History records various 'equivalents' from ancient Assyria onwards, sometimes rendered as 'chaplains'. Favored theories of derivation of the term relate to the relic cloak (capa or capella) of St. Martin of Tours or from the Latin term Capellanus. The word Almoner (e.g. Aumônier in French, Aalmoezenier in Dutch - but also Kapelaan with the military) is used in many instances where English uses chaplain, sometimes there are still other terms (e.g. also Proost, otherwise equivalent to Provost, in Dutch.
Almoner was in charge of distributing charity.Almoner was also used for a hospital official who interviews prospective patients to qualify them as indigent, and was later applied to the church officials who were responsible for patient welfare and after-care. The title "almoner" has fallen out of use in English, but its equivalents in other languages are often used for many pastoral functions covered by chaplains or pastors.
The evolution of the health care system from monastic and ecclesiastical to a seperate entity with the formation of secular hospitals maintained importance and role of the chaplain to minister to the spiritual needs of patients with compassion, mercy and grace. From giving hope, releiving anxieties and fears to' being there' to bring God into the equation chaplains have a complex work. In Christain terms there is something so profound and wonderful about walking into a room and bringing the presence of God. Just as Levites who carried the Ark of God's Presence so also modern day chaplains may usher in God's Presence. :
1.Though I speak with the tongues of men and of angels, and have not love I am become as sounding brass, or a tinkling cymbal. 2And though I have the gift of prophecy, and understand all mysteries, and all knowledge; and though I have all faith, so that I could remove mountains, and have not love I am nothing. 3And though I bestow all my goods to feed the poor, and though I give my body to be burned, and have not love it profiteth me nothing. 4Love suffereth long, and is kind; love envieth not; love not itself, is not puffed up, 5Doth not behave itself unseemly, seeketh not her own, is not easily provoked, thinketh no evil; 6Rejoiceth not in iniquity, but rejoiceth in the truth; 7Beareth all things, believeth all things, hopeth all things, endureth all things. 8Love never faileth: but whether there be prophecies, they shall fail; whether there be tongues, they shall cease; whether there be knowledge, it shall vanish away. 9For we know in part, and we prophesy in part. 10But when that which is perfect is come, then that which is in part shall be done away. 11When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things. 12For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known. 13And now abideth faith, hope, love, these three; but the greatest of these is love. A Chaplain ministers to a specific group of people in a non-sectarian framework.He may be assigned to an Army Unit or other DOD Branches or work in the Federal Penitentiary System.Or see himself standing beside a hospital bed of a patient facing death. The emphasis is on Hospital Chaplains who uniquely and daily are confronted with pain, trauma, injury, even death and all the distresses that come with life and death scenarios.The professional Chaplain is usually required to have a Masters Degree followed by a residency, i.e. CPE followed by ongoing training. He soon realizes he does not know everything.
2And though I have the gift of prophecy, and understand all mysteries, and all knowledge; and though I have all faith, so that I could remove mountains, and have not love I am nothing.
3And though I bestow all my goods to feed the poor, and though I give my body to be burned, and have not love it profiteth me nothing.
4Love suffereth long, and is kind; love envieth not; love not itself, is not puffed up,
5Doth not behave itself unseemly, seeketh not her own, is not easily provoked, thinketh no evil;
6Rejoiceth not in iniquity, but rejoiceth in the truth;
7Beareth all things, believeth all things, hopeth all things, endureth all things.
8Love never faileth: but whether there be prophecies, they shall fail; whether there be tongues, they shall cease; whether there be knowledge, it shall vanish away.
9For we know in part, and we prophesy in part.
10But when that which is perfect is come, then that which is in part shall be done away.
11When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.
12For now we see through a glass, darkly; but then face to face: now I know in part; but then shall I know even as also I am known.
13And now abideth faith, hope, love, these three; but the greatest of these is love.
A Chaplain ministers to a specific group of people in a non-sectarian framework.He may be assigned to an Army Unit or other DOD Branches or work in the Federal Penitentiary System.Or see himself standing beside a hospital bed of a patient facing death. The emphasis is on Hospital Chaplains who uniquely and daily are confronted with pain, trauma, injury, even death and all the distresses that come with life and death scenarios.The professional Chaplain is usually required to have a Masters Degree followed by a residency, i.e. CPE followed by ongoing training. He soon realizes he does not know everything.
Chaplain is: Ecumenical as embracing any and all religions and beliefs on an equal basis. Nonsectarian as not representing and pushing a specific group, church, religion or belief. Unbiased and not promoting their particular belief over any other belief. Refrains from proselytizing and promoting his church or denomination or religion. Equally accepts any person of any race, creed, color, persuasion or bent without judgement or reservation or personal bias. Free from all prejudice and partiality or societal or economic distinctions. Shares God's love and mercy to all persons knowing we are all equal in God's sight. Culturally sensitive to specific cultural beliefs, rites, rituals, prohibitions, cultural norms. A Chaplain must divorce and dichotomize his religious convictions to objectively minister.
ABRAHAM JOSHUA HESCHEL "A religious man is a person who holds God and man in one thought at one time, at all times, who suffers harm done to others, whose greatest passion is compassion, whose greatest strength is love and defiance of despair. "
GEORGE WASHINGTON CARVER "How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and strong. Because someday in life you will have been all of these."
Love brings ecstasy and relieves loneliness.
In the union of love I have seen In a mystic miniature the prefiguring vision Of the heavens that Three passions have governed my life:
The longings for love, the search for knowledge, And unbearable pity for the suffering of [humankind]. Love saints and poets have imagined. With equal passion I have sought knowledge. I have wished to understand the hearts of [people]. I have wished to know why the stars shine. Love and knowledge led upwards to the heavens, But always pity brought me back to earth; Cries of pain reverberated in my heart Of children in famine, of victims tortured And of old people left helpless. I long to alleviate the evil, but I cannot, And I too suffer. This has been my life; I found it worth living.
Patients Bill Of Rights
We the Chaplains view each patient as a unique creation of God to be given honor, respect, love and grace. Each patient is given equal status without regard to race, religion, proclivity or personal choices. It is a privilege for a chaplain to speak into a patients life at crisis and not to be taken lightly or handled irresponsibly. Chaplains are not physicians and not to perform a diagnosis or prognosis or to interfere with or enter into areas beyond his pervue. Chaplain see his need to focus on providing spiritual care and comfort, conflict resolution, crisis intervention and aiding the patient to face and accept,along with his family and support group, the severity and consequences of the patient's position.
Federal Guidelines protect the confidentiality of the patient's information and is to be considered by the chaplain as privileged in nature. Referred to as
The HIPAA Privacy Rule (Standards for Privacy of Individually Identifiable Health Information)procedure.
A General Outline of the Purpose of Chaplains:
What do hospital chaplains do?
A: Among many things, chaplains provide supportive counseling and care to patients, families, and staff who are emotionally distressed, struggling with religious or spiritual or ethical issues, or who are requesting a specific religious rite or ritual. Chaplains are available to provide a caring, listening ear. They also make referrals to appropriate religious groups on behalf of patients and families.
Q: Are your chaplains affiliated with a specific church?
A: As individuals, chaplains are affiliated with particular faith groups, but the work of the Department of Chaplaincy Services and Pastoral Education is interfaith (see below). Our goal is to help patients and families utilize their own faith resources.
Q: What does it mean to be "interfaith"?
A: Being an interfaith department means we value, honor and respect the religious diversity in our Health System. Provide spiritual care and understanding among people of all faiths.
Position Statement on Diversity
The Health System celebrates diversity in all forms.
We embrace the vision of "a community of respect, understanding, and tolerance."
We are enriched by the unique differences within our community,
And continuously strive to increase our inclusiveness.
We remain steadfast in our commitment to ensure that the delivery of patient care addresses the diversity within the populations that we serve.
With the knowledge that each patient is unique,
We continuously strive to provide culturally sensitive and appropriate care by learning to understand the beliefs, attitudes, behaviors, and desires of each patient.
We believe that the best patient care environment is one that fosters inclusiveness for all members of the community.
This community includes our patients, their families and friends, spiritual leaders, health care providers and staff, students, and volunteers who, together, help maintain our healing environment.
A Chaplain may soon discover:
I can not solve all problems.
I don't have all the answers.
Prayer may not always work.
I can't affect and accomplish what needs to be done in one visit.
Not every patient will want a chaplain.
Not every patient will recognize their spiritual need....denial.
Overenthusiasm on part of young chaplains is counter productive and turns patients off.
Chaplain not in the spiritual "band-aid' business. There is no quick fix.
Generally something that took a long time to build is not going to be solved instantaneously.
Chaplain procudures and clergy procedures differ.
Chaplain recognizes and respects place of clergy in the life of the patient.
Clergy recognizes and respects place of the Chaplain in the life of the patient.
Respect for patients of different race,culture,belief,even if I do not understand the patient.
Chaplain may need cross-cultural and world religion education.
People may not think like the Chaplain thinks.
chaplain........usually approaches a patient in an open forum. Top Ten Patient Assessment Statements as received by response or perception of the patient by the chaplain:
1. Where is the patient...using bio-psycho-social model?
2. What is the patient's expectations for himself?
3. What negative feelings are present...anxiety? fear?
4. Is the patient accepting his position?
5. How realistically is the patient viewing his situation?
6. Does the patient have a support group?
7. Is the patient religious//theistically orientated?
8. How can the chaplain assist if the patient is terminal?
9. How can the chaplain assist in the recovery process?
10. As the chaplain sees each patient as a unique individual how best can the chaplain relate to him? Common and shared experiences?
As always the chaplain maintains confidentiality and non-interference with the physician/nurseing procedures.
Introduction to Patient. The very first thing that happens is that you walk into a room and are introduced to the patient by name. You soon realize that it is better to be a listener. Poignant questions facilitate a response. What are you thinking about? Is there anything bothering you? What are your fears and worries? Every day for a hospital chaplain is new and exciting for the simple reason their are new patients with specific needs along with continued patient assessment and counseling. Patient may soon open up to you and tell you where he is at. worries, anxieties? Patients may fall into three catagories. Those who may never open up to you, those who partially open up and say what they feel you want to hear and those who are open to an honest and warm exchange. The latter makes it all worth while.
