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Retaining Emotional Health in Professional Caregiving Part III: Risks and Symptoms

Posted by Carla Cheatham on Tuesday, March 28th, 2017 in Spiritual Care Integrity and Excellence, The Power of Presence

Retaining Emotional Health in Professional Caregiving Part III: Risks and Symptoms

This is an on-going series from my presentations on the use of ethical boundaries and resilience to maintain both healthy professionals and teams as well as prevent compassion fatigue and burnout.

Each person will experience and manifest burnout and compassion fatigue in their own way. It is natural to feel irritable, exhausted, less or more sensitive here and there in the natural course of life. These can simply be a signal that we’re due for some time away and a greater infusion of self-care or that a situation in the workplace or with a client has gotten under our skin. In either case, it’s a cue to pay attention.

Often, simply being aware of what’s going on inside of us can be enough to ease the tension. At other times, after a particularly severe and/or long-term situation of strain on our compassion muscles or challenging workplace situation, we must take time repair and steps to heal, just as if a muscle has been overworked or injured.

Suggestions for prevention of and intervention during such times will come later in this series. For now, take note of the risks and symptoms for which to watch. As mentioned previously, there are various forms of burnout, vicarious trauma, etc. with their own distinguishing causes, risks, symptoms, and even diagnostic criteria.

For most of this series, I’ll be using compassion fatigue as the global term for what we can experience as professional caregivers, but I do want to take note of some of the unique risks for burnout and compassion fatigue since differing causes can require differing prevention and intervention techniques.

As mentioned in Part II of this series, burnout was once considered to be about people-oriented jobs, but over time came to be seen by researchers to be more about:

work overload values conflict

lack of reward lack of community

lack of fairness lack of control (with this one being of particular impact)

(Maslach, Schaufeli, & Leiter, 2001)

Compassion fatigue is more about care expenditure surpassing our care intake, to put it simply. When we’re caring for others and the balance between what goes out and what goes in is skewed, we don’t have enough left inside of us to give.

Sometimes, it arises from the gradual residue of caring for dying patients or grieving families, or persons suffering emotionally, mentally, and/or physically day by day and we don’t realize we aren’t taking sufficient time to offload that residue and care for ourselves. Other times, it can be an extreme case, or one that hits our own personal tweak buttons (I’ll talk about those later in the series) so that we feel it more extremely, that drains us in an acute way.

As we think about risks and symptoms, there are some distinctions that are important to consider between burnout and compassion fatigue, especially given the current state and culture of professional caregiving as having more stress and less support. Both can involve feelings of helplessness and control, conflict and frustration, emotional distress, decreased effectiveness on the job, etc.

With burnout, however, you may be more likely to see helplessness and frustration that is related to feeling put-upon, overworked, or otherwise misused in a workplace situation that seems unethical and/or unfair with inadequate compensation, recognition, connection, support, or options for making things better. The frustration here, then, is more about the dynamics of the business, leadership, and colleagues.

One may feel similarly frustrated, out of control, helpless, and as if things are unfair when a child is dying and nothing can be done to stop the progression of an illness, for instance. Here, the risk is more likely for compassion fatigue and moral distress rather than burnout, though they can arise simultaneously.

Burnout will likely involve more anger toward the workplace while compassion fatigue and moral distress may involve more existential angst with life and frustration or guilt about not being able to make things be different. With burnout, folks may be inclined to try less because of the helplessness and frustration with a system that just won’t seem to change. With compassion fatigue and moral distress, they may push harder to try to make things better for a patient.

I’ve often been asked to come into a team to help them with their compassion fatigue only to find out they are actually dealing with burnout. It’s not the patients and families with whom they work that’s pulling down morale, it’s the dynamics with colleagues and leadership and the system of their workplace.

Sometimes it’s both!

That is why, when leading trainings about burnout, compassion fatigue, and team morale, I speak about how to handle both the things we can change as well as take care of ourselves in the face of what we cannot. I’ll cover those in this series because it is a vital distinction that can either help us find freedom or drive us under even further into feeling victimized and helpless, which isn’t good territory for anyone!

