Diverse Voices: Building Bridges

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Diverse Voices Building Bridges

• Partnering with Nurses in providing
• Spiritual-Cultural Care in
• Healthcare Settings
• Janet Stark, Spiritual Care Manager and
  Multifaith Chaplain, Brockville General Hospital

2
Objectives

• To address the concept of Culturally-
  Appropriate Care in the provision of religious,
  spiritual and cultural care
• BGH spiritual care nursing survey will be
  discussed
• A Spiritual Care Assessment Tool will be shared
• Participants will be invited to share questions,
  barriers and what they have found works well in
  their practice

3
The Big Question

• As spiritual care providers, how are we going to
  improve nursing staff comfort level with the
  topic, and ensure that patients are provided with
  best practice spiritual-cultural care?

4
A Nurses Perspective

• Religious Care
• Are you kidding?
• Spiritual Care
• Whats that?
• Culturally-Appropriate Care
• Ah we get it!

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A Nurses Perspective

• Spiritual care is often poorly addressed in
  health organizations. We may profess to provide
  holistic care - body, mind and spirit - but are
  we all on the same page when it comes to spirit
  care? If we are not all on the same page, how
  can we provide spirit care to a consistent
  standard?

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A Nurses Perspective

• ..Vast range of educational backgrounds when it
  comes to spiritual health

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On a nursing team there may be

• An older nurse who was trained by the Catholic
  nuns
• A nurse with Aboriginal roots who feels that
  often traditional medicine is at odds with his
  customs and practices
• A young nurse who proudly claims to be an atheist
• A middle-age nurse who is an evangelical
  Christian and attends every worship service held
  in the hospital.

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On a nursing team there may be

• A nurse who is of oriental background and
  Buddhist in practice
• A nurse who seems angry at the church and
  fights against any personal connection with
  organized religion
• A nurse who is very spiritual and finds strength
  in sports and nature

9
Research Shows

• Health professionals are often inadequately
  prepared to provide spiritual care
• Penman et al 2009
• Nurses tend to equate spirituality with
  religion Oldnall, 1996
• Nursing assessment has been dominated by the
  medical model (physical needs)
• Baldacchino, 2006

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Research Shows

• 87 of patients consider spirituality to be
  important in their lives
• Between 51 and 77 consider religion to be
  important in their lives
• Edwards et al 2010
• Outcomes of spiritual care is that patients can
  count their blessings, achieve inner peace and
  explore coping strategies
• Baldacchino 2006

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A Nurses Perspective

• Spiritual Care is most often consulted at
  end-of-life
• Palliative Care nurses seem to have the most
  comfortable relationship practice
• with psycho-social-spiritual needs

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Canadian Nursing Association Position
Spirituality, Health and Nursing Practice

• The CNA expects registered nurses to be
  respectful of and sensitive to diversity in
  spiritual beliefs, to support spiritual
  preferences and to attend to spiritual needs

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CNA Position

• When planning for and providing care, nurses have
  an ethical responsibility to be aware of and
  adjust for an individuals spiritual beliefs as a
  component of a holistic nursing assessment and
  practice.
• Nurses are uniquely situated to ensure that an
  individuals spiritual values, beliefs and
  experiences are taken into account

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A Nurses Perspective

• Results from 121 nursing surveys at Brockville
  General Hospital in 2011 identified the vast
  differences in understanding nurses have for what
  constitutes best practice spiritual care.
• A key finding is that often the terms spiritual
  care and religious care are misunderstood.
  The term culturally-appropriate care seems
  better understood in the current Canadian
  environment of inclusiveness and tolerance.

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Spiritual Care Nursing Survey Where are you
at? RN RPN PSW

• 1. What is the difference between Religious and
  Spiritual care?
• 2. What is spiritual strength fostered by?
• 3. What is spiritual distress fostered by?
• 4. Do you have a developing spirituality of your
  own?

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Spiritual Care Nursing Survey What is your
role?

• 1. Is spiritual care within your scope of
  practice?
• 2. Are you comfortable providing a spiritual
  assessment?
• If not, why?
• 3. Do you currently refer patients to the
  spiritual care department?
• 4. Do you currently call a patients own clergy
  when needed?

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Spiritual Care Nursing Survey What do you need?

