Out of the Mystery and into the Light:

Screening Patients for Spiritual Needs.

Chaplain Jeremy Hudson MA, BCC
Spiritual Services Department
University of Iowa Hospital and Clinics
Objectives
1. Participants will be able to define/describe spirituality,
spiritual care, and spiritual distress to healthcare
colleagues.
2. Participants will be able to understand the importance of
building key relationships and identify allies with in their
organization.
3. Participants will be able to recognize barriers to spiritual
care with in the institution and identify opportunities for
collaboration with other disciplines to improve patient
satisfaction.
“Knowledge is static; wisdom is active
and moves knowledge, making it
effective.” -Dr. Will Mayo
Do you have a religious affiliation?
Spiritual Care Be Offered to
Every Patient Every Time.
Our Story - Background

• UIHC is a 732-bed hospital that annually admits more

than 33,000 patients for in-patient hospital care.

• UIHC has more than 57,000 emergency department

visits annually.

• UIHC has more than 935,000 clinic visits at our main

campus and community and outreach clinics annually.
Our Story - Background
• Spiritual Care is Provided 24/7
• Director of Spiritual Care
• Chaplains
– 3 Denominational Chaplains
– 1 Pediatric Chaplain (outside funded) and 2 Adult
Palliative Care Chaplains
– 4 Inter-Faith Staff Chaplains (1 FT, 2 PT, 1 PRN)
• All of the Intensive Care Units, Peds, Palliative Care,
Day of Surgery, and Psych have assigned chaplains.
Background
• May 2014 - BMT inquired about identifying pt/families
who desire/could benefit spiritual care.
• Ground Work (May 2014)
– Conversations with Dr. George Fitchett
– Formulation of a pilot project
– Trained Volunteers to administer screening (position description
completed)
– BMT Chaplain visit pts/families who desire care
– Prepare to submit project for IRB review
• Project submitted to IRB for review (June 2014)
Modified Rush Screening
Background

• Four Units – BMT adult and peds, CVICU, and Med

Psych unit.
• The unit social worker used a modified version of the
Rush Spiritual Screening tool added to EPIC.
• Patient/families would be automatically be added to a
system list for the Spiritual Services department to visit if
they desired care.
• The spiritual care assigned chaplains to visit.
Pilot
• Pilot from 2/7 – 3/31 had a 62% referral rate.
• Social Work Assessments are complete on about 50% of
patients.
• April 2015 collaboration began between Spiritual Care
and Nursing at the request of CNO.
• CNO requested July 1st rollout in the Nursing
Assessment.
Pilot

Spiritual Care 6/16/15

and Nursing Screening
began Screening
went live
collaboration became
on Screening.
on the
required in
Peds
Nursing
units.
Assessment.

7/14/2015
5/19/2015 Screening
Screening went live
went live in for the
the Nursing rest of the
Assessment hospital.
on 7 units.
Nursing Assessment
It was all smooth sailing and really
easy.
Opportunity 1: Education
“The Mysterious Realm”
Exercise
• What is the role of chaplain/spiritual care department in
your institution?
• How does your institution see role of chaplain/spiritual
care department?
• Are there gaps?
@ UIHC
• How does your institution see role of chaplain/spiritual
care department?
– Priests
– Attending Deaths
– Pray with people
– Rituals/Sacraments
• Baptize infants
• Communion
• “Last Rites”
– Supportive/Good Listeners
– Ethics
Confusion doesn’t stop
there…
Definitions of Spirituality

Those who speak of spirituality outside of religion often define

themselves as spiritual but not religious and generally believe in
the existence of different "spiritual paths," emphasizing the
importance of finding one's own individual path to spirituality.
Wikipedia
 Spirituality: the quality or state of being concerned with
religion or religious matters, the quality or state of being
spiritual.
Merriam-Webster Dictionary
“…the search for transcendent meaning” – can be expressed
in religious practice or …expressed ”exclusively in their
relationship to nature, music, the arts, a set of philosophical
beliefs, or relationships with friends and family” (Astrow et al. 2001)
Definitions of Religion

• Outward practice of a spiritual system of beliefs,

values, codes of conduct, and rituals (Speck 1998).

• Set of beliefs, practices, and language that

characterizes a community that is searching for
transcendent meaning in a particular way,
generally based upon belief in a deity
(Astrow et al. 2001).
Definitions of Spiritual Distress

• Spiritual distress “a disruption in the life principle that

pervades a person's entire being and that integrates and
transcends one's biological and psychological nature.” (North
American Nursing Diagnosis Association (NANDA), 1999, page 67)

• A person’s present experience is in conflict with personal

beliefs, values, purpose, and meaning
 How we communicate our
craft in a way that connects
with non-chaplains?
Exercise

1. Discuss and define spiritual/spirituality.

2. Discuss and define religion/religious.
3. Discuss and define spiritual distress.
4. How would you explain those to a non-chaplain
colleague in under sixty seconds in a way that
they would understand?
 πνεῦμα
ancient Greek word for "breath",
and in a religious context for
"spirit" or "soul"
spiritus
Latin term for breath, often used
figuratively to mean spirit.

Hebrew term for breath, wind, and spirit.

