Looking forward to a great 2016

There are two particular topics I am working on now and hope to bring to you in the first few months of 2016: body language and the clinical use of prayer.  Body language has at least two aspects: that of the person we are speaking to and our own body language.  There is much to learn about this that will make us more perceptive and effective in our work.  Prayer as a clinical intervention must be explored for its clinical effectiveness.  I invite you to study this along with me.

Have a blessed New Year and growth in your work.

I will be back at the blog the first week of January.

Merry Christmas!

To all of you who have taken the time to read this blog, Thank you.  A Merry Christmas to all.  You are a wonderful gift of compassion and service to your patients.

To Our Staff Working on Christmas

First of all, “Thank you.”  Hospice care is a 24/7/365 operation.  Illness does not call a truce for the holidays.  It marches on.  Your commitment to patient care is one of most noble commitments known.  You have my admiration and deep respect.  To my Chaplain Colleagues, you who will be on call during the day will seek to bring comfort and peace to troubled families.  As I was driving to work this morning, I noticed 5 police vehicles at a residence.  What could be happening?  I doubt the people were having a breakfast for this group of officers.  You may be called to a death or another type of spiritual emergency.  I know you will provide what that family needs.  I have great confidence in you.  To all of my Colleagues who are working on Christmas, peace and best blessings. 

A Hospice Take on a Familiar Christmas Story

'Twas the night before Christmas and all through the house no one was stirring but the hospice Chaplain in Grandpa’s room. The family was bowed low by the chimney in prayer, in hopes that God’s intervention would soon be there. The grandchildren were nestled all snug in their beds, with visions of life without Grandpop coursing through their troubled heads. And Mamma with her ‘kerchief, and I in my cap, wished we could settle our brains for a nap. When from the bedroom there arose such a clatter, we sprang from our knees to see what was the matter. The Chaplain sat holding Grandpop’s hand as he said, “Yes, Lord, I am coming home.” I knew in a minute he must be leaving and headed to Heaven. We wept, we hugged, we thanked the Chaplain for her care. Death comes to all, hospice is there.  On Nurse, on Physician, on Social worker, on Home Health Aide, on Chaplain, on IDT, “We care. We love. We serve.”


Thank you, Chaplains, for all you do. Your work is so essential. Have a blessed Christmas celebration. To my Jewish Chaplain friends, May the spirit of Chanukah continue bless

CPE? What's the Big Deal?

From time to time, a Chaplain will have a case that is complex. Complexities come in many forms:  family dynamics, patient internal dynamics, religious issues, conflict, and psycho-social complexities.  Preparation for and experience with theses type of issues are required of the Chaplain. These are key reasons why I am adamant that a hospice Chaplain have a minimum of 3 and hopefully 4 units of Clinical Pastoral Education. CPE prepares a Chaplain for the rigors of hospice chaplaincy. For many hospices one unit of CPE will suffice. In my opinion, that does an injustice to the patients and families. What, then, is CPE? CPE is a hands-on experience that incorporates such matters as pastoral formation and pastoral reflection in order that the Chaplain develops a methodology of ministry that will provide spiritual care to persons of all faiths or no faith. The issue of religious countertransference is often an issue that requires hard work for the Chaplain. CPE is a process. For this reason, there are four units of CPE required as a minimum for a Chaplain to seek Board Certification. Each unit is comprised of 400 hours of supervised study and clinical practice under the guidance of the CPE Supervisor. The end result of CPE is an equipped Chaplain who knows him/herself and has the means to identify those issues of his or her that could jeopardize the pastoral encounters with patients and families. Further, the CPE trained Chaplain possesses the ability to read what Anton Boisen, the founder of CPE, called the "living human document." One of the key reasons I endeavored to attain Board Certification, even though hospices do not require Board Certification or even more than 3 units of CPE, was to develop the skills necessary to benefit the patients and families I would serve. My Board Certification was earned through the Association of Professional Chaplains and the College of Pastoral Supervision and Psychotherapy. At this point, I find it valuable to state in a more detailed fashion what pastoral formation and pastoral reflection include. Pastoral Formation enables the Trainee to articulate an understanding of the pastoral role that is congruent with their pastoral values, basic assumptions, and personhood (312.1); demonstrate competent use of self in ministry and administrative function which includes: emotional availability, cultural humility, appropriate self-disclosure, positive use of power and authority, a non-anxious and non-judgmental presence, and clear and responsible boundaries (312.6) Pastoral reflection enable the Trainee to establish collaboration and dialogue with peers, authorities and other professionals (312.7; demonstrate awareness of the Spiritual Care Collaborative Common Standards for Professional Chaplaincy (312.8); demonstrate self-supervision through realistic self-evaluation of pastoral functioning (312.9). Over the course of 1,600 hours of clinical work and classroom supervision, a Chaplain's theory and theology of pastoral care is very well developed. Therefore, based upon the preparation a Board Certified Chaplain has undergone he or she becomes able to work with the complex cases with other members of the care team as a fully participating partner all for the patient's good. In posts to come will be examples of my understanding of pastoral formation and pastoral reflection.

Children and Spiritual Pain at Christmas

Children and Spiritual Pain at Christmas

 

For me this topic hits home.  As I reflect on Christmas when I was a child, the memories are a mixture of pleasant and pain.  When I was 10, my Dad died.  That was the line of demarcation between pleasant and pain, what was and what is, then and now.

 

If any family could have totally messed up grief and mourning it was mine.  I know the adults in the family were well-intentioned, but what a mess it was.  My grief counsel was “brave boys don’t cry” and “you are now the man of the house”.  Being a compliant kid that I was I didn’t cry.  I had no idea how to be the man of the house so I put that one on the back burner.  The fact was that my family had no idea how to handle a sudden death which my father’s death was.  He came home from work with terrible chest pain and died a few days later at the hospital.  There were no warnings of any physical problems, it just happened.  A wise person once said, “The death shapes the grief.”  The shape of our grief was intense at first and then silence.  It just wasn’t discussed.  So, we three kids (my older sisters and me) were left to ourselves.  There’s more to the story, but that is not germane to my point in this article.

 

Should you be suffering the loss of a loved one and you have children, may I gently suggest a few actions to take that might bring a measure of healing to your children’s wounded hearts?

 

• Kids need words.  I longed for my Mother to talk to me about how she was feeling and what she would say to me in my pain.  That never happened.  Kids need words.
• Kids benefit from rituals.  Light a candle, say a prayer, donate to a hospital that focuses on the illness that your loved died of, go to church/synagogue.
• Kids need routine.  What you’re going through is not part of your daily schedule, but as much as is possible, keep a routine.  Your child will benefit from that.  Believe me, there was no routine in our grief journey.
• Kids do not grieve as adults.  It’s just different for them.  Talking about what happened may come sooner than later, but expect it to come later than sooner. Within a year of my Dad’s death, my Mother had to have gall bladder surgery.  I stayed with my Aunt and Uncle during that time.  I lay awake at night wondering if she would die, too.  Grieving is a tough journey for kids.
• Kids benefit from hospice grief counsel for children.  If you do not know how to help your child with grief, please contact your local hospice.  They will have someone who specializes with children’s grief. 
• One last thing, time will NOT heal this wound.  Your child needs tools to work her way through this process. 

 

I do hope your Christmas is merry.  But, it isn’t and it is because of the loss of a loved one, my heart goes out to you.  If I can help, I am happy to hear you and connect you with someone with a focus on children’s grief.  Blessings for comfort and peace.

How a reputation is lost…

There are a few things a hospice chaplain must hold near and dear to his heart: respect, pastoral care skills, and relational skills.  Respect given and received will keep the chaplain in good stead with the IDT.  Lose it and you find yourself in a hole you dug for yourself.  The one sure way to lose respect of your co-workers is to be the source of rumors.  Rumor-mongering in the workplace is never good.  It creates a toxic environment.  For the Chaplain, of all people, to be the source of rumors is totally incongruous to what a Chaplain is to stand for.  As I researched the concept of rumor mongering in the workplace, I came upon Bull’sEyeCareers.com.  This site’s mission statement caught my eye: “Career advice for those who seek to enhance their lives through meaningful work, professional development and education.”  And, then, came the article titled, “A Bad Workplace Habit to Nip in the Bud this Year.”  Here is a small portion of the article you will find instructive:  “when the rumors get personal and fellow employees begin to discuss other employees or bosses negatively, it is really time to step away. There are toxic people in organizations who would love nothing more than to drag you into their own web as a partner in crime. You know these people. They are always happy to say what they heard or saw and they are not afraid to drop names about who else knows and what someone else said. They are always happy to be the one who lets you in on the “secret” everyone else knows but you. Make no mistake about it, your name will be the first on his/her lips as they share the story with the next willing listener. They may even embellish what you said or didn’t say.
“Here are my five "Be's" for the new year as it relates to workplace rumor mongering:
1. Be careful...about your sources and what you repeat.
2. Be elusive...and avoid being alone with people who always want to snare others into their, "Did you hear about..." trap.
3. Be selective...about what you believe.
4. Be honest...and let people know that you would really prefer to just not talk about other people.
5. Be adept...at changing the conversation.”

I urge my Chaplain Colleagues to guard your reputation as your most valuable possession.  We are reminded in Proverbs 22:1: “A good reputation and respect are worth much more than silver and gold.” (Darby)  What 3 things can you do to enhance your reputation?  What 1 behavior will you not do to prevent your reputation from being soiled?