Here are some techniques:
Creating a patient assessment.
Determinig anxiety level.
Determing level of 5 stressors
Determining level of receptivity on the part of the patient.
Creating an individual assessment base.
Exploring hope and meaning.
Using tools to establish ritual and meaning.
Using a life-review.
Affirmation of sources of strenght and comfort
Diversional and life affirming activities.
Prayer, Rituals & Observance of Religious Practices
Guidelines for Spiritual Care by Non-Chaplain Health Care Professionals
The Role of the Chaplain in End of Life Care
Different Chaplain hats and roles.................
Assessment of spiritual distress
The chaplain’s role in the interdisciplinary team
Awareness of one’s own spiritual & emotional biases
Chaplain vs. Clergy approach and bias.
Ensuring that medical professionals respect religious beliefs and prohibitions
Officiating at services in the hospital for religious holidays
Chaplains often work alongside the patient and family’s own clergy,
serving as a "translator"
and patient/family advocate within a complex and often confusing medical environment .
Dealing with clergy uncomfortability.
Chaplain’s role in ethical matters
Need for Chaplain to be flexible.
Need for chaplain to meet expectations
More than just sacramental Use and Ritual
Chaplains role may include......................
being an educator
being a translator
Counselor, healer, agent of hope
Calming presence in the face of crises
Liason with staff.
Chaplain’s role in providing spiritual care to staff to include memorial services especially for long term residential patients.
Facilitate de-briefing sessions directed at the needs of other staff
Make themselves available to help staff
Differences in Patient' Experience:
into surgery .....recovery...post op recovery ...in healing process to re-entry
The first skill that you can practice to be a good listener is to act like a good listener. We have spent a lot of our modern lives working at tuning out all of the information that is thrust at us. It therefore becomes important to change our physical body language from that of a deflector to that of a receiver, much like a satellite dish. Our faces contain most of the receptive equipment in our bodies, so it is only natural that we should tilt our faces towards the channel of information.
A second skill is to use the other bodily receptors besides your ears. You can be a better listener when you look at the other person. Your eyes pick up the non-verbal signals that all people send out when they are speaking. By looking at the speaker, your eyes will also complete the eye contact that speakers are trying to make. A speaker will work harder at sending out the information when they see a receptive audience in attendance. Your eyes help complete the communication circuit that must be established between speaker and listener.
When you have established eye and face contact with your speaker, you must then react to the speaker by sending out non-verbal signals. Your face must move and give the range of emotions that indicate whether you are following what the speaker has to say. By moving your face to the information, you can better concentrate on what the person is saying. Your face must become an active and contoured catcher of information.
It is extremely difficult to receive information when your mouth is moving information out at the same time. A good listener will stop talking and use receptive language instead. Use the I see . . . un hunh . . . oh really words and phrases that follow and encourage your speaker's train of thought. This forces you to react to the ideas presented, rather than the person. You can then move to asking questions, instead of giving your opinion on the information being presented. It is a true listening skill to use your mouth as a moving receptor of information rather than a broadcaster.
A final skill is to move your mind to concentrate on what the speaker is saying. You cannot fully hear their point of view or process information when you argue mentally or judge what they are saying before they have completed. An open mind is a mind that is receiving and listening to information.
If you really want to listen, you will act like a good listener. Good listeners are good catchers because they give their speakers a target and then move that target to capture the information that is being sent. When good listeners aren't understanding their speakers, they will send signals to the speaker about what they expect next, or how the speaker can change the speed of information delivery to suit the listener. Above all, a good listener involves all of their face to be an active moving listener. casaa-resources.net Active listening basics ...In most instances, active listening consists of a few deceptively simple techniques: Offering encouragement by nodding or saying "I see." Restating the basic ideas, using terms such as "If I understand you correctly, ..." or "So what you're saying is ..." Reflecting on the feelings that the speaker is trying to convey: "Seems like that bothered you a lot ..." Summarizing the speaker's key ideas.
Brownell says such a structured approach serves several purposes. "It allows the speaker to hear the message as interpreted by the listener and to adjust it if it has been misunderstood or is incomplete. It also prevents the listener from becoming judgmental, so that the speaker is free to express him/herself without becoming defensive," she says.
"The active listening response encourages the speaker to continue speaking," Brownell adds. "This type of listening is empowering because the speaker's thoughts and feelings are reflected and reaffirmed, providing a safe and supportive context."
At first, active listening techniques can seem stilted and artificial. But with practice, experts agree that you can learn to incorporate active listening skills seamlessly into your everyday conversations. Anyone is only going to understand another person when he/she truly hears what that person is saying.
The 12 things that destroy the ability to communicate interpersonal relationally or as between chaplain and patient.....
remember them better if you think of them as the “Dirty Dozen.” They are behaviors that typically turn-off communication.
BIO-PSYCHO-SOCIAL ROLE MODEL...
Chaplains may also use the bio-psycho-social model reflecting their understanding that human beings are biological, psychological and social creatures all at the same time. People seeking to benefit from scientific wisdom for purposes of helping themselves better manage life problem are wise to copy this comprehensive professional approach and do what they can to learn about these three important aspects of human experience. A basic understanding of medicine and human biology theory helps people to understand how their bodies and brains are constructed and then affected by disease. A little background in psychological theory helps people to understand how minds develop and operate, how thoughts and feelings work, and how behaviors and attitudes can be changed. Finally, knowledge about how relationships and other social processes (gained from learning a little about sociology and social work theories) helps people to develop an appreciation for the social systems in which people live and the impact these systems have on their group and individual health. The bottomline is that the chaplain should either receive education or at least educate himself/herself in all these broad and general areas in order to enhance their ability to function. No one is implying the chaplain should become a Medical Doctor or Psychiatrist or a Social Worker but that a general understanding of all the areas that affect a patient is useful.The more the hospital sees the professionalism of the chaplain whether he or she be degreed or a lay person the more the hospital will not only accept & appreciate but also utilize the services of the chaplain.
Cross cultural sensitivity as a need can be easily defined and seen as a need in Hawaii. In Hawaii there are many different cultures which are mixed into a wonderful potpourri of human expression. The Hawaiian language itself and the use of 'pidgin english' bring out the beauty of the culture. In schools a child is addressed by his hawaiian name which is given at birth in addition to his english name. John Doe may have a middle name such as "Ikaika" which means strong as every name in Hawaii speaks of a picture. Lani heavenly. The two main industiries prior to Military and Tourism were sugar and pineapple and many people from the Orient came over to Hawaii to work on the plantation and great ships came from Portugal to Kohala on the Big Island. In the generations following races mixed and intermarried and today present a wonderful canvas of cultural diversity. This diversity can be easily seen in language and the way people talk to each other. While pidgin may be seen by some as simplistic there are wonderful word in Hawaiian such as lokahi as unity, pono as righteousness. and words for tolerance and love.
One day I was eating lunch with the Lt. Governor of Hawaii and he gave me a card which applies in a society and in a hospital setting as to interpersonal relationships and how people treat each other. In Hawaii there is the "spirit of aloha" which attracts people to Hawaii. "aloha" is the hawaiian word for hello, good bye and love and can be extended to the type of love that comes from God. If a Chaplain does not love what he is doing or love the patient then not only will it reflect but limit his ability to function and if he does not show love to the hospital staff but is seen as a 'holier than thou person' who is religiously biased then he looses again . This is generally spoken and not directed personally to anyone.
SEED PLANTED..........................FRUIT OF SEED............................HARVEST
THE POINT IS THAT WHAT A PERSON DOES IN COLUMN ONE CREATES COLUMN TWO WHICH ENDS IN COLUMN 3
This generally appplies to all human behavior, all persons, all situations, whether the person is a health care professional who sometimes faces burn-out or to a chaplain or to a chaplain/patient personal assessment.
DEFINITIONS AND UNDERSTANDING ALL THESE WORDS HOSPITAL USE ALL THE TIME.....
How to deal with anxiety?
Anxiety is a physiological state characterized by cognitive, somatic, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). These components combine to create the feelings that we typically recognize as fear, apprehension, or worry. Anxiety is often accompanied by physical sensations such as heart palpitations, nausea, chest pain, shortness of breath, stomach aches, or headache. The cognitive component entails expectation of a diffuse and uncertain danger. Somatically the body prepares the organism to deal with threat (known as an emergency reaction): blood pressure and heart rate are increased, sweating is increased, bloodflow to the major muscle groups is increased, and immune and digestive system functions are inhibited. Externally, somatic signs of anxiety may include pale skin, sweating, trembling, and pupillary dilation. Emotionally, anxiety causes a sense of dread or panic and physically causes nausea, and chills. Behaviorally, both voluntary and involuntary behaviors may arise directed at escaping or avoiding the source of anxiety and often maladaptive, being most extreme in anxiety disorders. However, anxiety is not always pathological or maladaptive: it is a common emotion along with fear, anger, sadness, and happiness, and it has a very important function in relation to survival.
How to deal with worry?
A well accepted theory of anxiety originally posited by Liebert and Morris in 1967 suggests that anxiety consists of two components; worry and emotionality. Emotionality refers to physiological symptoms such as sweating, increased heart beat and raised blood pressure and refers to negative self-talk that often distracts the mind from focusing on the problem at hand. How Does A Chaplain/ Patient Deal with Pain?
How to deal with fear (s)
The physiological effects of fear can be better understood from the perspective of the sympathetic nervous responses (fight-or-flight), as compared to parasympathetic response, which is a more relaxed state.
Fear is the flip side of anger in the inbuilt human 'fight or flight' response. Many people feel the effects of fear on a day to day basis in the workplace through the stress of a modern working environment. This fear has a direct correlation to one's working efficiency and has been crystallised into a chart through an ongoing linear study in Bristol. The fear-o-meter shows the range of emotions caused by the latent fear that a significant workload and impending deadline can create. Whilst one's ability to work effectively diminishes as the level of fear increases, productivity on the other hand increases exponentially as the impending deadline approaches. For example, a student might fail to start an essay until the level of fear reaches 5 or above, choosing to either go out or perform menial tasks until the fear has increased to the required level.
