NACC main page | Vision main page | Vision archives | Submit an article | Contact | About Vision | Search
Vol. 19, No. 5
September/October 2009
Vision is published six times a year by the
National Association of Catholic Chaplains.
Its purpose is to connect our members with
each other and with the governance of the
Association. Vision informs and educates
our membership about issues in pastoral/
spiritual care and helps chart directions for
the future of the profession, as well as the
Association.
ISSN: 1527-2370
Executive Editor
David A. Lichter, D.Min.
Editor
Laurie Hansen Cardona
lcardona@nacc.org
Graphic Designer
Gina Rupcic
The National Association of Catholic
Chaplains advocates for the profession of
spiritual care and educates, certifies, and
supports chaplains, clinical pastoral
educators and all members who continue
the healing ministry of Jesus in the name of
the Church.
NACC Editorial Advisory Panel:
Sr. Michele LeDoux Sakurai; Michelle Lemiesz; Linda
Piotrowski; Rev. Freddy Washington, CSSp;
and board representative Norma Gutierrez,
MCDP.
NACC National Office
4915 S. Howell Avenue Suite 501
Milwaukee, WI 53207-5939
(414) 483-4898
Fax: (414) 483-6712
info@nacc.org
www.nacc.org
“Thanks for reminding me that spirituality and religion are not the same.”
“Great session, I, for one, badly needed the content. Thank you for having this -- would be a great pre-conference session for next year.”
“We need more of these types of programs in the practice setting. Spiritual care needs to be demystified. It’s as important as patients receiving their daily insulin. It should be mandatory like infection control classes and CPR.”
“Great topic and great speakers. It is good to hear from professionals other than nurses. We can learn a lot from other disciplines. I loved this session. Great!!!!!”
-- Nurses evaluate ONS clinical practice of spiritual care across the Cancer Continuum Workshop
Almost exactly a year ago an oncology nurse practitioner colleague approached Linda Piotrowski to submit a presentation proposal for the Oncology Nurse Symposium 2009 Congress in April. The Oncology Nursing Society (ONS) is the largest professional oncology association in the world. Membership includes more than 37,000 professionals representing a variety of roles, practice settings, and subspecialty practice areas. Karen Skalla, MSN, ARNP, AOCN, had completed 3 CPE for Healthcare Providers at Dartmouth Hitchcock Medical Center, in Lebanon, NH, where Karen practices in the Head and Neck Cancer Oncology Clinic and Linda serves the Palliative Care Service and the Norris Cotton Cancer Center Outpatient as well as the inpatient oncology unit. Karen Skalla is chair of the ONS Spirituality Interest Group (SIG). Linda leapt at the opportunity!
Because the ONS is highly research-oriented, they agreed upon the topic: Clinical Practice of Spiritual Care across the Cancer Continuum.” As it became clear that diagnosis and treatment; survivorship and end of life would be the focus of the presentation, Karen Pugliese was invited to collaborate on the project. Both Linda and Karen feel strongly about seizing every opportunity to present at another discipline’s educational offerings. For example, Linda has presented at the American Academy of Hospice and Palliative Medicine Annual Conference, The Vermont Breast Cancer Conference, The New Hampshire Cancer Consortium Conference, the New England Geriatric Nursing Course and Karen has spoken at The National Conference on the Aging and the American Society on Aging Joint Conference, The American Congress on Rehabilitation Medicine, the Mayo Medical Center Annual Nursing Research Conference, and the Catholic Health Association Annual Conference.
We agreed upon the following as their session description:
“Interest in both Spirituality and Spiritual Care has increased rapidly over the past several years. Similarities and distinctions between spirituality and religion, as well as other issues along the continuum from spiritual distress toward spiritual well-being, will be explored. Spiritual concerns specific to each phase of the cancer continuum will be presented: diagnosis, in-patient and outpatient treatment, survivorship and end-of-life. Spiritual assessment, intervention, and care planning processes will be addressed. We will discuss strategies to mobilize inner resources for coping, developing resilience, grieving and letting go. Stories of care will provide stimulus for the audience to actively participate in the closing discussion.”