Stressed?

Stressed? 

It will happen to every Chaplain.  There will come the “evil day” (using the Biblical idea found in the Bible book of Ephesians).  It may involve health, finances, family, or something deeply personal.  The issue I want to address has to do with how the Chaplain handles these types of situations and maintains his or her reputation.  I am not for a moment suggesting or advocating for stoicism or grin and bear it response.  I am advocating for a response to serious stress that will prevent the Chaplain from losing the most valuable possession in all that he or she has …reputation.

I want to suggest 5 Keys to maintaining one’s reputation:

1.      Develop a support system that will be there for such a time as this.  I recall a number of years ago when I was a senior pastor.  It was obvious to me that I made a terrible mistake in moving my family across the state to this new place of service.  The church was in disarray and in no way ready to even think of becoming a witness to the community.  There were factions upon factions.  I called upon the local denominational leader and spoke to him about my assessment of the situation.  He agreed with my assessment and then told me it was much worse.  That was not what I wanted nor needed to hear.  Time proved he was correct.  I then asked him a question that he scoffed at.  I asked if there were a safety net of sorts for such a situation so that I could move from that place.  I learned something of great value from that experience.  The lone ranger style of life and leadership will leave the pastor or Chaplain with no resources at a time of crisis.  I began to build a network of like-minded ministers who I could call or meet to unload the pain I was enduring.  There is almost a syndrome among ministers to go it alone, to be a lone ranger.  Build a network of colleagues who will encourage you and support you.

2.     Watch your emotions.  It is very easy to express emotions that will border on bitterness, but will definitely express anger or rage.  Lay persons will never understand the level of stress you are experiencing as a Chaplain.  The work of chaplaincy is something all to itself.  If you express the depth of your emotions, which probably are valid, but way too strong at the moment, you will leave your colleagues and managers wondering about what really is happening with you.  Of course, you haven’t told them the entire story, so they only hear what they hear and see what they see.  Be very careful at this point.  It is not wise to unpack your emotions with colleagues.  Unpack emotions within your network of close friends, instead.

3.     As you counsel those you visit and provide spiritual support, seek to deepen yourself spiritually.  Use your well-developed spirituality to find inner peace.  Pray, read your Sacred Texts, journal, ponder, meditate, and promise yourself you will keep the emotions between you and God.  If need be, seek counsel from your Pastor, Priest, or other Faith-community Leader.  Getting it out often helps reduce the stress level for a time.

4.     If you choose to speak to someone up the leadership chain, choose your words carefully.  Be careful that you do not come across as assigning blame on them for your plight.  That will not turn out well for you.  It’s not that they are too busy to hear you out, they need to understand what is happening and what it is you would like them to do to help.  Again, I caution, choose your words, your tone of voice and attitude carefully.

5.     When you come through the crisis (as you will) approach any and all you spoke to and assure them that their listening ear was helpful to you.  Exude humility and genuine gratitude.  Be gracious in expressing how much the time they took with you meant to you.  That will go a long way to solidifying your relationships. 

Crises happen.  It’s a fact of life.  Ruining your reputation over the crisis is rarely the first choice of the Chaplain.  Do your best to maintain your poise and dignity.  Tears are fine and understandable.  Emotional outbursts in front of the wrong audience will have lasting negative results.  Bless you as you endure. 

A research-based article on fostering hope in caregivers

A research-based article on fostering hope in caregivers

Caregivers shoulder physical, financial, emotional, and spiritual issues that for most would be back-breaking.  How many of us in hospice chaplaincy haven’t witnessed the exhaustion of the caregiver of an AD/dementia patient? or of the Parkinson patient? or ALS patient?  That is not to exclude the stress and mental, emotional, and spiritual exhaustion caregivers of COPD, cardiac, or cancer patient’s experience.

It is in the purview of the Chaplain to foster hope in the caregiver.  How?  “Previous research conducted by Benzein and Berg [Benzein E, Berg A. The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Palliative Med. 2005;19(3):234–240.] noted that family members of patients in palliative care had significantly lower hope than the patients, indicating that the family members' suffering may be greater than the patients. One reason for the lower level of hope noted by Benzein and Berg was that the needs of family members of patients in palliative care were insufficiently met, especially in regard to information and communication from healthcare professionals. Caregivers in the study by Perreault et al [Perreault A, Fothergill-Bourbonnais F, Fiset V. The experience of family members caring for a dying loved one. Int J Palliat Nurs. 2004;10(3):133–143.] also identified the lack of support from healthcare professional as a factor that negatively affected their caregiving experience. Thus, it was postulated that encouragement and support offered by healthcare professionals can provide family caregivers with the strength, confidence, and comfort necessary to participate in the caregiving process, which can ultimately foster hope and lead to a positive experience for both the family caregivers and their loved one.[Benzein and Berg] Similar findings were noted by family caregivers in the current study, indicating that physical support, informational support, and reassurance offered by healthcare professionals and other supportive individuals were necessary to maintain hope during the caregiving experience.” [The Lived Experience of Hope in Family Caregivers Caring for a Terminally Ill Loved One, Sara S. Revier, RN, ACNS-BC, Sonja J. Meiers, PhD, RN, Kaye A. Herth, PhD, RN, FAAN,Journal of Hospice and Palliative Nursing. 2012;14(6):438-446.] (emphasis mine)

Each Chaplain will have to decide how this information informs their approach to spiritual care, but there are several huge targets at which to aim one’s care: informational support, encouragement, and reassurance.  While it seems that these three arenas of support require a good bit of talking, they also require a good bit of listening.  I can recall listening to the exhausted pleas for help of the daughter of one of the dementia patients as she was at the end of her patience and emotional strength after what seemed to be several sleepless nights.  She needed to be heard more than she needed to be talked to.  I did, however, give the nurse a call to explain some of the issues she was having with her mother and have her provide education on those matters.  The daughter just needed to talk it out.  For this woman, prayer inspired new hope even in her most exhausted moments.  It provided a sacred break in her world.

I am convinced that hospice Chaplains have the background in pastoral care to provide for the needs of caregivers.  Thank you for all you do in your work!

The International Readership of this Blog

I am not sure of the state of chaplaincy across the world, but we have a following that is world-wide. To Chaplains in Australia, Russia, The Ukraine, France, and other countries, please feel free to provide input on how your work is going and how this blog might encourage you.

The 3 Most Important Needs of a Chaplain in Crisis

When a Chaplain needs help… There are times when a Chaplain needs emotional assistance. The reasons vary from their own grief at the loss of a loved one to burnout. It is essential that the Spiritual Care Manager or whatever your title might be is aware of the resources to give the Chaplain the support he or she needs. Here are the three most important needs of a Chaplain who is in crisis: 1. Your undivided attention and support. In the highly complex world of hospice care the manager must express compassion and understanding. Yes, it is a corporate world and not a religious institution we are working with. Patients need to be seen, compliance is always breathing down our backs, and productivity screams for fulfillment. With all of that said, your Chaplain needs your support. If a PRN Chaplain is not available and it appears the Chaplain will be on PTO for a few days, see the patients yourself. It will be a refreshing change of pace. Your Chaplain will never forget your help. 2. Keep it confidential. The only people that need to know that the Chaplain is engaged in EAP (if that is the route the Chaplain has chosen) is the Benefits Specialist and yourself. The outcome of the EAP is none of our business. Protecting the Chaplain’s privacy is. 3. Stay in contact with the Chaplain when he or she returns to work. An email or phone call of support does a world of good. We all remember the adage an ounce of prevention is worth a pound of cure. That is true when it comes to self-care. Chaplains are the worst at following our own advice. Perhaps an in-service like what follows would help: Christy Matta, M.A., writes with clarity about stress reduction and stress management. Her insights on the 5 Signs of Emotional Exhaustion at Work caught my eye. The work of the hospice Chaplain is heavily emotional. A Chaplain that does not practice self-care is a sitting duck for emotional exhaustion. Chaplains MUST engage in self-care or fall prey to a potentially career ending crash. Matta’s article can be found here: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=48310&cn=117 Her assertions about emotional exhaustion arrest our attention: o Negative Feelings: Frustration and irritation at work are common when you're emotionally exhausted. Your frustration might be focused on parts of the job, coworkers behavior, or job politics and bureaucracy. o Feeling Pressured and Out of Time: When we're emotionally exhausted we don't have the resources to handle the pressures of the job. You might find yourself feeling pressure to succeed, without time to finish your work or do a good job or without time to plan for your day and proactively deal with work demands. o Negative Thoughts: Our thoughts are closely linked to our feelings. When we're feeling bad, we're also often thinking negative thoughts. Thinking "I'm alone," having overly judgmental thoughts towards your co-workers or the organization or thinking harsh thoughts about yourself are all common signs of emotional exhaustion. Thoughts that "I shouldn't have to deal with this" "this is unfair" or "my coworkers/supervisors/management are incompetent" are judgmental thoughts that might be a sign of emotional exhaustion. o Strained Relationships: Feelings of isolation and negative thoughts about coworkers, supervisors and administrators can leave you with strained relationships at work, adding to feeling isolated and unappreciated. o Counterproductive Work Behaviors: When you're emotionally exhausted, you may feel drained or depleted and find that you are more emotional at work. When you're emotionally exhausted, you may lose the ability or desire to resist temptation. As a result, you may end up acting in ways you otherwise wouldn't. Do you find yourself acting in ways that undermine your colleagues or the company for which you work? Examples might include anything from stealing, or fraudulent behavior to purposeful tardiness and avoiding safety measures. Steps to healthy self-care: 1. Recognize you are in the throes of emotional exhaustion. 2. Talk to someone you trust about it. 3. Make any adjustments you can. 4. Take a few days off. 5. Evaluate how you spend your off hours. 6. Do something that gets your mind off of work. 7. Feed your spirit. 8. Talk to someone you trust. (not a repetition, just an emphasis) 9. Get your body moving. 10. Learn to relax. Most Chaplains don’t know how to do this well at all. Blessings, Chaplain friends. My model for ministry is Jesus Christ. He said to his weary disciples in Mark 6:31, “Then, because so many people were coming and going that they did not even have a chance to eat, he said to them, “Come with me by yourselves to a quiet place and get some rest.” When your work is such that you meet yourself coming and going, it is time to rest and to eat. For the glory of God and the inner healing of man …blessings upon you.