How to deal with suffering
and aversion associated with harm or threat of harm in an individual.
All sentient beings suffer during their lives, in diverse manners, and often dramatically. No field of human activity deals with the whole subject of suffering, but many are concerned with its nature and processes, its origin and causes, its meaning and significance, its related personal, social, and cultural behaviors, its remedies, management, and uses.
The need for compassion
Compassion is best described as an understanding of the emotional state of another; not to be confused with empathy. Compassion is often combined with a desire to alleviate or reduce the suffering of another; to show special kindness to those who suffer. Compassion may lead one to feel empathy with another person. Compassion is often characterized through actions, wherein a person acting with compassion will seek to aid those they feel compassionate for.
Compassionate acts are generally considered those which take into account the pain of others and attempt to alleviate that pain. In this sense, the various forms of the Golden Rule are in part based on the concept of compassion, if also on the concept of empathy.
Compassion differs from other forms of helpful or humane behavior in that its focus is primarily on the alleviation of pain and suffering. Acts of kindness which seek primarily to confer benefit rather than relieve existing pain and suffering are better classified as acts of altruism, although, in this sense, compassion itself can be seen as a subset of altruism, it being defined as the type of behavior which seeks to benefit others by reducing their suffering.
The Need For Empathy
Empathy (from the Greek εμπάθεια, transliterated as empatheia, meaning "physical affection, partiality") is commonly defined as one's ability to recognize, perceive and feel directly the emotion of another. Since the states of mind, beliefs, and desires of others are intertwined with their emotions, one with empathy for another may often be able to more effectively define another's mode of thought and mood. Empathy is often characterized as the ability to "put oneself into another's shoes", or to in some way experience the outlook or emotions of another being within oneself, a sort of emotional resonance.
The word 'empathy' comes from the German 'Einfühlung' (literally, "in-feeling"), coined by the psychologist Theodore Lipps in the late 1880s.
Empathy is also a concept recognized as "reading" another person, completely translating each movement into understandable conversation. Often, an empath can quite literally feel the emotions of another person or persons.
General Needs Of Long Term Care Patients
Reaffirmation of self worth and self esteem.
".....My life is not over, I have reasons to live..."
Reaffirmation of the significanse of their perceived and real needs.
Understanding the long term care patient's material and physical needs.
Diversional Therapy and Activity and Time Utilization. Outings.
Dealing with interpersonal conflicts.
A need to "celebrate" every day as significant.
Using birthdays to bring a sense of value to a patient's life and past (life review)
A need to feel love,respected and possessing sense of personal dignity.
Reaffirmation of hope,eternal life, Belief Patterns on the part of patients approaching death.
creating sense of family
creating a safe environment
establishing dignity and respect
meeting physical needs.
meeting mental,emotional needs.
meeting spirtual needs.
resolving inter-relational conflicts
dealing with hospice/terminal patients
identifying needs of staff.
promoting cultural sensitivity
A PATIENTS BELIEF BASE MAY INFLUENCE HEALING AND WILL TO LIVE:
Other than world religions and common cultural and anthropological similarities found in cultures there are basically 12 philosphical beliefs which define not only a person's self identity but his whole behavioral functioning. How a patient believes has a direct parellel on what the patients expects from himself, from the healthcare provider and generally speaking from life itself:
cogito ergo sum...I think therefore I am...
1. a spiritual person as partaining to the spirit and soul as distinquished from the physical nature. A spiritual approach to life encompassing many different belief bases, rituals and religions.
2. Existentialism as a philosophical attitude as distinguished by Heidegger , Jaspers, Marcel and Satre opposed to rationalism and empiricism. That stresses the individual's unique position as a self determining agent responsible for the authenticity of his or her own choices.
3. Rationalism implies the doctrine of human reason unaided by divine revelation as an adequate or sole guide to all spiritual truth,
4. Empiricism implies that all doctrine is derived from senses and sensory experience.
5. Agnosticism promotes uncertainty to all claims of religious knowledge.
6. Atheism as a doctrine or belief that there is no god.
7. Spiritualism and spiritualists that the spirits of the dead communicate with the living through a person "medium" influence.
8. Metaphysics imply that the ultimate reality is spirit and mind.
9. Relativism a theory, especially in ethics or aesthetics, that conceptions of truth and moral values are not absolute but are relative to the persons or groups holding them. Implies by necessity the absence of an absolute and/or absolute being.
10. Objectivism as promoted by Ayn Rand One of several doctrines holding that all reality is objective and external to the mind and that knowledge is reliably based on observed objects and events.
11. Theism as the belief in one God as the creator of the universe as opposed to Deism.
12. Deism as belief in the existance of God on the evidence of reason and nature only. With rejection of of supernatural revelation ie belief in God who created the World and since remained indifferent to it.
A chaplain's understanding of what a patient believes in helps the chaplain to establish receptivity on the part of the patient and influence the patient positively.
How To Cope With Loss
Grief is your emotional reaction to a significant loss. The words sorrow and heartache are often used to describe feelings of grief. Whether you lose a beloved person, animal, place, or object, or a valued way of life (such as your job, marriage, or good health), some level of grief will naturally follow.
Anticipatory grief is grief that strikes in advance of an impending loss. You may feel anticipatory grief for a loved one who is sick and dying. Similarly, both children and adults often feel the pain of losses brought on by an upcoming move or divorce. This anticipatory grief helps us prepare for such losses.
What is grieving?
Grieving is the process of emotional and life adjustment you go through after a loss. Grieving after a loved one's death is also known as bereavement.
Grieving is a personal experience. Depending on who you are and the nature of your loss, your process of grieving will be different from another person's experience. There is no "normal and expected" period of time for grieving. Some people adjust to a new life within several weeks or months. Others take a year or more, particularly when their daily life has been radically changed or their loss was traumatic and unexpected.
What are common symptoms of grief and grieving?
A wide range of feelings and symptoms are common during grieving. While feeling shock, numbness, sadness, anger, guilt, anxiety, or fear, you may also find moments of relief, peace, or happiness. While grieving is not simply sadness, "the blues," or depression, you may become depressed or overly anxious during the grieving process.
The stress of grief and grieving can take a physical toll on your body. Sleeplessness is common, as is a weakened immune system over time. If you have a chronic illness, grieving can worsen your condition.
Although it may be possible to postpone grieving, it is not possible to avoid grieving altogether. If life circumstances make it difficult for you to stop, feel, and live through the grieving process, you can expect grief to eventually erupt sometime in the future. In the meantime, unresolved grief can affect your quality of life and relationships with others.
How is grieving treated?
Social support, good self-care, and the passage of time are usually the best medicine for grieving. However, if you find that your grief is making it difficult to function for more than a week or two, contact a grief counselor or bereavement support group for help.
If depression or anxiety is making it difficult for you to function for longer than a couple of weeks, talk to your health professional about medicine; counseling can also help speed your recovery.
Coping with grief
Home treatment plays an important role in working through the grieving process. Talking about the loss, sharing cares and concerns, and getting support from others are very important components of healthy grieving.
If you are caring for a dying loved one, it is important to take good care of yourself as well. When you know that a loss is approaching, especially if you are able to participate in the care of a loved one who is dying, you may be better able to recognize and deal with your feelings of grief. It is important that you get caregiver support to help you care for your loved one as well as to help you prepare for your loss.
If you have just had a major loss in your life, it is important to: Get enough rest and sleep. During sleep, your mind makes sense of what is happening in your life. Not getting enough rest and sleep can lead to physical illness and exhaustion. Try activities to help you relax, such as meditation or guided imagery. Eat nourishing foods. Resist the urge not to eat or to eat only those foods that comfort you. If you have trouble eating alone, ask another person to join you for a snack or meal. If you do not have an appetite, eat frequent small meals and snacks. Consider taking a multivitamin daily. Exercise. If nothing else, take a walk. Brisk walking and other forms of exercise, such as yoga or tai chi and qi gong, can help release some of your pent-up emotions. Comfort yourself. Allow yourself the opportunity to be comforted by familiar surroundings and personal items that you value. Special items, such as photos or a loved one's favorite shirt, may also give you comfort. Treat yourself to something you enjoy, such as a massage.Maintain your normal activities. Staying involved in activities that include your support network, such as work, church, or community activities, may help you as you grieve.To help you work through the grieving process, make sure you:Surround yourself with loved ones. You may feel lonely and separate from other people when you are grieving. You may think that no one else can understand the depth of your feelings. Surrounding yourself with loved ones and talking about your feelings and concerns may help you feel more connected with other people and less lonely. Get involved. Participate in the activities that occur as a result of the loss. These may include making funeral arrangements after the death of a loved one, making plans for seeking new work after losing a job, or participating in a good-bye party for a beloved friend who is moving. Avoid quick fixes. Resist the urge to drink alcohol, smoke cigarettes, or take nonprescription medicines (such as sleeping aids). When you are under emotional stress, these may only add to your unpleasant feelings and experiences and may mask your emotions and prevent you from normal, necessary grieving. Ask for help. During times of emotional distress it is important to allow other people to take over some of your responsibilities. Other people often feel the need to show you how much they care about you.
Helping others cope with pain...There are many ways that family members and other people close to a person who is grieving can give help and support. The best way to help a grieving person often depends on how well the person was prepared for the loss, the person's perception of death, and his or her personality and coping style. The person's age and stage of emotional development are also important to consider when helping a person who is grieving.If someone you know is grieving: Encourage the person to grieve at his or her own pace. The grieving process does not happen in a step-by-step or orderly fashion. There will be good days and bad days. Do not try to "fix" the person's grief. Provide support and be willing to listen. Be sensitive to the effect of your words.Recognize that this person's life has changed forever. Encourage the person to participate in activities that involve and build his or her support network. Respect the person's personal beliefs. Listen to his or her feelings, without making judgments. Do not try to change the person's beliefs or feelings.