These dynamics also exist for family caregivers, not just professionals. When caring for a loved one, if a person feels put upon and unfairly used or unsupported, they are more likely to suffer deleterious effects on their health. So they may feel compassion fatigue from day in and day out care, but also may experience caregiver burnout from lacking support, reward, lack of community and connection and so on. It’s a rather universal phenomenon.

I’ll discuss more about the risks and symptoms in the next post, bringing in some of the research that tells us about what seems the most likely predictors of our distress. There ARE things we can do to care well for ourselves, no matter what our situation or which combination of the above we are facing. We can prevent and intervene when we find ourselves in a not good place.

For now, please hang in there knowing that you are not weak, you are not crazy, and you are not alone. Your colleagues across the country in all forms of professional caregiving industries are facing similar circumstances, similar struggles, and similar feelings. You will find your way through this and, while you do, there is support available to take care of you for a change. We’ll pick up with more of it next week.

For what it’s worth.

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.

Retaining Emotional Health in Professional Caregiving Part I: Introduction

Posted by Carla Cheatham on Tuesday, March 14th, 2017 in Spiritual Care Integrity and Excellence, The Power of Presence

Every week I receive an email or phone call from a colleague in the professional caregiving field from folks who are worn out, burnt to a crisp, feel helpless and overwhelmed and don’t know what to do about it. I speak to HR Directors and Clinical Managers who are desperate to know how to help their teams.

I’m asked more and more to speak about healthy boundaries, self-care, resilience, compassion fatigue (though don’t put those last two words on most continuing education proposals or they’ll get kicked out for being too froo froo, according to my friends in the know!), and other similar topics.

Certainly, in-person trainings are the best way to approach and care for these needs in organizations and amongst professionals, but I’m going to share a series of posts designed to give more of my content to all of you around these issues. My hope is that it will be of some help to you and your colleagues, save a few bald spots and ulcers (and even suicides), and support managers in keeping good staff.

It stinks to see good clinicians leave a team and walk away from professional caregiving because they’ve been overworked, underappreciated, under-supported, outright mis-used, and/or not trained well in how to take care of themselves and practice resilience while doing some of the toughest of jobs.

At the rate we’re going, I’m surprised more aren’t leaving the field and deciding working for the bomb squad is less dangerous to their health than caregiving. We stay because we love what we do, we’re good at it, we make a difference, and we feel absolutely built for it. Sometimes, though, the problem is that we love it too much, and need someone to pull us back from the edge of unreason by the nape of the neck and nudge us gently but firmly toward greater emotional health.

For the next several weeks, this will be my goal.

I’ll cover the history of burnout and compassion fatigue, signs and symptoms and what the research tells us about its causes and cures. As a sneak preview of the answers to those latter two, I’ll cover boundaries—bad ones lead to us be crispy critters—and resilience—more than just a buzzword, it’s a well-documented source of health, well-being, and longevity.

Part of this conversation involves the stories we tell ourselves and the ways in which we find our own sense of meaning in suffering, not to spoon-feed it to others, but to help us remain grounded and centered in a place of peace and empathy rather than getting caught up into the drama and drug under with them.

I’ll talk about what all of that really looks like in practice, how we off-load grief and manage our counter-transference that naturally arises because we’re human, and how we know when we’ve gone too far. Then we must consider how supervisors and colleagues can handle it when members of a team, the whole team, and/or managers go off the rails and we’re surrounded by dysfunction without contributing to the tangled mess, ourselves.

There’s more, but I hope this is enough of an overview and tease to have you be watching for the rest of the series. Business leaders know this—it costs more to find, recruit, hire, and on-board new staff than it does to take good care of and properly train the ones we already have.

Thankfully, they’re paying more attention to hiring the right fit and supporting them well in their positions so they won’t go anywhere. I give huge kudos to leadership that sees these problems and are seeking to remedy it, willing to go beyond lip-service and put real resources behind these efforts.

One durable medical equipment (DME) company that works with hospices nation-wide has done exactly that—hired me to develop hiring criteria so they hire technicians (drivers who deliver and set up needed items in homes and facilities like hospital beds, O2 concentrators, wheelchairs, etc.) who have the attitude of service to be able to walk into rooms or homes where a loved one has an illness that is terminal. Once they’re hired, they want me to train their technicians to be able to walk into any situation without fear or fumbling. I could have reached through the phone and hugged them when they called with their recognition of need and resulting request!