Patients’ expectations of Chaplains: What you need to know.

“What do patients expect of Chaplains?” This question was posed to me at a volunteer training event. At first, I thought it was a simple question to answer and because I was the speaker fielding questions, I proposed a few simple answers: kindness, respect, listening skills, no preaching, and expertise in matters religious and spiritual. I felt those were too simple, so I did a little exploration. From the Family Satisfaction Surveys in the Deyta reports, I analyzed the Positive Comments to find out more information. The Negative Comments gave no insight. Keep in mind, the family members received the Family Satisfaction Survey within a month of the death of their loved one. Here is a list of descriptors family caregivers used to describe their experience with hospice. The List—You will notice that I pulled together quite a number of descriptors as they were very similar in meaning. 1. By far, the number of times the following words were used were the most frequent: loving, nurturing, kind, respectful, considerate, warm, understanding, great help, gentle, comforting, sensitive, thoughtful, humane, patient, companionship, soothing, sent by God. Without question these attributes of the hospice team were valued far more than any of our expertise or clinical skill. These people had the expectation that we conveyed to them that were important to us, that they mattered. 2. Coming in second place in numbers of times used were these words: great, marvelous, wonderful, awesome, best, super, terrific, outstanding, incredible, exceptional, excellent. All of us like to hear these words said of us, but think about it...these words are filled with affirmation and energy! We met all of their expectations and in the midst of their grief they were able to find the words to express their positive emotions. 3. A very distant third were words used to describe clinical skills: expertise, professional, knowledgeable, skilled, informative. My sense is that it was assumed that the physicians and nurses, social workers, chaplains, home health aides, volunteer specialists, and bereavement counselors were all well trained and could do their jobs. It wasn’t the skills that mattered most it was how they went about using their skills that did. So, how do these positive words inform your hospice chaplaincy? Will you do something differently than you have been as a result? If so, what? What did you gain from this?

What our patients face …

I read a sign that went something like this: “Remember, dealing with death is an everyday thing for us, but for our patients it is their first time.” Do we know what the patient has been through? What is a ‘day-in-the-life-of’ our patient? What have been this patient’s experiences in the healthcare system? What do we really know about this patient? How do the previous questions inform your chaplaincy? I ask because in too many conversations with chaplains I get a queasy feeling that a one size fits all approach to spiritual is being used. That simply won’t cut if for excellence in spiritual care. Please listen carefully to the results of a compelling study conducted by Julia Overturf Johnson, BSN, MA, Daniel P. Sulmasy, OFM, MD, PhD, and Marie T. Nolan, PhD, RN titled, “Patients’ Experiences of Being a Burden on Family in Terminal Illness”, found in The Journal of Hospice and Palliative Nursing. September 2007; 9(5): 264–269. “An under-recognized aspect of care burden at the end of life is how dying persons experience and manage the fear of being a burden on their families. This burden can have emotional, physical, social, and financial aspects. Patients with terminal illnesses face grief and fear not only for their own future but also for their families’ future. These concerns over how their illness will affect their loved ones may influence how they seek care, what decisions they make about their care, and even how they experience dying. The purpose of this study was to further explore the concept of fear of being a burden on family from the perspective of the person in the terminal stage of illness.” My experiences as a field Chaplain attest to the validity of this finding. I recall a nursing home patient with a short while to live shared with me that she would be glad when her life ended so that she would no longer be a burden to her daughter. We explored those feelings a bit. My sense was her statement was not couched in terms of self-pity or depressed mood, but out of a sense of reality. Her daughter’s life was negatively impacted by her illness and the sooner her life could end the better. She was ready to die she said. In another case, the emotions of a husband erupted when he learned that his wife could no longer care for him at home and the option his wife had was to place him in a facility. His worst fears were realized. He was so great a burden that he was “put away.” How do these two episodes in real life inform a Chaplain’s spiritual caregiving? To the patient? To the caregiver? Herein lies another attribute that sets the hospice chaplaincy apart. The hospice chaplain develops a trusting relationship with the patient and family so these fears can find a place in conversation. And, in finding that place they are not diminished, marginalized, or ignored (perhaps a better word would be ‘missed’) by the attentively listening Chaplain. The Chaplain hears the pain, the wounded-ness, the grief the patient is expressing and applies soothing spiritual counsel to the wound. It takes skilled listening, mature understanding, and wise words to assist these persons through their journey of feeling like a burden.

An Emotionally Intelligent Chaplain

Emotional Intelligence is a newer term that has absolutely grabbed hold of the human resources world and business world. And, it makes sense as EI or EQ whichever you prefer has a good bit to do with how an employee perceives him/herself as well as others. It is built upon the concept of self-awareness. You, as a Chaplain, ought to be very familiar with the concept of self-awareness since having up to 1,200 or 1,600 hours of supervised clinical training through Clinical Pastoral Education. A lot of CPE is based on self-awareness. Self-discipline and discernment are also key elements of EI. A fun EI test to discover your level of emotional intelligence is found at this site: http://www.queendom.com/tests/access_page/index.htm?idRegTest=3037. I completed it and found that while I had a high level of EI, there was much I could do to grow. This ‘test’ would make a good discussion starter in Chaplain meetings. There are three benefits a Chaplain will gain from improving EI: 1. Emotional Intelligence helps us to “read a room”. How many times have you been in a patient’s hospital, facility, or other room with family and friends in it and the dynamics were both subtle and obvious. What were you learning about those persons surrounding the patient? What did you think was happening with the dynamics? Did this information assist you in relating in a more effective manner with the family? The hospice Chaplain must be keen in this skill. 2. Emotional Intelligence helps the Chaplain to be aware of his or her own emotions and not let them ruin a visit. There will be those times when it would be very easy for the Chaplain to get caught up in an emotional situation and lose effectiveness. As I interviewed a candidate for a position, I noticed that in discussing the loss of his father, he broke down and wept. It was clear his mourning was not complete. This really could get in the way of his work with family members who were in the process of losing their father to death. A Chaplain must be aware of his emotions or risk losing his ability to serve. Now, I am not saying that a Chaplain cannot weep with those who weep. I am saying that transference and projection are not acceptable for the Chaplain. 3. Emotional Intelligence helps the Chaplain understand the emotions of the patient and family/caregiver(s). People need to feel understood. People, at times, exhibit strange emotions. People at end-of-life are allowed to exhibit challenging emotions. If the Chaplain cannot understand the patient or the family caregiver, then an opportunity to assist these folks is lost and their inner peace is at risk. The hospice Chaplain has a lot riding on her connection with the patient or family member. When the Chaplain connects and conveys understanding and shows it with appropriate body language, the patient feels able to unburden a potentially deeply burdened soul. As you can tell, we have barely scratched the surface of this topic. I encourage you to do your own study and exploration of this topic. It is broader and deeper than I imagined. And, Chaplain Friend, bless you as you live out your ministry.

Wanted: Hospice Chaplain

Wanted: Hospice Chaplain Recently, we have interviewed for a number of full time Chaplains. This experience reinforces what I am about to write. There are ways that you will get an interview and ways to interview that will at least get you a second look and even make you a finalist and, further, get you hired. 1. When you respond to a posting for a Chaplain position, be sure to complete the application in as detailed a manner as possible. 2. When you send in a resume, the following are absolute MUSTS:  Choose a format. Word for Windows has several.  Be detailed. Dates and where you worked previously are necessary.  Why you left the position is helpful. We understand if you were to say, “It was not a good fit.”  I prefer a list of at least 3 references.  Since this is hospice chaplaincy, a cover letter that explains your calling to chaplaincy, your experience in chaplaincy, the reason you want to work at a hospice, if you are moving from another venue of chaplaincy to hospice tell us why. If you cannot clearly state a sense of calling, that may be a red flag. 3. Should you be selected for a face to face interview, please follow these guidelines:  Have an ‘elevator’ speech detailing who you are. It should take 3 minutes.  Convey an aptitude for hospice chaplaincy and a calling to it.  When answering questions take a moment to reflect on what you are about to say, then say it. The way you respond to a difficult question will give us some insight into how you will respond to a difficult situation in a hospice pastoral care scenario.  Give real life anecdotes to illustrate your points.  Do NOT ever use racial, ethnic, or gender slurs. That will immediately disqualify you even though the interview may proceed.  Smile … appear relaxed. Again, this will let us know how you will respond in a pastoral care scenario. 4. After the interview, send a “Thank you” email. That will let us know that you have manners and are professional in your business dealings. After all, no one owes you an interview. 5. If you are invited for a second interview, we are looking for even more of a professional manner of response. We are looking for further clarity on issues. It could be that there are one or two matters that are unsettled in our minds and we are looking to you for more information. 6. And, finally, throughout the process we are looking for someone polished, gracious, professional, and skillful. And, if you follow the above, you have a great chance of getting a chaplaincy career position. If you have any questions about resume writing, cover letter writing, or guidance in how to interview, please contact me at rbehers@cshospice.org.