Helping young children... who are grieving can be challenging for adult caregivers. The best way to help a child varies according to age and emotional development. For more information, see: Helping young children who are grieving. Teens may need special consideration and care when they are grieving. Many times it is difficult to know how to approach and help a teen in these circumstances. For more information, see:Helping teens who are grieving. Older adults may not express grief in the same way as other adults. Older adults are more likely to become physically ill after a major loss. They may already have a chronic physical illness or other conditions that interfere with their ability to grieve or that become worse when they are grieving. In addition, older adults may be likely to develop complications associated with grieving. Older adults may be more likely than other people to experience several losses in a short period of time. For more information, see: Online Resources http://www.americanhospice/.
The After Life... Another influence on the patient may be his view on an after life. As defined as a further continuation of existance after death. A person goes to another plane of existance relative to how he lived on this life. Or in the case of some religions a cycle of reincarnations until perfection is finally achieved. After Life as a concept has been a belief base in most cultures and periods of history. Egypt,Zoroastrianism, Greek and Roman Society, Norse Religions, Judaism, Christianity, Mormonism, Universalists, Jehovah Witnesses and Islam. As well as Hinduism, Buddhism and Sikhism. The fact that all these people groups accepted the concept reinforces it's validity. The after-life is generally viewed from observation or faith.
The Role of a Holistic Approach: The fact that the Chaplain is not a specialist in the sense of a physician being such. Implies not only a general approach towards the whole patient but a holistic approach which views all aspects of the patients physiology and condition. While noninterference with the work of the physician is stressed. The Chaplain is in a unique position to see the patient from four views. As a person, who possesses a mind, and a body and a spirit. As a holistic practitioner takes into account the entire person we are not implying every chaplain should be holistic, or provide alternative medicine and/or techniques, but that the chaplain may consider all factors proven to influence the dis-ease of the patient without interfering with treatment to the patient by the professional healthcare practitioner, physician, nurse, etc. Nor should the chaplain do anything "ama" (against medical advise) or interfere with patient healthcare.
The Role Of Anthropology and Religion as Viewed By a Patient:
What is missing from this kind of anthropology is the original meaning of "ritual", (at least as Asad believes the term was used in pre-modern Christianity) where it meant learning how to do something rather than the symbolic meaning of what is done (Asad 1988:79). Ritual practices, in other words, draw upon the "prestige of the body" (Zuesse 1979: 248) in which the deepest form of knowing is through doing. Just as concepts of sacred space create a linkage between local and heavenly geographies, so does the body become the vehicle through which decidedly insignificant individuals become sanctified participants in a divine order (especially in the Christian tradition). In Shinto ritual practices in Japan, for example, the body's physical condition, actions, and emotional responses serve to mobilize not only messages (in petitioning the deities) but the renewal of physical and spiritual energies in contexts ranging from private ceremonies enacted at a particular family's request to raucous street festivals that border on anarchy (see the volume on Matsuri )--all for the purpose of influencing "preternatural entities on behalf of the actor's goals and interests" (Turner 1973: 1100)...." endqoute.
The point being that in addition to an understanding of what and how a person believes about himself. The patients cultural and ritual understanding of life and how and what he believes in directly influences his health. While some rituals seem bizarre and go to extreme prayer and faith as a ritual on the part of a christian or religious person seems to influence on a positive level the health of the patient as seen in blind/placebo studies. General observation has seen dramatic improvement on the part of the patient who 'prays' and the opposite on the part of the patient who either refuses there is a "god" of some form and/or refuses to 'pray' to "god". The point being is that what a patient believes in has as much,or perhaps more so, bearing on his condition and improvement as physiological and psychological and pathological factors.
A Hospital, anyone working in a hospital or a patient has to make a mental, intellectual and emotional choice ...
Am I willing to approach the situation theistically?
Or am I willing to approach the situation as a humanist?
Why does humanism enter as a topic into a discussion of a hospital theme?
The simple answer is that if a patient is a humanist and sees man as an end in himself.
While a humanist does not necessarily deny the beliefs he refuse to accept the application of a supernatural element into his life. i.e. no hope outside of himself.
Humanism and religion....religion while not rejected per se may simply not apply.Humanism and search for the truth is taken internally and not given to revelation or mysticism.
Humanism and knowledge presupposes that all such knowledge is found entirely within man "know thyselfhimself.
Humanism and science based on scientific scepticism and scientific approach rejecting authoritarianism.Humanism and speciesism presupposing man is a better and unique species over and above other species. Singer.
Greek Humanism 7th century bc"know thyself" followed by the Renaissance Humanism 14th century Florence as Pelagius rejected original sin and man's accountability to God. Qualities seen as "grace" were seen by Pelagius as inherent to be found internally in a person.
If all the answer to man is found within man then why has not man in himself evolved into being perfect?
Secular humanists generally believe that following humanist principles leads to secularism, on the basis that supernatural beliefs cannot be supported using rational arguments and therefore all traditionally religiously associated activity must be rejected.
Why are we spending all this energy talking about humanism from the viewpoint of a hospital or as a chaplain? As a chaplain there must be an inherent belief and presupposition that a diety, a God, a force, as something that exists outside of a person is indeed valid and applicable and has a place in the condition of, and relationship to, and modus operandii of a chaplain towards a patient. If secular humanism and scientific application alone were solely responsible for the welfare and recovery of a patient why would there have been a thousand or more years of history of a person referred to as a "chaplain."? If a man's need were found within man entirely then medicine and all associated with modern healthcare as an outside influence would also not be necessary to the recovery of the patient and individuals would then find within themselves everything necessary for recovery and if speciesism was correct why is the aging and dieing process still applicable?
Who are you???????????
An Understanding of the personality type of the patient interviewed may give the chaplain a further understanding of where the patient is coming from in addition to philosophical belief patterns described. A proper understanding of a patient needs to be viewed from a holistic view encompassing his entire personhood.
General definition of 4 basic types:
choleric....easily moved to anger and hostility.
sanquine...generally optimistic see roses not thorns.
phlegmatic...calm,controlled,not easily excited.
melancholic... sees thorns,not roses, depressive tendencies.
Accordingly a person could have a dominent trait and a lesser trait of these tendencies such as a person being primarily phlegmatic and secondarily melancholic. And be an introvert or an exrovert,and a senser or a feeler, and a thinker and judge. As seen in the 16 possible Myers Briggs combinations.
Hippocrates 370 bc...choleric...sanguine..phlegmatic...melanchology.
The method used by most management training workshops and employers is the ever-popular Merrill-Reid method, which categorizes personality types into Driver ......Expressive.........Amiable........Analytical.The basic characteristics of each are:
Driver: · Objective-focused · Know what they want and how to get there! · Communicates quickly, gets to the point · Sometimes tactless and brusque · Can be an "ends justify the means" type of person · Hardworking, high energy · Does not shy away from conflict
Expressive: · Natural salesmen or story-tellers · Warm and enthusiastic · Good motivators, communicators · Can be competitive · Can tend to exaggerate, leave out facts and details · Sometimes would rather talk about things than do them! Amiable: · Kind-hearted people who avoid conflict · Can blend into any situation well · Can appear wishy-washy · Has difficulty with firm decisions · Often loves art, music and poetry · Highly sensitive · Can be quiet and soft-spoken .
Analytical: · Highly detail oriented people · Can have a difficult time making decisions without ALL the facts · Make great accounts and engineers · Tend to be highly critical people · Can tend to be pessimistic in nature · Very perceptive.
No one personality type outshines the other or is preferable to the other - but all complement each other in different ways. If you are choosing a team for a difficult task, it is a good idea to have representation for each on your team for a balanced approach to the task at hand.
This is a general interpretation presupposing the patient is not in a disassociative state and/or unaware of his own feelings. Disassociation is defined as a state in which some integrated part of a person's life becomes separated from the rest of the personality and functions independently It may be a common tendency on the part of some patients to either refuse to believe the severity of the situation they are facing or to psychologically attempt to remove themselves from it or to minimize it's on the part of the patient needs to be objective and non critical as the chaplain is not there to make a judgement call but to interpret the condition of the patient from an informed and educational viewpoint.
5 Common Stages of Grief.
How do you minister to a patient as a chaplain on the worst days of their life when they are suddenly comfronted with tgheir own mortality? Chaplains more than any other profession have to deal with this seemingly morbid concept on regular or routine basis.
Enumeration of stages are:
Denial: The initial stage: "It can't be happening." significanse in their life. The chaplain again is not a psychiatrist. Understanding the patients personality type is merely another tool to perform a proper patient assessment which is defined as act of judging or assessing a person or situation. Judgement .
Anger: "Why ME? It's not fair!" (either referring to God, oneself, or anybody perceived, rightly or wrongly, as "responsible") .
Bargaining: "Just let me live to see my child(ren) graduate." .
Depression: "I'm so sad, why bother with anything?"
Acceptance: "It's going to be OK."
Denial...Denial is a defense mechanism in which a person is faced with a fact that is too painful to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence. The subject may deny the reality of the unpleasant fact altogether (simple denial), admit the fact but deny its seriousness (minimisation) or admit both the fact and seriousness but deny responsibility (transference). The concept of denial is particularly important to the study of addiction.
Anger is part of the fight/flight brain response to the perceived threat of pain. When a person makes the cognitive choice to take action to immediately stop the threatening/painful behavior of another (person or organization, or any outside force) anger (as opposed to fear) becomes the predominant feeling, with behavioral, cognitive and physiological correlates. In the animal kingdom, when physically threatened, animals will make loud sounds, attempt to look physically larger, bare their teeth, and stare. Humans behave in a similar manner when a perception of potential pain occurs, and the decision to oppose (rather than flee) occurs. Anger is a behavioral pattern designed to communicate "Stop your behavior immediately, it is harmful or threatening- If you don't, violence towards you may follow." Rarely (if ever) does a physical altercation occur without the prior expression of anger by at least one of the participants.
