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A Workshop Model for Community Clergy
As part of Pastoral Care Awareness Week a workshop was organized for community clergy and religious visitors around the theme: Ministry to Patients/Families in the Intensive Care Unit. The goals of the workshop were to help spiritual care providers feel more comfortable in the ICU environment and to feel a part of the treatment team so they could work more effectively with patients and families. The hope was to empower these professionals to provide a level of care that was not presently available in the ICU and to provide on-going support to families after the ICU experience. The spiritual care providers work from a different paradigm of practice from the medical staff. They have different objectives. They often have a different kind of relationship with the patient or family. The spiritual care provider often has a longitudinal relationship to the patient/family. While the well-intentioned health care professional can be a skilled and kind stranger the spiritual care provider is a known friend. The spiritual care providers bring an authority and a presence that is different from other professionals.
In designing the workshop an attempt was made to replicate the ICU experience as closely as possible. Since it was not possible to take 45 people into an active Intensive Care Unit a replica of the ICU was set up in the conference room. All the elements that exist in the ICU were present. The dummy in the bed had multiple lines, PCA pump, ventilator, a warming blanket, chest tubes, urine bag etc. All the equipment was functioning so that the various sounds including the alarms were active.
After words of welcome and introduction, the medical director of the ICU, Dr. Susan Moffatt, made a presentation. This included an overview of the type of patient admitted to the unit, the average length of stay, the medical and nursing staffing compliment and policies related to visitation.
A role-play followed with two nurses (Kim Stuart, Aveleigh Kyle) and a respiratory therapist (Jennifer Lochhead) working around a patient that had just returned from emergency surgery. The patient's spouse was brought to the bedside to visit her husband for the first time. The nurse explained to the spouse what was being done and responded to questions from the spouse. The role-play was an exact replica of what happens in the ICU on a daily basis. This provided direct insight into how nurses and RT's orient and comfort families at the bedside. After the role-play the nurse and the respiratory therapist explained to the audience the equipment and how they saw the work of the spiritual care provider being integrated into their work. Questions from the floor were entertained. Questions included: Should we touch the patient? Should we talk to the patient? Where should we stand? What can the nurse tell us about the patient's condition? What do the nurses expect from the pastoral care provider?
Two short presentations were made one by a nurse (Aveleigh) and one by a respiratory therapist (Cynthia Phillips). The nurse emphasized the importance of the clergy in the whole process and what she expected from the clergy. The RT demonstrated the different intubation devises. She explained why the patient could not talk and why the patient might experience a sore throat after extubation.
Dr. Moffatt made a second presentation highlighting a number of critical times when important decisions are made. These included pain control, acute care treatment, withdrawal of treatment, and tissue or organ donation. The difference between brain death and coma was highlighted. Dr. Moffatt outlined the responsibility of the health care team to present to the patient/family possible effective treatments, what the treatments would involve, and what the treatments were likely to accomplish. From the point of view of a physician working in an Intensive Care Unit Dr. Moffatt outlined the role of the clergy. She saw the clergy as helping the patient/family place their decisions into the context of the patient's life, helping to reassure the family regarding the specific beliefs of their faith tradition, being a supportive presence to the family during the decision making process, and helping the family process the medical information that they had been given. The clergy's presence to support the family during the withdrawal of treatments was emphasized.
The clergy could advocate for specific end of life practices that would be meaningful for the family. The clergy could help the family with practical concerns around funeral arrangements. The clergy could be an on-going support for the family after the patient's death or discharge from the ICU.
A second role-play was presented. The doctor, the nurse, the chaplain, and the social worker met with the family to explain the condition of the patient and to seek guidance in terms of treatment. During this role-play the doctor took the lead in explaining to the family what was occurring medically with the patient, what decisions needed to be considered and what were the consequences of the decisions. The family member asked questions of clarification. No decisions were required at this time and the doctor indicated that she would be back later to discuss the options further. As the team left, the chaplain stayed with the family to continue processing the information. The role-play ended before any decisions were formulated.
Questions from the floor were entertained. A dialogue took place about the use of pain medication. Some of the clergy challenged the idea that keeping a person comfortable was a reasonable ultimate goal for the medical staff. How do large doses of pain medication affect the length of survival of the patient? Discussion revolved around the issue of withdrawal of treatment and euthanasia.
After the discussion the clergy and religious visitors were encouraged to take a closer look at the equipment and to ask further questions of the presenters.
The group was reassembled and three of the hospital chaplains presented their views on the work of the clergy. Using examples from their own practice the Reverends George McKnight, Bob Hunt and Shawn Hughes presented different aspects of pastoral care. Issues of how to work collaboratively with the medical team, how to use the sacraments to facilitate a family's sense of the sacredness of life and how to discern a family's operative theology were highlighted.
These presentations generated more questions from the floor including the different authority base between clergy and lay visitors, a desire to have a more concrete role and how to respond to particular situations.
Throughout the workshop an active dialogue was established between the presenters and the attendees which created a dynamism that provided learning for everyone. The spiritual care providers felt very positively about the workshop feeling that they had gained new insights and a new comfort level. The team that presented felt that they came to value each other and the clergy's role even more. It was experienced by all persons as a very worthwhile endeavor that should be repeated.
Douglas Wilson is the Director of Chaplaincy Services at Kingston General Hospital.
Posted by editor on September 30, 2003 10:03 AM