So, let’s do this! If there’s a particular topic you most want and need, let me know, and I’ll try to make sure to work it in. I’ll look forward to hearing your thoughts as the series goes along.

For what it’s worth.

Peace,
Carla

Nine Weeks of Must-Read Books: Week 6–Spiritual & Multi-faith Care

Posted by Carla Cheatham on Saturday, February 18th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 6—Spirituality and Multi-faith Care

With the cold weather, it’s more tempting to curl up and read, so I’m posting the books and videos I most recommend to caring professionals and to which I refer in my trainings. It’s not an exhaustive list and does not necessarily contain the latest titles, but they’re what I know works to support us while we prepare ourselves to support others. I hope you find these helpful.

Spirituality and Multi-faith Care

Making Healthcare Whole, Christina Puchalski & Betty Ferrell

I tell others that if Oprah calls and my business takes off or if I win the lottery, I’d buy a copy of this book for every single person in healthcare. Two gurus of palliative care, Puchalski and Ferrell know how important spirituality is for persons going through a life crisis.

Their book lays out an impressive argument, with supporting research, for the respectful inclusion of spirituality into healthcare. They provide a model and tools that make it more accessible for patients and families by making it more comfortable for professionals to include it in their daily practice of care. Definitely a worthy read!

Paging God: Religion in the Halls of Medicine, Wendy Cadge

A professor of sociology, Cadge brings these skills to this fascinating look behind the veil, exploring the visible and invisible ways professional care providers in hospitals include religion in their practice of medicine. Through interviews and observation, she gains keen insights and provides an interesting viewpoint of the ways healthcare integrates patients’ and professionals’ spiritual lives into the daily ups and downs in the sterile, yet human, environment of healthcare. An intriguing book I highly recommend.

How to Be a Perfect Stranger: The Essential Religious Etiquette Handbook, Stuart Matlins & Arthur Magida, Eds.

I keep this book available for my colleagues in whatever healthcare setting I find myself, and recommend others do, too. Think of it as “quick flips” for many of the major religions and denominations or sects of those religions one may find in the U.S. It’s written to help persons know how to dress and act in order to be respectful when visiting houses of worship different than your own.

However, it had brief explanations about beliefs and rituals, including around the end of life, that can help all disciplines in healthcare feel a bit more prepared to engage with persons from other cultures and faiths in a way that is respectful and comfortable for all. Keep this text handy!

The Little Book of Atheist Spirituality, Andre Comte-Sponville

A philosopher and former religious believer, Comte-Sponville moves past the angry rhetoric and debate over religion that often exists, and provide a gentler voice to discuss the often contentious question of God. As I teach respectful care for the existential needs of non-theists (atheists, agnostics, and humanists) to healthcare staff, including chaplains, I urge them to consider this delightfully compassionate book.

My goal is not to convince others to alter their beliefs, and neither is Comte-Sponville’s. The goal is to increase understanding and improve the ability to have respectful, even compassionate, dialogue around what can be a very charged topic for many. The more we understand, the less we fear; the less we fear, the more likely we will be to show up well for patients and families who do not share a theistic belief system. Give this one a try. You’ll be all the better for it.

Stages of Faith, James Fowler

After conducting hundreds of interviews with persons about their faith journey Fowler, a developmental psychologist, developed a stage theory, based on Piaget’s stages, of how our faith matures. While some have criticized Fowler’s work as being too Christo-centric, others point out that it can be applied to persons of any faith or ideology. The more we understand faith as a multi-faceted, often evolving part of an individual’s life the better we can truly meet them where they are at any given time.

I find this text appropriate for spiritual care providers, social workers, and other counselors, but nurses and physicians could also benefit from a deeper understanding of how our faith develops, ebbs, and flows over the course of our life experiences. You’ll learn about yourself and gain greater insight into others with this text.