Bargaining: I am willing to negotiate with "you" "God" if you are willing to give me some concessions. The implication is that I am avoiding recognizing where I am at or to accept it and wish to bargain my way out.
Depression occurs when I realize that no amount of denial or anger or bargaining is going to change my situation and I now internalize my grief. Depression can occur in many ways.
Manic depression or bipolar disorder....excessive excitement or enthusiasm see mania.
Clinical depression.....concerned with or based on actual observation and treatment of disease in patients rather than experimentation or theory.
Endogenous depression.....relating to pathology. Pathology. (of a disease) resulting from conditions within the organism rather than externally caused.
Reactive or Neurotic depression.....relating to neurosis. Possessing feelings of anxiety,obsessional thoughts,compulsive acts without any objective evidence of diseade. Or indecision or dgerees of social maladjustment.
Atypical depression...not typical; not conforming to the type; irregular; abnormal: atypical behavior; a flower atypical of the species.
Psychotic depression...relating to psychosis. A mental disease characterized by symptoms of delusions,hallucinations and impairee contact with reality. Or any severe form of mental disorder as schizophrenia or paranoia.
The Chaplain is not a clinical psychiatrist and not necessarily trained to deal with the complexities as seen above. The main desire and impetus of any chaplain is to bring a patient to a state of acceptance.
Acceptance, in spirituality, mindfulness, and human psychology, usually refers to the experience of a situation without an intention to change that situation. Acceptance does not require that change is possible or even conceivable, nor does it require that the situation be desired or approved by those accepting it. Indeed, acceptance is often suggested when a situation is both disliked and unchangeable, or when change may be possible only at great cost or risk. Acceptance may imply only a lack of outward, behavioral attempts at possible change, but the word is also used more specifically for a felt or hypothesized cognitive or emotional state. Thus someone may decide to take no action against a situation and yet be said to have not accepted it.
Acceptance is contrasted with resistance, but that term has strong political and psychoanalytic connotations not applicable in many contexts. Acceptance is sometimes used with notions of willingness: "Even if an unchosen, undesired, inescapable situation befalls me, I can still willingly choose to accept it." By groups and by individuals, acceptance can be of various events and conditions in the world; individuals may also accept elements of their own thoughts, feelings, and personal histories. For example, psychotherapeutic treatment of a person with depression or anxiety could involve fostering acceptance either for whatever personal circumstances may give rise to those feelings or for the feelings themselves. (Psychotherapy could also involve lessening an individual's acceptance of various situations.)
The concept of acceptance on the part of the patient is twofold.
Acceptance on the part of the patient facing death. And equally significant is acceptance on the part of the patient who realizes (and accepts). "I will never be who I was because of what happened to me." and "My life will never be the same." This is no less complex for the chaplain but may be even more complex in that with the dieing patient there is a conclusion eminent while with the living patient there is still life, time, years,days, months of in some cases continous moment by moment pain and inability and depend upon other in order to perform even the most simple functions of a human being.
One of the biggest and perplexing jobs of a chaplain is to bring the dieing patient to a place of acceptance and surrender and peace. And also to bring the living patient to a place of accepting and dealing with their situation. As in the case of a bed ridden paraplegic. The two things any patient needs to do is be at peace with self and be at peace with God. Until the patient comes to this point the patient may manifest anger, bitterness, hostility or all various forms of negitive emotions. A patient may return to a point of 'normalcy' where he is able to deal with his situation on a daily basis and accept his condition. A patient may be so severe in his situation as life will never be the same and he may spend the remainder of his (her) days totally dependant upon others for the basic necessitites of life such as in the case of the long term patient.(see below)
Maternity Is self explanatory and delicate in nature. Are the parents married? Absence of a father? Do they want a baby and all the life changing demands that go with it? Pro-life? What if the new mother is homelsess? Underage? What to do if the baby has defects or special needs? The vulnarability of the new mother sometimes manifesting symptoms of postparten syndrome. The delicate nature of a maternity ward demands a delicate touch.
The Mental Unit or 'psych ward" of the hospital that deals with patients who may be a danger to themselves and/or others. The nature and severity of mental problems necessitates not only a lockdown,safe environment but also is "by invitation only". Chaplain on duty presses the busser and announces he is on duty and available if patient needs a chaplain and deemed appropriate by worker. Even if a chaplain does indeed minister to a patient the root causes are deep and the 'band aid' approach is again superfluos.The best a chaplain can do is reassure the patient someone cares about them and be a listener, create appropriate responses and if the patient is open shift the session into a spiritual form and ask the patient if he desires prayer. The chaplain needs to be a sensitive and caring individual who dismisses the social stigma that often goes hand in hand with mental patients. You are not there to judge. And as in all cases the chaplain is not there to do his own prognosis or diagnosis. Ask the mental health worker if specific techniques are applicable to a particular patient.
Out Patient Surgery
Even though the patient knows he is going home the same day the fact that it is indeed surgery may create in the patient a degree of anziety which may need to be assuaged by the nurse and or chaplain. The fact that it is invasive surgery may still create a measure of fear on the part of the patient and family.
The intensive Care Unit works with patients who are critical and possibly immediately terminal. This again is a closed unit because of the intensity of the nature of the unit. The chaplain rings the busser and announces he is on duty and available to minister to the patient, in some case minister 'last rights' and engage in the grief process to the patients family and support group. An intensive care unit (ICU), critical care unit (CCU) or intensive treatment unit (ITU, popular in the UK) is a specialised department in a hospital that provides intensive care medicine. Many hospitals also have designated intensive care areas for certain specialities of medicine, as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized
The emergency room while gaining television popularity is more of an intense environment that the television program can possibly convey for the simple reason it is real with real persons who need immediate diagnosis and attention. The chaplain needs wisdom and sensitivity in knowing how to minister in this highly charged environment as not to interfere with hospital procedure and treatment but still be a comforting presence to the patient,victim and family in the waiting area. The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and requiring immediate attention. Emergency departments developed during the 20th century in response to an increased need for rapid assessment and management of critical illnesses. In some countries, emergency departments have become important entry points for those without other means of access to medical care.Upon arrival in the ED, people typically undergo a brief triage, or sorting, interview to help determine the nature and severity of their illness. Individuals with serious illnesses are then seen by a physician more rapidly than those with less severe symptoms or injuries. After initial assessment and treatment, patients are either admitted to the hospital, stabilized and transferred to another hospital for various reasons, or discharged. The staff in emergency departments not only includes doctors, but physician assistants (PAs) and nurses with specialized training in emergency medicine and in house emergency medical technicians, respiratory therapists, radiology technicians, Healthcare Assistants (HCAs), volunteers, and other support staff who all work as a team to treat emergency patients and provide support to anxious family members. The emergency departments of most hospitals operate around the clock, although staffing levels are usually much lower at night. Since a diagnosis must be made by an attending physician, the patient is initially assigned a chief complaint rather than a diagnosis. This is usually a symptom: headache, nausea, loss of consciousness. The chief complaint remains a primary fact until the attending physician makes a diagnosis.
Patients who are preparing for surgery.Patients who are recovering from surgery and in certain cases terminal patients. The latter deals with the grief process along with their families. Patient 'x' was here for a number of weeks. Not only did the chaplans have the opportunity to know patient 'x' but establish a relationship with patient 'x' family. On any given week it may take a chaplain two or three days to either establish a relationship with a patient or for the patient to open up to ascertain root causes and exactly where the patient is coming from and where he feels he is going. The patients anticipating surgery have anxiety and fears, will the surgery be successful? Will I be able to recover? Pain is present at both sides, prior to surgery and in the recovery process. Along with the five sources of stress. This unit is not a good place for any chaplain to apply 'band aids' and quick fixes as there aren't any. A weekly chaplain on Monday does not know the patient yet by Friday a wonderful thing happens as he sees a number of patients who have been touched or ministered to. He may remember the week with a real sense of satisfaction.
Long Term Care
Long Term Care on the first floor is housing two types of patients. Those who are bedridden and those who are mobile with wheel chairs. The stresses involved here are complex as the patients here are permanent hospital residents. They face not only physical discomfort, but psychological, emotional and societal problems on a daily basis. The need for long term care arises when an individual requires from someone else, assistance with medical care, daily activities, comfort, supervision or advice. Most long term care is provided by family members. In lieu of home care many patients become permanent hospital care which requires daily, hourly and continued care from nursing and CNA personnel. Long term patients need to maintain a sense of personal value and dignity and self worth. need to co-exist with other patients in a closed in environment. The chaplain may assist to resolve conflicts among patients which develop from close and continuos contact with other patients day after day after day.There is also the need not only to perform religious services weekly but to create rituals to affirm life itself. Friday volleyball games, monthly outings, celebrate holidays, silly costumes at Halloween, 4th of July Parade. There is a built in loneliness and vulnerability between Thanksgiving and Christmas and all effort is taken by chaplains and staff to make Christmas most joyable for the long term patient. The Chaplains coordinate with the Nursing Staff and identify needs of the shut-ins. One person may need new shoes. Another may need a sweater perhaps it is good to point out that in the case of any chaplain "Nobody cares what you know until they know that you care." "This (dayroom) is their home." The chaplain needs to be sentive not only to spiritual but also to emotions, physical,financial needs of patients. When any family lives together in a small environment there is a built in tension which is compounded by the fact that tomorrow will be like today. Each patient may find his own position around the tables which establishes personal territorial bounries and personal significanse. Special care needs to be constantly given not only to minister to the individual patient but also to minister to the patients entoto as a family. Many groups come to the dayroom to minister spiritually, play games, read, and special outings. Each long term care patients needs to feel significant,safe and protected as they daily sense their own self vulnerability. Even if it means just sitting there and playing a silly card game which affirms their significanse and value as a person? Each long term care patient from a chaplain's viewpoint experience death of their own fellow patients at which time the chaplain will conduct a memorial service and in the backround in their own minds an awareness of their own mortality.The chaplain and the visitor should approach each day as positive,uplifting and another day given by God. Each day there are specific programmes and activities and at certian times of the year to celebrate seasons and holidays.