Grief

I recently had the pleasure of hearing David Kessler speak on the topic of grief. David Kessler is one of the world’s foremost experts on healing and loss. His experience with thousands of people on the edge of life and death has taught him the secrets to living a happy and fulfilled life. He is the author of five bestselling books, including the newly released You Can Heal Your Heart: Finding Peace After Breakup, Divorce or Death with Louise Hay. He co-authored two bestsellers with the legendary Elisabeth Kübler-Ross: On Grief and Grieving and Life Lessons. Please be sure to visit Grief.com. That site has a great number of resources hospice Chaplains can use. With that said, there are some general guidelines we as hospice Chaplain need to follow and even encourage our IDT members to follow as well. On David’s site he has two lists: The Best Things to Say to Someone in Grief, and The Worst Things to Say to Someone in Grief. The Best Things to Say to Someone in Grief 1. I am so sorry for your loss. 2. I wish I had the right words, just know I care. 3. I don’t know how you feel, but I am here to help in any way I can. 4. You and your loved one will be in my thoughts and prayers. 5. My favorite memory of your loved one is… 6. I am always just a phone call away 7. Give a hug instead of saying something 8. We all need help at times like this, I am here for you 9. I am usually up early or late, if you need anything 10. Saying nothing, just be with the person The Worst Things to Say to Someone in Grief 1. At least she lived a long life, many people die young 2. He is in a better place 3. She brought this on herself 4. There is a reason for everything 5. Aren’t you over him yet, he has been dead for awhile now 6. You can have another child still 7. She was such a good person God wanted her to be with him 8. I know how you feel 9. She did what she came here to do and it was her time to go 10. Be strong Let’s do our best to connect our pure and good intentions with pastoral care skill in providing care to those grieving and experiencing anticipatory grief. Bless you, Chaplains, for your compassionate work.

Open Letter to CPE Supervisors and Diplomates

It is rare that I have ever written an article like this, but it’s time. What is on my mind has everything to do with the hire-ability and sustainability of your students and trainees. One of the key concepts of Clinical Pastoral Education is self-awareness. Dr. D. James Stapleford was my CPE Supervisor and he did a thorough job on this topic. He introduced the concept in Unit 1, emphasized it more in Unit 2, made a spectacle of it in Unit 3, and completed the process in Unit 4. What I am saying is simple; self-awareness is the coin of Hospice Chaplaincy. If a Chaplain is not applying his education in self-awareness, I can assure you his time working as a Hospice Chaplain will be short. There are several venues a Hospice Chaplain will work in: homes, long-term care facilities, hospice houses, and hospital units. Each has its own unique politic. The self-aware CPE trained Chaplain should be able to read a room, sense what his or her surroundings are saying, recognize the question behind the question, skillfully apply spiritual comfort, and work with the staff at each location. It may not be something you like to hear, but I have observed among a growing number of new Hospice Chaplains that there is a glaring absence of self-awareness. Therefore, I urge you to re-double your efforts to provide extended education on this key element of CPE. That you may know a little about how we operate at Cornerstone Hospice & Palliative Care, Inc.….We require an MDiv or similar Master’s degree, 5 years of experience in a congregational setting or hospice/hospital setting, and 3 Units of CPE. Our expectations of our Chaplains are high. We are happy to hire a new-to-hospice Chaplain and equip them to do great work. While I am aware that each CPE student/trainee comes to the table with their own box of rocks, the impact of their past and liabilities of their personalities must be addressed effectively in CPE. If this offends you, I apologize. If this moves you to address this topic more thoroughly then I am delighted. What is at stake is effective spiritual support for dying patients and their families.

Reflections on the National Institute for Jewish Hospice Annual Conference

For the last four years I have had the privilege to attend this vital conference. This year’s conference was wonderful for two reasons: the content of the program and the fellowship with other conferees. I was particularly inspired by the presentation by David Kessler. His topic was “How Judaism Heals Grief: How do we heal grief? What works and what doesn’t?” Kessler has five best-selling books on grief and is an experienced hospice bereavement expert. What struck me most about him was the fact that he is an excellent communicator whose humility makes his presentation extremely compelling. Kessler posed the provocative question, “Are we destined to die as failures?” Think about it. What is said about patients who died of cancer: “It’s sad she lost her battle with cancer.” “It’s sad he/she lost …” Is that the language we as hospice spiritual care providers want to perpetuate about our patients? Let’s change the language from “she was a great painter/a stellar actress/a fantastic friend”, to “she IS a great painter/a stellar actress/a fantastic friend”. Let’s keep the present tense when talking about patients. They are not a “was” until they die. There was so much more Kessler had to say… For more information, please go to his website, www.grief.com. Rabbi Young spoke with passion and energy as he presented “From Dying Until Burial”. No one should die alone was made crystal clear. That is one of the goals at Cornerstone Hospice. Humility is the value most important to a funeral. The casket is made of wood. The wealthy and the poor are buried in the same type of casket. The money not spent on the funeral may be given to a worthy charity that helps the poor. The fellowship around the lunch table was particularly energizing. Hearing from Rabbi’s, Chaplains, and hospice administrators dealing with such topics as Medicare requirements/reimbursements, programs for and methods of care for patients, and other things hospice made the conversation instructive and inspirational. Of the four annual conferences that I’ve attended, this one was the best. I want to thank the leadership of Cornerstone Hospice and Palliative Care, Inc. for making it possible for me to attend. By making this possible we remain an “Accredited Jewish Hospice.” This sends a strong message to our Jewish patients, their families, and the Jewish community as a whole.

The Chaplain and Social Courtesies

Chaplains have a wonderful opportunity to make a positive impact and impression upon patients and their families. To do so, it takes more than skill in spiritual support or in counseling or in providing encouragement. The Chaplain that excels in social skills and common courtesy will find his or her spiritual care greatly enhanced. I had a bit different upbringing than some as from the age of 10 my Mother educated me on manners and social skills as my Father died and could not add to my Mother’s advice. Opening doors, be they to buildings or vehicles, saying “Please” and “Thank you” were just the basics. Through my career I have learned that those basics can carry one a good way, but there are many other social courtesies to learn and apply to solidify great relationships with those we serve in hospice. The list that follows is by no means exhaustive nor given in any order of importance as they are all important. Key Courtesy Tips for Chaplains  Smile! It takes more facial muscles to frown than to smile.  Pause for a moment before answering the telephone. This will allow you to shift gears and focus on the caller.  Sitting down and making eye contact while talking to patients leaves a more favorable impression than standing and you are perceived to spend more time with the patient.  Eye contact should be made 40-60% of the time in conversation. Less than that suggests you’re not paying attention… more than 60 % makes people feel uncomfortable.  “Imagine yourself in the patient’s position… how would you feel?”  “Never let a patient hear you complain.”  Show compassion.  Never blame another Team Member for something that went wrong. Apologize right away and say,” I will try to correct that for you or I will get someone who can. I’m sorry that happened to you and it will not happen again.”  Anticipate patient needs. For example, if a patient is nauseous and looks like he will vomit, either hand him a plastic basin or hold the basin for him. Another example: If a family member is carrying patient clothing or other item, hold the exterior open so they may enter the building without fumbling to get a free hand to open the door. Perhaps assist with carrying a heavy item.  Introduce yourself to the family that is entering the Hospice House and walk with them to the patient’s room.  Be friendly. Be warm. Be approachable.  Use common courtesy that you learned early in life.  Saying, “Yes/No, Ma’am” and “Yes/No Sir” is not just Southern in it origin, it is just plain good communication and courteous.  Make people feel like they matter  Go the extra mile with the patients and their families. What this looks like has many faces and facets. Being kind is fundamental to this one.  Show appreciation that the patient and family chose Cornerstone Hospice. Say something like: “Thank you for the privilege of serving you and your (loved one) here at Cornerstone.” Every time I’ve said that, the family member reflects that they are the ones grateful that we are serving them. It goes a long way to building a great relationship.  Never be too busy to meet a need. I am sure that we could make a list twice as long as this, but please accept this as a good start. Whether you visit in a patient’s home, or LTC facility, hospital or hospice house it is always proper to be mannerly. When you read the Best Practices for Chaplains in each of those localities, you will come across Chaplain Etiquette. Please be mindful and apply these guidelines for great patient and family care.