On Aug. 26, we received word that our proposal was accepted and celebrated our major breakthrough in that it had been many years since ONS had accepted a major spiritual care session. ONS proposals guidelines are stringent and rigorously screened. The topic submission form required the content outline as well as the session description, level of content, content area, type of session, target audience and our CV’s.
What we didn’t know was just how rigorous the preparation process would be. Weaving research throughout the presentation, using case studies to illustrate our area of focus, and keeping to the 90-minute parameter proved challenging.
We communicated by e-mail and sometimes by phone, but finding times to meet in different time zones was challenging. In January we learned we would be presenting on May 1, the day before Karen Skalla’s birthday. A birthday post-presentation celebration in San Antonio served as a motivating force for us to continue to send one another our work in progress for critique and feedback. However, May seemed like a long way away when we were completing our bibliography and agreeing upon the number of slides, formatting, timing, etc. in January. Just when we thought we were making headway, we would receive a reminder such as this that would send us scrambling:
The syllabus upload must be completed by Feb. 12, 2009, by 5 PM EST. I highly recommend that you complete the upload way prior to the deadline in case there are computer or uploading issues. Any graphics, photos, graphs, etc. that you would like to include in the syllabus must have the granted permission request for each slide sent to the national office. If there is no permission, the slide will not be in the syllabus. With our clinical responsibilities, unplanned emergencies, different time zones and work schedules communication was mostly via email. We survived experiences of tension, frustration and disagreement: What source should we use for definitions: nurses’ perceptions of the challenges of working with chaplains; chaplains’ perceptions of nurses over-stepping their bounds; boundary issues in the area of spiritual screening and assessment; competency issues?
Through it all -- ever encroaching deadlines. And they were serious. At one point we received word that we had one too many slides; all slides needed to have at least one reference and the changes needed to be in by end of day.
Karen Skalla, as the coordinator, bore the brunt of the last week of touching up and refining the slides, but it was maddening for all of us. When she finally sent them in on April 21, we began working out the logistics of running through our presentation together for the first time in San Antonio. Just as we prepared for travel -- the Swine Flu hit with a vengeance, with San Antonio so hard hit we were all packing masks along with our business cards and handouts!
The day before we were due to present our workshop, we arrived at the speakers’ resource area, were welcomed, and offered a drink and snacks. We were provided a computer with our PowerPoint presentation already loaded. We fine-tuned our presentation and went to the next room to run through it on the big screen set up to mimic the room assigned us for the following day. The professionalism apparent in this high-tech process left us feeling reassured and valued.
The Spirituality Interest Group of ONS sponsored our presentation “Clinical Practice of Spiritual Care across the Cancer Continuum.” We arrived early and were amazed at the size of the room; there was seating for 200. A large-screen LCD projector with our presentation set to run completed the set up.
As time for the workshop drew near, the room quickly filled. Soon we reached the maximum number. People continued to attempt to enter the room. Finally, they put out a sign that said, “Workshop Closed!”
Karen Pugliese, in speaking about the spiritual needs of newly diagnosed cancer patients, used a competency-based model of care and explored dimensions of pain, addressing spiritual suffering including research initiated and conducted by Mary T. O’Neill and CPE students at Calvary Hospital in New York. Karen compared and contrasted nursing and chaplaincy interventions.
Karen Skalla followed with an exploration of the search for growth and meaning in survivorship. She provided participants with several spiritual assessment and research tools as well as a framework for growth and transformation.
Linda Piotrowski completed the discussion with an exploration of spiritual needs of persons approaching the end of life, including an overview of spiritual/religious beliefs, spiritual assessment in general, two specific tools, and numerous opportunities for growth at the end of life.
Workshop participants were treated to definitions of spiritual assessment, assessment tools and processes and strategies from three differing viewpoints. The use of three case studies/stories gave flesh to the abstract theories and tools presented. The nurses present were eager to engage with questions at the end of our presentation. Many stayed afterward to ask questions and share stories.
