that those who are highly religious would have hope and comfort in this life and even some form of comfort or hope about an afterlife of some form that comes from their religious faith. We tend to equate those who fight longer and harder, unless they are young and/or otherwise healthy, with those who are afraid or have unresolved issues or grief that leave them not yet ready to let go of this life and face death.

So we were all quite confused.

Then, in the follow-up studies, what Balboni began to tease out from the data is that if persons only receive spiritual support from their faith community, which usually does not understand medical processes and the impact of grief on acceptance of a diagnosis, for example, the patient is more likely to pursue unnecessarily aggressive treatments at the end of life.

But if the healthcare team is ALSO involved in providing spiritual care, that comes with education and grief counseling and knowledgeable support, it appears that effect is mediated–meaning highly religious persons become no more likely to pursue aggressive treatment than other less religious patients.

A well-meaning, well-intentioned faith community may push a patient and family to fight the good fight and trust in G_d’s help if they do not have a seasoned medical team joining them in a way that helps to educate everyone involved and support them through their grief.

So the next time you hear someone on the team say, “Oh, they have their own minister…” pull this out and borrow my soap box to make the case that we cannot leave them without professional, clinical, spiritual care counselors or spiritual support from the medical team!

The next time you hear another discipline say, “The chaplains can handle a bigger case-load…it’s not like they do that much”, avoid the initial visceral reaction toward snatching them nekid and burning their clothes. Instead, point them to the research and best practices listed here, or any of the growing literature that demonstrates the importance of good spiritual care.

It can be easy to sit distraught on the sidelines, claiming the other disciplines won’t let us play at the big kid’s table on the healthcare team, but that helps no one and gives away our power. We can equip ourselves with the data that backs up, and even gives us the language for, why what we do in spiritual care is so important. We can then demonstrate the importance with the way we practice our care…but that’s for another post, later in the series!

For now, I hope this information has been helpful, and I hope you’ll tune in next week as I take the information above and make the third point, that good spiritual care can tremendously impact an organization’s financial bottom line.

After next week’s post, I’m hoping that the next time you hear an administrator say, “We just can’t devote the budget to a stronger spiritual care program”, you’ll just smile and say, “Hang on a second. Let me show you something…”

So stay tuned!

Peace,

Carla

Astrow, A., Wexler, A., Texeira, K., He, M., Sulmasy, D. (2007). Is failure to meet spiritual needs associated with cancer patients’ perceptions of quality of care and their satisfaction with care? Journal of Clinical Oncology, Vol. 25, pp 5753-5757.

Balboni, T., Balboni, M., Paulk, M., et al (2011). Support of cancer patients’ spiritual needs and associations with medical care costs at the end of life. Cancer, V 117, pp. 5383-5391.

Balboni, T., Paulk, M., Balboni, M., et al (2010). Provision of spiritual care to patients with advanced cancer: associations with medical care and quality of life near death. Journal of Clinical Oncology, Vol. 28, pp. 445-452.

Daaleman, T., Williams, C., Hamilton, V., Zimmerman, S. (2008). Spiritual care at the end of life in long-term care. Medical Care, Vol. 46, pp 85-91.

Delgago-Guay, M., Hui, D., Parsons, H., Govan, K., De la Cruz, M., & Thorney, S. (2011). Spirituality, Religiosity, and Spiritual Pain in Advanced Cancer Patients. Journal of Pain and Symptom Management, 41:6, pp. 986-994.

Flannelly, K., Emanuel, L., Handzo, G., Galek, K., Silton, N., & Carlson, M.(2012). A national study of chaplaincy services and end of life outcomes. BMC Palliative Care, 11:10.

Mako, C, Galek K, & Poppito, SR. (2006). Spiritual pain among patients with advanced cancer in palliative care. Journal of Palliative Medicine, 9, pp 1106-1113.

Pargament, K., Koenig, H., Tarakeswar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A two-year longitudinal study. Archives of Internal Medicine, 161, pp 1881-1885.

Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2004). Religious coping methods as predictors of outcomes of psychological, physical, and spiritual outcomes among medically ill elderly patients: A two-year longitudinal study. Journal of Health Psychology, 9, pp. 713-730.

Wall, R., Engelberg, R., Gries, C., Glavan, B., Curtis, J. (2007). Spiritual care of families in the intensive care unit. Critical Care Medicine, Vol. 35, pp.1084-1090.

