All are Welcome

Internationality is the key, but not every community will be able to cultivate intercultural and intergenerational communities.  The dioceses in California all have this potential because of the diversity of the population and the amount of recent and long-standing immigration.  We were encouraged to invite a neighboring convent to dinner and invite others to work with us.  

The world around us is toxic and witnesses to a lack of understanding across generations and cultures.  Religious life may be the place where there is no competition among people from different generations and cultures.  We may be the witness the world needs in this regard if we can live the message we preach that “All are welcome.”  Sr. Mary suggested we bring this idea up in our local communities, and not to be dissuaded by the curmudgeons in our midst.  She said every community has one of those, and we should be thankful if we have only one.   Don’t let a “Crisis of Imagination” stifle the Spirit.

March 31, 2019 a presentation by Sr. Mary Hughes, OP at Diocese of San Jose Chancery Office.

Hard Choices for Loving People

This month I am looking into certification for Palliative Care and Advanced Hospice Chaplaincy with the National Association of Catholic Chaplains.  The prerequisite is a minimum of five years and 500 hours practice in palliative or hospice care chaplaincy.  I just have over 750 hours in palliative care chaplaincy and am preparing for interview this month.  I am not certain if I want to specialize in palliative care because it is only a fraction of what I do in the hospital.  I am discerning whether to specialize in this area or remain a generalist.  There are fourteen competencies that need to be demonstrated in word and practice.  The following posts describe those competencies without the details of my case studies that are confidential.  

Here are the two little guides that are recommended by the National Association of Catholic Chaplains (click on titles to see the more detail).  They are short and simple, but offer important information that is most helpful.  It is most important to remember to be kind to yourselves as you move through the grief process after the death a loved one.  Don't try to bull through it.  You are not alone, but each of us moves through grief in our own unique way.  Even within one family spouses and siblings each have their own way.  Love each other through it.  Give yourself time to mourn and honor sacred memories.

Sister Donna Maria 

Gone from My Sight: The Dying Experience by Barbara Karnes

What to expect in one to three months prior to death; one to two weeks prior to death; one or two days prior to death and in the final hours.   

Hard Choices for Loving People by Hank Dunn

Most common decisions that need to be considered when discussing the goals of medical care with the physician.  Cardiopulmonary Resuscitation (CPR), Feeding Tubes (Artificial Nutrition and Hydration); Palliative Care and Hospice Care; Treatment Options; Emotional and Spiritual Issues.   

Partners in Pastoral Care

These are the fourteen competencies for Palliative Care chaplaincy.  This specialization is very popular at the moment, but I'm not sure its for me.  I like the variety of my present ministry.  The workshop at the National Association of Catholic Chaplains conference this year was sold out months in advance. 

1. Understanding of the history of the hospice movement and the subsequent expansion of palliative care while differentiating between the current philosophy and goals of palliative care and hospice in practice.
2. Familiarity with state and federal laws regarding Advance Directives and other end of life practices.
3. Knowledge of implications of medical treatment for life-threatening or life limiting illness as it impacts a patient’s physical, psycho-social, emotional, and spiritual pain.
4. Utilization of family systems theory incorporated in the practice of palliative care and hospice as applied to care recipients, families and health care providers.
5. Application of culturally appropriate, evidence-informed strategies for addressing the breadth and depth of multifaceted grief including complicated and anticipatory grief to extend to bereavement resources.
6. Incorporation of a working knowledge and integration of psycho-socio, emotional and spiritual perspectives to function as a communication and emotional expert in the practice of palliative and hospice care.
7. Communication and facilitation of goals of care family meetings that align treatment plans with patient’s values and or advanced care plans.
8. Collaborative and facilitative leadership with care recipients, family, teams and organizations.
9. Application of best practices in palliative care and hospice spiritual assessment and documentation to facilitate aligning patient values and goals with the treatment plan.
10. Working knowledge of the difference in the provision of advanced practice chaplaincy care as care recipients and families negotiate through the trajectory of a life-threatening illness in various settings.
11. Skill in addressing ethical dilemmas at end of life and concerns as related to spiritual and/or religious issues.
12. Ability to attend to the physical, emotional, social and spiritual well-being of the transdisciplinary team.
13. Ability to teach and educate through articulating and integrating current research of best practices for the provision of palliative care and hospice chaplaincy care.
14. Participation in quality improvement projects and/or research to increase standard of palliative care and hospice care provided.

Evolution of Hospice and Palliative Care

Palliative Care evolved out of the Hospice Care movement that began in the late 1950’s in the United Kingdom. Dame Cicely Saunders is credited with fostering the idea that more needed to be done to provide profession care for those who were suffering from terminal illness.  Evidence-based research was used to demonstrate in clear and certain scientific terms that charitable homes and nursing homes were woefully inadequate to address the needs of patient and families at the end of life.  The concept of “total pain” was defined in 1964 as something that went beyond physical symptoms to include mental distress and social or spiritual issues, and a focus on relief of total pain became a main goal of care for terminal patients. 

Dame Saunders began the first hospice program at Saint Christopher’s in 1967.  At Saint Christopher's the initial research was done to identify ways to relieve the distress of the dying using a multidisciplinary approach to address fear and grief as well as physical symptoms of disease.  The idea began to spread throughout the Royal Medical Association. The term palliative care was coined in 1974 by Dr. Balfour Mount, an oncologist at the Royal Victoria Hospital of McGill University in Montreal to avoid the negative connotations the word hospice has in some cultures.  He described palliative care as a holistic approach to addressing the physical, psychological, social and spiritual distress of people with chronic or life-limiting disease.

        

Two common myths had to be overcome in order for palliative medicine to gain acceptance: the belief that patients would become drug dependent if doctors focused on pain relief and that increased drug tolerance would make the administration of pain medication ineffective.  Clinical pain researchers in the United Kingdom allied with their counterparts in the United States conducted international studies showing that these risks could be mitigated. 

Simultaneously public attitudes about end of life care changed as a result of ongoing philosophical, political and spiritual research into the most humane and effective way to support the dying.  In the initial years, hospices were buildings for the dying where research was conducted to improve the quality of care for the dying. By the 1990’s, hospice care and palliative care became services that could be offered at home or in a hospital as well as in a hospice setting. 

The American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education recognized the subspecialty of Hospice and Palliative Medicine in 2006 and by 2008 the American Academy of Hospice and Palliative Medicine had over 3000 members and the field has steadily grown in the past decade. From the beginning Palliative Medicine sought to integrate the care of social workers, psychologists and chaplains into the delivery of total care for patients referred for palliative care.  All three fields have developed subspecialties. 

The four professional organizations that certify chaplains in the United States through the ACPE process: Association of Professional Chaplains, the National Association of Catholic Chaplains, the National Association of Jewish Chaplains, and the American Association of Pastoral Counselors agreed upon the current common standards for Palliative Care and Hospice Advanced Care (PCHAC) in late 2018.    

Although there are some overlapping skills in the services provided by palliative care and hospice chaplains, there is a distinct difference between when one service or the other is recommended.  Palliative care has to do with quality of life and pain management when a person has a life-threatening or life-limiting illness.  Hospice care is recommended when a patient has 6 months or less to live and the family needs the supports it can offer to minimize pain and suffering at end of life.  Dame Saunders published several books about palliative and hospice care.  My favorite is Hospice and Palliative Care: An Interdisciplinary Approach.