The Chaplain and Staff...The Chaplains a lay, volunteer person or even as a professional needs to develop techniques which integrates himself into the Hospital Staff Life. As long as the staff sees the chaplain as nothing more than a religious outsider who frequently appears on his own initiative he the Chaplain is missing a wonderful opportunity. Not only to establish relationships with the staff but to be seen as a valued fellow worker. Someone who can be trusted and is there to assist a nurse or anyone as the need arises. The more the chaplain is seen. the more he sees friendships develop, it opens the door not only to acceptance but the chaplain to be able to minister to the staff also. To this end the Chaplains throw an appreciation Christmas Lunch for the Hospital Staff every December which is a perfect Bridge to build relationships.
The Need For Cultural Sensitivity On The Part Of A Chaplain:
1. I accept the patient unconditionally regardless of race,religion or behavior.
2. it is not my job as a chaplain to initiate and elevate my personal religious beliefs.
3. it is not my job to change the person.
4. I need to build a relational bridge either through commonality or shared experience.
5. I need to communicate on his level and if at all possible speak the same language.
6. In a multi-cultural environment I need to strive for assimilation.
7. I need to actively take steps to minimalize those qualities which make me different.
8. It is the patients acceptance of myself personally and as a chaplain which creates and determines the extent he is willing to accept or agree with my own particular religious belief base and it is not my job as a chaplain to initiate any discussion or attempt to prozelitize or convert or minimalize his particular spiritual condition or experience.
9. If a patient wants to be touched feel free to touch the patient. If the patient asks for prayer feel free to pray with the patient. Do not use prayer itself as a springboard to preach or share your own personal beliefs which may have been already questioned. Make sure your prayers are non-judgemental,non-critical,non-preaching or moralizing.
10.You as a chaplain are not representing your church nor are you as a chaplain forcing your beliefs on any patient. If a patient accepts your own beliefs you then are able to communicate from a position of commonality.
11. A Chaplain should approach every patient objectively, spirituality is one aspect of communicating with the patient. Some of the questions in my mind regarding a patient should be from a holistic framework? How is he feeling physically? What is he facing emotionally and mentally? Does he have a support system in place? Using the bio-psycho-social model I analyse each patient from a whole person viewpoint.
12. We are not a christian group but are ecumenical without personal bias.
The benfits of using Rogerian (Carl Rogers) Techniques in Patient Assesssment:
More than anything else the chaplain is a listener.
Rogerian counseling involves the counselor's entry into the person's unique world. In mirroring this world, the counselor does not disagree or point out contradictions. Neither does he / she attempt to delve into the unconscious. Rogers describes counseling as a process of freeing a person and removing obstacles so that normal growth and development can proceed and the person can become more independent and self-directed.
During counseling, the client can move from rigidly of self-perception to fluidity. Certain conditions are necessary for this process. A 'growth promoting climate' requires the counselor to be congruent, have unconditional positive regard for the person as well as show empathic understanding. Congruence on the part of the counselor refers to her / his ability to be completely genuine whatever the self of the moment. He / she is not expected to be a completely congruent person all the time, as such perfection is impossible.
Self-actualization can be defined as a state of psychological fulfillment, including acceptance of self and others, accurate perception of reality, close relationships, personal autonomy, goal directedness, naturalness, a need for privacy, orientation toward growth, sense of unity with nature, sense of brotherhood with all people, democratic character, sense of justice, sense of humor, creativity, and personal integrity.'
Rogers maintained that the human "organism" has an underlying "actualizing tendency", which aims to develop all capacities in ways that maintain or enhance the organism and move it toward autonomy. This tendency is directional, constructive and present in all living things. The actualizing tendency can be suppressed but can never be destroyed without the destruction of the organism. This concept is the only motive force in the theory, but encompasses all motivations; tension, need, or drive reductions; and creative as well as pleasure-seeking tendencies). Only the organism as a whole has this tendency, parts of it do not. Each person thus has a fundamental mandate to fulfill their potential
Transference is a Freudian term used to describe the unconscious assignment to others of feelings and attitudes associated with significant figures from the person's early life. It is considered a most important element of psychoanalytic treatment. It can be defined as an unconscious phenomenon in which the client projects onto the nurse or therapist attitudes, feelings, and desires originally linked with early significant persons. The nurse or therapist represents these figures in the client's current life.
Active listening also involves paraphrasing and summarizing the person's emotions back to them, asking questions to help them express what they feel or believe or asking questions to achieve a better understanding of what the worshiper is saying. To listen empathically setting aside as much as we can of our own "stuff" and entering as deeply as possible the perceptual world of the speaker, is actually a form of meditation. What the client needs is to know that they are being heard. This evidence that they are valued as a human being and supported in working through their issues creates the sense of safe space for their deeper internal explorations
The Person-Centered Therapy relationship must always be an honest one. The counselor needs to be real and true in the relationship. Individuals who cannot accept others (i.e. because of personal values and beliefs they hold rigidly and apply to all), or who will not listen and try to understand ... cannot do Person-Centered Therapy. The therapist must embody the attitudinal quality of genuineness and to experience empathic understanding from the client’s internal frame of reference and to experience unconditional positive regard towards the client. When the client perceives the therapist’s empathic understanding and unconditional positive regard, the actualizing tendency of the client is promoted.
Paraphrasing what the client has said, or restating the message in simple words, can help the client know that he or she has been heard. It will also ensure that the provider understands what the client is saying. In paraphrasing or restating the message, a provider might pay particular attention to reflecting back the client’s feelings.
Psychodynamic (Psychotherapy) uses the basic assumption that everyone has an unconscious mind (this is sometimes called the subconscious), and that feelings held in the unconscious mind are often too painful to be faced. Thus we come up with defences to protect us knowing about these painful feelings. Psychodynamic therapy tries to unravel them. It is assumes that once you are aware of what is really going on in your mind the feelings will not be as painful.
drawn from Communication in Organizations, by Dalmar Fisher)
Reflective listening has its roots the fields of counseling and psychotherapy, particularly in Carl Rogers's "client-centered" therapy.
Reflective listening is used in situations where you are trying to help the speaker deal with something. As you will see, it is very similar to what Tannen would called rapport-talk.
There are two major aspects of client-centered listening – the "listener orientation" and the "reflective technique".
In reflective listening, the listener adopts what Rogers called "the therapist's hypothesis". This is the belief that the capacity for self-insight, problem-solving, and growth resides primarily in the speaker. This means that the central questions for the listener are not 'What can I do for this person? or even "How do I see this person" but rather "How does this person see themselves and their situation?"
Rogers and others have made the underlying orientation of the listener more specific by noting that it contains four components: empathy, acceptance, congruence, and concreteness.
Empathy is the listener’s desire and effort to understand the recipient of help from the recipient's internal frame of reference rather than from some external point of view, such as a theory; a set of standards, or the listener's preferences. The empathic listener tries to get inside the other's thoughts and feelings. The idea is to obtain an emic rather than etic understanding of the situation.
Expressed verbally and nonverbally though messages such as "I follow you," "I’m with vou" or "I understand," empathy is the listener's effort to hear the other person deeply, accurately, and non-judgmentally. A person who sees that a listener is really trying to understand his or her meanings will be willing to explore his or her problems and self more deeply.
Empathy is surprisingly difficult to achieve. We all have a strong tendency to advise, tell, agree, or disagree from our own point of view.
Acceptance is closely related to empathy. Acceptance means having respect for a person for simply being a person. Acceptance should be as unconditional as possible. This means that the listener should avoid expressing agreement or disagreement with what the other person says. This attitude encourages the other person to be less defensive and to explore aspects of self and the situation that they might otherwise keep hidden
Congruence refers to openness, frankness, and genuineness on the part of the listener. The congruent listener is in touch with themselves. If angry or irritated, for example, the congruent person admits to having this feeling rather than pretending not to have it (perhaps because they are trying to be accepting). They communicate what they feel and know, rather than hiding behind a mask. Candor on the part of the listener tends to evoke candor in the speaker. When one person comes out from behind a facade, the other is more likely to as well.
In some cases, the principle of congruence can be at odds with the principles of empathy and acceptance. For example, if thc listener is annoyed with the other person, they probably have to suspend empathy and acceptance until they sort things out.
Concreteness refers to focusing on specifics rather than vague generalities. Often, a person who is has a problem will avoid painful feelings by being abstract or impersonal, using expressions like "sometimes there are situations that are difficult" (which is vague and abstract), or "most people want…" (which substitutes others for oneself). The listener can encourage concreteness by asking the speaker to be more specific. Foe example, instead of a agreeing with a statement like "You just can’t trust a manager. They care about themselves first and you second", you can ask what specific incident the speaker is referring to.
In active listening, it is important not only that the listener have an orientation with the four qualities of empathy, acceptance, congruence and acceptance, but that the speaker feel that listener has this orientation. Consequently, a good listener tries to understand how the other is experiencing the interaction and to shape their responses so that other person understands where they are coming from. Furthermore, the listener must be prepared to deviate from the four principles if that’s what the other person wants. For example, if the other person asks for an opinion, the listener should give it, rather than avoid it as implied by the principles of empathy and acceptance.
The Technique of Reflection
A listener can implement the elements of listening orientation through a method known as reflection. In reflection, the listener tries to clarify and restate what the other person is saying. This can have a threefold advantage: (1) it can increase the listener's understanding of the other person; (2) it can help the other to clarify their thoughts; and (3) it can reassure the other that someone is willing to attend to his or her point of view and wants to help.
Listening orientation and reflection are mutually reinforcing. Empathy, acceptance, congruence, and concreteness contribute to the making of reflectivc responses. At the same time, reflective responses contribute to the development and perception of the listening orientation.
Some principles of reflective listening:
More listening than talking
Responding to what is personal rather than to what is impersonal, distant, or abstract.
Restating and clarifying what the other has said, not asking questions or telling what the listener feels, believes, or wants.
Trying to understand the feelings contained in what the other is saying, not just the facts or ideas.
