Nursing home uses spiritual assessment tool
Caregivers must include spiritual needs
Getting staff to recognize the importance of meeting the spiritual needs of patients is one thing, but gathering patient information about spiritual needs and using it to help develop an overall care plan is quite another.
Ingleside Skilled Nursing and Rehabilitation Center, in Mount Horeb, WI, uses a spiritual assessment tool congruent with the minimum data set (MDS 2.0) to help determine each resident’s spiritual needs.
"Far less is known about the human spirit than is known about the body and the mind, says Sue Schoenbeck, RN, former director of resident care at Ingleside in a paper describing the assessment tool. "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. . . . It is judicious for the care-giving team to gather information about spiritual as well as physiological, mental, and psychosocial needs."
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. Frankl theorized people can find meaning in life’s events, including suffering and death. He believed people search for meaning in life up to and often through the death event.
With this in mind, caregivers must ask patients and their family members questions regarding spiritual needs, says Carol Gabor, BSW, a social worker at Ingleside. The open discussion allows residents and their families to feel at ease about sharing their spiritual side. It becomes the caregiver’s responsibility to collect information regarding a patient’s spiritual needs and incorporate it into the overall treatment of the patient.
The assessment tool
The first part of Ingleside’s spiritual care assessment tool focuses on information from the resident’s concept of a god or deity, religious practices, and helping others. "This tells us if they have a religious background and what types of services they want," Gabor says. "One thing we have seen is every situation is different, and this assessment tool acts like a guide for each individual case. It gets the resident, family, and caregiver focused on spiritual needs."
Part II of the spiritual assessment tool engages the resident in conversation about sources of help and strength, relation between spiritual self and health, and impending death, says Gabor.
"This part gives me a good handle on whether they’re ready for [spiritual care]," she says. "It tells me how much support we need to provide."
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 says prayer is a daily part of his or her life, staff should include "provide private times for prayer" in the care plan.
Schoenbeck uses the case of an Alzheimer’s patient as an example. "A resident with Alz-heimer’s disease for whom evening prayer had been a ritual can be guided by staff each evening in this routine," she wrote. "Staff can assist family members to record familiar prayers to play back to their loved ones. Furthermore, resident prayer and hymn requests can be incorporated into a weekly non-denominational service."
If the assessment shows the resident is experiencing spiritual distress, care plan approaches may include pastoral counseling, psychotherapy intervention, and medication regimen evaluation.
Caregivers should not assume, however, that residents’ feelings will remain static. "Entering a nursing facility does not mean a person stops growing and changing," Schoenbeck wrote. "Residents often re-evaluate 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
One of the services Ingleside offers its residents is a bedside closure service. As a patient’s death approaches, the patient and family have heightened spiritual needs. Staff, too, will have intensified needs because of their close interactions with residents.
To address resident, family, and staff needs, 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," wrote Schoenbeck.
Schoenbeck recalled one bedside closure service for a man who communicated only by repeating two syllables. At the service, 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 inspired 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 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 a study measuring the value of its spiritual care program for residents, families, and staff. Results shows 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.
"The staff has become more invested in patient care," Gabor says. "Patients become people to them, people with a past, people with value." Families also have benefited. Positive written responses have been received from the families of residents for whom a bedside closure service was held.
One daughter responded in the survey: "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."
(Editor’s note: The Schoenbeck article and Ingleside survey are available on the Internet at www.efmoody.com/longterm/spiritual.html, a consumer resource Web site.)
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