Relating to People of Other Religions: What Every Christian Needs to Know,Thomas M. Thangaraj

In a very sweet and engaging way, Thangaraj reveals his own struggles and thoughts when getting to know someone of another faith and how the journey strengthened his own. For those being asked to care respectfully for persons of another faith or belief system, this can be challenging at first.

Many whom I’ve taught have resonated with the reflections and struggles the author openly admits in the book and benefit from his ways of reconciling his love for his neighbors and his previous views. This book will help you clarify your own faith while opening up to have more respect for others’.

If Grace is True: Why God Will Save Every Person, Philip Gulley & James Mulholland

Another text I recommend to trainees is this one written by two Quaker ministers on their view of universal salvation. In their view, if grace is grace, then grace must really be full on grace, no exceptions. Sharing their own struggles with scripture, tradition, reason, and experience, Gulley and Mulholland make their case for a grace that is bigger than we can even comprehend and they do so in a gentle way that makes it easier for the readers to follow and consider.

Again, I do not ask folks to read this to change their beliefs, but to help them wrestle with their views to hopefully widen them enough to make room for others’ faith, so that they may provide professional and respectful care for persons of all backgrounds and ways of believing.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Grief and Meaning. 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 5–End of Life Care

Posted by Carla Cheatham on Friday, February 10th, 2017 in Uncategorized

Nine Weeks of Must-Read Books for Professional Care Providers

Week 5—End of Life Care

End of Life Care

Videos

1.) Dying Wish (DVD), Karen Van Vuuern, Wise Word Productions

A physician with cancer makes the choice to Voluntarily Stop Eating and Drinking (VSED) and allows his journey to be documented to share with others. A simple, powerful introduction to the concept, currently considered legal in all 50 states. It will make you think, wrestle with your own views, and find greater clarity.

Learn more at http://www.dyingwishmedia.com/

2.) A Family Undertaking (DVD), Elizabeth Westrate, Five Spot Films

The home funeral movement has grown in recent years, with many wanting to reclaim a natural connection with death. This documentary follows the stories of those who’ve made the choice for a home funeral and burial in a touching and personal look behind the veil that seems such a mystery to so many.

Available for purchase through PBS http://www.pbs.org/pov/afamilyundertaking/

3.) New Rules for End of Life Care (DVD), Barbara Karnes

From the author of the “little blue hospice book” called Gone From My Sight, this DVD goes even deeper into providing information that can be helpful to both clinicians and lay persons. Covering what to expect, medications, hydration, nutrition, and much more, this video will help everyone feel more comfortable with and prepared for caring for someone at the end of life.

Available at https://bkbooks.com/shop/new-rules-end-life-care-dvd-kit-guide-stages-death

Books

4.) Being Mortal, Atul Gawande

This surgeon certainly took the country by storm with his brilliant critique of both society and medicine’s approach to death, the practice of medicine, and end of life care. With a clear style and articulate arguments, he explores our current state and lays out a path for us all to follow to make the changes necessary for a better outcome for us all.

5.) It’s OK to Die, Monica Williams-Murphy & Kristian Murphy

An ER physician who grew tired of running full codes on 97-year old grandmothers, cracking every rib in their body with the first chest compression, because of our fear of letting go, Dr. Monica Williams-Murphy decided to do something about it! I first heard Monica speak a few years ago at a national hospice conference and fell in love with her spirit, immediately. Feisty and passionate, with brilliance and charm, she writes a book that is easy for anyone to grasp but that also provides great insight to professionals about having those dreaded end of life conversations with patients and families. It will make you think and make you cheer.

Learn more at: http://www.oktodie.com/

6.) Notes from Theme Park Earth: A Hospice Nurse’s Personal Journey of Life, Loss and Everlasting Love, Nancy Butler.

What does it look like when a hospice nurse experiences hospice from the other side of the bed? My friend and former colleague opened her still-grieving heart to share stories and insights with all of us about the journey with her husband through diagnosis, decline, and a lot of life and music and love.

As a seasoned hospice nurse, Nancy was in a unique position to see themes and lessons that many may have missed. She weaves them together for us by sharing many glimpses behind the veil of grief and her own professional service. Touching on many levels, it is far from a depressing read and is, in fact, truly inspirational. As Nancy says, “Dying is sad, but it doesn’t have to be grim.”