Spiritual Suffering

SPIRITUAL SUFFERING Spiritual pain can be defined as emotional distress due to spiritual and religious issues. These issues tend to fall into three categories: Theological and Religious Belief issues; Existential and Meaning issues; and, Relationship issues. Theological and Religious Belief issues are often characterized by the inability to participate any longer with the patient’s religious practice; detrimental beliefs about God, the Divine, or Transcendent One; an incongruence between beliefs and the patient’s experience in life; and conflicted beliefs about dying, death, and the afterlife. Existential and Meaning issues are characterized by a loss of a sense of meaning or a role in life which provided meaning; a feeling of hopelessness, anger, emotional pain caused by letting go of this world; a loss of dignity, control over life, feelings of inadequacy. Relationship issues are characterized by a need to seek forgiveness from God, a loved one, or some other person; a need to forgive God, a loved one, or some other person. A need to forgive self for some offense committed earlier in life is often a cause of spiritual pain, as well. For the hospice Chaplain, the above provide an understanding of the spiritual suffering patients at end-of-life experience. Building trust with the patient, providing a non-anxious presence, and listening with compassionate intensity are all skills the Chaplain must master to provide supportive spiritual care. Through my experience with patients I often wondered what they went through before they came to hospice and into my realm of care. I came to the conclusion that a hospice patient goes through a lot before they become a hospice patient. They have been ill for some time, they haven’t felt well, and to top all of this off, like a wrecking ball comes the terminal diagnosis from the physician that they have 6 months to live. The reaction of the patient to this devastating news is called “the existential slap.” In the International Journal of Palliative Nursing (November 2004,Vol. 10 Issue 11, p520) Nessa Coyle pens an article that focuses on the psychology of patients when a physician discloses the diagnosis of a life-threatening illness. The usual habit of allowing thoughts of death to remain in the background is now impossible. Death can no longer be denied. This awareness precipitates a crisis for most individuals, who are suddenly faced with addressing and most likely rearranging, their priorities in the time they now anticipate is left. The "existential slap," occurs when the reality and inevitability of one's own personal death sinks in. (Abstract to the article) Following this diagnosis a recommendation to hospice is made. In a flurry of activity the patient and family is met by an Admissions Nurse for a 3 hour meeting to enroll the patient in hospice followed by the Case Manager/Nurse, Social Worker, and Chaplain all within a 5 day Medicare mandated window. Is it any wonder that one of the key personality traits we look for in hospice Chaplains is compassion? The patient is reeling from the diagnosis of 6 months to live and is thrown into an environment they are totally new to and may never have heard of before or at least not understood. The Rev. Dr. Kathleen Rusnak references how her new patients described their reaction to the Existential Slap. The first time I heard a patient say, “When the doctor told me I had less than six months left to live, it felt like “I hit a brick wall,”-- I didn’t hear it. The second time a patient said that to me, I heard it the first time. And then I read this metaphor in a hospice nurse-practitioner’s thesis on suffering. The interviewed patient stated that she felt like she “hit a brick wall” when the doctor told her she had six months left to live. Metaphors are very powerful. They express in symbolic language the depth of raw feeling and emotions that cannot be directly expressed in words. (www.thebrickwall2.com) For now, as there is so much more to be explored in the Existential Slap, I want to do a deeper dive into what Dr. Rusnak so candidly wrote when she described her response to the patient, “I didn’t hear it.” If there is one regret I have as a Chaplain, it is that like Dr. Rusnak, I didn’t hear or at least didn’t “get” what the patient was actually trying to communicate. Could this be what Heidegger refers to as “the forgetfulness of being”? Could it be that we Chaplains are so incredibly busy that we often are thinking ahead to the next patient, the next this, the next that that we are not in the moment, but in the next moments? And, we forget. We forget that before us is a new patient who has just started the hospice journey and is about to have the most daunting experience of a lifetime that will conclude with the end of life on this planet. Which among us has died before and lived to tell about it? I’m not talking about near-death experiences. I’m speaking of the real experience of death. With that clarification, the answer is simple, none of us. Can we grasp the magnitude of what this new hospice patient is attempting to process? It’s pretty hard, isn’t it? In this article, I simply want to urge my fellow Chaplains to do whatever is necessary to be in the moment with your patients. We who are living fall prey to the “forgetfulness of being” while the patient we serve is moving rapidly to the stage of the “mindfulness of being.” Simply put, the mindfulness of being is encapsulated in the long hours of self-reflection where the patient pours over life searching for answers to these questions and more: “Who am I? What was my purpose? Did I have a purpose? Did I waste my life? Did I love? Was I greedy? Did people love me? Will I be remembered? Did I make a difference?”

IT’S ALL ABOUT THE PATIENT, RIGHT?

IN THE HOSPICE WORLD WE HAVE A SAYING, “IT’S NOT ABOUT US, IT’S ABOUT THE PATIENT.” WHO CAN ARGUE WITH THAT? WE EXIST TO SERVE PATIENTS AND THEIR FAMILIES. IT IS OUR CALLING, IT IS OUR PASSION, AND IT IS WHY WE GET UP IN THE MORNING. THERE IS NO DOUBT ABOUT THAT. BUT, UPON REFLECTION, IS IT REALLY ALL ABOUT THE PATIENT AND FAMILY? HOPEFULLY, IT IS A GOOD BIT ABOUT YOU, TOO! LET’S EXPLORE WHY. IN HOSPICE CARE, EMOTIONS AND SPIRITS GET FRAYED BY A NUMBER OF THINGS:  WHAT WE BRING WITH US TO HOSPICE: OUR OWN BOX OF ROCKS: PERSONAL ISSUES, FAMILY ISSUES, FINANCIAL ISSUES, DISAPPOINTMENTS, FAILURES, LET DOWNS, AND QUIRKS OF PERSONALITY, TO NAME SEVERAL. HOW WILL ANY OF THESE AFFECT HOW YOU DO YOUR HOSPICE WORK?  WHAT SKILL SET WE BRING TO OUR DISCIPLINE: ARE YOU NEW TO HOSPICE? HAVE YOU TRANSFERRED FROM A HOSPITAL SETTING OR A PARISH PASTORATE, OR HOME HEALTH SETTING? WHEREVER YOU SERVED BEFORE COMING TO HOSPICE YOU WILL FIND IT TO BE DIFFERENT FROM WHERE YOU ARE NOW SERVING. FOR INSTANCE, THE HOSPITAL SETTING FOR NURSES IS VERY STRUCTURED. HOSPICE SETTINGS TEND NOT TO BE STRUCTURED. FOR PASTORS, YOU CALLED THE SHOTS. YOU SET THE AGENDA. IN HOSPICE, YOU ARE PART OF A TEAM. YOU NO LONGER SET ANY AGENDA, INSTEAD, YOU FOLLOW ONE. THOSE EXAMPLES ARE FROM MY OBSERVATION AND OWN EXPERIENCE.  WHAT EXPECTATIONS DO YOU HAVE? THERE ARE SOME WHO HAVE ROMANTICIZED HOSPICE CARE. YES, IT IS A WONDERFUL AREA OF THE MEDICAL PROFESSION TO WORK IN. BUT, WHAT ARE YOUR EXPECTATIONS FROM THE COMPANY? THE TEAM? YOUR MANAGER? YOUR PATIENTS AND THEIR FAMILIES? CAN YOU DEAL WITH NOT HAVING A DESK ASSIGNED TO YOU? CAN YOU DEAL WITH NOT BEING THE LEADER? LIST YOUR EXPECTATIONS AND THEN REVIEW THEM. WHERE DID THESE EXPECTATIONS COME FROM? CAN YOU ADJUST THEM TO FIT THE HOSPICE WORLD? I THINK YOU CAN SEE FROM THE THREE PARAGRAPHS ABOVE THAT, INDEED, HOSPICE IS ABOUT YOU, TOO. WE TAKE OURSELVES WHEREVER WE GO. FOR THE SAKE OF OUR PATIENTS AND THEIR FAMILIES, LET’S COMMIT TO OURSELVES, OUR COMPANY, AND OUR PATIENT AND THEIR FAMILIES, THE GREAT MISSION STATEMENT OF DAME CICILY SAUNDERS, THE FOUNDER OF THE MODERN HOSPICE MOVEMENT: “YOU MATTER BECAUSE YOU ARE YOU, AND YOU MATTER TO THE LAST MOMENT OF YOUR LIFE. WE WILL DO ALL WE CAN; NOT ONLY TO HELP YOU DIE PEACEFULLY, BUT ALSO TO HELP YOU LIVE UNTIL YOU DIE.”

The Million Dollar Survey

Chaplains will have an impact on Medicare reimbursements with their provision of spiritual care. Since CMS is placing a high degree of importance on the new Hospice CAHPS Survey, it behooves every hospice Chaplain to look at the Survey to find out what is being evaluated by the surviving family member(s) who complete the Survey. If the results of the Surveys are not good, it could cost a hospice of our size (1,000+ patients) a 2% decrease in reimbursements or over 1 million dollars. So, what’s in that Survey that a Chaplain should be concerned about? The primary question the family will answer is #36: Support for religious or spiritual beliefs, including talking, praying, quiet time, or other ways of meeting your religious or spiritual needs. While your family member was in hospice care, how much support for your religious and spiritual beliefs did you get from the hospice team? The family will answer one of three ways: Too Little, Right Amount, Too Much. Please do not think that because the final 3 words in the question #36 end with “the hospice team” that it excuses the Chaplain from responsibility. As the Chaplain the family will be looking you for direction and effective spiritual support during their loved one’s and their journey in the hospice experience. Other than providing spiritual support for the patient that is loving, encouraging, and compassionate, how can a Chaplain positively impact the family? Particularly for facility patients (LTC, hospital, and hospice house), the family members are not always present when a Chaplain visits. However, the Chaplain has access to the Primary Care Giver’s telephone numbers. After each visit with the patient, the Chaplain will place a phone call to the PCG informing that person of the visit and will express sincere concern for the PCG by asking, “And how are you?” Chaplains, this is a million dollar survey. While we have a small part in it, it is a vital part. Do your hospice ministry and by all means, be sure to include a phone call to the PCG and document it.