Working to develop the best possible sense of the other's frame of reference while avoiding the temptation to respond from the listener's frame of reference.
Responding with acceptance and empathy, not with indifference, cold objectivity, or fake concern.
Responding to what is personal means responding to things the other person says about him- or herself rather than about other people, events, or situations. If a co-worker said, "I'm worried that I'll lose my job" the reflective listener would try to focus on the worried "I" rather than on the job situation. A response such as "It’s scary" would be better than "Maybe the cutbacks won't affect you." When the listener responds to personal statements rather than impersonal ones, the other usually stays at the personal level, exploring further aspects of his or her experience, improving his or her understanding of the situation, and developing a more realistic, active approach to solving problems.
Because the goal of the process is for the other person, rather than the listener, to take responsibility for the problem, reflective listening means responding to, rather than leading, the other. Responding means reacting from the other's frame of reference to what the other has said. In contrast, leading means directing the other person to talk about things the helper wants to see the other explore. The responsive listener addresses those things the other person is currently discussing, often testing his or her understanding of the other by restating or clarifying what the other has just said, This usually encourages the other to build on the thoughts and feelings he or she has just expressed and to explore further.
While questions can be responsive rather than leading, they very often work to limit the other's initiative by focusing attention on something the listener feels should be discussed. Though small, the question "Why?" can be particularly damaging, since it defies the other to find a justification or logical explanation that is acceptable to the helper. Instead, you might try: "That's interesting; can you tell me more about it?".
Perhaps most important, the reflective listener tries to respond to feelings, not just to content. Feelings emerge in the emotional tone that the speaker expresses, such as anger, disappointment, discouragement, fear, joy, elation, or surprise. Content refers to ideas, reasons, theories, assumptions, and descriptions -- to the substance of the speakcr's message. As Tannen notes, in troubles-talk, the speaker is often not looking for the solution of the surface problem, but rather for a way to deal with the emotional and social ramifications.
In addition, Carl Rogers notes that a person who receives response at the emotional level has "the satisfaction of being deeply understood" and can go on to express more feelings, eventually getting "directly to the emotional roots" of their problem.
Usually, the listener can be most in touch with the other's frame of reference by responding to feelings that are expressed rather than unexpressed. Since many people do not state their emotions explicitly, this may mean responding to the emotional tone that they express implicitly.
It is extremely important for the reflective listener to respond to negative and ambivalent feelings because this communicates that the listener accepts the unpleasant side of the other's experience and is willing to join in exploring it, Such acceptance provides a major release forr a person who has previously felt it necessary to suppress negative feelings. The energy that has been used to keep these feelings in check can now be devoted to exploring the problem.
Cultural Complications and Complexities...
While the following article uses 'clinician' the same applies to Chaplains. In that a hospital may be in a multi-cultural environment with many races, cultural patterns and even languages and customs the ability of the chaplain to minister is even further compounded which creates a definite need for sensitivity. Some cultures embrace, some cultures have a touching taboo. Some culture prohibit showing the bottom of one's feet. Cultural sensitivity begins with a recognition that there are differences between cultures. These differences are reflected in the ways that different groups communicate and relate to one another, and they carry over into interactions with health care providers. Cultural sensitivity does not mean, however, that a person need only be aware of the differences to interact effectively with people from other cultures. If health care providers and their patients are to interact effectively, they must move beyond both cultural sensitivity and cultural biases that create barriers. Developing this kind of culturally competent attitude is an ongoing process.A culturally competent clinician views all patients as unique individuals and realizes that their experiences, beliefs, values, and language affect their perceptions of clinical service delivery, acceptance of a diagnosis, and compliance.Cultural competence is an important component of nursing care. This is especially true given America's increasingly diverse patient population and the disparities in the health status of people from different racial, ethnic, socioeconomic, religious, and cultural backgrounds. To value this diversity a clinician must respect the differences seen in other people, including customs, thoughts, behaviors, communication styles, values, traditions, and institutions.Recognizing differences among cultures is important, but the clinician should also be aware that differences also exist within cultures. The assumption that a common culture is shared by all members of a racial, linguistic, or religious group is erroneous. The larger group may share common historic and geographic experiences, but individuals within the group may share nothing beyond that.Culture greatly influences how people view their health and the health care services they receive. Clinicians should be aware of these differences, respect them, and work within the parameters set by the patient's values. Clinicians must also recognize their own cultural values and draw parallels where possible; they should also identify any prejudices and stereotypes that prevent them from communicating effectively with patients from different cultures.
Language differences between the clinician and the patient are a further barrier to optimum health care. Where possible, hospital or local school translators should be used, since it's not always in the client's best interest to have a family member act as an interpreter. The client may feel uncomfortable discussing personal matters in front of a relative. In addition the interpreter may lack a medical vocabulary, or may reinterpret what the patient says in an effort to "help." Role conflicts may further hinder translation. For example, a child or a person of the opposite sex may be embarrassed by the information or feel it improper to convey the message intended.
When using an interpreter the clinician should:
Try to find an unrelated interpreter of the same sex as the patient, who is able to translate medical information clearly. Schedule more time for the appointment, if possible. Discuss the focus of the session with the interpreter before the patient arrives; be clear about what the interpreter should convey to the patient. Have the interpreter meet with the patient before the session to assess his or her educational level. This will determine how complex the discussion can become. If the patient has already met the clinician, the interpreter should be presented as a member of the healthcare team. Speak in short sentences or phrases, to make translating easier for the interpreter. Make sure the patient under- stands what he or she has been told by asking for him/her to repeat the message in his/her own words. Remember who the patient is—keep the focus on the patient, not the interpreter. Be sensitive to cultural differences when using nonverbal communication. For example, a touch has many cultural meanings. Clinicians must be aware that personal space has different boundaries in different cultures.
One of the biggest debates about cultural competence is whether the health care provider should be of the same culture or speak the same language as the patient. Many clinicians from racial, ethnic, or cultural minorities believe very strongly that providers should be of the same culture as the patient. Others believe this is unnecessary and wrongly maligns people who aren't members of that specific group.Another area of disagreement is whether training programs, such as diversity workshops, affect cultural competence. The argument against them is that cognitive information does not necessarily change attitudes or behavior.
In order to be culturally competent clinicians need not possess full knowledge of every cultural practice and belief. Instead they should be sensitive to others' preferences and values, and should not assume that one person's preferences and values apply to everyone in that same group. Patients are often willing to share their customs with those who seek to understand them. Genuine concern about what is important to the client is the best way to insure that culturally competent care will be provided.Gale Encyclopedia of Nursing and Allied Health,
HOW TO DEAL WITH STRESS taken from HELPGUIDE.ORG
Change the situation
Change your reaction
In our frenetic, fast-paced world, many people deal with frequent or even constant stress. The overextended working mother, the hard-charging “Type A” personality, the self-critical perfectionist, the chronic worrier: they’re always wound up, always stretched to the breaking point, always rushing around in a frenzy or juggling too many demands.
Operating on daily red alert comes at the high price of your health, vitality, and peace of mind. But while it may seem that there’s nothing you can do about your stress level—the bills aren’t going to stop coming, there will never be more hours in the day for all your errands, your career will always be demanding—you have a lot more control than you might think. In fact, the simple realization that you’re in control of your life is the foundation of stress management.
Managing stress is all about taking charge: taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun—and the resilience to hold up under pressure and meet challenges head on.
Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. You may be surprised, however, by the number of stressors in your life that you can eliminate.
Your ability to handle and bounce back from stress depends on many factors, including a:
If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem is avoided in the future. Often, this involves changing the way you communicate and operate in your daily life.
|Time management tips to reduce stress|
Create a balanced schedule
All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and solitary pursuits, daily responsibilities and downtime.
Don’t over-commit yourself
Avoid scheduling things back-to-back or trying to fit too much into one day. All too often, we underestimate how long things will take.
Make a list of tasks you have to do, and tackle them in order of importance. Do the high-priority items first. If you have something particularly unpleasant to do, get it over with early. The rest of your day will be more pleasant as a result.
Break projects into small steps
If a large project seems overwhelming, make a step-by-step plan. Focus on one manageable step at a time, rather than taking on everything at once.
You don’t have to do it all yourself, whether at home, school, or on the job. If other people can take care of the task, why not let them? Let go of the desire to control or oversee every little step. You’ll be letting go of unnecessary stress in the process.
Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.
If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.
How you think can have a profound affect on your emotional and physical well-being. Each time you think a negative thought about yourself, your body reacts as if it were in the throes of a tension-filled situation. If you see good things about yourself, you are more likely to feel good; the reverse is also true. Eliminate words such as "always," "never," "should," and "must." These are telltale marks of self-defeating thoughts.
Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by making healthy lifestyle choices and taking care of yourself. If you regularly make time for rest and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.
Don’t get so caught up in the hustle and bustle of life that you forget to take care of your own needs. Nurturing yourself is a necessity, not a luxury.
Stress management starts with identifying the sources of stress in your life. This isn’t as easy as it sounds. Your true sources of stress aren’t always obvious, and it’s all too easy to overlook your own stress-inducing thoughts, feelings, and behaviors. Sure, you may know that you’re constantly worried about work deadlines. But maybe it’s your procrastination, rather than the actual job demands, that leads to deadline stress.
Look closely at your habits, attitude, and excuses. Do you explain away stress as temporary (“I just have a million things going on right now”) even though you can’t remember the last time you took a breather? Do you define stress as an integral part of your work or home life (“Things are always crazy around here”) or as a part of your personality (“I have a lot of nervous energy, that’s all”). Do you blame your stress on other people or outside events, or view it as entirely normal and unexceptional? Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.
A stress journal can help you identify the regular stressors in your life and the way you deal with them. Each time you feel stressed, keep track of it in your journal.
Putting your worries on paper has a marvelous way of clarifying things. As you keep a daily log, you will begin to see patterns and common themes. Your journal may help you see that you don’t really have that much to worry about, or it may bring overlooked problems to light. Whatever your discoveries, your stress journal should help you establish a plan for moving forward.