• In order to improve your knowledge, skills, and
  comfort level with assessing providing
  spiritual care, I need
• ____short in-services
• ____half-day workshops
• ____full day workshops
• ____pastoral care course
• ____brochures, books websites
• ____mentoring
• ____other _____________________________________

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Findings

• Some nurses are well-informed but not comfortable
• Some nurses are not well-informed and not
  comfortable
• Some nurses are well-informed and comfortable

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Culturally-Appropriate Care

• Open, sensitive inquiring
• Proactive and not Reactive
• A harm reduction model explores early on-- being
  aware of, and adjusting to a persons own
  spiritual-religious culture.

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Culturally-Appropriate Care

• A person or familys lifestyle
• Education
• Economic background
• Sexual orientation
• Ethnicity
• Religion
• Local culture
• Family tradition

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What is Culturally-Appropriate Care?

• Understanding the patients living environment
• Being open and sensitive to diverse beliefs and
  practices
• Leaving personal bias at the door
• Not making assumptions
• Knowing where to find resources

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K-S-A

• Knowledge can be gained by study
• Skillscan be learned from experience
• Attitudethe hardest to change. Attitude is
  inherent in the individual and reflects the
  desire to stretch, grow, and self-reflect

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Barriers to being consulted

• Experiences in
• Personal bias or negativity
• Emergency Department
• Mock Disaster Exercise

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Spiritual-Cultural Assessment

• Patient/Client/Resident ________________________
  ___________
• Faith Group/Religion/ Ethnic Background__________
  __________
• Spiritual Contact_______________________Phone
  ___________
• Spiritual-Cultural History
• Do you have a faith practice or religion?
  __________________________________________________
  ___
• How would you describe your culture?______________
  ___________
• Do you have any rituals you wish to
  practice?____________________

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Spiritual-Cultural Assessment

• What spiritual practices gave you support in the
  past?
• (sometimes concrete examples need to be
  suggested prayer, nature, reading, pets, art,
  music, worship services, visits from family,
  clergy etc) ______________________________________
  _____________
• Who gives you support? __________________________
  _________________________
• Tell me about your family_________________________
  _________
• Is there anyone else who should be involved in
  making decisions about your care?_________________
  _____________________

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Spiritual-Cultural Assessment

• Goals of Care
• What is really important and meaningful to you
  right now?______
• Is there anything the care team needs to know
  about health practices or restrictions important
  in your culture/faith group?______________________
  ___
• What do you believe about your illness?
  ________________________________

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Spiritual-Cultural Assessment

• Spiritual Distress
• Is there anything bothering you right
  now?___________________
• Is there anything you are afraid
  of?__________________________
• How are your loved ones coping right
  now?___________________
• What would help?__________________________________
  _______
• How can we include this in the hospital
  setting?________________
• Are there any other concerns you would like to
  share with me?
• __________________________________________________
  ______

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Helpful Strategies

• Communication
• Relationship with Staff
• Team Concept
• Education

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What can help?

• Be sure nurses realize that you have the
  patients ( family) permission to be part of
  their care team
• Permission does not have to be in writing
• Gain permission of the patient to include their
  own personal clergy-
• person if desired

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What can help?

• Be sure nurses can observe spiritual care at the
  bedside. Seeing the interaction, developing
  relationship and the positive response can result
  in an informal mentoring opportunity
• Gain the support of the nursing managermake sure
  he/she totally gets it
• Ask for occasional moments to speak at nursing
  staff meetings

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What can help?

• Be sure nurses know that you are available to
  help provide spiritual care, bereavement care and
  stress mgt for them personally
• Make the referral process easy!
• Find opportunities to debrief nurses when
  something has worked well/not well

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What can help?

• Plans for mandatory annual education sessions to
  improve the healthcare providers comfort and
  skill in providing appropriate bedside spiritual
  care.
• Have up-to-date area clergy contacts lists
  available in all nursing areas
• Compliment nurses on specific interactions that
  are helpful

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What can help?

• Doing a really good job of explaining the role of
  spiritual care during new staff orientation
  education.
• Open discussion during annual nursing education
  days about what spiritual care is all about, and
  training in assessment
• Attending multidisciplinary patient rounds and
  having a voice at the table.

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What can help?

• Show nurses the value of including spiritual care
  volunteers in patient care
• Offer to assist/facilitate family meetings
• Get to know and build rapport with physicians

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Brainstorm Session!What works well in your
practice?
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