Our biggest day!

Yesterday was our biggest day. Hundreds of guests logged onto Embraced. Welcome! Please use this site to enhance your understanding of hospice chaplaincy and use the concepts and best practice principles to grow professionally. Your comments are also welcome and are a source of encouragement. Blessings!

3 Pitfalls of Value Judgments--Leadership Tips

Before I attempt to assign the 3 pitfalls, let me define what a value judgment is. A value judgment is an assessment that reveals more about the values of the person making the assessment than about the reality of what is assessed. In any value judgment there is the assumption that the person making the judgment knows all the facts, which they don’t. Yet, when a person with a title makes the judgment, the person who was assessed as deficient is pigeon-holed with a reputation he or she cannot shake. That is a shame, but it is the reality. This happens for some reason a lot in hospice work as leaders and team members work through their day to day challenges. The 3 pitfalls include: 1. An unfair assessment of an IDT member’s worth based upon a snapshot of time in an IDT meeting. When a value judgment is made about that person, it is quick like the cutting of a vegetable with a razor sharp knife. A value judgment disregards what the person is going through at the time and disregards one of the key elements of an IDT meeting. That element is safety. In an IDT the Team comes to work but a team also comes to care for its own. Value judgments take that aspect of the Team off the table and relegate people to robots. Not a good thing. 2. Value judgments cultivate a shallow view of people. It takes no time at all to decide whether someone is good or bad at their field work based on a Team member having a bad day. Shallow leadership is unhealthy leadership and unhealthy leadership is damaging to the organization and leads to recurring employee turnover. 3. Value judgments create instability on the IDT. It doesn’t take long for Team members to pick up on the fact that their leader thinks little of them. Again, a value judgment neglects the outstanding work a Team member may do in the field with patients and families and focuses on a small portion of time with that worker. Morale suffers when workers believe their leader think so little of them. A key value of leadership is to know one’s Team, to know the individuals on the Team, to know the issues they face at work and elsewhere. If the worker was hired because of excellent skills then that worker must be given the opportunity to be human from time to time. To pigeon hole a worker without knowing that person is exceptionally unwise. Beware then of falling into the trap of making quick, unfounded value judgments.

Assuming the Burden…

What burden is the hospice Chaplain to assume? There are many burdens hospice Chaplains like every other type of Chaplain assumes. Most are personal and independent of chaplaincy. The topic to which I am referring is hospice oriented only. What burdens do patients carry when they are in hospice care? If they are lucid and able to communicate, we may learn they carry burdens related to relationships, the need for reconciliation, fear of dying, the afterlife, and concerns for the welfare of their loved one after they die, to name just a few. They come to us with these burdens. Best practice in chaplaincy means the Chaplain is able to listen and identify these burdens and be a part of the healing ministry that supports the patient through the hospice journey. What burdens do the patients’ loved ones bear? Their burdens can relate to anger with God, wrestling with the “why” of it all, the need for reconciliation with their loved one, it might mean reconciliation with a clergy person or faith community as a funeral looms in the immediate future. How do these burdens find relief and lifting and what role does the Chaplain play in all of this? Let me answer this question by providing a bulleted list that hopefully gives a starting point for the Chaplain to begin. • When providing care for a patient who is lucid, the Chaplain uses the power of active and reflective listening. Giving the patient a Safe Haven, as Bowlby suggests, is a great starting place. It may be that the patient before the Chaplain has never unburdened his or her soul to anyone and now that death is near, the time may be ripe for this to occur. • When providing care for a patient who is minimally or non-responsive, the Chaplain may find him/herself in a quandary as to what to do next. Best practice answers the quandary. After the Chaplain provides spiritual care for the patient, the Primary Caregiver is contacted by phone and a brief summary of the Chaplain’s visit is provided. The Chaplain always thanks the PCG for the privilege they have given said hospice organization to provide care for this patient. Leaving a business card and not contacting the PCG after the visit adds an additional burden to the PCG to contact the Chaplain. If you think about it, why would you even think for a moment of adding an additional burden to an already burdened person? Is that not a form of arrogance rather than servant-hood that suggests that if they want to speak to me, then they can just call me? The Chaplain is to exude a servant-mindedness. Expecting a burdened family member to contact him or her is just not a good mindset. And, really, that is the point of this article. The Chaplain communicates his or her attitude with body language and tone of voice. The Chaplain’s attitude conveys all the family member(s) need to hear. If you leave a card, great. But, make the phone call. It’s just Best Practice, plain and simple.

3 Ways to Take Initiative

A Hospice Chaplain is a difference-maker. Being a difference-maker, however, doesn’t happen all by itself. Difference-making takes place when there is activity involved. In reading Forbes: Entrepreneurs I came across this article: “How 'Difference Makers' Think -- The Single Greatest Secret to Personal and Business Success”. (http://www.forbes.com/sites/groupthink/2013/06/04/how-difference-makers-think-the-single-greatest-secret-to-personal-and-business-success/) A portion of the article reads: A comprehensive set of new studies from OC Tanner Institute (including research we’ve conducted with Forbes Insight that we’ll be issuing shortly) shows a fundamental shift in the mindset of people who achieve groundbreaking results. The mindset is this: Great difference makers shift from seeing themselves as workers with an assignment to crank out, to seeing themselves as people with a difference to make. You, Hospice Chaplain, have a difference to make in the life of each of your patients and their family members. It is your calling. It is your destiny! Here are 3 ways you can make a difference by taking the initiative. I am sure you can think of many more, but consider these thought-starters. 1. Make a difference in the life of the patient. a. By actively listening. b. By a non-anxious presence. c. By advocating for them and their needs in a long-term care facility, home setting, or hospital. d. By assisting them to finish life well. 2. Make a difference on your IDT a. With your encouraging words and positive presence b. By helping without being asked to do so c. By working with your leadership to solve problems 3. Make a difference in your Inpatient Units. a. Do not wait to be told to do something. Take action: Meet, Greet, Move boxes, Do what is necessary, but do the unexpected. b. Support the staff with special seasonal rituals. c. Support the patients and families by giving extraordinary care. Chaplains who take existing job expectations—or job descriptions—and expand them to suit their desire to make a difference find great satisfaction and do great ministry for their patients/families and their company. Do what’s expected (because it’s required) and then find a way to add something new to their work. Do something that delights, something that benefits the souls on your caseload and those who work with.

Best Practice for Chaplains Serving in LTC Facilities (excerpt from the Handbook)

Basic Practice in Chaplaincy 1. Make contact with each new patient on your Team. You have a 5-day window to contact each new patient. Document each phone call in Allscripts. 2. Complete the Initial Spiritual Care Assessment. Document this in Allscripts. 3. Documentation of Initial and Routine visits will be completed the day of your visit. If the visit is late in the day, you have 24 hours to complete the documentation. 4. Synchronize in the morning and evening of each work day. 5. The following provides a primer on functioning with best practices in the facilities. Please keep in mind that each facility has its own nuances. Your professional presence will assist you to comply with the nuances of the facility. Checking In 1. Upon your arrival at the facility, check in at the front desk. Explain who you are, who you represent. Have your badge prominently placed on your blouse or shirt. 2. Ask for the room number of the patient(s). 3. Thank the person who assisted you. Entering the Patient’s Room 1. Remember that the patient’s room and bed are their personal space while they are in the facility. a. Knock before entering the room or, even, on the wall near the bed before crossing the line of a curtain that defines that patient’s particular area. b. If the curtain is completely drawn around the bed, speak outside the curtain and be sure you have the patient’s/family’s permission before stepping inside the curtained-off area. c. Announce yourself by name, with Cornerstone Hospice, and role and ask if it is OK to come in. For example, “Hello, my name is Rich; I am your Chaplain with Cornerstone Hospice. May I come in for a moment?” d. Respect for the humanity, privacy, and situation of each patient and the patient’s family are essential to what we do. Positioning Yourself in the Patient’s Room 1. Position yourself in a sensitive manner. a. Examples, depending upon patient and situation:  If the patient is at all physically exposed because of gown, equipment, etc., seek a facility staff member to cover patient. Do NOT do this yourself.  Perhaps the patient is hard of hearing; position yourself and speak clearly to maximize the patient’s ability to hear you and/or read your lips.  Perhaps the patient has a sight deficiency; position yourself accordingly and use your voice and/or touch to ensure the patient knows you are there and that you have identified yourself, as the patient may not otherwise be able to recognize you from a previous visit.  Sit in a chair, if possible, so that you are eye-level with the patient; however, do not immediately sit, because that might signal to the patient that you intend to stay for a while – make sure you have determined with the patient/family that an extended visit at that time is appropriate and welcomed. (Do not sit on the bed.) If the Patient Indicates He/She Does Not Wish a Visit 1. Do not stay if the patient does not desire a visit. We do take “no” for an answer! 2. Leave a Spiritual Care Services brochure with them for further information and later contact. Touch 1. Be cautious with physical touching. a. It is often natural for us to want to touch a patient: To hold hands or place a hand on the head, for example, while praying; b. To lay a hand on an arm or shoulder as an expression of comfort or reassurance. 2. However, touch can be a “touchy subject”. a. The patient may be in physical pain that even a little pressure might exacerbate. b. The patient’s personal history and/or personal temperament may make touch unwelcome or threatening. c. The patient may misunderstand the intent of the touch, especially if their condition in any way decreases their understanding and perception. d. Whenever possible, if you wish to touch a patient, ask the patient’s permission first. What We Do and Don’t Do 1. Remember, we emphasize listening. Our first concern, always, is simply TO BE WITH patients/families. o To listen. o To let them lead any conversation where they want/need it to go. o To be a quiet presence, if that is what is needed and possible. 2. We seldom or never:  Give advice.  Try to convince anyone of anything.  Proselytize (try to win converts to our religious beliefs and communities) – this one is a NEVER. Communicate with the patient’s faith community to provide a pastor, priest, Imam, Rabbi, or other religious leader to assist with your work with the patient. 3. We may pray with patients/families. a. We will pray:  If they request it.  If they agree to our suggestion/offer to pray.  After clarifying if they want us to pray with them, then and there, or for them, in our own time, perhaps back in the sanctuary.  After clarifying what prayer means to them and what style of prayer is appropriate for them. (We do not assume prayer using a particular religious form or language, unless it is clear from the patient/family that is what they want and expect and if we ourselves are comfortable with that kind of prayer.)

