REFLECTING RESIDENTS' SPIRITUAL NEEDS IN CARE PLANS


Authors: Sue Schoenbeck, R.N., is director of resident care; Michael Rock is administrator and chief executive officer; Jill Cullen is plan of care coordinator; and Carol Gabor is a social worker at Ingleside Skilled Nursing and Rehabilitation Center, Mount Horeb, Wis.

Far less is known about the human spirit than is known about the body and the mind. But issues of the spirit are important when caring for the elderly in long term care environments, as well as preparing residents, families, and staff for the death of a resident.

Therefore, it is judicious for the caregiving team to gather information about spiritual as well as physiological, mental, and psychosocial needs. Ingleside Skilled Nursing and Rehabilitation Center, Mount Horeb, Wis., has created a spiritual assessment tool congruent with the minimum data set (MDS 2.0) to help determine each resident's spiritual needs, which then can be addressed in the care plan.

Ingleside's spiritual care program is rooted in a theory of logotherapy developed by Viktor Frankl, a Viennese psychiatrist who survived several World War II concentration camps. He proposed that people can find meaning in life events, including suffering, and can transcend what fate bestows. Frankl believed that people search for meaning in life up to and often through the death event.

Asking questions pertinent to spiritual needs makes residents feel welcome to share their spiritual side. How a person chooses to live life is reflective of the spirit that lies within. By using an assessment tool to gather data, caregivers can build a care plan upon the experiences the resident values most and wishes to retain.

The Assessment Tool

The first part of Ingleside's spiritual care assessment tool (see box below) gleans information from the resident pertaining to concepts of a god or deity, religious practices, and helping others. Questions include: Do you usually attend church, temple, or synagogue? Do you find strength in your religious faith? Have you participated in or would you be interested in a Bible study group? Do you enjoy helping others? In what ways have you helped others?

Ingleside Spiritual Assessment

Part I: Activities

Name: _______________ Medical Record # ____________ Date___________

Concept of God

Is religion or a god important to you?

Is prayer helpful?

Does a god play a role in your life?

Customary Routine: Involvement Pattern

Do you find strength in your religious faith?

Do you usually attend church, temple, synagogue, etc.?

Are there any religious practices that are important to you?

Religious Practices

Has being sick made any difference in your religious practices or prayer?

What religious books or songs are helpful to you?

Have you participated in/would you be interested in a bible study group?

Helping Others

Do you enjoy helping others?

In what ways have you helped others?

Recommendations for care plan: __________________________________________________________________________________

______________________________________________________

Assessor's Name _____________________ Title _______________

Source: Ingleside Inc.

Part II of the spiritual assessment tool (see box below) engages the resident in conversation about sources of help and strength, relation between spiritual self and health, and impending death. Questions in this section include: What are your personal goals? Do you want to participate in or assist with religious services at the facility? Are there roles you had in your life before that now are closed off to you? What has given your life meaning in the past? What gives your life meaning now?

Ingleside Spiritual Assessment

Part II: Social Services

Name ______________ Medical Record # ________ Date _______

Sources Of Hope And Strength

Who is the most important person to you?______________________

Are there roles you had in your life before that are now closed off to you?

If so, how do you feel about this?

What has given your life meaning?

What gives your life meaning now?

In what ways do others help you?

What helps you most when you feel afraid or need special help?

What is your source of strength or hope?

Goals

What are your personal goals?

Do you want to participate in and/or assist with religious services at Ingleside?

Relation Between Spiritual And Health

What do you think is going to happen to you?

Has being sick made any difference in your feelings or beliefs about God or religion?

Is there anything particularly frightening or meaningful to you now?

Impending Death

Do you want a bedside service? __ No __ Yes Clergy: Your own? ______

Parish _______ Phone _______ Other? _______

Parish _______ Phone_______

Do you want it in your room or chapel? _______________

Do you wish to be present or would you prefer it be held without your presence?

Are there any special words, prayers, songs, or thoughts you would like expressed at the service?

Recommendations for care plan: ___________________________________________________________________________________

______________________________________________________

Assessor's Name _____________________ Title _______________

Source: Ingleside Inc.

Once the caregiver has completed the resident interview, information from the spiritual assessment tool is incorporated into the individual's care plan. For example, when a resident reports prayer as a daily part of his or her past life, staff can include "provide private times for prayer" in the care plan. A resident with Alzheimer's disease for whom evening prayer had been a ritual can be guided by staff each evening in this routine. Staff can assist family members to record familiar prayers for playing to their loved ones. Furthermore, resident prayer and hymn requests can be incorporated into a weekly nondenominational service. If the assessment shows the resident is experiencing spiritual distress, care plan approaches may include pastoral counseling, psychotherapy intervention, and medication regimen evaluation.

But caregivers should not assume that residents' feelings will remain  static. Entering a nursing facility does not mean a person stops growing and changing. Residents often reevaluate and change what they value.

Therefore, spiritual needs must be regularly monitored and changes to the care plan made accordingly to guide staff in providing the support the resident needs.

Bedside Closure Service

It is understandable that residents and families have heightened spiritual needs as death approaches. But facility management should remember that staff, too, will have intensified needs because of their close interactions with residents.

Therefore, Ingleside holds a bedside closure service to comfort those left behind. Part II of the assessment tool provides information about whether or not a resident and family want a service and what they would like incorporated into the service.

The service is designed not only to honor the resident in the manner requested, but to give staff the opportunity to say good-bye and to share with family, friends, and the departed some of the good times experienced together.

For example, at an Ingleside bedside closure service for a man who communicated only by repeating two syllables, certified nurse assistants (CNAs) told family members how they had learned what the resident wanted by his intonation of the two syllables. Another CNA thanked the family for the opportunity to care for a man who had taught her she wanted to make a career of helping people with speech impairments. A housekeeper commented he would miss joking around and seeing the resident's broad smile.

Ingleside staff has assembled a bedside closure service guide that includes some of the songs and prayers most frequently requested by the facility's population. This guide is printed in large type for ease in reading. A staff-written prayer book is given to each new resident and staff member to help people find words with which to pray together.

Program Benefits

In 1995, Ingleside conducted an exploratory descriptive study of the value of its spiritual care program for residents, families, and staff. Results indicated that the program led to increased knowledge of and response to residents' spiritual needs. Impending deaths were more openly discussed, leading staff to communicate with residents about their last wishes. The quality of life near death was enhanced as individual wishes were honored.

Families also benefited. Positive written responses have been received from the families of residents for whom a bedside closure service was held.

A daughter wrote on behalf of her family, "We felt the service for Mother was helpful and thoughtful. We felt she was liked and respected although we know she was a trying woman."

Giving spiritual care offers staff the opportunity to get to know the spiritual side of the residents and, with residents and families, explore the meaning of life.

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