Learn more at: https://www.chandlerdesignslimited.com/store/index.php?main_page=product_info&cPath=96_97&products_id=237

7.) Hospice Whispers: Stories of Life, Carla Cheatham.

Okay, I won’t practice false modesty; I’m truly proud of this book. Based on examples shared in a training curriculum for hospice and palliative care professionals, this collection of 38 stories was published to help persons increase their comfort with hospice and decrease their fear of death.

The unintended by-product has been that it has helped persons fear their own death less, learned more about how to show up better for patients and families (including their own), and has helped persons process their grief around their own story of life in the face of death. As one reader recently stated, “While reading this book, I laughed, I cried, and I heaved a huge sigh of relief!”

Learn more at: http://hospicewhispers.com

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Spirituality and Multi-faith Care. 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 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

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.

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

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

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.

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/

Manifesto for Competent Spiritual Care: 7 Things That Matter

Posted by Carla Cheatham on Tuesday, February 2nd, 2016 in Uncategorized

As a spiritual caregiver, I regularly hear persons ask, “Why?”, so I understand the power of that simple question sometimes whispered in anguish, sometimes forced out through teeth gritted in anger, and other times stammered out in shock.

But a couple of years ago, I was reminded of the power of the stated “Why” to motivate others and inspire change in the world. It came in the form of a TED talk by Simon O. Sinek called “How Great Leaders Inspire Action”.

Sinek reminds us that Dr. Martin Luther King inspired hundreds of thousands with his “I Have a Dream”, not his “I Have a Plan”, speech! We’re inspired by the clearly stated “Why” that resonates inside of, and speaks to, us. The goal is to find and connect with people who believe as we do in business and allow those connections to change our world.

Much of the success of the SCIE (“sky”–Spiritual Care Integrity & Excellence) curriculum to promote competent Spiritual Care for all healthcare disciplines came because we were clear about the “Why”. As the SCIE curriculum begins to reach and inspire others to higher quality spiritual care, that message must still be clear. So here goes:

1.) I believe all persons have the right to the powerful and protective benefits of faith, whatever that may be for them, especially during times of struggle and illness.

2.) I believe all persons deserve well-trained caregivers to be with them just as they are as they access and explore their own beliefs to find meaning, peace, and comfort.

3.) I believe that if we fail to provide competent spiritual care then we are subtly engaging in spiritual neglect, because we fail to treat the whole person.

4.) I believe when persons invite a spiritual care counselor (“chaplain”) or other healthcare worker into their home and life to care for them at one of the most vulnerable times imaginable, they deserve that care to come without judgment or coercion, whether unintentional or direct, which can equate to spiritual abuse.

5.) I believe that well-meaning and well-intentioned healthcare workers desperately want to serve patients and families well and simply need the support and training necessary to be able to do so without unwittingly committing either extreme of spiritual malpractice.

6.) I believe when we are personally developed well enough to BE with the suffering of others and trust them to find their way, we will be able to accept them, their path, and their pain without needing them to be different so we can feel better.

7.) I believe the greatest honor, dignity, and act of service we can give others is our ability to sit well-enough with our own pain so that we can be comfortable sitting with them in theirs until they find their own way, their own meaning, and their own answers.

It sounds deceptively simple to care for others this way, yet it is one of the most challenging and humbling jobs I’ve ever had the privilege of doing. I am so humbled and grateful that I now get to walk with others as they learn how to do the same. We WANT to do better. When we know how, we will.

That is WHY I do what I do. I regularly see persons struggling to reconcile old baggage or trauma or woundedness when they face the end of their life, because it just feels better to have the laundry put away and dirty dishes out of the sink before we leave on a trip. Dying, or even the fear of dying, is no different. We seek resolution.

We all deserve competent and ethical spiritual support to be with us as we find healing at the end of life, and to protect us from further damage.

Open-hearted healthcare staff are striving every day to learn and grow into even better versions of ourselves so we can provide exactly that kind of care. If this resonates with you, please let me know, and please help me help others make changes in the way we go about providing spiritual care, in healthcare and beyond.

~Peace…

About Rev. Dr. Carla Cheatham:

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 the book, for 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.