Commentary on Chaplain Qualifications

It is almost comical when I read qualifications for Hospice Chaplains. 1 Unit of CPE, Bachelors Degree, 1 year of experience in pastoral care...Seriously? What exactly are you expecting of this person you call Chaplain? Have you no idea what issues a Chaplain will encounter? Are you not aware that Hospice CAHPS will determine your reimbursement? Even with our high qualifications we spend time training our Chaplains to provide excellence in spiritual care. We assume nothing and seek to build a team of Chaplains that will make a difference in the life of the patient and their families. The issues hospice Chaplains face require experience and skill. Makes me wonder if the lack of qualifications is simply a financial issue rather than anything else. Something to think about when the results of the CAHPS come rolling in.

In the Face of Death...The Chaplain Ministering at the Hospice House

Best Practice for Chaplains Serving in Hospice Houses (an excerpt from the training guide) Basic Hospice Philosophy • Always remember patient care comes first. • This work is not about us as Chaplains, but about our patients and families. Before the Chaplain Enters a Facility Serving in a Hospice House will challenge you spiritually, emotionally, and physically. The stress of the position requires the Chaplain to address his or her inner person. Being spiritually centered before you enter the facility is an absolute necessity. You need to not only be there, you need to be ALL there. A healthy model for ministry is Jesus Christ. He said to his weary disciples in Mark 6:31, “Then, because so many people were coming and going that they did not even have a chance to eat, he said to them, “Come with me by yourselves to a quiet place and get some rest.” Before you enter the facility, if you are feeling seriously stressed, write down your stressors, your emotional pain, or whatever might be a distraction and purpose to deal with it later. You must be clear in your thinking, your sensing, your speaking, and your spirit. The needs of the patients are priority needs. Again, they need you there and ALL there. Basic Practice in Chaplaincy Because both patient and family members are going through extreme emotional and spiritual pain, I am asking that you follow this action plan to ensure high quality spiritual care in the Houses: 1. Check on each patient daily. Complete all Initial Assessments the day the patient arrives at the Hospice House. Complete a Routine Assessment for patients that are lucid or have family members present for whom you opened a Care Plan (Spiritual Care [Family]). Document a Clinical Note when no one is present and the patient is either sleeping or is actively dying. 2. If family members are NOT present at the time you are at the House, contact them by phone and write a Clinical Note. 3. Should the family members or patient request a Priest or other religious leader make every effort to contact that faith leader and document your efforts. This is the Chaplain’s responsibility, not the Nurse’s. 4. Respond as soon as possible to any request by the Nurse(s) for spiritual concerns. Be supportive of all staff at the House. 5. Make yourself available to provide support to the staff when you are not in direct patient care. 6. Serve as a Hospice Ambassador to ALL who are visiting in your House. Seek out ways to provide care for families that are new to the Hospice House, i.e. getting them coffee, or other beverage; providing information about the House; introducing them to key leaders in the House that they might interact with. Remember, this may be routine for us as we are familiar with all the systems in the House, but this is their first journey into a Hospice House. Please help make this stressful journey one they will remember in a positive manner. Always be alert to a family member who is seated alone and looks distressed. Be a friend and confidant. Be Chaplain of the entire facility.

Words that Heal

I’m not much on verbosity when brevity can be the better teacher. This is the case in writing on the subject of words that heal. The words that hurt deserve a long and painstaking explanation because those types of words are the product of a lack of thought and knowledge on the part of the speaker. I mentioned the friends of Job in my last posting. At the beginning of their time with Job, they were sensitive and caring. And, then, they got the idea that they needed to provide explanations to Job for his suffering. Human nature is such that we must fill the silence with something. This is not a good thing. So, here are a few scenarios and examples of words that heal… Remember your CPE Training and be present in the moment, listen more than talk, let your body language speak that you care and are with the patient. The patient says, “I think it’s more than a little unfair that I have this and that I’m going to die so young.” Your response: Think about it. What will you say? How will you say it? What will your body language tell this patient…your facial expression, your posture? If you say something, it might be something like this: (with outreached hand, hold the patient’s hand) “I am so sorry. It must be awful/painful/sad or whatever one word fits.” As you speak look the patient in the eyes and let your being speak to theirs. Have you thought that at the beginning of the conversation three thoughtfully and sensitively framed questions might guide the patient? “How are you doing physically?” “How are you doing emotionally?” How are you doing spiritually?” Of course, these questions are used when you have an established relationship of trust. Said slowly, waiting for response is the best approach. I am sure you have your own style, but whatever your style I think we can agree that we must be sensitive, carry no agenda, seek not to explain, openly desire to support and comfort. The humble spiritual caregiver you are will speak with a language no words can describe. Bless you, Chaplain Colleagues, in your efforts to express a heart of comfort.

The stupid things people say to those with cancer & their families

Powerful Article from Which We May Learn What Not to Say What you are about to read is one of the last blog entries from Lisa Bonchek Adams. She had cancer and she died March 3, 2015. Her words are gripping. The stupid things people say to those with cancer & their families February 27th, 2013 There are always eyebrow-raising things people say to those with cancer and/or their families. Maybe not everyone would find each of the comments listed below to be offensive but they’ve been submitted by readers as ones they wish they hadn’t heard. I like to revisit this topic every so often to allow people to post comments and add to the list. Some of these come from the comments the last time I discussed this topic (here). At the bottom you will find a link to the post I did on suggestions about what TO say and how to help a friend with cancer or other illness. I’m not going to respond to each of the statements below. I’m just going to list them for your consideration. Some are just strange. Some miss the mark. Some are downright rude. They weren’t all said to me, but they were said. Gee, that almost makes me want to have an award for the most offensive one listed below… **please make sure to see the link in red at the bottom of the page for a post of things that are recommendations of what to say …………………………………………………………… “It will all be okay, I just know it.” “Someday you will put this all behind you” (to a stage IV patient) “Don’t worry, things will get better.” (to a stage IV patient) “So when will you be all better?” (to a stage IV patient) “When will your cancer be gone?” (to a stage IV) “But you don’t look sick.” “Lance Armstrong cured his stage IV cancer. You can too.” “But I thought you had chemo and surgery last time. How could it be back? This is why people shouldn’t do chemo.” “Do you think it was a waste to do chemo last time?” “Live in the moment.” “Be strong.” “Fight hard.” “Keep your chin up.” “Don’t give up.” “Attitude is everything.” “We just need a miracle for you.” “If anyone can beat this, you can.” After telling someone I had stage IV: “Wow. I’m going to miss you.” “Is it terminal?” “What’s your prognosis?” “It could be worse, you know.” “Everything happens for a reason.” “It’s all part of a larger plan.” “You’re only given what you can handle.” “All you need to do is think positive.” “Half the battle is the mindset. Be determined to beat cancer and you will.” “Now that you’ve been through this you’re due for some good things to happen.” “I’m sure it’s fine/I’m sure it’s nothing.” “Well, you’ve been needing a vacation for a while and now [during chemo] you get to lie around and read books all day. What could be better?” “Well, do they think [the chemo] is going to do any good?” “At least it’s not on your face where everyone could see the scars, besides you don’t really need your breasts anyway.” “A new-agey friend asked me if I had been really angry about anything 7 years before my diagnosis that I had repressed. (What had I done to cause my DCIS?)” “I was advised to write a letter to my husband detailing how much I loved him so he could have something when I died. [My husband] was standing next to me as I was being given this little chestnut.” “One said to me the day after my malignant melanoma diagnosis: ‘Maybe this will help you evaluate all the things you need to change in your life.’ ” “Last year I had part of my cervix removed surgically for PRE-cancerous cell growth. I was at home recovering from surgery and still had days to await the results of whether or not I had clear margins, etc. Those days that drag on and you just wonder and hope. My mother in law came over with dinner (nice) and then proceeded to stand there and tell me about every person she knew with cancer, how they died, and how their families went on.” “When my mother was diagnosed with breast cancer, I was a wreck. My (now ex) husband got tired of it really fast and made a rule to confine my sadness to one day per week: “you are only allowed to cry about this on Fridays.” If I felt like I absolutely had to cry Sat-Thur, I had to do it in private.” “The worst thing said to me was right before I was to have a new lump checked out. I was a 7 yr breast cancer survivor at the time, with 3 children ranging from 14-8 yrs old. When I told a pastor’s wife I was worried about the lump, but was most worried about my children if I got bad news, she responded, ‘Oh, they will get over it. You’d be surprised how quickly. I know I got over my dad dying in a year, and I was about their age.’ ” “Gosh, I thought chemo was supposed to make you lose weight” “Nearly every person I told about my mother’s death felt the need to tell me about some relative of theirs that had passed away and how awful their death was.” “The very stupidest thing was said to me recently, a few months after treatment ended for a recurrrence. I was out to eat with my youngest son, now 16, and ran into an acquaintance. She said she’d given it a lot of thought, and wanted me to know that there were “perks” to dying at early age, in case I did. I’m 47. (and feeling fine by the way, and had just told her so.) But she proceeded to tell me 3 of “the perks” if I were to die early. One “perk” was that I wouldn’t be the grieving spouse, another was that I had already parented “through the fun years” and wouldn’t have to see my kids make bad life choices, and the other one….oh, I wouldn’t have the aches n pains that came with old age like she was experiencing. She was “sincere” and had “thought about it,” and is a nurse!! Just blew my mind.” 1. Random stranger on the street: Do you have cancer? Me: Yes. RS: How long do you have? Me: – 2. On telling peripheral people (e.g. hairdresser, or friend of a friend) of my diagnosis, they proceed to tell you that their uncle/cousin/friend’s mother had cancer and then that they died. I guess they are trying to make a connection and it’s the first thing that pops into their head, but I really did not want to hear about death at that time. 3. An email from a friend of a friend (a homeopath) telling me that breast cancer is caused my a negative relationship with your own mother. This is definitely not the case! 4. People asking me if I knew how I got my cancer (and then offering me something to read about some “natural” therapy they have heard about or are selling). 5. I fully got sick of hearing the words “positive” and “strong”; so much so that I banned my family and friends from saying them. “People choose their sicknesses. He chose to have cancer by not managing his negative energy and he chose to die by not fighting.” “Someone I know has pancreatic cancer. She didn’t suffer too many adverse effects throughout chemo which was fortunate for her. Her daughter, who knows I went through chemo all a year earlier, made a comment that her mother must have a particularly strong constitution because she didn’t have trouble with side effects. Ya, unlike like the rest of us weak wussies who who were knocked out by chemo! I knew that she was grasping at any tiny sign that her mom might experience a full recovery so I kept my mouth shut.”