Williams, J., Meltzer, D., Arora, V., Chung, G., & Curlin, F. (2011). Attention to Inpatients’ Religious and Spiritual Concerns: Predictors and Association with Patient Satisfaction. Journal of General Internal Medicine. DOI:10.1007/s11606-011-1781-y

About Rev. Dr. Carla Cheatham:

After a career in social services, with an MA in Psychology and certification in crisis counseling, Carla received her MDiv. and PhD. in Health & Kinesiology and began serving faith communities. For almost a decade, she has worked as a spiritual counselor in healthcare, primarily for hospice.

After realizing many lacked supportive education in multi-faith spiritual care, Carla and her colleagues created the SCIE (“sky”) curriculum, which expanded to include boundary training and presentations in a multitude of areas. She provides training for all healthcare staff both via webinar and live presentations.

Carla has taken stories from the curriculum and published them as a book of stories called Hospice Whispers: Stories of Life, available here or through Amazon. The Grief Companion Guide to Hospice Whispers designed for both individuals and groups, is set to publish later this Spring. She is also writing her second book on the art of presence with those who are suffering.

The “Sweet Spot”: Ethical Interdisciplinary Spiritual Care–Week 1

Posted by Carla Cheatham on Tuesday, March 8th, 2016 in Spiritual Care Integrity and Excellence

Research indicates patients want to talk to their providers about their religious and spiritual (R/S) concerns, but that they most often do not get to do so (Williams, et al, 2011). The reasons behind why this doesn’t happen are many. The reasons why it is critical that spirituality be included in differential diagnosis and a focus of care for ALL disciplines are even more.

It takes ALL of us to provide competent spiritual care that neither neglects nor abuses patients and families…and it’s easier than you may think!

This series will address that “Sweet Spot”–the perfect middle ground we can walk as we journey with others during medical or emotional crises and help them access their beliefs that help them find meaning, comfort, and peace. All members of the interdisciplinary team can, and must, be engaged in ethical and respectful spiritual and existential care for persons of all faiths, and no particular faith.

Next week, I’ll discuss more of the “Why?”, citing research, best practices, and making the case that quality spiritual care can greatly impact an organization’s financial bottom line. This week, I’ll jump straight into the “How?”.

When I speak, I often joke that when Oprah calls or I win the lottery, I’ll buy copies of Puchalski and Ferrell’s Making Healthcare Whole: Integrating Spirituality Into Patient Care (2010) for every healthcare worker in the country.

It is a terrific overview of the very issue I seek to address as they argue that all disciplines must be equipped to screen for and intervene when patients and families exhibit spiritual distress. Then they must coordinate care with a professional, clinically trained spiritual counselor to assess and treat those sources of distress.

To be clear, Puchalski and Ferrell come largely from the hospital setting, in which the ratio of chaplains to patients is very high. In other settings, such as hospice and palliative care organizations, where those ratios should be much lower (1/40 in hospice, for instance), best practices require the spiritual care counselor (SCC) be involved in the patient’s care from the very first days of admission, introducing spiritual care services and providing the clinical spiritual assessment and coordinating on-going plan of care interventions.

But that is not always the case. Some persons reject spiritual care services because they fear the very idea of a “pastor coming in and preaching” at them, which is NOT what qualified SCC’s do. Others have connections to their own faith community and do not feel the need for an SCC to be involved in their care, which research tells us is actually a dangerous proposition for the outcomes of care–details next week. Other times, an SCC simply isn’t available when spiritual distress is noted.

Regardless of the reasons, having nurses, physicians, social workers, certified nurses aides, etc. all feeling comfortable and competent to respond ethically to needs in the moment, until an SCC can be present, is a critical aspect of quality care.

One quick and easy tool provided by Puchalski (Puchalski and Romer, 2000) to screen for spiritual concerns is known as FICA. It stands for Faith and Belief, Importance, Community, and Address in Care or Action.

There are many ways these questions can be asked. Puchalski’s suggestions for ways of asking the questions may be found on the G-Wish website, here.

Below are ways that I train healthcare staff to ask the FICA questions. Over the years of my practice with patients and families, I’ve found the approach modeled below may increase how comfortable and safe patients feel answering honestly. Not only does it make for a gentler approach to them, it also helps ensure I gain the most accurate information possible, for the benefit of both them and the team navigating their care.

F- Is there any particular faith tradition in which you were raised?

Far better than “What church do you go to?”, which assumes they attend services and assumes they are Christian, the open language indicates acceptance if they answer is “No” or if they are of another faith.