Of special interest to us as chaplains was the Spiritual Care SIG Meeting held in the late afternoon following our workshop. Perhaps fueled by interest generated by the workshop, a large group gathered in the same meeting room. Excitement about learnings from the workshop was shared along with stories of nurses ministering spiritually to patients. One story that stands out is that of a nurse who told of tending to a comatose patient and her daughter. The patient was dying and as the end drew near the nurse asked her daughter if she would like the nurse to pray with her. The daughter assented and the nurse proceeded to pray from her Christian faith perspective. When she completed the prayer the woman said, “That was very nice and I think my mother may have liked it but we are Jewish.” The nurse went on to say that she and the patient’s daughter laughed. The nurse was not telling a cautionary tale of being sure to check a patient’s spirituality/faith tradition before offering to pray rather she stated proudly that she prayed and provided good spiritual care.
Another nurse was consumed by a desire to provide spiritual care to patients. She asked how one becomes a chaplain. When Clinical Pastoral Education was described she said she was interested. She inquired, “Is it a three hour workshop? Is it two evenings? Oh, it must be a weekend.” When she received the full explanation of the requirement of a master’s degree and four units of CPE, she was dismayed and couldn’t understand what could possibly take so long.
Many nurses have a strong desire to provide spiritually for their patients. Many believe themselves already competent to provide the in-depth type of professional spiritual care that patients need. Many give no thought to referring to a chaplain.
As our experience at the Oncology Nursing Conference taught us, nurses are hungry to “do spiritual care.” They are aware of the importance of the spiritual in their work. Nurses are attempting to return to the roots of their nursing heritage. Patricia Maher describes Florence Nightingale as “one of the first to bring spirituality and science together to improve the care of the sick.” Mary Elizabeth O’Brien describes the theological mandate for nursing care as involving three key activities: being with, listening, and touching. She also addresses nursing assessment of patients' spiritual needs, nursing’s role in the provision of spiritual care, the spiritual nature of the nurse-patient relationship, the spiritual history of the nursing profession, as well as looking at contemporary interest in spirituality within the nursing profession.
Nurses are forging ahead in exploring ways that they can do this important work. As the quotes at the beginning of this article suggest our workshop was widely accepted and appreciated. It would lead one to think that more invitations to present would follow. However, just this past week, Linda’s colleague, Karen Skalla, informed her that a Preconference Spirituality Workshop had been accepted for the 2010 Oncology Nursing Conference. Speakers for the workshop are already lined up. The speakers are two well known names in healthcare circles. Neither one is a chaplain! They are a physician and a nurse who specialized in nursing research and recently obtained a master’s degree in theology. Where, one asks, are the chaplains?
How are we to gain respect as experts in the field of spirituality and spiritual care? How can we help our nursing colleagues to understand the intricacies of our work? How can we partner with our nursing colleagues to provide the best spiritual care possible?
In his book, “Better: a Surgeon’s Notes on Performance,” Atul Gawande offers five suggestions on how one can go about making what he calls a “worthy difference.” He suggests: Ask an unscripted question. Don’t complain. Count something. Write something. Change.
As chaplains we would do well to heed Dr. Gawande’s advice. When we are with our nursing colleagues, we can be the one to raise a question that leads us all to explore different ways of approaching our work together. Rather than complain that we don’t receive referrals or that no one understands us or our work, we can do some research. We can count something and discover what it teaches us. We can write about what we discover, sharing our findings and ponderings with others inside and outside our profession.
We can embrace new ideas and change things from business as usual to risk-taking and partnering. Instead of limiting our workshop proposals and written articles to chaplaincy conferences and publication, we can stretch and submit to multiple organizations that take us beyond our comfort zones.
In an effort to heed Dr. Gawande’s advice we’ve prepared a brief survey. We ask that you copy and paste this web address into an e-mail to your nursing colleagues:
http://www.surveymonkey.com/s.aspx?sm=BcIroyCBl_2bHDOnPgVz1okA_3d_3d
We’ll report the results in a future issue of Vision. Thanks!
1CPE for Healthcare Providers originated at Massachusetts General Hospital in Boston and takes place during the winter extended unit. It is open to anyone involved in patient care.
2As quoted by Mary Elizabeth O'Brien, SFCC, PhD, MTS, RN, FAAN (2007). Spirituality in nursing: Standing on holy ground, 2nd ed. Boston: Jones & Bartlett.
3Andrist, Nicholas & Wolf (2006). History of nursing ideas: Reclaiming the spirit in nursing. Boston: Jones & Bartlett.
4Gawande, Atul (2007). Better: A surgeon’s notes on performance. New York: Picador.