Think about the ways you cope with stress. Your stress journal can help you identify them. Are your coping strategies healthy or unhealthy, helpful or unproductive? Unfortunately, many people cope with stress in ways that compound the problem. These coping strategies may temporarily reduce stress, but they cause more damage in the long run.
If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find ones that do.
There are many healthy ways to reduce stress or cope with its effects, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, accept, or adapt.
Since everyone has a unique response to stress, there is no “one size fits all” solution to managing it. No single method works for everyone or every situation, so experiment with different techniques and strategies. Focus on what makes you feel calm and in control.
PLAN HOW TO DEAL WITH PATIENTS AND THEIR SITUATIONS....
The chaplain or social worker often takes the lead.The chaplain or social worker customarily conduct an in-depth assessment at the start of care and develop a plan of spiritual care directed by patient and family goals. Ongoing assessment is crucial. As the patient’s health status changes. As new symptoms arise or are not relieved.If the dying process is prolonged. When death draws near.
Helpful assessment strategies include asking open-ended questions...
"Is there anything you are hoping for during this time?
"Where do you turn for strength?"
Providing options "Some persons find that music, meditation, or prayer help relieve pain. Are any of these something you would find helpful?"
What is empathetic presence?
"Don’t do something.
Just sit there!"
Health care professionals are experts at solving problems, identifying goals, measuring outcomes — that is, "fixing it" is our strength.The heart of spiritual care is empathetic presence, the opposite of fixing it
Empathetic presence helps people feel heard and not alone.
When patients and families are experiencing losses, despair, questions about the meaning of suffering, or a sense of abandonment by the divine more than anything else they need to be heard and know they are not alone. It is essential to create an environment in which the person feels free to explore their concerns and openly express their feelings without feeling rejected or judged.
Empathetic presence involves many skills and components
Relaxed yet engaged body posture
Eye contact (when culturally appropriate).
Reassuring touch (when culturally appropriate)
Listening beyond or beneath the literal words said by a person to the deeper emotions, meaning, and needs.
Empathetic presence may also involve a metaphorical "holding someone’s pain" as you are open-hearted but do not become overwhelmed emotionally.. It may also ask you to laugh, be joyous, and not focus on illness, pain, or dying...In the face of comments such as "why is God making me suffer so?" or "I just wish this were over, I can’t stand it anymore" empathetic presence might include:
Acknowledging their suffering...Saying you are sorry you don’t have the answer or solution..
Providing reassurance of your (or the team’s) ongoing care.
What does empathetic presence do?
Empathetic presence is doing something... Fear, anxiety, despair, and even physical pain frequently diminish with the person feels heard, understood, and accepted for where they are in the process of coming to terms or coping with their terminal illness.
Affirms personhood, self-worth, and dignity...Decreases isolation...Allows the person to find their own answers ...(For religious persons) mediates divine care.
When empathetic presence is hard to sustain In the face of unrelieved and prolonged suffering.
When our own fears and insecurities are evoked.
When we identify too strongly with the patient or family
Because of the age of the person.
Because of how they remind us of our own family or previous losses.
If we are the only team member involved in a case.
When the patient or family are highly anxious and struggling with their own feelings of powerlessness.
An exercise in empathetic presence Recall an experience from your own personal or professional life when you were unable to help someone feel better, take away their pain, or "fix" a problematic situation... How did you feel?...How did you cope with these feelings?...How did you respond to the person who was suffering? Reflect for a moment: Are you a problem solver, seeking solutions and offering advise? What does it mean for you as a nurse, doctor, social worker, etc. to be powerless?Do you feel a sense of failure in this situation?
Normalization of Patient/Family Experience.
What is normalization?
Patients and families need to hear that what they are going through is "normal"
Although every person’s experience of illness, pain, spiritual suffering and dying/death is unique and needs to validated as such Patients and families also benefit from hearing they are not "crazy".That is, their feelings, fears, and even disease progression are "normal"
Normalization builds trust..
Normalization of the experience builds trust in the palliative care/hospice team.
Conveys the message we have seen this before and know how to help.
Normalization calms fears.
Normalization can diminish anxiety and fear.Provides a "map" into this foreign territory.Normalization helps coping.It can sometimes help persons cope better with their own situation.
Connects them with others who are going through or who have successfully gone through a similar time of trial.
Ways of normalizing experience.
To illustrate by example:
A patient is highly anxious about their future ability to cope with symptoms and with the task of saying goodbye to loved ones.
Method one: One strategy of normalization would be to respond by saying "Of course you are anxious" "It makes sense to me" "After all, you’ve never gone through this before and it is a lot to take on at once"
Method two: Another strategy would be to Tell the person that many of your patients were also anxious at first But, with a little assistance, these persons grew more trusting in how they would cope with the future.
When normalization can be helpful.
When patient or family express wishes to hasten the dying process..
Frees persons to talk more about their underlying reasons or feelings by reducing judgment and guilt.
When the patient is actively dying.Relieves concerns about terminal agitation, lack of appetite, inability to swallow, visions of deceased loved ones, and their own feelings of powerlessness and grief.
Use of religion in normalization.
Examples drawn from the specific religious literature or faith community of patients and families can help normalize and validate spiritual experiences..
The example may help:
Affirm their strength to cope.
Free them from having to be perfect.
Sustain their connection with something beyond themselves (e.g., human community, tradition, the divine).
Appropriate vs. inappropriate use of normalization:
Please exercise great care in using this technique.If used at the wrong time or in the wrong way persons may feel you are disregarding their feelings or trying to minimize their suffering.How you use it makes all the difference.
Life review helps persons with concerns about:The purpose of their life
Need for forgiveness..
Closure with the past.
The progressive losses that accompany a life-limiting illness
.Life review can help establish a "legacy"
As a formal exercise, it can establish a person’s "legacy"
How they will live on in the future or how they wish to be remembered.In this way,
it can also be helpful to bereaved families as it gives them a tangible "piece" of the deceased loved one
Life review can have special religious or spiritual significance.
For spiritual or religious persons,
life review pays attention to their:
Role in a community of faith..
Religious identity or self-understanding..
Relationship with the divine..
For spiritual or religious persons life review can also be a useful tool:To increase a sense of trust in the future (if God has seen them through hard times in the past).For spiritual growth work.To resolve fears about the afterlife.
Exploration of Sources of Hope & Meaning.
A larger framework of meaning can give patients and families a sense of purpose and ease suffering.
It is preferable for the patient or family to uncover and identify their own meaning rather than have this offered to them by others.
Religious or spiritual explanations for suffering, loss, and life-limiting disease are complex and often may not be comforting.
Take care when exploring these issues with persons.
Follow rather than initiate and avoid intellectual debate.
Guidelines for exploring hope
Sustaining hope in a cure or divine miracle, even if it seems unfounded, may be necessary for some persons.
Refocusing on short term, achievable goals, when the patient and family are ready to do so, can defend against despair and help give a sense of purpose and control.Ask persons what they are hoping for during this time.If they indicate they have no hope, allow for expression of these feelings.It may then be helpful to offer them other things to hope for such as: Comfort,Strength for their family,To be well-remembered To see the birth of a grandchild, etc.
Affirmation of Sources of Strength & Comfort.
.Ask questions to assess sources of strength and comfort..
"How have you coped with difficult times in the past?
"Where did you find strength?"
"What gives you comfort?"
"Is there anything you would find comforting now?"
Provide a "laundry list" if persons fail to come up with their own sources of strength and comfort:
Some persons turn to their family, their clergy, scripture, or humor for strength"
"Have you ever tried massage, meditation, soothing music, prayer, a walk in the woods, being held or a good cry?"
.Explicitly name and affirm the qualities you observe as you work with patients and their families:Wisdom...Knowledge...Life experience...Decision-making power.Adaptability.Graceful way of dealing with change or conflict.Open ommunication.Denial.
Particular philosophy of life?
What is reframing?
At times, patients and families may benefit from seeing things from a different perspective.
Reframing a situation can help persons cope, find meaning, and hope.
A gentle way to introduce a different, more positive perspective is to begin with the words..
"I wonder whether you have at times thought of this experience in different ways"..
Or draw upon examples or stories of other patients and families to open up the possibility of a different meaning or outcome>
See Situations where reframing is helpful..
Palliative care and hospice professionals frequently use this technique as we explain our medical care:
"Although your doctor has told you nothing more can be done for your cancer, please rest assured there is a lot we can do to help you and your family during this difficult time."
Other areas that are commonly reframed by palliative care and hospice include:
Who needs to be present at the time of death?
The impact of a death on family members?
Reframing and spiritual care.
.In spiritual care, reframing draws upon the person’s own belief system and religious tradition... At times it includes educating persons about aspects of their own tradition that may not occur to them or be unknown to them .
Diversional & Life-Affirming Activities.
One of the most powerful ways to promote spiritual well-being is to connect persons with sources of life and joy,
even in the midst of illness, suffering, and death.
The laugh of a child, a sunny day, the love of family, a political victory, even an exciting sports event can expand the world of ill persons and of their families.Sometimes just taking the mind away from a problem, even for a short while, can be restorative.
As persons with terminal illness are able to "do" less and less, enjoying the simple pleasures of life may help restore a sense of purpose and personhood.
For spiritual or religious persons, this may help reconnect them with that which is sacred, divine, or transcendent and reestablish a sense of gratitude and peace.
This web site is dedicated to every patient in every hospital who may need love and encouragement and hope. Dr. Templar has not created this for the purpose of profit but from love with the hope that any chaplain may benefit from it and the sincere understanding that there may be more knowledgeable Chaplains who indeed know more than he and that in it's humble format it may indeed minister to someone.
God bless you,
Dr. Brian Templar
75-5776 Kuakini Hwy 124
Kailua Kona HI 96740
Hi Dr. Templar,
I thank you for sharing you book with me which was such an inspiration. The information that it contained will be so very beneficial to me and so many others. I attended an honoring and celebration of life for a dear lady that God called home on New Year's day. I enjoy being a blessing to others by giving them words of encouragement or showing compassion and giving love.