It also can place persons less on guard because, many persons who are sick or have moved to be near family as they age, or are just busy with their every day lives can feel guilty or even ashamed to admit if they do not attend services and fear judgment by the persons providing their care. It’s scary to “disappoint” the people bringing you the good drugs, the therapies, the supplies, the legal and logistical support, etc. Asking if their parents raised them in a tradition can take the pressure off of them, a bit, if they do not attend.

Lastly, what happens when you ask someone the beginning of the story? They will tell you the rest. In this one answer, persons can explain their spiritual journey in 60 second, “I was raised ______, then when I was a teenager all my friends went to _______, then I went to college and, well, you know, that was college, and then I married and he was _______, then we had a falling out with the minister so we went to…”

As they tell us their journey, we’re listening for whether they are spiritual, religious, both, or neither. They may have felt rejected or disillusioned with organized religion and have picked up some spiritual baggage which they may need to address. They may have old images from the faith of their childhood that can return during times of distress and fear, at the end of life for instance.

So we listen for landmines. We listen for spiritual strengths. We listen for the beliefs of other family members that may either support or be in conflict with the patient’s views. We listen for the language that they use to discuss their faith. We are open to hearing if they are non-theists (atheists, agnostics, humanists, etc.) and switch our language to more existential (meaning, love, connection, etc.) rather than religious words to meet them where they are.

Not bad for one question!

I- Which of your current beliefs/ideologies are most valuable or helpful to you right now? What brings you the most comfort?

Asking someone how important their faith is to them can leave persons feeling judged even before they answer if their religion isn’t of particular importance. But asking what is helping them can open up the possibilities to include a favorite rock song that keeps them going or art that speaks to them of peace or a pet that gives them connection. These all can be used to support their spiritual/existential well-being. It doesn’t always have to be a prayer or ritual. We are multi-dimensional creatures, so it’s no surprise if we connect with a deity in multiple ways.

C- If there is a crisis at 2 a.m., whom do you want me to call to come be with you and your family?

For some people, their clergy may be their primary source of support. But for others, it may be another member of their faith community, or a best friend or neighbor. We mustn’t assume.

For one woman who was a conservative Catholic, the answer was her Jewish accountant. He had started as a young, wet-behind the ears CPA when she and her husband started business 30 years before. She trusted him completely and he always watched out for her best interests. They had a spiritual bond that ran very deep. So when I DID need to call on him at 2am, he came and said prayers in Hebrew and English, went through the Rosary with her, and sang Amazing Grace while I sat in humbled silence in the corner and witnessed a beautiful moment of spiritual care unfold.

A- What do we need to know about how your particular culture and beliefs/ideologies will influence your decisions, or to which we should be respectful?

We do not want to offend. We want to provide ethical and respectful care. But if we do not directly ask, we may never know what that looks like for them. Merely asking the question can indicate to them how deeply we wish to honor them, their culture, their faith, their needs, and that they will not be judged by us for whatever they need. Asking ahead of time has saved my kiester on more than one occasion and, more importantly, allowed me to provide competent care.

I’ll tell you a story about that in the midst of this series, when a young CNA knew to ask a question that completely changed the outcome, and quality, of a case.

For now, I hope something of this has been helpful. I look forward to sharing more ideas for ways that all of us can be involved in spiritual care that is respectful, ethical, and makes a difference, and is far easier than you might imagine!

Peace…

About Rev. Dr. Carla Cheatham:

Follow Carla’s writings on her blog at http://carlacheatham.com/CCCG_SiteRevamp/carlas-blog/ and through Hospice Times at http://www.hospicetimes.com/index.php/category/guest-articles/carla-cheatham/

Symbols, barriers, and bridges: Where it all began!

Posted by Carla Cheatham on Tuesday, February 23rd, 2016 in Uncategorized

In 2012, I began Carla Cheatham Consulting Group, LLC to deliver my training curriculum, called SCIE™ (pronounced “sky”) Spiritual Care Integrity & Excellence, to spiritual care counselors and other healthcare workers. As the business grew, I became increasingly clear about how to communicate my vision and product to others. Whether meeting with my lawyer, CPA, graphic artist, business coach, potential clients, or colleagues, I had a very clear picture in my own head and heart but needed to find a way to clearly articulate and represent it to each of theirs!