Spirituality - is that which gives breath to life.
 Spirituality
Religion Vocation/Calling
Hobbies Relationships
Places
Literature
Music Science
Nature
Arts
“Never Happen” Events

Stressful, sometimes unanticipated, events that don’t fit in

our plan for life. Events that threaten or challenge the very
things that give breath to our life. Events that stretch even
the healthiest individuals, families, and communities.
“Never Happen” Events

• Death of spouse or child • Major change in health

• Death of a close family of family member
member (parent or • Major change in
sibling) financial state
• Major change in health or • Death of a close friend
living conditions • Violence/Abuse
• Major change in church • Revision of personal
or spiritual activities habits
• Major change in social
activities

(Holmes & Rahe Social Readjustment

Rating Scale)
Signs of Spiritual Distress

• Questioning the meaning of life

• Loss of purpose
• Being afraid to fall asleep at night
• Anger at God/higher power
• Feelings of being abandoned by God/higher power
• Questioning their own belief system
• “What good are they?”

Adapted from the Hospice and

Palliative Nurses Association
Signs of Spiritual Distress
• Feeling a sense of emptiness/loss of direction
• Loss of hope
• Impaired ability to cope
• Questioning the meaning of suffering
• Is this punishment?
• Pain and other physical symptoms can be expressions
of spiritual distress

Adapted from the Hospice

and Palliative Nurses
Association
Why is the spiritual important?

• Helps us know and understand our patients.

– What is at stake?
– At crossroads that requires a decision, we should ask:
'Where are you today, what's important to you, what
gives breath to your life, and how does this affect your
decisions?'
• Helps inform us of the whys…
– Why they do or don’t…
• Research shows it can impact patient outcomes.
Spirituality and Patient Outcomes
Spirituality and Patient Outcomes
Spirituality and Patient Outcomes
 Opportunity 2:
Identifying Allies and Growing Your
Influence
Making Inroads at UIHC
• Find a need, meet a need
– Mutual Benefit
• Nurse Manager and Social Worker on the BMT
units need was identifying pts who would like
spiritual care.
• Spiritual Care department would benefit from a
greater presence and relationships on BMT and
increase care to pts on BMT.
• It meets the pt/family’s need for spiritual care if
desired.
– Know your audience
Making Inroads at UIHC
• Be open to risk
– A growing opportunities.
• Origin Pilot on 1 Unit
• Partnering with Social Work – Grows to 4 units
• Partnering with Nursing – Goes House Wide
– Weighing the risk.
• Living into the unknown – not knowing the
numbers
• Will an opportunity be lost by not acting?
• Expect resistance
Making Inroads at UIHC
• The Ripple Effect
– One unit, a Nurse Manager, a Social Worker, and a
Chaplain.
– Personally presented to over two hundred fifty
collogues at UIHC and at the UIHC Management
Meeting.
– Every nurse, inpatient, and family at UIHC.
Exercise
• Who promotes spiritual care in you institution?
• Who are potential allies of spiritual care in your
institution?
 Opportunity 3:
Small Changes Big Impact
Small Changes Big Impact
• Don’t Overlook the Mundane
– A simple spiritual screening has had a huge impact
• Better patient care

• Better utilization of limited spiritual care providers.

• Greater collaboration among disciplines to provide

better patient care and increased visibility for
spiritual care.
• Expanded opportunities – Grand Rounds and
Outpatient Areas
Results

Spiritual Screening: September 2015 - February 2016

Percentage
of
Requests Visited Not Visited
Requests
Met

2015-9 268 150 118 56%

2015-10 280 137 143 49%
2015-11 250 140 110 56%
2015-12 249 148 101 59%
2016-01 250 169 81 67%
2016-02 261 154 107 59%
Total 1558 898 660 58%
Results
• On average 260 additional requests per month mainly
from units without a dedicated chaplain.

• 3100 additional patients indicating a desire for spiritual

care per year.

• Monthly visits up by an average of 114 visits per month

over the same period last year.

• Pilot is capturing a wide scope of patients.

Exercise
• What are the opportunities at your institution?
• Who do you need as your allies to make this
happen?
• What are the obstacles?
• What are you going to do about it?
References
Astrow, A.B., Puchalski, C.M., Sulmasy, D.P. (2001) Religion, spirituality, and health care:
social, ethical, and practical considerations. Am. J. Med. 110:283-287.

Bay, Paul S., Daniel Beckman,James Trippi, Richard Gunderman, and Colin Terry. 2008.
“The Effect ... Journal of Religion and Health 47, no. 1:57–69

Iler, William L., Don Obershain, Mary Camac (2001). “The Impact of Daily Visits from
Chaplains on Patients with Chronic Obstructive Pulmonary Disease (COPD): A Pilot
Study”. Chaplaincy Today, 17(1):5-11.

NANDA Nursing Diagnoses: definitions and classification, Philadelphia : North American

Nursing Diagnosis Association, 1999

Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. “Measuring spiritual well-
being in people with cancer: The Functional Assessment of Chronic Illness Therapy–
Spiritual Well-Being Scale (FACIT–Sp)” Annals of Behavioral Medicine. 2002;24:49–58.
doi: 10.1207/S15324796ABM2401_06.

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References
Speck P (1998b) The meaning of spirituality in illness. In Cobb M, Robshaw V eds. The
Spiritual Challenge of Health Care. Edinburgh: Churchill Livingstone.

“Spirituality and stress relief: Make the connection” By Mayo Clinic Staff July 23, 2010,
[Link])

[Link] and T.H. Rahe. "The Social Readjustment Rating Scale," Journal of
Psychosomatic Research. 11:213, 1967.

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Questions?