Words that Hurt, Words that Heal

Words that Hurt, Words that Heal In preparing for this series of articles, I did a painful review of comments made to persons suffering with cancer, those suffering loss of loved ones, and those facing end-of-life issues in hospice care. I suppose most people simply don’t know what to say, but seem to feel a need to say something to dispel the silence. Looking at a Biblical model for speaking to one suffering, I turn to the early chapters of the book of Job. By the end of chapter 2, Job has experienced deep losses. The pain of his suffering altered his physical appearance. His friends, upon seeing him, wept. “When Job’s three friends, Eliphaz the Temanite, Bildad the Shuhite and Zophar the Naamathite, heard about all the troubles that had come upon him, they set out from their homes and met together by agreement to go and sympathize with him and comfort him. When they saw him from a distance, they could hardly recognize him; they began to weep aloud, and they tore their robes and sprinkled dust on their heads. Then they sat on the ground with him for seven days and seven nights. No one said a word to him, because they saw how great his suffering was.” (Job 2:11-13) The wisest thing these friends did was to sit in the dust with Job and suffer with him and not say a word. It was not until they tried to explain things and link suffering to God’s judgment on Job that things got ugly. There was a time when I was serving as a church pastor that a tragedy occurred. An infant was accidentally shot by an older sibling. The infant was taken to a local hospital for care. A few days later the child died. Added to the pain of this tragedy was the fact that a member of the church I served felt it her responsibility to inform the child’s mother that if she had faith the child would heal and live a normal life. What pain that mother felt at the loss of her child and what added pain was hers as she thought it was her fault because she didn’t have enough faith to save her little one’s life. Words can hurt, even crush someone who is suffering. Chaplains can ill-afford to be emotionally unaware of what is happening around them as they support the suffering. An ill-timed word or phrase can complicate the pastoral care relationship and make suffering so much worse. Persons suffering with cancer, HIV/AIDS, cardiac, and other high profile disease processes are vulnerable to comments that will make their suffering worse. In the coming days I will provide a singular focus on one disease process at a time in hopes that this review will provide both warning and instruction. Bless you, Chaplain Colleagues, as you communicate to your patients and families.

Great News!

Great News! It is my pleasure to inform you that an invitation was extended to me by Healthcare Chaplaincy to present my work on Best Practice in Hospice Chaplaincy. The national conference is April 11-13, 2016, in San Diego, CA. As the time for the conference gets closer, I will fill you in on all the topics to be presented. Bless you, Chaplain Colleagues, for your work. It is sacred and without doubt exceptionally necessary.

Be back with you after I recover from pneumonia.

10 Highly Effective Habits of a Hospice Chaplain

10 Highly Effective Habits of Hospice Chaplains Over the years I have attempted to practice effective strategies and habits. They helped me carry ridiculously high caseloads and at the same time provided me a platform for beneficial pastoral care. Let me list several and perhaps you can add a few of your own: 1. Stay spiritually centered. The work we do demands our best, a clear head, a clean heart, a strong inner person. 2. Keep relationships strong at home. If you leave home and you’re all emotionally in turmoil from an argument with your spouse or children, your day can be doomed. Instead, as much as is possible, keep harmony in your relationships. Find a way to release the turmoil before you see your first patient if something does happen. 3. Organize your work. At Cornerstone Hospice we have a piece of our electronic charting to make out a daily/weekly schedule. Know where you’re going. Caseloads these days are higher than they have ever been. Don’t expect that to change. 4. Document your work. At Cornerstone Hospice we are required to document at the bedside or shortly thereafter. Do not allow your charting to grow stale. I promise you will miss something important. 5. Build relationships of trust with your patients and families. You may be the one to officiate at the funeral and your background with the patient and family will hold you in good stead. The surviving family members will appreciate you for it. 6. Work with the patient to achieve the Goals/Expected Outcomes. Help them to leave this world with as many loose ends tied up as possible. 7. Take time to assist a new Chaplain. Show him/her the ropes. Teach them good habits to practice. Introduce them to your IDT members. Always hold them in high regard among your colleagues. 8. Give a listening ear to IDT members that are going through difficult times. You will endear yourself to the Team and that is something very important. 9. Stay abreast of the chaplaincy world. Learn all you can and share it. 10. Become the go-to expert on matters spiritual and religious on your IDT. Ask your Team Manager for time to teach and train your Team. You will be the beneficiary of the Team’s high regard. These are 10 highly effective habits. What would you add?

The Chaplain and the Community

The Chaplain and the Community Does a Chaplain have a responsibility to get involved in the community, faith community, or other organization the Chaplain has an affinity for? Can an organization benefit from the experience and life expertise of the Chaplain? Those two questions should be answered carefully and thoughtfully. One of the characteristics of my particular generation is cocooning. It is challenging for me to spend the day at work, come home to dine with my lovely wife, go to the gym, and come home to relax and close out the day. I have my patterns, as do you. Is there time to carve out in the schedule for volunteering and connecting with the community? Have you ever gone to a networking meeting at a Chamber of Commerce or some other group? I remain amazed at the amount of time some of the people in those organizations spend not only during the day, but also, after hours to make those groups relevant. I would like to hear from you about what organizations appeal to you. It may be that you are active in APC or CPSP or ACPE. How do you make time to be involved with your favorite organization? T

Happy Independence Day!

To our American readers and Chaplains, have a safe and happy Independence Day! Freedom has never been free. Thank a Veteran.

3 Essential Qualities of a Chaplain Leader

The qualities of leadership are never more evident than when the Team needs support. In hospice there are circumstances that require involvement. A Team looks to their leader for passion, connection, and direction. Passion is something the leader must possess. To be overwhelmed by the mundane and exhibit a sour attitude will dispirit the Team. Being a “drama-king/queen” will distance the Team. Being a micro-manager will anger the Team. Being a curmudgeon will confuse the Team. Being ultra-demanding will move the Team to seek another job. Building a stable Team that will work together for the long haul is a great goal of the Leader. How that is done is another matter. I re-emphasize, when your Team sees passion in your eyes and action, they will respond positively. Connection builds bridges of understanding. There are times when you as a Leader need to jump in and do some visiting of patients. This will keep your clinical skills sharp and give you an understanding of what the Team is experiencing in the field. When census soars, the Team will be exhausted unless you either have an adequate number of PRN Chaplains or you jump in to assist. When the Team sees your willingness to help your reputation among the Team will soar. Also, connecting with the staff means you are approachable, amiable, and gracious. You will always be the Leader, but your Team needs a human leader. Direction is a quality of leadership that indispensable. The Leader has to know the way. The Leader has to know how to communicate company policy, procedures, and changes in any methodologies that impact the Team. The communication of the Leader must at all times be free of complaining, belittling, disagreeing with Senior Leadership, and negativity. If you as the Leader are unhappy with where you are working and communicate that to the Team, do you really think they will be happy in their work? Bless you, Chaplain Leaders, in your efforts to build a highly effective Team.