Designing my business’ logo was one of the most exciting and daunting parts of that process. Would others judge it as too stiff?….too fru-fru?…too amateurish?…too (insert insecurity here!) Once I got over myself (mostly) about this, I then grappled with how it would “land” inside others’ hearts and minds. Would it communicate my desire for professionalism combined with down-to-earth openness to all…deep spirituality that’s free of judgment or pressure on others…a passion for full-on peace and joy in life even in the midst of struggle and sometimes death?

In my trainings, I challenge participants to be mindful of the items they wear. I, personally, do not wear a cross when I’m working as a chaplain. I fear that doing so could serve as an instant barrier to anyone of another faith or to those for whom Christianity has been a harsh word of condemnation rather than a liberating word of radical acceptance and grace. Besides, unlike my work as clergy of a faith community, my work as a chaplain prohibits promoting my own religion, as ethical and regulatory guidelines require me to be present with patients and families and help them access their own beliefs, not mine, to find as much peace and meaning and comfort as possible.

I’m always a bit surprised by how difficult it is for some to let go of their “uniforms” or symbols. One described feeling the collar gave her a sense of professional credibility in the hospital surrounded by doctors, nurses, social workers, etc., who sometimes consider the chaplain to be “less than” a clinical professional or equal colleague. Another asked, “Well, how will folks know I’m a Christian if I don’t wear a cross?”

And I get that response. I get how much we desire to be acknowledged and respected professionally; to be able to express our own beliefs. So my response is to gently (hopefully) open a dialogue, “If ours is a clinical role, then is it appropriate for us to lead with our faith rather than making more open and safe space for patients and families to share theirs, free of fear of our rejection of who they are or how they believe? Will they tell me their deepest worries or struggles or baggage if I’ve established myself as being of a particular faith? Would their stereotypes, for good or for ill, get in the way of our relationship before it even begins?”

I choose to not risk an unintended barrier to that relationship. (SIDE NOTE: To be clear, this desire to build a relationship of trust and rapport is NOT about performing a “bait and switch” by trying to get them to feel safe enough with me or “inspired enough” by me that they ask me about my faith so I feel I have a loophole through which to proselytize–that’s opportunistic, coercive, and abusive of my position of power in the relationship relative to their vulnerability.)

But…I wanted something to wear, because I’m not above feeling “safer” and “more complete” with a “uniform”! About 10 years ago, I came across exactly what I was looking for (see pic above) in Austin at the Pecan Street Arts Festival in the booth of local artist, Amy Kappler, whose company is called Hippos Eating Alligators. Amy was one of the first-generation dichroic fused glass artists and she created the above necklace.

Lights shone and choirs sang as soon as I saw it, because I knew it was exactly what I was looking for. It captured the spiritual but non-religious nature I wanted to communicate to help offer open space to folks who may be skittish of “pastors” or may have baggage about religion they would not share with me if they did not feel safe. Besides, I think it’s pretty freaking gorgeous! I’ve worn it almost every single day since then.

Each day, I get no less than a half-dozen compliments on it, and as folks comment on or I ask them about what they see in it, they always say, “the Tree of Life”. They also often go on to tell me their stories. It’s always a gentle and spiritual exchange that leaves both of us smiling and feeling more peaceful, with our shoulders relaxing and dropping away from our earlobes where the stressors of life often take them, and our hearts are reminded of love and goodness and a power greater than ourselves.

So as the business began and my graphic artist and I brainstormed about my logo, we had a simultaneous “duh!” moment as I took off my necklace, which she scanned and began working into a digital version for my business logo (many thanks to Amy for granting me full permission for it’s use!)

Since then, the necklace became my book cover for Hospice Whispers: Stories of Life as a friend painted it in acrylic and added one small yellow leaf (to be consistent with the “life” theme). As of last December, Amy has recreated the piece for me to sell through my website so that now others can have access to it.

I was clear that image was the bridge I want to clearly communicate to patients, “You are accepted”, and to professionals in the healthcare field, “You can create sacred and safe space for others to find their way”. It is what I hope to bring to each interaction with patients, families, colleagues, workshop or conference attendees, agencies for whom I consult, and my readers.

Now, to let all of my life communicate that as clearly and constantly…

Peace

For more information, visit http://carlacheatham.com/CCCG_SiteRevamp or http://carlacheatham.com/CCCG_SiteRevamp/products/ to order. For the audio or e-book version of Carla’s book, go to Amazon. To schedule Carla for training live or via webinar for your group of 1 to 1,000 or for consulting for your practice or agency, contact her by clicking here.